基于元意识干预法改善焦虑伴失眠患者症状及注意回避
文献类型：学位论文
| 作者 | 宋蕊
|
| 答辩日期 | 2024-06 |
| 文献子类 | 硕士 |
| 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 | 王妍 |
| 关键词 | 焦虑 失眠 元意识 注意回避 |
| 学位名称 | 应用心理硕士 |
| 学位专业 | 应用心理 |
| 其他题名 | Improvement on symptoms and attention avoidance of patients with anxiety comorbid insomnia after meta-awareness intervention |
| 中文摘要 | Insomnia is one of the somatic symptoms of anxiety disorder. There is a two-way prediction between the severity of anxiety and insomnia. Alleviating sleep disturbance in chronic anxiety patients is the key to anxiety treatment. Attention bias caused by anxiety is an important cognitive factor that leads acute anxious feelings to chronic anxiety state. However, the relationship between attention bias and symptoms in patients with comorbid anxiety and insomnia still lacks supportive empirical evidence. Mindfulness has a significant intervention effect on attention bias and insomnia of anxiety patients, yet the mechanism of how mindfulness reduces attention bias and insomnia is still unclear. As the core element of mindfulness, meta-awareness might play a vital role in reducing attention avoidance and insomnia symptoms. Experiment 1 was conducted to investigate the relationship between attention bias, meta-awareness, and the symptoms in patients with anxiety and insomnia. In experiment 2 we tested the intervention effect of meta-awareness training on attention avoidance, emotion, and sleep symptoms in patients. Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Pittsburgh sleep quality index(PSQI), Insomnia Severity Index(ISI), cue-target task, and mind wandering report task were used to measure anxiety, depression, sleep quality, subjective severity of insomnia, attention bias, and meta-awareness in healthy control group and patients with anxiety and insomnia (29 participants in healthy control group, 54 participants in patients group) in experiment 1. The result showed that attention bias scores of threatening and sleep stimuli were significantly lower in patients compared with the healthy control group, indicating attention avoidance of patients. The difference in meta-awareness between patients with anxiety and insomnia and healthy control was marginally significant. The meta-awareness level of the patients was lower. The emotion about mind wandering was more negative in patients. PSQI, and ISI scores were positively related to sleep attention bias scores, respectively. HAMA were marginally positively related to sleep attention bias scores. Attention bias scores of neutral, threatening, and sleep stimuli were positively related to the ratio of sleep mind wandering, respectively. Attention avoidance might be an emotional adjustment strategy for patients with anxiety and insomnia. Experiment 2 included 40 patients with anxiety and insomnia, and the patients were separated into two groups receiving meta-awareness training and meta-awareness knowledge learning intervention, respectively. All participants finished HAMA, HAMD, PSQI, ISI, cue-target task, and mind wandering report task at baseline, two weeks after intervention, and four weeks after intervention. The results showed that HAMA, PSQI, and ISI scores at baseline were significantly higher than two weeks and four weeks after intervention in both groups. Both interventions could alleviate affect and sleep symptoms in patients with anxiety and insomnia. Attention bias scores of sleep stimuli were significantly higher at two weeks and four weeks after intervention than baseline in the two groups. Threatening attention bias scores were higher at four weeks after intervention than at baseline and two weeks after intervention. Sleep attention bias scores positively related to PSQI and ISI scores, respectively after two weeks intervention. It indicates that both meta-awareness interventions could reduce attention avoidance in patients with anxiety and insomnia, and the decreasing speed of sleep attention avoidance is faster than threatening attention avoidance. Meanwhile, attention avoidance and symptoms did not relate to each other after four weeks intervention which suggested patients might not use attention avoidance as a strategy to reduce sleep anxiety. Patients with anxiety comorbid insomnia have attention bias on threaten and sleep information, which relate to inhibition of thoughts. Meanwhile, meta-awareness are lower in patients, intervention targeting at meta-awareness is an effective non-drug treatment for alleviating symptoms and attention avoidance of patients with anxiety comorbid insomnia. |
| 英文摘要 | 焦虑患者通常伴随失眠问题，焦虑与失眠症状存在双向预测关系，减轻 慢性焦虑患者的失眠症状是治疗的关键点。受焦虑情绪影响而产生的注意回避是导致患者由急性焦虑情绪转为慢性焦虑状态的重要认知因素，目前缺乏焦虑伴失眠患者注意回避与其症状关系的实证依据。正念练习对于焦虑患者的注意回避及失眠问题有较好的干预效果，但正念改善注意回避和慢性失眠症状的具体机制尚不明确。元意识作为正念练习的核心成分，可能在缓解注意回避和失眠症状中起关键作用。本文采用两项研究，探究焦虑伴失眠患者注意回避、元意识特征与其症状的关联，并检验元意识训练对焦虑伴失眠患者注意回避、情绪和睡眠症状的干预效果。研究一招募焦虑伴失眠患者 54 名和健康被试 29 名，采用汉密尔顿焦虑量表（Hamilton Anxiety Scale, HAMA）、汉密尔顿抑郁量表（Hamilton Depression Scale, HAMD）、匹兹 堡睡眠质量指数量表（Pittsburgh sleep quality index, PSQI）、失眠严重程度量表（Insomnia Severity Index , ISI）、线索靶子任务和分心报告任务分别测量被试的焦虑情绪、抑郁情绪、睡眠质量、主观失眠严重程度、注意回避和元意识水平。结果显示，焦虑伴失眠患者对一般威胁刺激和睡眠刺激的注意偏向得分均显著低于健康组，焦虑伴失眠患者存在注意回避问题。焦虑伴失眠患者与健康被试元意识得分差异边缘显著，对分心内容的情绪评分差异显著。焦虑伴失眠患者元意识水平更低，产生的分心更消极。在焦虑伴失眠患者中，睡眠注意偏向得分与 PSQI 和 ISI 得分均显著正相关,与 HAMA 得分正相关边缘显著。睡眠相关分心得分与一般威胁和睡眠注意偏向得分（注意偏 向得分越低注意回避程度越强）显著正相关，注意回避更强的患者，症状得分更低，睡眠分心更少。注意回避可能为焦虑伴失眠患者缓解睡眠焦虑情绪的调节策略。研究二将焦虑伴失眠患者分为元意识训练组和元意识知识学习组，分别进行 4 周干预。干预前、干预两周后和干预四周后，所有患者均完成 HAMA、HAMD、PSQI、ISI、线索靶子任务和分心报告任务，共 39 名患者完成干预与全部测试。结果显示，元意识训练组和元意识知识学习组基线 HAMA、PSQI 和 ISI 得分显著高于干预两周后和四周后，两种元意识干预均有效缓解焦虑伴失眠患者情绪和睡眠症状。两组患者干预四周后一般威胁注意偏向得分显著高于干预前和干预两周后，干预两周后和四周后睡眠注意偏向得分显著高于干预前。干预两周后，睡眠分心得分与 PSQI 得分和 ISI 得 分正相关显著。两种元意识干预均有效改善焦虑伴失眠患者注意回避，且睡眠回避改善速度快于一般威胁。同时，四周元意识干预后，焦虑伴失眠患者注意回避与症状不再存在关联，患者不再采用回避调节睡眠焦虑。焦虑伴失眠患者对威胁及睡眠信息均存在注意回避，且与思维抑制相关。同时，焦虑伴失眠患者元意识水平更低，针对元意识的干预为改善焦虑伴失眠患者症状 及注意回避的有效非药物疗法。 |
| 语种 | 中文 |
| 源URL | [http://ir.psych.ac.cn/handle/311026/48149]  |
| 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 | 宋蕊. 基于元意识干预法改善焦虑伴失眠患者症状及注意回避[D]. 中国科学院心理研究所. 中国科学院大学. 2024. |
入库方式： OAI收割
来源：心理研究所
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