健康与遗传心理学研究室知识库

颞下领关节紊乱病(Temporomandibular Disorder, TMD)是一组常见于青壮年期的高发病率慢性综合征，主要症状为领面疼痛、关节弹响、下领运动功能受限，且具性别差异性，但发病机制尚不明确。该病常伴有抑郁、焦虑、压力等负性情绪。

本论文探讨了自我参照效应下负性情绪及情景记忆在慢性期疼痛为主TMD成年女患者病程特点及影响;基于研究一中揭示的患者特点，分别采用认知行为疗法((Cognitive Behavioral Therapy, CBT)和支持性疗法并结合生理治疗，干预慢性期疼痛为主伴抑郁、焦虑情绪TMD成年女患者负性情绪，从身心两维度纵向比较两种心理干预方法对改善疼痛的效果。

研究一、随机选择23名于2019-2021年初诊、病程大于三个月且疼痛为主要症状，年龄在19到60岁之间的TMD女性患者纳入CBT组;另外选择24名症状相同女患者纳入支持性组。要求23名CBT组患者用思维记录表记录三周自己体验到的情绪性情景记忆片段，然后采用质性分析方法深入分析获得的情绪性记忆的描述语词，探讨在自我参照效应下情绪性记忆的特点。研究结果表明:自我参照效应下慢性期疼痛为主TMD成年女患者负性情绪以抑郁情绪为主，负性情绪处于高唤醒状态且不稳定，负性情绪下情景记忆的联系性和组织性来源记忆概括化、自我参照程度效应减弱。

研究二、对23名患者的CBT组和24名支持性疗法组的患者分别实施50分钟/次/周，共8次的心理干预。同时，根据生理症状接受镇痛消炎药物治疗、关节腔透明质酸钠注射治疗、咬合板治疗和理疗。干预性治疗前采用DC/TMD中文版、DASS-21中文版、PCL-5中文版量表、心境检查表测查患者数据，采用思维记录表记录负性偏差信念，辅助以皮质醇(Cortisol)指标测试，以及第三个月随访时间点进行自我报告的半结构性访谈，探讨上述疗法从生理一心理层面对患者疼痛的改善效果。研究结果表明:CBT患者具有“以偏概全”、“世界是危险的”偏差信念影响抑郁情绪。与支持性疗法相比，CBT从生理一心理层面对慢性期疼痛为主TMD成年女患者疼痛症状改善效果更显著，增强患者心理韧性，获得创伤后心理成长。

慢性疼痛为主TMD成年女患者病程期伴以抑郁为主高唤醒水平的负性情绪，抑郁情绪成分自责、自罪、内疚、无能为力不足，以愤怒生气为主;联系性及组织性来源记忆自我参照程度效应减弱，概括化认知负性偏差;患者具“以偏概全”、“世界是危险的”偏差信念，与支持性疗法相比，采用CBT思维调整技术“寻找符合逻辑的证据”积极思维反当，能从生理一心理层面显著改善疼痛缓解抑郁，提高患者心理韧性获得创伤后成长。

Temporomandibular disorder (TMD) is a group of chronic syndromes with high morbidity commonly seen in young adults. The disease is often associated with depression, anxiety, stress, and other harmful effects. However, the pathogenesis is not clear. The condition is often associated with negative emotions such as depression, anxiety, and stress.

This study investigates the characteristics and effects of negative emotions and situational memory under the self-referential impact on the course of chronic-phase pain-oriented TMD in adult female patients. Based on the patient characteristics revealed in Study 1，we used Cognitive Behavioral Therapy (CBT) and supportive therapy in combination with physiological treatment to intervene in the negative emotions of adult female patients with chronic pain dominated TMD with depression and anxiety, and longitudinally compare the effects of the two psychological interventions on improving pain from both physical and psychological dimensions. The impact of the two psychological interventions on improving pain was compared longitudinally in both physical and psychological dimensions.

In Study 1，23 female patients with TMD whom, doctors in 2019-2021 firstly diagnosed with a duration of more than three months and pain as the primary symptom. Aged 19 to 60 years, were randomly selected to be included in the CBT group; picked another 24 female patients with the same symptoms to be included in the supportive group一asked the 23 patients in the CBT group to record their emotional memories for three weeks using a thought recorder. Then, the descriptive words of the emotional memories were analyzed in-depth using qualitative analysis to investigate the characteristics of the emotional memories under the self-referential effect. The study results showed that the primary negative emotion of adult female TMD patients with chronic pain under the self-reference effect is mainly depression. The negative emotion is high arousal and instability. The connection of episodic memory and organizational source memory under the negative emotion is overgeneralized, and the effect of self-reference degree is weakened.

In Study 2, Given 23 patients in the CBT group and 24 patients in the supportive therapy group 8 sessions of 50 minutes/week of psychological intervention. According to physiological symptoms, patients received physiotherapy about analgesics, anti- inflammatory medication, joint cavity sodium hyaluronate injection, and occlusal plate treatment. Before the intervention, measured patients' data using the Chinese version of DC/TMD, DASS-21，a Chinese version of PCL-5, and the Mindfulness Checklist. Moreover, recorded negative deviant beliefs using the Thought Record Form, supplemented by a Cortisol index test and a self-reported semi-structured interview at the third-month follow-up. The study results showed that CBT patients had a high level of pain. In addition, the study results showed that CBT patients have "biased" and "the world is dangerous" bias beliefs that influence depression. Compared with supportive therapy, CBT can significantly improve the pain symptoms of adult female TMD patients with chronic pain from the physiological psychological level, enhance their psychological resilience and achieve post-traumatic psychological growth.

Aadult female patients with chronic pain based TMD had high arousal levels of negative emotions during the disease, with depressive feelings consisting of self-blame, self-guilt, guilt, powerlessness, and mainly anger and rage; the effect of self-referential degree of connectedness and diminished organizational sources of memory and observed negative bias of overgeneralized cognition; patients had "generalization," "the world is dangerous," and "the world is dangerous" bias beliefs. "Compared to supportive therapies, positive thinking regurgitation using CBT "looking for logical evidence" can significantly improve pain relief at the physiological-psychological level. Depression and post-traumatic growth of patients' psychological resilience were enhanced.