国内外医学专业杂志发表医学人文相关文章情况分析

总结分析了201 2年1月～2013年5月国外4种医学专业杂志(BMJ、JAMA、LANCET和NEJM)医学人文相关文章的发表情况,并与国内4种知名医学专业杂志(《中华医学杂志》、《中国实用内科杂志》、《中华内科杂志》和《中华外科杂志》)发表的医学人文类文章的情况进行对比分析,结果发现,国外医学专业杂志医学人文类文章比重较大,而且涉及的领域较广,包括医疗卫生政策管理、医学社会学、对患者及医生的人文关怀、医疗风险告知和医疗差错告知的文章.而国内与国外杂志相比存在较大差距.     

Skill Acquisition During Transdiagnostic Treatment With the Unified Protocol

The Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders is an emotion-focused, cognitive-behavioral intervention developed to address the full range of anxiety, depressive, and related disorders. The UP consists of core therapeutic skills that, though unique in focus, are each designed to promote an approach-oriented stance toward emotional experiences. The goal of the present investigation was to characterize changes in these skills for patients that received a course of treatment with the UP, as well as to examine associations between skills and symptoms changes. Patients with principal anxiety disorders, assigned to receive treatment with the UP (N = 88) as part of a randomized controlled trial, were included in this study. They completed validated self-report measures of UP skills (Understanding Emotions, Mindful Emotion Awareness, Cognitive Flexibility, Countering Emotional Behaviors, and Interoceptive Awareness and Tolerance), as well as clinician-rated measures of psychological symptoms. Skill measures improved significantly over the course of 12 to 16 UP treatment sessions and changes in these skills measures were associated with improvements in anxiety symptoms. Determining whether improvement on all the skills learned during a course of treatment with UP is associated with symptom remission is critical to establishing the most streamlined and efficient interventions that may ultimately be best suited to widespread dissemination.     

Changes in Anxiety Control Beliefs Following a Brief CBT Treatment and Their Association With Anxiety Symptom Reduction

Anxiety control beliefs (i.e., beliefs regarding one’s ability to cope with external, fear-inducing threats and internal reactions to those perceived threats) have been found to negatively predict anxiety symptoms in children and adults and to be modifiable by cognitive-behavioral therapy for anxiety disorders. The current study examines whether changes in anxiety control beliefs were seen following a brief, intensive treatment for specific phobias, and whether those changes were associated with improvements in the targeted phobia and comorbid anxiety disorder symptoms. Participants were 135 children and adolescents (M age = 9.01 years, 49% male) who received one-session treatment (OST) with or without parental involvement for their primary specific phobia. Results indicated that self-reported anxiety control beliefs significantly increased following treatment and that these increases significantly predicted reductions in specific phobia severity and symptoms of comorbid anxiety disorders 6 months and 1 year following treatment. Findings illustrate that involvement in a single 3-hour OST was associated with changes in anxiety control beliefs and demonstrate the potential importance of targeting control beliefs in pediatric anxiety treatment.     

职场排斥对员工家庭的溢出效应：归属需求和工作家庭区隔偏好的作用

以往研究证实了职场排斥会对员工组织内诸多方面产生危害, 然而关于职场排斥向组织外部特别是家庭领域的溢出效应还知之甚少。本研究基于资源保存理论构建了一个有调节的中介效应模型, 探讨职场排斥对员工家庭贬损和家庭满意度的溢出效应和具体机制, 研究结果表明：(1)职场排斥对员工家庭贬损有显著正向作用, 对家庭满意度有显著负向作用; (2)工作压力中介了职场排斥与家庭贬损和家庭满意度的关系; (3)员工归属需求调节了职场排斥对工作压力的影响, 同时调节了工作压力在职场排斥与家庭贬损、家庭满意度之间的中介效应; (4)员工工作家庭区隔偏好调节了工作压力对家庭贬损和家庭满意度的作用, 并且调节了职场排斥通过工作压力对家庭贬损和家庭满意度的中介效应。     

Conducting Prolonged Exposure for PTSD During the COVID-19 Pandemic: Considerations for Treatment

The unprecedented effects and duration of the COVID-19 crisis are likely to elevate the population’s level of anxiety due to psychological stress, economic hardship, and social isolation. This effect may be especially potent for individuals with preexisting mental health conditions, such as posttraumatic stress disorder (PTSD). Prolonged Exposure (PE) therapy is a highly effective treatment for PTSD across trauma-exposed populations, and has been implemented effectively via telehealth. Nevertheless, PE implementation via telehealth may require specific adaptations during the COVID-19 crisis due to public health mandates calling for sheltering in place and physical distancing. This paper discusses strategies for implementing PE for PTSD during the COVID-19 pandemic, which may also be applied to other situations in which physical distancing must be considered.     

Mapping people's positions regarding the acceptability of somatic gene therapy

IntroductionAs gene therapy entails potential drawbacks, studies are needed in order to know people's opinions regarding its use.ObjectivesThe present study examined French people's positions regarding somatic gene therapy.MethodA sample of 224 adults living in various areas in France was presented with 32 realistic scenarios that were created by orthogonally combining the levels of four factors: the type of illness (e.g., hemophilia), the probability of transmission of the pathogenic gene, the technique used (e.g., transfer of a functional gene just after birth), and le probability of success of the therapy.ResultsThrough cluster analysis, six qualitatively different positions were found: Never very acceptable (8% of the sample, mostly males and more educated people), Legalist (17%, mostly people who have been informed of the legal and technical aspects of the therapy), Depends on the chances of success (18%), Fully acceptable after birth (5%), Fully acceptable before birth (8%), and Quite always acceptable (33%, mostly older people with children).ConclusionAlthough it has some few detractors, the recourse to gene therapy seems to be well accepted by a majority of the participants, and this high level of acceptation hold whether the pathology considered is hemophilia, immunodeficiency, propensity to develop cancer, or cardiovascular pathology.     

辩证行为疗法：理论背景、治疗效果及作用机制

辨证行为疗法（Dialectical Behavior Therapy, DBT）于20世纪90年代初由美国治疗师Linehan创立。作为第三代行为治疗之一,该疗法以行为主义理论、辩证哲学、生物社会理论及禅宗为哲学基础,通过增加患者的技能使用,提高其情绪调节能力,以达到治疗目的。临床研究已证明其在边缘人格障碍,自杀及自伤行为中具有良好的治疗效果,除此之外也广泛适用于其他心理障碍及群体。DBT的临床效果、改变机制及拓展应用都需进一步研究。     

正式反馈的发展与临床应用

摘要:正式反馈通过系统收集当事人的效果反馈来追踪其治疗进展,进而识别缺乏治疗进展的个案,并通过促进治疗策略的调整来阻止治疗失败。正式反馈是近20年来发展出的一种循证治疗手段,其目的为进一步提高当事人的咨询效果。正式反馈的发展大致经历了临床有效性检验和实用性发展两个阶段。正式反馈可用于促进个体、夫妻和团体咨询的效果,也可用于评估临床督导效果、确定督导个案和指导临床督导。未来研究可探讨咨询师对待正式反馈的态度,拓展正式反馈的使用价值,建立正式反馈系统的本土化常模。