PTSD在中国的研究进展

PTSD是近十年来在中国精神病学界逐渐引起重视的一种反应性精神障碍。随着国外对PTSD的深入研究以及中国心理卫生事业的发展,相关领域的学者开始从事这一方面的研究并取得了不少成就。文章对中国PTSD的流行病学、神经生物学基础、病因学以及诊断和治疗等各个方面的研究作了初步总结和探讨。     

The life and times of PSI

This paper describes the essential features of the personalized system of instruction (PSI). Results from outcome research examining the effectiveness of PSI-based courses relative to traditional methods provide unequivocal support for the superiority of PSI. Parametric studies, or component analyses, show that the mastery requirement, immediate performance feedback, and review units are the key features underlying high quality student performances in PSI courses. The use of student proctors as peer-tutors, optional lectures, and selfpacing do not, in and of themselves, appear to be vital to student success in PSI courses. Despite its superiority, PSI has not supplanted traditional methods as the dominant pedagogical system in higher education. Difficulties inherent in overcoming the inertia of the lecture within our established instructional system, the implications of PSI for that system, and the Zeitgeist that permeates educational reform are the major obstacles to widespread adoption of PSI.     

构建科学的冠心病介入治疗临床决策

临床决策已成为临床医学的重要内容,但目前还为许多冠心病介入医生所忽视。阐述了临床决策的概念,分析了冠心病介入治疗决策中存在的问题及原因,探讨了如何构建科学的冠心病介入治疗决策,为冠心病介入治疗合理应用提供科学的决策方法。     

Are psychodynamic and psychoanalytic therapies effective?: A review of empirical data

There is a need for empirical outcome research in psychodynamic and psychoanalytic therapy. However, both the approach of empirically supported therapies (EST) and the procedures of evidence‐based medicine (EBM) have severe limitations making randomised controlled trials (RCTs) an absolute standard. After a critical discussion of this approach, the author reviews the empirical evidence for the efficacy of psychodynamic psychotherapy in specific psychiatric disorders. The review aims to identify for which psychiatric disorders RCTs of specific models of psychodynamic psychotherapy are available and for which they are lacking, thus providing a basis for planning further research. In addition, results of process research of psychodynamic psychotherapy are presented. As the methodology of RCTs is not appropriate for psychoanalytic therapy, effectiveness studies of psychoanalytic therapy are reviewed as well. Studies of psychodynamic psychotherapy published between 1960 and 2004 were identifed by a computerised search using Medline, PsycINFO and Current Contents. In addition, textbooks and journal articles were used. Twenty‐two RCTs were identifed of which 64% had not been included in the 1998 report by Chambless and Hollon. According to the results, for the following psychiatric disorders at least one RCT providing evidence for the efficacy of psychodynamic psychotherapy was identifed: depressive disorders (4 RCTs), anxiety disorders (1 RCT), post‐traumatic stress disorder (1 RCT), somatoform disorder (4 RCTs), bulimia nervosa (3 RCTs), anorexia nervosa (2 RCTs), borderline personality disorder (2 RCTs), Cluster C personality disorder (1 RCT), and substance‐related disorders (4 RCTs). According to results of process research, outcome in psychodynamic psychotherapy is related to the competent delivery of therapeutic techniques and to the development of a therapeutic alliance. With regard to psychoanalytic therapy, controlled quasi‐experimental effectiveness studies provide evidence that psychoanalytic therapy is (1) more effective than no treatment or treatment as usual, and (2) more effective than shorter forms of psychodynamic therapy. Conclusions are drawn for future research.     

The Shattered Microcosm: Imperatives for Improved Family Therapy in Africa in the 21st Century

This paper provides an in-depth socio-political analysis of the basis for the limits of family therapy in Africa in the last 40 years. The goal is to make more visible the economic, social, political, and cultural factors that have combined to complicate and frustrate our macro-environments of practice. The conclusion is that family therapy in Africa cannot achieve any meaningful progress in the present millenium unless the structures of underdevelopment under which we live and work are dismantled and in their place the important preconditions for successful practice of modern family therapy are entrenched. The list of imperatives to be addressed is offered to suggest the direction along which we must move if we are to effect this adaptation.     

一例一般心理问题的咨询案例分析报告

本文详细介绍了一例因为英语四级考试没有通过引发的一般心理问题的咨询过程。来访者韩某,女,20岁,是一名大二学生,因为英语四级考试没有通过而出现了睡眠质量差,学习效率下降,情绪低落等症状,来访者主动求助于校心理健康中心,迫切希望改变现状,能够正常的学习生活。咨询师在和来访者商议后根据其个性特征和问题的特点采用了合理情绪疗法对其进行干预,帮助她改变了其非理性的信念,经过咨询,来访者情绪好转,可以正确看待困难,取得了比较好的咨询效果。     

Integrative problem-centered metaframeworks therapy I: core concepts and hypothesizing

Over the last 20 years psychotherapy and family therapy have been inundated with a plethora of empirically validated treatments for particular disorders. That trend will increase. Psychotherapists will increasingly be exhorted and ultimately required to integrate empirical data and multicultural competence into their practice. Additionally, individual psychotherapy's default dominance of psychotherapeutic discourse needs to integrate and come to theoretical and clinical terms with the implications of the growing body of research demonstrating the validity and value of a multisystemic perspective. This article (and its companion article) presents a comprehensive, integrative, multisystemic, and empirically informed psychotherapeutic perspective to help therapists and psychotherapy trainers successfully address these challenges-Integrative Problem Centered Metaframeworks (IPCM) Therapy. This first article presents and illustrates IPCM's theoretical foundation, core concepts, and "case formulating" components. It delineates a Blueprint for the practice and teaching of 21st century psychotherapists who can meld science and art into best practice.     

How does mindfulness-based cognitive therapy work?

Mindfulness-based cognitive therapy (MBCT) is an efficacious psychosocial intervention for recurrent depression ( [Kuyken et?al., 2008], [Ma and Teasdale, 2004] and [Teasdale et?al., 2000]). To date, no compelling research addresses MBCT’s mechanisms of change. This study determines whether MBCT’s treatment effects are mediated by enhancement of mindfulness and self-compassion across treatment, and/or by alterations in post-treatment cognitive reactivity. The study was embedded in a randomized controlled trial comparing MBCT with maintenance antidepressants (mADM) with 15-month follow-up (Kuyken et al., 2008). Mindfulness and self-compassion were assessed before and after MBCT treatment (or at equivalent time points in the mADM group). Post-treatment reactivity was assessed one month after the MBCT group sessions or at the equivalent time point in the mADM group. One hundred and twenty-three patients with ≥3 prior depressive episodes, and successfully treated with antidepressants, were randomized either to mADM or MBCT. The MBCT arm involved participation in MBCT, a group-based psychosocial intervention that teaches mindfulness skills, and discontinuation of ADM. The mADM arm involved maintenance on a therapeutic ADM dose for the duration of follow-up. Interviewer-administered outcome measures assessed depressive symptoms and relapse/recurrence across 15-month follow-up. Mindfulness and self-compassion were measured using self-report questionnaire. Cognitive reactivity was operationalized as change in depressive thinking during a laboratory mood induction.MBCT’s effects were mediated by enhancement of mindfulness and self-compassion across treatment. MBCT also changed the nature of the relationship between post-treatment cognitive reactivity and outcome. Greater reactivity predicted worse outcome for mADM participants but this relationship was not evident in the MBCT group.MBCT’s treatment effects are mediated by augmented self-compassion and mindfulness, along with a decoupling of the relationship between reactivity of depressive thinking and poor outcome. This decoupling is associated with the cultivation of self-compassion across treatment.     

案例概念化在临床上的应用

随着心理治疗方法的发展, 案例概念化作为治疗工作的重要组成部分, 日益成为临床关注的热点。案例概念化主要指在一定治疗理论的基础上, 就来访者的问题成因和维持因素提出假设, 为构建治疗方案提供指导蓝图。西方的临床研究表明案例概念化能有效地促进咨询师和来访者对于问题的认识和理解, 提高治疗效果。以认知行为治疗理论为基础, 具体地介绍案例概念化技术在焦虑症和抑郁症的临床应用。     

Family therapists in trauma-response teams: bringing systems thinking into interdisciplinary fieldwork

Attention to the mental health facets of disaster-preparedness and trauma-response teams has increased considerably over the past decade. As family therapists take part in these efforts, they bring with them a worldview that adds valuable contributions to the nature in which fieldwork is conducted and the manners in which interdisciplinary teams function on the ground. In this article, we present how systems thinking sensitizes trauma workers to a variety of clinical presentations and biopsychosocial complexities inherent in this work. We describe common clinical- and practice-related challenges, alongside practical strategies for effectively dealing with these challenges. We draw upon our experiences as family therapists trained in the field of trauma, and our work as field responders, supervisors and team leaders across a variety of local and large-scale disaster events and contexts.