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題名:正念冥想對焦慮癥狀的干預:效果及其影響因素元分析
書刊名:心理學報
作者:任志洪張雅文江光榮
出版日期:2018
卷期:2018(3)
頁次:283-305
主題關鍵詞:正念冥想焦慮干預調節作用文化差異元分析Mindfulness meditationAnxietyInterventionModerating effectCultural differencesMeta-analysis
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正念冥想對焦慮的干預效果結論不一,系統考察其干預效果及影響因素,有助于理解其作用機制,并為正念冥想干預焦慮提供實踐指導。本研究遵循PRISMA-Protocol,運用元分析技術,以即時效果與追蹤效果為結果變量,考察被試特征、干預特征、研究特征和結果分析4個方面(11個變量)的調節作用。通過數據庫檢索與篩選,最終納入東西方國家實證研究共55項(68個獨立效應量,4595名被試)。結果發現:正念冥想對焦慮干預的整體即時效果量達到顯著的中等到大效果(g=0.60),但追蹤效果不顯著。單因素回歸模型分析表明,研究質量、國家地域、年齡、干預形式(團體練習vs.個體練習)、家庭練習與脫落率顯著調節干預即時效果,其中國家地域變量對效果量影響程度最大;多元回歸分析顯示,對照組類型、國家地域、練習經驗、數據分析方式(ITT vs.PP)對干預效果存在調節作用;此外,國家地域與其他變量存在交互作用。后續研究需在研究質量、成本效益、不同焦慮類型及其他調節變量和提供客觀評價指標上作改進。
Mindfulness meditation(MM) has enjoyed a growing popularity in healthcare in recent years when bio-psycho-social approaches are becoming more and more emphasized in modern medicine. There has been mounting empirical evidence showing MM’s significant effectiveness in alleviating anxiety for both nonclinical and clinical populations. However, the effect size of the available empirical investigation results has remained inconsistent and possible moderators have yet to be explored comprehensively. In order to determine the immediate and long-term efficacy of MM in overcoming anxiety, we conducted a meta-analysis based on a systematic and comprehensive review of the published studies on mindfulness-based interventions for anxiety. We also examined whether some characteristics of research participants(e.g. age, geographic areas) and interventions(e.g. format, duration, at-home practice), and specifics of the study(i.e. types of control, quality of the study) and data analysis(e.g. attrition rate) moderate the magnitude of the effectiveness of MM interventions(11 variables). The review was performed following the rigorous PRISMA Protocol. Published studies using randomized controlled trial were selected from major databases worldwide to include investigations conducted in both Western and Eastern countries. Databases used include VIP Journal Integration Platform, Wan fang, China National Knowledge Infrastructure, Scopus, Web of Science, Embase, the Cochrane Library, and Pub Med. Keywords used are mindfulness, meditation, MBSR, MBCT, anxi*, mood, intervention, therapy, program. Using the random effect model, we pooled the effect size(Hedge’s g), and conducted a publication bias evaluation, a moderating effect analysis and an interaction analysis in CMA 3.3. Results of our analyses revealed fifty-five RCTs from both Eastern and Western countries(k = 68 samples, N = 4595 participants). Mindfulness meditation for treating anxiety is shown to be efficacious with a medium to large immediate effect(g = 0.60), but the effect is not reliably shown at follow-up assessments. The post-heterogeneity test result suggests that using the random effect model is reasonable. Univariate meta-regression analysis yielded that study quality, geographic areas, participants’ age, intervention format(Group vs. Individual), amount of at-home practice, and attrition rate shown in data analysis remarkably influenced the effect size of MM’s immediate effect, while types of control, health condition, mindfulness practice experience, intervention duration, or statistical analysis methods used(ITT vs. PP) did not appear to moderate MM’s immediate effectiveness for reducing anxiety. Additionally, geographic areas affect the effect size the most. Multiple meta-regression models suggested that type of control and geographic areas, as well as statistical analysis methods significantly moderate the effect size of intervention effectiveness. Overall, the study results demonstrated high immediate effect of mindfulness-based practices for alleviating anxiety, but the effect did not seem to last. In addition, geographic area turns out to be the strongest moderator, and practitioners in the East seem to benefit more than those who are in the West. Study quality, participants’ age, mindfulness practice experience, intervention format, at-home practice quantity and attrition rate also affect the effect size to a certain extent. Future research is warranted to improve methodological quality of outcome studies, to provide more clear and replicable evidence of MM efficacy, and to explore more underlying moderators for the intervention effect size, such as participant satisfaction and so forth.
 
 
 
 
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