意象思维与躯体化症状：疾病表达的文化心理学途径

意象思维是中国人的传统思维模式, 它通过观物取象和取象比类的方式认知世界、推演联系。这种思维模式塑造了中国人特有的身心不分而非两分的身体观、疾病观和治疗观。在中国人的观念中, 身体不仅仅是一具生理躯体, 还具有气、阴阳、五行等本土概念所体现的弥合物质与精神、联结生理与心理的模糊性与开放性。人们在表达疾病感觉时通常不分生理与心理, 任何一方面出现不适感觉即可认为自己生病, 在面对心理医生时也倾向于同时报告躯体状况与心理感觉, 从而使得临床报告出现较高的躯体化报告率。这正是文化心理影响疾病表达的体现。这也使得疾病不仅是一种医学现象, 也是一种文化现象; 医学不仅需要生理知识, 也需要人文知识。     

中国人的躯体化现象探析

躯体化是一个较为复杂的概念。西方学者往往将其归结为是中国人不善表达情绪的结果。本文就躯体化现象进行了探究,着重分析了导致这一现象的经济、文化、社会因素。最后文章就躯体化进行了更深一步的思考和探索,分析了躯体化本身的适应性意义,以及盲目采用西方诊断方式对医患关系等方面造成的负面影响,从而指出发展本土化治疗的必要性。     

恐惧的代价：疼痛恐惧、心理忧虑和躯体化对疼痛感知预测作用的比较

首次在无痛群体中比较疼痛恐惧、心理忧虑和躯体化对疼痛感知的预测作用大小及调节和中介关系。以多个同类量表得分的Z分数加和作为三者的因子分,以冷压痛觉测验（CPT）疼痛指标（阈限、耐受性、强度、不愉快度）为目标变量,通过分层回归及调节和中介作用分析,发现疼痛恐惧对疼痛不愉快度的预测作用最强,心理忧虑对疼痛体验（强度、不愉快度）的预测作用被疼痛恐惧完全中介,躯体化只有在高疼痛恐惧条件下才显著负向预测疼痛不愉快度。综上,疼痛恐惧是三因素中预测CPT疼痛体验的主要因素。     

躯体化的心身交互机制及其中的文化因素

基于神经生物学的心身交互作用是当前躯体化病理机制的一个研究重点。在生理-心理的功能连续体中, 认知学习、感觉监控、注意、记忆过程等都会影响躯体症状的呈现。文化则会通过这些过程塑造个体对症状的归因和解释, 引发躯体症状的呈现和扩大, 最终通过不同文化特有的民族生理学模式形成具有文化特异性的疑病焦虑和医学无法解释症状。     

书写表达对身心健康的影响

<正>书写表达是一种通过书写行为来披露和表达与个人重要经历有关的感受和想法,以达到促进个体身心健康的心理干预方法,又称书面情感表达、表达式写作等。它强调以书写的方式将情感语言化,进而促进情绪的调节或社会功能的恢复。在过去的30多年里,书写表达逐渐发展为一种较成熟的心理干预方法,越来越多的研究也表明书写内心深处的情绪和想法能够有效改善个体的身体和心理健康状况,     

认知重评阻断条件化恐惧记忆的习得与表达——对恐惧反应的长程抑制作用

情绪调节是人类特有的、并能有效控制个体情绪反应的行为方式,认知重评是其中最有效的调节策略之一。恐惧记忆是参与情绪障碍形成的重要病理机制,且已习得的恐惧反应难消退、易复发。为了考察认知重评能否起到长久抑制恐惧反应的效应,本研究利用条件化恐惧范式,第一天进行条件化恐惧习得训练,并在习得后间隔24 h及31天进行恐惧记忆的表达及自发恢复测试。实验1中,随机将被试分为两组,要求其在恐惧习得过程中进行认知重评或自然感受;在实验2,同样随机将被试分为两组,但要求其在恐惧记忆表达过程中进行认知重评或自然感受。结果发现,习得阶段进行认知重评显著降低了恐惧记忆的习得、表达及自发恢复过程中的SCR水平。同样,表达阶段进行认知重评也降低了此阶段的恐惧水平,且显著抑制了恐惧记忆的自发恢复。结果提示,在面对应激时,个体如果能够成功地利用想象进行认知重评,就有可能避免应激事件对个体的心理或精神造成伤害。     

心智化社会认知观的演变及发展——来自潜心智化的思考

社会认知的机制一直存在心智化与具身认知观点的争论。前者认为社会认知是对心理状态的推测,而后者则认为社会认知是具身实践活动。虽然,心智化研究者认为具身认知有关灵长类动物和婴儿的社会认知的解释可以兼容于内隐心智化,但内隐心智化在解释社会互动时仍然存在间接性的问题。近期,潜心智化理论旨在挑战上述立场中有关社会认知先天论的预设,该理论将个体的潜心智化视为内隐心智化的替代,通过检验与分析相关研究的构想效度,强调社会认知是从非社会性的一般认知功能中衍生而来的,这种立场在社会认知的领域特殊性与非社会认知的领域一般性之间建立起了纽带,从而挑战了心智化与具身认知的争论。未来研究应设计更为严谨的心智化研究方法并对其进行方法学验证,借助先进的技术手段,尝试在神经科学层面探索一般认知功能与社会认知的关系。     

躯体形式障碍的社会心理学分析

本研究对躯体形式障碍患者的社会心理特点进行调查分析.按照中国精神障碍分类与诊断标准第3版（CCMD-3）,试验组躯体形式障碍患者51例,在社区分层抽样51人作为对照组,用防御方式问卷、多伦多述情障碍量表进行测量.试验组不成熟型防御方式明显高于对照组,成熟型防御方式低于对照组,差异有统计学意义;述情障碍总分高于对照组,差异有统计学意义.情绪表达障碍、不成熟心理防御方式和社会文化因素共同作用形成了躯体形式障碍发病机制中的社会心理原因.在预防与治疗中需加强心理干预,以有效预防疾病的发生和提高治疗效果.     

躯体化概念的争议及本土化审视

两种认识躯体化的方式值得关注:一是继发于精神痛苦的现象;一是以医学无法解释的症状为特征的基本现象.躯体化概念受到争议的根本原因,即其基于西方心身二元论的特征.本土背景下,躯体化应理解成一种普遍且正当的求医理由与症状诉说方式,应该更多倾向于临床评估与治疗.     

用生物心理社会医学模式指导疾病的诊治

惊恐障碍作为一种精神科疾病,由于伴有明显的躯体化症状,使大多患者首诊于综合医院非精神科,极易引起该病的误诊误治,同时也浪费了大量的卫生资源。针对这一情况,本期“临床决策研究”栏目中熊新英撰写的“从惊恐障碍看生物心理社会医学模式的必要性和紧迫性”,对于惊恐障碍就诊于综合医院误诊率高的原因及高误诊率导致的后果进行了分析,并提出了相应的对策。作者认为,惊恐障碍属于精神医学范畴,但由于此病患者多突然出现躯体化症状,使患者多到综合医院就诊,     

Strategic and Automatic Threat Processing in Chronic Musculoskeletal Pain: A Startle Probe Investigation

Attentional bias research with chronic pain samples has yielded conflicting results. In the present investigation the startle paradigm was used to test the postulate that fear‐based mechanisms play an important role in attentional biases for pain‐related threat in chronic pain. Participants, including 31 individuals with chronic musculoskeletal pain and 20 healthy controls, completed a startle task designed to measure attention to different types of words (neutral vs sensory pain vs affective pain vs health catastrophe) presented at different levels of cognitive processing (strategic vs automatic). Measures of fear‐based individual difference variables, including anxiety sensitivity and fear of pain, were also completed. Startle amplitudes and latencies to acoustic startle probes that followed word presentations were recorded. Data were analyzed with repeated measures ANOVAs and correlational analysis. Significant between‐group differences were found indicating that, relative to chronic pain participants, healthy controls had higher startle amplitude index scores for health catastrophe words. There was also a trend among patients with chronic pain for greater startle amplitude index scores for strategic presentations of sensory pain words. In the automatic condition, all participants demonstrated a lower startle latency index for sensory words relative to both affect and health catastrophe words, suggesting participants had more difficulty disengaging from affect and health catastrophe words or were more avoidant of sensory words. Correlational analyses indicated that startle response indices for words related to health catastrophe became more pronounced for chronic pain patients as anxiety sensitivity and fear of pain increased. Implications and directions for future research are discussed.     

Strategic and automatic threat processing in chronic musculoskeletal pain: a startle probe investigation

Attentional bias research with chronic pain samples has yielded conflicting results. In the present investigation the startle paradigm was used to test the postulate that fear-based mechanisms play an important role in attentional biases for pain-related threat in chronic pain. Participants, including 31 individuals with chronic musculoskeletal pain and 20 healthy controls, completed a startle task designed to measure attention to different types of words (neutral vs sensory pain vs affective pain vs health catastrophe) presented at different levels of cognitive processing (strategic vs automatic). Measures of fear-based individual difference variables, including anxiety sensitivity and fear of pain, were also completed. Startle amplitudes and latencies to acoustic startle probes that followed word presentations were recorded. Data were analyzed with repeated measures ANOVAs and correlational analysis. Significant between-group differences were found indicating that, relative to chronic pain participants, healthy controls had higher startle amplitude index scores for health catastrophe words. There was also a trend among patients with chronic pain for greater startle amplitude index scores for strategic presentations of sensory pain words. In the automatic condition, all participants demonstrated a lower startle latency index for sensory words relative to both affect and health catastrophe words, suggesting participants had more difficulty disengaging from affect and health catastrophe words or were more avoidant of sensory words. Correlational analyses indicated that startle response indices for words related to health catastrophe became more pronounced for chronic pain patients as anxiety sensitivity and fear of pain increased. Implications and directions for future research are discussed.     

Pilot assessment of pain of orthopaedic patients in Hong Kong

This pilot study examined the internal consistency and concurrent validity of the Chinese version of the Acute Lower Back Pain Screening Questionnaire. A sample of 45 acute low back pain patients (27 men and 18 women; mean age = 47.8) were recruited from the Department of Orthopaedics and Traumatology of the Tuen Mun Hospital in Hong Kong. Three items of the original questionnaire were excluded from the analyses because response was low by 30 of the 45 patients. The questionnaire showed good internal reliability (Cronbach alpha = .88) and correlated significantly with other test scores: the Faces Pain Scale-Revised (alpha = .74), the Chinese (Hong Kong) SF-12 Health Survey (Mental subscale, alpha = -.47; Physical subscale alpha = -.62), and the Chinese Hospital Anxiety and Depression Scale (Anxiety subscale, alpha = .42; Depression subscale, alpha = .43). The questionnaire could be used in research and clinical work to provide data on the multicomponents of a pain experience as well as psychosocial risk factors related to pain among the Chinese. Researchers might examine the course of change in chronic pain.     

“Everybody feels a broken bone,but only we can feel a broken heart”: Group membership influences the perception of targets' suffering

There is surmounting evidence in the literature demonstrating that social pain (e.g. rejection, humiliation, and isolation) and physical pain (e.g. injury or assault) overlap in personal experiences. The present investigation focuses on second‐hand perceptions of social and physical pain. We argue that judgments of others' pain may vary as a function of group membership. By integrating research on intergroup bias in pain judgment with intergroup attributions of humanity, we predicted that observers tend to underestimate social pain more than physical pain in out‐groups compared with in‐groups. Across two studies that considered different scenarios, we found that Italian participants attributed less severe social pain when considering an out‐group (Chinese and Ecuadorian) than an in‐group member. No such effect was found for physical pain. Overall, the current work suggests an additional way through which people preserve a privileged human status to in‐group members while denying out‐group members' humanness. Copyright © 2012 John Wiley & Sons, Ltd.     

急性疼痛与慢性疼痛对奖赏加工的影响及神经机制

疼痛和奖赏能够为个体提供不同的行为动机和主观价值体验,寻求奖赏和避免疼痛对于生存都很重要。疼痛可划分为急性疼痛和慢性疼痛,奖赏可区分为预期阶段的动机成分和体验阶段的享乐成分。奖赏对疼痛的抑制作用已经被广泛证实,但关于疼痛对奖赏的影响,目前的研究结果并不一致。因此需要进一步区分并探究急性疼痛与慢性疼痛对奖赏加工不同阶段的影响,分析两种疼痛对奖赏加工产生不一致影响的现象。这种现象出现的原因可能与急性疼痛向慢性疼痛转变过程中出现的奖赏加工能力缺陷有关。未来可以考虑从改善奖赏加工能力缺陷的角度进行检测和治疗,提前预防急性疼痛向慢性疼痛转变。     

4O例皮肤恶性黑色素瘤患者生存质量的临床分期评价

皮肤恶性黑色素瘤是一种高度恶性的皮肤肿瘤,且转移早、易复发、治疗效果不理想,如何提高患者的生存质量成为医学领域一个重要的课题。本文用EORTCQLQ-C30V3．0中文版量表对40例皮肤恶性黑色素瘤患者的生命质量进行临床分期测评,采用t检验与因子分析法进行比较分析,结果发现I期、Ⅱ期患者积分公因子在疲乏、情绪低落、食欲...     

Temporal summation of pain from radiant stimulation

Latency thresholds of pricking pain, using radiant thermal stimulation, were obtained. Ten Ss were tested for 10 sessions, and, in each session, single latency determinations were made at each of 10 stimulus intensities. Each intensity was administered to a different spot along the volar surface of S’s nonpreferred forearm. Thus, 10 latency thresholds were obtained from each S at. each intensity and each spot. Initial skin temperature was controlled so that a threshold determination was made when skin temperature measured 33.5° ± 0.5° C. Analysis of variance of the log₁₀ t (seconds) values revealed a highly significant linearity of regression of log t on log intensity, thus confirming the hypothesized inverse and exponential relationship between latency and intensity. The parameters (slope and x-intercept) of the curve were discussed. The x-intercept may be interpreted as an index of an aversive threshold and could be used as a possible measure of the physiological component of pain.     

A longitudinal study of pain sensitivity and blood pressure in adolescent boys: results from a 5-year follow-up.

A growing literature has observed a significant reduction in pain sensitivity among hypertensive animals and humans. It is uncertain whether a reduced sensitivity to pain can be observed in nonnotensive individuals who go on to develop high blood pressure. Blood pressure (BP) was reassessed in one hundred fifteen 19-year-old boys initially tested at age 14, when they were also presented with a pain stimulus (mechanical finger pressure). Hierarchical regression analyses indicated that information regarding pain tolerance improved prediction of changes in systolic and diastolic blood pressure beyond that afforded by differences in BP at age 14, parental history of hypertension, and body mass index. These analyses suggest that pain sensitivity may be associated with physiological processes involved in the development of sustained high blood pressure.     

阅读不同颜色中、英文时的眼动特征

采用眼动实验方法,对20名大学生阅读不同颜色中、英文材料时的眼动特征进行考察。结果发现：（1）颜色对中、英文阅读成绩影响趋势一致,红色成绩最好,黄色最差;（2）颜色对被试阅读眼动指标影响差异显著：注视次数上,红色和黑色最多;注视时间上,红色最短;眼跳距离上,黄色最长;注视频率上,黄色最低。     

Effect size indices for analyses of measurement equivalence: understanding the practical importance of differences between groups

Because of the practical, theoretical, and legal implications of differential item functioning (DIF) for organizational assessments, studies of measurement equivalence are a necessary first step before scores can be compared across individuals from different groups. However, commonly recommended criteria for evaluating results from these analyses have several important limitations. The present study proposes an effect size index for confirmatory factor analytic (CFA) studies of measurement equivalence to address 1 of these limitations. The application of this index is illustrated with personality data from American English, Greek, and Chinese samples. Results showed a range of nonequivalence across these samples, and these differences were linked to the observed effects of DIF on the outcomes of the assessment (i.e., group-level mean differences and adverse impact).