自助式正念减压疗法改善高龄孕妇负性情绪的随机对照研究

doi:10.12280/gjfckx.20241059

摘要/Abstract

摘要：

目的： 探究自助式正念减压疗法（self-help mindfulness based stress reduction，Self-MBSR）改善高龄孕妇负性情绪的作用。方法： 将2023年9月—2024年6月上海市静安区15家社区卫生服务中心早孕门诊建册的136例孕妇（年龄≥35岁）纳入研究，随机分为训练组和对照组，每组68例。训练组采取为期21 d和为期16周的两阶段Self-MBSR课程，对照组不采取任何干预。分别采用9项患者健康问卷（Patient Health Questionnaire-9 items，PHQ-9）、广泛性焦虑量表（Generalized Anxiety Disorder-7，GAD-7）、妊娠压力量表（Pregnancy Pressure Scale，PPS）、五因素正念量表（Five Facet Mindfulness Questionnaire，FFMQ）评估干预前（T0）、第一阶段干预后（T1）和第二阶段巩固后（T2）的得分情况。结果： 训练组完成率为76.47%，对照组完成率为79.41%。训练组T1、T2时点的PHQ-9评分、GAD-7评分和PPS评分均低于对照组（均P<0.05），训练组T1、T2时点的评分均低于干预前（均P<0.01），训练组T2时点的PHQ-9评分低于T1时点，差异有统计学意义（P<0.05），训练组T1和T2时点的GAD-7评分和PPS评分差异无统计学意义（均P>0.05）。训练组T1、T2时点的观察、描述、觉知、不行动的得分及总分均高于对照组（均P<0.05）。训练组T1、T2时点的观察、描述、觉知、非评判的得分及总分均高于干预前，差异有统计学意义（均P<0.05）。结论： Self-MBSR有助于改善高龄孕妇妊娠期负性情绪，降低妊娠压力，提高正念度。

关键词: 正念, 孕妇, 情绪调节, 表现焦虑量表, 随机对照试验, 自助式正念减压疗法

Abstract:

Objective: To explore the effect of self-help mindfulness based stress reduction (Self-MBSR) on improving negative emotion of advanced maternal age. Methods: A total of 136 pregnant women (age≥35 years) registered in the early pregnancy clinics of 15 community health service centers in Jing′an District, Shanghai from September 2023 to June 2024 were included in the study and randomly divided into a training group and a control group with 68 cases in each group. The training group was trained with Self-MBSR, and the control group was not trained. After 21 days of training (first stage) and 16 weeks of training (second stage), Patient Health Questionnaire-9 items (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Pregnancy Pressure Scale (PPS), and Five Facet Mindfulness Questionnaire (FFMQ) were used to count the scores before intervention (T0), after the first stage of intervention (T1), and after the second stage of consolidation (T2). Results: The completion rate in training group was 76.47%, and the completion rate in control group was 79.41%. Scores of PHQ-9, GAD-7 and PPS in the training group were significantly lower than those in the control group at T1 and T2 (both P<0.05). Scores at T1 and T2 in the training group were significantly lower than baseline (both P<0.01). Scores of PHQ-9 at T2 were significantly lower than those at T1 in the training group (P<0.05). There were no significant differences in GAD-7 and PPS scores at T1 and T2 in the training group (both P>0.05). Scores of FFMQ in observing, describing, acting with awareness, nonreactivity and total scores in the training group were significantly higher than those in the control group at T1 and T2 (all P<0.05). Scores of FFMQ in observing, describing, acting with awareness, nonjudging and total scores at T1 and T2 in the training group were significantly higher than baseline (all P<0.05). Conclusions: Self-MBSR therapy is conducive to improve negative emotion of advanced maternal age, reduce pregnancy stress and enhance their mindfulness.

Key words: Mindfulness, Pregnant women, Emotional regulation, Manifest anxiety scale, Randomized controlled trial, Self-help mindfulness based stress reduction

张淼苗, 王健, 杨亮, 陈珏, 范霞, 周健红. 自助式正念减压疗法改善高龄孕妇负性情绪的随机对照研究[J]. 国际妇产科学杂志, 2025, 52(2): 137-142.

ZHANG Miao-miao, WANG Jian, YANG Liang, CHEN Jue, FAN Xia, ZHOU Jian-hong. A Randomized Control Trial of Self-Help Mindfulness Based Stress Reduction to Improve Negative Emotion of Advanced Maternal Age[J]. Journal of International Obstetrics and Gynecology, 2025, 52(2): 137-142.

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参考文献 28

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时间	主题	内容	练习
第1~7天	走进正念；正念呼吸	讲解正念理论知识，指导患者正念进食；注意力放到呼吸上，非评判地察觉思想的活动和可能的“分神”情况	每天跟着音频练习正念饮食；练习正念呼吸
第8~14天	身体扫描；静观情绪、念头想法	按照顺序依次从头到脚或从脚到头察觉身体不同部位的感觉；以察觉呼吸为基础，以友善的态度、非评判地觉察念头和想法，不断培育正念	每天跟着音频练习身体扫描；练习静观情绪、念头和想法、放下等
第15~21天	正念行走；正念听和说	通过行走时一系列姿势的变化增加平衡性和灵活性，增加对身体的觉察力；用接纳与善意感受当下发生的一切，有意识地带着正念去听，说出真实而有益的话	每天跟着音频练习正念行走；练习正念听和说

时间	主题	内容	练习
第1~7天	走进正念；正念呼吸	讲解正念理论知识，指导患者正念进食；注意力放到呼吸上，非评判地察觉思想的活动和可能的“分神”情况	每天跟着音频练习正念饮食；练习正念呼吸
第8~14天	身体扫描；静观情绪、念头想法	按照顺序依次从头到脚或从脚到头察觉身体不同部位的感觉；以察觉呼吸为基础，以友善的态度、非评判地觉察念头和想法，不断培育正念	每天跟着音频练习身体扫描；练习静观情绪、念头和想法、放下等
第15~21天	正念行走；正念听和说	通过行走时一系列姿势的变化增加平衡性和灵活性，增加对身体的觉察力；用接纳与善意感受当下发生的一切，有意识地带着正念去听，说出真实而有益的话	每天跟着音频练习正念行走；练习正念听和说

项目	训练组（n=52）	对照组（n=54）	χ²或t	P
年龄（岁）	36.57±1.63	37.31±1.99	1.595	0.114
受教育程度			5.615	0.132
研究生及以上	17（32.69）	10（18.52）
大专及本科	29（55.77）	31（57.41）
高中及中专	3（5.77）	10（18.52）
初中	3（5.77）	3（5.56）
民族			0.001	0.979
汉族	51（98.08）	53（98.15）
少数民族	1（1.92）	1（1.85）
家庭收入			0.348	0.555
<上海市平均收入	11（21.15）	9（16.67）
≥上海市平均收入	41（78.85）	45（83.33）
初产			0.569	0.451
是	29（55.77）	34（62.96）
否	23（44.23）	20（37.04）
不良孕产史			0.115	0.734
有	3（5.77）	4（7.41）
无	49（94.23）	50（92.59）
妊娠合并症			0.136	0.712
有	7（13.46）	6（11.11）
无	45（86.54）	48（88.89）
计划妊娠			2.330	0.127
是	46（88.46）	52（96.30）
否	6（11.54）	2（3.70）

项目	训练组（n=52）	对照组（n=54）	χ²或t	P
年龄（岁）	36.57±1.63	37.31±1.99	1.595	0.114
受教育程度			5.615	0.132
研究生及以上	17（32.69）	10（18.52）
大专及本科	29（55.77）	31（57.41）
高中及中专	3（5.77）	10（18.52）
初中	3（5.77）	3（5.56）
民族			0.001	0.979
汉族	51（98.08）	53（98.15）
少数民族	1（1.92）	1（1.85）
家庭收入			0.348	0.555
<上海市平均收入	11（21.15）	9（16.67）
≥上海市平均收入	41（78.85）	45（83.33）
初产			0.569	0.451
是	29（55.77）	34（62.96）
否	23（44.23）	20（37.04）
不良孕产史			0.115	0.734
有	3（5.77）	4（7.41）
无	49（94.23）	50（92.59）
妊娠合并症			0.136	0.712
有	7（13.46）	6（11.11）
无	45（86.54）	48（88.89）
计划妊娠			2.330	0.127
是	46（88.46）	52（96.30）
否	6（11.54）	2（3.70）

组别	n	T0	T1	T2	t（P）
组别	n	T0	T1	T2	T0:T1	T0:T2	T1:T2
训练组	52	8.54±1.38	8.06±1.21	7.64±1.05	5.117（0.000）	4.860（0.000）	2.548（0.036）
对照组	54	8.46±1.34	8.56±1.27	8.48±1.24	1.011（0.681）	0.104（0.999）	0.454（0.957）
t		0.284	2.066	3.798
P		0.776	0.041	0.000