儿童青少年强迫症的认知行为理论研究探讨

强迫症已经被认为是儿童青少年常见的心理障碍之一,强迫症的认知行为模型在成人研究中得到了大量的实证支持,但这个模型在儿童青少年群体中研究相对较少.从儿童青少年强迫症的界定及其流行病学调查出发,回顾了强迫症认知行为理论的解释及儿童青少年强迫症认知行为理论实证研究,最后对该理论模型提出了一些建议.     

强迫症的脑功能障碍

近期,对强迫症(OCD)的现象学解释强调了病人在特定情境下错误识别和情绪与动机功能的异常加工。来自神经解剖、神经生理以及近期神经心理和功能成像等的相关研究证据显示：OCD病人眶额皮层（OFC）、前扣带回皮层（ACC）的过度激活可能会导致错误识别功能和对行为结果预期的情绪与动机评价增高;背外侧前额皮层(DLPC)的活动减弱损害了对信息加工的认知整合能力。以上这些皮层信号在控制行为活动程序的尾状核进行整合。OCD病人的强迫性观念和行为可能由这些结构相关的神经网络中一个或多个环节的功能障碍所致     

认知行为疗法治疗儿童青少年强迫症的应用研究

强迫症已经被认为是儿童青少年常见的心理障碍之一。强迫症的认知行为模型在成人研究中得到了大量的实证支持,但这个模型在儿童青少年群体中研究相对较少。认知行为疗法被广泛认为是治疗儿童青少年强迫症的有效心理治疗方案,但对于认知行为治疗儿童青少年强迫症的实证研究还有待进一步深入。     

认知行为疗法治疗儿童青少年强迫症的应用研究

强迫症已经被认为是儿童青少年常见的心理障碍之一.强迫症的认知行为模型在成人研究中得到了大量的实证支持,但这个模型在儿童青少年群体中研究相时较少.认知行为疗法被广泛认为是治疗儿童青少年强迫症的有效心理治疗方案,但对于认知行为治疗儿童青少年强迫症的实证研究还有待进一步深入.     

强迫表象及其心理治疗

什么是强迫表象?强迫症按其内容不同划分,有强迫思想和强迫行为两大类。前者包括强迫观念、强迫回忆、强迫表象等;后者包括反复洗涤(清洁癖)、反复核对检查、反复询问等;也有二者相结合的混合强迫症。 显然,强迫表象属于强迫思想范畴,即患者在一定条件下强迫自己脑中反复出现某种没有意义的形     

调节性匹配理论述评

在决策、动机领域,Higgins（2000）提出了一种新的理论——调节性匹配理论。所谓调节性匹配（regulatoryfit）,指的是个体的自我调节定向与其行为策略之间的匹配。该理论认为,调节性匹配能增强个体在目标追求过程中的动机强度、主观评价和情绪体验,从而对个体的行为决策产生重要影响。文章围绕调节性匹配的概念、产生、效应及应用价值等问题对相关研究进行综述,并在此基础上提出了现有研究存在的问题及未来的研究方向     

认知、动机、情感因素对谈判行为的影响

谈判,指两方或多方就利益不同而进行的协商,是解决选择冲突最常见的方式之一。认知、动机及情感因素,影响谈判者的信息处理与判断推理过程。谈判中它们既可能导致决策偏差,也可能促进决策质量。长期以来着眼于认知过程的谈判研究在社会心理学中占主流地位。近年,动机与情感因素对谈判行为的影响受到越来越多的关注。从社会认知的冷（cold：认知）、热（hot：动机、情感）两个角度,系统解析相关研究近年来的进展与成果,可以为揭示认知、动机、情感间的互动如何影响谈判行为打下基础     

不同趋近动机强度积极情绪对认知控制的影响

情绪的动机维度模型认为, 积极情绪对认知加工的影响受其趋近动机强度的调节, 高、低趋近动机积极情绪对认知加工的影响不同。本研究运用情绪图片诱发被试高、低趋近动机积极情绪, 采用停止信号任务和任务转换作业考察了不同趋近动机强度积极情绪对认知控制的影响。结果发现：(1)与中性条件相比, 高趋近动机积极情绪促进了停止信号任务中Go任务和任务转换作业中重复任务的反应执行。(2)在停止信号任务中, 相对于中性条件, 低趋近动机积极情绪条件下的停止信号反应时显著缩短; 在任务转换作业中, 低趋近动机积极情绪条件下的反应时转换损失和错误率转换损失均显著降低, 而高趋近动机积极情绪条件下的反应时转换损失显著增加。因此, 积极情绪对认知控制的影响受其趋近动机强度的调节, 即低趋近动机积极情绪增强认知灵活性, 提高停止反应与任务转换的速度; 而高趋近动机积极情绪增强认知稳定性, 加快停止信号任务中Go任务和任务转换作业中重复任务的反应执行, 增加了反应时转换损失。     

基于助推的环保行为干预策略

近年来, “助推”被越来越多地用于气候变化与生态环境治理实践, 成为促进人们环保行为的有效策略。但目前国内基于助推思想的环保行为干预研究和实践探索都还很缺乏。环保行为需要助推的根本原因在于人们在环保领域的决策存在认知局限和动机不足。相应的, 在认知和动机两大视角下主要有7种环保行为助推策略。认知视角的助推策略包括默认选项、框架效应和示范性规范, 动机视角的助推策略旨在激发家国动机、遗产动机、获益动机和自主动机以促进人们的环保行为。助推环保行为在实践中也存在争议, 实践工作者需明确助推环保行为的外部环境与传统社会治理思路的关系, 并掌握选择架构设计的技术要点。     

动机性信息加工理论及其在工业与组织心理学中的应用

“团队作为信息加工者的观点”认为, 团队执行复杂任务需要经过一系列认知决策, 哪些信息被共享, 以及信息共享和整合的质量, 共同决定团队效能的高低。动机性信息加工理论则进一步提出, 认知动机和社会动机共同决定了哪些信息被共享, 以及信息共享和整合的质量。认知动机决定信息加工的深度, 社会动机决定信息加工的方向, 两种动机共同决定决策质量。这一理论可以很好地整合谈判和创造力领域的研究结果, 并在团队效能领域得到很好的应用。动机性信息加工理论是对双过程模型和“团队作为信息加工者观点”的发展和整合, 并为决策质量的影响因素提供新的分类框架和研究思路。     

元认知视角下的强迫症的特征、模型及干预

强迫症的元认知模型认为, 元认知是理解强迫症病理的关键。强迫症患者存在错误的元认知知识信念、消极的元认知体验及不恰当使用元认知策略等问题。强迫症的元认知疗法强调思维过程(如自我聚焦注意、对担忧不变的思维风格和威胁调节的注意策略等)的重要性, 而非思维的具体内容, 并在个体心理干预、团体心理干预等研究中显示出较好的疗效。未来研究应从认知神经科学等视角考查强迫症的记忆等元认知特征, 并进一步验证和修正强迫症的元认知模型。     

Inferential confusion in obsessive-compulsive disorder: the inferential confusion questionnaire

The current article represents the further validation of the construct of inferential confusion amongst clinical samples. Inferential confusion is proposed to be a meta-cognitive confusion particularly relevant to obsessive compulsive disorder (OCD) that leads a person to confuse an imagined possibility with an actual probability. As such, it conceptualizes OCD as a form of belief disorder similar to a delusion or overvalued idea that is a product of distorted reasoning processes. In contrast, other cognitive models of OCD emphasize a phobic model of development in OCD, and thus consider the exaggerated interpretation of intrusions as an essential element in OCD. The present study administered a revised version of the Inferential Confusion Questionnaire, and the Obsessive Belief Questionnaire (OBQ), to a total of 183 participants in three clinical groups and a non-clinical control group. Results suggest that OCD, at least in part, follows a non-phobic model of development with inferential confusion significantly related to obsessive-compulsive symptoms independently of cognitive domains as measured by the OBQ, and mood states. Further, scores on inferential confusion were particularly high in those with OCD and delusional disorder as compared to anxious and non-clinical controls.     

Is obsessive-compulsive disorder a disturbance of security motivation? Comment on Szechtman and Woody (2004)

H. Szechtman and E. Woody (2004) proposed that obsessive-compulsive disorder (OCD) is caused by a malfunctioning brain security motivation system. In the current article, the authors' review of the model suggests that it is limited in the following ways: (a) It is built on a selective review of the empirical literature, (b) it offers no explanation for many important OCD phenomena, (c) it fails to distinguish OCD from generalized anxiety disorder, (d) some of the model's predictions are ambiguous or unfalsifiable, and (e) other predictions are refuted by previously published research. Models proposing that OCD is caused by a single dysfunctional mechanism, such as the security motivation model, have difficulty explaining the complexity and heterogeneity of OCD.     

Clarifying the Placement of Obsessive-Compulsive Disorder in the Empirical Structure of Psychopathology

Recent work on the empirical structure of psychopathology has aimed to address some limitations that can arise from traditional categorical classification approaches. This research has focused on modeling patterns of co-occurrence among traditional diagnoses, uncovering a variety of well-validated dimensions (or spectra) of psychopathology, spanning common and uncommon mental disorders. A model integrating these empirically derived spectra (the Hierarchical Taxonomy of Psychopathology; HiTOP) has been proposed. However, the placement of obsessive-compulsive disorder (OCD) within this model remains unclear, as studies have variably found OCD to fit best as part of the Fear, Distress or Thought Disorder spectra. One reason for this may be the heterogeneity of symptoms experienced by individuals with OCD, which is lost when analysing categorical diagnoses. For example, different symptom clusters within OCD—such as washing and contamination versus obsessions and checking—may be differentially associated with different spectra in the HiTOP model. The aim of this study was to test this hypothesis. Data were collected in an anonymous online survey from community participants (n?=?609), largely with elevated symptoms of mental illness, and analyzed in a factor analytic framework treating OCD as a unitary construct and as four separate symptom clusters. The results indicated that OCD and its constituent symptom clusters had significant loadings of varying strength on the Fear and Thought Disorder spectra. These findings suggest that OCD may be best characterized as cross-loading on both the Fear and Thought Disorder spectra, and highlight the importance of accounting for diagnostic heterogeneity in future research.

     

Is thought-action fusion specific to obsessive-compulsive disorder?: a mediating role of negative affect

Thought-action fusion (TAF) is a cognitive bias presumed to underlie the development of obsessional problems (i.e. obsessive-compulsive disorder; OCD). Previous studies have found that TAF is related to not only OCD, but also to other anxiety disorders. In the present study we compared levels of TAF in OCD patients and in patients with other anxiety disorders, depression, and healthy controls to examine whether TAF is characteristic of individuals with emotional distress in general, as opposed to anxiety disorders per se. We also examined whether negative affect (i.e. anxiety and depression) mediates the relationship between OCD and TAF. Results indicated that OCD patients were characterized by higher scores on likelihood-self and likelihood-other TAF, but that this difference was predominately due to differences in negative affect. These findings support a model in which negative affect mediates the relationship between OCD and TAF.     

Comparative neuropsychology of adult obsessive-compulsive disorder and attention deficit/hyperactivity disorder: Implications for a novel executive overload model of OCD

Research implicates frontostriatal pathophysiology in both attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Nevertheless, ADHD is characterized with frontostriatal hypoactivity and OCD with hyperactivity. Furthermore, both disorders seem to lie on opposite ends of a clinical impulsive-compulsive continuum. While never having directly been compared, and despite these differences, OCD and ADHD appear to share similar neuropsychological impairments especially in executive functions. This study aimed at comparing adults with OCD and adults with ADHD on neuropsychological measures and behavioural impulsivity and OC measures. Thirty OCD, 30 ADHD, and 30 matched healthy control (HC) participants were administered a comprehensive neuropsychological battery and completed several questionnaires. The groups were compared on all neuropsychological and clinical measures and correlations between neuropsychological and clinical symptoms were computed. The ADHD and OCD groups performed more poorly than HC on all neuropsychological domains and most domain subtests. The ADHD group reported significantly higher impulsivity than the OCD group. OCD patients did not differ from HC on behavioural impulsivity. A unique dissociation was found between impulsivity and response inhibition where both clinical groups showed similar response inhibition deficit, but differed significantly on impulsivity. Moreover, a negative association between OC symptoms and response inhibition and a bias in self-perception of impulsivity was found only in the OCD group. We propose an executive overload model of OCD that views neuropsychological impairments in OCD as an epiphenomenon, according to which continuous attempts to control automatic processes are associated with obsessive thoughts overflow that causes an overload on the executive system.     

Inference processes in Obsessive-Compulsive Disorder: Some clinical observations

In this paper we outline a cognitive model of Obsessive-Compulsive Disorder (OCD) which proposes that the core belief of OCD evolves through a series of illogical inferences. These faulty inference processes involve inferring the plausibility of events on the basis of irrelevant associations, dismissing actual evidence on the grounds of going beyond surface reality to a deeper reality, and finally inferring that a completely fictional narrative is a remote probability. A therapy aimed specifically at changing these inference processes is illustrated with case examples of OCD clients who had not benefited from conventional behavior therapy. The inference based approach (IBA) complements existing cognitive-behavioral therapy but suggests that in certain cases, the conventional cognitive therapy view of OCD beliefs as exaggerated fears of remote possibilities may actually reinforce the obsessional belief since even remote events are real. The IBA on the contrary suggests that an important goal in therapy is to highlight this confusion found in OCD between imagination and reality and illuminate for the OCD client how their compulsions, far from reassuring them about a remote possibility, actually take them further away from reality and reinforce their imaginary doubt.     

Psychostimulant-induced behavior as an animal model of obsessive-compulsive disorder: an ethological approach to the form of compulsive rituals

Rats treated chronically with the D2/D3 dopamine receptor agonist quinpirole show a pattern of behavior that meets a set of ethologically derived criteria of compulsive behavior in obsessive-compulsive disorder (OCD). Moreover, in both quinpirole-treated rats and OCD patients, the structure of compulsive rituals appear similar in being composed of relatively few motor acts that are organized in a flexible yet recurrent manner. In addition, the development of compulsive behavior in quinpirole-treated rats is attenuated by the OCD pharmacotherapeutic drug clomipramine. These similarities support the validity of quinpirole-treated rats as a psychostimulant-induced animal model of OCD. Considering that the induction of compulsive behavior in the rat model involves chronic hyperstimulation of dopamine receptors, this raises the possibility that dopaminergic mechanisms may play a role in OCD, at least in some subtypes of this disorder.     

Attenuated Access to Emotions in Obsessive-Compulsive Disorder

The Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) posits that OCD is associated with attenuated access to internal states. Here we explored the implications of this model in the realm of emotions. Participants with OCD, anxiety disorders, and nonclinical control participants completed the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), assessing two domains of emotional intelligence: Experiential emotional intelligence (EI), reflecting the ability to perceive and feel emotions accurately, and Strategic EI, reflecting the ability to understand and manage emotions correctly. As only Experiential EI requires accurate perception of one’s emotions for adequate performance, we predicted an interaction between group and EI area. Specifically, we predicted that compared to both anxiety disorders and healthy control participants, OCD participants would show a larger deficit in Experiential area of the MSCEIT relative to the Strategic area. Results were fully in line with this prediction. Moreover, supporting the specificity of the hypothesized deficit to OCD, participants with anxiety disorders did not differ from nonclinical control participants in their performance, and findings were not attributable to anxiety or depression levels. These results replicate and extend previous findings obtained with analogue samples and suggest that OCD is associated with attenuated access to emotional states, which may be partially compensated for by reliance on semantic knowledge of emotion.     

Predictors of treatment outcome for youth receiving intensive residential treatment for obsessive–compulsive disorder (OCD)

ABSTRACT

Little is known about the predictors of outcome from intensive residential treatment of OCD. This study aimed to examine age, gender, and baseline OCD severity, as well as measures of comorbid anxiety and depressive, internalizing/externalizing, and inattention symptoms, as predictors of treatment outcome in adolescents receiving intensive residential treatment for OCD.

The sample comprised 314 adolescents aged 13–17 years with treatment-resistant OCD and a Children’s Yale–Brown Obsessive–Compulsive Scale Self-Report (CY-BOCS-SR) total score ≥16. Bivariate and multiple regression models were used to evaluate the predictors of continuous OCD severity outcome and treatment response.

Results of the bivariate regression analyses of predictors demonstrated that length of treatment, pre-treatment OCD severity, and symptoms of anxiety and depression significantly predicted post-treatment OCD severity, while only symptoms of depression and anxiety predicted treatment response. When including all predictors in the same model, only baseline OCD severity remained a significant predictor of post-treatment OCD severity, and none of the assessed variables significantly predicted treatment response.

Results indicate that low pre-treatment OCD severity predicts lower OCD severity following treatment, although it did not predict treatment response.