三、正念癌症康复(mindfulness based cancer recovery,MBCR)MBCR由加拿大卡尔加里大学Tom Baker癌症中心Michael Speca和Linda Carlson博士研究组在1996年独立提出,随即接受MBSR课程核心内容而创立[37]。MBCR可有效减轻癌症患者的压力、焦虑和抑郁等心理困扰,改善睡眠[12]。适用对象:适用对象为心理压力大、有抑郁焦虑等心理困扰的癌症患者、康复者和家属。禁忌对象包括精神心理问题严重、正进行精神药物治疗、不能自主进行心理课程学习者,如重度抑郁焦虑、有自杀倾向等。主要内容:正念癌症康复的课程结构和经典八周MBSR一致,加入了针对癌症患者特殊需求设计的内容,包括癌症患者个人形象和定位变化带来的心理问题和癌症相关症状控制以及治疗副反应的正念应对。特色练习包括平衡呼吸的“迷你”练习、“我是谁”的练习和“减轻预期性恶心”的练习[5]。
四、正念分娩(the mindfulness-based childbirth and parenting program, MBCP)正念分娩与养育课程由美国加州大学旧金山分校Osher整合医学中心的NancyBardacke在1998年创立[6],是结合正念干预技术与孕产妇行为认知教育的心身保健课程。正念分娩与养育课程可减少怀孕期压力和焦虑,应对分娩带来的疼痛和恐惧,促进自然分娩并改善妊娠结局,以及促进夫妻关系、亲子关系、自我成长[41]。适用对象:适用对象包括需改善孕产期心身健康状况、促进自然分娩的待产父母。禁忌对象为身体及精神心理问题严重,不能自主进行心理课程学习者[6]。主要内容:正念分娩与养育课程分三部分。其中,基本正念练习与MBSR大部分内容一致,只是针对孕产期特殊情况调整了部分练习引导语及练习内容。分娩疼痛认知教育及分娩疼痛模拟练习包括针对分娩疼痛的规律特点及其生理心理机制进行讲解和讨论,模拟宫缩疼痛的冰水练习,减少听课对象对分娩疼痛的恐惧,增强应对分娩疼痛的信心。正念心理调适、正念哺乳与养育指导孕产妇及配偶应用正念的七个态度应对孕产期常见事件,为分娩、哺乳、养育等事件做好心理准备[6]。
五、接纳承诺疗法(acceptance and commitment therapy, ACT)接纳承诺疗法由Hayes等创立,旨在通过完全接纳、认知解离、接触当下、自我觉察、澄清价值、承诺行动等提高心理灵活性的体验性行为疗法,是行为治疗第三浪潮的代表[7]。适用对象:ACT是美国心理学会(APA)推荐的有循证支持的心理治疗方法,被广泛运用于精神科及内科临床,对慢性疼痛、精神病性症状、抑郁症、焦虑症、强迫症、PTSD、糖尿病、肥胖、艾滋病、癌症等都有很好的效果[42]。而且,基于ACT理论技术开发的团体培训还用于提升企业员工绩效管理、压力管理、愤怒管理、沟通管理、家庭关系管理、婚姻管理等[43]。基于ACT的教学方法用于学校教育以提升学生学习效率,基于ACT的训练还用于改善孤独症患儿的行为适应性及促进患儿父母的情绪稳定。缺乏自知力的严重精神障碍患者及有强烈自杀风险的患者不推荐使用ACT[44]。主要内容:ACT包含两个基本过程。第一步是正念与接纳过程。ACT试图通过无条件接纳、认知解离、接触当下、觉察自我来观察、减少主观评判,减弱语言统治,减少经验性回避,更多地生活在当下;与此时此刻经验相联系,与我们的价值相联系,使行为更具灵活性。第二步是承诺与行为改变过程。ACT通过接触当下、自我觉察、明确价值、承诺行动帮助来访者调动和汇聚资源,迈向目标,过有价值、有意义的人生[7]。
七、正念干预的广泛应用正念干预的应用越来越广泛。研究者开始探索针对睡眠障碍的正念干预方案,通过正念练习培养非评判性的态度和对当下的觉察能力,帮助练习者放下对睡眠的过度依赖,增加对睡眠不足反应的灵活性,并接受不愉悦的体验,进而有效减少睡前觉醒。研究表明,正念干预对提高睡眠质量和减少睡眠障碍有积极疗效[48]。正念干预也被运用于养育中,通常基于MBSR和MBCT方案,或加入自悯、慈心冥想、太极、瑜伽等练习,从5个维度(全神贯注倾听、对自己和孩子不评判接纳、对自己和孩子的情绪觉察、亲子关系中的自我调节、对自己和孩子的慈悲)将正念的理念与方式应用于亲子互动过程中;尤其对困难儿童的养育效果明显[49]。另外,研究者也探讨将正念干预应用于教育场景。教师群体通常基于MBSR或MBCT课程在学习方式上灵活处理。为保证学生群体的兴趣和易于理解,课程内容进行卡通化、形象化和游戏化改编,用于提升学生的注意力、社会情感能力、心理健康以及学业成绩[50]。在竞技体育领域,结合运动员训练和比赛需要,以注意、态度、内部体验(情绪、想法、身体感受)等为核心,形成了正念运动表现提升(mindfulness sport performance enhancement,MSPE)、正念接纳投入(mindfulness-acceptance-commitment approach,MAC)、运动正念冥想(mindfulness meditation training for sport,MMTS)、正念接纳觉悟投入(mindfulness-acceptance-insight-commitment,MAIC)[51]等训练方法。实证研究表明,这些基于正念的干预方法既有助于运动员学习和掌握运动技能,应对训练和比赛压力,促进运动(比赛)表现,又能提升教练员执教效果[52]。在组织管理领域,正念通过对注意力、认知、情绪和生理功能的作用,与工作场所的功能促进有根本性的联系,并影响绩效、关系和福利等关键工作成果[53]。此外,由于正念干预的师资有限,课程对参与者时间的要求较高,为提升正念冥想的广泛性和实用性,推广正念冥想的普及应用,保留正念核心要素的“短时简易正念冥想训练”也逐渐成为部分难以长期坚持、缺少时间空余的人士的实用方法[54]。展望未来,正念将可能成为维护身心健康的常规方法,成为人们生活的一部分,既可以作为公共卫生、预防医学的一部分,也可以作为身心疾病的干预。学组倡导并鼓励在中国文化框架下探索正念内涵,发展经济可行的本土循证正念干预方法。建议开展多学科多中心合作研究,搭建正念研究大数据收集和分享平台,检验多媒介(如地面、网络实时、音视频)分享和教授正念的可行性和效果,探索正念起效的机制,制定文化敏感性的正念测量工具,以回应国内不同人群的身心健康需要。
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