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11.
12.
Outcomes for cognitive-behaviour therapy (CBT) in randomised controlled trials (RCTs) have rarely been compared to those in routine clinical practice. Taking the case of CBT for chronic fatigue syndrome (CFS), we evaluated the results of a successful RCT against those of the same treatment given in the same setting as part of routine practice. Fatigue and social adjustment scores were compared for patients who received CBT for CFS as part of a RCT (N=30) and patients who received CBT as part of everyday clinical practice (N=384). The results in the RCT were superior to those in routine clinical practice. Between pre-treatment and 6-month follow-up, the RCT showed a larger reduction in fatigue and greater improvement in social adjustment than those in routine treatment. The changes in fatigue scores were similar for both groups during treatment but were greater in the RCT between post-treatment and follow-up. Potential reasons for the superior results of the RCT include patient selection, therapist factors and the use of a manualised treatment protocol. Practitioners need to pay particular attention to relapse prevention and ensuring adequate follow-up in addition to encouraging patients to continue with cognitive-behavioural strategies once treatment has ended. 相似文献
13.
Iwanowski PS 《Science and engineering ethics》2007,13(3):333-336
Setting reasonable and fair limits of emergency research acceptability in ethical norms and legal regulations must still adhere
to the premise of well-being of the research subject over the interests of science and society. Informed consent of emergency
patients to be enrolled in clinical trials is a particularly difficult issue due to impaired competencies of patients’ to
give consent, short diagnostic and therapeutic windows, as well as the requirement to provide detailed information to participants.
Whereas the Declaration of Helsinki, Good Clinical Practice guideline, Additional Protocol to the European Bioethical Convention
concerning Biomedical Research, as well as appropriate regulations adopted by the Food and Drugs Administration (USA) allow
waivers from participants’ consent or deferred consent for emergency research, the regulations of most European Community
countries following the Clinical Trial Directive (2001/20/EC) do not give space for a deferred consent or a waiver from consent
for adult patients (unless surrogate consent is made use of). This is even more confusing in case of Poland, where conflicting
regulations on a waiver from a participant’s consent in emergency research exist and the regulations on surrogate consent
of temporarily incompetent adults are too restrictive and authorise only the guardianship courts to consent, which is not
or hardly feasible in practice. European Community regulations need to be amended to allow for implementation of the deferred
consent or waivers from consent for emergency research in order to enable ethical research of emergency conditions that should
become a large part of important public health priorities. 相似文献
14.
This article reviews existing research pertaining to antidepressant medications, psychotherapy, and their combined efficacy
in the treatment of clinical depression in youth. Based on this review, we recommend that youth depression and its treatment
can be readily understood from a social-psycho-bio model. We maintain that this model presents an alternative conceptualization
to the dominant biopsychosocial model, which implies the primacy of biological contributors. Further, our review indicates
that psychotherapy should be the frontline treatment for youth with depression and that little scientific evidence suggests
that combined psychotherapy and medication treatment is more effective than psychotherapy alone. Due primarily to safety issues,
selective serotonin reuptake inhibitors should be initiated only in conjunction with psychotherapy and/or supportive monitoring. 相似文献
15.
David J. Kolko Lorah D. Dorn Oscar G. Bukstein Dustin Pardini Elizabeth A. Holden Jonathan Hart 《Journal of abnormal child psychology》2009,37(5):591-609
This study examines the treatment outcomes of 139, 6–11 year-old, clinically referred boys and girls diagnosed with Oppositional
Defiant Disorder (ODD) or Conduct Disorder (CD) who were randomly assigned to a modular-based treatment protocol that was
applied by research study clinicians either in the community (COMM) or a clinic office (CLINIC). To examine normative comparisons,
a matched sample of 69 healthy control children was included. Multiple informants completed diagnostic interviews and self-reports
at six assessment timepoints (pretreatment to 3-year follow-up) to evaluate changes in the child’s behavioral and emotional
problems, psychopathic features, functional impairment, diagnostic status, and service involvement. Using HLM and logistic
regression models, COMM and CLINIC showed significant and comparable improvements on all outcomes. By 3-year follow-up, 36%
of COMM and 47% of CLINIC patients no longer met criteria for either ODD or CD, and 48% and 57% of the children in these two
respective conditions had levels of parent-rated externalizing behavior problems in the normal range. We discuss the nature
and implications of these novel findings regarding the role of treatment context or setting for the treatment and long-term
outcome of behavior disorders.
This study was supported by grants to the first author from the National Institute of Mental Health (MH 57727) and to the
second author by the National Institute of Nursing Research (NR 07615). The fourth author was supported by grant K01 MH078039
from the National Institute of Mental Health. The authors acknowledge the research and clinical staff of the Resources to
Enhance the Adjustment of Children (REACH) program, and Drs. David Brent, Tammy Chung, William Gardner, John Lochman, and Wayne Osgood. Reprints may be obtained from
Dr. Kolko, WPIC, 3811 O’Hara St., Pittsburgh, PA 15213. 相似文献
16.
Jake Linardon 《Cognitive behaviour therapy》2018,47(2):107-125
The original and enhanced cognitive model of eating disorders proposes that cognitive-behavioral therapy (CBT) "works" through modifying dietary restraint and dysfunctional attitudes towards shape and weight. However, evidence supporting the validity of this model is limited. This meta-analysis examined whether CBT can effectively modify these proposed maintaining mechanisms. Randomized controlled trials that compared CBT to control conditions or non-CBT interventions, and reported dietary restraint and shape and weight concern outcomes were searched. Twenty-nine trials were included. CBT was superior to control conditions in reducing shape (g=0.53) and weight (g=0.63) concerns, and dietary restraint (g=0.36). These effects occurred across all diagnoses and treatment formats. Improvements in shape and weight concerns and restraint were also greater in CBT than non-CBT interventions (g's=0.25, 0.24, 0.31, respectively) at post-treatment and follow-up. The magnitude of improvement in binge/purge symptoms was related to the magnitude of improvement in these maintaining mechanisms. Findings demonstrate that CBT has a specific effect in targeting the eating disorder maintaining mechanisms, and offers support to the underlying cognitive model. If changes in these variables during treatment are shown to be causal mechanisms, then these findings show that CBT, relative to non-CBT interventions, is better able to modify these mechanisms. 相似文献
17.
Lubin A 《American journal of psychoanalysis》2005,65(4):367-379
The need to establish a borderline between legitimate and illegitimate political trial is one of the central societal discourses.
In this paper the author claims that the issues are complex and that a political trial can remain legitimate as long as it
is not dealing with a confrontation with the symbolic order on which the society (and the court itself) is founded and as
long as the subject (or action) it is dealing with does not threaten the symbolic order’s (or the “Big Other”) existence.
When the symbolic order’s existence is in danger, the court is bound to participate in an act of “sacrifice” that is intended
to protect the “order.” The author uses Jacques Lacan’s psychoanalytic theory of the “Big Other” (and its development to ideological-political
terms) in examining three categories of sacrifice. Through these categories the author claims that in extreme cases of confrontation
with the existence of the symbolic order, the court cannot remain objective and it would be difficult to justify the trial
as legitimate (especially in historical perspective). 相似文献
18.
Based on worldwide consultations with experts in science and ethics the revised CIOMS 2002 International Ethical Guidelines
for Biomedical Research Involving Human Subjects provide guidance on when the use of placebo as a comparator in clinical research
is ethically acceptable. The article reviews the main points of the CIOMS Guidelines and commentaries including the use of
placebo in situations where the best current method is available and the relation of placebo to established effective intervention.
It discusses the use of placebo in externally sponsored research in low-resource countries and requirements for informed consent
related to placebo studies.
An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research
Today,” held in Warsaw, Poland on 12–13 April, 2003. 相似文献
19.
An emerging population-based paradigm is now being used to guide the design of preventive trials used to test developmental models. We discuss elements of the designs of several ongoing randomized preventive trials involving reduction of risk for children of divorce, for children who exhibit behavioral or learning problems, and for children whose parents are being treated for depression. To test developmental models using this paradigm, we introduce three classes of design issues: design for prerandomization, design for intervention, and design for postintervention. For each of these areas, we present quantitative results from power calculations. Both scientific and cost implications of these power calculations are discussed in terms of variation among subjects on preintervention measures, unit of intervention, assignment, balancing, number of pretest and posttest measures, and the examination of moderation effects. 相似文献
20.