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  • 學位論文

呼吸訓練對停經後憂鬱婦女憂鬱症狀與自主神經功能之成效探討

Effects of breathing training on depressive symptoms and autonomic functioning in postmenopausal women with depressive symptoms

指導教授 : 蔡佩珊

摘要


目的:本研究旨在探討竇性心律不整生物回饋引導之呼吸訓練對於改善停經後憂鬱婦女憂鬱症狀與自主神經功能之成效。 方法:本研究招募45至64歲自然停經滿12個月且貝克憂鬱量表(BDI-II)得分10分(含)以上的婦女參與研究。個案經隨機分派至實驗組與對照組。實驗組接受一週一次、每次一小時、為期八週以竇性心律不整生物回饋引導之呼吸訓練課程,而對照組會在相同時間點接受壓力管理訓練課程以作為控制。主要結果測量包括憂鬱症狀(BDI-II)及自主神經功能(以功率頻譜分析之心跳變異性及以交相關法估算之壓力反射器敏感度)。個案在第0(治療前)、9(第一次後測)及16週(第二次後測)接受測量,以重複測量變異數進行資料分析,並計算組間及組內前後測Cohen’s d值。 結果:共有81位45~64歲的研究對象(平均年齡56.49歲)納入分析。BDI-II得分平均為21.16 ?b 11.13分(範圍10~57分)。重複測量變異數結果顯示,接受竇性心律不整生物回饋引導之呼吸訓練個案,其憂鬱症狀的改變幅度與控制組的改變幅度間無統計上顯著差異(F(1, 158) = 0.994, p = .322),亦無時間與組別間的交叉效應(F(1, 158) = 0.994, p = .322 and F(2, 158) = 1.645, p = .203, respectively);自主神經功能參數隨時間的改變幅度亦無顯著的組間差異或時間與組別間的交叉效應(所有p > .05)。然而,實驗組的憂鬱症狀與前測值相較,在訓練後一週 (p < 0.001)及八週(p < 0.001)均顯著的下降,且呼吸訓練對憂鬱症狀可產生大的效應量(0至9週,Cohen’s d = -0.80;0至16週,Cohen’s d = -1.12),且對壓力反射器敏感度可產生小的效應量(0至16週,Cohen’s d = 0.34)。接受呼吸訓練之婦女其憂鬱症狀降低程度與心跳速率及壓力反射器敏感度應激反應的改善程度有顯著相關(r = .35,p = .039及 r = -.37,p = .030)。 結論:竇性心律不整生物回饋引導之呼吸訓練對於改善憂鬱症狀及自主神經功能並未能優於研究的控制條件(壓力管理教育)。然而,在竇性心律不整生物回饋引導之呼吸訓練完一週及八週之後,可有效改善憂鬱症狀及產生壓力反射器敏感度小的效應量。接受呼吸訓練之停經婦女其憂鬱症狀的改善可能與自主神經功能的改善有關。

並列摘要


Purpose: To examine the effects of respiratory sinus arrhythmia (RSA) biofeedback-assisted breathing training on depressive symptoms and autonomic functioning in postmenopausal women with depressive symptoms. Methods: Participants, aged from 45 to 64, reporting cessation of menstrual cycles with natural causes for more than 12 consecutive months and scored 10 or greater on the Beck Depression Inventory-II (BDI-II) were eligible for participation. Participants were randomly assigned to either an experimental or an active control group. Participants assigned to the experimental group underwent 8 one-hour weekly RSA-biofeedback assisted breathing training sessions. Participants randomized as controls underwent stress management training during the same time period for controlling the attention effect. Primary outcomes included depressive symptoms assessed using the BDI-II and autonomic function determined by power spectral analysis of heart rate variability (HRV) and baroreflex sensitivity (BRS). Spontaneous BRS was determined using a cross-correlation method. Outcomes were assessed at Week 0 (pretest), 9 (posttest 1), and 16 (posttest 2). Data were analyzed using Repeated Measures Analysis of Variance (ANOVA). Between-group and within-group (pretest to posttest) Cohen’s d was also calculated. Results: Eighty-one participants aged from 45 to 64 with a mean of 56.49 years were analyzed. The mean BDI-II score, ranging from 10 to 57, was 21.16 ?b 11.13. Repeated measures ANOVA revealed that the magnitude and pattern of changes in depressive symptoms over time from baseline to posttest were not significantly different between the group receiving RSA biofeedback-assisted breathing training and the group receiving the control condition (F(1, 158) = 0.994, p = .322); neither the group nor the group by time interaction effects were found to be significant (F(1, 158) = 0.994, p = .322 and F(2, 158) = 1.645, p = .203, respectively). Similarly, the magnitude and pattern of changes in autonomic parameters over time were not significantly different between groups (all p > .05). Nevertheless, the BDI-II scores reduced significantly in the experimental group (all p < .001) and the breathing training also elicited a large treatment effect on depressive symptoms 1week and 8weeks after completion of breathing training (Cohen’s d = -0.80 and -1.12, respectively). Breathing training also elicited a small treatment effect on resting BRS from Week 0 to Week 16 (Cohen’s d = 0.34). The decrease in the severity of depressive symptoms is significantly associated with the improvement in autonomic functioning as determined by HR and BRS stress reactivity in postmenopausal women who receive breathing training (r = .35, p = .039 and r = -.37, p = .030, respectively). Conclusion: RSA biofeedback-assisted breathing training is no better than the control condition (i.e., stress management education) for improving depressive symptoms and autonomic function. Nevertheless, RSA biofeedback-assisted breathing training is effective in reducing depressive symptoms 1 week and 8 weeks after completion of training and elicited a small treatment effect size on BRS. The improvement in depressive symptoms associated with breathing training in postmenopausal women may be related to the improvement in autonomic function.

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