Objective:
This study examines how short-course Embodied Imagination therapy is used to treat acute coronary syndrome patients paired with depression in a clinical setting, as well as to determine whether it improves patients' mood, their somatic symptoms and their quality of life, with the aim of exploring effective psychological intervention models for those suffering from psychosomatic conditions.
Methods:
1. There were a total of 30 patients in Study 1 who, between September 2020 and March 2022, attended outpatient clinics of cardiology departments at two hospitals in Beijing with acute coronary syndrome and mild to moderate depression. They were randomly assigned to either the Embodied Imagination treatment group (30 cases) or the medication treatment group (30 cases) based on the results of a randomized, controlled, non-inferiority experimental design. Embodied imagination was given to patients in the Embodied Imagination group, along with conventional cardiology medication, for eight weeks, twice a week, in addition to conventional cardiology treatment. In the drug group, the antidepressant sertraline was given orally in addition to the conventional cardiology treatment. The Hamilton Depression Scale (HAMD-17), Hamilton Anxiety Inventory (HAMA), Seattle Angina Scale (SAQ), and Medical Coping Questionnaire (MCMQ) were used for assessment before treatment, after 4 and 8 weeks of treatment, and at the follow-up visit at the end of 24 weeks, respectively, to detect heart rate variability (HRV), and to record adverse effects and cardiovascular events. Statistical analysis was used to compare the differences between groups and within groups, to verify the psychosomatic efficacy of Imagery Embodiment therapy in patients with acute coronary syndrome, to test whether the efficacy was not inferior to the antidepressant sertraline, and to analyze its superior treatment dimension.
2. Using a case study approach to collect process data and to investigate in depth the mechanism of change in the Embodied Imagination therapy model.
Results:
1. Embodied Imagination treatment improved depression, anxiety, insomnia, and concomitant somatic symptoms in patients with acute coronary syndrome combined with depression. The study showed that antidepressant medication had a faster onset of action early in treatment (at the end of 4 weeks of treatment) and that the short-term efficacy of the medication was better than that of Embodied Imagination treatment. However, at the end of treatment (8 weekends of treatment) and at the six-month follow-up, there was no significant difference in the improvement of depression, anxiety, and concomitant symptoms between the two groups.
2. Statistical analysis of the scores of the five dimensions of the Seattle Angina Scale showed that the scores of the five dimensions of limitation of physical activity, stable state of angina, frequency of angina attacks, satisfaction with treatment and disease perception increased in both groups at 4 weeks, 8 weeks and 24 weeks follow-up of the intervention, and further comparison revealed that the Embodied Imagination group had higher scores in the disease perception dimension, at The scores at 4 weeks, 8 weeks and 24 weeks follow-up of the intervention were statistically higher in the Embodied Imagination group than in the drug group. Both Embodied Imagination treatment and antidepressant treatment improved functional status and quality of life in patients with acute coronary syndrome while relieving mood. Patients in the Embodied Imagination group had significantly better outcomes than the medication group in the disease perception dimension.
3. Embodied Imagination treatment can help patients to cope with the disease less negatively and more confrontation with the disease, which is beneficial to the prognosis of the disease. After 8 weeks of treatment, the Embodied Imagination group showed a significant decrease in "avoidance" coping and a significant increase in "confrontation" coping compared to the medication group. This difference persisted at the six-month follow-up.
4.Compared with baseline, there was no significant change on heart rate variability(HRV) after 4 weeks of Embodied Imagination treatment . However, the values of SDNN, SDANN, RMSSD, PNN50 were significantly higher at the end of 8 weeks and at the six-month follow-up, and the LF value decreased significantly , which were generally consistent with the trend of the drug group, indicating that both interventions had similar effects on heart rate variability in patients with acute coronary syndrome. The effects of both interventions on HRV in patients with acute coronary syndrome were similar.
5.The non-inferiority test with the HAMD-17 scale score at the end of 8 weeks showed a non-inferiority threshold of 3.2, which was statistically significant, and the antidepressant efficacy of Embodied Imagination was not inferior to that of antidepressants in patients with acute coronary syndrome combined with depression.
6. There was no statistically significant difference between the two groups in terms of re-vascularization, non-fatal myocardial infarction, heart failure, and overall cardiovascular events.
Conclusion:
Embodied Imagination treatment has a definite intervention effect on patients with acute coronary syndrome combined with depression, and the efficacy is not inferior to antidepressant medication. Embodied Imagination treatment can improve the prognosis of patients with acute coronary syndrome, reduce the incidence of cardiovascular events, and improve the functional status and quality of life of patients while alleviating their emotional problems. Embodied Imagination treatment can interfere with the deep psychological factors of the treatment, reduce the patient's "avoidance" response, and may affect the long-term prognosis of patients with coronary syndromes by influencing the arousal of the autonomic hypothalamic-pituitary-adrenergic axis (HPA), which in turn affects the sympathetic and parasympathetic tone of the heart.
Through a detailed analysis of the short course of Embodied Imagination, we explore the healing path and alters mechanisms of psychotherapy for psychosomatic disorders. In the treatment, the case is first asked to identify the physical discomfort and to identify the cardiac and psychological sources of the symptoms. Through the perspective-shifting technique, the dreamer expands the usual obsessive "I" and has more experience from a non-dominant perspective in the treatment. In addition, with the emergence of imagery, past experiences are awakened, memories repressed in the body are recalled, and new memories are formed by comparing and integrating multiple bodily sensations, and traumatic bodily memories are dissolved. The body, as a mind-body network, becomes a holding place for spiritual materials, constantly adapting to its surroundings, making adjustments, and achieving mind-body healing effects.
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