雙相症病患接受正念認知治療之成效：系統性文獻回顧

Effectiveness of the Mindfulness-Based Cognitive Therapy for Bipolar Disorder：A Systemic Review

許倍甄(Pei-Chen Hsu) ； 林靜蘭(Esther Ching-Lan Lin) ； 李宜燕(Yi-Yen Lee) ； 盧美柔(Mei-Jou Lu)

《高雄護理雜誌》 35卷3期 (2018/12) Pp. 1-11

https://doi.org/10.6692/KJN.201812_35(3).0001

摘要

背景：雙相症為高復發率的嚴重精神疾病，經常造成多層面功能損害，其兩次發作期間經常持續經歷殘餘症狀，且多以憂鬱症狀為主，實證研究支持藥物治療應合併心理介入方能達到較佳的臨床成效，其中正念認知治療為具有理論基礎的心理治療模式。目的：採用系統性文獻回顧方法，評析雙相症病患接受正念認知治療之成效。方法：以系統性文獻回顧搜尋2002年至2018年期間發表於Cochrane Library、EBSCO-CINAHL、MEDLINE、PsycINFO、PsycARTICLES、PubMed及CEPS（Chinese ElectronicPeriodical Services）等資料庫的實證文獻，使用關鍵字bipolar disorder/雙相症、mindfulness-basedcognitive therapy（MBCT）/正念認知治療，建立檢索範圍，共得21篇，選取符合篩選標準及排除重複出現的文獻，最後納入3篇隨機臨床試驗研究。以Modified Jadad Quality Scale及Oxford Centre for Evidence-Based Medicine評定其研究品質及證據等級。結果：三篇研究之研究品質介於6至7分、證據等級皆為2，屬於中高品質實證研究。正念認知治療以團體形式為主，介入時間為期八周，每周約2小時，其內容包含簡單的呼吸、靜觀及瑜珈伸展，與對鬱症的基礎心理衛生教育的介入，治療成效以降低憂鬱與焦慮情緒症狀為主。結論/實務運用：整體而言，正念認知治療對雙相症病患具有減緩憂鬱及焦慮情緒的潛力，但目前實證證據的外推性與數量仍待加強，且研究場域仍侷限於歐洲地區，建議未來研究宜朝向更為嚴謹的研究設計，並進一步探討其於不同地區或族群的實證成效。

關鍵字

雙相症 ； 正念認知治療 ； 系統性文獻回顧

並列摘要

Background: Bipolar disorder is a high-recurrence severe mental illness that may lead to increased multiple function impairment, and during the concurrence of two episodes, residual symptoms and most depressive symptoms are often experienced. Evidence has shown that combined pharmacological and psychosocial interventions help optimize the clinical effectiveness of therapy. Mindfulness-based Cognitive Therapy (MBCT) is an effective psychosocial treatment model based on cognitive therapy. Purpose: To examine the effectiveness of MBCT for patients with bipolar disorder using a systematic review of the literature. Methods: Seven Chinese and English electronic databases were searched: Cochrane Library, EBSCO-CINAHL, MEDLINE, PsycINFO, PsycARTICLES, PubMed, and CEPS (Chinese Electronic Periodical Services). Articles with the keywords ＂bipolar disorder＂ and ＂mindfulness-based cognitive therapy (MBCT)＂ published between January 2002 and June 2018 were targeted. Twenty-one articles were initially identified. After excluding duplicates and filtering using the inclusion criteria, three randomized clinical trials were retained for analysis. Research quality was assessed using the Modified Jadad Scale (MJS) and the Oxford Centre for Evidence-Based Medicine (OCEBM). Results: Middle-to-high-quality levels of evidence were rated 6-7 (MJS) and 2 (OCEBM). Results showed that MBCT was used primarily in group formats for a period of time ranging from 8 weeks; participants met weekly for 2 hours; it consisted of depressive symptom management and breathing and meditation with mindfulness as well as hatha yoga exercises. Outcome indicators were assessed using depressive, anxiety symptom assessment and relapse. Conclusions/Implications for Practice：The studies examined in this literature review support that MBCT benefits patients with bipolar disorder by improving depressive and anxiety mood symptoms. However, published extrapolation related to MBCT is rare and limited to patients in western countries. Future studies should use more rigorous research designs and explore the effectiveness of this intervention in different national/ethnic settings.

並列關鍵字

bipolar disorder ； mindfulness-based cognitive therapy ； systematic review

參考文獻

陳惠君、吳羿諠、許民憲、高靖雯、陳秀蘭、陸汝斌(2008)‧第一型與第二型雙極症臨床表徵及生活品質之比較‧實證護理，4(4)，307 - 317。

Berk, L., Hallam, K. T., Colom, F., Vieta, E., Hasty, M., Macneil, C., & Berk, M. (2010). Enhancing medication adherence in patients with bipolar disorder. Human Psychopharmacology: Clinical and Experimental, 25(1), 1-16. Centre for Evidence-Based Medicine. (2011). Oxford centre for evidence-based medicine-levels of evidence. Retrieved from http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-20 11/

Chang, Y. H., Chen, S. L., Chen, S. H., Chu, C. H., Lee, S. Y., Yang, H. F., … Angst, J. (2012). Low anxiety disorder comorbidity rate in bipolar disorders in Han Chinese in Taiwan. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 36(1), 194-197. doi: 10.1016/j.pnpbp.2011.09. 013

De Dios, C., Ezquiaga, E., Agud, J. L., Vieta, E., Soler, B., & Garcia-Lopez, A. (2012). Subthreshold symptoms and time to relapse/recurrence in a community cohort of bipolar disorder outpatients. Journal of Affective Disorders, 143(1), 160-165. doi: 10.1016/j.jad.2012.05.047

Frank, E., Kupfer, D. J., Thase, M. E., Mallinger, A. G., Swartz, H. A., Fagiolini, A. M., … Monk, T. (2005). Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Archives of General Psychiatry, 62(9), 996-1004.