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引导式在线写作练习减少 乳腺癌女性体像相关困扰 我的身体变了（MyCB） ——随机对照研究结果 编者按：体像又称体象、身体意象，是指人对自己身体给予美丑、强弱等的主观评价，即对自己身体外貌特征的感受与评价以及感受到的别人对自己外貌特征的看法。乳腺癌治疗不良反应引起大约三分之一的存活者出现体像相关困扰，可对女性乳腺癌后的康复和生存产生消极影响。 2018年4月24日，美国临床肿瘤学会《临床肿瘤学杂志》在线发表麦考瑞大学心理健康中心、澳大利亚淋巴水肿教育研究治疗中心、悉尼大学威斯密医院、新南威尔士大学利物浦医院、威尔加山私立康复医院的随机对照研究报告，发现引导式在线写作练习可以减少乳腺癌女性体像相关困扰。 我的身体变了（MyCB）属于一种网络心理干预，通过单次在线引导式写作，以自我关怀（又译善待自己、自我同情、自我友善、自我疼惜、自我慈悲、自我悲悯、自我仁慈）取代自怨自艾，改善乳腺癌存活者的体像相关困扰和身体自我评价能力。 该随机对照研究入组I～III期乳腺癌后无病生存并且经历身体变化所致消极事件（例如感到失败、受辱或被拒）女性304例，随机分配至引导式写作组（149例）或宣泄式写作对照组（155例），分析了MyCB对乳腺癌存活者体像相关困扰和身体自我评价的影响，包括对淋巴水肿状态（受累或未受累）和外貌关注（对个人外貌的自我重视）以及自我关怀的调节作用。主要研究结局为干预1周后体像相关困扰的减少和身体自我评价的改善，次要研究结局包括心理困扰（抑郁和焦虑）和自我关怀。写作后1周、1个月和3个月时进行随访评定。 结果，MyCB干预完成率88%，失访率9.2%。根据意向治疗线性混合模型分析表明，引导式写作参与者与宣泄式写作参与者相比：
干预对体像相关困扰的影响调节因素：
自我关怀对两种主要研究结局（体像相关困扰的减少和身体自我评价的改善）均有调节作用。干预后1个月（体像相关困扰和身体自我评价）和3个月（身体自我评价）的治疗效果仍保持。MyCB对于淋巴水肿患者，可使心理困扰显著减少：
因此，该研究结果表明，MyCB对于乳腺癌存活者可以有效减少体像相关困扰并且提高身体自我评价。 自我关怀 自我关怀与关怀他人其实并没有太多区别。回想一下关怀他人的时候你是什么样的感受。首先，你需要注意到他们正深陷痛苦之中。如果你没有注意街上的流浪汉，你不会同情他可能遭遇的困境。其次，关怀意味着你被他人的痛苦打动，于是你的心对这份痛苦做出回应（关怀一词的字面意思是一起受苦）。当遇到这种情况时，你会感到温暖、关爱，并渴望以某种方式帮助苦难的人。关怀也意味着当他人失败或者犯错的时候，你对他们的理解和善意，而不是严厉的评判。最后，当你关怀他人时（而不仅仅是怜悯），这意味着你意识到痛苦、失败和不完美是我们共通人性中的一部分——就和我一样啊！ 自我关怀意味着：当你遇到困难、遭遇失败或开始讨厌自己身上某一点的时候，像对待好朋友那样，用同样支持和理解的方式对待自己。不要咬紧牙关忽略自己的痛苦，你应该停下来告诉自己：现在这种情况真的是很艰难，在这种境遇下，我该如何帮助和安慰自己？自我关怀意味着当遭遇失败时，温柔地对待自己、理解自己，而不是无情地批判自己各种不足和缺点。毕竟，谁说过你一定要是完美的人？你或许尝试许多方法来使自己变得更加健康和快乐，但是只有当你真的关爱自己，而不是认为自己没有价值和不可理喻的时候，这些才可能实现。或许最重要的是，关怀自己意味着你尊重和接纳你本来的样子。生活并不总是如你所想的一帆风顺。你会遇到挫折，会失去、会犯错、会挑战极限、会理想落空。但这就是人类自身的状况，是所有人类都无法改变的现实。你越接纳这个现实，而不是一直抗拒，你就越能关怀自己，也就越能关怀他人的生命旅程。 J Clin Oncol. 2018 Apr 24. [Epub ahead of print] Reducing Body Image-Related Distress in Women With Breast Cancer Using a Structured Online Writing Exercise: Results From the My Changed Body Randomized Controlled Trial. Sherman KA, Przezdziecki A, Alcorso J, Kilby CJ, Elder E, Boyages J, Koelmeyer L, Mackie H. Center for Emotional Health, Macquarie University; Westmead Breast Cancer Institute, Westmead Hospital; Liverpool Cancer Therapy Centre, Liverpool Hospital, and South Western Sydney Clinical School, University of New South Wales; Australian Lymphedema Education, Research, and Treatment Center, Macquarie University; Mt Wilga Lymphedema Center, Mt Wilga Private Hospital, Sydney, New South Wales, Australia. PURPOSE: Breast cancer treatment adverse effects result in one in three survivors experiencing body image-related distress (BID) that negatively impacts on a woman's ability to recover after cancer and into survivorship. My Changed Body (MyCB) is a Web-based psychological intervention to alleviate BID and improve body appreciation in survivors of breast cancer (BCSs) through a single-session, self-compassion focused writing activity. This randomized controlled trial evaluated the impact of MyCB on BID and body appreciation in BCSs. The moderating effect of lymphedema status (affected or unaffected) and appearance investment (self-importance placed on personal appearance) and the mediating effect of self-compassion were evaluated. PATIENTS AND METHODS: Women (disease-free stage I to III BCSs who had experienced at least one negative event related to bodily changes after breast cancer) were randomly assigned to MyCB (n = 149) or an expressive writing control arm (n = 155). Primary outcomes were reduction in BID and improvement in body appreciation 1 week after intervention. Secondary outcomes included psychological distress (depression and anxiety) and self-compassion. Follow-up assessments occurred 1 week, 1 month, and 3 months after writing. RESULTS: Compliance with the MyCB intervention was 88%, and attrition was 9.2%. Intent-to-treat linear mixed models indicated that participants who received MyCB reported significantly less BID (P = .035) and greater body appreciation (P = .004) and self-compassion (P < .001) than expressive writing participants. Intervention effects on BID were moderated by lymphedema status (P = .007) and appearance investment (P = .042). Self-compassion mediated effects on both primary outcomes. Therapeutic effects were maintained at 1 month (BID and body appreciation) and 3 months (body appreciation) after intervention. Significant reductions in psychological distress (1-month depression, P = .001; 1-week and 1-month anxiety, P = .007) were evident for MyCB participants with lymphedema. CONCLUSION: This study supports the efficacy of MyCB for reducing BID and enhancing body appreciation among BCSs. PMID: 29688834 DOI: 10.1200/JCO.2017.76.3318
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