心理剧联合药物对伴童年创伤抑郁症患者焦虑抑郁、应对方式及自发低频振幅的影响

王培佳; 王尔东; 郁仁强; 胡潇予; 周俊鑫; 黄杰; 夏兴文; 李晓梅; 陈军君; 吕发金; 胡华

doi:10.16016/j.1000-5404.201908164

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心理剧联合药物对伴童年创伤抑郁症患者焦虑抑郁、应对方式及自发低频振幅的影响

神经科学 | 更新时间：2026-01-09

- 心理剧联合药物对伴童年创伤抑郁症患者焦虑抑郁、应对方式及自发低频振幅的影响
- Effects of psychodrama combined with antidepressants on anxiety and depression, coping style and neuroimaging features in patients with major depressive disorder and childhood trauma
- 第三军医大学学报 2020年42卷第2期页码：111-118
- 作者机构：
  
  1.400016 重庆，重庆医科大学附属第一医院: 精神科
  2.215006 江苏苏州，苏州大学艺术学院
  3.400016 重庆，重庆医科大学附属第一医院:放射科
- 作者简介：
  
  [胡华, E-mail: huhuateam@126.com HU Hua, E-mail: huhuateam@126.com
- 基金信息：
  
  重庆市卫生计生委医学重点科研项目(2016ZDXM003)
- DOI：10.16016/j.1000-5404.201908164
  中图分类号： R445.2;R749.055;R749.4
- 收稿：2019-08-22，
  
  修回：2019-10-08，
  
  纸质出版：2020-01-30
- 稿件说明：
移动端阅览
王培佳, 王尔东, 郁仁强, 等. 心理剧联合药物对伴童年创伤抑郁症患者焦虑抑郁、应对方式及自发低频振幅的影响[J]. 第三军医大学学报, 2020,42(2):111-118.

Peijia WANG, Erdong WANG, Renqiang YU, et al. Effects of psychodrama combined with antidepressants on anxiety and depression, coping style and neuroimaging features in patients with major depressive disorder and childhood trauma[J]. Journal of Third Military Medical University, 2020, 42(2): 111-118.
王培佳, 王尔东, 郁仁强, 等. 心理剧联合药物对伴童年创伤抑郁症患者焦虑抑郁、应对方式及自发低频振幅的影响[J]. 第三军医大学学报, 2020,42(2):111-118. DOI： 10.16016/j.1000-5404.201908164.

Peijia WANG, Erdong WANG, Renqiang YU, et al. Effects of psychodrama combined with antidepressants on anxiety and depression, coping style and neuroimaging features in patients with major depressive disorder and childhood trauma[J]. Journal of Third Military Medical University, 2020, 42(2): 111-118. DOI： 10.16016/j.1000-5404.201908164.

摘要

目的

从临床症状、应对方式、神经影像学3个方面比较抗抑郁药物联合(易术)心理剧和抗抑郁药物联合普通心理健康教育对伴童年创伤抑郁症患者的效果。

方法

在重庆医科大学附属第一医院精神科门诊收集伴童年创伤抑郁症患者，采用简单随机化分组的方法将其分为药物联合(易术)心理剧干预组(观察组，16例)与抗抑郁药物联合普通心理健康教育组(对照组，16例)进行前瞻性病例对照研究，两组患者均以选择性5-羟色胺再摄取抑制剂(selective serotonin reuptake inhibitors

SSRIs)为主要抗抑郁药，服用6个月。以贝克抑郁自评量表(Beck depression inventor-13 item，BDI-13)、贝克焦虑自评量表(Beck anxiety inventor

BAI)、特质应对方式问卷(trait coping style questionnaire，TCSQ)及静息态功能磁共振(resting-state functional MRI

rs-fMRI)的自发低频振幅(amplitude of low frequency fluctuation

ALFF)为观察指标，比较干预结束后两组患者各指标的变化值差异。

结果

经过6个月的干预，两组患者之间的BDI、BAI变化值无明显差异，但是观察组TCSQ积极(

0.05)及TCSQ消极(

0.01)均较对照组改善更明显。rs-fMRI检查获得了19个交互作用脑区(经过

0.05的FDR校正)

事后检验发现，干预后观察组与对照组相比，观察组左内侧额上回激活增强趋势明显(

0.05)、右侧海马旁回(

0.01)激活增强较多，左侧楔前叶(

0.05)激活减弱较多。

结论

抗抑郁药物联合(易术)心理剧干预在改变伴童年创伤抑郁症患者的应对方式方面较联合普通心理健康教育效果可能更好，这可能与(易术)心理剧可以通过增强右侧海马旁回激活和减弱左侧楔前叶的激活，从而减弱负性经历对情绪和认知-应对的负面影响有关。(易术)心理剧可用于伴童年创伤抑郁症患者的药物联合治疗中。

Abstract

Objective

To compare the effects of the combination of (Yishu) psychodrama versus general mental health education with antidepressants on clinical symptoms

coping style and neuroimaging features in patients with major depressive disorder (MDD) who experienced childhood trauma.

Methods

This prospective case-control study was conducted in MDD patients with childhood trauma recruited from our department of psychiatry. The patients were randomly assigned into observation group (

=16) for treatment with antidepressants combined with (Yishu) psychodrama and control group (

=16) treated with antidepressants and general mental health education

and selective serotonin reuptake inhibitors (SSRIs) was used as the main antidepressants for 6 months in both groups. After the interventions

the patients were assessed using Beck Depression Inventory-13 item (BDI-13)

Beck Anxiety Inventory (BAI)

and Trait Coping Style Questionnaire (TCSQ)

and the amplitude of low frequency fluctuations (ALFF) in resting functional magnetic resonance imaging (fM

RI) was determined and compared between the two groups.

Results

After 6 months of intervention

no significant differences were found in the changes of BDI score (

0.05) or BAI score (

0.05) between the two groups

but the changes in TCSQ positive score (

0.05) and TCSQ negative score (

0.01) differed significantly between them. Resting fMRI results showed 19 interactive brain regions (corrected by FDR

0.05) in these patients. Post hoc analysis revealed that after the intervention

the patients in the observation group

as compared with the control patients

tended to have enhanced activation of the left medial superior frontal gyrus (

0.05) and showed significant enhancement of activation in the right parahippocampal gyrus (

0.01) with attenuated activation in the left precuneus lobe (

0.05).

Conclusion

Antidepressants combined with psychodrama can more effectively modify the coping style of depressed patients with childhood trauma than the combination of medications and general mental health education

possibly due to the effect of psychodrama to enhance the activation of the right parahippocampal gyrus and attenuate the activation of the left anterior cuneiform lobe

which leads to reduction of the adverse effects of negative experiences on emotion and cognition-coping. Psychodrama combined with medications can be used in the treatment of depressed patients with childhood trauma.

关键词

Keywords

references

ZHOU J, FENG L, HU C, et al . Associations among depressive symptoms, childhood abuse, neuroticism, social support, and coping style in the population covering general adults, depressed pa tients, bipolar disorder patients, and high risk population for depression.[J ] . Front Psychol, 2019(10): 1321.DOI: 10.3389/fpsyg.2019.01321.

TAKESIAN A E, HENSCH T K. Chapter 1 - Balancing Plasticity/Stability Across Brain Development[J]. Progress in Brain Research, 2013, 207: 3-34. DOI: 10.1016/B978-0-444-63327-9.00001-1.

PIM C, ANNEMIEKE V S, GERHARD A, et al . Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies[J ] . J Consult Clin Psychol, 2008, 76(6): 909-922. DOI: 10.1037/a0013075.

ALLSOPP K, READ J, CORCORAN R, et al . Heterogeneity in psychiatric diagnostic classification[J ] . Psychiatry Res, 2019, 279: 15-22. DOI: 10.1016/j.psychres.2019.07.005.

PAMPALLONA S, BOLLINI P G, KUPELNICK B, et al . Combined pharmacotherapy and psychological treatment for depression: a systematic review[J ] . Arch Gen Psychiatry, 2004, 61(7): 714-719. DOI: 10.1001/archpsyc.61.7.714.

[刘巧.运用心理剧技术对大学生抑郁症状的干预研究[D ] .南京大学, 2013. DOI: CNKI:CDMD:2.1013.191615 http://dx.doi.org/CNKI:CDMD:2.1013.191615

[LIU Q. An empirical research on psychodrama therapy for depressive university students[D ] . Nanjing University, 2013. DOI: CNKI:CDMD:2.1013.191615 http://dx.doi.org/CNKI:CDMD:2.1013.191615

BELIL F E. The effects of psychodrama on depression among women with chronic mental disorder[J]. Eur Psychiatry, 2011, 26(Suppl 1): 621. DOI: 10.1016/s0924-9338(11)72327-6.

COASTA E M S, ROSILDA A, SOARES M B D M, et al . Psychodramatic psychotherapy combined with pharmacotherapy in major depressive disorder: an open and naturalistic study[J ] . Revista Brasileira De Psiquiatria, 2006, 28(1): 40-43. DOI: 10.1590/S1516-44462006000100009.

ERBAY L G, REYHANI i, Vnal S, et al . Does psychodrama affect perceived stress, anxiety-depression scores andsaliva cortisol in patients with depression?[J ] . Psychiatry Investig, 2018, 15(10): 970-975. DOI: 10.30773/pi.2018.08.11.2.

龚鉥.易术: 与改变共处的生活艺术[M].陈信昭, 译.广州: 世界图书出版公司, 2018: 45-185.

GONG S.Yi shu: The art of living with change[M].Guangzhou: World Publishing Corporation, 2018: 45-185.

纪忠红, 王尔东, 林婕.易术心理剧对丧亲者的干预过程及疗效探讨[J].中国医学伦理学, 2019, 08(32): 1077-1080.

JI Z H, WANG E D, LIN J. The intervention process and curative effect of yishu psychodrama on the bereaved person[J]. China Med Ethics, 2019, 08(32): 1077-1080.

丁慧思, 韩娟, 张敏莉, 等.青少年抑郁症状与儿童期创伤、心理弹性的关系[J].中国心理卫生杂志, 2017, 31(10): 798-802. DOI: 10.3969/j.issn.1000-6729.2017.10.009.

DING H S, HAN J, ZHANG M L, et al . Relationship among childhood trauma, resilience and depressive symptom in adolescents[J ] . Chin Ment Health J, 2017, 31(10): 798-802.

汪向东, 王希林, 马弘, 等.心理卫生评定量表手册(增订版)[M].北京:中国心理卫生杂志社, 1999: 120-253.

WANG X D, WANG X L, MA H, et al .Manual of Mental Health Rating Scale (Revised version)[M ] .Beijing:Chinese Mental Health Journal, 1999: 120-253.

纪忠红, 王尔东.易术疗法的治疗模式、过程及特征[J].中外医学研究, 2012(25): 151-152. DOI: 10.3969/j.issn.1674-6805.2012.25.113.

JI Z H, WANG E D.The mode, process and characteristics of Yishu treatment[J]. Chin Foreiqn Med Res, 2012(25): 151-152. DOI: 10.3969/j.issn.1674-6805.2012.25.113.

罗伯特.厄萨诺.精神分析治疗指南[M].北京:北京出版社, 2000: 6-7. R J

URSANO. Psychodynamic psychotherapy[M]. Beijing: Beijing Publishing House, 2000: 6-7.

[钟永如.心理剧治疗抑郁症的效果观察[J ] .齐齐哈尔医学院学报, 2015(26): 4053-4054. DOI: CNKI:SUN:QQHB.0.2015-26-087 http://dx.doi.org/CNKI:SUN:QQHB.0.2015-26-087

[ZHOGN Y R. Observation on the effect of psychodrama in the treatment of depression[J ] . J Qiqihar Univ Med, 2015 (26): 4053-4054. DOI: CNKI:SUN:QQHB.0.2015-26-087 http://dx.doi.org/CNKI:SUN:QQHB.0.2015-26-087

王怀静.心理剧治疗对抑郁症患者的作用[J].中国民康医学, 2009, 21(17): 2124-2125. DOI: 10.3969/j.issn.1672-0369.2009.17.046.

WANG H J. The Psychological Play Treats to Depression Patients Function[J]. Med J Chin People Health, 2009, 21(17): 2124-2125.

KRZYSZTOF S. The Coping Circumplex Model: An Integrative Model of the Structure of Coping With Stress[J]. Front Psychol, 2019(10): 694. DOI: 10.3389/fpsyg.2019.00694.

姚树桥, 杨艳杰.医学心理学[M].第7版.北京:人民卫生出版社, 2018: 96-117.

YAO S Q, YANG Y J. Medical Psychology[M].7th Edition. Beijing: People's Medical Publishing House, 2018: 96-117

WANG Y, WANG P. Perceived stress and psychological distress among chinese physicians: The mediating role of coping style[J]. Medicine, 2019, 98(23): e15950. DOI: 10.1097/MD.0000000000015950.

RYAN L, CLAUDIA C, JONATHAN B, et al . Coping strategies and psychological morbidity in family carers of people with dementia: a systematic review and meta-analysis[J ] . J Affect Disord, 2012, 139(1): 1-11. DOI: 10.1016/j.jad.2011.05.055.

KLEIN D N, ARNOW B A, BARKIN J L, et al . Early adversity in chronic depression: clinical correlates and response to pharmacotherapy[J ] . Depression Anxiety, 2010, 26(8): 701-710. DOI: 10.1002/da.20577.

[吴韦玮, 陆邵佳, 位照国, 等.童年虐待经历及认知偏差与抑郁的关系[J ] .中国临床心理学杂志, 2013, 21(4): 609-612. DOI: CNKI:SUN:ZLCY.0.2013-04-021 http://dx.doi.org/CNKI:SUN:ZLCY.0.2013-04-021

[WU W W, LU S J, WEI Z G, et al . Relationship Between Childhood Maltreatment Experience, Cognitive Bias and Depression[J ] . Chin J Clin Psychol, 2013, 21(4): 609-612. DOI: CNKI:SUN:ZLCY.0.2013-04-021 CNKI:SUN:ZLCY.0.2013-04-021 .

BALDWIN P R, VELASQUEZ K, KOENIG H G, et al . Neural correlates of healing prayers, depression and traumatic memories: A preliminary study[J ] . Complement Ther Med, 2016, 27: 123-129. DOI: 10.1016/j.ctim.2016.07.002.

LENA L, JOAQUIM R, KATYA R. Gray matter abnormalities in childhood maltreatment: a voxel-wise meta-analysis[J]. Am J Psychiatry, 2014, 171(8): 854-863.DOI: 10.1176/appi.ajp.2014.13101427.

PENG W, CHEN Z, YIN L, et al . Essential brain structural alterations in major depressive disorder: a voxel-wise meta-analysis on first episode, medication-naive patients[J ] . J Affect Disord, 2016, 199: 114-123. DOI: 10.1016/j.jad.2016.04.001.

BORA E, FORNITO A, PANTELIS C, et al . Gray matter abnormalities in Major Depressive Disorder: A meta-analysis of voxel based morphometry studies[J ] . J Affect Disord, 2012, 138(1-2): 9-18. DOI: 10.1016/j.jad.2011.03.049.

HUANG M, LU S, YU L, et al . Altered fractional amplitude of low frequency fluctuation associated with cognitive dysfunction in first-episode drug-naïve major depressive disorder patients[J ] . Bmc Psychiatry, 2017, 17(1): 11. DOI: 10.1186/s12888-016-1190-1.

WERFF S J A V, PANNEKOEK J N, VEER I M, et al . Resting-state functional connectivity in adults with childhood emotional maltreatment[J ] . Psychol Med, 2013, 43(9): 1825-1836. DOI: 10.1017/s0033291712002942.

ZAMOSCIK V, HUFFZEGER S, Ebnerpriemer U, et al . Increased involvement of the parahippocampal gyri in a sad mood predicts future depressive symptoms[J ] . Soc Cogn Affect Neurosci, 2014, 9(12): 2034-2040. DOI: 10.1093/scan/nsu006.

VIARD A, DESGRANGES B, EUSTACHE F, et al . Factors affecting medial temporal lobe engagement for past and future episodic events: An ALE meta-analysis of neuroimaging studies[J ] . Brain Cognition, 2012, 80(1): 111-125. DOI: 10.1016/j.bandc.2012.05.004

WEINGARTEN C P, STRAUMAN T J. Neuroimaging for psychotherapy research: current trends[J]. Psychotherapy Res J, 2015, 25(2): 185-213. DOI: 10.1080/10503307.2014.883088.

WHITFIELD-GABRIELI S, Moran J M, NIETO-Castañón A, et al . Associations and dissociations between default and self-reference networks in the human brain[J ] . Neuroimage, 2011, 55(1): 225-232. DOI: 10.1016/j.neuroima ge.2010.11.048.

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