燒傷癢的心理病理與康復機制及正念減壓介入研究

Abstract

燒傷癢是燒傷倖存者於復健期間最難以忍受的困擾之一，廣泛的影響燒傷患者之身心健康，且可在傷後維持數年以上，然而迄今對燒傷癢的心理病理學機制和理解仍相當稀少。本研究旨在提出燒傷癢的相關心理機制，該模型包含惡化循環以及康復路徑，並探討正念減壓（MBSR）對燒傷癢的影響。研究一為為橫斷研究 （n = 83），檢驗燒傷癢之心理機制，測量的項目包括燒傷癢敏感度、與癢相關之認知評估、負向情緒、睡眠品質、燒傷癢後果、正念特質以及接納慢性癢，以階層迴歸和序列中介進行分析。研究二為縱貫式研究，採三波調查進行探討，參與正念減壓組為13人、控制組為21人，分別完成基線期（T0） 、完成正念團體後之介入調查（T1） 以及兩個月後追蹤調查（T2）。測量的項目包括燒傷癢、負向情緒、睡眠困擾以及正念特質，以t 檢定和階層回歸以及中介分析進行分析。研究一結果顯示，序列中介確認了雙向的燒傷癢惡化循環以及單向的康復路徑，且發現正念特質可分別調節燒傷癢敏感度與慢性癢接納以及燒傷癢敏感度與康復狀態之關係。研究二結果顯示，正念介入組與控制組在基線期、介入後調查以及兩個月後追蹤調查之正念特質、負向情緒、睡眠困擾及燒傷癢皆無顯著差異，然而T0之正念特質可分別透過T0、T1、T2之睡眠困擾預測T0、T1、T2之燒傷癢。綜上所述，正念特質對燒傷癢敏感度具緩衝作用並可促進慢性癢接納和康復，因此能減緩相關之負向認知評估、負向情緒、睡眠困擾和燒傷癢後果，使得燒傷患者得以跳脫惡化循環進入康復路徑。同時，正念特質可提升燒燙傷患者的睡眠品質，減緩睡眠困擾，進而使燒傷癢得以減緩; 正念特質亦可分別透過2個月和4個月後的睡眠困擾預測2個月和4個月後之燒傷癢。但未來針對燒傷癢之正念團體，仍需調整以更符合燒傷患者之身心需求。

Introduction: Burn pruritus is one of the most unbearable disturbances during the rehabilitation period and can last for years after the burn incident. However, there is sparse empirical exploration on its psychopathological mechanisms and potential intervention as of date. This study aimed to propose a psychological model for burn pruritus, which contains a vicious cycle and a recovery process, and to investigate the effect of mindfulness-based stress reduction (MBSR) in burn patients. Methods: Study 1 is a cross-sectional study (n = 83), that examines the proposed psychological model for burn pruritus. Sensitivity to itch, itch related cognitive appraisal, negative emotions, sleep quality, itch consequences, mindfulness, and acceptance of chronic pruritus were measured. To analyze the data, hierarchical regression and multiple serial mediation analyses were conducted. Study 2 is a prospective and longitudinal study with three-time points for data collection. Participants of MBSR group (n = 13) and control group (n = 21) completed assessments at baseline (T0), after MBSR intervention (T1), and 2 months after intervention follow up (T2). Burn pruritus, negative emotions, sleep quality, and mindfulness were measured. To analyze the data, t-tests, hierarchical regressions, and mediation analyses were used. Results: In study 1, multiple serial mediation analyses confirmed the bidirectional vicious cycle and unidirectional recovery path of burn itch. In addition, mindfulness moderated the relationships between sensitivity to itch and acceptance of chronic itch and the relationship between sensitivity to itch and recovery. In study 2 no significant differences were found between MBSR and the control group in mindfulness, negative emotions, sleep quality, or pruritus level at T0, T1, and T2. Besides, mindfulness at T0 predicted pruritus at T0, T1, and T2 via sleep quality at T0, T1, and T2. Conclusions: Trait mindfulness has a buffering effect on itch sensitivity and promotes acceptance of chronic itch and recovery, hence mitigating itch related cognitive appraisal, negative emotions, and itch consequences. Concurrently trait mindfulness alleviates burn itch by improving sleep quality of burn patients. It also predicts burn pruritus in 2 and 4 months through sleep disturbances in the same interval. Taken together, by cultivating mindfulness, burn patients can break the vicious cycle of itch and enter the recovery path via mindfulness practice. Nevertheless, MBSR needs further modification to tailor to burn patients.