正念干预在突发公共卫生事件中的应用

突发公共卫生事件可能会引发个体焦虑、抑郁、急性应激障碍、创伤后应激障碍等心理反应。以正念为基础的心理干预(MBI,Mindfulness-Based Intervention)作为一种新兴的心理治疗方法,在治疗这些心理障碍中有着积极作用。本文对正念干预在焦虑、抑郁、急性应激障碍、创伤后应激障碍患者中的应用研究现状进行探讨,为进一步的研究和临床应用提供参考。     

焦虑障碍虚拟现实暴露治疗的效果研究进展

本文目的是对虚拟现实暴露疗法治疗焦虑障碍各亚型效果的研究进展进行综述，以期为临床应用提供参考。虚拟现实技术的日益普及与发展，为焦虑障碍的治疗提供了新的有效方法。近年来，大量研究表明虚拟现实暴露疗法治疗焦虑障碍有一定的效果。本文探讨了虚拟现实暴露疗法治疗焦虑障碍各亚型的效果以及药物对虚拟现实暴露治疗的增效作用，并总结了虚拟现实暴露疗法的优点及不足。     

广泛性焦虑障碍的元认知理论

广泛性焦虑障碍（GAD）是一种以担忧为核心心理特征的，并伴有机体紧张等躯体症状的焦虑障碍。Wells的元认知模型通过探讨GAD患者的病态性担忧的形成、运作和循环，提出了GAD患者存在两种担忧的假设-Ⅰ型担忧和Ⅱ型担忧（元担忧），并认为元担忧是导致患者的弥漫的、持续的以及难以控制的担忧的核心因素。由该模型发展起来的元认知疗法在治疗GAD过程中体现出有效的作用。本文对此作如下浅述。     

焦虑障碍用心理治疗有效吗——来自系统文献综述的证据?

现代心理治疗(无论是精神分析与动力学治疗,还是行为与认知治疗)的发展与临床应用最初是基于神经症患者,其中相当一部分患者是焦虑障碍,尤其在精神药物治疗出现(20世纪50年代)以前,即心理治疗是焦虑障碍的主要治疗方法.当然, 20世纪60年代以来随着苯二氮类药物以及抗抑郁药的临床应用推广,焦虑障碍的治疗方法选择亦趋多样化,但心理治疗在焦虑障碍中的应用与地位并未完全削弱,如Bandelow等[1]曾系统复习文献,对有关焦虑障碍的心理治疗、药物治疗以及联合治疗的对照研究进行Meta 分析,共有16项惊恐障碍对照研究、6项社交焦虑障碍对照研究和2项广泛性焦虑障碍对照研究符合入组分析标准,结果显示,药物、认知行为治疗、药物和心理治疗联合均能有效治疗焦虑障碍,其中对惊恐障碍、社交焦虑障碍,联合治疗的效果优于任何单一治疗组.     

焦虑个体奖赏反馈的脑电研究

随着社会压力的加重,焦虑逐渐成为当代社会常见的心理现象。而奖赏作为个体的基础生理反应,影响焦虑个体处理环境信息的过程,对焦虑的发生和发展产生了重要作用。本文综述了焦虑个体奖赏反馈的脑电研究,通过事件相关电位技术,从神经活动的时间进程角度揭示焦虑个体奖赏信息加工特征,从而为全面了解焦虑个体的一般心理特征、焦虑障碍患者的临床诊断和治疗提供理论方向,也为后续的科学研究提供思路。     

社交焦虑障碍的认知行为集体治疗效果的影响因素

目的 探讨社交焦虑障碍的认知行为集体治疗疗效的影响因素。方法 上海市精神卫生中心就诊的社交焦虑障碍患者中自愿参加认知行为集体治疗者,每个治疗小组6～8人,治疗8周,每周1次2．5小时,内容包括认知重建、放松训练、社交技巧训练、系统暴露、现场暴露和家庭作业。疗效评定工具为Liebowitz社交焦虑评定量表。结果 58例患者中社交焦虑评定量表总分、恐惧因子分和回避因子分治疗前后差异均有统计学显著性意义。在研究可能影响治疗的20种因素中有19种因素有显著的影响作用。结论 认知行为集体治疗社交焦虑障碍有效,但影响疗效因素较多,应用该治疗方案时应予充分考虑。     

基于催产素的抗焦虑作用向临床转化的研究进展

焦虑障碍的病因及发病机制未明,治疗方面的进展有限,疾病的治愈率低而复发率高。近年来,催产素因其抗焦虑作用引起了人们的关注,尤其在动物实验中得到了验证,但相关的人类研究仍较少。因此,本文对近年来有关催产素与焦虑的研究进行综述,以期更深入地理解焦虑的病理机制。焦虑障碍是最常见的精神障碍之一,神经递质的失衡被认为是其发生的原因之一。催产素作为脑内一种常见的神经递质参与了焦虑情绪调节的过程。本文目的是通过总结与催产素相关的基础研究,探索其调节焦虑的可能机制,并结合临床研究结果,为焦虑障碍的诊断和治疗提供新思路。     

惊恐障碍患者心率变异性的研究进展

惊恐障碍是一种常见的精神障碍,常伴有自主神经系统功能失调。心率变异性是评估自 主神经系统功能的重要指标,该指标降低被认为是自主神经系统功能异常的体现。本文总结了惊恐障 碍患者与健康人群、其他焦虑障碍患者和心血管疾病患者在心率变异性方面的差异,回顾了药物和心 理治疗对惊恐障碍患者心率变异性的影响,旨在为有效治疗惊恐障碍提供参考。     

神经反馈在卒中后抑郁和焦虑中应用的研究进展

卒中后情绪障碍发生率很高,严重的抑郁、焦虑对于患者的治疗、康复有着不同程度的消 极影响。神经反馈技术是通过对脑电参数的适应性训练,从而改善患者的情绪症状。目前应用神经 反馈干预卒中后抑郁、焦虑的研究相对较少,且对于干预脑区及脑波尚无统一定论。本文将对神经 反馈在卒中后抑郁、焦虑方面的应用加以综述。     

儿童青少年焦虑障碍认知行为治疗效果预测因素的研究进展

焦虑障碍是以过度担心不良的预期结果为特征的情绪和行为障碍,全球患病率为6.5%[1]。多个国家的治疗指南均推荐认知行为治疗(cognitive behavior therapy,CBT)作为青少年焦虑障碍的一线治疗手段[2]。一项关于CBT对广泛性焦虑障碍、社交焦虑障碍、惊恐障碍相对影响的meta分析发现,CBT治疗成人焦虑障碍患者都有较好的反应[3]。然而,针对儿童青少年的研究发现接近半数焦虑障碍患儿经CBT治疗后没有完全缓解[4],这与成年人的研究结果有较大差异。明确儿童青少年疗效预测因子能更好地指导治疗,从而达到更显著的疗效,这也是目前儿童青少年焦虑障碍研究的热点之一。本文就心理社会因素、症状学、脑影像与电生理、基因预测等4个方面对儿童青少年焦虑障碍患者经CBT后的疗效预测作用做一综述。     

Acceptance and commitment therapy for anxiety and OCD spectrum disorders: An empirical review

A fair amount of research exists on acceptance and commitment therapy (ACT) as a model and a treatment for anxiety disorders and OCD spectrum disorders; this paper offers a quantitative account of this research. A meta-analysis is presented examining the relationship between psychological flexibility, measured by versions of the Acceptance and Action Questionnaire (AAQ and AAQ-II) and measures of anxiety. Meta-analytic results showed positive and significant relationships between the AAQ and general measures of anxiety as well as disorder specific measures. Additionally, all outcome data to date on ACT for anxiety and OCD spectrum disorders are reviewed, as are data on mediation and moderation within ACT. Preliminary meta-analytic results show that ACT is equally effective as manualized treatments such as cognitive behavioral therapy. Future directions and limitations of the research are discussed.     

Guided and unguided Acceptance and Commitment Therapy for social anxiety disorder and/or panic disorder provided via the Internet and a smartphone application: A randomized controlled trial

Acceptance and Commitment Therapy (ACT) can be effective in treating anxiety disorders, yet there has been no study on Internet-delivered ACT for social anxiety disorder (SAD) and panic disorder (PD), nor any study investigating whether therapist guidance is superior to unguided self-help when supplemented with a smartphone application. In the current trial, n = 152 participants diagnosed with SAD and/or PD were randomized to therapist-guided or unguided treatment, or a waiting-list control group. Both treatment groups used an Internet-delivered ACT-based treatment program and a smartphone application. Outcome measures were self-rated general and social anxiety and panic symptoms. Treatment groups saw reduced general (d = 0.39) and social anxiety (d = 0.70), but not panic symptoms (d = 0.05) compared to the waiting-list group, yet no differences in outcomes were observed between guided and unguided interventions. We conclude that Internet-delivered ACT is appropriate for treating SAD and potentially PD. Smartphone applications may partially compensate for lack of therapist support.     

Low baseline pCO2 predicts poorer outcome from behavioral treatment: Evidence from a mixed anxiety disorders sample

Low levels of end-tidal partial pressure of carbon dioxide (pCO₂)—the amount of carbon dioxide measured from expired air—are commonly found in individuals with anxiety disorders but have not been examined as predictors of outcome from anxiety treatment. The current study examined pre-treatment baseline pCO₂ as a predictor of outcome from cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for anxiety disorders. Sixty-one individuals with a Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defined principal anxiety disorder diagnosis completed 12 sessions of either CBT or ACT. Baseline pCO₂ was measured prior to entering treatment. Self-reported anxiety symptoms and quality of life were assessed at pre-treatment, post-treatment, and 6- and 12-month follow-up from baseline. Low baseline pCO₂ was associated with higher anxiety symptoms and lower quality of life across follow-up timepoints, above and beyond baseline symptom severity. These results suggest that low baseline pCO₂ predicts poorer outcome from CBT and ACT for anxiety and may warrant treatment that directly addresses respiratory dysregulation.     

Acceptance and commitment therapy for generalized social anxiety disorder: a pilot study

Despite the demonstrated efficacy of cognitive-behavior therapy (CBT) for social anxiety disorder (SAD), many individuals do not respond to treatment or demonstrate residual symptoms and impairment posttreatment. Preliminary evidence indicates that acceptance-based approaches (e.g., acceptance and commitment therapy; ACT) can be helpful for a variety of disorders and emphasize exposure-based strategies and processes. Nineteen individuals diagnosed with SAD participated in a 12-week program integrating exposure therapy and ACT. Results revealed no changes across a 4-week baseline control period. From pretreatment to follow-up, significant improvements occurred in social anxiety symptoms and quality of life, yielding large effect size gains. Significant changes also were found in ACT-consistent process measures, and earlier changes in experiential avoidance predicted later changes in symptom severity. Results suggest the acceptability and potential efficacy of ACT for SAD and highlight the need for future research examining both the efficacy and mechanisms of change of acceptance-based programs for SAD.     

Acceptance and commitment therapy in the treatment of posttraumatic stress disorder

The current article describes the application of a behavioral psychotherapy, acceptance and commitment therapy (ACT), to the treatment of post-traumatic stress disorder (PTSD). It is argued that PTSD can be conceptualized as a disorder that is developed and maintained in traumatized individuals as a result of excessive, ineffective attempts to control unwanted thoughts, feelings, and memories, especially those related to the traumatic event(s). As ACT is a therapeutic method designed specifically to reduce experiential avoidance, it may be a treatment that is particularly suited for individuals with PTSD. The application of ACT to PTSD is described, and a case example is used to demonstrate how this therapy can be successfully used with individuals presenting for life problems related to a traumatic event.     

Cognitive-behavioral therapy for social anxiety disorder: current status and future directions.

Cognitive-behavioral therapy (CBT) is the most thoroughly studied nonpharmacologic approach to the treatment of social anxiety disorder, and its efficacy has been demonstrated in a large number of investigations. This article summarizes the data on the efficacy of CBT for the treatment of the symptoms of social anxiety disorder and impaired quality of life. The relative efficacy of various CBT approaches, both in the short-term and over extended follow-up periods, is reviewed. Factors associated with more or less positive response to CBT among patients with social anxiety disorder are examined. Special attention is given to the comparison of CBT with pharmacologic approaches to the treatment of social anxiety disorder and the potential utility of combining these approaches. Future directions in the application of combinations of CBT and pharmacotherapy to the treatment of social anxiety disorder are discussed.     

A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression

Acceptance and commitment therapy (ACT) has a small but growing database of support. One hundred and one heterogeneous outpatients reporting moderate to severe levels of anxiety or depression were randomly assigned to traditional cognitive therapy (CT) or to ACT. To maximize external validity, the authors utilized very minimal exclusion criteria. Participants receiving CT and ACT evidenced large, equivalent improvements in depression, anxiety, functioning difficulties, quality of life, life satisfaction, and clinician-rated functioning. Whereas improvements were equivalent across the two groups, the mechanisms of action appeared to differ. Changes in "observing" and "describing" one's experiences appeared to mediate outcomes for the CT group relative to the ACT group, whereas "experiential avoidance," "acting with awareness," and "acceptance" mediated outcomes for the ACT group. Overall, the results suggest that ACT is a viable and disseminable treatment, the effectiveness of which appears equivalent to that of CT, even as its mechanisms appear to be distinct.     

Adults who feared school: is early separation anxiety specific to the pathogenesis of panic disorder?

Although juvenile separation anxiety disorder is maintained to be a predisposing factor to adult panic disorder in DSM-III-R, past research has failed to clarify (a) whether it is separation anxiety per se or school refusal that is the pathogenic risk factor and (b) whether affected youngsters are specifically at risk of developing panic disorder rather than symptoms of general anxiety or phobias in later life. The present study of 74 adults who responded to media publicity found that a measure of early separation anxiety but not a history of school refusal was associated with risk of adult panic disorder according to DSM-III-R criteria. In contrast, separation anxiety scores were not associated with the presence or absence of general anxiety symptoms or phobic-avoidance in adulthood. Subjects with higher separation anxiety scores were more likely to have either a sibling or child with school refusal. Although the present study is limited in its method to mailed survey responses and, in part, to retrospective data, the results do provide additional support for Klein's influential separation anxiety theory of panic disorder.     

Quality of life and anxiety and depressive disorder comorbidity

The present investigation evaluated the relations among anxiety and depressive disorder comorbidity and quality of life (QOL) by utilizing self-report measures of life satisfaction and functional disability. Participants were 94 individuals who were presented for treatment at an outpatient anxiety disorders clinic and 26 nonclinical participants. Results indicated that participants diagnosed with anxiety disorders reported lower QOL than did nonclinical participants. Anxiety disorder comorbidity did not additionally impact QOL; however, presence of a depressive disorder comorbid with an anxiety disorder did negatively impact QOL as these individuals reported significantly more functional disability and less life satisfaction than did individuals with anxiety disorders alone or those without a psychiatric diagnosis. These results highlight the negative nature of anxiety disorders and improve clarification on the role of diagnostic comorbidity on QOL among those with an anxiety disorder.     

临床常见的三种女性性功能失调的诊断和治疗

女性性功能失调是指女性在体验性愉悦的能力上具有临床意义的紊乱。本文将简要探讨临床诊疗中常见的三种女性性功能失调,包括女性性高潮障碍、女性性兴趣/唤起障碍及生殖器-盆腔痛/插入障碍的诊断和治疗,为临床工作中相关疾病的识别和诊治提供参考。