中医证实质研究的困惑及出路

根据中医证实质研究的现状,分析了证实质研究存在困惑的原因,并提出证的诊断标准化以及走病证结合的研究之路是中医证实质研究的出路。     

不同概化的问题原型对问题归类和解决的影响

探讨原理学习过程中形成不同概化程度／问题原型对解决不同适宜程度问题的影响。实验1探讨个体形成不同概化程度问题原型对解决表面内容不同适宜程度的问题的效果;实验2探讨形成不同概化程度问题原型的被试解决问题的信息加工方式与机制;实验3进一步探讨形成不同概化程度问题原型的个体解决复杂问题的效果与机制。结果表明：(1)形成概化程度较高的问题原型有利于个体对表面内容不适宜题目的解答;(2)形成概化程度较高问题原型的被试在解答适宜或不适宜问题时均能迅速激活问题原型而通达原理图式,因此,更多地采用图式的方法解决问题;(3)形成概化程度较高的问题原型会有助于被试排除题目的无关信息,正确进行解答。     

Design of randomized controlled trials: Principles and methods applied to a treatment for early stuttering

The “gold standard” methodology for treatment efficacy research is the randomized controlled trial (RCT), which is used extensively in medical research and in other areas such as psychology. Results from a well designed and conducted RCT, which show a new treatment to be clinically and statistically superior to current standard practice, can lead to a change in clinical practice. This paper presents a tutorial on RCTs, presenting and discussing the following principles and methods: the trial protocol, choice of control treatment, eligibility criteria, random allocation, outcomes and hypotheses, sample size, subject recruitment, analysis by intention to treat, interim analysis, stopping rules, safety data monitoring/trial management, and study documentation. RCTs are a complicated and logistically involved methodology. Hence, prior to the commitment of resources to such a trial in the development of a new treatment, the safety and clinical promise of the new treatment needs to be demonstrated with preliminary studies. Such preliminary studies have been completed for the Lidcombe Program (LP) of early stuttering intervention, and an RCT of that treatment is being conducted at the time of writing. The principles and methods of RCTs are illustrated with reference to that study.

Educational objectives: The reader will understand the design principles and methods of RCTs. The reader will understand the logistics of conducting a RCT of a treatment for early stuttering.     

Conversing while driving: The importance of visual information for conversation modulation

Multiple studies have shown an increased accident risk due to telephoning while driving. On the other hand, driving with passengers leads to a decreased accident risk. One explanation is a conversation modulation by passengers in cars which leads to a different conversation pattern which is not so detrimental to driving as that when phoning. A driving simulator study was conducted in order to examine this conversation modulation more closely and to find out more about the factors involved in this modulation, especially about the role of visual information available to the passenger. In a within-subject design the conversational patterns of 33 drivers and passengers in different in-car settings (passenger as usual, passenger without front view or passenger without view of the driver) were compared to a hands-free cell phone and to a hands-free cell phone with additional visual information either about the driving situation or the driver. Participants were instructed to have a naturalistic small-talk with a friend. Results of the drivers’ speaking behavior showed a reduction of speaking while driving. Compared to a conversation partner on the cell phone, a passenger in the car varies his speaking rhythm by speaking more often but shorter. Further analyses showed that this effect is also found with a cell phone when providing the conversation partner additional visual information either about the driving situation or the driver. This latter finding supports the idea that conversation modulation is not triggered by being in the car but by the visual information about the driver’s state and the driving situation.     

Psychodynamic therapists' dilemmas in providing personal therapy to therapists in training: An exploratory study

Aim: This study explores dilemmas facing psychodynamic therapists who provide personal therapy to therapists in training. Method: Eight experienced psychodynamic psychotherapists were interviewed using a semi‐structured interview format during which they were asked about the importance of personal therapy, if they encountered any dilemmas and, if so, how they resolved those dilemmas. Their responses were analysed using a qualitative form of content analysis. Findings: Two categories of dilemma emerged: clinical and personal. Clinical dilemmas arose out of the mandatory requirement for therapy, boundaries, fitness to practice and the suitability of trainees. Personal dilemmas included pressure to model, sense of responsibility, therapeutic narcissism, countertransference reactions, over‐use of self and stressful involvement. The therapists' strategies for resolving the dilemmas are described. Conclusion: The results show participants considered personal therapy to be essential for trainees and thought it should be mandatory even though it led to difficulties in the therapy. Questions arose about the suitability of some trainees, the person of the therapist and stressful involvement. Further research into these important areas is recommended.     

情感创伤青年的箱庭疗法个案研究

结合荣格分析心理学相关理论概念,使用箱庭疗法对一名遭受情感创伤的青年进行心理治疗,并对其箱庭作品中呈现的象征和原型心象进行分析。结果发现:箱庭作品展现了该青年的情感创伤和心理问题,反映了心理的成长历程。箱庭疗法在治愈情感创伤方面取得了较好的效果。     

Young adult narcissism: A 20 year longitudinal study of the contribution of parenting styles, preschool precursors of narcissism, and denial

The role of parenting styles in the development of young adult narcissism is investigated with individuals from the Block and Block (1980) longitudinal study. At age 3, participants were assessed for the presence of narcissism precursors, and mothers and fathers provided information about their parenting styles. At age 23, the presence of both healthy and maladaptive narcissism was assessed, along with the use of denial. The results showed that parenting styles had a direct effect on the development of healthy narcissism, but the effect on the development of maladaptive narcissism depended on the child’s initial proclivity towards narcissism. Also, the use of denial was positively associated with the presence of maladaptive narcissism, but not with healthy narcissism.     

患者报告结局（PRO）在临床疗效评价体系中的应用与思考

现代医疗模式的转变,使得患者对疾病的直接感受,对疗效的评价,成为临床决策和药物安全性评价的重要指标。而PRO量表的问世,使患者有机会真正参与到医疗过程中来,也为临床疗效评价及药物管理提供了珍贵资料。本文将通过什么是PRO、PRO的价值以及PRO的发展近况来对PRO做一个初步的介绍,以便为后来的研究者提供可能的帮助。     

Factors associated with self-efficacy in persons with chronic illness

Change of lifestyle may be necessary for persons with chronic illnesses in order to manage their health situation and reduce symptom distress. Success in changing lifestyle partly depends on a person's self-efficacy beliefs. This cross-sectional study explores social support, physical activity, and illness perceptions in relation to self-efficacy in a sample with morbid obesity and in a sample with chronic obstructive pulmonary disease (COPD). The linear regression analyses showed that higher physical activity and less emotional response to illness were directly associated with higher self-efficacy among persons with obesity, while more social support; fewer perceived consequences from illness; and more understanding of the illness were directly associated with higher self-efficacy among persons with COPD. The results indicate that obese persons are likely to benefit from increasing physical activity and from receiving emotional support. Persons with COPD may be empowered by being able to utilize cognitive coping strategies and by receiving social support.     

The relationship between implicit and explicit motives, goal pursuit, and autobiographical memory content during a diary study

This online diary study investigated how motives interact with goal pursuit to predict daily autobiographical experiences. Participants (N = 141) completed measures of implicit and explicit achievement, provided daily memories and reports of their goal pursuit during a 3-week diary period. A stronger implicit achievement motive at the onset of the study was associated with more agentic (and fewer communal) autobiographical content. Goal progress was linked with using more agentic words, while goal attainability was related to using more communal words. Interactions between motives and goal pursuit on autobiographical memory suggests a trade-off: Favorable goal pursuit conditions may prompt people not motivated for achievement to shift their focus from agentic to communal themes, while individuals motivated for achievement maintain their priorities.