健康与遗传心理学研究室知识库

目的：本研究聚焦于老年人焦虑抑郁相关影响因素，以及接纳承诺疗法（ACT）与认知行为疗法（CBT）缓解其焦虑抑郁的比较。分析老年人焦虑抑郁的影响因素， ACT 和CBT疗法缓解老年人焦虑、抑郁情绪的效果，经验性回避、认知融合在ACT 疗法和焦虑抑郁中的中介作用。
方法：研究一用问卷调查方式，选取北京市社区和养老院共92位老人为研究对象，采用自编老人一般资料调查表、简易精神状态量表（MMSE） 、接纳与行动问卷（AAQ-II）、认知融合问卷（CFQ）、正念注意觉知量表（MAAS）、老年焦虑量表（GAI）、老年抑郁量表（GDS）进行评估。研究二将研究一中81名自愿参与团体心理辅导的老人根据居住地分配进入ACT组 （38 人） 、 CBT组 （18人） 、心理健康讲座组（25人） ，并分别在干预前（T1） 、干预后（T2）和干预后的第五个星期（T3）进行评估。
本研究得到以下结果：
第一， （1）老年人焦虑与正念负相关（r=-0.442，P<0.01） ，焦虑与抑郁、经验性回避、认知融合正相关（r=0.755、0.573、0.661，P<0.01） ，抑郁与正念负相关（r=-0.499，P<0.01） ，抑郁与经验性回避、认知融合正相关（r=0.654、0.626，P<0.01） 。 （2）在排除正念变量后，经验性回避、认知融合对焦虑的解释力分别为13.0%、23.2%，且均达到了显著水平（ΔF=16.740，35.037，P<0.01）。同样，排除正念变量后， 经验性回避和认知融合对抑郁的解释力分别为 18.4%、 15.9%，且均达到了显著性水平（ΔF=27.538，22.870，P<0.01）。
第二，ACT 组与CBT 组的人口学资料上的差异均无显著性（P>0.05） 。 （1）正念水平上两组的差异性： 不同测量时点正念水平存在差异 （F=9.935， P＝0.002） ，不同分组之间正念水平差异无显著性（F=1.859，P=0.184） 。 （2）焦虑水平上两组的差异性：不同测量时点老年焦虑存在差异（F=39.291，P<0.001） ，不同分组之间老年焦虑水平差异有统计学意义（F=47.864，P<0.001） 。 （3）抑郁水平上两组的差异性：不同测量时点老年抑郁存在差异（F=5.089，P=0.009） ，不同分组之间老年抑郁水平差异无统计学意义（F=0.448，P=0.509）。（4）心理僵化水平上两组的差异性： 不同测量时点心理僵化水平存在差异 （F=181.407， P<0.001） ，不同分组之间心理僵化水平差异有统计学意义（F=61.070，P<0.001）。 （5）经验性回避在 ACT疗法与抑郁之间，认知融合在 ACT疗法与焦虑、抑郁之间，经验性回避、认知融合在 CBT 疗法与焦虑、抑郁之间的中介效应未见显著性，经验性回避仅在ACT 疗法与焦虑间的中介效应达到了显著水平。在 ACT组中，经验性回避对焦虑情绪的中介效应量为 11.40%（95%CI=-0.060~-1.060）。
本研究得出的结论：
第一，老年人正念水平与心理僵化、焦虑、抑郁情绪呈负相关，正念水平越高，心理僵化程度越低，老年人的焦虑、抑郁水平越低。经验性回避、认知融合分别可以在一定程度上预测焦虑、抑郁情绪的发生，且正念对焦虑、抑郁的预测作用在经验性回避与认知融合进入回归模型后均消失。
第二，ACT 组老人正念水平显著提高，CBT 组正念水平无显著差异。ACT组和 CBT 组对老人焦虑情绪的干预都有显著效果，但 ACT 组疗效更为持久。CBT 组对老人抑郁情绪的干预效果显著，ACT 组对老人抑郁情绪的干预效果不显著但有一定改善作用。ACT组和CBT 组老人心理僵化水平均显著降低，即心理灵活性水平均显著提高，且ACT组心理灵活性提升速度比 CBT 组快。
第三，经验性回避在 ACT疗法与焦虑之间发挥着中介作用。在ACT组，通过提高个体心理灵活性，降低经验性回避来减轻焦虑水平的，而在 CBT 疗法中则不是。

Objective: To investigate the factors that affect anxiety and depression  in older adults, with the comparison between Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) in the treatment of anxiety and depression. To analyze factors that influence anxiety and depression, and the effectiveness of ACT and CBT to reduce anxiety and depression among elderly people, and the mediating effects of experiential avoidance and cognitive fusion in ACT and anxiety, depression.  
Methods: The first study used a questionnaire survey method, selected Beijing city communities and nursing homes in 92 elderly people as the research object, used self-made general information questionnaire,  The Min-Mental State Examination Questionnaire (CFQ), Mindful Attention Awareness Scale (MAAS), Geriatric Anxiety Inventory (GAI), Geriatric Depression Scale (GDS) assessment.  In the second study,81 volunteers of group counseling in the elderly according to the residence distribution were divided into ACT group (38), CBT group (18), mental health group (25). The intervention effects of  three intervention groups were evaluated by above-mentioned questionnaires among  three periods which were before intervention(T1), after intervention(T2), and 5 weeks after intervention(T3).
The results of this study are as follows:
Firstly, (1) The score of anxiety of older adults was significant negative correlation with  mindfulness  (r=-0.442，P<0.01),  the score of  anxiety  of  older adults  was significant positive  correlation with  depression,  experiential avoidance,  cognitive fusion (r=0.755、0.573、0.661，P<0.01), the score of depression of older adults was significant negative  correlation with mindfulness  (r=-0.499，P<0.01),  the score of depression  of  older adults  was  significant positive  correlation with  experiential avoidance,  cognitive fusion  (r=0.654、0.626，P<0.01). (2) In the exclusion of mindfulness variables, experiential avoidance, cognitive fusion for the elderly anxiety explanation were 13.0%, 23.2%, and reached a significant level (∆F=16.740, 35.037, P<0.01). Similarly, excluding  mindfulness  variables,  experiential avoidance and cognitive fusion for the elderly anxiety explanation were 13.0%, 23.2%, and reached significant level (∆F=27.538, 22.870, P<0.01).
Secondly, there was no significant difference in demographic data between ACT group and CBT group (P>0.05). (1) The difference between the two groups at the level of mindfulness: there was a difference in the level of mindfulness  at different time points(F=9.935, P=0.002), and there was no significant difference between  levels of mindfulness in different groups  (F=1.859, P=0.184). (2) The difference between the two groups at the level of  anxiety:  there was a difference in the level of anxiety  at different time points (F=39.291,  P<0.001), and there was  statistically  significant difference between levels of anxiety in different groups（F=47.864，P <0.001）. (3) The difference between the two groups at the level of depression: there was a difference in the level of depression at different time points (F=5.089, P=0.009), and there was no statistically significant difference between levels of depression in different groups (F=0.448,  P=0.509). (4)  The difference between the two groups at the level of psychological inflexibility:  there was a difference in the level of  psychological inflexibility at different time points（F=181.407，P <0.001）and there was statistically significant differences between levels of psychological inflexibility in different groups (F=61.070, P <0.001). (5) The mediating effect of experiential avoidance between ACT therapy and depression was not significant. The mediating effect of cognitive fusion between ACT therapy and  anxiety,  depression  was not significant.  The mediating effects  of  experiential avoidance and cognitive fusion between CBT therapy and anxiety, depression were not significant. The mediating effect of experiential avoidance between ACT therapy and anxiety reached a significant level. In the ACT group, the amount of mediating effect between experiential avoidance and anxiety was 11.40% (95%CI=-0.060~-1.060).
The conclusions of this study:
Firstly,  There was a negative correlation between the level of mindfulness, psychological inflexibility, anxiety and depression. The higher the level of mindfulness, the lower the degree of psychological inflexibility, the lower the level of anxiety and depression.  The experiential avoidance and cognitive fusion have some predictive effects on anxiety. Likewise, the experiential avoidance and cognitive fusion have a certain prediction on depression.
Secondly, the level of mindfulness of the elderly in the ACT group was significantly improved, and there was no significant difference in the CBT group at the level of mindfulness. ACT group and CBT group had significant effect on the anxiety of the elderly, but the curative effect of ACT group was more lasting. The intervention effect of CBT group on depression of the elderly was significant, and the intervention effect of ACT group on depression was not significant, but it had a certain improvement. ACT group and CBT group, the level of psychological inflexibility of the elderly were significantly reduced, that is, the level of psychological flexibility were significantly improved, and the ACT group was faster than the CBT group.
Thirdly,  the experiential avoidance played an intermediary effect between ACT therapy and anxiety. In the ACT group, the level of anxiety was reduced by improving the individual's psychological flexibility and reducing the experiential avoidance, but not in the CBT therapy.