辩证行为疗法对青少年非自杀性自伤行为患者认知情绪调节的影响

张俊蕾; 赵玉洁; 彭莎栗; 郭斐斐; 张燕

doi:10.16835/j.cnki.1000-9817.2023.12.006

辩证行为疗法对青少年非自杀性自伤行为患者认知情绪调节的影响

doi: 10.16835/j.cnki.1000-9817.2023.12.006

新乡医学院第二附属医院儿童少年精神科，河南 453002

基金项目:

新乡市社科联调研课题 SKL-2022-087

详细信息

作者简介:
张俊蕾(1980-)，女，河南安阳人，硕士，副主任护师，主要研究方向为儿童青少年精神障碍护理

通讯作者:
张燕, E-mail: zhangyan800102@126.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: B844.2 C913.5 R179
计量
- 文章访问数: 397
- HTML全文浏览量: 359
- PDF下载量: 68
- 被引次数: 0
出版历程
- 收稿日期: 2023-09-06
- 修回日期: 2023-10-16
- 网络出版日期: 2023-12-26
- 刊出日期: 2023-12-25

Effects of dialectical behavior therapy on cognitive emotion regulation in adolescents with non-suicidal self-injury behaivor

Department of Child and Adolescent Psychiatry, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang (453002), Henan Province, China

摘要

摘要: 目的探讨辩证行为疗法(DBT)对青少年非自杀性自伤(NSSI)患者认知情绪调节的影响，以期为改善NSSI青少年认知情绪提供参考依据。方法采用便利抽样法，选取2021年3月至2023年3月在新乡医学院第二附属医院儿童少年精神科住院治疗的青少年NSSI患者166例为研究对象，按照随机数字表法分为试验组和对照组各83例。对照组给予常规护理8周；试验组在此基础上实施DBT方案干预8周，干预频次为每周1次，每次45~60 min。对照组和试验组在干预前后均采用汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)和认知情绪调节问卷(CERQ)进行评估。采用t检验和χ²检验进行统计学分析。结果干预前，试验组和对照组HAMA、HAMD、CERQ量表评分差异均无统计学意义(P值均>0.05)；干预8周后，试验组和对照组HAMD评分(13.58±3.24，33.02±7.59)、HAMA评分(12.41±2.51，24.25±7.14)、CERQ适应性调节策略评分(69.20±11.97，60.51±7.29)及缺乏适应性调节策略评分(37.43±7.87，47.87±5.20)比较，差异均有统计学意义(t值分别为-21.46，-14.25，5.57，-10.08，P值均 < 0.01)。结论 DBT有助于改善青少年NSSI患者焦虑、抑郁情绪和认知情绪调节方式。应采取积极干预方式调节青少年NSSI患者的情绪，减少NSSI的发生。
- 自我伤害行为 /
- 认知 /
- 情绪 /
- 行为 /
- 干预性研究 /
- 青少年
Abstract: Objective To explore the effect of dialectical behavior therapy (DBT) on cognitive emotion regulation in adolescents with non-suicidal self-injury (NSSI), so as to provide reference for improving the cognitive and emotional well-being of NSSI adolescents. Methods A total of 166 adolescents with non-suicidal self-injury who were hospitalized in the Department of Child and Adolescent Psychiatry of the Second Affiliated Hospital of Xinxiang Medical University from March 2021 to March 2023, were selected by the convenient sampling method. According to the random number table method, participants were divided into the experimental group and the control group, with 83 cases in each group. The control group was given routine nursing, while the experimental group was given dialectical behavior therapy on the basis of routine nursing. The 8-week-intervention was conducted once a week, with 45-60 minutes each time. The control group and the experimental group were evaluated with Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and Cognitive Emotion Regulation Questionnaire (CERQ) before and after the intervention. Statistical analysis was conducted using t-test and χ² test. Results Before the intervention, there was no significant difference in the scores of each scale include HAMA, HAMD and CERQ between the experimental group and control group (P>0.05). The scores of HAMD (13.58±3.24, 33.02±7.59), HAMA (12.41±2.51, 24.25±7.14), adaptive adjustment strategy score (69.20±11.97, 60.51±7.29) and non-adaptive adjustment strategy scores (37.43±7.87, 47.87±5.20) of CERQ, significantly changed after 8 weeks of intervention (t=-21.46, -14.25, 5.57, -10.08, P < 0.01). Conclusions Dialectical behavior therapy can improve the anxiety, depression and cognitive emotion regulation of adolescents with NSST. Active intervention should be taken to regulate the emotions of adolescent with NSSI and reduce the occurrence of NSSI.
- Self-injurious behavior /
- Cognition /
- Emotions /
- Behavior /
- Intervention studies /
- Adolescent
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

表 1 两组干预前后HAMD和HAMA评分比较(x±s)

Table 1. Comparison of HAMD and HAMA scores between the two groups before and after intervention (x±s)

干预前后	组别	人数	统计值	HAMD	HAMA
干预前	试验组	83		32.28±8.76	24.18±7.60
	对照组	83		34.25±8.15	25.95±6.95
			t值	-1.51	-1.57
			P值	0.13	0.12
干预后	试验组	83		13.58±3.24^**	12.41±2.51^**
	对照组	83		33.02±7.59^**	24.25±7.14
			t值	-21.46	-14.25
			P值	< 0.01	< 0.01
差值^a	试验组	83		20(13，23)	11(7，15)
	对照组	83		1(1，2)	3(-3，6)
			Z值	-7.92	-7.38
			P值	< 0.01	< 0.01
注：组内干预前后比较，**P < 0.01；a不符合正态分布，用M(P₂₅，P₇₅)表示。

下载: 导出CSV

表 2 两组干预前后CERQ评分比较(x±s)

Table 2. Comparison of CERQ scores between the two groups before and after intervention (x±s)

干预前后	组别	人数	统计值	适应性调节策略	缺乏适应性调节策略
干预前	试验组	83		58.65±10.63	50.01±12.42
	对照组	83		58.70±8.55	51.27±6.77
			t值	-0.03	-0.81
			P值	0.94	0.42
干预后	试验组	83		69.20±11.97^**	37.43±7.87^**
	对照组	83		60.51±7.29^*	47.87±5.20^**
			t值	5.57	-10.08
			P值	< 0.01	< 0.01
差值^a	试验组	83		13(3，20)	-11(-17，-3)
	对照组	83		-2(-7，3)	4(-2，8)
			Z值	-6.17	-5.99
			P值	< 0.01	< 0.01
注：组内干预前后比较，P < 0.05，*P < 0.01；a不符合正态分布，用M(P₂₅，P₇₅)表示。

下载: 导出CSV

参考文献(24)

[1]	ZETTERQVIST M, PERINI I, MAYO L M, et al. Nonsuicidal self-injury disorder in adolescents: clinical utility of the diagnosis using the clinical assessment of nonsuicidal self-injury disorder index[J]. Front Psychiatry, 2020, 11: 8.
[2]	章薇, 胡德英, 丁小萍, 等. 青少年非自杀性自伤的护理研究进展[J]. 护理学杂志, 2022, 37(7): 109-113. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202207030.htm ZHANG W, HU D Y, DING X P, et al. Nursing of adolescents with non-suicidal self-injury: a review[J]. J Nurs Sci, 2022, 37(7): 109-113. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202207030.htm
[3]	LIU R T, WALSH R F L, SHEEHAN A E, et al. Prevalence and correlates of suicide and non-suicidal self-injury in children: a systematic review and Meta-analysis[J]. JAMA Psychiatry, 2022, 79(7): 718-726. doi: 10.1001/jamapsychiatry.2022.1256
[4]	韩阿珠, 徐耿, 苏普玉. 中国大陆中学生非自杀性自伤流行特征的Meta分析[J]. 中国学校卫生, 2017, 38(11): 1665-1670. doi: 10.16835/j.cnki.1000-9817.2017.11.019 HAN A Z, XU G, SU P Y. A Meta-analysis of characteristics of non-suicidal self-injury among middle school students in mainland China[J]. Chin J Sch Health, 2017, 38(11): 1665-1670. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2017.11.019
[5]	郑仲璇. 认知情绪因素对大学生自伤行为的影响: 以心理活性为中介作用[D]. 深圳: 深圳大学, 2017. ZHENG Z X. The mediation effect of psychological flexibility on the relationship between cognitive and emotional factors and self-harm[D]. Shenzhen: Shenzhen University, 2017. (in Chinese)
[6]	宦宗素, 何旭斌, 杜娜, 等. 青少年非自杀性自伤发病机制及治疗研究进展[J]. 中国学校卫生, 2023, 44(4): 636-640. doi: 10.16835/j.cnki.1000-9817.2023.04.036 HUAN Z S, HE X B, DU N, et al. Progress in the pathogenesis and treatment of non-suicidal self-injury in adolescents[J]. Chin J Sch Health, 2023, 44(4): 636-640. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2023.04.036
[7]	MCKAY M, WOOD J C, BRANTLEY J. The dialectical behavior therapy skills workbook: practical DBT exercises for learning mindfulness, interpersonal effectiveness, emotion regulation and amp; distress tolerance[M]. Oakland: New Harbinger Publications, 2007: 1-2.
[8]	纪宇. 大学生认知情绪调节对心理弹性的干预研究: 基于辩证行为疗法[D]. 长春: 东北师范大学, 2018. JI Y. Intervention of college students' cognitive emotion regulation on psychological resilience: based on dialectical behavior therapy[D]. Changchun: Northeast Normal University, 2018. (in Chinese)
[9]	American Psychiatric Association. Diagnostic and statistical manual of mental disorders[M]. 5th ed. Washington D C: American Psychiatric Association, 2013: 803.
[10]	马修·麦克凯. 辩证行为疗法: 掌握正念、改善人际效能、调节情绪和承受痛苦的技巧[M]//王鹏飞, 李桃, 钟菲菲, 译. 重庆: 重庆大学出版社, 2017. MATTHEW M. Dialectical behavior therapy: master of mindfulness, improve interpersonal effectiveness, regulate mood and suffering techniques[M]//WANG P F, LI T, ZHONG F F, translate. Chongqing: Chongqing University Press, 2017. (in Chinese)
[11]	张雪莹, 武克文. 辩证行为疗法对缓解期精神分裂症患者社会功能和病耻感的影响[J]. 国际精神病学杂志, 2021, 48(3): 410-412, 422. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202103008.htm ZHANG X Y, WU K W. Effect of dialectical behavior therapy on social function and stigma of schizophrenics in remission[J]. J Int Psychiatry, 2021, 48(3): 410-412, 422. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202103008.htm
[12]	汤毓华, 张明园. 汉密顿焦虑量表(HAMA)[J]. 上海精神医学, 1984(2): 64-65. https://www.cnki.com.cn/Article/CJFDTOTAL-JSYI198402004.htm TANG Y H, ZHANG M Y. Hamilton Anxiety Scale (HAMA)[J]. Shanghai Arch Psychiatry, 1984(2): 64-65. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-JSYI198402004.htm
[13]	汤毓华, 张明园. 汉密顿抑郁量表(HAMD)[J]. 上海精神医学, 1984(2): 61-64. https://www.cnki.com.cn/Article/CJFDTOTAL-JSYI198402003.htm TANG Y H, ZHANG M Y. Hamilton Depression Scale (HAMD)[J]. Shanghai Arch Psychiatry, 1984(2): 61-64. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-JSYI198402003.htm
[14]	董光恒, 朱艳新, 杨丽珠. 认知情绪调节问卷中文版的应用[J]. 中国健康心理学杂志, 2008, 16(4): 456-458. https://www.cnki.com.cn/Article/CJFDTOTAL-JKXL200804045.htm DONG G H, ZHU Y X, YANG L Z. Practice of the Chinese version on the Cognitive Emotion Regulation Questionnaire (CERQ)[J]. Chin J Health Psychol, 2008, 16(4): 456-458. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-JKXL200804045.htm
[15]	STEINE I M, NIELSEN B, PORTER P A, et al. Predictors and correlates of lifetime and persistent non-suicidal self-injury and suicide attempts among adult survivors of childhood sexual abuse[J]. Eur J Psychotraumatol, 2020, 11(1): 1815282. doi: 10.1080/20008198.2020.1815282
[16]	赵若兰, 楼淑萍, 陈辉. 适应不良与大学生持续性自我伤害行为的关系及抑郁的中介效应[J]. 华中科技大学学报(医学版), 2019, 48(3): 334-338. https://www.cnki.com.cn/Article/CJFDTOTAL-TJYX201903016.htm ZHAO R L, LOU S P, CHEN H. Mediation effect of depression on the association between presistent non-suicidal self-injury and college adjustment among college students[J]. Acta Med Univ Sci Technol Huazhong (Med Edit), 2019, 48(3): 334-338. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-TJYX201903016.htm
[17]	李昀熹. 青少年非自杀性自伤的临床辨识特征及中医辨证论治探索研究[D]. 广州: 广州中医药大学, 2021. LI Y X. Study on the clinical recognition characteristics of non-suicidal self-injury in adolescents and exploration of TCM syndrome differentiation[D]. Guangzhou: Guangzhou University of Chinese Medicine, 2021. (in Chinese)
[18]	李陆. 蒙古族高校学生非自杀性自伤行为与抑郁焦虑的关联[J]. 中国学校卫生, 2022, 43(1): 96-99. doi: 10.16835/j.cnki.1000-9817.2022.01.021 LI L. Non-suicidal self-injury behavior and its relationship with depression and anxiety in Mongolian college students[J]. Chin J Sch Health, 2022, 43(1): 96-99. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2022.01.021
[19]	林信竹, 况利. 辩证行为疗法联合舍曲林药物治疗对伴非自杀性自伤抑郁症青少年的疗效[J]. 国际精神病学杂志, 2021, 48(3): 439-442, 465. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202103016.htm LIN X Z, KUANG L. Analysis on the efficacy of dialectical behavior therapy combined with sertraline drug therapy on adolescent depression with non-suicidal self-harm[J]. J Int Psychiatry, 2021, 48(3): 439-442, 465. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202103016.htm
[20]	熊庆, 申秀云, 阳红, 等. 述情障碍与青少年非自杀性自伤: 非适应性情绪调节和抑郁的链式中介作用[J]. 中国临床心理学杂志, 2023, 31(3): 574-577, 582. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLCY202303012.htm XIONG Q, SHEN X Y, YANG H, et al. Alexithymia and adolescents' non-suicidal self-injury: the chain mediating of maladaptive emotion regulation and depression[J]. Chin J Clin Psychol, 2023, 31(3): 574-577, 582. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZLCY202303012.htm
[21]	丁寒琴, 杨帆, 何夏君. 情绪调节策略对抑郁障碍青少年非自杀性自伤行为的影响[J]. 护理学杂志, 2021, 36(8): 62-65. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202108021.htm DING H Q, YANG F, HE X J. Effect of emotional regulation strategy on non-suicidal self-injury in adolescents with depression[J]. J Nurs Sci, 2021, 36(8): 62-65. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ202108021.htm
[22]	CIPRIANO A, CELLA S, COTRUFO P. Non-suicidal self-injury: a systematic review[J]. Front Psychol, 2017, 8: 1946. doi: 10.3389/fpsyg.2017.01946
[23]	WHTTLOCK J, PRUSSIEN K, PIETUSZA C. Predictors of self-injury cessation and subsequent psychological growth: results of a probability sample survey of students in eight universities and colleges[J]. Child Adolesc Psychiatry Ment Health, 2015, 9: 19. doi: 10.1186/s13034-015-0048-5
[24]	SHAREH H, YAZDZNIAN M. The effectiveness of dialectical behavior group therapy on stress, depression, and cognitive emotion regulation in mothers of intellectually disabled students: a randomized clinical trial[J]. Clin Child Psychol Psychiatry, 2023, 28(3): 1092-1108. doi: 10.1177/13591045231163068