中学生创伤后成长、创伤后应激障碍的发展趋势:心理复原力的预测效应

以问卷调查的方法对汶川震后初一年级的学生进行2.5年的追踪研究,通过多层线性模型(HLM)来探索创伤后成长(PTG)和创伤后应激障碍(PTSD)的发展趋势以及心理复原力对二者的预测效应。结果发现,随着时间的发展,心理复原力仅在第二次施测时呈显著下降趋势,PTSD与PTG均呈现出先下降后上升的非线性发展趋势;心理复原力的三个因子对PTG均有显著的正向预测作用,力量因子对PTSD有显著负向预测作用,其中,乐观因子可进一步预测PTG的发展速度,力量因子可进一步预测PTSD的发展速度;在灾后中学生PTG的增长、PTSD的降低中,心理复原力可以分别解释18.87%和14.74%的变异。     

震后儿童创伤后应激障碍的症状网络演化

本研究借助网络分析方法,探讨儿童创伤后应激障碍(PTSD)症状的演化规律。以经历汶川地震的197名儿童为研究对象,在灾后4、29、40和52个月对其PTSD症状进行了历时4年的追踪测量。网络分析结果显示,闪回的中心性一直较高,而其他高中心性的症状随时间的推移发生了变化：侵入性想法和创伤线索引发生理性反应的中心性随时间推移呈上升趋势,线索引发情感反应和未来无望的中心性随时间推移呈下降趋势。本研究拓宽了学界对儿童PTSD症状学的认识, 并为建立灾后阶段性干预模式提供启示。     

创伤后应激障碍患者的正念疗法

本文回顾了正念干预在创伤后应激障碍(PTSD)领域的应用进展,分析了正念疗法的核心内容、作用机制,创伤后应激障碍患者正念干预具体实施过程及身心干预效果。分析表明,作为辅助药物治疗方式可降低创伤后应激障碍患者创伤后应激症状阳性率,调节皮质醇水平,缓解疼痛与疲乏症状,改善认知功能障碍、心理健康及情绪调节,以提高PTSD患者正念水平及生存质量,目前对于单纯用药疗效差的PTSD患者,正念疗法作为辅助治疗手段来解决其PTSD是非常有益的尝试。     

地震对灾民创伤后应激障碍的长期影响

创伤后应激障碍是震后最常见的心理创伤。以往研究多关注灾民在震后短时间内的应激反应, 地震两年后创伤心理研究非常缺乏。本研究拟结合汶川地震后进行的6次重复测量数据(2008~2016)重点探讨：创伤后应激障碍在震后不同时点的变化轨迹及影响因素; 震后针对创伤后应激障碍在不同时点的干预内容。预期研究成果不仅是对灾后心理创伤长期影响研究的补充, 也将为灾后救助政策以及心理干预提供依据。     

创伤后应激障碍的民族差异问题

创伤后应激障碍(PTSD)的民族差异主要体现在少数民族PTSD的发生率较高和症状反应与症状结构的差异。以美国代表的西方国家的研究表明, 这些差异主要是源于暴露水平、少数民族的社会地位以及不同的文化背景。汶川地震后, 有研究也发现羌族PTSD发生率高于汉族, 然而对于羌汉民族间症状反应的具体差异及其原因, 还并不十分明确。因此, 有必要在中国进行PTSD民族差异系统深入的研究, 这既有助于灾后心理援助工作更加有针对性的开展, 也能够为从东方文化视角下理解PTSD提供理论依据。     

调控去甲肾上腺素能系统对防治创伤后应激障碍的影响

个体经历严重创伤性事件后可能会形成创伤后应激障碍(posttraumatic stress disorder, PTSD)。在创伤经历中形成的情绪记忆是以后发展为PTSD的重要病理机制。PTSD的形成涉及到情绪记忆的过度巩固, 而去甲肾上腺素能神经信号可增强情绪记忆的巩固和再巩固。因此, 在创伤记忆的巩固和再巩固期间阻断去甲肾上腺素能神经信号, 而在创伤记忆的消退期间增强去甲肾上腺素能神经信号, 可能会破坏和或抑制病理性的情绪记忆, 从而预防或治疗PTSD。     

表达性写作应用于社会灾难时期心理救援的理论探讨

疫情等社会灾难时期, 创伤经历者急剧增加, 加之交通阻断, 传统的心理救援很难及时应对大范围的灾民心理危机; 而表达性写作便于心理学工作者大规模实施, 且可通过电话、网络等远程通讯工具进行指导, 治疗PTSD等心理创伤, 改善生理、心理健康。社会灾难时期表达性写作的机制复杂, 涉及暴露脱敏、意义重建、自我抽离—自我调节、工作记忆优化和认知神经机制正常化; 其疗效受到作者特质、干预时间和写作形式等潜在因素的影响。相应地, 未来应结合本土社会文化因素, 重视在线干预研究, 探索表达性写作相关的认知神经机制, 综合不同的生理、心理健康指标评估表达性写作的疗效。     

青少年的自我同情对创伤后应激障碍与创伤后成长的影响:感恩的中介作用

采用自我同情量表、感恩问卷、创伤后应激障碍症状核查表和创伤后成长问卷对雅安地震4.5年后的499名中学生进行调查,以考察自我同情对创伤后应激障碍(PTSD)和创伤后成长(PTG)的影响,并检验感恩在其间的中介作用。结果发现,积极自我同情可以直接负向预测PTSD、正向预测PTG,消极自我同情可以直接正向预测PTSD;积极自我同情可以通过感恩负向预测PTSD、正向预测PTG,消极自我同情可以通过感恩正向预测PTSD、负向预测PTG。研究显示,积极的自我同情可以缓解青少年的PTSD、促进PTG的发展,而消极自我同情会加重青少年的PTSD;感恩在自我同情与PTSD和PTG之间发挥了显著的中介作用。     

青少年的情绪调节策略对创伤后应激障碍和创伤后成长的影响:社会支持的调节作用

为了考察雅安地震后青少年的情绪调节策略、社会支持与创伤后应激障碍(PTSD)和创伤后成长(PTG)之间的关系,采用创伤暴露程度问卷、情绪调节策略问卷、社会支持问卷、儿童创伤后应激障碍症状量表和创伤后成长问卷对雅安市芦山县的315名中学生进行调查,结果发现:创伤暴露程度对认知重评和表达抑制的预测作用不显著,对PTSD和PTG具有显著的正向预测作用。青少年的认知重评策略可以显著地负向预测PTSD、正向预测PTG,表达抑制策略仅对PTSD有显著的正向预测作用、对PTG的预测作用不显著;社会支持可以显著地调节表达抑制策略对PTSD和PTG的作用,表现为表达抑制对PTSD的正向预测作用随着社会支持的增加而降低,并可随着社会支持的增加而对PTG发挥促进作用。     

小学生创伤后应激障碍对睡眠问题的影响:积极认知的调节作用

本研究采用创伤暴露程度问卷、儿童创伤后应激障碍症状量表、应对方式问卷和儿童行为问题核查表对汶川地震30个月后844名小学生进行调查,探讨汶川地震后小学生的创伤后应激障碍(PTSD)、积极认知与睡眠问题之间的关系。结果表明,PTSD对睡眠问题具有正向预测作用,积极认知对睡眠问题的预测作用不显著。调节效应的检验结果发现,积极认知调节着PTSD及其回避性症状对睡眠问题的影响,具体表现为PTSD及其回避性症状对睡眠问题的预测作用随着积极认知水平的增加而降低,但是积极认知分别在PTSD的闯入性症状和警觉性增高症状与睡眠问题的关系之间不起调节作用。     

Clinical Decision-Making Following Disasters: Efficient Identification of PTSD Risk in Adolescents

The present study aimed to utilize a Receiver Operating Characteristic (ROC) approach in order to improve clinical decision-making for adolescents at risk for the development of psychopathology in the aftermath of a natural disaster. Specifically we assessed theoretically-driven individual, interpersonal, and event-related vulnerability factors to determine which indices were most accurate in forecasting PTSD. Furthermore, we aimed to translate these etiological findings by identifying clinical cut-off recommendations for relevant vulnerability factors. Our study consisted of structured phone-based clinical interviews with 2000 adolescent-parent dyads living within a 5-mile radius of tornados that devastated Joplin, MO, and northern Alabama in Spring 2011. Demographics, tornado incident characteristics, prior trauma, mental health, and family support and conflict were assessed. A subset of youth completed two behavioral assessment tasks online to assess distress tolerance and risk-taking behavior. ROC analyses indicated four variables that significantly improved PTSD diagnostic efficiency: Lifetime depression (AUC = .90), trauma history (AUC = .76), social support (AUC = .70), and family conflict (AUC = .72). Youth were 2–3 times more likely to have PTSD if they had elevated scores on any of these variables. Of note, event-related characteristics (e.g., property damage) were not related to PTSD diagnostic status. The present study adds to the literature by making specific recommendations for empirically-based, efficient disaster-related PTSD assessment for adolescents following a natural disaster. Implications for practice and future trauma-related developmental psychopathology research are discussed.     

A prospective investigation of the role of cognitive factors in persistent posttraumatic stress disorder (PTSD) after physical or sexual assault

The effectiveness of psychological treatments for PTSD is likely to be enhanced by improved understanding of the factors involved in maintaining the disorder. Ehlers and Clark [A cognitive model of persistent posttraumatic stem disorder Behav. Res. Ther. 38 (2000) 319-345] recently proposed a cognitive model of maintenance. The current study aimed to investigate several cognitive factors highlighted in Ehlers and Clark's model using a prospective design. Fifty-seven victims of physical or sexual assault participated in the study. Cognitive factors were assessed within 4 months of assault and victims were followed-up 6 and 9 months after the assault. Cognitive variables which significantly predicted PTSD severity at both follow-ups were: cognitive processing style during assault (mental defeat, mental confusion, detachment); appraisal of assault sequelae (appraisal of symptoms, perceived negative responses of others, permanent change); negative beliefs about self and world; and maladaptive control strategies (avoidance/safety seeking). Relationships between early appraisals, control strategies, and processing styles and subsequent PTSD severity remained significant after statistically controlling for gender and perceived assault severity. These findings support the cognitive model of PTSD proposed by Ehlers and Clark and suggest that effective treatment will need to address these cognitive factors.     

Cognitive Factors in the Maintenance of PTSD

Abstract

Cognitive behavioural therapies have the strongest empirical support as the treatments of choice for Post-traumatic Stress Disorder (PTSD). Despite the relative efficacy of these treatments compared to other psychological treatments, and no treatment, a large proportion of PTSD patients retain their diagnosis after treatment. In this article, a review of cognitive factors that are suggested to be responsible for the maintenance of PTSD in unimproved patients is presented. Among these factors are: anger and rage, guilt and shame, attentional bias and memory bias, negative attributional style, low self-efficacy, cognitive avoidance, dysfunctional schemas, catastrophic interpretations of intrusive recollections and pathological trauma memory structures. In the discussion section, suggestions about how therapy programmes might be modified in order to maximize cognitive change are provided.     

Psychological correlates of PTSD symptoms following stroke

This study assessed associations between a number of demographic, medical and psychological risk factors and post-traumatic stress disorder (PTSD) symptoms following stroke. Individuals (N = 102) who had experienced a stroke within the previous year participated in the study. Participants completed questionnaires containing measures of PTSD symptoms and a range of psychological risk factors (i.e., anxiety, depression, negative affect, dissociation, cognitive appraisals). Regression analyses revealed the variables under consideration were able to explain large proportions of the variance in the number (R(2) = .54, p < 0.001) and severity (R(2) = .58, p < 0.001) of PTSD symptoms. Number of strokes, negative affect and cognitive appraisals emerged as significant predictors of both the number and severity of PTSD symptoms. The present findings suggest that a significant proportion of stroke patients may benefit from the detection and treatment of PTSD symptoms.     

Prolonged Exposure Therapy for a Vietnam Veteran With PTSD and Early-Stage Dementia

Although prolonged exposure therapy (PE) is considered an evidence-based treatment for PTSD, there has been little published about the use of this treatment for older adults with comorbid early-stage dementia. As the number of older adults in the United States continues to grow, so will their unique mental health needs. The present article describes the successful coordination of care and application of PE in the assessment and treatment of a Vietnam veteran with comorbid PTSD and early-stage dementia. Measures related to the patient's cognitive and psychological functioning were obtained before, during, and after treatment. PE was associated with significant declines in PTSD and depression symptoms. Moreover, the patient's cognitive functioning was made clearer in the absence of severe psychiatric symptoms. Factors contributing to the patient's positive response are discussed.     

Cognitive factors involved in the onset and maintenance of posttraumatic stress disorder (PTSD) after physical or sexual assault.

Cognitive factors hypothesised to influence the development and maintenance of PTSD were investigated. 92 assault victims completed questionnaires assessing a range of cognitive variables. Factors relating to onset of PTSD were investigated by comparing victims who did and who did not suffer PTSD. Factors relating to maintenance of PTSD were investigated by comparing victims who had recovered from PTSD with victims who had persistent PTSD. Cognitive factors associated with both onset and maintenance of PTSD were: appraisal of aspects of the assault itself (mental defeat, mental confusion, appraisal of emotions); appraisal of the sequelae of the assault (appraisal of symptoms, perceived negative responses of others, permanent change); dysfunctional strategies (avoidance/safety seeking) and global beliefs impacted by assault. Cognitive factors that were associated only with the onset of PTSD were: detachment during assault; failure to perceive positive responses from others and mental undoing. Relationships between the cognitive variables and PTSD remained significant when variations in perceived and objective assault severity were statistically controlled. The cognitive factors identified in the study may contribute to PTSD directly, by generating a sense of ongoing threat, or indirectly, by motivating cognitive and behavioural strategies that prevent recovery, or by affecting the nature of the traumatic memory.     

Group Cognitive Behavioral Treatment for PTSD: Treatment of Motor Vehicle Accident Survivors

Individual cognitive behavioral therapies (CBT) are now considered the first-line treatment for posttraumatic stress disorder (PTSD; Foa, Keane, & Friedman, 2000). As mental health reimbursement becomes more restricted, it is imperative that we adapt individual-format therapies for use in a small group format. Group therapies have a number of advantages, including provision of a natural support group, the ability to reach more patients, and greater cost efficiency. In this article, we describe the development of a group CBT for PTSD in the aftermath of a serious motor vehicle accident (MVA). Issues unique to the group treatment format are discussed, along with special considerations such as strategies to reduce the potential for triggering reexperiencing symptoms during group sessions. A case example is presented, along with discussion of group process issues. Although still in the early stages, this group CBT may offer promise as an effective treatment of MVA-related PTSD.     

A Clinician's Guide to PTSD Treatments for Returning Veterans

What options are available to mental health providers helping clients with posttraumatic stress disorder (PTSD)? In this paper we review many of the current pharmacological and psychological interventions available to help prevent and treat PTSD with an emphasis on combat-related traumas and Veteran populations. There is strong evidence supporting the use of several therapies including prolonged exposure (PE), eye movement desensitization and reprocessing (EMDR), and cognitive processing therapies (CPT), with PE possessing the most empirical evidence in favor of its efficacy. There have been relatively fewer studies of non-exposure based modalities (e.g., psychodynamic, interpersonal, and dialectical behavior therapy perspectives), but there is no evidence that these treatments are less effective. Pharmacotherapy is promising (especially paroxetine, sertraline, and venlafaxine), but more research comparing the relative merits of medication vs. psychotherapy and the efficacy of combined treatments is needed. Given the recent influx of combat-related traumas due to ongoing conflicts in Iraq and Afghanistan, there is clearly an urgent need to conduct more randomized clinical trials research and effectiveness studies in military and Department of Veterans Affairs PTSD samples. Finally, we provide references to a number of PTSD treatment manuals and propose several recommendations to help guide clinicians' treatment selections.     

Cognitive Behavioral Therapy for PTSD: The Role of Complex PTSD on Treatment Outcome

Posttraumatic stress disorder (PTSD) represents an often chronic and debilitating mental illness resulting from exposure to trauma. Although the most compelling evidence for the treatment of PTSD is cognitive behavioral therapy (CBT), many patients experience residual functional impairment, or relapse, suggesting that this approach does not work for all cases of PTSD. Repeated severe trauma, particularly during development, might increase the risk for a more intricate clinical profile, called complex PTSD (CPTSD), which might contribute to poorer treatment response. The following provides a comprehensive summary of the evidence examining whether CPTSD symptomatology is related to poorer treatment outcome of CBT, reviews the literature on the treatment of CPTSD, and offers insights into current issues and future directions of the construct.     

拖延行为的认知神经模型及干预

拖延是一种普遍存在, 具有跨时间和跨情景稳定性的问题行为, 它会危害到人们的学习、工作和身心健康。然而目前拖延行为的认知神经机制仍不清晰, 且缺乏因果证据, 本项目拟从拖延的时间决策模型和三重神经结构网络模型出发, 构建拖延的认知神经模型, 并利用认知干预和神经调控技术, 检验和完善拖延行为的认知神经模型, 进而试图制定拖延的精准化干预方案。本项目分为3部分：(1)从记录与关联研究的视角出发, 利用多模态神经影像方法系统考察拖延行为的认知神经机制; (2)从因果/近因果研究视角出发, 利用认知干预和神经调控技术, 验证并完善拖延的认知神经模型; (3)从临床应用的视角出发, 建立拖延行为障碍的临床筛查-诊断体系, 并制定精准化治疗方案。本项目的开展对于探明拖延产生的核心认知神经机制具有十分重要的理论贡献, 同时对于拖延行为的有效预防和精准治疗具有重要的现实意义。