分类和概念对恐惧泛化的影响机制

恐惧泛化与多种焦虑障碍的病理基础密切相关。例如创伤后应激障碍个体往往持续地逃避与创伤事件有关的刺激,遭受着创伤痛苦折磨。本文在厘清知觉辨别与恐惧泛化关系的基础上,着力于高级认知过程(分类与概念相似性、典型性和人工概念)对恐惧泛化的影响,回顾了恐惧泛化的相关神经机制,并揭示恐惧泛化对焦虑障碍患者的临床治疗启示。未来研究应将知觉和高级认知维度的恐惧泛化进行整合研究,同时扩充恐惧习得和泛化的神经回路,以促进人类恐惧泛化更深入的研究。     

儿童青少年创伤后应激障碍患者的家庭问题研究

创伤后应激障碍(PTSD)是个体在经历重大创伤后出现的一种非常严重的心理障碍,儿童青少年由于身心发展尚未成熟,是患病的高危群体。家庭已被证实是PTSD发病、维持以及好转恢复过程中一个重要的影响因素。本文聚焦于家庭视角,从家庭关系、家庭功能、家庭治疗三个方面对儿童青少年PTSD患者家庭问题的研究进行了总结,未来研究者应加强对儿童青少年PTSD家庭治疗效果的阶段性长期纵向研究,并注重中西文化的差异性,在研究方法上加强定性研究和追踪研究。     

灾后孤儿创伤后应激障碍的发生发展及其认知神经机制

灾后孤儿亲历双重重大创伤, 是创伤后应激障碍(post-traumatic stress disorder, PTSD)的高发群体; 同时, 巨大创伤对其认知功能和行为模式也带来一定程度的影响。本研究拟以灾后孤儿这一特殊群体为研究对象, 考察“PTSD发生发展及其认知神经机制”, 具体如下：(1) 采用序列研究设计, 展开灾后孤儿PTSD流行病学调查, 描述其PTSD发生发展、变化的轨迹和时程特点; (2) 展开横断研究, 考察灾后孤儿认知发展特点, 并通过结构方程模型, 揭示其PTSD发生发展的心理行为机制; (3) 采用眼动和脑电技术展开比较研究, 考察罹患PTSD孤儿的认知神经机制。本研究的研究结果将对今后的灾后孤儿安置及心理援助提供科学建议; 为有针对性地提供心理干预、制定心理干预的总体规划提供科学依据; 力争为今后孤儿的创伤心理的诊断、干预效果评估提供科学客观的指标和方法。     

状态焦虑对条件性恐惧泛化的影响

恐惧的过度泛化是焦虑障碍患者重要的潜在病因,探索焦虑对恐惧泛化的影响具有重要意义。本研究在恐惧习得后,通过恐惧创伤电影范式诱发状态焦虑组被试的焦虑水平,采用主观预期值和皮电反应值作为指标,考察状态焦虑对条件性恐惧泛化的影响。结果表明,恐惧创伤电影范式显著提高了状态焦虑组被试的焦虑水平。在泛化阶段,状态焦虑组被试表现出更强的恐惧泛化,对与条件刺激相似的泛化刺激表现出更强烈的恐惧以及更高的预期。状态焦虑使得被试恐惧泛化的消退更慢,持续时间更长。研究同时发现,在状态焦虑下,被试对条件刺激的辨识出现增强趋势。研究结果提示在对经历负性事件个体进行临床干预时,可通过降低其焦虑水平来减少过度泛化。     

基于知觉的恐惧泛化的认知神经机制

恐惧泛化是条件性恐惧反应转移到另一个相似但安全的刺激的现象。适当的恐惧泛化对人类有积极意义, 而过度的恐惧泛化则不利于个体有效地适应环境。基于知觉的恐惧泛化研究揭示了恐惧泛化的规律, 因而被广泛应用。本文首先梳理了对知觉恐惧泛化的相关研究, 介绍恐惧泛化的经典理论基础—巴普洛夫条件反射以及恐惧泛化梯度; 其次简要回顾基于多个感觉通道(即视觉、听觉、情景)的知觉恐惧泛化研究现状; 再次, 分别对海马、杏仁核、脑岛和前额叶等脑区在恐惧泛化中的作用进行回顾, 进一步总结出恐惧泛化的神经环路结构模型。最后, 简要区分了基于知觉的恐惧泛化和正在兴起的基于概念的恐惧泛化, 进而指出未来研究需要结合基于概念的恐惧泛化、区分被试对刺激的辨别力、增加恐惧刺激材料的准确性及多样化、结合激素等个体差异和多模态脑成像数据来展开。     

蓄意创伤受害者的创伤后应激障碍症状及影响因素分析

目的:研究蓄意创伤受害者的PTSD症状及影响因素。方法:采用事件冲击问卷、创伤经历揭露问卷、受害人认可问卷和攻击描述问卷等测查工具对163名蓄意创伤受害者进行调查。结果:(1)蓄意创伤受害者的PTSD三大症状之间相关显著,且方差分析结果差异显著,闯入性症状>回避症状>高警觉症状;(2)创伤严重程度与PTSD三大症状的相关显著;(3)创伤揭露中情绪反应对PTSD三大症状都有显著的预测作用;(4)社会认可度中的一般性排斥对PTSD三大症状都有显著的预测作用。结论:蓄意创伤受害者有着较强的PTSD症状,且以闯入性症状最为严重,回避和高警觉症状次之;创伤的严重程度、揭露时的情绪反应和社会认可度中的一般性排斥等都对蓄意创伤受害者的PTSD症状有影响作用。     

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。     

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。     

创伤暴露程度对青少年物质滥用的影响：创伤后应激障碍与依恋的中介作用

为了考察汶川地震后青少年的创伤暴露程度、创伤后应激障碍（PTSD）、父母依恋和同伴依恋与物质滥用之间的关系,采用创伤暴露程度问卷、儿童创伤后应激障碍症状量表、父母与同伴依恋问卷和物质滥用问卷对汶川县和茂县的1435名中学生进行调查,选取有物质滥用的青少年354名作为本研究的对象。结果发现：创伤暴露程度可以直接正向预测作用物质滥用。不过,在创伤暴露与物质滥用直接关系之间加入PTSD、父母和同伴依恋之后,创伤暴露程度对物质滥用的直接预测作用不再显著,并且创伤暴露程度不能通过同伴依恋预测物质滥用,也不能通过PTSD经同伴依恋对物质滥用发挥多重中介作用;但创伤暴露程度能通过PTSD正向预测物质滥用,可以通过父母依恋负向预测物质滥用,并且创伤暴露程度还可以通过PTSD经过父母依恋对物质滥用发挥正向的多重中介作用。     

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。     

汶川地震8.5年后青少年身心状况研究

汶川地震8.5年后,对地震极重灾区的2291名青少年进行问卷调查,考察其创伤后应激障碍(PTSD)、抑郁、创伤后成长(PTG)和生活满意度等身心反应的现状及其共存形态。结果发现:(1)地震发生8.5年后4.75%的青少年有明显的PTSD症状,29.98%的青少年有明显的抑郁症状,其中女生、少数民族学生、高年级学生的症状水平更高;46.13%的青少年报告其出现了明显的PTG,其中女生和少数民族学生的PTG水平更高;青少年的生活满意度较低,其中初一年级显著高于其他年级,但性别和民族差异不显著;(2)青少年的PTSD与抑郁呈显著正相关、与生活满意度呈显著负相关、与PTG相关不显著,抑郁与PTG和生活满意度呈显著负相关,PTG与生活满意度呈显著正相关;(3)青少年的PTSD、抑郁、PTG和生活满意度之间具有共存的形态,具体表现为成长组(32.6%)、低症状组(39.4%)、症状-成长共存组(5.8%)、中等症状共病组(17.8%)和高度症状共病组(4.4%)等5种类别。     

Examination of the Relationship Between PTSD and Distress Tolerance in a Sample of Male Veterans With Comorbid Substance Use Disorders

Distress tolerance (DT), the perceived or actual ability to tolerate negative emotional or physical states, is inversely related to posttraumatic stress disorder (PTSD) symptoms in civilian, community samples. No studies to date have examined the relationship between DT and PTSD in clinical samples of veterans with a comorbid diagnosis of PTSD and a substance use disorder (SUD). Thus, the present study examined the relationship between DT and PTSD in a sample of predominately African American, male veterans (n = 75) diagnosed with comorbid PTSD and SUD (according to a structured clinical interview). Results of hierarchical linear regression models indicated that DT was inversely related to total PTSD symptom severity score, above and beyond depressive symptoms and SUD severity. Of the 4 symptom clusters, DT was inversely associated with intrusions and hyperarousal. These findings are discussed in light of previous work with civilian samples. Determining whether treatment incorporating DT skills would be useful for veterans undergoing PTSD treatment should be evaluated.     

Sleep disturbances in the aftermath of trauma and posttraumatic stress disorder

Sleep disturbances, including nightmares and insomnia, are prominent following trauma and with posttraumatic stress disorder (PTSD) and likely contribute to the pathogenesis of the disorder. Findings from laboratory studies of PTSD have been inconsistent in terms of documenting objective impaired sleep maintenance but have been somewhat more consistent in indicating alterations of rapid eye movement (REM) sleep. Studies of the early aftermath of trauma can reduce the complexity associated with chronicity and comorbidity, and may have implications for early diagnosis and prevention. Multiple studies indicate that dream content is affected by recent threatening experiences. The development of PTSD is associated with a more replicative type of nightmare content. Sleep is reported to be generally disrupted following trauma especially among those developing PTSD. The limited number of studies that provide objective recorded indices during the early aftermath of trauma also provide a mixed picture regarding overall sleep maintenance. Recent data suggest that a more specific disruption of REM sleep may be associated with the development of PTSD and that this disruption is associated with an increased signal of sympathetic nervous system activation during REM sleep. Disrupted REM sleep and increased sympathetic/noradrenergic activity may have implications for understanding recent promising interventions for PTSD sleep disturbance that can be applied to early intervention.     

Fear and Loathing: A Meta-Analytic Review of the Specificity of Anger in PTSD

The available empirical literature suggests that anger may be characteristic of posttraumatic stress disorder (PTSD). Meta-analytic strategies were used to evaluate the extent to which the experience of anger is specific to PTSD rather than anxiety disorders in general. Thirty-four anxiety disorder patient samples (n = 2,169) from 28 separate studies were included in the analysis. Results yielded a large effect size indicating greater anger difficulties among anxiety disorder patients versus controls. Compared to control samples, a diagnosis of PTSD was associated with significantly greater difficulties with anger than was any other anxiety disorder diagnosis. Other anxiety disorder diagnoses did not differ significantly from each other. However, the specific association between PTSD and anger did vary depending on the anger domain assessed. Difficulties with anger control, anger in, and anger out significantly differentiated PTSD from non-PTSD anxiety disorder samples, whereas difficulties with anger expression, state anger, and trait anger did not. These findings are discussed in the context of future research on the role of anger in PTSD.     

Neurocognitive Functioning in Posttraumatic Stress Disorder

This paper reviews the literature on performance on standard neuropsychological tests among individuals with posttraumatic stress disorder (PTSD). Of 19 studies, 16 reported impairment of attention or immediate memory (or both); however, most of these studies included PTSD patients with significant psychiatric comorbidity, so that the extent to which the observed deficits are specifically attributable to PTSD remains unclear. Other potential confounds, including medical illness, substance abuse, and motivational factors, further preclude definitive conclusions at present. Results of structural and functional neuroimaging studies of PTSD are also summarized. Two studies have reported correlations between hippocampal volume and cognitive findings in PTSD patients; functional studies have indicated specific findings in limbic regions, although the relationship of these results to neuropsychological performance remains to be explored.     

From prematurity to parenting stress: The mediating role of perinatal post-traumatic stress disorder

Preterm delivery may lead to the emergence of symptoms of Post-Traumatic Stress disorder (PTSD), which may, in turn, affect the quality of the mother-child relationship. The aim of this study is to shed light on the development of parenting stress in mothers of preterm and full-term children. It is hypothesized that PTSD symptoms mediate the relationship between preterm/full-term birth and the levels of parenting stress. Perinatal PTSD, parenting stress and social support were assessed in 156 mothers of full-term children and 87 mothers of preterm children. Mothers of preterm children experienced more post-traumatic stress and parenting stress than mothers of full-term children. However, the relationship between preterm delivery and subsequent levels of parenting stress was mediated by PTSD symptoms. These findings suggest that the maternal perception of childbirth as a traumatic experience and the subsequent development of PTSD symptoms are pivotal in the emergence of parenting stress.     

灾后中小学生创伤后应激障碍和抑郁症状的共存模式

为揭示灾后中小学生创伤后应激障碍(PTSD)和抑郁在症状层面的共存模式, 本研究分别在汶川地震和雅安地震1年后, 对灾区的中小学生进行问卷调查, 并基于高斯图形模型和贝叶斯爬山算法构建了二者的共存症状网络。结果发现, 在DSM-IV的框架下, PTSD和抑郁的重叠症状以及情绪麻木症状在二者的共存网络中起到了桥接作用; 子网络探测结果与DSM-IV划分的症状边界不同, PTSD中的闯入性症状和回避性症状是其区别于抑郁的特异性症状, 且多为闯入性症状激发回避性症状; 在二者的共存模式中, 多为抑郁症状激发PTSD症状。上述结果在汶川和雅安两个样本中均得到了交叉验证, 具有一定的可推广性。     

Attachment Representation and Sensitivity: The Moderating Role of Posttraumatic Stress Disorder in a Refugee Sample

It has been hypothesized that adult attachment representations guide caregiving behavior and influence parental sensitivity, and thus affect the child's socio‐emotional development. Several studies have shown a link between posttraumatic stress disorder (PTSD) and reduced parental sensitivity, so it is possible that PTSD moderates the relationship between insecure attachment representations and insensitivity. In this study symptoms of PTSD (Harvard Trauma Questionnaire), parental sensitivity (Emotional Availability Scales), and attachment representations (Attachment Script Assessment) were assessed in 53 parents who were asylum seekers or refugees. Results showed that when parents were less able to draw on secure attachment representations, symptoms of PTSD increased the risk of insensitive parenting. These findings suggest that parental sensitivity is affected not just by attachment representations, but by a conjunction of risk factors including symptoms of PTSD and insecure attachment representations. These parents should therefore be supported to establish or confirm secure models of attachment experiences, to facilitate their ability interact sensitively and form a secure relationship with their children.     

The relationship between acute stress disorder and posttraumatic stress disorder in severely injured trauma survivors

This prospective longitudinal study was designed to investigate the relationship between acute stress disorder (ASD) and the subsequent development of posttraumatic stress disorder (PTSD) in a population of severely injured hospitalised trauma survivors. Symptoms of ASD were assessed just prior to discharge in 307 consecutive admissions to a Level 1 Trauma Centre, with PTSD assessments completed at 3 and 12 months post-injury. A well-established structured clinical interview was adopted for both assessments. Only 1% of the sample met criteria for an ASD diagnosis (at a mean of 8 days post-injury), while the incidence of PTSD was 9% at 3 months and 10% at 12 months. Although all ASD symptom clusters contributed to the prediction of subsequent PTSD severity, logistic regression indicated that only re-experiencing and arousal predicted a categorical PTSD diagnosis. The dissociative symptoms that form the core of ASD were rarely endorsed and showed high specificity but low sensitivity, resulting in a high proportion of false negative diagnoses. Reducing the number of dissociative symptoms required for a diagnosis ameliorated, but did not resolve, the problem. In this particular population, the low sensitivity of the ASD diagnosis renders it a poor screening test for use in identifying high risk individuals for early intervention and prevention strategies.     

Borderline Personality Disorder and Posttraumatic Stress Disorder: Time for Integration?

The increasing prevalence of borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) diagnoses among women illustrates problems and limitations of the medical model system (Diagnostic and Statistical Manual of Mental Disorders, fourth edition; American Psychiatric Association, 1994). In particular, diagnoses of BPD continue the trend of overpathologizing women's issues and reinforcing a patriarchal system of diagnosis and treatment. A PTSD diagnosis, with similar criteria, is preferred for traumatized women because it portrays them in a more positive context. This article explores the overlapping relationship between BPD and PTSD and critiques how both are viewed within the mental health community. Previous research on BPD and PTSD is explored, as well as concerns and limitations regarding both diagnostic categories.