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。     

接纳与承诺疗法的功能性语境主义解读

接纳与承诺疗法(ACT)是认知行为疗法“第三次浪潮”中最有代表性的疗法之一。依托功能性语境主义,探究ACT中的语境主义和实用主义。在功能性语境主义背景下,分析心理事件时要综合考虑其背景和功能及其相应的交互作用,提升分析的准确性、全面性。同时,以目标为导向,明确心理事件的内涵及其改善措施。基于此,在ACT的两大治疗过程中,充分渗透功能性语境主义,并通过灵活多样的治疗方法,提升个体的心理灵活性。     

接纳与承诺疗法的理论背景、实证研究与未来发展

接纳与承诺疗法(Acceptance and Commitment Therapy, ACT)于上世纪90年代初由美国治疗师Steven C. Hayes提出。作为基于正念技术的第三代行为治疗理论之一, 该疗法以功能情境主义为哲学基础, 立足于人类认知和语言基本性质的实证研究, 旨在通过平衡接纳与改变来提高心理灵活性。临床研究已证明其在相当广泛的临床问题上都取得了良好效果, 并在与CBT等传统疗法的对比中展现优势。ACT的临床效果和技术细节可做进一步研究, 该疗法与CBT的融合及其在临床领域之外的应用也是未来的研究方向。     

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。     

抑郁反刍的认知神经机制

抑郁反刍是指个体把注意力集中在抑郁症状以及这些症状含意的行为和想法, 包含反复思虑抑郁症状、抑郁的可能原因、以及抑郁可能引起的后果。抑郁反刍主要表现出对负性信息过度关注、认知控制缺陷以及非适应性的自我参照加工等认知特点。基于这些特点, 近期脑成像研究发现, 抑郁反刍主要与杏仁核、前额叶以及默认网络等脑区或神经网络有关。未来应在不同亚型抑郁反刍的神经机制、基因以及开发有效的干预技术与方法等方面展开深入研究。     

心理理论与同伴接纳

近年来的相关研究表明 ,心理理论能力的发展与儿童被同伴喜欢接纳的程度之间具有复杂的、双向作用的关系 ,二者的相关程度随着年龄增长有增强的趋势并且存在性别差异。对矛盾的和被忽视群体以及学龄儿童的研究也许有助于进一步理解二者间的关系。     

受欺负对抑郁情绪的影响:悲伤、愤怒反刍的中介作用及性别差异

为探究受欺负对于个体抑郁情绪的影响,以及反刍这一认知因素在其中的作用与性别差异,采用受欺负问卷、儿童应对方式问卷中的悲伤反刍分量表、愤怒反刍问卷、儿童抑郁量表对2582名初中二年级学生（男生1328人,女生1254人;平均年龄13.95岁,SD=0.60）进行问卷调查。结果发现：（1）受欺负与悲伤反刍、愤怒反刍、抑郁情绪均呈显著正相关;（2）受欺负、悲伤反刍、愤怒反刍均可显著正向预测个体的抑郁情绪,且悲伤反刍和愤怒反刍在受欺负和抑郁情绪的关系中发挥部分中介作用;（3）该模型存在性别差异。女生悲伤反刍对抑郁情绪的预测作用显著大于男生。研究从悲伤反刍和愤怒反刍的角度揭示了受欺负对青少年抑郁情绪的作用机制,为从认知水平上干预青少年心理健康问题提供了参考。     

抑郁的团体心理治疗

本文研究了团体心理咨询在治疗大学生的抑郁症方面的效果。我们采用的治疗形式是团体心理咨询 ,治疗方法是认知行为疗法 (包括理性情绪疗法 ) ,被试是四名大学生。我们对团体活动的效果采用了多种方法进行评估 ,结果发现 ,团体心理治疗可以有效地减轻大学生的抑郁程度。活动中我们取得了一定的经验 ,但同时也发现了一些问题 ,值得我们做进一步的研究     

初中生校园排斥对抑郁的影响：反刍思维与特质正念的作用

研究对955名初中生进行问卷调查,探讨校园排斥对抑郁的影响,以及反刍思维和特质正念的作用。结果表明：（1）校园排斥正向预测初中生抑郁,反刍思维在校园排斥与抑郁间具有中介作用;（2）校园排斥对抑郁的直接效应受到特质正念的调节,直接效应对低特质正念初中生更为显著;（3）特质正念调节反刍思维对校园排斥与初中生抑郁中介过程的后半段路径,在低特质正念下,反刍思维对抑郁的影响更为显著。研究以校园排斥、反刍思维和特质正念为切入点构建了初中生抑郁的影响机制模型,为预防和干预青少年抑郁提供了新的研究视角。     

儿童期心理虐待与大学生抑郁的关系：侵入性反刍的中介作用和自然联结的调节效应

为探究儿童期心理虐待与大学生抑郁的关系及其作用机制——侵入性反刍的中介作用和自然联结的调节效应,采用儿童期心理虐待量表、侵入性反刍量表、自然联结量表和抑郁量表对455名大学生进行调查。结果表明：(1)在控制性别的条件下,侵入性反刍在儿童期心理虐待与抑郁的关系中起中介作用;(2)自然联结在中介过程的后半路径中起调节效应。研究揭示了儿童期心理虐待对大学生抑郁的作用机制。     

Acceptance and Commitment Therapy as a Spiritually Integrated Psychotherapy

This article presents acceptance and commitment therapy (ACT) as a spiritually integrated therapeutic modality. ACT is a value‐driven therapy that involves facilitating transcendence of physical, mental, and emotional experience to alleviate human suffering; as such, ACT shares common ground with the domain of spirituality. Approached as a spiritually integrated therapy, ACT can help clients to access spiritual resources and create life meaning as well as aid in the resolution or transformation of spiritual struggles. Given that spiritual struggles, in particular, can have a significant impact on mental health and well‐being, this article provides guidance in how ACT can address such struggles.     

Safety Planning Within Acceptance and Commitment Therapy

Acceptance and commitment therapy (ACT) is a contextual behavioral psychotherapy that helps clients build meaningful lives in the service of their own chosen values, rather than specifically focusing on symptom reduction or prevention of destructive behaviors. However, empowering ACT clients to navigate suicidal crises effectively is vital to ensuring the opportunity to build a life they will choose to live. Suicide safety planning is a widely used empirically supported approach to prepare clients to survive suicidal crises, and can be effectively incorporated into ACT. In this paper, we offer a contextual behavioral conceptualization of suicide as an extreme attempt to solve the problem of painful thoughts, emotions, and sensations, and provide an example of how this conceptualization and the necessity of safety planning can be introduced to clients. Use of chain analysis of suicidal behavior is introduced as a tool to inform the suicide safety plan. We describe how ACT processes can enhance safety plans and, in turn, create safety plans that will serve as means to develop skills associated with efficacious/effective ACT interventions. Finally, we discuss the ongoing evaluation and revision of the safety plan from an ACT framework.     

School-Based Acceptance and Commitment Therapy for Adolescents With Anxiety: A Pilot Trial

Anxiety disorders are one of the most prevalent diagnoses in youth, often resulting in impaired social and school functioning. Research on treatments for youth anxiety is primarily based in traditional clinical settings. However, integrating youth psychotherapies into the school environment improves access to evidence-based care. The present study is a pilot, randomized waitlist-controlled trial of a school-based, group Acceptance and Commitment Therapy–based (ACT) intervention for adolescents with anxiety. Students at two separate schools (N = 26) with elevated anxiety were randomized to a 12-week waitlist or to immediate treatment. Participants in the immediate treatment condition reported statistically significant decreases in anxiety and class absences at posttreatment and follow-up compared to the waitlist group. No statistically significant differences were found between groups for depression, psychological flexibility, positive mental health, and student well-being. However, medium within-condition effect sizes were seen in the treatment group for all outcomes. Participants reported the treatment as favorable with good acceptance ratings. Overall, this study supports ACT as a viable intervention for schools and other clinical settings providing services to adolescents with anxiety.     

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 Comprehensive Examination of the Model Underlying Acceptance and Commitment Therapy for Chronic Pain

The therapeutic model underlying Acceptance and Commitment Therapy (ACT) is reasonably well-established as it applies to chronic pain. Several studies have examined measures of single ACT processes, or subsets of processes, and have almost uniformly indicated reliable relations with patient functioning. To date, however, no study has performed a comprehensive examination of the entire ACT model, including all of its component processes, as it relates to functioning. The present study performed this examination in 274 individuals with chronic pain presenting for an assessment appointment. Participants completed a battery of self-report questionnaires, assessing multiple aspects of the ACT model, as well as pain intensity, disability, and emotional distress. Initial exploratory factor analyses examined measures of the ACT model and measures of patient functioning separately with each analysis identifying three factors. Next, the fit of a model including ACT processes on the one hand and patient functioning on the other was examined using Structural Equation Modeling. Overall model fit was acceptable and indicated moderate correlations among the ACT processes themselves, as well as significant relations with pain intensity, emotional distress, and disability. These analyses build on the existing literature by providing, to our knowledge, the most comprehensive evaluation of the ACT theoretical model in chronic pain to date.