| Objectives:1.To explore the influence of childhood trauma on psychological capital of depressed patients.2.Comparing the effects of Yi Shu psychodrama combined with antidepressants and general health education combined with antidepressants on depressed patients with childhood trauma from three aspects of clinical symptoms,psychological capital and neuroimaging,so as to provide scientific evidence for the clinical application of YiShu psychodrama.3.Exploring the relationship between the changes of brain activation and the improvement of psychological capital in depressed patients with childhood trauma after Yi Shu psychodrama combined with antidepressants intervention,so as to further learn the psychological and neurological mechanism possibly of Yi Shu psychodrama.Methods:1.The general information,Childhood Trauma Questionnaire(CTQ),Beck Depression Inventor-13 item(BDI-13),Beck Anxiety Inventor(BAI)and Positive Psychological Capital Questionnaire(PPQ)score of depressed patients who met the inclusion criteria were collected.According to the results of CTQ and childhood experience interview,the patients were divided into childhood trauma group and non-childhood trauma group.The differences of PPQ score between the two groups were compared.Besides,the correlation and regression analysis between childhood trauma questionnaire and psychological capital questionnaire of depressed patients with childhood trauma were carried out.2.A prospective experimental control study was conducted after matching the gender,age and antidepressants of depressed patients with childhood trauma in Yishu psychodrama combined with antidepressants intervention group(observation group,n=16)and general health education combined with antidepressants group(control group,n=16).Patients in both groups were treated with Selective Serotonin Reuptake Inhibitor(SSRIs)as the main antidepressant for 6 months.Taking BDI-13,BAI,PPQ score and ALFF as observation indexes,the different changes of each observation index of the two groups after intervention were compared by repeated measurement analysis of variance(ANOVA)and post-hoc analyse.3.Pearson correlation analysis was carried out between the changes of the Positive Psychological capital Questionnaire’s score and the ALFF signal changes of the interactive brain regions after intervention in the observation group.Results:1.Through a cross-sectional case-control study,we found that under the same degree of depression and anxiety,except the score of hope between depressed patients with and without childhood trauma didn’t have statistical difference(p>0.05),the scores of self-efficacy(p<0.01),resilience(p<0.05),optimism(p<0.05)and the total score of positive psychological capital(p<0.01)in the group with childhood trauma were lower than those in the group without childhood trauma,and the difference is statistically significant.Besides,we found that both emotional abuse and neglect could negatively predict the total score of psychological capital and optimism(p<0.05),among them,emotional abuse had a greater negative prediction effect(β values were-0.200,-0.222 respectively).However,only emotional neglect could negatively predicte self-efficacy(p<0.01,β=-0.223),only emotional abuse could negatively predicte resilience(p<0.01,β=-0.200).We haven’t find either of emotional abuse or emotional neglect could predicte hope(p>0.05).2.After 6 months of intervention and observation,comparison between the observation group and the control group:there were no interactionresults of treatment *time in BDI and BAI score between the two groups,but the time had statistical effect on it.However,there were treatment *time interaction results existence between the two groups in PPQ’s total score(F=20.62,p<0.05)and its’ four dimensions: self-efficacy(F=9.713,p<0.01),resilience(F=9.694,p<0.01),hope(F=21.036,p<0.01),optimism(F=13.865,p<0.01).3.After intervention,comparison before and after intervention:the scores of BDI and BAI in two groups were significantly lower than them before intervention(p<0.05).In the observation group,the total scores of PPQ(p<0.01)and self-efficacy(p<0.01),resilience(p<0.01),hope(p<0.01),optimism(p<0.01)were higher than them before intervention,and the differences were statistically significant.However,in the control group,there were no statistical differences in the scores of all dimensions and total scores of PPQ after intervention compared with before intervention.4.After 6 months of intervention and observation,18 brain regions have treatment * time interaction results between the two groups(corrected by FDR at p<0.05,cluster >78).After intervention,the activation of left medial superior frontal gyrus(p<0.05)and right parahippocampal gyrus(p<0.05)was enhanced in the observation group compared with before intervention.And in the control group,the activation of the left precuneus(p<0.05)was enhanced,while the activation of the right parahippocampal gyrus(p<0.05)was weakened after intervention.Inaddition,after intervention,compared with the control group,the right parahippocampal gyrus activation was enhanced more(p<0.05),and the left precuneus activation was weakened more in the observation group(p<0.05).5.The correlation analyse between the change value of ALFF in the interactive brain region and the total score,the each dimension’s score of PPQ in the observation group showed that the improvement of the total score of psychological capital was positively correlated with the activation enhancement of the left fusiform gyrus(r=0.553,p<0.05),left inferior temporal gyrus(r=0.530,p<0.05),left precentral gyrus(r=0.651,p<0.01),and right paracpocampal gyrus(r=0.677,p<0.01);the self-efficacy improvement was positively correlated with the enhanced activation of the left fusiform gyrus(r=0.637,p<0.01),the left precentral gyrus(r=0.702,p<0.01)and the right parahippocampal gyrus(r=0.660,p<0.01);the resilience improvement was positively correlated with the enhanced activation of the left precentral gyrus(r=0.511,p<0.01)and the right parahippocampal gyrus(r=0.705,p<0.01);the hope improvement was positively correlated with the enhanced activation of the left inferior temporal gyrus(r=0.565,p<0.05),left medial superior frontal gyrus(r=0.534,p<0.05),left precentral gyrus(r=0.628,p<0.01),right paracpocampal gyrus(r=0.549,p<0.05),right angular gyrus(r=0.549,p<0.05)and right medial superior frontal gyrus(r=0.636,p<0.05).Conclusions:1.In the case of the same degree of depression and anxiety,the positive psychological state of depressed patients with childhood trauma is worse than that of patients without childhood trauma,in particular,childhood emotional abuse and neglect have significant negative effects on individuals’ positive psychological capital,which may be one of the reasons for poor prognosis and higher recurrence rate of depressed patients with childhood trauma.2.Intervention of psychodrama combined with antidepressants or general health education combined with antidepressants both could improve the anxiety and depression levels of depressed patients with childhood trauma.3.Antidepressants combine with psychodrama can improve positive psychological capital and regulate the abnormal activation of the default network and the emotional regulation related brain areas in depressed patients with childhood trauma.Besides,the improvement of psychological capital may be related to the activation changes of the associative brain regions,so that patients can find and mobilize their accessible resources to solve the dilemma,so as to improve their prognosis.Therefore,this study suggests that Yi Shu psychodrama combined with antidepressents can be used in the clinical treatment of depressed patients with childhood trauma. |
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