接纳与承诺疗法对精神分裂症患者病耻感、自我效能及依从性的影响

杨皓; 潘宇鸿; 王双; 周广凤

doi:10.16766/j.cnki.issn.1674-4152.003428

接纳与承诺疗法对精神分裂症患者病耻感、自我效能及依从性的影响

doi: 10.16766/j.cnki.issn.1674-4152.003428

杨皓¹,
潘宇鸿^2, ,,
王双³,
周广凤⁴

1.
哈尔滨精神专科白渔泡医院老年七疗科，黑龙江哈尔滨 150000
2.
哈尔滨精神专科白渔泡医院精神科六疗科
3.
大庆市第三医院精神科七病区，黑龙江大庆 164700
4.
哈尔滨精神专科白渔泡医院老年八疗科

基金项目:

黑龙江省卫生健康委科研项目 20220303090993

详细信息

通讯作者:
潘宇鸿，E-mail：286534720@qq.com

中图分类号: R749.3
计量
- 文章访问数: 121
- HTML全文浏览量: 38
- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2023-07-02
- 网络出版日期: 2024-05-27

Effect of acceptance and commitment therapy on stigma, self-efficacy, and medication adherence in patients with schizophrenia

1.
Geriatric No.7 Department, Harbin Psychiatry Specialist Baiyupao Hospital, Harbin, Heilongjiang 150000, China

摘要

摘要: 目的精神分裂症患者具有严重的病耻感及较低的自我效能，影响患者的依从性和疾病的康复。本研究探讨接纳与承诺疗法对精神分裂症患者病耻感、自我效能及依从性的影响，以期为减轻精神分裂症患者的病耻感，提高其自我效能及依从性提供一种有效、安全的方法。方法选取2022年10月—2023年4月就诊于哈尔滨精神专科白渔泡医院门诊的精神分裂症患者为研究对象，将招募的178例精神分裂症患者使用随机数字列表法分为对照组89例和研究组89例，对照组给予常规药物治疗，研究组在此基础上给予接纳与承诺疗法。于干预前后采用精神疾病内化病耻感量表(ISMI)、一般自我效能量表(GSES)、Morisky服药依从性量表(MMAS-8)进行评估。结果干预后，研究组ISMI评分为(61.39±9.93)分，低于对照组的(67.34±10.48)分，GSES评分为(21.01±3.63)分，高于对照组的(19.21±3.93)分，MMAS-8评分为(7.66±1.21)分，高于对照组的(6.07±1.48)分，差异均有统计学意义(P＜0.05)。干预后，研究组ISMI评分为(61.39±9.93)分，低于干预前的(67.24±10.34)分，GSES评分为(21.01±3.63)分，高于干预前的(19.17±3.89)分，MMAS-8评分为(7.66±1.21)分，高于干预前的(6.01±1.42)分，差异均有统计学意义(P＜0.05)。结论接纳与承诺疗法能有效减轻精神分裂症患者的病耻感，提高其自我效能及依从性。
- 精神分裂症 /
- 接纳与承诺疗法 /
- 病耻感 /
- 自我效能 /
- 依从性
Abstract: Objective Patients with schizophrenia have a severe stigma and low self-efficacy, which seriously affects their medication adherence and recovery of the disease. This study explores the effects of acceptance and commitment therapy on the stigma, self-efficacy, and medication adherence of patients with schizophrenia, in order to provide an effective and safe method for reducing the stigma, improving self-efficacy, and medication adherence of patients with schizophrenia. Methods Patients with schizophrenia who visited the Harbin Psychiatry Specialist Baiyupao Hospital from October 2022 to April 2023 were selected as the research subjects. A total of 178 recruited patients with schizophrenia were divided into a control group of 89 cases and a study group of 89 cases using a random number list method. The control group received conventional drug treatment, while the study group received acceptance and commitment therapy. Before and after the intervention, the internalized stigma of mental illness scale (ISMI), general self efficacy scale (GSES), and Morisky medication adherence scale-8 (MMAS-8) were used to evaluate the efficacy of mental illness. Results After intervention, the ISMI score of the study group was (61.39±9.93) points, which was lower than that of the control group [(67.34±10.48) points], and the GSES score of the study group was (21.01±3.63) points, which was higher than that of the control group [(19.21±3.93) points], and the MMAS-8 score of the study group was (7.66±1.21) points, which was higher than that of the control group [(6.07±1.48) points], and the differences were statistically significant (P < 0.05). After intervention, the ISMI score of the study group was (61.39±9.93) points, which was lower than that before intervention [(67.24±10.34) points], and the GSES score of the study group was (21.01±3.63) points, which was higher than that before intervention [(19.17±3.89) points], and the MMAS-8 score of the study group was (7.66±1.21) points, which was higher than that before intervention [(6.01±1.42) points], and the differences were statistically significant (P < 0.05). Conclusion Acceptance and commitment therapy can effectively reduce the stigma in patients with schizophrenia, improve their self-efficacy and medication adherence.
- Schizophrenia /
- Acceptance and commitment therapy /
- Stigma /
- Self-efficacy /
- Medication adherence

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表 1 ACT课程内容

Table 1. Content of the ACT course

时间	内容
第1周	了解精神分裂症；了解病耻感；入组人员相互了解，逐渐形成整体团队；正常化问题；分析具体问题。
第2周	让入组的人员分享自己遭受嘲笑、歧视的真实经历，同时分享自身患病的真实感受；引导患者进行认知解离和接纳自我，接受现实。
第3周	通过正念训练引导入组人员看到其身边的资源，活在当下，提升控制情绪能力；引导入组人员学会寻求支持和帮助。
第4周	通过创造性无望让入组人员理解回避问题不是一种可取的方式；让入组人员了解如何有效拒绝回避；要从一个观察者的角度去对待遇见的问题，运用积极的方式处理遇见的问题。
第5周	明确价值；承诺行动做出改变；处理行动中的障碍；基于价值的目标表、迈出最小的一步。
第6周	探讨如何有效保持长期治疗效果；回顾和总结。

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表 2 2组精神分裂症患者一般情况比较

Table 2. Comparison of Baseline characteristics between two groups of patients with schizophrenia

组别	例数	年龄(x±s，岁)	受教育年限(x±s，年)	总病程(x±s，年)	PANSS量表评分(x±s，分)	性别[例(%)]		婚姻[例(%)]				首次发作[例(%)]
组别	例数	年龄(x±s，岁)	受教育年限(x±s，年)	总病程(x±s，年)	PANSS量表评分(x±s，分)	男性	女性	未婚	已婚	离异	丧偶	是	否
研究组	71	40.44±9.05	12.01±3.29	18.41±7.48	48.51±6.89	34(47.89)	37(52.11)	18(25.35)	41(57.75)	11(15.49)	1(1.41)	5(7.04)	66(92.96)
对照组	73	40.10±9.43	11.92±3.26	18.12±7.72	48.03±6.80	33(45.21)	40(54.79)	20(27.40)	42(57.53)	9(12.33)	2(2.74)	3(4.11)	70(95.89)
统计量		0.221^a	0.176^a	0.225^a	0.421^a	0.104^b		0.623^b				0.590^b
P值		0.825	0.860	0.822	0.675	0.747		0.891				0.442
注：^a为t值，^b为χ²值。

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表 3 2组精神分裂症患者ISMI总评分及各因子评分、GSES评分、MMAS-8评分比较(x±s, 分)

Table 3. Comparison of the total ISMI scores, various factor scores, GSES scores, and MMAS-8 scores between two groups of patients with schizophrenia (x±s, points)

组别	例数	ISMI总分		疏远因子得分		刻板因子得分		歧视因子得分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
研究组	71	67.24±10.34	61.39±9.93^a	13.87±3.84	12.54±3.62^a	15.35±4.06	13.91±3.57^a	10.68±2.59	9.76±2.82^a
对照组	73	67.36±10.78	67.34±10.48	13.92±4.07	13.88±3.97	15.33±4.14	15.40±4.06	9.56±2.58	9.93±2.64
t值		0.066	3.494	0.068	2.115	0.086	2.323	1.665	0.375
P值		0.947	0.001	0.946	0.036	0.973	0.022	0.098	0.708

组别	例数	抵抗因子得分		社会退缩因子得分		GSES得分		MMAS-8得分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
研究组	71	13.31±3.06	12.15±3.20^a	14.03±3.46	13.03±3.54^a	19.17±3.89	21.01±3.63^a	6.01±1.42	7.66±1.21^a
对照组	73	13.18±3.10	13.27±3.08	14.97±3.49	14.86±3.60	19.29±3.95	19.21±3.93	6.05±1.51	6.07±1.48
t值		0.257	2.137	1.631	3.083	0.181	2.868	0.167	7.058
P值		0.798	0.034	0.105	0.005	0.856	0.005	0.868	＜0.001
注：与同组干预前比较，^aP＜0.01。

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