2012-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/658287摘要：研究計畫名稱：身心靈團體治療於改善年輕乳癌存活者憂鬱和唾液可體松反應之成效探討: 長期追蹤研究背景. 台灣40歲以下的年輕乳癌存活者是西方國家的兩倍，年輕乳癌存活者是罹患憂鬱症的高危險群，而憂鬱常影響她們停止後續的追蹤治療並影響其神經內分泌的功能和存活。導致他們憂鬱的原因包含：化療和賀爾蒙治療影響她們生殖、性功能、停經的相關困擾，害怕復發，憂慮追蹤的結果，缺乏社會支持，以及擔心被伴侶拒絕。但目前缺乏探討社會心理措施介入後對於改善年輕乳癌病患於存活期憂鬱和神經內分泌功能長期影響之研究。目的. 本追蹤研究計畫其目的為發展身心靈團體治療並探討其對年輕乳癌存活者之憂鬱狀態、生活品質、親密關係、性功能、生命意義、唾液可體松濃度和可體松晝夜型態的長期影響。研究方法. 本14個月追蹤研究計畫採用隨機控制臨床實驗(the randomized controlled trial, RCT)之設計。本研究將邀請醫院外科門診年齡介於18至40歲且完成積極治療的年輕乳癌存活者參與本研究，預期120位存活者將經由隨機選擇的方式分別至兩個組別：控制組的乳癌存活者接受一次個別關於健康行為之衛教，實驗組的乳癌存活者接受八週身心靈團體治療介入措施和之後每兩個月所舉辦團體討論會共三次。實驗組和控制組的所有個案皆會在每次追蹤測量後收到她們個別的可體松報告，以幫助她們了解身體的狀況及鼓勵她們持續練習健康行為和正向的壓力調適行為。結果測量工具包含BDI-II憂鬱量表、SF-12生活品質量表、ECR-R親密關係量表、SAQ性功能量表、MLQ生命意義及唾液可體松收集於睡醒、睡醒後30-45分鐘、12:00, 17:00 及 21:00的樣本。測試時間將於治療前、治療後（八週身心靈團體治療後）以及治療後第三個月、六個月和十二個月進行。Univariate analyses 將分析個案之基本特性. Correlational analyses 將探討變項之間的關係. Generalized estimating equation models 將比較兩組在五次測量時在依變項(dependent variables)平均值的差異性，每次追蹤的評估將與前測作重複的比較測量並且病患的基本特質作為covariates.預期貢獻：本14個月追蹤研究計劃的預期貢獻是說明身心靈團體治療介入於年輕乳癌患者於存活期的長期成效以及發展適用於臨床人員的身心靈團體治療手冊。<br> Abstract: The title of the research project: The efficacy of body-mind-spirit group therapy on depression and salivary cortisol responses for young breast cancer survivors: The long-term follow-up studyBackground. The numbers of young breast cancer patients aged below 40 years old are two times higher in Taiwan than western country. Young breast cancer patients are regarded as a high risk group for suffering from depressive disorders which often lead them to discontinue with follow-up treatments and affect their neuroendocrine function and survival. The causes of depression include the negative impacts of adjuvant chemotherapy and hormonal therapy on fertility, sexuality and menopause-related problems, fear of cancer recurrence, worry about outcome of medical follow-up, loss of social support and fear of being rejected by partners. However, no study focuses on examining the long-term effects of psychosocial interventions on depression status and neuroendocrine function for young breast cancer patients during survivorship phase.Aims and objectives. This follow-up study aims to develop the body-mind-spirit group psychotherapy and to examine its long-term effects on depression status, quality of life, close relationships, sexual dysfunction, the meaning in life, salivary cortisol levels and diurnal cortisol patterns in young breast cancer survivors.Methods. This 14-month follow-up study adopts the randomized controlled trial (RCT) design. The young breast cancer survivors aged between 18 and 40 years old and completing active treatments will be recruited from outpatient department of surgery. The 120 subjects will be randomly assigned into an experimental group or a control group. The subjects in an experimental group will receive 2 months time body-mind-spirit group psychotherapy followed by 3 additional group meetings every two months while those in a control group will receive one-session individual education on health behaviors in the same period of time. All the subjects in both groups received their individual report of cortisol profiles for each measurement time in order to help them understand their physical conditions and to continually encourage for practicing healthy behaviors and positive stress coping strategies. The outcome measures include BDI-II depression scale, Short-form 12 health-related quality of life questionnaire, Experiences in Close Relationships-Revised (ECR-R), Sexual Activity Questionnaire (SAQ) , the meaning in life questionnaire (MLQ) and Salivary cortisol samples collected at waking, 30-45 minutes after waking, 12:00, 17:00 and 21:00. Measurement time-points include pre intervention, post intervention (after 8 weekly group therapy), & then 3, 6, 12 months after the end of intervention for the maintenance effect.Univariate analyses will be performed to explore the basic characteristics of participants. Correlational analyses will be performed to explore the relationships between different variables. Comparisons of mean scores in the dependent variables among the intervention group and control group over these five time-points will be used in the generalized estimating equation models with each follow-up assessment as a repeated measure and pre-intervention baseline score, and patient demographics as covariates.The contribution. This 14-month follow-up study aims to demonstrate the long-term effectiveness of body-mind-spirit group psychotherapy for young breast cancer patients during survivorship and to compile a manual of body-mind-spirit group psychotherapy for health professionals.年輕乳癌存活者身心靈治療憂鬱狀態生活品質親密關係性功能障礙生命意義唾液可體松濃度可體松晝夜型態Young breast cancer survivorsbody-mind-spirit psychotherapydepressionquality of lifeclose Relationshipssexual dysfunctionmeaning in lifesalivary cortisol levelsdiurnal cortisol patterns