如何建立聊天机器人与用户间的数字治疗联盟：关系线索的作用

近年来,研究者们将“治疗联盟”(Therapeutic Alliance,TA)的概念与在线自助干预(Internet-based Self-help Interventions,ISIs)相结合,以解决ISIs中用户参与度较低的问题。这种在数字环境中形成的TA,被称之为“数字治疗联盟”(Digital Therapeutic Alliance, DTA)。随着人工智能的迅速发展,聊天机器人可模拟人类指导,相对于传统ISIs程序更易于与用户建立关系,可通过友好、尊重、倾听、鼓励、真诚、理解、信任这几个关系线索来促进DTA的发展,为解决用户低参与度的问题提供了一种新思路。未来的研究可从影响因素、ISIs技术迭代、测量规范、实验操纵等方面对DTA作进一步的探索。     

Evidence for the Impact of Organisational Resources Versus Job Characteristics in Assessments of Occupational Stress Over Time

Considerable evidence demonstrates the importance of both job demands and job resources in the prediction of employee health and motivational outcomes. However, scant empirical evidence explains how broader organisational factors can also have an impact on these outcomes. Utilising the job demands-resources (JD-R) model as a theoretical explanation of occupational stress, we examined the impact of employees’ alignment with their organisation's strategic objectives (strategic alignment) in predicting long-term occupational health outcomes. The sample consisted of 1,601 police officers employed in one Australian police service, who completed two self-report surveys over 12 months. Results of the study indicated that strategic alignment was the only resource to reduce psychological strain, and to increase work engagement over time. Job demands were not found to be significantly associated with either psychological strain or work engagement over time. There was also no evidence of the moderating effects of job resources on health and motivational outcomes. The theoretical and practical implications of the inclusion of strategic alignment as an organisational resource are discussed.     

Counselling in primary care: a review of the practice evidence

This paper describes the level of mental health problems that are encountered in primary health care. The limitations of using randomised control trials (RCTs) in evaluating effectiveness of psychological therapies in primary health care are described. Although the RCT may be useful in evaluating interventions in highly controlled situations, its use in evaluating clinically representative service delivery research is limited. A three-stage model of psychological therapies research is described to show that distinct stages require different methodologies in order to evaluate them, and this model is used to structure the review. The literature on research carried out in more naturalistic circumstances is then reviewed. Evaluating psychological interventions in this way shows there is considerable evidence that psychological therapies are effective in a number of ways in a primary care setting. The naturalistic studies that are more typical of clinical practice support the use of psychological interventions. The theme of the grey literature is almost entirely positive from the point-of-view of patients and GPs alike. However, there is considerable diversity in the sophistication of the methodology of the latter studies. Some were comprehensive evaluations, while others were more akin to audit. A major shortcoming is that few described their qualitative methodology. This said, the themes arising from the reports are very consistent and, had they been supported by a more robust qualitative methodology, would have added even more support, financially and clinically, for the arguments for counselling provision in primary health care. The level of referred clients' distress, measured by a variety of measures, was shown to be moderate to severe and similar to the level of patients referred to Community Mental Health Teams (CMHTs). When they were measured, there was a considerable reduction in subsequent psychiatric symptoms.     

Acceptance and commitment therapy (ACT) for people with dementia experiencing psychological distress: A hermeneutic single-case efficacy design (HSCED) series

Introduction

People with dementia have a high prevalence of psychological distress but are underserved with evidence-based psychological interventions. To promote choice and improve clinical outcomes, there is a necessity to test different psychological intervention options for this population.

Purpose

This study aimed to investigate the effectiveness and acceptability of acceptance and commitment therapy (ACT) for people with dementia, considering carer-supported, remote delivery and necessary therapy adaptations.

Methods

A hermeneutic single-case efficacy design series was used to analyse the therapy process and change for three clients with dementia and psychological distress. A matrix of quantitative and qualitative data was collated (“rich case records”) and subject to critical analyses by three independent psychotherapy experts (“judges”) who identified change processes and determined the outcome for each client.

Results

Adjudication concluded that one client made positive changes, specifically reliable reductions in psychological distress, which were largely attributable to ACT. Two clients remained unchanged.

Discussion/Conclusion

Where change was achieved, the ACT-specific processes of values, committed action and acceptance, in combination with non-specific therapy factors, including a strong client–carer relationship, existing client interests and individualised therapy adaptations, were facilitative. Hence, ACT may be a feasible and effective vehicle for therapeutic change by helping carers to better meet the needs of their loved ones. Future research to optimise ACT delivery in this population may be beneficial. Furthermore, the assessment of carer factors (e.g., their psychological flexibility and the client–carer relationship) may strengthen the evidence base for systemic ACT use.     

Emotion Regulation in Adolescent Well-Being and Positive Education

Emotion regulation (ER) becomes increasingly important across adolescent development, and promotes psychological flexibility, resilience and well-being in youth. Positive education programs (PEPs) combine academic training with positive psychology interventions (PPIs) to increase well-being and reduce mental ill-health. Despite considerable overlap between PPIs and ER models, the role and relevance of ER to PEPs remains unclear. This review aimed to evaluate the relationship of ER to PEPs targeting adolescents. First, to evaluate the relationship of ER to domains of well-being targeted by school-based PPIs. Second, to examine whether school-based PPIs can improve adolescents’ ER capacity. Third, to evaluate the role of ER in well-being outcomes of PEPs. Results support the relevance of ER to domains of well-being outlined by the revised PERMA model, including positive emotions, engagement, relationships, meaning, and health. ER can influence the degree to which students benefit from PEP participation. It remains to be determined whether ER capacity is improved as a result of exposure to positive education programs. Findings are limited by the small and heterogeneous group of interventions examined, and the use of inconsistent ER measures. Further research of the role of ER in positive education may contribute to greater understanding of the mechanisms underlying their effectiveness and further promote the psychological well-being of adolescents.     

Resilience and Health: Implications for Interventions and Policy Making

Resilience is a complex phenomenon which mediates in successful adaptation to adversity. Researchers are trying to understand its various trajectories, and this is evident in the growing literature relating resilience to health across the life span. This article intends to understand the nature of resilience, its characteristics and its various social, psychological and cultural sources. The research evidence presented provides a glimpse of the meaningful relationship that exists between resilience and health while unfolding the consequences of resilience on various health outcomes. While understanding the underlying reasons for the relationship between resilience and health, interventions at social, psychological, and clinical level have been suggested followed by recommendations for policy initiatives that will facilitate resilience and health.     

当事人的投入与会谈效果、咨询效果的关系研究

本研究探索了当事人会谈时的投入与即时会谈效果的关系;当事人咨询初期的投入与整体咨询效果的关系。结果发现当事人会谈时的投入与即时会谈效果、在咨询初期的投入与整体咨询效果都呈现显著的正相关。进一步回归分析发现,当事人在咨询初期的投入与整体咨询效果呈现正U型的偏态分布,少数投入水平最低的当事人获得中等水平的咨询效果,中等投入水平的当事人咨询效果最差,投入水平最高的当事人的咨询效果最好。     

Psychotherapie mit Migranten

After an introduction and presentation of the influence of immigration on psychological health, the present overview focuses on several models of psychological development in immigration. Cross-cultural psychodynamics and culturally conditioned transference in ethnically mixed cultural psychotherapy settings are explored. The effectiveness of Western therapy methods based on Christian – Jewish values is discussed with regard to the therapy of patients from different ethnic backgrounds, i. e. so-called traditional societies. In Western cultures, proximity in object relations is based on autonomy whereas in traditional societies proximity is based on relatedness. Knowledge of specific cultural issues are considered to be an important instrument in cross-cultural therapies. Joining, activation of ethnic resources, and culture-sensitive interventions are considered to be helpful psychotherapeutic interventions. Specialized therapy settings, e.g. integration of ethnic therapists in established institutions, mono-cultural ethnic settings and collaborative projects are described. Last but not least, the authors point out the necessity of cross-cultural therapeutic competence because of an expanding cultural heterogeneity of society.     

What to Do When Evidence-Based Treatment Manuals Are Not Enough? Adapting Evidence-Based Psychological Interventions for Primary Care

Significant barriers exist in accessing high-quality, evidence-based psychological interventions in traditional mental health settings. Adapting these interventions for delivery within primary care is particularly advantageous given that the majority of individuals with mental health conditions are more likely to seek care in this environment much earlier in their course of illness than in specialty mental health clinics. The aim of this paper is to summarize efforts at Mayo Clinic to develop and disseminate evidence-based psychological interventions across multiple primary care clinics. Adaptations aimed at improving access to care, enhancing the quality of care, and incorporating a system of measurement-based outcomes are unique features that are essential to the sustainability and advancement of integrated behavioral health programs within primary care.     

Exploring programmatic moderators of the effectiveness of marriage and relationship education programs: a meta-analytic study

This study uses meta-analytic methods to explore programmatic moderators or common factors of the effectiveness of marriage and relationship education (MRE) programs. We coded 148 evaluation reports for potential programmatic factors that were associated with stronger intervention effects, although the range of factors we could code was limited by the lack of details in the reports. Overall, we found a positive effect for program dosage: moderate-dosage programs (9-20 contact hours) were associated with stronger effects compared to low-dosage programs (1-8 contact hours). A programmatic emphasis on communication skills was associated with stronger effects on couple communication outcomes, but this difference did not reach statistical significance for the relationship quality/satisfaction outcome. There was no evidence that institutionalized MRE programs (formal manuals, ongoing presence, formal instructor training, multiple evaluations) were associated with stronger effects. Similarly, there was little evidence of differences in program setting (university/laboratory vs. religious). We discuss possible explanations for these findings and implications for program design and evaluation.     

Long‐term Effects of Dieting: Is Weight Loss Related to Health?

“Success” in dieting interventions has traditionally been defined as weight loss. It is implicit in this definition that losing weight will lead to improved health, and yet, health outcomes are not routinely included in studies of diets. In this article, we evaluate whether weight loss improves health by reviewing health outcomes of long‐term randomized controlled diet studies. We examine whether weight‐loss diets lead to improved cholesterol, triglycerides, systolic and diastolic blood pressure, and fasting blood glucose and test whether the amount of weight lost is predictive of these health outcomes. Across all studies, there were minimal improvements in these health outcomes, and none of these correlated with weight change. A few positive effects emerged, however, for hypertension and diabetes medication use and diabetes and stroke incidence. We conclude by discussing factors that potentially confound the relationship between weight loss and health outcomes, such as increased exercise, healthier eating, and engagement with the health care system, and we provide suggestions for future research.     

Group Cognitive-Behavioral Therapy via Telebehavioral Health for Those With Psychotic Spectrum Disorders: A Case Series

Telebehavioral health emerged as an important practice during the coronavirus disease 2019 (COVID-19) pandemic as an opportunity for continued evidence-based mental health intervention, while minimizing exposure to coronavirus contagion. Though preliminary research suggests feasibility and positive outcomes of telebehavioral health practice for people with schizophrenia spectrum and other psychotic disorders, there is limited research about implementation and effectiveness of this practice (Kasckow et al., 2014). This case series highlights the transition from in-person to telebehavioral health practice of a Cognitive Behavioral Social Skills Training for Schizophrenia group due to the COVID-19 pandemic. This article summarizes: (a) the staff procedures needed to transition the group from in-person to telebehavioral health, (b) participant outcome data, (c) session attendance data, and (d) survey results from facilitators and participants about barriers and facilitators of the transition to telebehavioral health, and about how the virtual platform altered the therapeutic relationship and engagement. Participant outcome and engagement data suggest that, not only were two participants able to transition to telehealth and complete the program, but both participants also showed notable improvement in treatment engagement, goal progress, and skill acquisition. Surveys of six facilitators and one participant highlight how the transition to telebehavioral health had treatment advantages (e.g., therapeutic relationship, treatment engagement, group dynamics). Though survey results highlighted several implementation challenges in using the new virtual platform (e.g., technological connectivity, confidential space for engagement), no survey respondents reported that participation in this program resulted in harm to facilitators or participants. All facilitators and one participant agreed that the transition from in-person to virtual services was easy and reduced transportation barriers. Given the limited treatment engagement for this population (Lora et al., 2012) and the importance of early intervention to maximize clinical outcomes (Black et al., 2001; Bottlender et al., 2003), unanimous facilitator and participant report about improved patient attendance and participation in treatment after the transition to telebehavioral health was critically important. Though results of this case study are promising in suggesting telebehavioral health could be a viable modality for providing psychosocial treatment to people with schizophrenia spectrum and other psychotic disorders, more rigorous study is needed.     

Daily fluctuations in teachers' well-being: a diary study using the Job Demands–Resources model

Abstract

The study tests the dynamic nature of the Job Demands–Resources model with regard to both motivational and health impairment processes. It does so by examining whether daily fluctuations in co-workers' support (i.e., a typical job resource) and daily fluctuations in work/family conflict (i.e., a typical job demand) predict day-levels of job satisfaction and mental health through work engagement and exhaustion, respectively. A total of 61 schoolteachers completed a general questionnaire and a daily survey over a period of five consecutive work days. Multilevel analyses provided evidence for both the above processes. Consistently with the hypotheses, our results showed that day-level work engagement mediated the impact of day-level co-workers' support on day-level job satisfaction and day-level mental health, after general levels of work engagement and outcome variables had been controlled for. Moreover, day-level exhaustion mediated the relationship between day-level work/family conflict and day-level job satisfaction and day-level mental health after general levels of exhaustion and outcome variables had been controlled for. These findings provide new insights into the dynamic psychological processes that determine daily fluctuations in employee well-being. Such insights may be transformed into job redesign strategies and other interventions designed to enhance work-related psychological well-being on a daily level.     

接纳承诺疗法的作用机制——基于元分析结构方程模型

接纳承诺疗法(Acceptance and Commitment Therapy, ACT)被认为是行为治疗“第三浪潮”的重要代表。本研究使用元分析结构方程模型, 考察ACT的作用机制。通过数据库检索与筛选, 最终纳入文献50篇。结果发现: ACT所假设的心理灵活性、接纳、此时此刻、价值的中介作用都达到统计显著, 认知解离这一中介变量并不显著; 中介机制在网络化干预中仍然得到检验; 相较之传统CBT, ACT在所假设的机制上有其区别于CBT的优势。后续临床研究应更全面地测量6大核心机制, 关注对美好生活提升的影响, 采用多点瞬时评价法, 并尽可能使用更高级、更先进的统计方法检验其作用机制。     

Leisure, coping and health: the role of social, family, school and peer relationship factors

The relationship between social, family, peer and school factors and leisure engagement within a transactional model of stress and health was investigated in 655 young adults. Results show that the family environment, encouragement from parents and teachers, relationships with peers and socioeconomic factors in childhood predict adult attitudes to and engagement in leisure. In turn, leisure attitude and engagement are related to psychological distress, optimism, perceived control and social support. It is argued that the development of patterns of leisure attitudes and engagement in childhood need to be understood in predicting and changing adult leisure behaviours relevant to health and illness.     

Effects of a personified guide on adherence to an online program for alcohol abusers.

The quality of the therapeutic alliance has robust effects on the outcome of psychotherapy and psychopharmacologic interventions. Automated behavioral health programs that are being developed to increase access to mental health treatment are administered in the absence of direct human participation, thereby precluding the development of a traditional therapeutic relationship. The aim of this study was to develop a personified guide designed to stimulate reactions similar to those experienced in a therapeutic relationship, and evaluate the effect of the guide on adherence to and satisfaction with an online alcohol use evaluation program. After completing a battery of four standard questionnaires used to evaluate problem drinking, 288 subjects were randomized to receive feedback on their results in text form or via a multimedia condition involving a personified guide. Those who received feedback via the guide demonstrated greater levels of program adherence by completing more modules. Reported satisfactions levels did not differ between the two conditions. Encouraging the personification of an automated behavioral health intervention may lead to greater levels of engagement with the program.     

Flourishing is Associated with Higher Academic Achievement and Engagement in Filipino Undergraduate and High School Students

Flourishing emphasizes the importance of integrating subjective well-being and psychological well-being to offer a more comprehensive view of mental health. Recognizing the potential advantage of flourishing, previous empirical studies have examined the relations of flourishing to positive psychological outcomes such as hope, life satisfaction, mental health, and positive emotions. However, it appears that limited research has been carried out to assess the role of flourishing in the educational context. Hence, the current research examined the association of flourishing with relevant academic outcomes (i.e., perceived academic achievement, academic achievement, behavioral engagement, and emotional engagement) after controlling for relevant demographic variables, life satisfaction, positive affect, and negative affect among Filipino undergraduate and high school students. Study 1 showed that flourishing positively predicted self-report academic achievement of Filipino undergraduate students after controlling for age, gender, and subjective well-being domains (life satisfaction, positive affect, and negative affect). Similarly, Study 2 showed that flourishing positively predicted objective measure of academic achievement, behavioral engagement, and emotional engagement in Filipino high school students even after controlling for the influence of demographic variables and subjective well-being domains. The theoretical and practical implications are discussed.     

Therapeutic Factors in Adolescents’ Groups With and Without Movies

ABSTRACT

The study explores the therapeutic factors in two types of group interventions–-film therapy (n = 69) and affective support therapy (n = 48) for Arab adolescents (ages 13–14) in Israel. Film therapy is a relatively new method for groups, aimed at enhancing adolescents’ engagement in the process of group counseling. Six-hundred students from 11 schools were screened for the level of parent–adolescent conflict, based on a self-report measure. The 117 students who met the cutoff point constituted our sample. They were randomly divided into 12 small groups (6 in each type of intervention). A previous study reported the outcomes of these two interventions, showing equal progress in both groups (compared to control). The current study explores process variables, specifically therapeutic factors, in an attempt to enhance our understanding of those outcomes. Results indicated common therapeutic factors across both types of intervention. The factors of relationship–climate and other- versus self-focus were ranked the highest and, contrary to expectations, were significantly higher in affective support therapy than in film therapy.     

Working with the complexities of adolescent mental health problems: applying time-limited adolescent psychodynamic psychotherapy (TAPP)

This article discusses the application in a CAMHS setting of a distinctive intervention for adolescent mental health difficulties, time-limited adolescent psychodynamic psychotherapy (TAPP). TAPP has been developed specifically for working with adolescents and the characteristic developmental and psychosocial complexities they present to mental health services. It is widely recognised that supporting the developmental process in adolescence is central to therapeutic interventions and the therapeutic aim of TAPP is to enable recovery of the capacity to meet developmental challenges. The key factors of TAPP are described, including the formulation and working with a developmental focus, the therapeutic stance, working with transference and counter-transference, working with time limits, and the emphasis is placed on engagement of adolescents in therapy in TAPP. The experiences of introducing and developing TAPP in the CAMHS service are discussed with two brief and one extended case examples and this leads to a discussion of the kinds of outcomes achieved. It is concluded that TAPP is a key and relevant intervention for adolescents in complex and vulnerable situations; further work will be undertaken to continue its application in these settings and to formally assess outcomes.