接纳承诺疗法团体干预对孤独症儿童父母连带内化污名和心理健康的影响研究

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	接纳承诺疗法团体干预对孤独症儿童父母连带内化污名和心理健康的影响研究
其他题名	Study on the Effects of Acceptance and Commitment Therapy Group Intervention on Affiliate Stigma and Mental Health of Parents of Children with Autism
	陈燕红
导师	祝卓宏
	2020-01
摘要	目的：孤独症儿童家长面临孩子照顾难、康复难、入学难、社会融入难的困境，承受着巨大的体力、经济和精神压力。然而，对孤独症儿童家长有效的心理支持还非常缺乏。因此，本研究以孤独症儿童父母连带内化污名为线索，分析连带内化污名与认知融合和经验性回避的关系，并进一步通过接纳承诺疗法（Acceptance and Commitment Therapy, ACT）团体干预实证研究，探讨ACT团体干预对提高孤独症儿童父母心理灵活性、降低连带内化污名、改善心理健康的作用，分析ACT团体干预对我国孤独症儿童父母心理支持的可行性，弥补当前孤独症儿童父母心理干预匮乏的局面。方法：本研究分为两个部分：研究一为孤独症儿童父母连带内化污名与认知融合和经验性回避的关系研究，通过开展全国范围的孤独症儿童父母心理健康网络调查，回收有效问卷1396份，通过对数据进行统计分析，探讨孤独症儿童父母连带内化污名与认知融合和经验性回避的关系。研究二为ACT团体干预对孤独症儿童父母连带内化污名和心理健康的作用研究，采用类实验研究设计，以方便抽样的方法选取参与研究一的北京地区的孤独症儿童父母39名，其中20人进入干预组，19人进入等候组。对干预组开展了1天（7小时）的ACT工作坊。在干预前1个月和干预后2周对干预组和对照组进行问卷测试,以配对样本t检验和重复测量方差分析探索ACT团体干预对孤独症儿童父母心理灵活性、连带内化污名和负性情绪的影响，以Cohen d分析ACT团体干预的效应量。通过干预组对ACT工作坊的满意度调查分析，探讨孤独症儿童父母对ACT团体干预的接受度。结果：研究一结果：孤独症儿童父母连带污名得分与家长性别、家长年龄、孩子年龄、家长受教育水平、康复补贴数额之间不存在显著相关（P > 0.05），与家庭年收入、孩子语言能力、孩子智力发育水平、孩子孤独症相关行为存在显著相关（P < 0.05）。连带内化污名与亲职愁苦和抑郁、焦虑、压力等负性情绪显著正相关（r = 0.431～0.540，P < 0.001）。认知融合和经验性回避显著预测了连带内化污名的水平（ΔR2 =0.26，F（2,1389）=274.60， P < 0.001）。研究二结果：组内配对样本t检验表明，对照组各个观测变量的前后测得分没有统计学差异，而干预组在经验性回避、认知融合、连带内化污名和亲职愁苦4个变量的得分出现显著性变化（P < 0.05）。重复测量方差分析轮廓图显示,除焦虑量表得分外,干预组在其它各观测变量的得分均出现比对照组更明显的下降趋势。干预后各个观测变量的效应量统计表明ACT团体干预对经验性回避、连带内化污名以及亲职愁苦这3个观测变量的影响达到中等以上效应（Cohen d > 0.5），对认知融合和抑郁-焦虑-压力量表各维度得分及总分的影响效应为小效应（Cohen d = 0.08～0.49）。干预组对工作坊的满意度调查显示整体满意度为9.05分（满分10分），84.21%的家长选择“肯定会”把工作坊推荐给其他需要的家长。结论：孤独症儿童父母的连带内化污名与亲职愁苦、抑郁、焦虑、压力等负性情绪显著相关，认知融合和经验性回避显著预测了连带内化污名水平，认知融合和经验性回避越严重，连带内化污名水平越高。1天的工作坊形式开展的ACT团体干预可显著提升孤独症儿童父母的心理灵活性水平，显著降低连带内化污名水平，显著降低亲职愁苦水平，对抑郁和压力也有改善趋势。ACT团体干预符合我国孤独症儿童家长的心理需求，家长对ACT工作坊的满意度较高，ACT团体干预可作为孤独症儿童家长心理支持的一种适宜的方法。
其他摘要	Objectives: Faced with challenges in child care, difficulties in child rehabilitation, barriers in entering schools, and rejection by the society, parents of autistic children are suffering from enormous physical, economic and mental stress. However, the current psychological support for parents of children with autism is still very scarce. This study focused on affiliate stigma and mental health of parents of autistic children, investigated the relationship between affiliate stigma and cognitive fusion and experiencial avoidance. Further, through an empirical study of Acceptance and Commitment Therapy (ACT) group intervention, this study investigated the effects of ACT group intervention in improving the psychological flexibility, reducing affiliate stigma and improving mental health of parents of autistic children, and analyzed the feasibility of the use of ACT group intervention in the psychological support of parents of children with autism. This study was aimed at making up for the lack of psychological interventions for parents of autistic children.Methods: This study was divided into two parts: Study 1 focused on the relationship between affiliate stigma and cognitive fusion and experiencial avoidance of parents of autistic children. A nationwide online survey on the mental health of parents of children with autism was conducted and 1396 copies of valid questionnaires were collected. Statistical analysis were run to analyze the relationship between affiliate stigma, cognitive fusion and experiencial avoidance. Study 2 focused on the effects of ACT group intervention on affiliate stigma and mental health of parents of autistic children. The experimental study design was used with an intervention group and a control group (waitlist group). A total of 39 parents of autistic children from Beijing who participated in Study 1 were recruited, 20 of whom were assigned to the intervention group and 19 to the waiting group. A one-day (7-hour) ACT workshop was conducted for the intervention group. Questionnaire tests were conducted one month before the workshop (pre-test) and two weeks after the workshop (post test). Paired sample t-test and repeated measures ANOVA were used to explore the effects of ACT group intervention on the psychological flexibility, affiliate stigma and negative emotions of parents of autistic children. The effect size of ACT group intervention was measured by Cohen’s d. Through analysis of the satisfaction survey of ACT workshop by the intervention group, the parents' acceptance of ACT group intervention was investigated.Results: The results of the Study 1: There was no significant correlation between affiliate stigma score and parental gender, parental age, child's age, parental education level, and rehabilitation subsidy (P > 0.05), but there were significant correlations between affiliate atigma score and family annual income, child's language ability, child's intellectual development, and child’s autism related behaviors (P < 0.05). There was a significant positive correlation between affiliate stigma and negative emotions such as parental distress, depression, anxiety, and stress (r = 0.431～0.540, P < 0.001). Cognitive fusion and experiencial avoidance significantly predicted the level of affiliate stigma (ΔR2 = 0.26, F(2,1389) = 274.60, P < 0.001).Results of Study 2: Paired sample t-test within the group showed that there was no statistical difference in the pre- and post-test scores of the observed variables in the control group, but in the intervention group, there were significant changes in the scores of experiential avoidance, cognitive fusion, affiliate stigma and parental distress(P < 0.05). From the changes in the estimated marginal means in the repeated measures ANOVA, it can be seen that, compared with the control group, all the observed variables except the anxiety showed a more significant decline in the intervention group. The effect size measured by Cohen’s d showed that the effects of ACT group intervention on three observed variables (experiential avoidance, affiliate stigma and parental distress) reached above moderate level (Cohen’s d > 0.5), and the effects on cognitive fusion, depression, anxiety and stress were small (Cohen’s d = 0.08 ~ 0.49). The analysis of the satisfaction survey of the workshop by the intervention group showed that the overall satisfaction was 9.05 (out of 10), and 84.21% of the parents chose to “definitely” recommend the workshop to other parents in need.Conclusion: The level of affiliate stigma of parents of autistic children is significantly associated with negative emotions such as parental distress, depression, anxiety, and stress. The level of cognitive fusion and experiential avoidance significantly affect the level of affiliate stigma. Higher level of cognitive fusion and experience avoidance predict higher level of affiliate stigma. An ACT group intervention in the form of a one-day workshop can significantly improve the psychological flexibility level of parents of autistic children, significantly reduce the level of affiliate stigma, significantly reduce the level of parental distress, and shows a trend in reducing depression and stress. ACT group intervention meets the psychological needs of parents of autistic children in China. Parents had high satisfaction with the ACT workshop. ACT group intervention can be a suitable method for the psychological support of parents of autistic children.
关键词	孤独症父母连带内化污名接纳承诺疗法团体干预
学位类型	硕士
语种	中文
学位名称	理学硕士（同等学力硕士）
学位专业	健康心理学
学位授予单位	中国科学院心理研究所
学位授予地点	中国科学院心理研究所
文献类型	学位论文
条目标识符	http://ir.psych.ac.cn/handle/311026/41647
专题	应用研究版块
推荐引用方式 GB/T 7714	陈燕红. 接纳承诺疗法团体干预对孤独症儿童父母连带内化污名和心理健康的影响研究[D]. 中国科学院心理研究所. 中国科学院心理研究所,2020.

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