心理咨询与治疗中的领悟

不管哪种心理咨询和治疗流派,其最终目的都是促进来访者领悟,而领悟能不能出现,是治疗成功与否的关键。心理咨询师应该为了领悟的出现,作好充分的准备,促进领悟的出现,巩固领悟的成果,取得心理治疗的圆满成功。     

Family Involvement in Residential Treatment: Staff, Parent, and Adolescent Perspectives

We conducted interviews with staff members, parents, and adolescents at a residential treatment center to examine the frequency, nature, and satisfaction with contact between parents and adolescents and parents and staff. We also assessed perceived barriers to family involvement and possible solutions for improving this involvement. Results indicated that there is more contact between parents and adolescents than in previous studies. In addition, contact between parents and staff occurred frequently, although there were discrepancies regarding their reasons for the contact. Most parents and adolescents reported that the amount of contact was adequate, but the majority of staff members perceived there to be not enough contact. Adolescents reported that there was not enough contact with secondary sources of support, most often other family members. Barriers to family involvement included transportation, parent responsibilities and personal problems, and legal issues. In addition, parents reported that strained family relationships and problematic adolescent behavior interfered with their involvement. The need for residential treatment centers to broaden services to include parents as well as members of the larger support network is discussed.     

The influence of background music on learners with varying extraversion: Seductive detail or beneficial effect?

Seductive details in general affect learning and cognitive load negatively. However, especially background music as a seductive detail may also influence the learner's arousal, whose optimal level depends on the learner's extraversion. Therefore, the effects of extraversion and background music on learning outcomes, cognitive load, and arousal were investigated. We tested 167 high school students and found better transfer outcomes for the group with background music. They also reported higher germane load, but no impact of background music on extraneous cognitive load or arousal was found. In the group without background music, learners with higher extraversion reached better recall scores, which was not found in the group with background music. Results may cautiously be interpreted that there is a beneficial impact of background music that compensates for the disadvantages of low extraverted learners and which cannot be explained through arousal.     

What Is a Nonresponder? A Qualitative Analysis of Nonresponse to a Behavioral Intervention

This study used qualitative methods to understand reasons for treatment nonresponse following a behavioral intervention for family caregivers of people with dementia. Caregivers and interventionists completed semistructured interviews about their experience of the treatment after completing a course of Resources for Enhancing Alzheimer’s Caregiver Health in VA (REACH VA). Treatment response from the 22 caregivers who completed the 12-session treatment was assessed using pre- to posttreatment change scores on measures of depression and caregiver burden. Interviews from the 14 nonresponder caregiver/interventionist dyads (28 total) were analyzed qualitatively to identify caregiver factors that negatively impacted improvement in depression and caregiver burden, such as emotional processing difficulties, wanting more support than structure, and limited support/difficulty asking for help. Ways nonresponders benefited from REACH VA beyond improvement on self-report symptom measures were also identified and included learning to problem solve more effectively, feeling understood and supported by another, and taking a different perspective on caregiving. The benefits of using qualitative methods to assess the experience of treatment nonresponders and identify individuals who may benefit from additional treatment or a different approach are discussed.     

An Inhibitory Learning Approach to Cognitive-Behavioral Therapy for Children and Adolescents

Although exposure-based cognitive-behavioral therapy (CBT) is efficacious for childhood anxiety and obsessive–compulsive disorder (OCD), many youth do not adequately respond to treatment. Extinction learning is an important process in exposure-based CBT. However, youth with anxiety disorders and OCD exhibit impairments in extinction processes that are best characterized by deficits in inhibitory learning. Therefore, the utilization of strategies to optimize inhibitory learning during exposures may compensate for these deficits, thereby maximizing extinction processes and producing more robust treatment outcomes for exposure-based CBT. This paper reviews several strategies to optimize inhibitory learning in youth with anxiety disorders and OCD, and presents practical examples for each strategy. This paper also highlights the difference between inhibitory learning-based exposures and prior conceptual approaches to exposure therapy in clinical practice. It concludes with a discussion of future directions for clinical research on inhibitory learning and exposure-based CBT in youth.     

Therapeutic progress and symptom elevation in treating dismissive attachment: A case study

A dismissive or avoidant attachment style can present clinical challenges in psychotherapy as the attachment style may interfere with the development of a constructive therapeutic alliance and impact the level of disclosure, expressions of distress, and risks for premature drop-out. This paper reports a naturalistic case study and offers an in-depth examination of a treatment with a client with dismissive attachment, including a detailed examination of relational interventions and countertransference struggles. Furthermore, this paper considers the notable differences between quantitative scores on a well-validated, practice-based clinical symptom inventory and the qualitative outcomes for this client to offer clinical and research implications in treatment with dismissive attachment.     

Predictors of improvement in an open-trial multisite evaluation of emotion regulation group therapy

Emotion regulation group therapy (ERGT) is a novel treatment specifically targeting deliberate non-suicidal self-harm (DSH) in individuals with borderline personality disorder (BPD). Identifying robust predictors of positive response to ERGT could aid clinicians in treatment selection; however, to date, only one such study has been conducted. Thus, we aimed to replicate previously identified predictors of treatment response to ERGT by investigating demographic, clinical, and diagnostic predictors in 95 women with BPD or subclinical BPD who had participated in an open-trial evaluation of ERGT. Outcomes evaluated were frequency of DSH and emotion dysregulation. Assessments were conducted at pretreatment, post-treatment, and 6-month follow-up. Multilevel mixed linear models and multilevel negative binomial generalized estimated equations were used to identify significant interactions between the predictors and outcomes.

We found that greater pretreatment DSH frequency was associated with greater improvements in DSH during treatment (b = 0.998, SE = 0.00, p = 0.03) and follow-up (b = 0.997, SE = 0.00, p < 0.01) and that greater BPD severity was associated with greater improvements in DSH during treatment (b = 0.84, SE = 0.06, p = 0.02) and in emotion dysregulation at follow-up (b = ?3.05, SE = 1.47, p = 0.04). Co-occurring disorders were associated with poorer treatment response during follow-up. Results were generally consistent with a previous study of the predictors of response to ERGT. The findings provide further support for the utility of this treatment across a range of BPD patients, including patients with severe DSH and BPD.     

系统论视角下重型急性胰腺炎的治疗

重症急性胰腺炎(severe acute pancreatitis,SAP)是临床上常见的急腹症之一,本文试从系统生物学角度出发,探讨其在SAP营养支持治疗、抗生素的选用以及外科手术治疗中的应用。强调应用整体的、综合的、发展的观点去研究SAP的治疗,从而找到最佳治疗方案。