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  • 學位論文

生理回饋治療對改善憂鬱患者憂鬱及焦慮之成效

The therapeutic effect of biofeedback intervention for depression and anxiety in patients with depression

指導教授 : 賴倩瑜
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摘要


本研究主要目的在了解生理回饋治療對改善憂鬱患者憂鬱及焦慮之成效。本研究採實驗研究設計,以隨機分派方式將個案分為實驗組與對照組,實驗組個案除維持一般門診常規治療外,額外接受每週一次,為期六週的生理回饋治療;對照組個案則僅接受一般門診常規治療,無接受任何額外的相關治療。共收案42位憂鬱症個案為研究對象,包括實驗組20人,對照組22人。研究過程中,實驗組與對照組個案進行憂鬱與焦慮程度的前測(第一週)、期中測(第三週)、後測(第六週)及追蹤測量(第十週)共四次。實驗組個案接受六次生理回饋治療,每一次皆收集呼吸、心跳、指溫、心率變異性等生理變化平均數值。 研究結果顯示,實驗組在不同時間點的生理指標(呼吸、心跳、指溫)與心律變異性( Heart Rate Variability;HRV )與前測比較,心跳部分,在第一( β= -6.70, SE= 2.34, P< .01 )、二( β= -5.37, SE= 2.34, P< .05 )、四( β= -5.74, SE= 2.34, P< .05 )、五(β= -6.26, SE= 2.34, P< .01 )次與前測比較,有顯著性差異。在情緒指標部份,實驗組與對照組個案的憂鬱程度前測平均值為23.6與26.55,皆屬中度憂鬱,焦慮程度前測平均值為19.40與23.61,同屬中度焦慮,兩組間的前測皆無顯著差異。經六次的生理回饋治療,實驗組在第六週( β= -4.00, SE= 1.97, P=< .05 )與第十週( β= -3.96, SE= 1.97, P< .05 )憂鬱值與前測基準值相比有達顯著性差異,顯示生理回饋介入能有效降低憂鬱程度;而焦慮程度部分,實驗組與對照組個案在整個治療過程中,焦慮數值都有持續下降,但兩組改變量皆未達顯著性差異,而值得注意的是,實驗組個案焦慮程度的下降幅度,仍大於對照組。 本研究結果肯定生理回饋治療對憂鬱情緒的控制效益,但對於焦慮情緒的效果反而較不明顯。本研究建議可將生理回饋治療推廣於憂鬱症患者的治療與照護,藉由教導患者自我放鬆練習,透過生理回饋儀器,可以協助患者了解身體症狀和情緒的關係,也讓患者學會自我控制生理現象,進而加強放鬆並自行調整情緒壓力的能力,而且生理回饋治療本身不會產生嚴重副作用,也可以輔助患者藥物治療的效果。在未來研究部分,若能將生理回饋介入時間延長、增加訓練次數,並於結束後進行長期效應的追蹤,相信可以更加落實生理回饋治療對社區憂鬱病患情緒控制的成效。

關鍵字

生理回饋治療 憂鬱症 憂鬱 焦慮

並列摘要


The aim of this study was to examine the therapeutic effects of biofeedback intervention for depression and anxiety of patients with depressive disorder. An experimental study design was used. Forty-two patients with depressive disorder under treatment from outpatient department of a medical center in Southern Taiwan were recruited. Among them, 20 participants were randomly assigned to experimental group to receive biofeedback intervention for 6 times and the other 22 participants were randomly assigned as control group to take general treatment only. Every participant was asked to finish questionnaires including Beck Depression Inventory-II and Beck Anxiety Inventory to assess the changes of depression and anxiety in the first, third, sixth, and tenth week respectively. In addition to emotional data, physical data such as respiration rate, heart rate, finger temperature, as well as heart rate variability were collected each time of biofeedback intervention in experimental group. The result revealed that different therapy sessions, physiological index(breathing, heart rate, finger temperature) and heart rate variability (Heart Rate Variability; HRV) of experimental group compared with the pre-test, heart rate of the first ( β= -6.70, SE= 2.34, P< .01 ), second ( β= -5.37, SE= 2.34, P< .05 ), fourth ( β= -5.74, SE= 2.34, P< .05 ) and fifth (β= -6.26, SE= 2.34, P< .01 ) sessions have significant differences. Depression level of the experimental group and the control group were 23.60 and 26.55 respectively; the anxiety level of them were 19.40 and 23.61 respectively. The pretesting depression and anxiety level of both groups were within the range of moderate level. The experimental group got significant reduction in depression level in the sixth ( β= -4.00, SE= 1.97, P=< .05 ) and tenth week ( β= -3.96, SE= 1.97, P< .05 ) which indicated that the biofeedback intervention could contribute to those change. Its effect might start 6 weeks later. There was no significance difference between experimental and control groups in anxiety level after biofeedback intervention course although a more reduction tendency of anxiety level was noted in the experimental group than the control one. The results confirm the therapeutic effects of biofeedback intervention for depression, but the effect for anxiety is not obvious. This study suggests that biofeedback intervention can be promoted in the treatment and care of patients with depression by educating patients self-relaxation exercises. According to the data expression of the biofeedback instruments, the process of biofeedback intervention can help patients understand the relationship between physical responses and their emotions, in the meantime, patients may learn how to control the physiological responses by their own and then strengthen the ability of self-relaxation and stress adjustment. There is no serious side effects in terms of biofeedback intervention, it can also assist patients with medication treatment. In the future studies, extending biofeedback training courses, to make a long-term tracking of the effects after treatment will be recommended. The effects of biofeedback intervention to emotional control of patients with depression in community may be demonstrated.

參考文獻


中文部份
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