【作者】 李婷；

【导师】 潘芳；

【作者基本信息】 山东大学 ， 应用心理学， 2008， 硕士

【摘要】 支气管哮喘是一种与心理社会因素关系密切,严重危害人类健康的心身疾病。哮喘疾病的发生和发展受个人情绪、心理状况、外界环境刺激、社会活动等因素的影响。哮喘与心理社会因素的关系已得到大量研究证实,一方面,社会心理因素与哮喘的发生、发展、转归和预后有密切的关系,另一方面,哮喘引发患者的各种不良情绪、心理问题及应激性生理反应,影响其社会功能。这些问题反过来加重病情,形成恶性循环。心理干预是在心理学理论指导下,有计划、按步骤地对一定对象的心理活动、个性特征或心理问题施加影响,使之发生指向预期目标变化的过程。国外已有研究证实,心理干预不但可以改善哮喘患者的情绪和心理功能,而且能起到调节患者生理机能的作用。但因干预的方法、观察指标不同,其结果存在差异。本研究拟观察心理干预对哮喘患者的情绪状态、心理状况、应对方式以及神经内分泌反应的影响,旨在:(1)建立一种适合支气管哮喘患者的心理干预方法。(2)调查支气管哮喘患者存在的不良情绪和心理问题,验证心理干预是否有效。(3)探讨心理干预对支气管哮喘患者存在的应激性生理反应的影响。本研究选取聊城市人民医院60例门诊哮喘患者和30例健康体检者为研究对象,60例患者随机分为干预组和非干预组,每组30例。采用SDS、SAS、TCSQ、SCL-90心理学评定量表对被试者进行调查,两组患者于干预前后各调查一次;用BD-Ⅱ-603型数字皮阻计测量被试者的皮肤电阻值,两组患者于干预前后各检测一次;收集三组被试者的唾液,其中两组患者于干预前后各收集一次,用放射免疫法检测唾液中皮质醇的含量,用碘-淀粉比色法检测α-唾液淀粉酶的活性。研究结果显示:干预前两组患者抑郁、焦虑、NC得分、SCL-90总分和躯体化、人际关系、抑郁、焦虑、敌对、恐怖6项因子分显著高于对照组,PC得分显著低于对照组;干预后干预组患者抑郁、焦虑、NC得分、SCL-90总分和躯体化、人际关系、抑郁、焦虑、敌对、恐怖6项因子分显著低于干预前,PC得分显著高于干预前;干预后干预组患者抑郁、焦虑、NC得分、SCL-90总分和躯体化、抑郁、焦虑、恐怖4项因子分显著低于非干预组,PC得分显著高于非干预组;干预后非干预组患者仅人际关系和敌对2项因子分显著低于干预前。心理干预对哮喘患者交感神经紧张度有明显的影响,干预前两组患者皮肤电阻值显著低于对照组,干预后干预组患者皮肤电阻值与干预前比较明显升高,干预后干预组患者皮肤电阻值显著高于非干预组。心理干预对唾液皮质醇水平和α-唾液淀粉酶活性有明显的影响,干预前两组患者唾液中皮质醇水平和α-唾液淀粉酶活性显著高于对照组,干预后干预组患者唾液中皮质醇水平和α-唾液淀粉酶活性与干预前比较明显下降,干预后干预组患者唾液中皮质醇水平和α-唾液淀粉酶活性显著低于非干预组。本研究得出以下结论:成年哮喘患者普遍存在情绪、心理问题和应激性生理反应,主要表现为抑郁、焦虑、躯体症状、人际关系敏感、敌对、恐怖和交感神经活动亢进及应激激素的过多分泌等。本研究建立了包括哮喘相关知识健康教育,渐进性放松训练和个别心理疏导在内的适合支气管哮喘的心理干预方法,研究证实,心理干预可明显缓解患者的抑郁和焦虑情绪,改善患者的躯体化、人际关系敏感、敌对、恐怖等心理状况,提高患者的应对水平。降低交感神经兴奋性,稳定下丘脑-垂体-肾上腺轴,抑制蓝斑核去甲肾上腺素神经系统。有效阻断哮喘的恶性循环,降低哮喘患者的应激反应水平,不但从心理上减轻不良反应,而且在生理上能调节自主神经功能紊乱,促进内环境的稳定。更多还原

【Abstract】 Bronchial asthma is a psychosomatic disease closely related with social-psychological factors.It severely harms human’s health.The occurrence and development of asthma is affected by many factors,such as emotions,the psychological status of patients,the stimulations of surroundings and social activities.Large numbers of studies have proved the relationship between asthma and psychological factors.The social-psychological factors relate closely with the occurrence,development,return and prognosis of asthma.On the other hand,asthma can lead to negative emotions,psychological problems and physiological reactions in asthma patients,thus affect the social functions of patients.These problems in return worsen patients’ mental and physical conditions,and result in a vicious cycle.Psychological intervention is a process which exerts effects on a subject’s psychological activities,individual characteristic or psychological problems under the guidance of psychological theories to make them change to the anticipated directions. Studies abroad suggest that the psychological intervention can not only improve emotions and psychological functions,but also regulate physiological functions of asthma patients.But these studies conclude diversely due to the applications of different intervention methods and different observation indexes.The present study observes the influences of the psychological intervention on asthma patients’ emotions,psychological status,coping style and nerve-endocrine reaction.The purposes of the project are:(1) To set up a psychological intervention method suitable for asthma patients.(2) To explore the negative emotions and psychology of asthma patients,and to evaluate the effectiveness of the psychological intervention.(3) To study the effects of the psychological intervention on the stress physiological reaction of asthma patients.Sixty clinic asthma patients were randomly divided into intervention and nonintervention groups.Thirty normal people attended the study as comparison group. We used SDS、SAS、TCSQ、SCL-90 psychological evaluation charts to study the subjects.Two groups of patients were tested once before and once after the intervention.BD-Ⅱ-603 digital skin resistance meter was used to measure the electric skin resistance.Two groups of patients were tested once before and once after the intervention.The salivary of the patients in the two groups was collected once before and once after the intervention.We used radioactive immunology to analyze the content of cortisol in patients’ salivary,and use iodine-starch colorimetry to examine the activeness ofα-ptyalin of salivary.The results show that:The scores of depression,anxiety,negative coping, SCL-90 and the six factors(somzatization,human relationship,depression,anxiety, opposition,terror) of patients are noticeably higher than that of the comparison group. Meanwhile,the scores of positive coping are clearly lower than that of the comparison group.After the intervention,the scores of depression mood,anxiety, negative coping,SCL-90 and the six factors of the patients in intervention group are significantly lower than before the intervention,and the scores of positive coping after the intervention are obviously higher than before the intervention.The scores of depression,anxiety,negative coping,SCL-90 and the four factors(somzatization, depression,anxiety,terror) of the patients in intervention group after the intervention are significantly lower than that of the patients in nonintervention group.The scores of positive coping of the patients in intervention group are notably higher than that of the patients in nonintervention group.Only the scores of human relationship and opposition of the patients in nonintervention group after the intervention are lower than that before the intervention.The influences on tension of consensual nerve are significant.Before the intervention,the values of the electric skin resistance of the two groups of patients are lower than that of comparison group.After the intervention the values of the electric skin resistance of the patients in intervention group notably raised comparing with that before the intervention.The electric skin resistance values of the patients in intervention group after the intervention are higher than that of the patients in nonintervention group.The influences on the content of cortisol and the activeness ofα-ptyalin in patients’ salivary are also obvious.The content of cortisol and the activeness ofα-ptyalin of the patients are higher than that of the normal people before the intervention.After the intervention the content of cortisol and the activeness ofα-ptyalin of the patients in intervention group lowered obviously comparing with that before the intervention.After the intervention the content of cortisol and the activeness ofα-ptyalin of the patients in intervention group are significantly lower than that of the patients in nonintervention group.The conclusion of the study are:There are extensive emotional,psychological problems and physiological stress reactions in patients group,mainly showing they have high scores in depression,anxiety,somzatization,human relationship tension, opposition,terror,hyperactivity of the consensual nerve and excessive secretion of stress hormone in asthma patients.This study established a psychological intervention method suitable for bronchial asthma,including knowledge and healthy education of psychosomatic diseases,progressive relaxation training and individual psychological coaching.The study shows that psychology intervention can obviously relieve depression and anxiety of asthma patients,improve the psychology of somzatization, human relationship tension,opposition,terror,improve the coping style notably.The psychological intervention can also reduce the excitability of the consensual nerve, stabilize the HPA axis,restrain the neuromodulatory locus coeruleus-noreinephrine system,effectively prevent the vicious cycle of asthma,and reduce the level of the stress reactions.So we conclude that psychological intervention can lessen the negative psychological reactions of the asthma patients,regulate the functional disorders of the independent nerve,and promote the stability of the internal body.更多还原