目的:虽然有足够的证据表明接受和承诺疗法在允许患者治疗慢性疼痛方面的有效性,认知融合的有效性,心理学灵活性模型的六个核心组成部分之一,尚未建立。本文的目的是评估心理干预是否会降低认知融合。
方法:WebofScience,Scopus,Medline,和PsycINFO数据库搜索了截至2024年6月的主要研究。包括认知融合措施的研究,其中慢性疼痛患者接受了心理干预。将方法学质量量表应用于选定的研究,并计算平均效应大小(Hedgesg)。
结果:本综述包括18篇文章和24项研究(19项前/后随访研究和5项随机对照试验)。干预后认知融合明显下降。试验后的效应大小为小/中等,g=-0.39,p<.001,95%CI[-0.52,-0.26];长期随访中期,g=-0.55,p<.001,95%CI[-0.74,-0.36]。在测试后的RCT研究中发现了类似的趋势,g=-0.61,p=0.006,95%CI[-1.05,-0.17],短期随访,g=-0.79,p<.001,95%CI[-1.18,-0.40]和长期随访,g=-0.58,p=0.003,95%CI[-0.95,-0.20])。调节变量,如失业,性别,疼痛强度,干预前的抑郁水平,并确定了持续时间和干预方式。
结论:心理干预倾向于降低慢性疼痛患者的认知融合。尽管如此,需要更多的临床试验来确定认知融合在心理灵活性中的作用。
OBJECTIVE: While there is sufficient evidence of Acceptance and Commitment Therapy\'s effectiveness in allowing patients to deal with chronic pain, the effectiveness in cognitive fusion, one of the six core components of the Psychology Flexibility Model, has yet to be established. The aim of this article is to assess whether psychological interventions decrease cognitive fusion.
METHODS: The Web of Science, SCOPUS, Medline, and PsycINFO databases were searched for primary studies up to June 2024. Studies with a cognitive fusion measure in which chronic pain patients received a psychological intervention were included. A methodological quality scale was applied to the selected studies and the average effect sizes (Hedges g) were calculated.
RESULTS: This
review included 18 articles with 24 studies (19 pre-post/follow-up studies and five randomized control trials). Cognitive fusion decreased significantly after the intervention. The effect sizes were small/medium at post-test, g = -0.39, p < .001, 95% CI [-0.52, -0.26]; and medium at long-term follow-up, g = -0.55, p < .001, 95% CI [-0.74, -0.36]. A similar tendency was found for studies with RCTs at post-test, g = -0.61, p = .006, 95% CI [-1.05, -0.17], short-term follow-up, g = -0.79, p < .001, 95% CI [-1.18, -0.40] and long-term follow-up, g = -0.58, p = .003, 95% CI [-0.95, -0.20]). Moderator variables such as unemployment, gender, pain intensity, level of depression before the intervention, and duration and intervention modality were identified.
CONCLUSIONS: Psychological interventions tended to decrease cognitive fusion in chronic pain patients. Nonetheless, more clinical trials are needed to establish the role of cognitive fusion in psychological flexibility.