(34.204.201.220) 您好!臺灣時間:2021/04/20 12:28
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
: 
twitterline
研究生:黃佳如
研究生(外文):Chia Ju Huang
論文名稱:探討認知行為治療用於有憂鬱與焦慮的血液腫瘤科患者之成效
論文名稱(外文):Cognitive behavioral therapy for depression and anxiety in patients with hematological malignancies
指導教授:陳美伶陳美伶引用關係
指導教授(外文):M. L. Chen
學位類別:碩士
校院名稱:長庚大學
系所名稱:護理學系
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2011
畢業學年度:99
論文頁數:95
中文關鍵詞:認知行為治療血液腫瘤科患者憂鬱焦慮前瞻性隨機化臨床試驗
外文關鍵詞:Cognitive behavioral therapyhematological malignanciesdepressionanxietyprospective randomized clinical trial
相關次數:
  • 被引用被引用:1
  • 點閱點閱:275
  • 評分評分:系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:2
研究目的:評估認知行為治療在血液腫瘤科住院患者憂鬱與焦慮的減輕效果。
研究方法:使用前瞻性隨機化臨床試驗的方式,隨機分派個案於三個組別:(1)認知行為治療組(n=17)(2)關心控制組(n=19)及(3)例行照顧控制組(n=20),認知行為治療組的個案接受6次共6小時之個別的實驗措施,關心控制組的個案接受6次共6小時之個別性的傾聽支持。結果變項(Hospital Anxiety and Depression Scale;HADS)之測量時間點分別為措施前、措施中、措施完成時、措施後2個月及措施後4個月。
研究結果:認知行為治療組比例行照顧控制組有減輕焦慮的效果(p=0.04),組別在憂鬱方面無顯著減輕效果。在時間主效應上達顯著,隨著時間焦慮越減輕(p=0.00),憂鬱越減輕(p=0.00)。憂鬱方面,控制變項有顯著較高分數的為年長者、已婚者、教育程度低者、家庭年收入低者、有疼痛者。
研究結論:認知行為措施可減輕住院的血液腫瘤科患者之焦慮情形。隨時間進展血液腫瘤科患者之憂鬱與焦慮也隨之減輕。
關鍵字:認知行為治療、血液腫瘤科患者、憂鬱、焦慮、前瞻性隨機化臨床試驗。

Purpose: Examine the effect of cognitive behavioral therapy on depression and anxiety in hospitalized patients with hematological malignancies. Method: A prospective study with randomization was used. Patients were assigned to one of the three groups: (1) cognitive behavioral therapy (CBT) group (n =17) ( 2) attention control group (n =19), and (3) usual-care control group (n =20). Patients in the cognitive behavioral therapy group received 6 individual CBT interventions for a total of 6 hours. Patients in the attention control group received listening support for a total of 6 hours. The main outcomes were anxiety and depression measured by the Hospital Anxiety and Depression Scale (HADS). Data were collected at baseline (before intervention), during intervention, at completion of intervention, and at 2 and 4 months after intervention. Results: The anxiety level in cognitive behavioral treatment group was significantly lower than that of usual-care group (p =0.04). No significant group effect was found for depression. There was a significant time effect (p =0.00); Patients’ anxiety and depression level decreased along the time. Patients with older age, married, lower education level, lower family income, and pain had higher level of depression. Conclusion: The cognitive behavioral therapy can reduce the anxiety level in patients with hematological malignancies. Depression and anxiety level can also decrease as time going.
Key word: Cognitive behavioral therapy, hematological malignancies, depression, anxiety, prospective randomized clinical trial.

目 錄
中文摘要..Ⅴ
英文摘要..Ⅵ
第一章 緒論..1
第一節 研究動機與重要性..1
第二節 研究目的..2
第三節 研究問題..3
第二章 文獻查證..4
第一節 癌症患者憂鬱與焦慮的心理處置措施..4
第二節 認知行為治療的觀點與處理..7
第三節 認知行為治療於癌症患者情緒問題的應用..9
第四節 影響癌症病患憂鬱與焦慮的相關因素..12
第五節 總結..13
第三章 研究方法..15
第一節 名詞解釋..15
第二節 研究架構..16
第三節 研究設計..16
第四節 研究對象與場所..21
第五節 研究工具..21
第六節 資料收集過程..24
第七節 資料分析..25
第八節 研究對象保護權益..27
第四章 研究結果與分析..28
第一節 研究個案的人口學、CBT與AC組治療滿意度與疾病特性之描述性分析與組別之差異..30
第二節 三組的憂鬱與焦慮之變化..41
第三節 人口學、疾病特性、疼痛與組別對憂鬱與焦慮的影響..45
第五章 討論..52
第一節 認知行為治療的成效..52
第二節 時間效應及時間與組別的交互作用..58
第三節 關心控制組(AC)的效應..59
第四節 討論其他控制變項..60
第六章 結論與建議..62
第一節 結論..62
第二節 研究限制與建議..63
第三節 護理應用..64
參考資料..66
中文資料..66
英文資料..67
附錄..75
圖次目錄
圖 3-1 研究架構..16
圖 4-1 各時間點三組個案人數異動圖..29
圖 4-2 HADS-A平均分數線型圖..42
圖 4-3 HADS-D平均分數線型圖..44
表次目錄
表 3-1 研究設計..17
表 3-2 各時間點的評估內容..25
表 3-3 統計分析方法..25
表 4-1 人口學特性與三組之差異..32
表 4-2 措施組(CBT與AC)治療滿意度之差異..35
表 4-3 疾病特性與三組之差異..37
表 4-4 三組在五個時間點的焦慮分數..42
表 4-5 三組在五個時間點的憂鬱分數..44
表 4-6 HADS-A成效的GEE分析..47
表 4-7 HADS-D成效的GEE分析..50
附錄目錄
附錄一 Hospital Anxiety and Depression Scale(HADS)..75
附錄二 Karnofsky Performance Rating Scale and Eastern Cooperative Oncology Group Scale of Performance Status ..78
附錄三 Pain Assessment Form ..79
附錄四 治療滿意度調查 ..80
附錄五 人口學及疾病治療相關資料表 ..81

丁思惠、陳喬琪 (民95)。憂鬱症的婚姻與家庭治療。 北市醫學雜誌,3(10), 954-961。
行政院衛生署 (民98)。歷年死因統計。民100年1月3日,取自:http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=10327&class_no=440&level_no=4
林玲華、陳景彥、劉嘉逸、陳美伶 (民91)。 癌症住院病患憂鬱狀態的盛行率及預測因素。 台灣醫學, 6(4), 535-545。
翁一婷 (民94)。探討一認知行為團體方案對921地震受創學童之焦慮與憂鬱問題之成效研究。長庚大學臨床行為科學研究所碩士論文,未出版,桃園縣。
張凱理 (民97)。論心理治療研究。民100年1月3日,取自: http://psychspace.com/psych/viewnews-2132
郭思琪 (民98)。焦慮情緒當事人認知行為網路即時團體諮商之研究。國立彰化師範大學輔導與諮商學系碩士論文,未出版,彰化市。
劉彥君、藍玉玲、劉志如、周育如 (民97)。認知行爲團體治療對憂鬱症狀緩解之成效:近十年之統合分析。臺灣心理學刊, 50(4), 383-402。
劉嘉年 (民98)。社會經濟狀況、一般健康狀態、健康行為與社區成年民眾憂鬱情緒的關係。 臺灣衛誌, 28(4), 300-311。
Akechi, T., Okuyama, T., Sugawara, Y., Nakano, T., Shima, Y., & Uchitomi, Y. (2004). Major depression, adjustment disorders, and post-traumatic stress disorder in terminally ill cancer patients: associated and predictive factors. Journal of Clinical Oncology, 22(10), 1957-1965.
Antoni, M. H., Lechner, S., Diaz, A., Vargas, S., Holley, H., Phillips, K., et al. (2009). Cognitive behavioral stress management effects on psychosocial and physiological adaptation in women undergoing treatment for breast cancer. Brain Behav Immun, 23(5), 580-591.
Antoni, M. H., Wimberly, S. R., Lechner, S. C., Kazi, A., Sifre, T., Urcuyo, K. R., et al. (2006). Reduction of cancer-specific thought intrusions and anxiety symptoms with a stress management intervention among women undergoing treatment for breast cancer. Am J Psychiatry, 163(10), 1791-1797.
Arving, C., Sjoden, P.-O., Bergh, J., Hellbom, M., Johansson, B., Glimelius, B., et al. (2007). Individual psychosocial support for breast cancer patients: a randomized study of nurse versus psychologist interventions and standard care. Cancer Nursing, 30(3), E10-19.
Ballenger, J. C., Davidson, J. R., Lecrubier, Y., Nutt, D. J., Jones, R. D., & Berard, R. M. (2001). Consensus statement on depression, anxiety, and oncology. Journal of Clinical Psychiatry, 62 Suppl 8, 64-67.
Bottomley, A. (1998). Depression in cancer patients: a literature review. European Journal of Cancer Care, 7(3), 181-191.
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical Psychology Review, 26(1), 17-31.
Chen, M. L., Chang, H. K., & Yeh, C. H. (2000). Anxiety and depression in Taiwanese cancer patients with and without pain. Journal of Advanced Nursing, 32(4), 944-951.
Chen, P. Y. (1999). The effect of pain on cancer patients' anxiety and depression. Chang Gung University, Tao-Yuan, Taiwan.
Chiang, C. Y., Chen, M. L., Yu, W. P., & Huang, T. H. (2001). Physical and psychological distress of brain tumor patients receiving radiotherapy [chinese]. Chang Gung Nursing, 12(4), 271-281.
Conill, C., Verger, E., & Salamero, M. (1990). Performance status assessment in cancer patients. Cancer, 65(8), 1864-1866.
Duffy, S. A., Ronis, D. L., Valenstein, M., Lambert, M. T., Fowler, K. E., Gregory, L., et al. (2006). A tailored smoking, alcohol, and depression intervention for head and neck cancer patients. Cancer Epidemiology, Biomarkers & Prevention, 15(11), 2203-2208.
Eastern Cooperative Oncology Group (1982). ECOG-a measure of performance status of cancer patients. American Journal of Clinical Oncology(5), 649-655.
Edwards, A. G., Hulbert-Williams, N., & Neal, R. D. (2008). Psychological interventions for women with metastatic breast cancer. Cochrane Database Syst Rev(3), CD004253.
Evans, R. L., & Connis, R. T. (1995). Comparison of brief group therapies for depressed cancer patients receiving radiation treatment. Public Health Reports, 110(3), 306-311.
Fossa, S. D., & Dahl, A. A. (2002). Short Form 36 and Hospital Anxiety and Depression Scale. A comparison based on patients with testicular cancer. Journal of Psychosomatic Research, 52(2), 79-87.
Frick, E., Tyroller, M., & Panzer, M. (2007). Anxiety, depression and quality of life of cancer patients undergoing radiation therapy: a cross-sectional study in a community hospital outpatient centre. European Journal of Cancer Care, 16(2), 130-136.
Gerald Corey. (2001). Theory and practice of counseling and psychotherapy (修慧蘭校訂、鄭玄藏和譯).台北市:新加坡商湯姆生.
Greenberg, D. B., Kornblith, A. B., Herndon, J. E., Zuckerman, E., Schiffer, C. A., Weiss, R. B., et al. (1997). Quality of life for adult leukemia survivors treated on clinical trials of Cancer and Leukemia Group B during the period 1971-1988: predictors for later psychologic distress. Cancer, 80(10), 1936-1944.
Greer, S., Moorey, S., & Baruch, J. (1991). Evaluation of adjuvant psychological therapy for clinically referred cancer patients. British Journal of Cancer, 63(2), 257-260.
Greer, S., Moorey, S., Baruch, J. D., Watson, M., Robertson, B. M., Mason, A., et al. (1992). Adjuvant psychological therapy for patients with cancer: a prospective randomised trial. BMJ, 304(6828), 675-680.
Herschbach, P., Book, K., Dinkel, A., Berg, P., Waadt, S., Duran, G., et al. (2010). Evaluation of two group therapies to reduce fear of progression in cancer patients. Support Care Cancer, 18(4), 471-479.
Hopko, D. R., Bell, J. L., Armento, M., Robertson, S., Mullane, C., Wolf, N., et al. (2008). Cognitive-behavior therapy for depressed cancer patients in a medical care setting. Behav Ther, 39(2), 126-136.
Hu, L. C. (1999). The Caregiving burden, depression and quality of life & primary caregivers of metastatic patirnts receiving home care. Chang Gung University, Tao-Yuan, Taiwan.
U. S. National Cancer Institute (2002). Cancer Statistics, Retrieved January 3, 2011, from the World Wide Web: http://seer.cancer.gov/seerstat/
Jacobson, E. (1938). Progressive relaxation. Chicago: University of Chicago Press.
Karnofsky, D. A., & Burchenal, J. H. (1949). The clinical evaluation of chemotherapeutic agent used in cancer. In C. M. Macleod (Ed.), Evaluation of chemotherapeutic agents (pp.196). New York: Columbia University Press.
Larbig, W. (1998). [Psycho-oncologic interventions--critical review]. Psychotherapie, Psychosomatik, Medizinische Psychologie, 48(9-10), 381-389.
Lee, M. B., Lee, Y. J., Chiu, C. H., Liao, S. C., Wu, C. H., & Tseng, M. C. (2004). Prevalence and Psychiatric Referrals of Mental Disorders in Hospitalized Cancer Patients. 北市醫學雜誌, 1(1), 63-74.
Lin, L. H. (2000). Screening for depression in cancer impatient. Chang Gung University, Tao-Yuan, Taiwan.
Lovejoy, N. C., & Matteis, M. (1997). Cognitive-behavioral interventions to manage depression in patients with cancer: research and theoretical initiatives. Cancer Nursing, 20(3), 155-167.
Luebbert, K., Dahme, B., & Hasenbring, M. (2001). The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: a meta-analytical review. Psychooncology, 10(6), 490-502.
Manuel, J. C., Burwell, S. R., Crawford, S. L., Lawrence, R. H., Farmer, D. F., Hege, A., et al. (2007). Younger women's perceptions of coping with breast cancer. Cancer Nursing, 30(2), 85-94.
Montgomery, C., Pocock, M., Titley, K., & Lloyd, K. (2003). Predicting psychological distress in patients with leukaemia and lymphoma. Journal of Psychosomatic Research, 54(4), 289-292.
Moorey, S., Cort, E., Kapari, M., Monroe, B., Hansford, P., Mannix, K., et al. (2009). A cluster randomized controlled trial of cognitive behaviour therapy for common mental disorders in patients with advanced cancer. Psychol Med, 39(5), 713-723.
Moorey, S., Greer, S., Watson, M., Gorman, C., Rowden, L., Tunmore, R., et al. (1991). The factor structure and factor stability of the hospital anxiety and depression scale in patients with cancer. Br J Psychiatry, 158, 255-259.
Morrey, S., & Greer, S. (1989). Psychological Therapy of patients with cancer: A new approach: Heinemann Medical Books: Oxford.
Newell, S. A., Sanson-Fisher, R. W., Savolainen, N. J., Newell, S. A., Sanson-Fisher, R. W., & Savolainen, N. J. (2002). Systematic review of psychological therapies for cancer patients: overview and recommendations for future research. Journal of the National Cancer Institute, 94(8), 558-584.
Osborn, R. L., Demoncada, A. C., & Feuerstein, M. (2006). Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. International Journal of Psychiatry in Medicine, 36(1), 13-34.
Owen, J. E., Klapow, J. C., Hicken, B., & Tucker, D. C. (2001). Psychosocial interventions for cancer: review and analysis using a three-tiered outcomes model. Psycho-Oncology, 10(3), 218-230.
Petrie, K. J., Jago, L. A., & Devcich, D. A. (2007). The role of illness perceptions in patients with medical conditions. Curr Opin Psychiatry, 20(2), 163-167.
Phillips, K. M., Antoni, M. H., Lechner, S. C., Blomberg, B. B., Llabre, M. M., Avisar, E., et al. (2008). Stress management intervention reduces serum cortisol and increases relaxation during treatment for nonmetastatic breast cancer. Psychosom Med, 70(9), 1044-1049.
Pocock, S. J. (Ed.). (1983). Clinical trial : A practical approach. New York: John Wiley & Sons.
Ross-Petersen, L., Johansen, C., & Olsen, J. H. (1998). [Does psychosocial intervention in cancer patients affect survival and psychological well-being?]. Ugeskrift for Laeger, 160(39), 5625-5634.
Ross, L., Boesen, E. H., Dalton, S. O., & Johansen, C. (2002). Mind and cancer: does psychosocial intervention improve survival and psychological well-being? European Journal of Cancer, 38(11), 1447-1457.
Sandgren, A. K., McCaul, K. D., King, B., O'Donnell, S., & Foreman, G. (2000). Telephone therapy for patients with breast cancer. Oncology Nursing Forum, 27(4), 683-688.
Santos, F. R. M., Kozasa, E. H., Chauffaille, M. d. L. L. F., Colleoni, G. W. B., & Leite, J. R. (2006). Psychosocial adaptation and quality of life among Brazilian patients with different hematological malignancies. Journal of Psychosomatic Research, 60(5), 505-511.
Savard, J., Simard, S., Ivers, H., & Morin, C. M. (2005). Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: Sleep and psychological effects. Journal of Clinical Oncology, 23(25), 6083-6096.
Schag, C. C., Heinrich, R. L., & Ganz, P. A. (1984). Karnofsky performance status revisited: reliability, validity, and guidelines. Journal of Clinical Oncology, 2(3), 187-193.
Schnur, J. B., David, D., Kangas, M., Green, S., Bovbjerg, D. H., & Montgomery, G. H. (2009). A randomized trial of a cognitive-behavioral therapy and hypnosis intervention on positive and negative affect during breast cancer radiotherapy. J Clin Psychol, 65(4), 443-455.
Sloman, R. (2002). Relaxation and imagery for anxiety and depression control in community patients with advanced cancer. Cancer Nursing, 25(6), 432-435.
Stark, D., Kiely, M., Smith, A., Velikova, G., House, A., & Selby, P. (2002). Anxiety disorders in cancer patients: their nature, associations, and relation to quality of life. Journal of Clinical Oncology, 20(14), 3137-3148.
Tatrow, K., & Montgomery, G. H. (2006). Cognitive Behavioral Therapy Techniques for Distress and Pain in Breast Cancer Patients: A Meta-Analysis. Journal of Behavioral Medicine, 29(1), 17-27.
Toubassi, D., Himel, D., Winton, S., & Nyhof-Young, J. (2006). The informational needs of newly diagnosed cervical cancer patients who will be receiving combined chemoradiation treatment. Journal of Cancer Education, 21(4), 263-268.
Tsai, S. W., Lai, Y. H., Chen, M. L., & Chen, C., C. (2000). The relationship between physio-sensory characteristics of cancer pain and uncertainty in illness[Chinese]. Nursing Research (taiwan, ROC), 8(1), 59-70.
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatr Scand, 67(6), 361-370.

連結至畢業學校之論文網頁點我開啟連結
註: 此連結為研究生畢業學校所提供,不一定有電子全文可供下載,若連結有誤,請點選上方之〝勘誤回報〞功能,我們會盡快修正,謝謝!
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
系統版面圖檔 系統版面圖檔