时间洞察力对成瘾行为的影响及其机制

成瘾行为给个体和社会带来了严重的危害。对成瘾人群时间洞察力的研究成为探讨成瘾行为产生和发展的一个新的视角。过去消极、现在享乐和现在宿命时间洞察力取向的个体更可能出现成瘾行为, 而未来时间洞察力取向则是成瘾行为的一个保护性因素, 它不仅可以减少成瘾行为的发生, 也有利于成瘾行为的康复。从自我调节, 冲动性决策等行为机制和前额叶的神经机制方面可以帮助我们深入理解时间洞察力对成瘾行为的影响。未来研究可以进一步探讨不同成瘾行为者时间洞察力的一致性与特异性; 采用纵向研究方法探讨成瘾者时间洞察力的动态变化过程; 对成瘾者的洞察力进行干预, 增加成瘾者的未来时间洞察力, 减少其过去消极和现在时间洞察力取向来帮助成瘾者实现时间洞察力的平衡, 从而提高其戒断效果。     

毒品成瘾者情绪加工及应对方式的特点:基于负性情绪的视角

负性情绪是导致个体毒品成瘾及复吸的主要心理因素。毒品成瘾者在情绪加工过程中会夸大负性刺激,产生负性化偏向,提高负性情绪的唤醒度,最终导致其产生更多负性情绪体验。而当毒品成瘾者体验到诸如焦虑、抑郁、压力等负性情绪时,他们却更倾向于使用毒品来缓解或逃避负性情绪带来的不愉快体验。研究表明,毒品成瘾者这种负性情绪加工异常的根本原因在于长期毒品滥用所导致的个体大脑情绪回路相关脑区的受损,如杏仁核、海马、额叶等。未来研究应更进一步探讨成瘾者负性情绪加工与毒品成瘾之间的关系;并对戒断者在负性情绪加工能力的恢复方面做进一步探索,开展更多的关于如何改善成瘾者及戒断者对负性情绪应对方式的研究,从而更为有效抑制个体对毒品形成的心理依赖及强迫的药物渴求行为。     

奖赏对海洛因成瘾者执行功能的影响机制

一些研究发现海洛因成瘾者奖赏失调表现为:对海洛因相关线索的注意偏向、渴求感增加,对金钱奖赏表现出"即时收益优先"的高风险决策模式和对长时收益的敏感性降低。另一些研究发现海洛因成瘾者的执行功能存在障碍。奖赏失调和执行功能障碍在成瘾物质使用的维持和复吸中起着重要作用。双重竞争模型认为奖赏和执行功能的交互作用决定着行为的结果,但是奖赏对海洛因成瘾者执行功能的影响机制还不清楚。因此,拟使用事件相关电位技术来考察海洛因相关线索和金钱奖赏对不同戒断期成瘾者执行功能的影响机制,短期(1~3个月)、长期(18个月以上)海洛因戒断者和健康对照组被比较。这不仅有助于构建完善的成瘾理论体系,还有助于确定临床戒断后复吸的风险因素和不同戒断期的治疗目标。     

网络相关文字刺激和压力对网络成瘾者线索诱发渴求的影响

渴求感特别是线索诱发渴求是成瘾行为维持和戒断失败的主要原因。本研究通过两个实验分别探讨了网络相关文字刺激和压力对网络成瘾者线索诱发渴求的影响。研究一以25名网络成瘾大学生为被试,以网络相关和中性词语为实验材料,采用线索暴露范式（Cue-reactivity Paradigm）的研究发现,只有网络相关文字刺激能显著诱发网络成瘾者的渴求感。在此基础上,研究二以40名网络成瘾大学生为被试,以公开演讲范式为压力诱发情境,以网络相关词语和中性词语为实验材料,采用线索暴露范式（Cue-reactivity Paradigm）的研究发现,在压力条件下,网络相关文字能诱发网络成瘾者更为强烈的渴求感。本研究深化了对网络成瘾形成维持心理机制的研究,也为网络成瘾的干预矫正提供了思路。     

冲动性对不同成瘾行为发展的调控及其神经机制

近年来越来越多的研究证据提示, 个体冲动性在成瘾疾患发生发展机制中具有关键作用, 可能成为成瘾行为的潜在易感标记以及早期识别和干预的重要靶点, 但冲动性对不同成瘾行为变化发展的调控机制尚不明确。项目拟综合跨成瘾谱系比较、纵向追踪设计、冲动行为干预等研究途径, 采用人格测量、神经认知、神经影像等技术, 首先比较尼古丁依赖者与网络游戏成瘾者的冲动性结构及其在前额叶–纹状体环路的结构功能改变; 然后采用混合分组设计筛选出具有高低冲动性的非成瘾青少年进行连续追踪研究, 考察冲动性对尼古丁依赖与网络游戏成瘾的预测效力; 并采用认知行为训练, 对吸烟成瘾者与网络游戏成瘾者进行冲动干预, 考察行为干预对冲动性水平及前额叶–纹状体环路功能的改变, 以及对不同成瘾行为发展的抑制后效。旨在探索冲动性作为成瘾的潜在易感标记及干预靶点的效力。     

物质成瘾及其戒除:基于反转学习的视角

物质成瘾与反转学习损伤密切相关,成瘾者往往不能灵活地适应变化的刺激—结果的联结,这可能进一步加剧成瘾者的物质使用。近年来研究发现,物质成瘾者的反转学习相关的腹外侧前额和背外侧前额等脑区激活异常,这些异常与成瘾者的冲动性和强迫性有关。此外,个体的反转学习能力对其成瘾行为具有一定预测性。今后应增加对不同类型物质成瘾者的反转学习脑机制及物质相关线索对成瘾者反转学习影响的研究,并且进一步探讨成瘾者的冲动性和强迫性对其反转学习的调节及个体反转学习能力对其成瘾行为的预测。     

长期戒断海洛因成瘾者冲动性相关脑区的结构及功能特征

冲动性是药物成瘾者的典型特征, 它既包含了抑制控制成瘾者药物使用的力量, 也包含驱动成瘾者使用药物的成分, 两者不平衡导致冲动性用药行为。海洛因成瘾者本身具有冲动性人格特质, 长时间的海洛因使用又会造成成瘾者冲动性相关的大脑结构与功能的异常。目前难以确定戒断后, 冲动性及相关的大脑结构与功能是否还呈异常状态。本研究采用基于体素的形态学分析、低频振幅、局部一致性和功能连接方法, 以35例海洛因成瘾戒断者和无任何成瘾史的健康个体26人为研究对象, 探索在长期戒断后, 海洛因成瘾者与其冲动性相关的驱动、控制系统脑网络的结构和功能情况。结果显示, 相比对照组, 戒断组灰质总体积及右内侧额上回的灰质体积显著减小, 右侧颞中回和左内侧旁扣带回的灰质体积随用药总量的增加而降低; 右侧眶部额下回与尾状核功能连接显著增强, 右侧颞中回和左侧中央前回功能连接显著降低; 右眶额中回的ReHo值、右眶额下回和左海马体的ALFF值比对照组显著更低, 而右中央后回的ReHo值显著更高。这些脑区的状况与冲动性的神经基础相吻合, 说明海洛因成瘾戒断者在戒断44个月, 奖赏、凸显、习惯性行为等网络系统仍然呈现异常状态, 且与成瘾药物使用总量有关。这些异常可能是成瘾冲动性的驱动力的神经基础, 可以作为解释成瘾者戒断后容易复吸的因素之一。     

成瘾人群跨期选择的神经机制及干预方法

成瘾可分为物质成瘾和行为成瘾, 两类成瘾人群在跨期选择上都表现出高时间折扣率的缺陷, 但也有各自的特异性特征。成瘾人群跨期选择缺陷的神经基础主要集中在评估网络(腹内侧前额叶、纹状体、后扣带皮层等)、认知控制网络(前额叶皮层、前扣带皮层等)和预期想象网络(海马、杏仁核等); 可利用心理训练来改善成瘾人群跨期选择缺陷, 其干预方法包括工作记忆训练、预期想象训练、金钱管理指导等。未来研究应该从成瘾者跨期选择缺陷的认知机制、3个神经网络系统的交互作用机理、行为遗传学以及开发有效的干预方法等方面展开大量研究。     

网络成瘾病理心理机制及综合心理干预研究

针对中国青少年网络成瘾问题,综合运用心理测评、深度访谈、脑事件相关电位、心率变异性等多层面的心理学研究方法,系统、深入研究网络问题的成因、病理心理机制、评估方法及心理干预方法等多项课题。依据得到的人群调查数据、网络成瘾者的心理测量结果、脑电与心电的生理心理学数据,同时结合临床干预疗效评估,提出研究结论：（1）使用谱系概念对中国青少年网络使用问题进行分型,并制定分型标准与评估方法;（2）从青少年心理发展角度分析了网络成瘾的形成原因,提出“失补偿”假说揭示网络成瘾形成过程;（3）提出“注意功能易化机制”从脑功能水平揭示网络“成瘾”病理心理机制;（4）制定“系统补偿综合心理干预”方案,包括团体、家庭、个体及家长干预等多项心理治疗方案,在临床研究中取得了良好实效     

提示潜在机会成本对男性海洛因戒断者跨期决策的改善

由于物质成瘾者的跨期决策缺陷在成瘾行为发生、发展及戒断预后中的重要作用,其已成为成瘾研究中的一个靶向干预目标。研究旨在检验提示潜在机会成本能否有效改善男性海洛因戒断者的跨期决策。两个实验分别选取男性海洛因戒断者30名与27名,让其在提示潜在机会成本和未提示潜在机会成本两种决策条件下,分别完成金钱跨期决策任务与海洛因-金钱跨类别延迟折扣任务。结果发现,提示潜在机会成本可以显著减少男性海洛因戒断者在金钱跨期决策任务中选择即时金钱奖赏的数量,但未能显著降低其在海洛因-金钱跨类别延迟折扣任务中的延迟折扣水平。研究结果表明,提示潜在机会成本可以改善男性海洛因戒断者在金钱跨期决策中的短视倾向,但无法改善其在海洛因-金钱跨类别跨期决策中的短视倾向。     

A randomized controlled trial of contingency management for smoking cessation in substance use treatment patients

Background/ObjectiveContingency management (CM) is one of the most effective interventions for smokers with substance use disorder (SUD), and no empirical assessment of its long-term efficacy has been conducted so far in a real-world context. The objectives were: (1) examine the additive effectiveness of CM on cognitive-behavioral treatment (CBT) for smoking cessation, and (2) examine the relationship between smoking cessation and substance use abstinence.MethodA total of 80 participants (75.8% males; M_age = 45.31; SD = 9.64) were assigned to two smoking cessation treatments: CBT or CBT+CM. A set of generalized estimating equations were conducted to examine the effect of treatment condition on smoking outcomes, as well as the effect of smoking status on substance abstinence.ResultsAdding CM to CBT for smoking cessation improved tobacco abstinence rates at the end-of-treatment (p = .049). Tobacco abstinence rates declined over time (p = .012), but no significant effects of treatment condition were observed across follow-ups (p = .260). Smoking cessation was not significantly related to substance abstinence (p ≥ .488).ConclusionsCM facilitates early abstinence in smokers with SUD, although effects subside after treatment termination. The lack of association between smoking abstinence and substance use suggests no jeopardizing effects as a result of quitting smoking.     

Treatment of Depression and Suicide in Older Adults

This article describes a cognitive behavior therapy (CBT) intervention for suicide prevention in older adults. Although many studies have found that CBT interventions are efficacious for reducing depressive symptoms in the elderly, researchers have yet to evaluate the efficacy of such interventions for preventing suicide or reducing suicide risk in older adults. In this article we describe a 12-session CBT protocol for reducing depression, suicide ideation, and other risk factors of late-life suicide. The following aspects of the treatment are described: assessing suicide risk, conceptualizing the problem through a cognitive behavioral framework, developing a safety plan, increasing hope and reasons for living, improving social resources, improving problem-solving skills and efficacy, improving adherence to medical regimen, and relapse prevention. In addition, we review other behavioral and cognitive strategies such as activity scheduling and cognitive restructuring that are commonly associated with CBT interventions for depression. We illustrate the application of these strategies through the use of case examples.     

New Strategies for Combining Mindfulness with Integrative Cognitive Behavioral Therapy for the Treatment of Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) severely impacts social functioning, distress levels, and utilization of medical care compared with that of other major psychiatric disorders. Neither pharmacological nor psychotherapy interventions have adequately controlled cardinal symptoms of GAD: pervasive excessive anxiety and uncontrollable worry. Research has established cognitive behavioral therapy (CBT) as the most effective psychotherapy for controlling GAD; however, outcomes remain at only 50% reduction, with high relapse rates. Mindfulness has been integrated with CBT to treat people suffering from numerous psychiatric disorders, with mindfulness based stress reduction (MBSR) being the most researched. Preliminary evidence supports MBSR’s potential for controlling GAD symptoms and key researchers suggest mindfulness practices possess key elements for treating GAD. Classical mindfulness (CM) differs significantly from MBSR and possesses unique potentials for directly targeting process and state GAD symptoms inadequately treated by CBT. This article introduces the theory and practice of CM, its differences from MBSR, and a critical review of MBSR and CBT treatments for GAD. CM strategies designed to complement CBT targeting cardinal GAD symptoms are outlined with a case study illustrating its use.     

Ambulatory group treatment for cocaine dependent patients combining cognitive behavioral therapy and motivational interviewing

Psychological interventions in cocaine dependent patients have demonstrated efficacy. Remarkable approaches are Contingency Management (CM) and Cognitive Behavioral Therapy (CBT). Lack of treatment adherence is the most important limitation. Motivational Interview (MI) has been shown to be an adherence enhancer. The objective of this study is to evaluate retention and abstinence in a combined CM and CBT group treatment in patients who have reached maintenance stage according to Prochaska and DiClemente's transtheoretical model (1982). Therefore, a longitudinal study was carried out with cocaine dependent patients with or without concomitant mental health disease. A 12-session open group was conducted weekly. Nineteen patients were included (78.9% men, mean age 36.6 years), 95% consumed intranasally and 47% had another psychiatric comorbidity. Treatment retention was 84%. During treatment and the first month of follow-up, all patients remained abstinent whereas at three months, 3 patients relapsed. These data confirm that using combined CM and CBT group therapy in cocaine dependents undergoing maintenance treatment enhances adherence and is effective to achieve abstinence.     

A randomized pilot study of motivation enhancement therapy to increase utilization of cognitive–behavioral therapy for social anxiety

Despite the efficacy of cognitive–behavioral therapy (CBT), most socially anxious individuals do not seek treatment or seek treatment only after many years of suffering. This study evaluated the efficacy of a three-session motivation enhancement therapy (MET) designed to increase CBT utilization among socially anxious individuals. Twenty-seven non-treatment-seeking socially anxious individuals (92.6% met current DSM-IV criteria for social anxiety disorder) were randomly assigned to either MET for CBT (n = 12) or a control condition (n = 15). The primary outcome was attendance at first CBT appointment. Secondary outcomes included openness to therapist contact and willingness to schedule a CBT appointment. After the intervention, seven of the 12 (58.3%) participants in the MET condition attended a CBT appointment compared to two of 15 (13.3%) control participants. Eight of 11 (72.7%) participants in the MET condition indicated they would like a CBT therapist to contact them compared to four of 12 (33.3%) controls. Further, willingness to schedule a CBT appointment increased at a significantly greater rate in the MET condition. Results suggest MET for CBT may be a time-efficient means to increase CBT utilization among socially anxious individuals.     

Motivational Interviewing as an Adjunct to Cognitive Behavior Therapy for Anxiety Disorders: A Critical Review of the Literature

Cognitive behavior therapy (CBT) is efficaciously and effectively used in the treatment of anxiety disorders; however, as CBT for anxiety routinely utilizes exposure components, clients often experience ambivalence about treatment and their clinicians often must deal with resistance. Motivational Interviewing (MI) is a therapeutic strategy that addresses ambivalence about change in clinical interventions. MI has been applied as an adjunct for treatments such as CBT in order to increase motivation for and commitment to the intervention, especially when components of the treatment may be challenging (e.g., exposure, cognitive restructuring). Though researchers have commented specifically on the use of MI as a supplement to CBT for anxiety disorders, no comprehensive review has systematically assessed the strengths and limitations of extant literature on the topic, nor across anxiety disorders. Findings are summarized from 6 case studies and uncontrolled trials and 11 randomized controlled trials published through March 2016. An integrated critique of this literature also is offered. Limitations and the preliminary nature of the work in this area notwithstanding, it appears that it is feasible to supplement or integrate CBT with MI and that doing so has the potential to improve treatment initiation and engagement, as well as clinical outcomes. A number of directions for future research are addressed, such as determining which MI approaches to implement, with whom, when, and in what contexts.     

Cognitive Behavioral Therapy for Attention-Deficit/Hyperactivity Disorder in College Students: A Review of the Literature

The current review presents a theory-guided review of the existing cognitive behavioral therapy (CBT) interventions for attention-deficit/hyperactivity disorder (ADHD) in college students. Across the eight studies that investigated this topic, moderate reductions were shown in inattentive symptoms but little to no change was reported in hyperactive/impulsive symptoms. Results indicated a moderate treatment effect on self-reported quality of life and school/work functioning, yet less of an impact on GPA, response inhibition, social functioning, and executive functioning. Methodological and statistical problems and inconsistencies were noted. Since college students are emerging adults, it is likely that the optimum CBT intervention for college students with ADHD lies somewhere in between the existing clinic-based adult ADHD CBT interventions as well as the school-based adolescent ADHD psychosocial interventions. Directions for future research and recommendations for clinicians in university settings are provided in an attempt to further develop the existing college students CBT clinical research evidence base.     

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.     

Change and processes of change within interventions to promote adjustment to multiple sclerosis: Learning from patient experiences

This qualitative study was nested within a trial of cognitive behaviour therapy (CBT) and supportive listening for patients with multiple sclerosis (MS). It aimed to enrich understanding of the changes made during therapy and to explore processes of change. In-depth interviews with 30 participants from the treatment trial were analysed inductively and five main themes were developed. The benefits that participants described experiencing as a result of the interventions were highly variable, idiosyncratic and often departed from outcomes measured within the trial. Tuning into and sharing one’s thoughts and feelings and learning specific strategies for living with MS appeared to be important processes for change, and participants identified the latter as particularly important for sustaining long-term benefits from therapy. Whether participants fully engaged with the interventions appeared to be related to their perceptions of being the right sort of candidate for the intervention, their expectations and motivations, the therapeutic relationship, adequate tailoring of the intervention, and practical issues. This study builds on previous research on factors and processes involved in adjustment to MS, the benefits of CBT for this population and highlights important issues to consider when developing psychosocial interventions for people with MS.     

Parental Involvement: Contribution to Childhood Anxiety and Its Treatment

Anxiety disorders are prevalent in youth. Despite demonstrated efficacy of cognitive behavioral therapy (CBT), approximately 40 % of anxiety-disordered youth remain unresponsive to treatment. Because developmental and etiological models suggest that parental factors are relevant to the onset and maintenance of childhood anxiety, researchers have proposed and investigated family-based interventions with increased parent work in treatment, aiming to improve the efficacy of treatment for childhood anxiety. However, contrary to what theoretical models suggest, data to date did not indicate additive benefit of family-based CBT in comparison with child-centered modality. Is parent/family involvement unnecessary when treating childhood anxiety disorders? Or could there be the need for specificity (tailored family-based treatment) that is guided by a revised conceptualization that improves the implementation of a family-based intervention? The current review examines (1) relevant parental factors that have been found to be associated with the development and maintenance of childhood anxiety and (2) interventions that incorporate parental involvement. Relevant findings are integrated to formulate a “targeted” treatment approach for parental involvement in CBT for youth anxiety. Specifically, there is potential in the assessment of parent/family factors prior to treatment (for appropriateness) followed by a target-oriented implementation of parent training.