Clinical Efficacy And Mechanism Of Cognitive Comprehension Narrative Therapy In The Intervention Of Mixed Anxiety And Depression Disorde

1 CENT technology theory and operation processObjective:Psychological therapy is produced in the western cultural background,which is difficult to apply to the psychological problems arising in the current Chinese cultural background.The integration of modern cognitive therapy,post-modern narrative therapy,and traditional Chinese medicine to recuperate the body and mind,as well as Confucianism,Buddhism and Taoism wisdom,forms a local psychological therapy method that fits the Chinese culture.Methods:Summarizes the mentor fusion narrative therapy cognitive therapy Methods and Confucianism,Buddhism,Taoism wisdom and spirit of traditional Chinese medicine nursing experience for patients with psychological counseling,dig the Cognitive Enlightened Narrative Therapy theoretical basis,definite therapeutic principles,standard operating procedures Operation steps,for the clinical application of cognitive comprehension of narrative therapy and provide theoretical guidance to the process method of operation.Results:Cognitive Enlightened Narrative Therapy with emotional ABC theory postmodern construction thoughts of Confucianism,Buddhism and Taoism and spirit of traditional Chinese medicine View as the theoretical basis,empathy to understand Sincere transparent Keep curiosity and the specimen shape and phase should be treated as a principle,the treatment of the therapy is based on psychosomatic mindfulness interaction,early treatment by dual narrative listen to body and mind Externalization dilemma story technology to comb context Externalization curing cognitive,mid treatment by rewriting the story Body awareness of wisdom Back in the life of noble story technology to amplify power Understand the wisdom of the original,late treatment by witnessing a new story The aftercare of mental guidance to consolidate and maintain positive experience of visitors to upset.Conclusions:Cognitive Enlightened Narrative Therapy（CENT technology）integrates the cognitive therapy narrative therapy of TRADITIONAL Chinese medicine and Confucianism,Buddhism and Taoism to establish a set of specific operation methods,which is consistent with the cultural background of China,and is a psychological therapy method in line with the Chinese cultural background.2 Clinical researchObjective:To preliminarily explore the changes of intestinal flora and serum metabolomics in mixed anxiety and depression disorder,and explore the clinical efficacy and effect mechanism of Cognitive Enlightened Narrative Therapy（CENT technology）.Methods:First through a clinical trial,in 57 patients with mixed anxiety depression disorder 20 cases healthy subjects,the detection of serum non targeted metabonomics and fecal intestinal flora 16S rRNA high-throughput sequencing Then adopt the method of randomized controlled clinical trial,61 patients with mixed anxiety depression disorder were randomly divided into treatment group 30 cases and control group in 31 cases The experimental group was given Cognitive Enlightened Narrative Therapy intervention on the basis of sending health propaganda videos,once a week,50-60 minutes/time;The control group was given Jieyu pill on the basis of sending health education video,3 times a day,1 bag/time.Both groups were treated for 6 weeks.On the day of admission and 2 weeks,4 weeks and 6 weeks,the patients were evaluated by HAMD-17,HAMA.SDS,SAS,HAD,AIS,FIRST,TCM symptom Self-rating Scale.Venous blood and stool samples were collected before and after treatment to detect serum untargeted metabolomics and fecal intestinal flora by 16S rRNA high-throughput sequencing.Results:（1）Experiment 1:Intestinal microbiota sequencing results showed that compared with the healthy group,the intestinal microbiota α diversity of patients with mixed anxiety and depression disorder was not different except Shannon index and Simpson index,Chao1 index,ACE index and Observed_species index,β-diversity UniFrac distance analysis showed that there were differences in colony structure between the two groups（P<0.5）,Bacteroidetes,Proteobacteria,Bacteroidetes,γproteobacteria,αProteobacteria,Bacteroidetes,Ent erobacteria,pseudomonas,desulphurvibrio,Prevotellaceae,Enterobacteria,Pseudomonas,Desul phurvibrio,Prevotellaceae₉,Bacteroidetes,Escherichia coli-Shigella,The relative abundance of Pseudomonas increased significantly（P<0.5）;Serum untargeted metabolomics results showed that 33 different metabolites were found in patients with mixed anxiety and depression disorder compared with the healthy group,among which 11 metabolites increased and 22 metabolites decreased.Compared with the healthy group,phosphatidylcholine（14:1（9Z）/20:0）,3-hydroxy-3-methyl-2-oxybutyric acid increased,Sphingomyelin（D18:0/18:1（11Z））,4-hydroxy-2-oxyhexanoate adipic acid 3,4-dihydroxyphenylpropionate,sphingomyelin（D18:1/18:0）,arachidonic acid,4-pyridoxate mevalonate,levodopa;Decreased metabolites were phosphatidylcholine（14:1（9Z）/22:1（13Z））,lysophosphatidylcholine（16:0）,lysophosphatidylch oline（18:1（11Z））,2-ketocaproic acid,（3R）-3-methyl-2-oxyvalerate,L-octylcarnitine,L-tryptophan,decyl carnitine,compared with the healthy group L-leucine,phosphatidylcholine（14:0/22:1（13 Z））,sphingomyelin（D18:1/22:1（13Z））,lysophosph atidylcholine（20:3（5Z,8Z,11Z））,L-phenylalanine,kandotretrel,3-indoleacrylic acid,L-glutamine,Sphingomyelin（D17:1/24:1（15Z））,lysophosphatidylcholine（16:1（9Z））,ciliat e surface cholestosterone tetrachloropipecide.（2）Experiment 2:Efficacy scale score:Cognitive Enlightened Narrative Therapy group and Yu Pill group,compared with the two groups of patients before treatment:HAMD-17 total score,HAMA total score,SDS standard score,SAS standard score,HAD total score,HAD anxiety score,HAD depression score,AIS total score,FIRST total score,Chinese medicine symptom score were significantly reduced（P<0.01 or P<0.05）;After treatment,HAMD-17 total score,HAMA total score,SDS standard score,SAS standard score,HAD total score,HAD anxiety score,HAD depression score,AIS total score,FIRST total score,TCM symptoms There was no significant difference in scores（P>0.5）.Intestinal microbiota sequencing results:Compared with before and after treatment,the relative abundance of Firmicutes increased and the relative abundance of Bacteroidetes decreased significantly in Cognitive Enlightened Narrative Therapy group（P<0.5）,there was no statistical difference in a diversity before and after treatment,β diversity showed that the structure of intestinal flora after treatment was more similar to that of the healthy group,and the relative abundance of bacteroidetes,Bacteroidetes,and bacteroidetes decreased significantly after treatment（P<0.5）,the relative abundance of Clostridium trichospiraceae,Christenseniaceae,was significantly increased（P<0.5）;Resolve depression pill group comparison before and after the treatment,the treatment after door relatively thick wall bacteria abundance increase Bacteroides door and door relative abundance of deformation is reduced,alpha diversity had no statistical difference before and after the treatment,the beta diversity shows flora structure tend to be more healthy group after treatment,after treatment the lilac MAO spirillum really coli relative abundance of casein aureus anaerobic bacteria increased significantly（P<0.5）.Serum untargeted metabolomics results:Compared with before and after treatment,5 metabolites increased after treatment in Cognitive Enlightened Narrative Therapy group were L-octyl carnitine 5-hydroxyindoleacetic acid 2-ketocaproate hypoxanthine;The decreased metabolites were phosphatidylcholine（14:1（9Z）/22:1（13Z））phosphatidylcholine（14:0/22:1（13Z））adrenalin arachidonic acid D-glucosphingomatidyl（D18:1/22:1（13Z））L-glutamine;The 8 metabolites that increased after treatment in Jieyu Pill group were phosphatidylcholine（14:1（9Z）/22:1（13Z））L-octyl carnitine 2-ketocaproic acid 4-hydroxy-2-oxycaproic acid phosphatidylcholine（14:0/22:1（13Z））（3R）-3-methyl-2-oxyvalerate acid Ciliate cholate;The five metabolites decreased after treatment were 3-hydroxy-3-methyl-2-oxybutyric acid,d-glucose arachidonic acid,D-erythritose,L-glutamine.Conclusions:（1）The intestinal flora diversity of patients with mixed anxiety and depression disorder decreased,the relative abundance of harmful bacteria increased,and the relative abundance of beneficial bacteria decreased,indicating that patients with mixed anxiety and depression disorder intestinal flora imbalance;Patients with mixed anxiety and depression disorder have phenylalanine metabolism,arachidonic acid metabolism,tryptophan metabolism,glycerol phospholipid metabolism,abnormal glutamic acid metabolism,decyl carnitine（3R）-3-methyl-2-oxyvalerate,lysophosphatidylcholine（16:0）.Phosphatidylcholine（14:1（9Z）/20:0）may be a potential biomarker for diagnosis of mixed anxiety and depression disorder.（2）Cognitive Enlightened Narrative Therapy is effective in improving anxiety and depression,insomnia,susceptibility to stress insomnia and somatic symptoms in patients with mixed anxiety and depression,which is comparable to the Chinese medicine Jieyu Pill.（3）After Cognitive Enlightened Narrative Therapy intervention,the relative abundance of beneficial bacteria in the intestinal flora of patients increased,the relative abundance of pathogenic bacteria decreased,the intestinal flora structure was adjusted,and the serum metabolite L-octyl carnitine,5-hydroxyindoleacetic acid was observed.The content of hypoxanthine increased while the content of arachidonic acid decreased,suggesting that psychological intervention,as a beneficial external stimulus,can adjust the intestinal microflora structure of patients,improve energy metabolism and 5-HT synthesis,and reduce oxidative stress and inflammation levels.（4）After treatment with Jie Yu Wan,the number of beneficial bacteria related to the synthesis of short-chain fatty acids in intestinal flora of patients with mixed anxiety and depression disorder increased,the intestinal flora structure was adjusted,and the serum metabolites phosphatidylcholine（14:1（9Z）/22:1（1 3Z））,phosphatidylcholine（14:0/22:1（13Z））,L-octyl carnitine were adjusted.The content rollback of（3R）-3-methyl-2-oxyvalerate.3-hydroxy-3-methyl-2-oxybutyrate.arachidonic acid indicated that Jieyu Pill could play a role by increasing the number of intestinal beneficial bacteria,regulating the metabolism of branched amino acids,glycerol phospholipid,energy,and inflammatory disorders.