同一性混乱和青少年自伤的循环作用关系: 疏离感的纵向中介效应

青春期是同一性发展的关键期, 这一时期同时伴随着心理社会发展的不适应问题(例如, 自伤)。本研究采用随机截距交叉滞后模型(RI-CLPM), 考察青少年同一性混乱和自伤(NSSI)的动态双向作用模式, 并检验疏离感在二者之间的中介作用。采用同一性混乱量表、疏离感量表和自伤行为量表对1258名中学生进行为期一年的三波段调查(分别记作T1、T2和T3)。RI-CLPM结果表明:(1)分离了个体间效应后, 个体内水平上T1的NSSI显著正向预测T2的同一性混乱, 而T2的同一性混乱显著正向预测T3的NSSI, T2的NSSI也显著正向预测T3的同一性混乱。青少年同一性混乱和NSSI之间存在双向影响关系; (2)个体内水平上T2的疏离感在T1的NSSI与T3的同一性混乱的关系中具有纵向中介作用。本研究基于Erikson的心理社会发展理论的视角, 将同一性这一青少年的关键发展任务和NSSI在时间尺度上联系起来, 对青少年NSSI的预防和干预具有一定的启示意义。     

Does worry affect adjustment to bereavement? A longitudinal investigation

Background and objectives: Repetitive thought is a trans-diagnostic risk-factor for development of psychopathology. Research on repetitive thought in bereaved individuals has focused primarily on clarifying the role of rumination, repetitive thinking about past negative events and/or negative emotions. While detrimental effects of rumination have been demonstrated following bereavement, surprisingly few studies have aimed to clarify the role of worry, repetitive thinking about potential future negative events, in adjustment to loss. This study sought to fill this gap in knowledge. Methods/Design: One hundred eighty-three bereaved individuals (85.3% women) filled out questionnaires on sociodemographic and loss-related characteristics, worry, and symptom measures of depression, anxiety, and prolonged grief. After six months, 155 participants completed worry and symptom measures again. Using multiple regression analyses, concurrent and longitudinal associations between loss-related variables, worry, and symptoms of psychopathology were examined. Results: Main results were that worry was strongly positively associated with symptoms of anxiety, depression and prolonged grief concurrently and also predicted higher levels of anxiety, depression and prolonged grief longitudinally. Conclusions: Findings suggest that worry influences adjustment to bereavement negatively and may be a potential target in grief therapy, especially when aiming to reduce anxiety.     

A Randomized Open Trial Assessing the Feasibility of Behavioral Activation for Pathological Grief Responding

This study investigated the feasibility of using behavioral activation to treat enduring postbereavement mental health difficulties using a two-arm, multiple baseline design comparing an immediate start group to a delayed start group at baseline, 12-, 24-, and 36-weeks postrandomization. Participants received 12–14 sessions of behavioral activation within a 12-week intervention period starting immediately after the first assessment or after 12 weeks for the delayed start group. Prolonged grief, posttraumatic stress, and depression symptoms were assessed as outcomes. Compared with no treatment, behavioral activation was associated with large reductions in prolonged, complicated, or traumatic grief; posttraumatic stress disorder; and depression symptoms in the intent-to-treat analyses. Seventy percent of the completer sample at posttreatment and 75 percent at follow-up responded to treatment with 45 percent at posttreatment and 40 percent at follow-up being classified as evidencing high-end state functioning at 12-week follow-up.     

The Traumatic Grief Inventory Self-Report Version (TGI-SR): Introduction and Preliminary Psychometric Evaluation

Persistent Complex Bereavement Disorder (PCBD) is a disorder of grief newly included in the “Emerging Measures and Models” section of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. [Google Scholar]). Prolonged Grief Disorder (PGD) is a disorder with similar symptoms, likely to be included in the forthcoming 11th edition of the International Classification of Diseases (ICD-11; World Health Organization, 1992 World Health Organization. (1992). International classification of diseases and related health problems (10th revision). Geneva, Switzerland: World Health Organization. [Google Scholar]). We developed the Traumatic Grief Inventory Self-Report version (TGI-SR), an 18-item measure, for the assessment of symptoms of PCBD and PGD in clinical and research settings. This study was an initial attempt to evaluate psychometric properties of the TGI-SR. To this end, the measure was administered to 327 patients of a mental health institute specialized in the treatment of psychopathology associated with loss and trauma. We found evidence that items of the TGI-SR (all 18 items, as well as the selection of 17 items representing PCBD criteria, and 11 items representing PGD criteria) loaded on one dimension. The TGI-SR demonstrated strong internal consistency. Elevated scores on the TGI-SR were significantly correlated with elevated scores on indices of psychopathology and lower quality of life, attesting to the concurrent validity. Receiver operation characteristic (ROC) analyses of the TGI-SR total score against provisional diagnoses of PCBD and PGD yielded a high area under the curve index suggesting that the TGI-SR total score can be used as an indicator for probable diagnoses of both PCBD and PGD. Results of this study provide initial evidence that PCBD and PGD symptoms may be readily and reliably measured using the TGI-SR.     

Development and Validation of an Instrument for the Assessment of Dependency Among Bereaved Persons

Dependency among bereaved individuals has been hypothesized to be an important predictor of severe and enduring grief reactions. However, although there are a number of instruments that assess interpersonal dependency as a personality trait or style, no scales are available to assess bereavement-related dependency. Data from 170 widowed participants in a community-based longitudinal investigation, who had been bereaved for an average of 10.8 months, were used to investigate the reliability and validity of the Bereavement Dependency Scale (BDS), an instrument that was developed to assess dependency on the deceased among bereaved persons. Results indicated that the BDS demonstrated acceptable internal reliability and satisfactory convergent, discriminant, and construct validity. The BDS may be a clinically useful predictor of enduring and complicated grief reactions, major depressive disorder, and suicidality among recently bereaved individuals.     

延长哀伤障碍的概念、流行病学和病理机制

延长哀伤障碍是一种由亲近的人去世引发的病理性哀伤反应, 即死亡发生6个月后, 个体对死者的想念影响到了生活各方面, 且社会功能受损, 其最近20年才开始受到临床心理学研究者关注和探讨。本文首先回顾了概念提出及后续发展, 并讨论了其与持续性复杂哀伤相关障碍的区别与联系。随后, 本文综述了其独立的诊断标准、评估工具和流行病学调查、以及与正常哀伤、抑郁症和创伤后应激障碍的区别。接下来, 本文对其病理机制的理论思考和实证研究进行了讨论。最后, 本文指出未来可考察诊断标准的跨文化适用性、丰富病理机制的理论与研究。     

青少年早期亲社会行为倾向、内化问题和外化问题发展级联的个体内分析

认识亲社会行为倾向、内化问题和外化问题的发展级联对青少年心理健康促进具有重要价值。采用个体内分析方法分析了894名初中生3年的追踪数据, 并与传统的交叉滞后面板模型进行比较。结果发现：(1)在个体内水平, 亲社会行为倾向与内化问题和外化问题具有中等或较弱的协同变化关系, T1亲社会行为倾向可负向预测T2内化问题, T2亲社会行为倾向可负向预测T3外化问题, 具有较弱的预测作用; (2)在女生群体中, T2内化问题可正向预测T3外化问题, 而在男生群体中, 内化问题和外化问题没有相互预测作用; (3)亲社会行为倾向的4个因子(公开的、依从的、情绪的和利他的)可负向预测内化问题, 它们仅在T2可负向预测外化问题, 具有较弱的预测作用; (4)个体内分析方法得到的研究结果与传统交叉滞后分析方法不同, 不同的个体内分析模型得到的研究结果也不同。结论: 青少年早期亲社会行为倾向的发展可降低内化问题和外化问题, 这种作用具有性别差异; 个体内分析方法在青少年心理病理发展研究中具有重要应用价值。     

Factors Associated With Treatment Response in an Internet-Based Intervention for Prolonged Grief Disorder After Cancer Bereavement

Internet-based psychological interventions have proven effective in the treatment of prolonged grief disorder (PGD). Yet, some patients do not benefit from treatment in a clinically significant way. We aimed to examine predictors of symptom reduction in an Internet-based intervention for PGD after cancer bereavement, in order to identify possible treatment mechanisms and discern directions for future intervention design. A secondary analysis of data from a randomized wait-list controlled trial on an Internet-based intervention for PGD after cancer bereavement was conducted. Multiple regression models were used (1) to test for the influence of pretreatment PGD, working alliance, avoidance and gender on PGD symptom reduction; and (2) to explore further predictors of treatment success with a best subset selection protocol. The regression models explained 18% (Model 1) and 34% (Model 2) of variance in symptom reduction. Participants with more favorable symptom change had more severe pretreatment PGD scores and better working alliance. Those with lower social support and less posttraumatic growth experienced more PGD symptom change. In conclusion, therapeutic alliance is an important factor that should be monitored and fostered. Findings regarding social support and posttraumatic growth need further replication and clarification.     

Psychometric Properties of the Grief Cognitions Questionnaire (GCQ)

Cognitive behavioral conceptualizations of complicated grief propose that negative cognitions play a core role in the development and persistence of emotional problems after bereavement, because they generate negative emotions and cause mourners to engage in counterproductive attempts to avoid the implications and the pain of the loss. To facilitate the assessment of potentially problematic cognitions after bereavement, the Grief Cognitions Questionnaire (GCQ) has been developed—a 38-item questionnaire representing 9 categories of cognitions. Building on a previous study that supported the reliability and validity of the GCQ, the current study further examined its psychometric properties, with data of 531 bereaved individuals who completed research questionnaires online through the Internet. Confirmatory factor analyses supported the nine-factor structure with 9 interrelated factors. The reliability and convergent and discriminative validity were found to be adequate. Altogether the GCQ seems to be a useful tool for the assessment of negative thinking after bereavement in research and clinical practice.