正念训练对胃癌患者心理困扰的康复效应及心理机制探讨

Psychological distress is one of the important factors which impact cancer patients' life quality, treatment adherence and prognosis, simultaneously has serious adverse effects on patients family and society. Therefore, it is very urgent to explore the effective intervention therapy. In the present proposal, we intend to recruit patients with gastric cancer, which is the most popular gastrointestinal cancer. By using cross-sectional study, we plan to investigate the condition of perceived stress, rumination and its sub-dimension, psychological distress and etc. in patients with different disease stages, including chemotherapy phase, follow-up phase and recurrence phase. By using structural equation model, we are expected to interpret the relationships between these elements and provide important information for the rectification of the psychological distress in gastric cancer patients. Based on this, we plan to carry out psychological treatment based on mindfulness. Gastric cancer patients during chemotherapy phase will be recruited. After obtaining informed consent, these recruited patients will be randomly allocated into mindfulness training and waitlist group. In training group, patients will receive a network-based mindfulness curriculum designated by our group based on the Mindfulness- based Stress Reduction invented by Professor Jon Kabat-Zinn and our survey data. To examine the rehabilitation effect of our mindfulness curriculum, the score of psychological distress and life quality will be determined at different time point including pre-, post-, 6 months and 12 months after training. Furthermore, we will investigate the changes of the mindfulness, attention awareness and acceptance, rumination and its sub-dimension, and psychological distress in patients at the time point of pre- and post-training. Based on these clinical intervention data, we will detect and construct the relationship among the above essential elements by using structural equation model. These findings will help to elucidate the mental mechanism of our mindfulness training curriculum, and provide important references and basis for the upgradation of our curriculum. The implementation of our proposal will provide theoretical support and practical evidence for the formulation and promotion the mindfulness training curriculum project for gastric cancer patients.

心理困扰是影响癌症患者生命质量、治疗依从性和预后等的重要因素，对家庭和社会也存在严重不良影响，迫切需要探索有效的心理干预方法。本项目选择我国最常见的消化道肿瘤—胃癌，采用横断面调查，招募化疗、随访和复发阶段患者，分析患者知觉压力、冗思及其维度、心理困扰等，运用结构方程构建冗思等与心理困扰间的关系，为有效评估和干预心理困扰提供参考和依据；在此基础上，将正念训练应用于胃癌患者，设计正念训练方案，选择化疗期患者，应用基于网络的授课模式，比较训练前后、干预6月和12月后，患者心理困扰、生命质量等的变化，系统评价此方案的心身康复效应；进而，通过分析训练前后患者正念、注意觉知和接纳水平，冗思及其维度，心理困扰等的变化，依据临床干预数据，采用结构方程探测和构建各因素间关系，探讨正念训练是否通过改善冗思的反应风格发挥效应并揭示其心理机制，本项目将为应用于胃癌患者正念训练的实施和推广提供实践证据和理论支持。

背景：. 心理困扰是影响癌症患者生命质量、治疗依从性和预后等的重要因素，对家庭和社会也存在严重不良影响，迫切需要探索有效的心理干预方法。.研究内容：. 招募恶性肿瘤患者，采用横断面调查方法，使用心理困扰筛查量表（DMSM）、知觉压力量表（PSS）、冗思反应方式量表（RRS）和正念五因素量表（FFMQ）等评价患者心理困扰、知觉压力、冗思及正念水平，运用结构方程模型等分析各因素间的内在联系与作用机制；在此基础上，招募恶性肿瘤患者，采用基于网络的授课模式，设计正念训练方案，将此方案应用于患者，对比正念训练前、后患者正念水平及知觉压力的改善状况，系统评价此方案对恶性肿瘤患者的康复效应。.研究结果：.1.患者知觉压力、正念、冗思及心理困扰总分分别为（23.91±7.19）分、（123.33±9.80）分、（37.41±8.51）分、(4.28±1.96)分；心理困扰的检出率为62.4%，高知觉压力者占23.9%。.2.患者的正念水平与心理困扰呈负相关（r=-0.314，P<0.001），正念水平对心理困扰变异的解释力为9.2%；患者的冗思、抑郁、强迫冥思维度与心理困扰呈正相关（r=0.350，P<0.001），抑郁和强迫冥思维度解释心理困扰总变异的15.5%。.3.患者的冗思水平在躯体疼痛对心理困扰的动态影响中存在调节效应（△R2=0.03,P<0.05）。.4.患者的冗思水平在知觉压力与心理困扰间具有中介效应，占总效应的59.8%。.5.正念训练后，患者的FFMQ总分、观察、觉知的行动、对内在经验不评判、对内在经验不反应得分高于训练前（P<0.01）；正念训练后，高压力癌症患者的PSS-14得分低于训练前（P<0.01）。.结论：.1.患者心理困扰和高知觉压力检出率较高，正念和冗思为中等水平。 .2.患者的正念、冗思、抑郁、强迫冥思维度均可以预测其心理困扰的严重程度。.3.低冗思水平具有缓解躯体疼痛对心理困扰的作用。.4.改善肿瘤患者冗思认知风格，有助于降低知觉压力所导致的心理困扰的水平。.5.开展正念训练，有助于提升癌症患者的正念水平，降低知觉压力。.

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