焦虑障碍的系统式家庭治疗

焦虑障碍是最常见的心理障碍之一.其具有症状重、病程慢、复发率高、社会功能明显缺损等特点,给个人、家庭和社会造成了巨大的负担.家庭环境因素在焦虑障碍的发病、转归和预后方面都起到重要作用.本文介绍了国内外关于焦虑障碍患者家庭特点和家庭互动模式的研究结果.系统式家庭治疗作为一种家庭治疗模式,具有其独特的治疗理念和方法,国内外研究结果表明系统式家庭治疗用于焦虑障碍具有良好疗效.今后,还应该运用更加多元化的研究方法探讨中国焦虑症家庭动力学特点和家庭功能,并采用更加严格的随机对照设计,进一步证实系统式家庭治疗对焦虑障碍的治疗效果.     

广泛性焦虑障碍的治疗进展

广泛性焦虑障碍心理治疗、药物治疗均可选择.心理治疗主要是CBT.药物治疗主要是抗抑郁药物,SSRI、SNRI是一线选择,NICE推荐舍曲林作为初始治疗药物.对于难治性的患者,可以试用第二代抗精神病药物,如喹硫平.如果药物治疗有效,最佳治疗时间为一年.     

结构式家庭治疗在精神分裂症患者中应用的研究概况

精神分裂症属于重性精神病,在世界人口中的患病率约为1％,其特点是病程迁延,治疗进展缓慢,且复发率以及病残率均相对较高.它是一类病因尚未完全明了的精神障碍,社会心理因素(尤其是家庭关系)在其发病、转归和预后方面具有重要作用.针对精神分裂症家庭特点的研究,推动了家庭治疗的发展,也增加了帮助患者全面康复的治疗手段.结构式家庭治疗假设家庭中被标定的个体的问题与家庭的动力和结构有着密切的联系,改变家庭的动力及其组织过程,可改变个人及家庭,可以应用于精神分裂症患者家庭中,并且具有良好的治疗效果.     

元认知模型：广泛性焦虑障碍研究中的新理念

1　广泛性焦虑障碍的本质广泛性焦虑障碍 (以下简称ＧＡＤ)最初是由ＤＳＭ -Ⅲ(美国精神障碍诊断手册第 3版 1980 )界定的。ＤＳＭ认为ＧＡＤ的诊断标准是 :患者必须具备如下 4种特征中的 3种且要持续 1个月 :(1)运动性紧张 ;(2 )多动性 ;(3)忧虑性期望 ;(4 )警觉和扫描。这个诊断标准在 1987年的时候发生了改变 ,即把忧虑看作为ＧＡＤ的主要特征。在ＤＳＭ -Ⅳ (美国精神障碍诊断手册第 4版 1994年 )中 ,保留了这种更改 ,确定ＧＡＤ的主要诊断特征就是“过度的忧虑和担心”且持续时间要超过 6个月。其他的诊断特征则包括如下 6种特征中的 3…     

一例广泛性焦虑障碍的案例报告

工程师焦某,数年来一直渴望能得到提升。而在最终得到此机会被提拔为部门主管时,却又因极度担心而长期精神紧张,以致于影响到正常的工作和生活。心理咨询师经过收集焦某的基本资料,有针对性地进行心理测验,并与其商定了阶段性的咨询目标。咨询师主要运用认知疗法帮助焦某调整认知观念,用焦虑暴露疗法消除了焦某的认知偏见和行为,大大缓解了其对自己工作表现的焦虑,躯体症状也随之消失,咨询效果明显。     

萨提尔家庭治疗模式评析

萨提尔家庭治疗模式是建立在经验人本理论基础之上的。她认为人类本身具有成长改变的能量,症状行为是对误入歧途的适应性努力,而不是人的固有的个性特征。为此,她逐渐拓展了自我价值、家庭系统的内涵,形成了沟通姿态、转化历程等核心理念,并开发出一系列生动实用的干预技术。萨提尔家庭治疗模式具有独特的优越性。     

广泛性焦虑障碍的元认知理论

广泛性焦虑障碍（GAD）是一种以担忧为核心心理特征的,并伴有机体紧张等躯体症状的焦虑障碍。Wells的元认知模型通过探讨GAD患者的病态性担忧的形成、运作和循环,提出了GAD患者存在两种担忧的假设——Ⅰ型担忧和Ⅱ型担忧（元担忧）,并认为元担忧是导致患者的弥漫的、持续的以及难以控制的担忧的核心因素。由该模型发展起来的元认知疗法在治疗GAD过程中体现出有效的作用。     

“问题孩子”的家庭治疗

家庭治疗作为心理学上的一个理论分支，同时也是一种治疗方式．在西方经过80多年的研究和实践已相当成熟．而在我国刚刚起步，家庭治疗不同于个体治疗之处，在于治疗师不是把注意力放在发生症状的个人身上．而是放在整个家庭单位的功能失调上。在治疗过程中．要求整个家庭参与。     

自闭症谱系障碍个体的焦虑：发生机制、评估与治疗

自闭症谱系障碍是一种神经发育性障碍, 主要表现为社会交往互动障碍和重复刻板性行为。焦虑或焦虑障碍常被认为是自闭症个体最普遍的共病之一。焦虑与自闭症之间的关系尚不明确, 自闭症个体的焦虑与无法忍受不确定性、杏仁核功能和体积、情绪调节策略、消极思维存在一定关联; 目前已经开发出专门用于自闭症个体焦虑的评估工具; 修订版认知行为疗法对自闭症个体焦虑的治疗取得了良好效果。未来的研究应着重探索自闭症个体焦虑的认知与神经机制, 检验专用评估工具的有效性, 继续关注现代技术(如虚拟现实技术)对自闭症个体焦虑的治疗效果。     

关于社交焦虑障碍的家庭教育因素及心理咨询

介绍了社交焦虑障碍的界定,包括一般概念、对它的诊断和测量。预防社交焦虑障碍的关键是良好的家庭教育。本文探讨了家庭教育中的哪些因素对这一病症影响最大,最后重点介绍了当前比较流行的具体的心理咨询方法。     

Systems-Centered Therapy: A Protocol for Treating Generalized Anxiety Disorder

The systems-centered short-term therapy protocol was adapted and applied in three single case studies with generalized anxiety disorder (GAD) patients in a ten-session individual treatment over a two week period. All three subjects showed substantial improvement and no longer met diagnostic criteria post-treatment. Changes were maintained at follow up both six months and one year later. These results are promising and suggest the importance of further research on SCT as a viable, alternative treatment for generalized anxiety disorder.     

Seeing Is Believing: Using Video Feedback in Cognitive Therapy for Social Anxiety Disorder

Distorted negative self-images and impressions appear to play a key role in maintaining Social Anxiety Disorder (SAD). In previous research, McManus et al. (2009) found that video feedback can help people undergoing cognitive therapy for SAD (CT-SAD) to develop a more realistic impression of how they appear to others, and this was associated with significant improvement in their social anxiety. In this paper we first present new data from 47 patients that confirms the value of video feedback. Ninety-eighty percent of the patients indicated that they came across more favorably than they had predicted after viewing a video of their social interactions. Significant reductions in social anxiety were observed during the following week and these reductions were larger than those observed after control periods. Comparison with our earlier data (McManus et al., 2009) suggests we may have improved the effectiveness of video feedback by refining and developing our procedures over time. The second part of the paper outlines our current strategies for maximizing the impact of video feedback. The strategies have evolved in order to help patients with SAD overcome a range of processing biases that could otherwise make it difficult for them to spot discrepancies between their negative self-imagery and the way they appear on video.     

Cognitive Mediators of Treatment for Social Anxiety Disorder: Comparing Acceptance and Commitment Therapy and Cognitive-Behavioral Therapy

Objective

To assess the relationship between session-by-session mediators and treatment outcomes in traditional cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for social anxiety disorder.

Method

Session-by-session changes in negative cognitions (a theorized mediator of CBT) and experiential avoidance (a theorized mediator of ACT) were assessed in 50 adult outpatients randomized to CBT (n = 25) or ACT (n = 25) for DSM-IV social anxiety disorder.

Results

Multilevel modeling analyses revealed significant nonlinear decreases in the proposed mediators in both treatments, with ACT showing steeper decline than CBT at the beginning of treatment and CBT showing steeper decline than ACT at the end of treatment. Curvature (or the nonlinear effect) of experiential avoidance during treatment significantly mediated posttreatment social anxiety symptoms and anhedonic depression in ACT, but not in CBT, with steeper decline of the Acceptance and Action Questionnaire at the beginning of treatment predicting fewer symptoms in ACT only. Curvature of negative cognitions during both treatments predicted outcome, with steeper decline of negative cognitions at the beginning of treatment predicting lower posttreatment social anxiety and depressive symptoms.

Conclusions

Rate of change in negative cognitions at the beginning of treatment is an important predictor of change across both ACT and CBT, whereas rate of change in experiential avoidance at the beginning of treatment is a mechanism specific to ACT.     

A Contemporary View of Applied Relaxation for Generalized Anxiety Disorder

Applied relaxation (AR), originally developed by Lars-Göran Öst, is a long-standing, efficacious treatment for generalized anxiety disorder (GAD). While newer treatments are continuing to be developed, AR remains one of the most efficacious treatments for GAD. However, AR has received less in-depth attention more recently, particularly in terms of potential mechanisms of action. This article is written to honor the development and history of AR and to highlight the ways that it has continued to be adapted. In this article, AR treatment strategies are presented, which include: noticing early signs of anxiety, learning relaxation skills, and applying relaxation at the first sign of anxiety. Then, additional adaptations to AR are presented along with recommendations of how AR may be enhanced by understanding potential mechanisms of change. Finally, recommendations are made for the continued evolution of AR as a powerful and efficacious treatment for GAD.     

Bridging Conversations: Discussing the Intra‐professional Relationship between Medical Family Therapy and Family Therapy

This article examines the conceptual and practice relationship between medical family therapy (MedFT) and its parent field, family therapy, with MedFT viewed as the extension of relational sense‐making and understanding into a specific venue; that of medicine. The extension of this relational meaning system into medicine is typified by the ability of the therapist to negotiate and connect three main areas of conceptual difference that often account for conflictual relationships between mental and biomedical healthcare providers: (i) patient and provider conceptualizations of issues and goals, (ii) linear and circular understanding of issues and goals and (iii) consultative and expert positions on issues and goals. Two case examples are offered to describe how these three areas of tension are reconciled in practice.     

Marital Conflict Among Parents: Implications for Family Therapy with Adolescent Conduct Disorder

Conduct disorder is associated with several causative and maintaining factors, with family functioning being an important one. This is especially true in the Indian context, where a lot of the problem behaviors manifested by adolescents with conduct disorders are in the family context. Marital relationship of the parents is a key aspect of family functioning, affecting a number of other dimensions of family functioning, including adolescent adjustment. The paper highlights the role of parents’ marital conflict in the emergence and maintenance of adolescent conduct problems. The importance of family therapy in managing adolescent conduct disorder is discussed through case examples from India. Shalini Anant, MPhil, PhD Scholar, Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India. Ahalya Raguram, PhD, Additional Professor, Department of Clinical Psychology, NIMHANS, Bangalore 560029, India. Address correspondence to Shalini Anant (shalinianant@gmail.com).     

Changes in Decentering Across Cognitive Behavioral Group Therapy for Social Anxiety Disorder

To further improve treatments, we need to better understand potential common treatment mechanisms, such as decentering, or the ability to observe thoughts and feelings as objective events in the mind rather than personally identifying with them (Safran & Segal, 1990). Therefore, this study examined whether 12 sessions of Cognitive Behavioral Group Therapy (CBGT) for 63 clients (57.6% female, 50.8% White) diagnosed with social anxiety disorder led to increases in decentering and whether increased decentering was associated with improved outcome. Furthermore, this study examined whether decentering was associated with outcome over and above a competing mechanism—cognitive reappraisal. Overall, results indicated that CBGT in this study led to similar outcomes compared to previous studies and decentering increased over CBGT (d’s from 0.81 to 2.23). Change in decentering predicted improvement on most, but not all, measures of outcome and those who no longer met criteria for social anxiety disorder at posttreatment had significantly greater change in decentering across therapy and significantly higher decentering scores at post-treatment compared to those who retained a social anxiety disorder diagnosis at posttreatment. Finally, changes in decentering predicted outcome over and above changes in reappraisal on all outcome measures. These results largely support the role of decentering in CBGT for social anxiety; however, the implications of the inconsistencies in results based on which outcome measure was used are discussed.     

Interpersonal Problems,Mindfulness, and Therapy Outcome in an Acceptance-Based Behavior Therapy for Generalized Anxiety Disorder

Objective: To better understand the role interpersonal problems play in response to two treatments for generalized anxiety disorder (GAD); an acceptance-based behavior therapy (ABBT) and applied relaxation (AR), and to examine how the development of mindfulness may be related to change in interpersonal problems over treatment and at follow-up. Method: Eighty-one individuals diagnosed with GAD (65.4% female, 80.2% identified as white, average age 32.92) were randomized to receive 16 sessions of either ABBT or AR. GAD severity, interpersonal problems, and mindfulness were measured at pre-treatment, post-treatment, 6-month follow-up, and 12-month follow-up. Results: Mixed effect regression models did not reveal any significant effects of pre-treatment interpersonal problems on GAD severity over treatment. After controlling for post-treatment GAD severity, remaining post-treatment interpersonal problems predicted 6- but not 12-month GAD severity. Participants in both conditions experienced a large decrease in interpersonal problems over treatment. Increases in mindfulness over treatment and through follow-up were associated with decreases in interpersonal problems, even when accounting for reductions in overall GAD severity. Conclusions: Interpersonal problems may be an important target of treatment in GAD, even if pre-treatment interpersonal problems are not predictive of outcome. Developing mindfulness in individuals with GAD may help ameliorate interpersonal difficulties among this population.     

Worry and Rumination in Generalized Anxiety Disorder and Obsessive Compulsive Disorder

Ample work has already been conducted on worry and rumination as negative thought processes involved in the etiology of most of the anxiety and mood related disorders. However, minimal effort has been exerted to investigate whether one type of negative thought process can make way for another type of negative thought process, and if so, how it subsequently results in experiencing a host of symptoms reflective of one or the other type of psychological distress. Therefore, the present study was taken up to investigate whether rumination mediates the relationship between worry and generalized anxiety disorder (GAD), and between worry and obsessive compulsive disorder (OCD) in two clinical groups. Self-report questionnaires tapping worry, rumination, generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) were administered to a clinical sample of 60 patients aged 30–40. Worry, rumination, generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) correlated substantially with each other, however, rumination did not mediate the relationship between worry and generalized anxiety disorder (GAD) and between worry and obsessive compulsive disorder (OCD). We also analyzed differences of outcome variables within two clinical groups. These results showed that worry and rumination were significantly different between GAD and OCD groups.