远程正念防复吸训练对物质使用障碍者的疗效研究
文献类型：学位论文
| 作者 | Gorowska Monika Paula |
| 答辩日期 | 2023-12 |
| 文献子类 | 博士 |
| 授予单位 | 中国科学院大学 |
| 授予地点 | 中国科学院心理研究所 |
| 其他责任者 | 李勇辉 |
| 关键词 | 物质使用障碍 正念防复吸干预 在线干预 随机对照试验 网络分析 系统综述 |
| 学位名称 | 理学博士 |
| 学位专业 | 健康心理学 |
| 其他题名 | The effectiveness of the online-delivered Mindfulness-Based Relapse Prevention among individuals with Substance Use Disorder |
| 中文摘要 | Substance Use Disorder (SUD) is a global problem. In the year 2021，a total of 63.5 million individuals worldwide fulfilled the DSM一5 criteria for being diagnosed with SUD. Despite receiving treatment, more than 50% of individuals with SUD experience relapse. Craving serves as a significant factor that maintains SUD and it is a common precipitant of relapse. Therefore, addressing craving presents a significant challenge in treating SUD. Craving is often associated with multiple factors, and individuals with SUD who exhibit high impulsivity and have comorbid disorders such as depression, anxiety, and insomnia, are at a higher risk of relapse and treatment drop-out. Mindfulness-Based Relapse Prevention (MBRP) has demonstrated effectiveness in reducing cravings and other psychopathological symptoms across various studies. Despite its effectiveness, the implementation of the program remains a challenge. The therapeutic needs of individuals with SUD are not being met, and treatment resources are scarce. This problem has become more apparent during the COVID-19 pandemic. To address this issue, there is a need to prioritize the expansion of treatment options and the development of innovative approaches to treating SUD. Research has shown that digital interventions, mainly CBT-based, are effective for screening, assessment, and treatment of SUD. To date, only one study has provided preliminary evidence on the efficacy of online-delivered MBRP for individuals with concurrent smoking and alcohol use, and its early results are promising. Given the high prevalence of SUD and their associated high relapse rates, as well as the burden they impose on both individuals and society, it is imperative to gain a deeper understanding of the psychological characteristics of individuals with SUD and to develop and test innovative treatment delivery approaches that can improve access to effective interventions for SUD, especially in light of the evidence gathered during the COVID-19 era. Therefore, the present project has three main objectives centered around online Mindfulness-Based Relapse Prevention (MBRP). Firstly, it aims to conduct a systematic review to determine whether mindfulness, as a trait or state, can function as a protective factor against addictions and related psychopathology. Secondly, the unique network present in individuals with SUD will be identified, with a focus on pinpointing the key variables that have the most significant impact on the SUD network. Thirdly, the effect of MBRP training on key variables within the SUD network will be assessed. In addition, given the growing acceptance of remote interventions and the importance of addressing treatment barriers, the project aims to investigate the effectiveness of delivering MBRP intervention online. Methods and Materials Study 1:The main goal of this study was to systematically review whether mindfulness, in both a trait and state form, can serve as a protective factor against addictive behaviors during the COVID-19 period. We also aimed to investigate if there has been an increase in the adoption and acceptance of Mindfulness-Based Interventions (MBIs) in online settings during the pandemic. We followed PRISMA guidelines for systematic reviews and meta-analyses. We searched the following databases: Embase, Cochrane Library, PubMed, and ProQuest. Empirical studies published in English from 1 January 2020 to 14 August 2023 on the topic of mindfulness and mindfulness-based interventions for substance use and behavioral addictions during the COVID-19 pandemic were searched. Study 2: The main goal of this study was to conduct the network analysis and examine the specific psychological network of individuals with SUD and to identify the central nodes and unique finks that are characteristic of this network. In addition, through cluster analysis, the study aimed to establish specific groups based on the outcomes from network analysis and examine the unique connections between particular clusters and their association with craving. We examined 171 individuals with SUD in the Monar inpatient rehabilitation center in Poland. The following outcomes were assessed: craving measured by the Penn Alcohol Craving Scale, impulsivity measured by the Barrat Impulsiveness Scale, insomnia measured by the Athens Insomnia Scale, depression and anxiety measured by the Hospital Anxiety and Depression Scale, mindfulness measured by the Five Facets Mindfulness Questionnaire, metacognition measured by the Metacognitions Questionnaire, emotional regulation measured by the Difficulties in Emotional Regulation Scale, and coping orientation measured by the Brief-COPE, satisfaction with life measured by the Satisfaction with Life Questionnaire. Firstly, we conducted the Network Analysis using R language in order to draw inferences about relationships between variables tested at the baseline. A simple correlation method was chosen to estimate the structure of the network between variables. We aimed to assess the role of particular variables in the tested network, with three measures being calculated, including Strength, Closeness, and Betweenness. Secondly, utilizing Network Analysis, we partitioned the dataset into clusters by identifying similarities among the groups. Subsequently, we calculated the variations between the groups in relation to clinical variables. Study 3: The main goal of this randomized controlled trial (RCT) was to evaluate the efficacy of an online-delivered MBRP program in treating SUD. The study aimed to determine whether remotely delivered MBRP can mitigate cravings and other psychopathological symptoms such as impulsivity, depression, anxiety, and insomnia. Additionally, the study sought to establish whether the program has an impact on coping orientation in individuals with SUD. We designed the RCT examining the effectiveness of the online delivered MBRP, employing a stepped-wedge design protocol. Deeply paraphrased and scientifically changed: A total of 171 participants (147 males and 24 females) were carefully selected from the MONAR inpatient treatment facility centers in Poland. They were then randomly assigned to two groups: Group 1 (n=92), which received an eight-week online-delivered MBRP intervention, and Group 2 (n=79), which served as a waitlist control and received the standard eight-week treatment as usual (TAU). During Phase I (eight weeks), Group 1 underwent the MBRP intervention, while Group 2 remained in TAU. In Phase II (eight weeks), Group 2 received the MBRP intervention, while Group 1 continued with TAU. Assessments were conducted at baseline, post-intervention (after 8 weeks), and follow-up (after 8 weeks) to evaluate the outcomes of the interventions. We selected craving, impulsivity, depression and anxiety, insomnia, coping orientation, mindfulness, metacognition, emotional regulation as evaluation indicators. The measurement methods were the same as in Study 2. Results Study 1:twelve studies were selected for this systematic review, seven investigating trait mindfulness and five exploring MBIs. The results indicated that higher levels of trait mindfulness were associated with lower addiction levels in most studies, except for one study, where the opposite outcome was observed. Conversely, lower levels of trait mindfulness were found to be correlated with higher levels of psychopathological symptoms, including depression, anxiety, and poor attentional control, across all seven studies. In terms of the efficacy of MBIs, four studies demonstrated significant improvements in addiction levels and abstinence. Two studies evaluated anxiety and depression, with one showing a decrease in symptoms, while the other did not find any significant differences. Finally, one study measured positive and negative coping, and the outcomes indicated a significant improvement for both variables. Results indicated that individuals were receptive to remote delivery of programs, such as online and text messaging. Study 2: The estimated network included twelve nodes of SUD variables including craving, impulsivity, depression and anxiety, insomnia, mindfulness, metacognition, emotional regulation, coping orientation such as emotion-focused, avoidant coping, problem-focused, and satisfaction with life. The central node in the SUD network was emotion-focused coping, which had a key role in the network of SUD-related variables. Closer links were observed with problem-oriented and avoidant coping, insomnia, and anxiety. Based on the data from network analysis, we carried out a cluster analysis and subsequently divided the data into clusters based on coping orientation: emotion-focused (BC1), problem-focused (BC2), and avoidant coping (BC3). Results from the four cluster solution showed that Group 1 scored the highest in avoidant coping (BC3, M=0.75), with the following results in problem-focused coping (BC1，M=-0.15), and emotion-focused coping (BC2, M=0.06). Group 2 scored very low in all categories of coping orientation, including problem-focused coping (BC1，M=-0.96), emotion-focused coping (BC2, M=-0.90), and avoidant coping (BC3, M=-0.74). Group 3 can be characterized by their predominant use of problem-oriented coping (BC1，M=0.71), as opposed to emotion-focused coping (BC2, M=0.09) or avoidant coping (BC3, M=-0.77). Group 4, had all the coping orientation strategies increased in comparison to other groups, but the most increased variable was emotional-focused coping (BC2, M=1.63) with the following results in problem-focused coping (BC1，M=1.18), and avoidant coping (BC3, M=0.99). Furthermore, we aimed to investigate the relationship between the coping orientation as the central node of the network and craving. The subsequent analysis revealed that in the cluster with the highest levels particularly of emotion-focused coping (M=1.63) in comparison to other forms of coping orientation including problem-focused (M=1 .18), and avoidant coping (M=0.99), the higher levels of cravings were observed (M=13.41，SD=5.53). Conversely, in the cluster characterized by problem-oriented coping, the levels of craving were significantly lower (M=9.88, S.D=2.13). Study 3: The results of the post-term evaluations indicated that MBRP had a meaningful impact on reducing craving, insomnia, anxiety (p<0.05), impulsivity (p<0.001), and increasing mindfulness (p<0.001).However, there was no significant effect on depression (p>0.05) and emotional-focused coping (p>0.05). The findings also revealed that the effects of online-delivered MBRP were sustained at the 8-week follow-up on craving, insomnia, and impulsivity and mindfulness (p>0.05). The results of the mediation analysis demonstrated significant mediation effects of insomnia between the MBRP and impulsivity (p<0.01) as well as emotion regulation (p<0.05). Impulsivity was a significant mediator between the MBRP and insomnia切<0.01), as well as anxiety切<0.05). Finally, anxiety was a significant mediator between MBRP and impulsivity (p<0.05). The results of the moderation analysis demonstrated that psychiatric comorbidity was a significant moderator of insomnia in terms of post-test切<0.001) and follow-up (p<0.05), as well as mindfulness in terms of post-test (p<0.001) and follow-up (p<0.001). The abstinence period was a significant moderator of problem-focused coping in terms of post-test (p<0.05), as well as emotion-focused coping (p<0.05). Conclusions Based on the results of a systematic review that emphasized the potential role of mindfulness as a protective factor against addiction and associated psychopathology, as well as its acceptance through remote delivery, we conducted an RCT to evaluate the efficacy of MBRP administered online. Before the trial, we used network analysis to identify the central node of the SUD network and found a strong correlation between emotion-focused coping and other variables such as anxiety and insomnia. We then used cluster analysis to group participants based on their coping orientation and assessed their relationship to craving. Results showed that the group with heightened emotion-focused coping had the highest level of craving, while the group with problem-focused coping had the lowest. Our findings suggest the need for further examination of the link between coping orientation and craving in SUD. In the trial, we aimed to assess the effects of online-delivered MBRP training on key variables in the SUD network. MBRP was found to effectively reduce cravings and improve outcomes related to insomnia, impulsivity, and anxiety in individuals with SUD. The benefits of mindfulness practice appeared to be sustained over time. Even though the program did not show any direct effect on emotion-focused coping, additional analysis revealed that the experimental group with a high score in emotion-focused coping exhibited lower levels of craving compared to the control group with a high score in emotion-focused coping. As a result, we can infer that undergoing the MBRP training in the experimental condition serves as a protective measure against the adverse effects of emotional-oriented coping. Future research should explore MBRP's efficacy in this domain. Insomnia, impulsivity, and anxiety were found to mediate the relationship between MBRP and certain study outcomes. Psychiatric comorbidity and abstinence period were identified as significant moderators of the relationship between MBRP and treatment outcomes. While the study on MBRP's digital delivery is preliminary, the findings suggest that it can be effectively delivered through online platforms without compromising its effectiveness. With further research to validate and extend these results, the online-delivered MBRP could become a widely accessible resource for individuals seeking assistance and potentially open up new avenues for innovative mental health treatment approaches. |
| 英文摘要 | 物质使用障碍(Substance Use Disorder, SUD)是一个全球性严重问题。截至2021年，全球有6350万人被DSM-5诊断为患有SUD。高达50%以上的SUD患者在治疗后复吸。渴求是维持这一障碍的一个主要因素，也是复吸的常见诱因。因此，降低渴求是治疗SUD的一项重要挑战。渴求常与多种因素有关，SUD患者表现出高度的冲动行为，并伴随抑郁、焦虑和失眠等共病症状，这使得他们更容易复吸并难以坚持治疗。多项研究表明，正念防复吸干预(Mindfulness-Based Relapse Prevention, BRP)可以有效降低渴求，减轻其他精神病理症状。然而，与其他治疗方法一样，MB RP的可用性仍然受限，这是实施该疗法的主要挑战之一。由于缺少治疗资源，导致SUD患者无法获得他们所需的治疗。特别是在COVID-19大流行期间，这一问题变得尤为突出。因此，迫切需要扩大治疗选择的范围，开发新的SUD治疗方法。 本项目以在线正念防复吸(MBRP)为中心，有三个主要目标。首先，通过进行系统性综述，确定正念是否可以作为一种特质或状态，对防止成瘾和相关精神病理症状具有保护作用。其次，要识别存在于SUD个体中的特定网络，重点是确定对SUD网络影响最大的关键变量。第三，将评估MBRP疗法对SUD网络中关键变量的影响。此外，鉴于越来越多的人接受远程干预，并考虑到解决治疗障碍的重要性，该项目旨在考察在线MBRP干预的有效性。 材料和方法: 研究1的主要目的是系统回顾COVID-19大流行期间，正念(包括特质和状态)是否可以作为预防成瘾行为的保护因素，以及在疫情期间，在线环境对正念干预(MBI)的采用和接受程度是否有所提高。我们遵循了系统综述和荟萃分析的PRISMA指南，检索了以下数据库:Embase , Cochrane Library ,PubMed和ProQuest。检索了2020年1月1日至2023年8月14日以英文发表的关于COVID-19大流行期间药物使用和行为成瘾的正念和基于正念的干预措施的实证研究。 研究2的主要目的是采用网络分析的方式，研究患有SUD个体的特定心理网络，并确定该网络的中心节点和独特联系。此外，通过聚类分析，根据网络分析的结果建立特定的群体，并研究特定聚类之间的独特联系以及它们与渴求之间的关联。我们对波兰莫纳尔住院康复中心的171名药物依赖者进行了研究。我们评估了以下指标:宾夕法尼亚酒精渴求量表(Penn Alcohol Craving Scale )测量的渴求程度、巴瑞特冲动量表(Barrat Impulsiveness Scale)测量的冲动程度、雅典失眠量表(Athens Insomnia Scale)测量的失眠程度、医院焦虑和抑郁量表(Hospital Anxiety and Depression Scale)测量的抑郁和焦虑程度、五因素正念量表(Five Facets Mindfulness Questionnaire)测量的正念程度、元认知问卷(Metacognitions Questionnaire)测量的元认知程度、情绪调节困难量表(Difficulties in Emotional Regulation Scale)测量的情绪调节程度、简明COPE C Brief-COPE)测量的应对取向以及生活满意度问卷(Satisfaction with Life uestionnaire)测量的生活满意度。首先，我们使用R语言进行了网络分析，以推断基线测试变量之间的关系。我们采用相关方法来估计变量之间的网络结构。我们的目的是评估特定变量在测试网络中的重要性，并计算了三个测量值，包括强度(Strength、紧密度(Closeness)和关联度(Betweenness。其次，通过网络分析，我们将数据集分成若干组，根据组内的相似性进行聚类分析。随后，我们计算了与临床变量相关的组间差异。 研究3的目的是评估在线MBRP项目在治疗SUD方面的疗效，包括能否减轻渴求和其他精神病理症状，如冲动、抑郁、焦虑和失眠，以及该计划是否会对SUD患者的应对取向产生影响。我们采用阶梯式楔形集群随机试验，验证在线MBRP的干预效果。我们从波兰莫纳尔住院康复中心选择了171名参与者 (147名男性和24名女性)。然后将他们随机分配到两组:第一组(92人)接受为期八周的在线MB RP干预;第二组(79人)作为候补对照，接受为期八周的标准常规治疗(TAU。在第一阶段((8周)，第一组接受MBRP干预，第二组继续接受TAU。在第二阶段((8周)，第2组接受MB RP干预，第1组继续接受TAU。分别在基线、干预后((8周后)和随访((8周后)进行评估，以评价干预的结果。评估指标我们选择了渴求、冲动、抑郁和焦虑程度、失眠程度、应对取向、正念程度和元认知程度，测量方法和问卷同研究2。 结果 研究1:系统综述选取了12个研究，其中7个研究特质正念，5个研究MBIs。结果表明，在大多数研究中，较高的正念水平与较低的成瘾水平相关，只有一项研究观察到了相反的结果。相反，在所有七项研究中，较低的正念水平与较高的精神病理症状水平相关，包括抑郁、焦虑和注意力控制较差。在MBIs的干预疗效方面，有四项研究显示成瘾水平和戒断率均有显著改善。此外，两项研究对焦虑和抑郁进行了评估，其中一项显示症状有所减轻，而另一项则未发现显著差异。最后，一项研究测量了积极和消极应对，结果显示这两个变量都有明显改善。研究结果表明，人们对网络在线和短信形式的远程干预的接受意愿较高。 研究2:估算出的网络包括12个SUD变量节点，其中包括渴求、冲动、抑郁和焦虑、失眠、正念、元认知、情绪调节、应对取向(如以情绪、回避、问题取向)以及对生活的满意度。SUD网络的中心节点是情绪取向，它在SUD相关变量网络中起着核心作用，和问题导向型应对和回避型应对、失眠和焦虑之间的联系更为紧密。基于网络分析的数据，我们进行了聚类分析，随后根据应对取向将数据分为:情绪取向型(}BC} )、问题取向型(}BC2)和回避型((BC3)。四种聚类解决方案的结果显示，第一组回避型应对得分最高((BC3, M=0.75)，其次是问题取向型应对((BC1, M=-0.15)和情绪取向型应对((BC2, M=0.06)。第二组在所有应对取向类别中得分都很低，包括问题取向型应对((BC1, M=-0.96),情绪取向型应对((BC2, M=-090)和回避型应对((BC3, M=-0.74)。第三组的特点是主要使用问题取向的应对((BCI, M= 0.71)，而不是情绪取向型的应对((BC2, M=0.09)或回避型的应对((BC3, M=-0.77)。第四组的所有应对取向策略均较其他组有所增加，但增加最多的变量是情绪取向型应对((BC2, M=1.63)，其次是问题取向型应对(BC1, M=1.18)和回避型应对(BC3, M=0.99)。此外，我们还研究了网络中心节点与渴求之间的关系。随后的分析表明，与问题导向(M=1.18)和回避型应对(M=0.99)等其他形式的应对取向相比，情绪取向型应对(M=1.63 )水平最高的群体中，渴求的水平更高(M=13.41, SD=5.53)。相反，在以问题取向应对为特征的群体中，渴求水平显著降低(M=9.88， SD=2.13)，研究3:后期评估结果表明，MBRP对减少渴求、失眠、焦虑(p<0.05 )和冲动(p<0.001)有显著影响。但对抑郁(p>0.05 )和情绪取向应对(p>0.05)没有显著影响。结果表明，在8周的随访中，MB RP对渴求、失眠和冲动的影响是持续的(p > 0.0)。 中介分析的结果表明，失眠在MBRP和冲动(p < 0.01)以及情绪调节(p<0.05)之间具有显著的中介效应。冲动是MB RP与失眠(p<0.01)和焦虑 (p<0.05)之间的重要中介。最后，焦虑在MBRP和冲动之间起着重要的中介作用(p<0.05 )。 调节分析的结果表明，精神疾病合并症是失眠的显著调节因素，在后测(p< 0.001)和随访(p < 0.05)中都是如此;正念也是失眠的显著调节因素，在后测(p<0.001)和随访(p<0.001)中都是如此。就测试后(p<0.05)以及情绪取向应对(p < 0.05)而言，戒断期是问题集中应对的重要调节因素。 结论 我们首先进行了一项系统综述，强调了正念作为一种预防成瘾和相关精神病理的保护因素的潜在作用，以及远程正念的可接受性，基于这一结果，我们进行了一项随机对照试验来评估在线实施MBRP的效果。在实验前，我们通过网络分析确定了SUD网络的中心节点，发现情绪取向的应对与焦虑、失眠等其他变量之间存在很强的相关性。然后，我们根据参与者的应对取向对他们进行聚类分析，并评估他们与渴求的关系。结果表明，情绪取向组的渴求程度最高，而问题取向组的渴求程度最低。我们的研究结果表明，需要进一步研究应对取向和渴求之间的联系。在实验中，我们旨在评估在线提供的MBRP培训对SUD网络中关键变量的影响。结果表明，MB RP可以有效地减少渴求，改善与失眠、冲动和焦虑相关的结果。正念练习的好处似乎可以持续一段时间。尽管该项目没有显示出对情绪取向的应对有任何直接影响，但进一步的分析显示，与以情绪取向的应对得分较高的对照组相比，以情绪为中心的应对得分较高的实验组表现出较低的渴求水平。因此，我们可以推断，在实验条件下进行MBRP训练是对情绪取向应对不利影响的保护措施。未来的研究应进一步探索MBRP在这一领域的功效。发现失眠、冲动和焦虑介导MBRP与某些研究结果之间的关系。精神合并症和戒断期被确定为MBRP与治疗结果之间关系的显著调节因子。虽然对MBRP数字化干预的研究是初步的，但研究结果表明，它可以通过在线平台有效地实施，而不会影响其有效性。通过进一步的研究来验证和扩展这些结果，在线提供的MBRP可能成为寻求帮助的个人广泛访问的资源，并可能为创新的心理健康治疗方法开辟新的途径。 |
| 语种 | 中文 |
| 源URL | [http://ir.psych.ac.cn/handle/311026/46651]  |
| 专题 | 心理研究所_健康与遗传心理学研究室 |
| 推荐引用方式 GB/T 7714 | Gorowska Monika Paula. 远程正念防复吸训练对物质使用障碍者的疗效研究[D]. 中国科学院心理研究所. 中国科学院大学. 2023. |
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来源：心理研究所
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