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  • 學位論文

運用生理回饋與放鬆訓練對憂鬱症狀改善之成效探討

Effects of biofeedback and relaxation in patients with depression

指導教授 : 許玫琪 郭士民

摘要


憂鬱症的盛行率極高,其所伴隨的生理、心理的健康問題更可能惡化精神問題或疾病;加上病程的慢性化,增加自殺的機率。除了接受藥物的治療之外,輔助性的治療如生理回饋(biofeedback)為除了藥物之外的介入措施。生理回饋是治療者利用一系列的電子儀器設備,將人體正常或異常的生理現象(如皮膚溫度、肌肉電位、呼吸狀態、腦波、血壓、心跳等)轉化成可以辨認的數值,並將這些數值以視覺或聽覺的訊號回饋(呈現)給當事人知道,藉此人們可經由嘗試錯誤的學習,學會控制或操作自己的生理指標,進而達到控制身體或情緒緊張的狀態。 本研究的研究目的為探討運用生理回饋與放鬆訓練,對於精神科住院的憂鬱症個案其憂鬱症狀之影響效果。研究採實驗設計法,以方便取樣於精神科病房選取符合條件之62位憂鬱症病人,依隨機方式分配至對照組22位、實驗組1(肌肉放鬆合併生理回饋組)20位及實驗組2(肌肉放鬆組)20位。對照組接受一般病房之常規照護。於介入前(T1)、最後一次介入(T2),以及最後一次介入後的一個月(T3)進行問卷調查以及生理指標的測量。對照組也與實驗組於同樣的時間完成所有測量。統計分析的方法包括描述性統計、單因子變異數分析、卡方檢定、廣義估計方程式、麥內瑪關聯樣本檢定(Mcnemar test)。 研究結果顯示,在醫院焦慮憂鬱量表得分上,經廣義估計方程式統計分析後可得知,在「焦慮」方面,僅實驗組1從介入前到治療後一個月的改變幅度具有顯著差異(p < 0.05),至於實驗組2則未達顯著水準(p > 0.05)。在「憂鬱」方面,實驗組1及實驗組2從介入前到治療後及治療後一個月的改變幅度皆具有顯著差異(p <0.05)。單因子變異數分析結果也發現在焦慮方面,控制組分數顯著高於實驗組1,而在憂鬱方面,控制組分數顯著高於實驗組1及實驗組2,而實驗組2分數又顯著高於實驗組1。在生理指標變化情形,經由廣義估計方程式的統計分析結果顯示,在放鬆時,實驗組1在肌電圖(Electromyograph; EMG)及Lower-frequency power (LF)的變化達顯著差異。這些數值變化顯示在肌肉放鬆部分,實驗組1比控制組及實驗組2顯著的成效。在交感及副交感活性的成效部分,控制組交感活性增加,而實驗組交感活性減少,其中實驗組1比實驗組2更能降低交感活性。在生理回饋時期,發現實驗組1有更多的生理數值在統計上出現顯著差異,分別為膚電阻、指溫、HF(High-frequency power)。在交感神經興奮後影響到血管收縮所引起指溫降低部分,發現二組實驗組部分趨向於平穩上升的情形。在與副交感神經有關的HF變化上,實驗組1較具成效。在放鬆的部分,實驗組1更是持續且有成效。 對於精神科住院的憂鬱症個案其憂鬱、焦慮及生理測量上,生理回饋合併放鬆組(實驗組1) 比放鬆組(實驗組2)更能減輕憂鬱症個案的焦慮與憂鬱,並能在生理測量的變化上有明顯成效。生理回饋合併放鬆可協助減緩憂鬱症症狀,以及HF提升、皮膚溫度上升、肌肉電位下降等,達到降低交感神經活性並提升副交感活性的情形,憂鬱症病人改善了憂鬱症狀,而達到比較好的生活品質。 本研究結果可應用於減緩病人憂鬱症狀,增加病人自我照顧其憂鬱症狀的能力。本研究結果可提供護理人員和其他健康照顧者作為照護上的參考,在照顧此類個案時,配合運用藥物之外的輔助治療,能有效的降低憂鬱症狀,並進而改善其個人生活品質。

關鍵字

生理回饋 放鬆訓練 憂鬱

並列摘要


Depression has a high prevalence worldwide. It makes depression physical and mental health worse and suicide risk increased. Except pharmacotherapy, the complementary treatments such as biofeedback may be a promising intervention to alleviate depressive symptoms. Biofeedback uses a series of electronic devices to monitor normal or abnormal signals such as skin temperature, electromyogram (EMG), breathing rate, electroencephalography (EEG), blood pressure and heart rate and convert them into recognizable data to the test subject. Biofeedback can therefore help people having more control over these involuntary functions, and their emotional or anxious status. The main purpose of this study was to examine the effects of biofeedback and relaxation on depression. This study adopted a pre-post test experimental design using a convenience sampling from psychiatric wards. A total of 62 patients were randomly assigned to either control group (n=22), experimental group I (relaxation combined with biofeedback, n=20), and experimental group II (relaxation only, n=20). The control group received the standard routine care, whereas participants in the experimental groups (I and II) received 10 consecutive biofeedback and/ or relaxation sessions. Data were collected and assessed before intervention (T1), just finished the 10th (the final) intervention (T2), and one month after the intervention (T3). Data from the control group were also collected at the same time frame. Statistical analyses included descriptive statistical methods, One-Way ANOVA, chi-square test, Generalized Estimating Equation (GEE), and McNemar test. The GEE results based on the Hospital Anxiety and Depression Scale (HADS) scores, showed that anxiety score from T1 to T3 in the experimental group I was significantly different and decreased (p< 0.05). Depressive symptoms from T1 to T3 in both experimental groups (I and II) were also significantly improved (p< 0.05). ANOVA analyses showed that anxiety scores of the control group were significantly higher than the experimental group I. The depression scores in the control group were higher than those in both experimental groups. However, the experimental group I had even lower depression scores than the experimental group II. In physiology indices, GEE results showed that electromyography (EMG) and lower-frequency power (LF) were significantly different in the experimental group I when relax. The findings indicated that the experimental group I had more effective muscle relaxation effects compared with both control group and experimental group II. Concerning the sympathetic and parasympathetic activity, the sympathomimetic activity was increased in the control group, while decreased in the experimental group II, and more so in the experimental group. During the biofeedback sessions, skin conductance, finger temperature and HF in the experimental group I showed significant change. When sympathetic tone was increased, it caused vasoconstriction and subsequently decreased the skin temperature. However, this study found temperature increased in both experimental groups. The experimental group I showed significantly improved and effective in the HF changes, which reflected an improved parasympathetic activity. Overall, the experimental group I in comparison with the experimental II showed more effective in reducing depressive symptoms, anxiety and physiological parameters. This study demonstrates that relaxation in combination with biofeedback could effectively improve depressive symptoms, increased HF and skin temperature, and decreased EMG. As a result, sympathetic activity was decreased and parasympathetic activity was increased. Thus, depressive symptoms in patients with depression were improved, and better quality of life achieved. The results found in this study may be useful in improving physical and psychological health in patients with depression. Our evidence-based research findings that a combined use of pharmacotherapy and complementary therapies could effective decreased depressive symptoms and improved quality of life, could provide a useful reference to nurses and other health professionals when caring for depression patients.

並列關鍵字

biofeedback relaxation training depression

參考文獻


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