非自杀性自伤与接纳承诺疗法的多维解析

接纳承诺疗法干预非自杀性自伤已经被一些临床案例证实疗效显著,与其他传统的心理治疗相比,接纳承诺疗法的干预效果更加持久。首先分析了非自杀性自伤基本含义以及各类特征,从心理动机的角度简要说明了非自杀性自伤发生的原因,再结合接纳承诺疗法的心理病理模型及治疗模型,阐述了接纳承诺疗法是通过提高个体心理灵活性减少非自杀性自伤发生的的理论依据与治疗过程,最后梳理了近年来国外学者通过接纳承诺疗法干预非自杀性自伤的实证研究及效果,为其他研究者实践该疗法治疗非自杀性自伤提供借鉴思路。     

基因-脑-行为视角下的自伤行为产生机制

自伤是遗传与环境共同作用的结果。目前对于自伤行为的探讨已深入到基因及神经系统层面，基因-脑-行为的综合视角为客观揭示自伤产生机制提供了一条有效途径。本文将在已有研究的基础上，结合分子遗传学和神经生物学的最新成果，对自伤候选基因多态性及其可能的脑机制进行系统阐述，并提出今后应在基因多态性的交互作用及其脑机制、积极环境下自伤行为研究、自伤青少年的追踪研究以及自伤行为的系统性探讨等方面进一步深化。     

自我批评与青少年自伤:有调节的中介效应

采用情绪调节量表、自我批评量表、心理痛苦量表和自伤行为量表对914名中学生进行测查,从中筛选出311名有自伤行为的青少年进行统计分析,探讨自我批评与青少年自伤行为的关系,并在此基础上提出一个有调节的中介模型,考察心理痛苦的中介作用和认知重评的调节作用。结果表明:(1)在控制了性别和是否独生子女的影响后,自我批评可以显著正向预测青少年的自伤行为,心理痛苦在二者之间起中介作用;(2)自我批评通过心理痛苦对自伤行为的间接效应受到认知重评的调节,认知重评可以减弱自我批评对自伤行为的间接影响。     

Early maladaptive schemas and non-suicidal self-injury among young adults: A preliminary investigation

Non-suicidal self-injury (NSSI) represents a critical mental health issue among young adults. Accordingly, it is important to understand potentially modifiable processes involved in its enactment. The current investigation built on previous work to better understand the nature of early maladaptive schemas (EMS) in the context of NSSI. One hundred and thirty young adults completed questionnaires assessing NSSI history, EMS and depressive symptoms. Results indicate that EMS may play a role in NSSI engagement after controlling for depressive symptoms. Specifically, higher scores on social isolation and emotional inhibition and possibly lower scores on entitlement/grandiosity schemas may differentiate those who self-injure from those who do not. Furthermore, higher levels of dependence/incompetence schema may differentiate those who report a higher NSSI frequency and those who report a less frequent NSSI history. Although a nascent area of study, our findings suggest that it may be fruitful to consider conceptualizing NSSI within a schema therapy framework.     

青少年重度抑郁患者自伤行为及危险因素研究

为探讨重度抑郁青少年非自杀性自伤(non-suicidial self-injury,NSSI)行为发生的风险因素,采用贝克自杀意念量表、焦虑自评量表、Barratt冲动量表、认知情绪调节量表、青少年生活事件量表、家庭亲密度及适应性量表对160例抑郁障碍青少年患者进行调查。结果发现,青少年重度抑郁发作患者中NSSI行为发生率较高,性别差异不显著。伴NSSI组患者的冲动性、自杀危险、焦虑、自我责难、灾难化及人际关系得分显著高于不伴NSSI组(P<0.05);计划、积极重新评价,家庭实际适应性得分显著低于不伴NSSI组(P<0.05)。二分类Logistic回归分析显示,自杀危险得分、冲动性总分、人际关系、自我责难是NSSI的危险因素。     

累积环境风险与大学生自伤的关系:情绪调节策略的作用

通过两个子研究分别考察累积环境风险与大学生自伤行为间的关系模式,并探讨注意分散与认知重评两种情绪调节策略对高风险大学生自伤意图的缓解作用。研究1在1066名大学生中采用问卷调查,探索累积环境风险对大学生自伤行为的作用及模式。基于研究1的结果,研究2选取符合高风险背景的62名大学生为被试,采用实验室实验对两种情绪调节策略的作用予以考察。本研究结果表明：累积环境风险对男女大学生自伤行为均有显著的正向作用,且均符合非线性“正加速模式”,但男生群体随累积风险数量增加而引发的自伤行为增长速度明显快于女生。对于高环境风险背景下的大学生,注意分散和认知重评两种策略均能降低其自伤倾向性与自伤认同,但不能降低其自伤意念。这提示应重视对经历了高环境风险的大学生进行情绪调节策略等方面的干预,以减少其采取自伤行为的倾向性。     

Measurement of Deliberate Self-Harm: Preliminary Data on the Deliberate Self-Harm Inventory

Deliberate self-harm has recently begun to receive more systematic attention from clinical researchers. However, there remains a general lack of consensus as to how to define and measure this important clinical construct. There is still no standardized, empirically validated measure of deliberate self-harm, making it more difficult for research in this area to advance. The present paper provides an integrative, conceptual definition of deliberate self-harm as well as preliminary psychometric data on a newly developed measure of self-harm, the Deliberate Self-Harm Inventory (DSHI). One hundred and fifty participants from undergraduate psychology courses completed research packets consisting of the DSHI and other measures, and 93 of these participants completed the DSHI again after an interval of 2–4 weeks (M = 3.3 weeks). Preliminary findings indicate that the DSHI has high internal consistency; adequate construct, convergent, and discriminant validity; and adequate test-retest reliability.     

负性生活事件对初中生自我伤害行为的影响:有调节的中介效应

采用负性生活事件量表、自我批评量表、亲子关系量表和青少年自我伤害行为问卷对333名初中生进行测查,探讨负性生活事件对初中生自我伤害行为的影响及作用机制。结果表明:(1)负性生活事件对初中生的自我批评和自我伤害行为均有显著的正向预测作用;(2)自我批评在负性生活事件与初中生自我伤害行为之间起着部分中介作用;(3)负性生活事件和自我批评的关系(中介效应的前半段路径)受到亲子关系的调节,即负性生活事件对自我批评的正向影响随着父子关系和母子关系的增强而减弱。因此,负性生活事件和初中生自我伤害行为之间存在有调节的中介效应。     

Active but not consistent: dietary behaviour and the stages of change model

In Stages of Change studies on dietary fat, standard algorithms allocate many respondents to the maintenance stage and their stage allocations are not always supported by objective criteria. In defining the preparation stage standard instruments emphasise inactivity allied to confident intention to change. In contrast Lamb and Joshi's (1996) staging instrument emphasises inconsistent effort, and thereby allocates inconsistently active respondents to preparation when a standard instrument might place them in action or maintenance. In the current cross-sectional study 375 respondents completed a standard algorithm, the Lamb and Joshi instrument and a 24-hour recall food diary. They also gave judgements of their current weight and diet. Unlike the standard instrument, the Lamb and Joshi instrument: (a) allocated fewer respondents to action/maintenance, (b) discriminated key behavioural stages by percent fat in diet, and (c) captured non-linear discontinuities in the respondents’ weight and diet self-perceptions. Such discontinuities in the psychosocial processes are predicted by the transtheoretical model, and support the claim that its stages are categorically distinct rather than artificially isolated points on a continuum. Distinguishing between respondents who describe themselves as consistently active and those who describe themselves as inconsistently active may help to overcome some apparent problems in the application of the transtheoretical model to behavioural change.     

青少年自伤行为的机制及影响因素:基于情绪管理的视角

青少年是自伤的高危人群,这与自伤的情绪管理功能密切相关。基于情绪管理视角,生物社会模型、回避体验模型和情绪管理模型分别从不同侧面揭示了情绪管理在自伤发生中的核心地位。综合目前关于自伤的心理学及跨学科研究成果发现,青少年自伤的影响因素主要包括基因与脑等生物学因素、家庭与学校环境中的人际因素,以及个体的人格特征。其中,基因、脑与家庭环境对青少年自伤的影响尤为关键。今后应在纵向研究、基因与环境交互作用以及脑成像技术融合等方面对自伤进行进一步探讨。     

Predictors of improvement in an open-trial multisite evaluation of emotion regulation group therapy

Emotion regulation group therapy (ERGT) is a novel treatment specifically targeting deliberate non-suicidal self-harm (DSH) in individuals with borderline personality disorder (BPD). Identifying robust predictors of positive response to ERGT could aid clinicians in treatment selection; however, to date, only one such study has been conducted. Thus, we aimed to replicate previously identified predictors of treatment response to ERGT by investigating demographic, clinical, and diagnostic predictors in 95 women with BPD or subclinical BPD who had participated in an open-trial evaluation of ERGT. Outcomes evaluated were frequency of DSH and emotion dysregulation. Assessments were conducted at pretreatment, post-treatment, and 6-month follow-up. Multilevel mixed linear models and multilevel negative binomial generalized estimated equations were used to identify significant interactions between the predictors and outcomes.

We found that greater pretreatment DSH frequency was associated with greater improvements in DSH during treatment (b = 0.998, SE = 0.00, p = 0.03) and follow-up (b = 0.997, SE = 0.00, p < 0.01) and that greater BPD severity was associated with greater improvements in DSH during treatment (b = 0.84, SE = 0.06, p = 0.02) and in emotion dysregulation at follow-up (b = ?3.05, SE = 1.47, p = 0.04). Co-occurring disorders were associated with poorer treatment response during follow-up. Results were generally consistent with a previous study of the predictors of response to ERGT. The findings provide further support for the utility of this treatment across a range of BPD patients, including patients with severe DSH and BPD.     

Implementing and Adapting the SAFETY Treatment for Suicidal Youth: The Incubator Model,Telehealth, and the Covid-19 Pandemic

The Safe Alternatives for Teens and Youth (SAFETY) treatment was developed to decrease the risk of repeat suicidal and self-harm behavior in youth presenting with elevated suicide risk. This paper uses case illustrations to demonstrate the SAFETY treatment, building upon the companion paper describing our “incubator” treatment development model and process (Asarnow et al., 2022). As illustrated in the second case illustration, the incubator model approach was particularly useful during the COVID-19 pandemic switch to telehealth. SAFETY specifically targets suicide and self-harm risk reduction using an individually tailored principle-guided approach, grounded in a case conceptualization that identifies cognitive-behavioral processes and reactions that contribute to increased suicide attempt risk and explains the youth’s suicidal/self-harm behavior within the context of his or her broader social systems. The SAFETY treatment has been tested in two treatment development trials, and results support the efficacy of SAFETY for preventing suicide attempts in adolescents presenting with recent self-harm.     

Counsellors' perspectives on self-harm and the role of the therapeutic relationship for working with clients who self-harm

Aims: To gain insight into counsellors' experiences of and ideas about self-harm, and to develop understanding of relational depth when working with clients who self-harm. Method: A qualitative exploration of counsellors' perspectives on working with people who self-harm. The research proposal gained approval from the University Ethics Committee. Data were collected from a sample of counsellors who have experience of working with people who self-harm (n = 8) using tape-recorded interviews. Grounded Theory was used for analysis. Findings: Two major categories emerged from the findings: (i) the activity of self-harm; (ii) the therapeutic relationship with people who self-harm. These categories and sub-categories were integrated to form the core category. Implications: Counsellors have a valuable role to play in the lives of people who self-harm, by embodying confidentiality and so facilitating a sense of trust, by opening minds through acceptance, and by expanding knowledge through participation in research. Conclusions: In order to effectively accompany clients from a life of self-harm to a life of self-healing, counsellors must be aware of and responsive to the many concepts underpinning the emergent categories of the research.     

青少年抑郁与自伤关系的追踪研究：亲子沟通的调节作用

为考察青少年抑郁与自伤的双向关系及亲子沟通的调节效应,采用青少年自我伤害问卷、流动中心用抑郁量表和亲子沟通量表对595名初一学生进行为期10个月的追踪研究。结果发现,从初一到初二,抑郁呈增长趋势,且性别差异显著,而自伤的增长趋势不明显,但到初二后表现出了明显的性别差异;抑郁和自伤的同时性相关和继时性相关均显著;前测抑郁对后测自伤有明显的预测作用,但前测自伤对后测抑郁的预测作用不明显;父子沟通和母子沟通在前测抑郁与后测自伤水平之间有显著的负向调节作用。     

Therapeutic processes in group therapy: Intersections between general change mechanisms and motivational stages of change from patient perspective

Intersections between Grawe’s General Psychotherapy and Prochaska’s Transtheoretical Model were investigated in group therapy in a longitudinal design. It was assumed that general change mechanisms have an impact on patients’ stages of change. Specifically, the main hypotheses were that experiential change mechanisms (ECM; clarification of meaning, problem actuation, emotional bond and group cohesion) should be especially relevant for early stages of change (precontemplation and contemplation), whereas behavioral change mechanisms (BCM; resource activation, mastery/coping and task and goals) should be especially relevant for late stages of change (action and maintenance). Therefore, 140 outpatients attending different types of group therapy, with a typical duration of 8 sessions, were investigated. Patients completed the Form for the Evaluation of Therapeutic Processes in Group Therapy (FEPiG), the University of Rhode Island Change Assessment, short version (URICA-S) and several symptomatology measures (BDI-II, BSCL and IIP-32) at two measuring times. Intersections were analysed through correlational analyses, cross-lagged panels and a path-analytic model, supporting the hypotheses. Specifically, results suggested that experiencing ECM at t1 predicted higher levels of reported contemplation at t2. Patients experiencing higher levels of BCM at t1 reported higher levels of action at t2. Clinical implications of the results are discussed.     

It is never the right time: How to help a mother to separate from her young child

In this paper I have described a short-psychotherapy treatment with a mother, a 3-year-old girl, and occasionally a father, over the difficulty in separating and settling down at nursery. The mother's unresolved mourning for the early miscarriage of her second baby was one important factor. She held on to the company and comfort provided by the little girl, who had become the vessel of maternal projections. Filled with Poppy's projections, the mother had also felt unable to withstand and process them. Mr Green was a conflictual element in the family, rather than a supportive husband and father, and Poppy's care and problems were left with the mother. Nine sessions unblocked the situation and allowed Poppy to settle down at a private nursery.     

青少年早期抑郁和自伤的联合发展轨迹：人际因素的作用

通过对859名初中生历时3年的3次追踪测量, 考察了抑郁和自伤的独立与联合发展轨迹, 并对3种重要人际关系(亲子关系、同伴关系、师生关系)在二者联合发展中的作用进行检验。结果发现, 青少年早期抑郁和自伤分别呈现4条和3条异质性发展轨迹; 二者的联合发展轨迹包含“低抑郁-低自伤-稳定”、“低抑郁-低自伤-增长”、“中抑郁-中自伤-降低”三类; 父母心理控制和同伴接纳分别为青少年早期抑郁和自伤的风险与保护性因素。     

Effects of age and ability on components of cognitive change

Prior experience with a cognitive task is often associated with higher performance on a second assessment, and these experience effects can complicate the interpretation of cognitive change. The current study was designed to investigate experience effects by obtaining measures of cognitive performance separated by days and by years. The analyses were based on data from 2017 adults with two longitudinal occasions, of whom 948 had also completed a third occasion, with each occasion consisting of three parallel versions of the tests on separate sessions. Change across short intervals was typically positive, and greater among older adults and adults with low levels of cognitive ability, whereas change over intervals of approximately three years was often negative, particularly at older ages. In contrast to the expectation that change over short intervals might be informative about change over longer intervals, relations between short-term change and long-term change were negative, as the individuals who gained the most with assessments separated by days tended to experience the greatest losses across assessments separated by years.     

Using system differences to orchestrate change: a systems-guides intervention model

Successful community-based interventions require that change agents give attention to the complexities of interwoven systems, described in the literature as complicated or complex, purposeful or purposive. The author further notes the separate standards, norms, principles and/or goals (here-named systems-guides) of systems. This paper describes the author's experience as a consultant to a multi-system collaboration where observed tensions among participants resulted in the author's implementation of a three-step systems-guides model, which can increase change agents' effectiveness with systems. The steps comprise: detection (of systems, systems-guides, and discrepancies between them; here through observation); documentation (of discrepancies; here through small group discussions); dissemination (to systems participants; here to the collaboration). Two small but fundamental systems changes emerged from systems participants, not from the change agent/author who facilitated systems members' recognition of discrepancies. A major limitation in the implementation of this systems-guides model centers on the critical necessity of the close relationship change agents must have with the involved systems.