大肠癌的早期诊断与治疗研究进展

大肠癌的早期诊断与治疗是临床研究的热点。本文主要从大肠癌人群筛查、粪便检查、基因诊断以及内镜诊断,从早期大肠癌内镜下黏膜切除术和内镜下黏膜剥离术的研究进展进行述评。     

Readiness to adaptively change under three conditions: Clinical,careers, and natural change situations

The Adaptive Change Model (ACM) was developed as an alternative form of the Transtheoretical Model of Change to address some of the criticisms of early operationalisation. Both models provide a framework for measuring the potentialities of change and to facilitate targeted behaviour change in general and clinical settings. In this research, the eight factors of the Adaptive Change Questionnaire (ACQ) operationalising the ACM were validated using confirmatory factor analysis, involving 238 respondents. The findings indicated a good fit between the model and data. A comparison of the mean scores of the factors of the ACM showed respondents seeking clinical therapy (n = 85) were lower on self‐rating of factors related to adaptive change than a group receiving career counselling (n = 88) and a non‐therapy group (n = 65). The ACQ factors correctly predicted the allocation of 79.3% of the clinical and non‐therapy respondents which confirmed previous research. The relevance of the findings for therapeutic interventions and future research are discussed.     

Dante's Comedy: Precursors of psychoanalytic technique and psyche

This paper uses a literary approach to explore what common ground exists in both psychoanalytic technique and views of the psyche, of 'person'. While Western literature has developed various views of psyche and person over centuries, there have been crystallizing, seminal portraits, for instance Shakespeare's perspective on what is human, some of which have endured to the present. By using Dante's Commedia , particularly the Inferno , a 14th century poem that both integrates and revises previous models of psyche and personhood, we can examine what features of psyche, and 'techniques' in soul-healing psychoanalysts have inherited culturally. Discovering basic features of technique and model of psyche we share as psychoanalysts permits us to explore why we have differences in variations on technique and models of inner life.     

Coordination after gains and losses: Is prospect theory’s value function predictive for games?

We analyze the effects of prior gain and loss experiences on individuals’ behavior in two coordination games: battle of the sexes and simultaneous market entry. We propose subjectively transformed games that integrate elements of prospect theory, aggregation of prior and subsequent payoffs, and social projection. Mathematical predictions of behavior are derived based on equilibrium selection concepts. Males’ behavior in our experimental studies is largely consistent with our predictions. However, the behavior of many female respondents appears to be rather consistent with interpreting the initial random lottery outcomes used to manipulate prior experiences as a signal for the players’ abilities to compete. This could be related to females’ known uneasiness of competing against counterparts that might be male and thus, a generally higher salience of rivalry in our incentivized experiments. Females also chose to play far more mixed strategies than males indicating some uncertainty about what type of behavior is appropriate.     

Priming attachment security improves attitudes towards a range of therapies

We sought to understand how attachment orientation influenced attitudes towards different types of psychological therapies. In two studies, we (1) examined attachment orientation as a predictor of attitudes towards different therapies and (2) tested whether attachment security priming could improve attitudes. Study 1 (n = 339) found associations between attachment orientation and attitudes towards, and likelihood of using different therapies. Positive and negative attitudes about different therapies mediated the relationship between attachment avoidance and likelihood of use. Study 2 (n = 412) showed that primed security (vs. neutral prime) improved attitudes towards relational, non‐relational and distanced‐relational therapies for those with a fearful‐avoidant attachment orientation. For relational and distanced‐relational therapies, the mechanism of this effect was increased cognitive openness. Attachment orientation is a determinant of therapy attitudes and anticipated help‐seeking behaviour. Priming security may promote open‐minded decision‐making about some therapies. Findings are discussed with relevance to attachment theory, research and clinical practice.     

Considering boundaries when doing therapeutic work with people who are seeking asylum: a reflective case study

People who are seeking asylum often have lived experience of their personal boundaries and human rights being violated. For this reason, it is especially important that we consider the impact of boundaries in therapeutic work with this population. This paper explores work with a woman with a severe trauma history who was seeking asylum in England. Examples of perceived boundary crossings in the therapeutic relationship are examined. Considerations for other clinicians working with asylum seekers are discussed. These include: addressing socio-political factors; being sensitive to cultural differences; the importance of supervision and reflective practice; the personal impact of such work; and using critical thinking and warmth to manage boundaries rather than rigidly following rules.     

Symptom reduction and termination: client change and therapist identified reasons for saying goodbye

Empirical efforts have focused on predicting whether or not clients prematurely terminate therapy, with nonattendance of last session equated to premature termination. However, this fails to explore the relationship between clients’ distress reduction and reasons for termination. With this study, we aimed to understand how clients’ distress change relates to premature termination and examine clients’ distress change in conjunction with therapists’ perceptions of termination reasons. We collected data from 797 clients who prematurely terminated or attended termination but completed therapy a minimum of three individual sessions provided by 38 therapists. Clients completed an assessment of psychological symptoms before each session. At the end of treatment, therapists identified the reasons they believed termination occurred for all clients in the sample. Results demonstrate that total sessions attended and missed predict premature termination, whereas distress change does not. Additionally, clients who were believed to accomplish goals do show greater change. However, therapists’ indicated that over half of clients did not reach goals at termination and they did not perceive nonattendance at last session to equate to drop out in all cases. Implications are discussed with respect to understanding why clients’ terminate, therapeutic goal conceptualization, and review of goals during termination in time-limited psychotherapy.     

Therapist activities preceding therapy setbacks in a poor-outcome case

Progress in psychotherapy is typically irregular, as advances alternate with setbacks. This study investigated the therapist’s activities prior to two main types of setbacks, one involving the client following therapist proposals and one involving the client failing to follow from therapist proposals, in the case of a poor-outcome client treated with a linguistically-oriented kind of cognitive therapy. Setbacks were defined as decreases of at least one level on an index of therapeutic progress, the 8-level Assimilation of Problematic Experiences Scale (APES), in adjacent client passages. Therapist activities were coded in 361 setback episodes that each included a client pre-setback passage, a therapist passage, and a client setback passage; both client passages had been previously rated on the APES. The main categories of therapist activities showed distinctive patterns in relation to the two main types of setbacks, the therapeutic zone of proximal development and the balance strategy. The two main patterns were described as an exploratory and a challenging configuration. These patterns of therapist activities and setbacks showed how the therapist seemed to persevere with approach-guided interventions while this poor-outcome client continued to have setbacks to low APES levels.     

A client‐generated psychometric instrument: The development of ‘PSYCHLOPS’

PSYCHLOPS (Psychological Outcome Profiles) is a recently developed, client‐generated, psychometric instrument that can be used as an outcome measure. Based on a similar instrument developed primarily for use in physical illnesses (MYMOP — ‘Measure Your Medical Outcome Profile’), it seeks the client's perspective on their psychological distress. It asks them to describe and then score the problem that troubles them the most at the start of counselling. We describe the development of PSYCHLOPS, including the involvement of the Plain English Campaign and two national mental health organisations: the mental health charity and support group, Depression Alliance (DA) and Primary Care Mental Health Education (PRIMHE). We review the literature and suggest that PSYCHLOPS, by focusing on the problems of greatest priority to the client, might prove a sensitive measure of improvement after counselling.