Effect of group psychological therapy on anxiety and cortisol and sleep in gastric cancer patients
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摘要: 目的探索团体心理干预对胃癌患者血浆皮质醇、焦虑和睡眠质量的影响。方法采用完全随机对照设计，将已确诊为胃癌且已完成临床治疗的78名患者，分为团体心理干预组（n=39）和空白对照组（n=39）。对干预组进行每周1次，每次90 min，共8周的团体心理干预，同时对照组不接受任何形式的心理干预。采用焦虑自评量表（SAS）、血浆皮质醇浓度和阿森斯（AIS）睡眠自评量表分别对两组患者进行干预前和干预结束当周进行评估。结果8周干预结束时，干预组脱落病号3人，对照组脱落病号5人。干预前两组患者焦虑（SAS）得分无显著性差异（t=1.31，P>0.05），血浆皮质醇浓度无显著性差异（t=0.65，P>0.05），两组患者睡眠质量评分（AIS）无显著差异（t=0.84，P>0.05）。经团体心理干预后，干预组患者焦虑（SAS）评分显著低于对照组（t=-2.72，P < 0.01），血浆皮质醇浓度显著低于对照（t=-2.44，P < 0.05），AIS评分显著低于对照组（t=-3.00，P < 0.01）。结论对胃癌患者进行团体心理干预能显著改善患者的焦虑程度，降低血浆皮质醇浓度，减少身体不良应激，改善睡眠质量，提高患者的生存质量，值得运用和推广Abstract: Objective To explore the effect of group psychological therapy on anxiety and Cortisol and Sleep in gastric cancer patients. Methods Totally 78 patients previously diagnosed with gastric cancer, and finished active treatment, were equally randomized into observation group and control group. 39 patients joined the intervention group, which consisted of 8 consecutive, weekly sessions of 90 minutes each in length, whereas another 39 served as control subjects without receiving any psychological interventions during this study. All participants completed baseline measures and post-intervention measures(8 weeks later or after 8 times interventions) by Self-Rating Anxiety Scale (SAS), and Cortisol and AIS. Results there are no significant differences(P>0.05)between this two groups patients on SAS and Cortisol and AIS before the treatment. After the treatment, anxiety(t=-2.72, P < 0.01) and Cortisol(-2.44, P < 0.05)and AIS(t=-3.00, P < 0.01) of patients were all decreased. SAS and Cortisol and VAS level in both groups had significant differences. Conclusion This study provides evidence for the positive effect of group psychological therapy for gastric cancer patients on SAS, Cortisol and sleep.
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Key words:
- gastric cancer /
- group psychological therapy /
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表 1 团体心理干预方案
干预次数 主题 内容 1 相遇风雨中 介绍活动，了解患者基本情况，建立关系；介绍团体目标，制定团体规范；第一次专注于呼吸的训
练，并布置家庭作业。2 了解胃癌 胃癌的发病机制，发放胃癌科普防治手册，医师宣讲，分享交流： 我得胃癌的原因；专注于呼吸训
练，身体扫描训练。3 风雨同舟 分享我如何进行饮食运动，心态如何调节；分享呼吸和身体扫描训练的体会。 4 癌症不等于死亡 认识癌症复发和转移，活在当下。讨论如果生命是一本书，在书盖上之前，今天你想要书写什么
故事？呼吸和身体扫描训练。5 如何与情绪相处 医生宣讲情绪在癌症发生发展中的作用；抗焦虑正念练习，布置家庭作业，每天一次抗焦虑正念
练习6 风雨中前进 认知训练：认识情绪，用 ABC理论控制情绪；呼吸和身体扫描训练抗焦虑正念练习。 7 不断成长 分享情绪控制的经验；分享呼吸练习、 身体扫描练习体会，并继续练习。 8 雨后彩虹 分享整个活动的经验，自己的转变，答疑，总结。并鼓励大家把练习融入生活，坚持下去。 
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表 2 两组患者焦虑的比较（x±s）
组别 例数（n） 干预前 干预后 干预组 36 57.23±4.6 46.32±5.13 对照组 34 56.55±7.3 55.12±3.15 t 1.31 -2.72 P 0.2 0.01
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表 3 两组患者血浆皮质醇浓度的比较（x±s，nmol/L）
组别 例数（n） 入院时 术后 7 d 心理干预组 36 480.2±198.0 271.2±54.7 对照组 34 471.3±207.5 360.63±173.2 t 0.65 -2.44 P 0.54 0.02
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表 4 两组患者睡眠质量的比较（x±s）
组别 例数（n） 入院时 术后 7 d 心理干预组 36 6.18±4.70 4.86±2.11 对照组 34 5.87±3.77 7.09±3.54 t 0.84 -3 P 0.4 0.01
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