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1.
Objective
Relationships between bully victimization and symptoms of depression/anxiety were examined. In addition, it was studied whether this relationship was moderated by specific cognitive coping strategies.Methods
Participants were 582 secondary school students who filled out online self-report questionnaires on bully victimization, cognitive coping, and depression/anxiety. (Moderated) Multiple Regression analysis was performed.Results
Strong relationships were found between bully victimization and symptoms of depression and anxiety. On top of that, two cognitive coping strategies moderated the relationship between bullying and depression, i.e. rumination (strengthening) and positive refocusing (reducing). Cognitive coping strategies that moderated the effect of bullying on anxiety symptoms were rumination, catastrophizing (strengthening) and positive reappraisal (reducing).Conclusion
The results provide possible targets for intervention: when helping adolescents who have been bullied, maladaptive cognitive coping strategies could be assessed and challenged, while more adaptive strategies could be acquired. 相似文献2.
Background and objectives
Evidence from the depression literature suggests that an analytical processing mode adopted during repetitive thinking leads to maladaptive outcomes relative to an experiential processing mode. To date, in socially anxious individuals, the impact of processing mode during repetitive thinking related to an actual social-evaluative situation has not been investigated. We thus tested whether an analytical processing mode would be maladaptive relative to an experiential processing mode during anticipatory processing and post-event rumination.Methods
High and low socially anxious participants were induced to engage in either an analytical or experiential processing mode during: (a) anticipatory processing before performing a speech (Experiment 1; N = 94), or (b) post-event rumination after performing a speech (Experiment 2; N = 74). Mood, cognition, and behavioural measures were employed to examine the effects of processing mode.Results
For high socially anxious participants, the modes had a similar effect on self-reported anxiety during both anticipatory processing and post-event rumination. Unexpectedly, relative to the analytical mode, the experiential mode led to stronger high standard and conditional beliefs during anticipatory processing, and stronger unconditional beliefs during post-event rumination.Limitations
These experiments are the first to investigate processing mode during anticipatory processing and post-event rumination. Hence, these results are novel and will need to be replicated.Conclusions
These findings suggest that an experiential processing mode is maladaptive relative to an analytical processing mode during repetitive thinking characteristic of socially anxious individuals. 相似文献3.
Filip Raes Jorien Smets Ineke Wessel Filip Van Den Eede Sabine Nelis Erik Franck Yves Jacquemyn Myriam Hanssens 《Journal of psychosomatic research》2014
Objective
Maladaptive response styles to negative affect have been shown to be associated with prospective (postpartum) depression. Whether maladaptive styles to positive affect are also critically involved is understudied, even though anhedonia (a correlate of low positive affectivity) is a cardinal symptom of depression. The present study is the first to investigate the predictive value of cognitive response styles to both negative (depressive rumination) and positive affect (dampening) for postpartum depressive symptoms.Methods
During the third trimester of pregnancy, 210 women completed self-report instruments assessing depression (symptom severity and current and/or past episodes) and scales gauging the presence of depressive rumination and dampening. Of these women, 187 were retained for postpartum follow-up, with depressive symptoms being reassessed at 12 (n = 171) and 24 (n = 176) weeks after delivery.Results
Regression analyses showed that higher levels of dampening of positive affect during pregnancy predicted higher levels of depressive symptoms at 12 and 24 weeks postpartum, irrespective of initial symptom severity, past history of depression and levels of rumination to negative affect. Prepartum trait levels of rumination, however, did not predict postpartum symptomatology when controlled for baseline symptoms and history of major depressive episode(s).Conclusions
The results of this investigation suggest that the way women cognitively respond to positive affect contributes perhaps even more to the development of postpartum depression than maladaptive response styles to negative affect. 相似文献4.
Jeroen S. Legerstee Nadia Garnefski Francine C. Jellesma Frank C. Verhulst Elisabeth M. W. J. Utens 《European child & adolescent psychiatry》2010,19(2):143-150
To investigate differences in cognitive coping strategies between anxiety-disordered and non-anxious 9–11-year-old children.
Additionally, differences in cognitive coping between specific anxiety disorders were examined. A clinical sample of 131 anxiety-disordered
children and a general population sample of 452 non-anxious children were gathered. All children filled out the child version
of the Cognitive Emotion Regulation Questionnaire (CERQ-k). Structured clinical interviews were used to assess childhood anxiety
disorders. Results showed that anxiety-disordered children experience significantly more ‘lifetime’ negative life events than
non-anxious children. Adjusted for the ‘lifetime’ experience of negative life events, anxiety-disordered children scored significantly
higher on the strategies catastrophizing and rumination, and significantly lower on the strategies positive reappraisal and
refocus on planning than non-anxious children. No significant differences in cognitive coping were found between children
with specific anxiety disorders. Anxiety-disordered children employ significantly more maladaptive and less adaptive cognitive
coping strategies in response to negative life events than non-anxious children. The results suggest that cognitive coping
is a valuable target for prevention and treatment of childhood anxiety problems. 相似文献
5.
Background and objectives
Because anxiety and depression are highly comorbid, it is likely that individuals with co-occurring cognitive vulnerabilities to depression and anxiety will experience more severe symptoms of anxiety and depression. However, no study to date has examined the effects of co-occurring (simultaneous) cognitive vulnerabilities to depression and anxiety on the severity of symptoms.Method
The present study examines the co-occurring effects of Alloy and Abramson’s (1999) Negative Cognitive Style, a vulnerability to depression, and Riskind’s (2000) looming cognitive style, a vulnerability to anxiety.Results
Results indicated that those with co-occurring vulnerabilities experience a more severe level of anxiety and depression symptoms.Limitations
The present study used a measure of symptoms rather than actual clinical diagnoses.Conclusion
These findings address the previously ignored area of cognitive vulnerability to comorbidity. Co-occurring cognitive vulnerabilities to anxiety and depression synergistically confer risk for more severe anxiety and depression symptoms than the individual or additive effects of either vulnerability do alone. 相似文献6.
Nilly Mor Paula Hertel Thuy Anh Ngo Tal Shachar Shimrit Redak 《Journal of behavior therapy and experimental psychiatry》2014
Background and objectives
Rumination, a maladaptive cognitive style of responding to negative mood, is thought to be maintained by a variety of cognitive biases. However, it is unknown whether rumination is characterized by interpretation biases.Methods
Two experiments examined the link between rumination and interpretation biases, revealed in lexical-decision tasks (LDT). A homograph with both benign and ruminative or otherwise negative meaning was presented on each trial and followed by a letter string, to which participants responded by judging whether it was a word or a non-word. Letter strings were non-words or words related or unrelated to one meaning of the homograph.Results
In both experiments, faster latencies to respond to targets related to the ruminative meaning of the homographs were produced by students with higher scores on self-report measures of rumination. Moreover, these biases were associated with both brooding, the maladaptive form of rumination, and reflection, the more adaptive component. No measure of rumination was significantly correlated with general biases toward negative meaning (Experiment 1) or with threatening interpretations of homographs (Experiment 2).Limitations
The paucity of available rumination-related homographs dictated the use of non-fully randomized stimuli presentation (Experiment 1) or the use of only one set of the meanings associated with the homographs (Experiment 2).Conclusions
Rumination is associated with a tendency to interpret ambiguous information in a rumination-consistent manner. This tendency may exacerbate ruminative thinking and can possibly be a target for future intervention. 相似文献7.
Kohl A Rief W Glombiewski JA 《Journal of behavior therapy and experimental psychiatry》2012,43(4):988-1001
Background and objectives
Experimental research on psychological acceptance strategies revealed discrepant results regarding superiority of these strategies compared to other emotion regulation strategies. A review examining results of experimental comparisons between acceptance and other emotion regulation strategies (e.g. suppression, distraction, reappraisal) is still missing. The present meta-analytic approach aims to fill this gap.Method
A literature search was performed using PsychInfo and PubMed and effect sizes (ES; Hedge's g) were calculated.Results
The search identified 30 relevant studies. Many studies reported that acceptance strategies were superior when compared to other emotion regulation strategies for the outcomes of pain tolerance, negative affect and believability of thoughts. Meta-analytic results replicate findings of primary studies for pain tolerance: A small to medium between-group ES was found favoring acceptance strategies (g = 0.43, p < 0.01, 95% CI[0.12, 0.73]). With respect to pain intensity and negative affect, meta-analysis did not show any significant differences between acceptance and other emotion regulation strategies.In sum, acceptance strategies proved to be superior to other emotion regulation strategies with respect to pain tolerance but not for pain intensity and negative affect.Limitations
Future research should address which characteristics of participants lead to respond to either acceptance or to other emotion regulation strategies.Conclusions
Acceptance strategies are at least as useful in treatments for chronic pain and depression as other emotion regulation strategies. 相似文献8.
Objectives
Retrospective studies suggest a link between PTSD and difficulty regulating negative emotions. This study investigated the relationship between PTSD symptoms and the ability to regulate negative emotions in real-time using a computerised task to assess emotion regulation.Method
Trauma-exposed ambulance workers (N = 45) completed self-report measures of trauma exposure, PTSD symptoms and depression. Participants then completed a computer task requiring them to enhance, decrease or maintain their negative emotions in response to unpleasant images. Skin conductance responses (SCR) were recorded and participants also made ratings of emotion intensity. Immediately after the computer task, participants were asked to describe the strategies they had used to regulate their negative emotions during the task and recorded spontaneous intrusions for the unpleasant images they had seen throughout the following week.Results
PTSD symptoms were associated with difficulty regulating (specifically, enhancing) negative emotions, greater use of response modulation (i.e., suppression) and less use of cognitive change (i.e., reappraisal) strategies to down-regulate their negative emotions during the task. More intrusions developed in participants who had greater reductions in physiological arousal whilst decreasing their negative emotions.Limitations
PTSD was measured by self-report rather than by a clinician administered interview. The results suggest a relationship between emotion regulation ability and PTSD symptoms rather than emotion regulation and PTSD.Conclusions
Difficulty regulating negative emotions may be a feature of trauma-exposed individuals with PTSD symptoms, which may be linked to the types of strategies they employ to regulate negative emotions. 相似文献9.
Séverine Lannoy Alexandre Heeren Lucien Rochat Mandy Rossignol Martial Van der Linden Joël Billieux 《Comprehensive psychiatry》2014
Background
Emotion reactivity is defined as the extent to which an individual experiences emotions in response to a wide array of stimuli, intensely, and for a prolonged period. This construct is a key psychological factor in the development and maintenance of psychopathological disorders. The aim of the current study was to develop and validate a French version of the Emotion Reactivity Scale (ERS), which gauges three aspects of emotion reactivity: (1) emotional sensitivity, (2) emotional intensity, and (3) emotional persistence.Method
The French ERS and both concurrent and divergent validated scales were administered to 258 participants from the community.Results
Confirmatory factor analyses revealed good fit indices for: (1) a single-factor model, (2) a three-factor model, and (3) a hierarchical three-factor solution with a single-factor solution as a second-order latent variable for a generic construct of emotion reactivity. The French version of the Emotion Reactivity Scale also exhibits acceptable internal scale score reliability (total scale and subscales). Eventually, meaningful relationships were found between factors of emotion reactivity and depression, distinct aspects of impulsive behaviors, and maladaptive emotion regulation strategies.Conclusion
Findings of the confirmatory factor analyses are consistent with previous studies suggesting that the ERS is mainly captured by a single major construct of emotion reactivity. 相似文献10.
Garnefski N Legerstee J Kraaij VV Van Den Kommer T Teerds J 《Journal of adolescence》2002,25(6):603-611
The present study focused on comparability of adolescents and adults in the reporting of cognitive coping strategies and their relationship to symptoms of depression and anxiety. Two samples were included: 487 adolescents attending a secondary school and 630 adults from a general practitioners practice. Data were obtained on symptoms of depression and anxiety and the use of nine cognitive coping strategies: acceptance, catastrophizing, other-blame, positive reappraisal, putting into perspective, refocus on planning, positive refocusing, rumination and self-blame.The results showed that all cognitive coping strategies were reported by adolescents to a significantly lesser extent than by adults. Further, it was shown that both in adolescents and adults a considerable percentage of the variance in symptomatology was explained by the use of cognitive coping strategies. Although adolescents and adults differed in relative strength of the relationships, generally speaking, conclusions were the same: in both groups, the cognitive coping strategies self-blame, rumination, catastrophizing and positive reappraisal were shown to play the most important role in the reporting of symptoms of psychopathology, showing the importance of introducing prevention and intervention programmes at an early stage. 相似文献
11.
Background
Recent epidemiologic studies have found an increased risk of suicide among Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF-OIF) with psychiatric disorders. However, little is known about whether variables other than psychiatric conditions, such as coping strategies, resilience, and social support, may be related to suicidality in this population.Methods
A total of 167 OEF-OIF Veterans seeking behavioral or primary care services completed a survey containing measures of combat exposure, psychopathology, pain, psychological resilience, social support, and cognitive coping strategies.Results
Thirty-six respondents (21.6%) reported contemplating suicide in the two weeks prior to completing the survey. Compared to suicide non-contemplators, suicide contemplators were older, and more likely to screen positive for depression and posttraumatic stress disorder (PTSD), and to report a deployment-related pain condition or complaint. They also scored higher on measures of worry, self-punishment, and cognitive-behavioral avoidance strategies, and lower on measures of psychological resilience and postdeployment social support. Multivariate analysis revealed that a positive depression screen, and higher scores on measures of self-punishment and cognitive-social avoidance coping were positively associated with suicidal ideation, while higher scores on measures of psychological resilience (i.e., positive acceptance of change) were negatively related to suicidal ideation. Moderator analysis revealed that a positive screen for depression or PTSD significantly diminished the protective effect of postdeployment social support on suicidal ideation.Conclusions
1 in 5 treatment-seeking OEF-OIF Veterans may contemplate suicide. Interventions to reduce depressive symptoms, and maladaptive cognitive-behavioral coping strategies of self-punishment and cognitive social avoidance, and to bolster psychological resilience may help mitigate suicidality in this population. 相似文献12.
Raes F Schoofs H Griffith JW Hermans D 《Journal of behavior therapy and experimental psychiatry》2012,43(4):1002-1007
Background and objectives
Reduced Autobiographical Memory Specificity (rAMS) is a hypothesized vulnerability factor for depression. Rumination is thought to be one of the processes underlying rAMS, but research has failed to show an association between trait rumination and rAMS in individuals who are not currently depressed (e.g., community samples, college samples, and formerly depressed samples). The present study tested whether a challenge procedure that induces a self-discrepancy focus can elicit an association between trait rumination and rAMS in formerly depressed participants.Methods
Trait rumination was assessed via self-report. Measures of psychopathology and cognitive function, including depression, were assessed via self-report and interview. Autobiographical Memory Specificity (AMS) was evaluated before and after the induction of a self-discrepancy focus in formerly depressed participants.Results
Results showed that trait rumination was indeed negatively correlated with AMS after, but not before the induction. Moreover, high trait ruminating participants showed a decrease in AMS following the induction. In other words, memory specificity was reactive to the induction, but no such decrease was observed in low trait ruminating individuals.Limitations
This study is mostly of women. These results may not generalize well to men. Our experimental control was within-subjects, which, although powerful and economical, cannot rule out certain confounding processes including natural changes in self-discrepancy, or non-specific or unintended effects of the induction.Conclusions
In order to detect rAMS in formerly depressed individuals or to observe associations between rAMS and trait measures of rumination, state ruminative processing needs to be activated. Results are discussed by framing rAMS as an example of cognitive reactivity, a general type of processing that is associated with depression. 相似文献13.
Background
Previous studies suggest that temperament and character may impact depression and anxiety through dysfunctional cognition. This study targets the mediating role of meta-cognitive beliefs in the relationship between Cloninger’s temperament and character dimensions and symptoms of depression and anxiety.Method
One hundred and sixty-one healthy subjects filled out Cloninger’s Temperament Character Inventory (TCI), a Metacognitions Questionnaire (MCQ), the Beck Depression Inventory (BDI) and the State and Trait Anxiety Inventory (STAI). Correlation and mediation analyses according to Baron and Kenny’s method were performed.Results
Harm avoidance (HA) and self-directedness (SD) were related to depression and anxiety. HA was related to negative beliefs about uncontrollability of thoughts and to beliefs about cognitive confidence. SD was associated with the same types of meta-cognitive beliefs and with general negative beliefs. Cooperativeness (CO) was related to positive beliefs about worry, beliefs about cognitive confidence and to general negative beliefs. Self-transcendence (ST) was related to all types of meta-cognitive beliefs. Mediation analysis revealed that the relationship between HA and depression and anxiety is partially mediated by certain types of meta-cognitive beliefs. The same results were obtained for the relationship between SD and depression and anxiety. General negative beliefs fully mediated the relationship between CO and depression and the relationship between ST and anxiety.Conclusions
Meta-cognitive beliefs mediate the relationship between temperament and character dimension and depressive and anxiety symptoms, thus providing further evidence for the meta-cognitive theory of emotional disorders as presented by Wells and Matthews (Behav Res Ther 1996;32:867-870). 相似文献14.
Sternheim L Startup H Saeidi S Morgan J Hugo P Russell A Schmidt U 《Journal of behavior therapy and experimental psychiatry》2012,43(4):1095-1103
Background and objectives
The majority of people with eating disorders (ED) experience high levels of comorbid anxiety and depression, yet the maintenance processes of these in ED remain largely unknown. Worry, a defining cognitive feature and important maintenance factor of anxiety, has not been well-studied amongst people with ED. This is the first study to explore both the process and content characteristics of catastrophic worry in ED.Methods
Twenty-nine patients with anorexia nervosa (AN), 15 patients with bulimia nervosa (BN) and 37 healthy controls (HC) completed measures assessing anxiety, depression, worry and eating disorder pathology. Catastrophic worry was assessed using the Catastrophizing Interview and catastrophic worry content was explored using qualitative Thematic Analysis.Results
Compared to HCs, ED groups had higher levels of anxiety, depression and worry and they generated a greater number of catastrophic worry steps. Worry was further found associated with depressive symptomatology in those with ED. Worry content for the ED groups included ED themes, but also themes reflecting broader inter and intrapersonal concerns.Limitations
The degree to which worry is driven by depressive versus anxious symptomatology remains unclear. The current study does not include an anxious or depressed control group, and results should be considered in the light of relatively small samples sizes.Conclusion
Findings indicate that interventions that target worry processes may be a useful adjunct to treatment for those ED patients with clinical worry levels. 相似文献15.
Bianca A. Lever-van Milligen Nicole Vogelzangs Johannes H. Smit Brenda W.J.H. Penninx 《Journal of psychosomatic research》2014
Objective
Both low and high hemoglobin levels lead to more physical diseases, and both are linked to mortality. Low hemoglobin, often classified as anemia, has also been linked to more depressive symptoms, but whether both hemoglobin extremes are associated with depressive disorder and potentially also with anxiety disorder has not been examined before. This study examines to which extent hemoglobin levels are associated with depression and anxiety disorders in a large cohort.Methods
The study sample consisted of 2920 persons from the Netherlands Study of Depression and Anxiety. Hemoglobin levels were determined after venipuncture. Depressive and anxiety disorders were determined according to a DSM-IV-based psychiatric interview. Clinical psychiatric characteristics included the severity of depression and anxiety, the duration of symptoms, the age of onset and the antidepressant use.Results
Higher hemoglobin levels were found in those with current depressive and/or anxiety disorders after sociodemographic adjustment and both higher, and lower hemoglobin levels were found in persons with higher depression and anxiety severity. However, after full adjustment for sociodemographics, disease indicators and lifestyle, associations were no longer significant.Conclusions
This cohort study showed that there is no independent association between depressive and/or anxiety disorders and hemoglobin levels or anemia status. 相似文献16.
Samantha L. Connolly Clara A. Wagner Benjamin G. Shapero Laura L. Pendergast Lyn Y. Abramson Lauren B. Alloy 《Journal of behavior therapy and experimental psychiatry》2014
Background and objectives
The current study tested the resource allocation hypothesis, examining whether baseline rumination or depressive symptom levels prospectively predicted deficits in executive functioning in an adolescent sample. The alternative to this hypothesis was also evaluated by testing whether lower initial levels of executive functioning predicted increases in rumination or depressive symptoms at follow-up.Methods
A community sample of 200 adolescents (ages 12–13) completed measures of depressive symptoms, rumination, and executive functioning at baseline and at a follow-up session approximately 15 months later.Results
Adolescents with higher levels of baseline rumination displayed decreases in selective attention and attentional switching at follow-up. Rumination did not predict changes in working memory or sustained and divided attention. Depressive symptoms were not found to predict significant changes in executive functioning scores at follow-up. Baseline executive functioning was not associated with change in rumination or depression over time.Conclusions
Findings partially support the resource allocation hypothesis that engaging in ruminative thoughts consumes cognitive resources that would otherwise be allocated towards difficult tests of executive functioning. Support was not found for the alternative hypothesis that lower levels of initial executive functioning would predict increased rumination or depressive symptoms at follow-up. Our study is the first to find support for the resource allocation hypothesis using a longitudinal design and an adolescent sample. Findings highlight the potentially detrimental effects of rumination on executive functioning during early adolescence. 相似文献17.
目的 探讨认知情绪调节策略与抑郁症状水平的关系.方法 采用认知情绪调节问卷中文版(CERQ)和Beck抑郁自评问卷(BDI)对90例住院抑郁发作患者和90名健康对照组人群进行评定.结果 抑郁组CERQ非适应性策略得分[(38.38±11.68)分]高于健康对照组[(31.27±7.91)分],而适应性策略得分[(41.33±10.79)分]低于健康对照组[(45.43±12.08)分],差异均有统计学意义(P＜0.05);灾难化、积极重新评价、重新关注计划与抑郁组的抑郁症状水平显著相关(r值分别为0.429,-0.402,-0.384;P＜0.01);多元线性回归结果表明,灾难化和积极重新评价是预测抑郁发作患者抑郁症状最重要的变量,而沉思是预测健康人群抑郁症状的重要变量.结论 认知情绪调节与抑郁密切相关,提升积极重新评价策略可能有助于改善和缓解抑郁患者的抑郁症状水平. 相似文献
18.
L.H. Thorell M. Wolfersdorf R. Straub J. Steyer S. Hodgkinson W.P. Kaschka M. Jandl 《Journal of psychiatric research》2013
Background
A meta-analysis of studies investigating electrodermal activity in depressed patients, suggested that electrodermal hyporeactivity is sensitive and specific for suicide.Aims
To confirm this finding and to study electrodermal hyporeactivity relative to type and severity of depression, trait anxiety, its stability and independence of depressive state.Method
Depressed inpatients (n = 783) were tested for habituation of electrodermal responses and clinically assessed using the Beck Depression Inventory (BDI) and the STAI-Trait scale for trait anxiety.Results
The high sensitivity and raw specificity of electrodermal hyporeactivity for suicide were confirmed. Its prevalence was highest in bipolar disorders and was independent of severity of depression, trait anxiety, gender and age. Hyporeactivity was stable, while reactivity changed into hyporeactivity in a later depressive episode.Conclusions
The findings support the hypothesis that electrodermal hyporeactivity is a trait marker for suicidal propensity in depression. 相似文献19.
Vivek Pillai Lindsey A. Steenburg Jeffrey A. Ciesla Thomas Roth Christopher L. Drake 《Journal of psychosomatic research》2014
Objectives
Trait ruminators exhibit significantly higher levels of sleep disturbance than those without this cognitive vulnerability. However, support for the sleep disruptive effects of state rumination, especially in the pre-sleep period, is rare, and hindered by methodological drawbacks such as self-report and single night assays of sleep. Finally, despite the pervasiveness of the ruminative response style among individuals with depression, the association between rumination and sleep disturbance has not been explored in this population. The present study employed a week-long daily sampling approach to examine the effects of naturally occurring pre-sleep rumination on self-reported and actigraphy-based sleep among individuals with high depressive symptomatology.Methods
Forty-two university students (19.6 ± 3.2 yo;73.8% female), all of whom reported at least moderate levels of depressive symptoms, completed a short questionnaire after waking each morning for seven days. On this questionnaire, they self-reported sleep indices from the previous night and levels of engagement in pre-sleep rumination. Sleep was also monitored throughout this period via wrist actigraphy. Hierarchical-linear-modeling was used to examine the association between nightly rumination and sleep.Results
Nightly variations in pre-sleep rumination were predictive of significantly longer actigraphy- and diary-based sleep onset latency (SOL). Notably, a 1 SD increase on the pre-sleep rumination scale was associated with an approximately 7 minute increase in actigraphy-based SOL, even after controlling for baseline sleep disturbance and depressive symptoms.Conclusions
These data offer compelling evidence for the impact of pre-sleep rumination on sleep onset, providing insight into one potential mechanism that triggers sleep disturbance among individuals with depressive symptoms. 相似文献20.
Kikul J Van Allen TS Exner C 《Journal of behavior therapy and experimental psychiatry》2012,43(3):863-870