强戒期毒品成瘾人员的认知干预 ——抑制能力训练与正念防复发训练的比较研究

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	强戒期毒品成瘾人员的认知干预 ——抑制能力训练与正念防复发训练的比较研究
其他题名	Cognitive Intervention among Drug Dependent Individuals during Incarceration：A Randomized Controlled Trial of Inhibitory Control Training versus Mindfulness Based Relapse Prevention (MBRP)
	王金凤
	2014-05
摘要	预防药物成瘾复发是成瘾领域研究不可回避的难题。近年来，双过程理论模型对反复复发的行为提供了理论解释。该模型认为长期使用药物不断复发的行为是两个系统，即冲动系统（impulsive system）和反思系统（reflective system）相互作用的结果。本研究的主要目的是，在考察强戒期吸毒人员认知损伤特点的基础上，采用抑制能力训练和正念防复发训练两种方法，分别针对双过程模型的两个系统（反思系统和冲动系统）进行干预，比较两种训练方法对强戒期毒品成瘾人员认知能力的影响，探索更有效的预防复发的干预方法。本研究主要包括三方面的内容：1）选取66名强戒期毒品成瘾人员和33名看守所未接触过毒品的短刑人员，系统考察强戒期吸毒人员的认知损伤特点。2）选取50名强戒期毒品成瘾人员，采用随机入组的方法分配到抑制能力训练组（16人）和正念防复发训练组（17人），进行为期六周的认知干预。3）采用事件相关电位（Event‐Related Potentials，ERP）技术，选用 GO/NOGO任务和延迟匹配任务，分别考查两种训练对强戒期吸毒人员两种抑制能力（行为抑制和认知抑制）的影响。主要结果如下：第一，与未接触过毒品的短刑犯相比，强戒期毒品成瘾人员（平均戒断期为13个月）不存在显著的认知损伤，提示经过一段时间的恢复，吸毒人员的认知损伤已经有了较大程度的恢复。第二，与控制组相比，两个训练组都发现在认知能力上有一些积极的改变。六周的训练后，抑制训练组在抑制任务（stop‐signal）上的成绩有显著提高；正念训练组在注意瞬脱任务（attentional blink）中更容易从毒品刺激中解离出来，在数字符号任务（digit symbol）中的加工速度也有提高。这些训练效应三个月后大都也得到了保持。第三，ERP的研究结果显示，虽然两项任务的行为学指标均未发现有显著的训练效应，但在 ERP指标上均有积极的训练效应。具体来说，两个训练组后测在延迟匹配任务的 CDA（contralateral delay activity）指标上出现积极的变化，正念组的变化更多一些，提示两种训练方式都能改善强戒期毒品成瘾人员的认知抑制能力。正念组后测在 GO/NOGO任务的 NOGO条件下P3潜伏期提前，提示正念训练提高了冲突识别的速度。综合上述研究结果，本研究的结论如下：1）药物成瘾造成的损伤经过较长时间的戒断后，认知能力可以得到较大程度的恢复。2）针对双过程理论中反思系统的抑制能力进行干预，可能需要更多的时间和训练强度才能达到较好的效果；针对双过程理论中冲动系统的干预方法，如正念训练可能是更有效的途径。
其他摘要	Relapse prevention of drug addiction is an unavoidable issue within the field of drug dependence. Recently, dual‐process model provided theoretical explanations for the repeated behavior of drug relapse. This model suggested that two systems are involved with the maladaptive behaviors of long term intake of illicit drugs, that is, the interaction between the impulsive system and the reflective system. The main purpose of this study was firstly to understand the characteristics of cognitive deficits among drug dependent individuals during incarceration, and based on such understandings, to deliver inhibitory control training and mindfulness based relapse prevention (MBRP), targeting on the two processes (reflective and impulsive systems) of the dual processes model, and to compare the effectiveness of such interventions to the cognitive functions of drug dependent individuals during incarceration, which in the end is to explore more effective relapse prevention interventional method. The current study contained three main parts, which in turn were 1) to select 66 incarcerated drug dependent individuals and 33 participants who were serving a short sentence in prison without prior access to illicit drugs, so as to systematically investigate the characteristics of cognitive deficits of drug dependent individuals during incarceration; 2) to select 50 drug dependent individuals during incarceration, randomly allocating them into the inhibitory control training group (N = 16), the MBRP group (N = 17), and the active control group (N = 17), to undertake cognitive intervention over six weeks; 3) based on event‐related potential techniques, using the Go/NoGo task and the delay match to sample task to investigate the effects of the two types of interventions to the two types of inhibitory control abilities (i.e., behavioral inhibition and cognitive inhibition) on drug dependent individuals during incarceration. Main results were listed below: Firstly, compared to those serving short sentences, incarcerated drug dependent individuals (in average with 13 months duration of abstinence) were not found to possess cognitive deficits. This was perhaps due to the recovery of abstinence, that drug dependent individuals’ cognitive deficits were largely ameliorated. Secondly, compared to the active control group, both interventional groups showed positive changes in cognitive functions. After six weeks of intervention, the inhibitory control training group showed better performance in the stop‐signal task; and the MBRP group was more readily disengaged from drug related stimuli during the attentional blink task, the mindfulness intervention group also showed improvements in processing speed in the digit symbol coding task. Most of the training effects could be maintained for 3 months. Thirdly, for the ERP results, although no interventional effects were found in behavior results, ERP results showed positive interventional effects. In specific, both intervention groups showed positive changes in terms the contralateral delay activity index (CDA) of the delayed match to sample task, with the MBRP group showing better improvements. Such results supported that both interventions enhanced the cognitive inhibition function for the incarcerated drug dependent individuals. The MBRP group, in addition, showed earlier P3 latency in the NoGo condition during the Go/NoGo task, indicating the MBRP intervention accelerated the speed for conflict detection. To sum up the above results, the current study concluded that 1) with comparative long duration of abstinence, the cognitive function of drug dependent individuals can be largely recovered; 2) intervention focused on the “reflective” system, more specifically inhibition, of the dual process model may require longer training duration and higher training intensity to reach proper interventional effects; while intervention targeting the “impulsive” system, for instance MBRP in this case, is perhaps a more effective approach.
学科领域	发展与教育心理学
关键词	成瘾人员双过程理论抑制正念认知干预事件相关电位
学位类型	博士
语种	中文
学位专业	心理学
学位授予单位	中国科学院研究生院
学位授予地点	北京
文献类型	学位论文
条目标识符	http://ir.psych.ac.cn/handle/311026/19709
专题	认知与发展心理学研究室
作者单位	中国科学院心理研究所
推荐引用方式 GB/T 7714	王金凤. 强戒期毒品成瘾人员的认知干预 ——抑制能力训练与正念防复发训练的比较研究[D]. 北京. 中国科学院研究生院,2014.

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