探讨二次焦虑——对焦虑的焦虑

1　概念二次焦虑的概念是指对原发的焦虑反应及与此反应有相对固定联系的症状产生的 ,并使之维持和加强的焦虑。如 ,惊恐发作患者对自己惊恐发作的焦虑 ,社交恐怖症患者对自己因为焦虑而出现的脸、红口吃等症状的焦虑 ,强迫症患者对自己那些与焦虑相连的强迫症状的焦虑 ,疑病症患者对自己因焦虑、专注而有的症状的焦虑 ,甚至身心疾病患者对自己被焦虑反应加强的症状的焦虑 ,这些焦虑都是由原发的焦虑反应和症状引起的 ,又产生或加强这些反应和症状的继发性焦虑。2　作用2 1　理解某些焦虑症状螺旋上升和迁延持续的原因。正常焦虑随刺激的消…     

一例高中生人际交往焦虑的咨询案例报告

本文是一例利用认知行为疗法对高中生进行心理咨询的案例报告。来访者王某因在班级当众出丑的现实冲突引发持续的焦虑、抑郁情绪,严重影响其学习和生活——近三个月处于情绪焦虑、低落、不安,内容充分泛化的心理不健康状态。心理测验显示有中度的焦虑症状,其心理问题符合严重心理问题的诊断标准。咨询师根据来访者的症状及其相关认知特点帮助来访者调整认知观念,用系统脱敏法消除了来访者的负性情绪,取得了良好效果。     

焦虑症状的识别与处理

本文从6个方面探讨时焦虑症状的识别与处理:焦虑有关的理论研究、焦虑的症状特征、焦虑症状分类及其意义、焦虑的病因与发病机制、焦虑的评定与诊断、焦虑的药物治疗与心理治疗.焦虑患者在综合医院很常见,需要临床各科医生提高识别率,积极处理.     

焦虑障碍的认知偏向矫正元分析:效果量、影响因素及中介检验

焦虑障碍的认知偏向矫正效果及作用机制是当前一个研究热点且有争议的主题。采用元分析、元回归分析并且组合两步结构方程元分析技术,探索认知偏向矫正对焦虑障碍干预的临床和亚临床有效性,分析可能的影响因素并考察认知偏向改变在认知偏向矫正(Cognitive Bias Modification,CBM)和焦虑症状之间的中介作用。元分析共纳入46篇文献,CBM对焦虑症状干预具有虽小但显著的效果量(包含非标准化测量:g=0.29;标准化测量:g=0.26,p0.001;压力任务后焦虑症状g=0.34,p0.001),对认知偏向有中等效果量(g=0.48,p0.001);干预范式、出版特征、实验环境是焦虑症状CBM效果量的调节因素,焦虑障碍类型和实验环境对CBM认知偏向效果量有调节作用;认知偏向改变在CBM干预与焦虑障碍改变之间起显著的中介效应(z=3.13,SE=0.014,p0.001),为部分中介。将来研究可关注提升CBM症状测量或者认知偏向测量工具的信效度、发展新干预范式,尝试CBM同其他干预方式相结合,进一步探索CBM理论基础和干预机制,提升干预效果。     

认知训练对不同类型考试焦虑的作用

以163名高中一年级学生为被试,采用现场实验法考察了认知训练对认知主导型考试焦虑(C型)、生理唤醒主导型考试焦虑(P型)和学习技能缺乏型考试焦虑(S型)的作用效果.结果表明:认知训练能显著地降低三种考试焦虑类型的状态考试焦虑,提高C型和P型的考试成绩.认知训练在降低考试焦虑和提高考试成绩两方面对C型考试焦虑者作用尤为明显.认知训练没有表明对S型考试焦虑者有提高考试成绩的作用.     

焦虑中的安全行为及其影响

安全行为是个体用于预防或者减轻恐惧后果的行为, 它被认为是焦虑障碍维持的重要机制之一, 也会对焦虑的暴露治疗产生干扰。安全行为与焦虑水平、焦虑相关的认知偏差存在联系, 错误归因假说、注意资源偏离假说和行为信息假说对这种联系做出了解释。此外, 安全行为的使用会削弱焦虑暴露治疗的效果、提高暴露的接受性。未来研究应对安全行为做出更清晰的界定和准确的测量, 进一步改进研究设计, 借鉴第三代行为治疗的理论解释安全行为与焦虑的关系; 同时还需要考察安全行为的双重作用, 开发聚焦于安全行为的治疗方案并评估其效果。     

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。     

焦虑症状的识别与处理

本文从6个方面探讨对焦虑症状的识别与处理:焦虑有关的理论研究、焦虑的症状特征、焦虑症状分类及其意义、焦虑的病因与发病机制、焦虑的评定与诊断、焦虑的药物治疗与心理治疗。焦虑患者在综合医院很常见,需要临床各科医生提高识别率,积极处理。     

社交焦虑障碍：自我认知偏倚与疾病的发展

社交焦虑障碍患者具有特征性的自我认知模式。消极自我评价、以自我为焦点的注意是使疾病持久难以自愈的重要因素,妨碍了人格的健康发展。探索社交焦虑障碍患者的自我认知特点、寻找规律创建符合本土文化背景的认知模型,将有利于深入了解疾病形成与发展的易患性因素和病理心理学机制。     

慢性腰背痛患者和抑郁症患者的情绪、睡眠及疼痛症状

本研究对慢性腰背痛患者、抑郁症患者和对照人群的疼痛、抑郁水平、焦虑水平和睡眠质量进行测评,发现慢性腰背痛患者的抑郁、焦虑程度增高,失眠较常见;抑郁症患者的焦虑和失眠现象严重,疼痛是其常见症状.结果提示临床上对慢性疼痛患者和抑郁症患者的疼痛、情绪和睡眠问题予以评定和治疗具有重要意义.     

Specific and differential prediction of health anxiety by disgust sensitivity and propensity

Current models of health anxiety suggest that fear resulting from false alarms to perceived threats to one's health results in the development of hypochondriasis and related disorders. Disgust has been proposed as an affective response that may function as an etiological and maintenance mechanism in health anxiety. Moreover, the way in which an individual perceives the disgust response (disgust sensitivity) may affect health anxiety, separately from their likelihood of experiencing disgust (disgust propensity). The present study utilized multiple hierarchical regression analysis to investigate the degree to which self-reported disgust sensitivity and disgust propensity differentially predict elevated health anxiety in a sample of 620 non-treatment-seeking undergraduates. Further, this effect is tested in comparison to that of anxiety sensitivity, a construct demonstrated to be strongly related to health anxiety. Analyses indicate that disgust sensitivity, rather than disgust propensity, is primarily responsible for this relation. An additional analysis tested the specificity of disgust sensitivity relative to anxiety sensitivity. Disgust sensitivity was no longer significant after including anxiety sensitivity in the model. Suggestions for further evaluation of this relation are provided. These results suggest that although disgust sensitivity may appear related to health anxiety, this relation may be confounded by anxiety sensitivity.     

存在焦虑的研究述评

存在焦虑是焦虑本体论的一种定义,是哲学、文学和心理学领域的重要概念之一。在心理学领域,存在焦虑理论主要包括罗洛·梅的焦虑本体论,布根塔尔的存在焦虑理论及存在焦虑与心理健康关系理论等等。目前的研究方法主要是量表测量法,但尚不成熟。为数不多的实证研究主要集中在：存在焦虑与心理健康的关系,与同一性地位的关系,与焦虑、抑郁的关系等等。今后研究的重点应包括概念研究的丰富、研究对象的拓宽及研究方法的改进和完善等     

How Do Elements of a Reduced Capacity to Withstand Uncertainty Relate to the Severity of Health Anxiety?

Intolerance of uncertainty (IU)—a multidimensional cognitive vulnerability factor—is associated with a variety of anxiety disorders and health anxiety (HA). To date, few studies have assessed whether IU dimensions (prospective and inhibitory IU) are differentially associated with HA and whether their contributions are independent of anxiety sensitivity (AS). This study addressed these issues using independent community (n = 155; 81% women) and undergraduate (n = 560; 86% women) samples. Results indicated that prospective IU, but not inhibitory IU, had significant positive associations with HA in community dwellers and undergraduate students. AS somatic and cognitive concerns were also significant predictors among both samples. In addition, severity of IU dimensions among individuals reporting elevated HA were compared against individuals diagnosed with generalized anxiety disorder, social anxiety disorder, panic disorder, and obsessive–compulsive disorder. Results indicated minimal differences between those with elevated HA and each of the anxiety disorder diagnoses. Findings lend support to the unique transdiagnostic nature of IU and support commonalities between HA and anxiety disorders.     

Norwegian versions of the Living with Asthma Questionnaire (LWAQ) and Asthma Bother Profile (ABP), validation and comparison of two asthma groups

The Living with Asthma Questionnaire (LWAQ) and the Asthma Bother Profile (ABP) were translated into Norwegian using conventional back translation procedures, and completed by 30 asthma outpatients and 30 asthma patients admitted to inpatient rehabilitation. Reliability (Cronbach's alpha and retest-reliability) was shown to be good for both scales. Validity was established by showing significantly poorer health in the rehabilitation sample, and correlations with state and trait anxiety. The Norwegian translations are reliable and valid versions of the original questionnaires.     

Recommendations for the Treatment of Hypochondriac Patients

Hypochondriasis is a debilitating condition in which patients are persistently preoccupied with the possibility of being seriously ill. Its is a costly problem for the health care system whose treatment has not received systematic attention until recently. Although based on few controlled studies, results indicated that various brief cognitive-behavioral techniques produce significant changes in illness fears and attitudes. A list of therapeutic questions that require further study is presented and some indications for both therapists and patients are given.     

The role of disgust in patients with hypochondriasis

Theoretically, disgust sensitivity and disgust proneness could play an important role in hypochondriasis, since disgust is a defensive emotion widely believed to protect the organism from illness. However, empirical evidence to support this hypothesis has so far been based only on nonclinical samples, so that the importance and specificity of disgust for hypochondriasis remains unclear. In the current study, 36 patients with hypochondriasis, 27 with an anxiety disorder, and 29 healthy controls completed several measures which included the assessment of disgust sensitivity (Scale for the Assessment of Disgust Sensitivity) and disgust proneness (Questionnaire for the Assessment of Disgust Proneness). We found that patients with hypochondriasis and those with an anxiety disorder had higher scores than those of the healthy controls for several measures of disgust proneness. Moreover, measures of hypochondriacal characteristics were associated with those of disgust proneness and disgust sensitivity. However, no differences were found between patients with hypochondriasis and those with anxiety disorders, with respect to disgust proneness and disgust sensitivity. Therefore, it can be assumed that disgust proneness and disgust sensitivity seem to be less specific than previously suggested for the development and maintenance of hypochondriasis.     

Health anxiety and hypochondriasis in the light of DSM-5

Background: In the DSM-5, the diagnosis of hypochondriasis was replaced by two new diagnositic entities: somatic symptom disorder (SSD) and illness anxiety disorder (IAD). Both diagnoses share high health anxiety as a common criterion, but additonal somatic symptoms are only required for SSD but not IAD. Design: Our aim was to provide empirical evidence for the validity of these new diagnoses using data from a case–control study of highly health-anxious (n = 96), depressed (n = 52), and healthy (n = 52) individuals. Results: The individuals originally diagnosed as DSM-IV hypochondriasis predominantly met criteria for SSD (74%) and rarely for IAD (26%). Individuals with SSD were more impaired, had more often comorbid panic and generalized anxiety disorders, and had more medical consultations as those with IAD. Yet, no significant differences were found between SSD and IAD with regard to levels of health anxiety, other hypochondriacial characteristics, illness behavior, somatic symptom attributions, and physical concerns, whereas both groups differed significantly from clinical and healthy controls in all of these variables. Conclusion: These results do not support the proposed splitting of health anxiety/hypochondriasis into two diagnoses. Further validation studies with larger samples and additional control groups are warranted to prove the validity of the new diagnoses.     

Treatment of Hypochondriasis with Exposure

Cognitive-behavioral therapy has been shown to be an effective treatment for hypochondriasis. An important element of most of the empirically validated CBT protocols for this problem is exposure. Various approaches to exposure may be useful including in vivo exposure to health and death-related situations, interoceptive exposure to feared bodily symptoms, and imaginal exposure to symptoms and feared illnesses that are difficult to reproduce in real life. Strategies for enhancing the effectiveness of exposure, such as response prevention, cognitive reappraisal, and acceptance, are also discussed. Practical suggestions for implementation of exposure with this population are provided.     

Health Perceptions and Anxiety Sensitivity in Patients with Panic Disorder

Separate lines of research indicate that patients with panic disorder display negative perceptions of physical health and elevated fear of autonomic arousal. Because health perceptions and anxiety sensitivity may be related, the present study evaluated the degree to which these constructs can be distinguished in patients meeting DSM-IV criteria for panic disorder (N = 44). Perceived health, anxiety sensitivity, and the clinical features of panic disorder were assessed at pretreatment and following 12 sessions of cognitive–behavioral treatment. Findings consistently indicated that perceived health and anxiety sensitivity can be meaningfully differentiated. Perceived physical health was only moderately associated with anxiety sensitivity, and each was uniquely associated with pretreatment symptomatology and posttreatment end-state functioning. Perceived physical health appears to be a clinically useful index in the overall evaluation of panic disorder and is readily distinguishable from anxiety sensitivity.     

不同类型考试焦虑影响考试成绩的差异模式

调查了440名高中生,以不同类型考试焦虑为预测变量,以掌握目标、情绪性、应对反应、考试自我效能感、成绩-接近目标、成绩-回避目标、担忧、学习和考试技能、认知干扰为中介变量,期末数学考试成绩为最终结果变量,探讨不同类型考试焦虑影响考试成绩的模式。结果表明:不同类型考试焦虑具有不同的影响考试成绩的模式,即存在认知主导型模式(简称C模式)、生理唤醒主导型模式(简称P模式)、技能缺乏主导型模式(S模式)等三种不同的模式。担忧是C模式中的主要中介变量,P模式的主要特征是担忧对情绪性存在显著影响,S模式的特点是中介变量较少,学习和考试技能变量受考试焦虑和考试自我效能感双重影响并作用于考试成绩。