心臟心理社會復健方案：認知行為團體心理治療取向

Cardiac Rehabilitation Program for Patients with Coronary Heart Disease: A Cognitive-Behavior Group Therapy Approach

目的：本研究目的在針對冠狀動脈心臟病患者，開發一套認知行為團體治療方案，以降低其主要心理危險因子敵意，並檢驗此一心理社會復健方案在敵意與心血管反應之療效。方法：本研究採用個案配對研究。實驗組共16位成員（平均58.56 ± 6.63歲；46至69歲；75%為男性）參與八週每週兩小時的認知行為治療團體；而控制組的14位成員（平均57.50 ± 9.91歲；38歲至74歲；78.5%為男性）則未介入治療。團體內容包括：（一）心理衛教：情緒反應如何介入心血管疾病病理機制；（二）自我覺察；（三）腹式呼吸輔以可攜式生理回饋儀放鬆訓練；（四）認知治療：認知彈性與正向思考；（五）行為治療：自我慈悲與正向人際互動；（六）社會支持。為提高療效，本研究加入個人化檢測報告與生理回饋儀輔助以提升自我覺察與改變動機；並且參酌本國文化特色，以自我慈悲做為敵意介入之核心要素。兩組研究參與者在團體前後，皆填答敵意、憂鬱、焦慮量表，並接受生氣回憶作業下之呼吸速率與血容積脈波振幅檢測。結果：八週治療之後，實驗組相較於等待控制組在心理因子方面，敵意總分（F(1,28) =10.07, p < .05）、表達敵意（F(1,28) = 4.58, p < .05）、壓抑敵意（F(1,28) = 5.72, p < .05）、與特質焦慮（F(1,28) = 13.75, p < .05）有顯著改善；在生理因子上，呼吸速率（F(1,28) = 5.24, p < .05）與血容積脈波振幅（F(1,23) = 4.64, p < .05）亦顯著改善。結論：針對冠狀動脈心臟病患者所開發之認知行為團體心臟復健方案，不僅可有效降低患者的壓抑與表達敵意行為，同時能緩和其在生氣作業下的呼吸速率，並提升其血管舒張功能。

Objective: This study attempted to examine the effectiveness of a cognitive-behavior group therapy (CBGT) program in reducing hostility and producing changes in its associated cardiovascular activity during the anger-recall task among patients with coronary heart disease (CHD). Method: This study adopted a case-control trial. In addition to standard medical care, the 16 intervention-group patients (mean age: 58.56 ± 6.63 years; men: 75%) attended eight weekly 2-hour sessions with the following components: (1) psycho-education; (2) self-awareness; (3) biofeedbackassisted relaxation training; (4) cognitive therapy, including cognitive flexibility and positive thinking; (5) behavior therapy to foster compassion towards oneself and others; and (6) social support. In order to improve the therapy's efficacy, individualized stress-assessment reports and portable biofeedback devices (stress eraser) were provided to all participants to enhance their self-awareness and motivation to change. In Chinese culture, self-compassion is a fundamental aspect of CBGT that can reduce hostility. The 14 patients in the wait-list control (WLC) group (mean age: 57.50 ± 9.91 years; men: 78.5%) received standard medical care without clinical psychological treatment. Hostility, depression as well as anxiety, respiration rate, and blood volume amplitude (BVA) during the anger-recall task were assessed before and after intervention for the CBGT group and at identical time points for the WLC group. Results: Suppressive hostility (F(1,28) = 5.72, p < .05), expressive hostility (F(1,28) = 4.58, p < .05), total hostility (F(1,28) = 10.07, p < .05), and anxiety (F(1,28) = 13.75, p < .05) at post-intervention were significantly lower than at pre-intervention in the CBGT group, compared to the WLC group. Moreover, vasodilation function (F(1,23) = 4.64, p < .05) -- indexed by BVA -- increased, and respiration rate decreased (F(1,28) = 5.24, p < .05) in the CBGT group but not the WLC group. Conclusion: Patients with CHD experienced improved vasodilation function, lower anxiety, and fewer suppressive and expressive hostility behaviors following the CBGT psychosocial rehabilitation program.