| OBJECTIVE To evaluate the effects of cognitive-behavioral therapy ( CBT ) on the quality of life(QOL) in the maintenance hemodialysis(MHD) patients, especially on the psychological function and the subjective life satisfaction.METHODS In the experiment, psychological intervention was performed.Sixty maintenance hemodialysis patients were divided into two groups:the intervention group and the control group,30 patients respectively.All the participants were older than 18 years, who were undergoing MHD, 2-3 times a week, and the duration of MHD was more than 3 months, with the exception of carcinoma, severe body disability, severe psychological problem, eyes or ears disfunction and operation in the last 3 months. Based on the conventional MHD nursing,we performed cognitive-behavioral therapy on the intervention group,including rational emotional therapy (RET) and relaxtion therapy. All the CBT were performed by one researcher,to one patient each time. The intervention was performed once a week to each participant, 40min each time. Meanwhile we just performed conventional MHD nursing on the control group. Thefirst, round of intervention went on for 8 weeks. After a break of 4 weeks, another round of intervention went on for 4 weeks, that was the second one.All the participants were administered the General Information Questionair(self-designed),Self-Rating Depression Scale(SDS), Self-Rating Anxiety Scale(SAS) and the Generic Quality of Life lnventory-74(GQ0LI-74)before the intervention, after the first round of intervention and after the second round. The questionairs are all well-known standardized and have high viability and validity. The original data were put into the computer and the statistical tool was SPSSJO. 0. ANOVA and t-test was used.RESULT 1.After the intervention,the score of SDS,SAS decreased while the score of QOL increased significantly in the intervention group.We evaluted the score of this group before the intervention, after the first round and after the second round. ANOVA indicated severe significant statistic difference(K0. 000) existed among the score of SDS, SAS, QOL-physical function, psychological function,the total score,as well as social function (/K0. 01). But no difference existed in the substantial wealth(P>0. 05). Compare the score after both rounds of intervention, statistic difference existed in SDS, SAS, QOL-physical function and psychological function (/K0. 05, K0. 01, K. 000). Meanwhile ANOVA indicated no difference existed among the score of the control group. For the intervention group, LSD-t test was performed to the twenty factors of QOL before the intervention and after the first round, after the first round and after the second round. Statistic difference(K0. 05, /K0. 01,/*. 000) existed in the factor of sleep and energy, nervous, negative emotion, positive emotion, work or study, entertainment and family life. No statistic difference(/^>0. 05) existed in the factor of sexal activity, movement and awareness, self-esteem, social support. Severe significant difference(KQ. 01,K. UO0)exsited in the factor of the overall evaluation of QOL before and after the intervention.2.No difference existed in the demographic characters between the intervention group and the control group. Meanwhile, before the intervention,there was no difference(P>0. 05) in the score of SDS, SAS, QOL between this two groups. However, after the first round of intervention,statistic difference(PCO. 01, K. 000) came into being in SDS, SAS, QOL-physical function, social function and the total score of QOL. between the two groups, but no difference (f=-0. 787, P=. 435, i=l. 290, /^0.202) existed in the substantial wealth and the psychological function.After the second round of intervention, severe significant difference(fK. 000) emerged in SDS,SAS and the four aspects, with the exception of the substantial wealth, of QOL.3. For the intervention group, after the first and second round of intervention,the objective life status and the subjective life satisfaction was improved greatly. Statistic difference(j°CO. 05) existed in the score of the the objective life status of physical function before and after the first round of intervention, while no statistic difference(P>0. 05) existed in that after the first round of intervention and after the second.Severe significant statistic difference(K0. 01) existed in the score of the objective status of psychological function after the both round of intervention. After the first round of intervention, severe significant difference(/<0.01) existed in the score of the subjective life satisfaction of physical function, psychological function in the contrast of that before the intervention.After the second round of the intervention, statistic difference(￡=2. 433, P=0. 044) existed in the score of the subjective life satisfaction of physical function and severe significant difference(f=-3.567, P=0. 002) existed in that of psychologicalfunction. No statistic difference(P>0. 05) existed in the objective life status and subjective life satisfaction the the substantial wealth and the social function after the both round of intervention.CONCLUSION l.The cognitive-behaviral therapy is a very effective way to improve the quality of life and subjective life satisfaction of the maintenance hemodialysis patients. After the intervention,the score of SDS,SAS decreased and the score of physical function, psychological function,social function and the total score of the quality of life increased significantly.2. Cognitive-behavioral therapy is a very effective way to improve the objective life status and the subjective life satisfaction of the physical function and psychological function of the maintenance hemodialysis patients.3. After the second round of intervention,the score of SDS, SAS decreased and the score of quality of life increased more. So the effect of long term of intervention is better.A long term of intervention should be established to the maintenance hemodialysis patients in the clinical settings.
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