抑郁症认知治疗理论及实践进展

认知治疗分化为认知行为与认知分析治疗两个流派.抑郁的贝克认知模型、归因模型、自我价值关联模型以及抑郁的注意过程等认知理论为认知治疗奠定了基础.认知行为治疗、认知行为分析系统心理治疗以及基于冥想的认知治疗等已经在实践中被较有力的临床证据检验.认知治疗在抑郁症的治疗中已显示出广泛的应用前景.     

抑郁的内隐认知与治疗

认知模型认为抑郁个体存在认知加工的偏向,但是,相对于外显认知,抑郁的内隐认知研究较少。现有研究表明：抑郁个体沉迷于特定的内隐认知偏向：抑郁个体倾向于注意环境中的负性刺激;在概念驱动内隐记忆测验中表现出偏向;更可能呈现出无望感的内隐态度。内隐认知可能是抑郁个体维持抑郁的重要因素,在治疗中,可采用知觉内隐认知、扩展功能失调思维记录、记忆日志和增进注意控制等认知技术改变抑郁患者的内隐认知偏向。     

失眠的自助式认知行为治疗元分析:疗效、影响因素及证据评价

通过元分析评估自助式失眠认知行为治疗的疗效,考察疗效影响因素,并评价证据质量。元分析共纳入35篇文献,研究发现:(1)自助式失眠认知行为治疗在治疗结束时对睡眠效率、入睡潜伏期、入睡后醒来时长、睡眠总时间、睡眠质量、抑郁和焦虑的效果量分别为0.66、-0.52、-0.47、0.20、0.34、-0.32和-0.33。(2)自助式失眠认知行为治疗与面对面失眠认知行为治疗疗效同等;自助式失眠认知行为治疗疗效显著优于最小化治疗和药物治疗。(3)共病情况与支持形式对疗效有显著影响。证据质量评价表明睡眠效率、入睡后醒来时长、睡眠总时间、抑郁和焦虑5项指标的证据质量为中等,真实值可能接近于估计值;入睡潜伏期与睡眠质量为低,真实值与估计值可能存在着差异。     

认知疗法对服刑人员的心理咨询

黄犯,男,28岁,因"情绪低落、失眠多梦、感到对前途无望"主动要求心理援助。本案例诊断为一般心理问题。采用认知行为治疗,经过四次的心理咨询,加强了对抑郁的认知,配合精神科的药物治疗,抑郁情绪基本缓解,消极行为和想法基本消失,工作、生活能力提高。SDS、测评结果达到正常范围。     

认知行为治疗对老年抑郁症病人的生活质量影响研究

将200例老年抑郁患者随机分为研究组和对照组.研究组认知行为治疗联合药物治疗,对照组单纯药物治疗.治疗前后进行CRI、SDSS、GAF等量表评定.6个月后,两组在大体功能、生活满意度、应对方式等方面有显著性差异(P<0.01).认知行为治疗有效改善老年抑郁症病人的应对方式,提高患者的生活满意度.     

认知行为治疗对老年抑郁症病人的生活质量影响研究

将200例老年抑郁患者随机分为研究组和对照组。研究组认知行为治疗联合药物治疗,对照组单纯药物治疗。治疗前后进行CRI、SDSS、GAF等量表评定。6个月后,两组在大体功能、生活满意度、应对方式等方面有显著性差异（P〈0．01）。认知行为治疗有效改善老年抑郁症病人的应对方式,提高患者的生活满意度。     

抑郁反刍的认知神经机制

抑郁反刍是指个体把注意力集中在抑郁症状以及这些症状含意的行为和想法, 包含反复思虑抑郁症状、抑郁的可能原因、以及抑郁可能引起的后果。抑郁反刍主要表现出对负性信息过度关注、认知控制缺陷以及非适应性的自我参照加工等认知特点。基于这些特点, 近期脑成像研究发现, 抑郁反刍主要与杏仁核、前额叶以及默认网络等脑区或神经网络有关。未来应在不同亚型抑郁反刍的神经机制、基因以及开发有效的干预技术与方法等方面展开深入研究。     

认知行为治疗的生物学机制

现阶段认知行为治疗的生物学机制尚不明确。本文将从脑功能、神经电生理、神经内分泌与免疫以及遗传与表观遗传这四个方面对认知行为治疗的生物学机制进行讨论, 综合心理、生理和遗传三方面的结果, 从微观、中间和宏观多层面提出了认知行为治疗生物学机制的整合模型。并进一步对目前研究的局限性进行了讨论, 为未来探究认知行为治疗的生物学机制提供了新的方向。     

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。     

无望与希望：从认知方式看无望抑郁的风险和恢复

由于视角和侧重点的差异, 无望抑郁认知研究基本上可以分为两大取向。一是以认知易感-压力模型为核心, 围绕“无望”展开的病因学研究, 关注认知危险因素、消极生活事件与无望以及抑郁风险之间的关系。二是以恢复模型为核心, 围绕重获“希望”展开的无望抑郁恢复研究, 关注认知保护因素、积极生活事件与重获希望以及抑郁缓解之间的关系。厘清一些相关问题、整合两个研究取向有利于准确评估个体无望抑郁的风险和弹性恢复。     

Cognitive Reappraisal

A central tenet of Beck’s cognitive therapy (or cognitive behavior therapy) of the emotional disorders is that change in negative thought and beliefs is necessary for clinically significant symptom reduction in anxiety, depression, and other psychological conditions. Cognitive restructuring, a uniquely Beckian innovation, is a treatment strategy that directly targets cognitive reappraisal as the change mechanism responsible for symptom reduction. This commentary considers the origins of cognitive reappraisal in Beck’s cognitive therapy through the lens of cognitive restructuring and what treatment process research tells us about the mechanisms of change in cognitive restructuring.     

Strategies included in cognitive behavioral therapy programs to treat internalized disorders: a systematic review

This review aimed to identify the strategies used in programs based on cognitive behavioral therapy (CBT) to prevent and treat symptoms of anxiety, depression, and internalized behaviors of children and adolescents. Based on an online search (ERIC, PsycInfo, Virtuose UQAM, and Google Scholar), 61 studies describing different cognitive behavioral programs were selected. Results showed that 40 strategies were implemented in at least one program. However, none of the strategies were systematically present in all programs, and only few were reported in more than 50% of the studies. Cognitive restructuring and problem-solving were the most popular strategies to treat depressive symptoms, whereas anxiety programs also generally included relaxation and exposure. Furthermore, six strategies were identified in a single anxiety program, whereas nine strategies were implemented in only one depression program. These results suggest that in anxiety and depression programs designed for children and adolescents, the label “CBT” encompasses a wide variety of programs with only few similar strategies. Such findings highlight the need to define a common basis for CBT programs, in order to better reflect CBT theory and to identify the effectiveness of the strategies included in these programs.     

Bridging the Theory-Practice Gap by Getting Even Bolder With the Boulder Model

Cognitive behavioral therapy is an effective treatment for virtually all psychiatric disorders. However, very few patients have access to it and few therapists are trained in the theory and practice of cognitive behavioral therapy. Based on the existing evidence and the articles of this series, the following recommendations are made: (a) all mental health care providers (including Psy.D. and social workers) need to be trained in the practice and theories of empirically supported treatments, specifically cognitive behavioral therapy; (b) clinical practice also needs to be based on theory, not just treatment manuals; and (c) psychological treatments have to move beyond the DSM boundaries.     

The Transportability and Utility of Cognitive Therapy in South African Contexts: A Review

Cognitive therapy could be more widely promoted in South Africa given the great disparity between the need and provision of psychological therapies. Three possible objections to the promotion of cognitive therapy are considered: uncertainty surrounding the effectiveness of cognitive therapy in South African contexts; uncertainty surrounding the applicability in multicultural contexts; and suggestions that cognitive therapy is decontextualised and therefore objectionable in a country facing major social challenges. A systematic review of the literature indentified 15 outcome studies, and suggests that cognitive therapy is a viable and much-needed approach in South Africa.     

Effectiveness of cognitive behavioral therapy on the signs,symptoms and clinical consequences of premature ejaculation

The purpose of this research was to assess the effectiveness of cognitive behavioral therapy (CBT) on the signs, symptoms, and clinical‐sexual consequences of premature ejaculation, including sexual esteem, sexual anxiety, sexual depression, sexual fear, and sexual satisfaction of patients and their wives. Fifteen patients with premature ejaculation were selected and received cognitive behavioral therapy of eight to 12 sessions. Finally, the data collected from 12 patients were analyzed using paired t‐tests. The results of the analysis showed that all of the variables changed after the treatment. All of the changes were statistically significant with a tendency towards improvement. CBT can be a more popular and effective treatment provided to patients suffering from premature ejaculation.     

A Cognitive-Behavioral Approach to Family Therapy

Although cognitive behavioral spectrum approaches with individual children are plentiful and demonstrate effectiveness, cognitive behaviorally oriented clinicians are frequently left to their own devices when it comes to treating families. Cognitive behavioral family therapy is a relatively recent development and there are precious few reports of its clinical use. This article presents a conceptual foundation and clinical rubrics for the practice of cognitive behavioral family therapy. Basic theoretical background information is presented and places the therapeutic processes and procedures in a proper context. Session structure in cognitive behavioral therapy is illustrated and the way it propels therapeutic momentum and adds focus to each session is explained. Rudimentary processes of self-monitoring, self-instruction, rational analysis, and behavioral enactment are described and augmented with case material. Finally, the conclusion offers directions for further theory building, research, and clinical practice.     

The neuropsychology of depression and its implications for cognitive therapy

The past few years have witnessed a growing interest in the specialty of neuropsychology as well as continued support for cognitive therapy of depression. The purpose of this paper is the examination of the neuropsychology of depression and its implications for A. T. Beck's cognitive theory and therapy of depression ([1963] Thinking and Depression: Idiosyncratic Content and Cognitive Distortions,Archives of General Psychiatry, Vol. 9, pp. 324–333; [1964] Thinking and Depression,Archives of General Psychiatry, Vol. 10, pp. 561–571; [1967]Depression: Clinical, Experimental, and Theoretical Aspects, New York: Harper & Row). Specifically, the neuropsychological and cognitive theory and therapy literatures related to depression are reviewed followed by an antegration of these areas. Neuropsychological evidence is presented that both supports cognitive theory and therapy of depression and helps explain why such therapy may prove ineffective in treating depression. Implications for clinical practice, including neuropsychological assessment of depressives, and potential future research directions are also provided.     

Individually tailored internet-based cognitive behaviour therapy for older adults with anxiety and depression: a randomised controlled trial

Mixed anxiety and depression is common among older adults. The aim of the study was to compare the effects of an eight-week-long tailored internet-supported cognitive behaviour therapy (ICBT) programme and to compare against the provision of weekly general support. A second aim was to investigate if pre-treatment cognitive flexibility and self-reported cognitive problems would predict outcome. We included 66 older adults (aged over 60 years) with mixed anxiety/depression following media recruitment and randomised them into treatment and control groups. We also included a one-year follow-up. As a measure of executive function, we used the Wisconsin Card Sorting Test (perseverative errors) and the Cognitive Failures Questionnaire during the pre-treatment phase. Results showed a moderate between-group effect on the main outcome measure, the Beck Anxiety Inventory (BAI) (d= .50), favouring the treatment group. Nearly half (45.5%) of that group were classified as responders. One person (3%) in the treatment group deteriorated. There were significant correlations between perseverative errors and outcome (on the BAI r = ?.45), but not among self-reported cognitive function. We conclude that guided, tailored ICBT may be effective for some older adults and that the role of cognitive function needs to be investigated further.     

一种认知分析心理治疗模式对抑郁症患者的干预

为了探索基于"自我"与感受、需要、能力和角色交互相整合的认知分析心理治疗模式及其在抑郁症患者治疗中的效果,对7例门诊和8例住院抑郁症患者进行心理治疗,采用HAMD和CGI-GI评估治疗的效果,并追踪治疗1年后患者的社会功能及健康状况。所有患者治疗前后HAMD分值差异显著,配对t=8.08(P0.01),门诊与住院治疗患者HAMD分值和CGI-GI分值均无明显差异(P0.05),但产生治疗有效的平均时间差异显著,住院者(11.6±3.6)天,门诊者(60.6±25.0)天(P0.01)。该心理治疗模型能够整合到抑郁症患者的药物治疗中,产生整体治疗效果。