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抑郁症治病更要“治心”-给力心理
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抑郁症治病更要“治心”

抑郁症治病更要“治心”
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发表时间:2015-04-21 10:20:38 289 0 0

临床实践中我有这样的感触:如果对抑郁症患者只使用药物治疗,患者常表现被动,病情易反复。如果采用药物加心理治疗,患者就能主动配合,治疗也不会局限于就病论病,而是由治病扩展到“治心”,疗效显著且稳固。由此可见,抑郁症需要心理治疗,虽然其形式与药物治疗截然不同,但殊途同归,都是纠正大脑相关高级神经通路的生化功能与心理功能。

心理学的理论和方法很多,抑郁症究竟需要哪些具体的心理治疗?从临床反馈的情况看,以下方法患者喜闻乐见,并卓有成效。

一、引导宣泄。积“压”成疾是抑郁症一个重要的致病因素,患者在寻求心理治疗前的处境是无人理解,无处诉说。他们来到心理医生面前首要的需求是表达痛苦,吐露心声,但又顾虑重重。此时,医生应该做的除了为患者提供宽松、保密的环境外,重要的是平等、热情地接纳患者,尽可能地使用开放式的提问,恰如其分地引导患者宣泄。

当患者控制不住眼泪,觉得不好意思时,医生应告诉患者让情感自然地流露,不要去克制,边哭边说无所谓;当患者觉得想说的内容太多太繁杂,不知从何说起,医生可以告诉患者别着急,从发病当初的某件事因说起,也可以先选择最痛苦最重要的说;当患者说了很长时间,还觉得意犹未尽,医生可以引导患者在某些问题上说深说透,或跟患者约定下次交谈的时间和内容。

宣泄疗法的主角是患者,医生是一个倾听者。此法的重要意义在于患者有了从未体验过的被人接纳、认同、轻松和释然的愉快感,同时又逐渐解除了心理防卫机制,为下一步治疗奠定了良好的基础。

二、共同诊病。如果说宣泄是患者的第一需要,那么了解病情就是患者的第二需要,这也是心理治疗的第二个着眼点。

临床上,如果医生单纯地按医疗程序,为诊断而诊断,让患者做抑郁量表测查,然后根据患者的症状体征和测评分数下结论,这样的做法,患者不会完全信服,不能产生共鸣,治疗也就容易搁浅。如果医生把印制的抑郁症诊断标准交给患者,让其逐条对照,然后再针对抑郁症的特异症状,如“心境低落”、“清晨失眠”、“晨重夕轻”、“躯体化障碍”、“病理性自杀意念及行为”等进行适当的解释,这就满足了患者的潜在需求,在一定程度上解除了患者的忧虑和彷徨,同时又增进了其对医生的信任,与医生形成了积极的互动。

共同诊病的实质是把诊断当作心理治疗的重要部分,通过这种形式在医患间架起人际桥梁。同时,又使患者确切地认识到:我不是“精神病”,不是思想落后,不是身体上的病,不是鬼神作用。由此扫除许多外围心理压力,使治疗得以深化。

三、认知治疗。从心理的角度看,抑郁症的深层问题是患者的病理性认知模式,这种认知模式就像一副有色眼镜,它导致了患者的感知错误,促使其情感及行为异常。当然也间接影响到自主神经、内分泌、免疫等系统的生理生化功能,形成心身恶性循环。由此可见,改变这种认知模式是心理治疗的核心。 这种病理性认知模式在临床上主要表现为负性思维和逻辑错误,如患者对自身、对以往经历以及对自己的前途总是负性评价,认为自己无能为力,过去一无是处,前途一片灰暗。在对具体的人际交往或学习工作及生活上,患者惯常任意推断,过分概括,放大或缩小,选择性注意,二分法思维(非此即彼),个人化(“揽错”于己)等。这样,使患者陷入了“不识庐山真面目,只缘身在此山中”的境地。

认知治疗是通过医生帮助患者辨认这些负性思维和逻辑错误,让患者亲自用事实检验自己的认知假设,以及用改变行为来改变认知等方法,去掉患者的“有色眼镜”,引导患者走出“云雾山中”,重建健康的认知结构,使患者能客观地对待自己,看待世界,预测未来,该病也就从根本上得以治愈。

总之,抑郁症的心理治疗在临床上举足轻重。从临床实践看,患者需要的不是教条呆板的说教和一成不变式的心理治疗,而是需要医生的人格、素养、经验与理论有机结合,具有创造性的心理治疗。

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