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.     

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.     

强迫症病理的认知–行为研究述评

认知–行为领域对强迫症(OCD)的病理进行了深入的探索。强迫症的认知–行为理论认为功能失调性信念、应对策略及中和行为对强迫症的发生和维持有重要作用; 强迫症的安全动机模型把强迫行为归因于安全动机系统不能产生停止安全防卫行为的信号, 在此基础上有研究表明, 在做停止强迫行为的决策时, 强迫症患者依赖于主观停止标准, 导致决策困难, 延长了强迫行为持续的时间。通过整理近年来此领域的研究, 认为趋–避冲突存在于一些强迫症患者中, 且可能是导致强迫症的又一重要因素。     

儿童青少年创伤后应激障碍(PTSD)治疗的研究热点——基于美国文献的知识图谱分析

为了解近10年(2006~2016)来美国18岁及以下的儿童青少年创伤后应激障碍(PTSD)治疗研究的热点和重点,利用Bicomb 2.0软件和IBM SPSS Statistics 20.0软件,对ISI Web of Science数据库中查询到的363篇论文进行了知识图谱的可视化分析。结果表明,近10年来美国儿童青少年PTSD治疗研究可分为两个大的研究领域。领域一为儿童青少年PTSD的精神科和神经生物学相关的治疗,包括了两个小的研究热点:(1)儿童青少年PTSD精神科药物治疗相关的研究;(2)儿童青少年PTSD眼动脱敏再加工治疗等神经生物学机制的疗法。领域二为儿童青少年PTSD的心理学治疗,包括了两个小的研究热点:(1)家庭暴力导致的儿童青少年PTSD心理学治疗研究;(2)儿童青少年PTSD的认知行为治疗研究。其中关于儿童青少年PTSD的认知行为治疗研究是研究的热点和重点领域,但关于儿童青少年PTSD治疗效果的长期纵向研究还较为缺乏,未来研究者应加强对儿童青少年PTSD治疗效果的追踪研究,并开展心理治疗与药物治疗相结合的疗效研究。     

同伴关系的发展功能及影响因素

同伴关系在儿童青少年社会能力、认知、情感、自我概念和人格的健康发展和社会适应中起着重要作用.儿童青少年的行为特征和社会认知是影响同伴关系的主要因素.近年来,研究者也开始注意到儿童青少年的情感层面和其它社会关系的影响作用.同伴关系影响因素研究的动态模型为未来研究提供了新视点.     

强迫症认知行为团体治疗的疗效及其相关因素的质性探索

目的:研究认知行为团体治疗(Group Cognitive Behavioral Therapy,GCBT)对强迫症患者的疗效,并分析与疗效相关的因素,为强迫症的认知行为团体治疗供理论与实践的参考。方法:运用质的研究方法,对10例中重度门诊强迫症患者开展连续12次的认知行为团体治疗,治疗结束后进行个案深度访谈,并采用主...     

5—7岁幼儿的同伴关系、社会行为与其母亲教养方式

家庭是儿童社会化的最早执行者和基本执行者,它对儿童社会性发展有着极为重要的影响。在影响儿童社会性发展的家庭诸因素中,父母教养方式是其中最主要的因素之一。这也是近三十年来父母教养方式一直受到儿童心理学重点研究的一个主要原因。有些研究发现,儿童的消极行为与母亲教养行为的消极倾向具有密切的内在关系。而在影响儿童同伴关系的诸因素中．一般认为儿童青少年的行为特征和社会认知是影响同伴关系的主要因素。     

亲子关系、朋友关系影响问题行为的3种模型

家庭和同伴是影响个体发展的最重要的微系统, 是儿童青少年问题行为的重要影响因素,以往对上述问题的实证研究非常广泛, 但很零散。对前人研究的分析发现亲子关系、朋友关系影响问题行为有3种模型：独立模型、交互影响模型和间接效应模型, 然而这些模型及其有关研究仍存在诸多问题与不足, 如亲密关系测量指标不统一, 内外化问题行为研究不均衡, 评价主体单一化, 文化差异, 缺乏充分的追踪研究和实验设计等, 未来研究应对上述方面加以关注。     

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。     

学习障碍儿童的社会信息处理、依恋及情绪调节特点

SIP是儿童社交能力的一个重要组成部分,它给儿童提供一个如何处理及解读社会情境中发生的社会线索的模型,并且根据这些线索作出行为和情绪上的决定。作为一个社会认知能力,SIP被认为是学习障碍儿童中最具有挑战性的领域之一。潜在的认知加工过程和情绪处理过程对SIP六阶段步骤起重要作用。过去的研究注重儿童认知能力对SIP能力的作用。在此研究中,我们新增了儿童的情感纽带如(安全依恋)以及强调儿童管理情绪的能力对儿童SIP能力的作用。本文通过对学习障碍儿童的情绪管理、依恋质量及社会信息加工特点的研究,希望提供关于安全依恋和情绪管理在学习障碍儿童中社会信息加工的作用一些理论参考。     

Addressing Barriers to Change in the Treatment of Childhood Obsessive Compulsive Disorder

Although considerable evidence supports the use of cognitive behavior therapy (CBT) for the treatment of childhood obsessive compulsive disorder, large numbers of youth fail to respond and clinical remission is often elusive. Poor family functioning frequently is implicated as an obstacle for youth undergoing CBT, with features such as symptom accommodation, family conflict, and blame known to attenuate outcomes. These features are common in child and adolescent obsessive compulsive disorder (OCD) and they may pose particular challenges for exposure-based treatments. Nonetheless, interventions that focus specifically on family functioning have, to date, been limited. This paper reviews the literature on family features associated with childhood OCD and discusses their links to treatment outcome. It then describes the development of a brief family intervention tailored to address the needs of highly distressed families of youth with OCD in the service of improving individual child CBT outcomes. Preliminary pilot data are presented and clinical implications are discussed.     

Group versus individual cognitive-behavioural treatment for obsessive-compulsive disorder: a controlled trial

The efficacy of group cognitive behaviour therapy (CBT) for obsessive-compulsive disorder (OCD) has received relatively little research attention compared with the large number of studies that have investigated individual CBT. The current study is the first controlled study to compare an identical CBT protocol, containing both cognitive and behavioural elements, delivered either individually or in a group. Participants were randomly assigned to either 10 weeks of individual CBT, 10 weeks of group CBT or a 10 week wait-list. Participants with significant rates of secondary comorbidity were included in the study to enhance the generalisability of results. Intention-to-treat and completer analyses were carried out and indicated no differences between the group and individual treatments on outcome measures. Large effect sizes were found for both conditions. Analysis of clinically significant change indicated that the individual treatment was associated with a more rapid response but that both treatments had equivalent rates of recovered participants by brief follow-up. The importance of further investigations of the efficacy of group CBT for OCD is discussed.     

Obsessive-Compulsive Disorder in Late Life

Although obsessive-compulsive disorder (OCD) has received increasing attention, the study and treatment of OCD in late life has been neglected. The obsessions and compulsions seen with older adults do not appear to differ from the symptoms experienced by other age groups, although developmental issues might influence symptom focus (e.g., memory functioning-related obsessions). Hoarding difficulties might be prevalent in late life, although additional studies are needed. Seniors with OCD can present with comorbid psychiatric disorders, multiple general medical problems, and impaired cognitive functioning, complicating evaluation. There have not been controlled clinical trials of cognitive-behavioral therapy (CBT) for late-life OCD, although initial reports suggest older adults respond to CBT that includes age-related treatment modifications. We illustrate the challenges to assessing and treating older adults with OCD with case examples involving memory-related obsessions and clinical hoarding. The successful strategies used for adapting CBT for the treatment of late-life generalized anxiety disorder might serve as a model for advancing the study and treatment of late-life OCD.     

An Inhibitory Learning Approach to Cognitive-Behavioral Therapy for Children and Adolescents

Although exposure-based cognitive-behavioral therapy (CBT) is efficacious for childhood anxiety and obsessive–compulsive disorder (OCD), many youth do not adequately respond to treatment. Extinction learning is an important process in exposure-based CBT. However, youth with anxiety disorders and OCD exhibit impairments in extinction processes that are best characterized by deficits in inhibitory learning. Therefore, the utilization of strategies to optimize inhibitory learning during exposures may compensate for these deficits, thereby maximizing extinction processes and producing more robust treatment outcomes for exposure-based CBT. This paper reviews several strategies to optimize inhibitory learning in youth with anxiety disorders and OCD, and presents practical examples for each strategy. This paper also highlights the difference between inhibitory learning-based exposures and prior conceptual approaches to exposure therapy in clinical practice. It concludes with a discussion of future directions for clinical research on inhibitory learning and exposure-based CBT in youth.     

Obsessive-compulsive disorder in children and adolescents: Clinical syndrome and treatment

Abstract

Obsessive-compulsive disorder (OCD) in children and adolescents has been relatively neglected by clinicians and researchers. We aim to show that childhood OCD is a serious condition that requires early identification and treatment. The DSM-III-R criteria for OCD are presented along with recent findings on psychopathology. Clinical management of childhood OCD is a challenging and difficult task for mental health professionals. We briefly describe and evaluate advances in behavioural treatment — mainly in vivo exposure and response prevention. Also the adjunctive use of anti-depressant medication is examined. Whilst these clinical innovations are promising, further controlled evaluations are necessary before the efficacy of behaviour therapy can be confidently asserted     

Cognitive-behavioral psychotherapy for pediatric obsessive-compulsive disorder

Discusses the cognitive-behavioral psychotherapy for pediatric obsessive-compulsive disorder (OCD). Over the past 15 years, cognitive-behavioral psychotherapy has emerged as the psychosocial treatment of choice for OCD across lifespan. Unlike other psychotherapies that have been applied usually unsuccessfully to OCD, cognitive-behavioral treatment (CBT) presents a logically consistent and compelling relationship between the disorder, the treatment, and the specified outcome. Nevertheless, despite a consensus that CBT is usually helpful, clinicians routinely complain that patients will not comply with behavioral treatments and parents routinely complain that clinicians are poorly trained in CBT, with the result that many if not most children and adolescents are denied access to effective psychosocial treatment. This unfortunate situation may be avoidable, given an increased understanding regarding the implementation of CBT in children and adolescents with OCD. To this end, we review the principles and the practical aspects of the cognitive-behavioral treatment of OCD in youth, move on to discuss empirical studies supporting the use of CBT in the pediatric age group, and conclude by discussing directions for future research.     

First-Line Treatment for Pediatric Obsessive–Compulsive Disorder

Pediatric obsessive–compulsive disorder (OCD) is a common psychiatric disorder that impairs children’s functioning in home, school, and community settings. Once thought to be an untreatable or treatment refractory disorder, evidence-based treatments now exist for pediatric OCD. Various psychological treatment approaches for pediatric OCD have been investigated and research supports the use of cognitive-behavioral therapy (CBT) with exposure and response prevention (E/RP) and combined CBT/E/RP with serotonin reuptake inhibitor pharmacotherapy. This paper reviews these approaches and highlights the prominent role of CBT/E/RP as a first-line treatment for pediatric OCD.     

Cognitive Behavior Therapy for Obsessions and Compulsions: New Applications and Emerging Trends

This paper describes recent developments in the cognitive behavioral treatment (CBT) of obsessive compulsive disorder (OCD). Although behavioral treatment of OCD consisting of exposure and response prevention (ERP) has been shown to be clinically effective, certain limitations with ERP have led clinical researchers to propose that treatment should be augmented with direct cognitive interventions. Modification of dysfunctional beliefs and faulty appraisals or interpretations of the obsession are now considered a crucial component of CBT for obsessions and compulsions. This paper discusses the conceptual basis of the new CBT for OCD and reviews its limited empirical status. A case example is provided in which CBT is used to treat obsessional ruminations of becoming sick. The article concludes with a discussion of the challenges and pitfalls involved in offering CBT for obsessions and compulsions.     

Changes in quality of life following cognitive-behavioral therapy for obsessive-compulsive disorder

Cognitive-behavioral therapy (CBT) incorporating exposure and response prevention is a first line treatment for obsessive-compulsive disorder (OCD). Although, the efficacy of CBT in reducing OCD symptoms is well documented, less is known about its effects on quality of life (QOL). In the current study, functional impairment aspects of QOL (as measured by the Sheehan Disability Scale) were assessed among 70 adult outpatients with OCD before and after CBT. Statistically significant improvements in QOL and large pre- to post-treatment effect sizes were observed for work, social, and family functioning. Improvements in social and family functioning were predicted by improvements in OCD symptom severity even after controlling for improvements in depressive symptoms. In addition, clinically significant change in OCD symptoms and QOL were highly related, although there was a subset of participants whose symptoms improved without corresponding improvements in QOL. These results suggest that the effects of CBT may extend beyond OCD symptom reduction to QOL.     

Videoconferencing-based cognitive-behavioral therapy for obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a prevalent, chronic and disabling anxiety disorder. Despite the efficacy and strength of pharmacologic interventions for OCD, medications are not always well accepted or effective, making an efficacious psychosocial alternative especially attractive. Cognitive-behavioral therapy (CBT) has been established as an effective treatment for adult OCD, yet access to such treatment is limited, especially in rural areas. Technological advances allow for therapy to be provided in a real-time format over a videoconferencing network. This method allows therapists to provide state-of-the-art treatment to patients who would not otherwise have access to it. This paper presents three cases of OCD successfully treated via videoconferencing CBT. The presence of OCD was established via structured clinical interview and clinician-rated outcome measures were completed by evaluators blinded to the method of treatment. A multiple baseline across individuals design was used to support the internal validity of the CBT outcome data. Patient ratings of therapeutic alliance were high across all three cases. Information gathered from qualitative interviews post-treatment confirmed quantitative measures finding high levels of patient satisfaction. This pilot study suggests that videoconferencing-based CBT is a promising method to bring appropriate treatment to thousands who live far distances from well-trained therapists.