初产妇产后育儿效能影响因素的研究

目的探讨影响初产妇产后育儿效能的因素。方法选取北京市某三甲医院住院分娩的147名初产妇,分别在产后3天、6周、12周时对研究对象进行问卷调查,问卷包括一般资料、育儿效能量表、爱丁堡产后抑郁量表、产后社会支持问卷4部分。结果评价支持、情感支持和产后抑郁共同解释了产后3天育儿效能总变异的27.3%(F=19.297,P0.01);评价支持、信息支持和产后抑郁共同解释了产后6周育儿效能总变异的40.2%(F=28.324,P0.01)和产后12周育儿效能总变异的34.4%(F=20.907,P0.01)。结论产后抑郁和社会支持中的评价支持、信息支持是初产妇产后育儿效能的主要影响因素。     

Cognitive Behavioral Therapy Techniques for Distress and Pain in Breast Cancer Patients: A Meta-Analysis

This meta-analysis is the first to examine cognitive behavioral therapy (CBT) techniques for distress and pain specifically in breast cancer patients. Twenty studies that used CBT techniques with breast cancer patients were identified and effect sizes were calculated to determine (1) whether CBT techniques have a significant impact on distress and pain, (2) if individual or group treatments are more effective, (3) whether severity of cancer diagnosis influences distress and pain outcomes, and, (4) if there is a relationship between CBT technique efficacy for distress and pain. Results revealed effect sizes of d = 0.31 for distress (p < 0.05) and .49 for pain (p < 0.05), indicating that 62 and 69% of breast cancer patients in the CBT techniques treatment groups had less distress and less pain (respectively) relative to the control groups. Studies with individual treatment approaches had significantly larger effects compared to studies that employed group approaches for distress (p = 0.04), but not for pain (p > 0.05). There were no significant differences in effects between those with or without metastases (p > 0.05). The correlation between effect sizes for distress and pain was not significant (p = 0.07). Overall, the results support the use of CBT techniques administered individually to manage distress and pain in breast cancer patients. However, more well-designed studies are needed.     

Expectations Among Patients and Health Professionals Regarding Web-Based Interventions for Depression in Primary Care: A Qualitative Study

BackgroundOne-quarter of the world’s population will suffer from depression symptoms at some point in their lives. Mental health services in developed countries are overburdened. Therefore, cost-effective interventions that provide mental health care solutions such as Web-based psychotherapy programs have been proposed.ObjectiveThe intent of the study was to identify expectations regarding Web-based psychotherapy for the treatment of depression in primary care among patients and health professionals that might facilitate or hinder its effects.MethodsThe expectations of untreated patients and health professionals were examined by means of interviews and focus groups. There were 43 participants (20 patients with mild and moderate levels of depression, 11 primary care physicians, and 12 managers; 22 of them for interviews and 21 for groups). A thematic content analysis from the grounded theory for interviews, and an analysis of the discursive positions of participants based on the sociological model for groups were performed. Interpretations were achieved by agreement between three independent analysts.ResultsAll participants showed a good general acceptance of Web-based psychotherapy, appreciating possible advantages and improvements. Patients, physicians, and managers shared the same conceptualization of their expectations, although highlighting different aspects. Patients focused on the need for individualized and personalized interaction, while professionals highlighted the need for the standardization of the program. Physicians were concerned with extra workload, while managers were worried about optimizing cost-effectiveness.ConclusionsExpectations of the different participants can conflict with each other. Finding a balanced position among them is needed if we are to harmoniously implement effective Web-based interventions for depression in routine clinical practice.     

ACTH-Producing Breast Cancer: A Patient Report

Ectopic ACTH secretion in the setting of breast cancer is extremely rare but when present affects both the tumor’s behavior and the incidence of complications. The patient, a 58-year-old woman, first presented with a mass in her left breast as well as multiple osseous metastases and a right femur fracture. Laboratory data revealed a hypokalemic alkalosis. Her plasma ACTH level was elevated. She was diagnosed with breast cancer with ectopic ACTH secretion, and underwent a left mastectomy and axillary lymph node dissection. Histological examination demonstrated a poorly differentiated neuroendocrine carcinoma with ectopic ACTH secretion. Although the signs and symptoms of ectopic ACTH secretion from a breast cancer are frequently subtle, the recognition of ectopic ACTH secretion from breast cancer is important for patient management.     

综合性心理治疗对癌症患者焦虑、抑郁情绪的作用

目的：了解综合性心理治疗对癌症患者焦虑、抑郁情绪的作用。方法：对８３例肿瘤患者进行对照治疗和观察,研究组在常规放疗、化疗等生物治疗的基础上合并应用一般性心理支持治疗、疾病知识教育、个别心理治疗、患者互助治疗、家庭和社会支持治疗、音乐结合肌网放松训练及内心意念引导等常用的综合心理治疗方法。对照组仅用常规肿瘤治疗。观察治疗前后焦虑、抑郁情绪变化。结果：研究组较对照组患者焦虑、抑郁情绪有明显改善。结论：     

Coping and Adjustment in Children with Cancer: A Meta-Analytic Study

The current meta-analysis assessed the efficacy of coping strategies on psychological and physical adjustment in children with cancer (n = 1230). Coping strategies were operationalized in accordance with two coping taxonomies; the first is based on the general orientation of the child's coping attempts (approach or avoidance), and the second is based upon coping efforts to regulate the stressor and/or feelings of distress attributed to it (problem-focused and emotion-focused). Approach, avoidance, and emotion-focused coping were unrelated to overall adjustment. A small-to-medium but negative association was found between problem-focused coping and adjustment, indicating more use of the strategies that compose this dimension are associated with poorer adjustment. However, homogeneity analyses also indicated significant variation for all of these effect sizes. Follow-up moderator analyses found coping-adjustment relations were both dependent upon time since diagnosis and the particular stressor the child was dealing with during treatment.     

师范大学生一般自我效能感、自我和谐与学习适应性的关系

目的探讨师范大学生一般自我效能感、自我和谐与学习适应性的关系。方法以423名师范大学生为对象,采用大学生学习适应量表、自我和谐量表、一般自我效能感量表进行调查分析。结果师范大学生的总体学习适应状况中等偏上(t=18.77,P0.001);学习适应性与一般自我效能感和自我和谐及其各因素显著相关(r0.240,P0.001);一般自我效能感和自我和谐能够显著预测学习适应性,判定系数为0.276。结论师范大学生的一般自我效能感、自我和谐与学习适应性具有显著相关。     

癌症患者心理调节问卷的编制与测评

目的:研制癌症患者心理调节问卷(PASCP)。方法:以严谨的程序编制问卷,随机抽取557例癌症患者进行测定,请患者、183位亲属和96位医护人员做重要性评分,并对问卷进行筛选和信度、效度检验。结果:(1)问卷共有36个条目,包括患癌症后对情绪/自尊、主观感受、日常生活、人际关系/社会生活、其他等五个维度和一项总的心理调节自我评价条目。(2)问卷具有较好的内容效度,结构与设计的理论构思相符,5个因子负荷范围和方差分析分别为0.63~0.79和7.44,0.67~0.76和5.42,0.69~0.88和4.77,0.66~0.91和4.77,0.63~0.80和4.38,参照于HAD和FLIC两个问卷的效标效度分别为0.78和0.69。(3)五个维度和总分的重测信度分别为0.83、0.82、0.86、0.78、0.76和0.89,Cronbach α系数分别为0.83、0.86、0.80、0.78、0.69和0.89。结论:PASCP有较好的效度、信度和灵敏度,问卷能较敏感地反映治疗及康复前后患者心理调节的变化。     

A Randomized trial of a cognitive‐behavioral therapy and hypnosis intervention on positive and negative affect during breast cancer radiotherapy

Breast cancer radiotherapy can be an emotionally difficult experience. Despite this, few studies have examined the effectiveness of psychological interventions to reduce negative affect, and none to date have explicitly examined interventions to improve positive affect among breast cancer radiotherapy patients. The present study examined the effectiveness of a multimodal psychotherapeutic approach, combining cognitive‐behavioral therapy and hypnosis (CBTH), to reduce negative affect and increase positive affect in 40 women undergoing breast cancer radiotherapy. Participants were randomly assigned to receive either CBTH or standard care. Participants completed weekly self‐report measures of positive and negative affect. Repeated and univariate analyses of variance revealed that the CBTH approach reduced levels of negative affect [F(1, 38)=13.49; p=.0007, ω²=.56], and increased levels of positive affect [F(1, 38)=9.67; p=.0035, ω²=.48], during the course of radiotherapy. Additionally, relative to the control group, the CBTH group demonstrated significantly more intense positive affect [F(1, 38)=7.09; p=.0113, d=.71] and significantly less intense negative affect [F(1, 38)=10.30; p=.0027, d=.90] during radiotherapy. The CBTH group also had a significantly higher frequency of days where positive affect was greater than negative affect (85% of days assessed for the CBTH group versus 43% of the Control group) [F(1, 38)=18.16; p=.0001, d=1.16]. Therefore, the CBTH intervention has the potential to improve the affective experience of women undergoing breast cancer radiotherapy. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65: 1–13, 2009.     

Impact of messaging on views of depression treatment options: Examining credibility and expectations

Objective

Understanding how people respond to information about treatment options is important for informing efforts that promote treatment initiation and adherence. We examined the impact of informational treatment videos on treatment naive participants' views regarding the credibility of and their expectations for three treatment options.

Materials and Methods

Adults (N = 300) who had experienced elevated depressive symptoms but had not participated in a treatment for depression were randomly assigned to one of four conditions. Three of the conditions were shown videos, providing information about (1) cognitive behavioral therapy (CBT), (2) antidepressant medication (ADM), or (3) the combination of CBT and ADM. The fourth condition was not shown a video. Participants' self-reported views of the credibility of and expectations for treatment served as primary outcome variables.

Results

Compared with the control condition, videos about active treatments enhanced credibility and expectations for those treatments. When comparing CBT and ADM alone, messaging about either treatment enhanced credibility of and expectations for that treatment. The CBT only video produced the most positive expectations and highest credibility for CBT. Likewise, the ADM only video led to the most positive expectations and credibility for ADM. The video focused on combined treatment did not lead to particularly positive views of the combined treatment option.

Conclusion

These findings demonstrate the importance of providing focused messaging to enhance the credibility of and expectations for treatment. Future research is needed to examine the impact of messaging in different contexts, as well as the impact of such messaging on treatment seeking, adherence, and outcomes.     

Pessimism and Physical Functioning in Older Women: Influence of Self-Efficacy

The purpose of the present study was to examine the nature of the relationships among dispositional optimism/pessimism, self-efficacy, and physical function in a cross-sectional sample of older women (N = 249, M age = 69 years). Initial bivariate analyses indicated that both pessimism and self-efficacy, but not optimism, were significantly correlated with objectively measured physical function. Subsequent analyses using covariance modeling with the full-information maximum likelihood estimator indicated that pessimism was no longer correlated with function when controlling for self-efficacy. That is, consistent with a social cognitive perspective, controlling for self-efficacy attenuated the relationship between pessimism and function. Our findings provide support for using a social cognitive perspective to understanding dispositional and modifiable influences on declines in function associated with aging.     

Brief Report: An Intervention Program for Parents of Pediatric Cancer Patients: A Randomized Controlled Trial

Objective: To evaluate a psychoeducational intervention programfor parents of pediatric cancer patients, using cognitive andbehavioral techniques. Methods: Parents were randomly assigned to an intervention (n= 39) and a control condition (n = 42). Baseline assessmenttook place at diagnosis. Short-term effects were measured immediatelyafter the intervention, long-term effects six months later.Control parents received standard care. Intervention parentsreceived, in addition, a manual-guided program during the firstsix months following the diagnosis. Results: With time all parents became significantly less psychologicallydistressed. However, no between-group differences were notedin psychological functioning, satisfaction with support, andintensity of emotions immediately postintervention and six monthslater. Conclusions: Although the clinical evaluation of the interventionwas positive, it appeared that a structured intervention programas described in this study was not any more effective than standardcare.     

认知行为治疗对改善乳腺癌患者术后抑郁以及生活质量的Meta分析

目的:通过Meta分析的方法评价认知行为治疗(cognitive behavioral therapy,CBT)对改善乳腺癌患者术后抑郁以及生活质量的效果.方法:手动检索Cochrane Library,EMBASE,PubMed,Web of Science英文数据库以及中国生物医学文摘数据库(CBM)、维普数据库(VIP)、万方数据库及中国知网数据库(CNKI),纳入认知行为疗法改善术后抑郁以及生活质量的随机对照研究,评价结果包括焦虑自评量表(Self-Rating Anxiety Scale,SAS)评分,抑郁自评量表(Self-Rating Depression Scale,SDS)评分、生活质量核心问卷(Quality of Life-Core 30 Questionnaire,QLQ-C30)总分以及各个项目的评分进行Meta分析.结果:共纳入17篇文献,纳入患者1645例,认知行为护理组832例,对照组813例.与对照组比较,行为认知疗法可以改善乳腺癌患者术后抑郁以及焦虑情绪评分,差异有统计学意义(P<0.05).同时行为认知疗法可以降低患者术后QLQ-C30各个项目评分,差异有统计学意义(P<0.05).结论:认知行为疗法可以改善乳腺癌患者术后抑郁以及焦虑情绪,改善患者生活质量.     

Exercise and Self-Esteem in Middle-Aged Adults: Multidimensional Relationships and Physical Fitness and Self-Efficacy Influences

In the context of sedentary middle-aged adults, the present study examined the relationships among domain-specific and global levels of self-esteem over the course of a 20-week exercise program. Additionally, the roles played by physical fitness, body composition, self-efficacy, and exercise participation as possible contributors to changes in physical self-worth were examined. Significant improvements in self-esteem at all levels were discovered with global esteem, physical self-worth, and perceptions of physical condition and attractive body increasing. Tests of the hierarchical structure of self-esteem showed greater improvements in physical condition and physical self-worth than global esteem and the relationships between global esteem and subdomain levels were shown to be mediated by physical self-worth. Hierarchical regression analyses showed changes in ratings of importance to have little impact on changes in physical self-worth. Both changes in efficacy and aerobic capacity were demonstrated to account for modest but significant variation in physical self-esteem. Results are discussed in terms of contemporary models of self-esteem, potential mediators of exercise effects on esteem, and the need to measure the constructs of interest appropriately.     

乳腺癌与良性病患者人格、情绪适应和心境比较

目的 探讨乳腺癌患者的人格倾向以及确诊前的情绪适应和心境特点。方法 确诊前以艾森克人格问卷（EPQ）、癌症病人情绪适应问卷（MAC），简明心境问卷（BPOMS）测查乳腺病就诊者的人格、情绪适应以及心境状况，将其中42名乳腺癌患者与60名乳腺良性疾病患者比较。结果 乳腺癌患者的外向人格分数明显高于乳腺良性痰病患者（P〈0．01）；乳腺癌患者的宿命情绪适应分数明显高于乳腺良性痰病患者（P〈0．01）。结论 乳腺癌患者具有外向人格特点，确诊前具有高宿命情绪适应特点。     

The Effect of Guided Web-Based Cognitive Behavioral Therapy on Patients With Depressive Symptoms and Heart Failure: A Pilot Randomized Controlled Trial

BackgroundDepressive symptoms, and the associated coexistence of symptoms of anxiety and decreased quality of life (QoL), are common in patients with heart failure (HF). However, treatment strategies for depressive symptoms in patients with HF still remain to be established. Internet-based cognitive behavioral therapy (ICBT), as guided self-help CBT programs, has shown good effects in the treatment of depression. Until now, ICBT has not been evaluated in patients with HF with depressive symptoms.ObjectiveThe aims of this study were to (1) evaluate the effect of a 9-week guided ICBT program on depressive symptoms in patients with HF; (2) investigate the effect of the ICBT program on cardiac anxiety and QoL; and (3) assess factors associated with the change in depressive symptoms.MethodsFifty participants were randomized into 2 treatment arms: ICBT or a Web-based moderated discussion forum (DF). The Patient Health Questionnaire-9 was used to measure depressive symptoms, the Cardiac Anxiety Questionnaire (CAQ) was used to measure cardiac-related anxiety, and the Minnesota Living with Heart Failure questionnaire was used to measure QoL. Data were collected at baseline and at follow-up at the end of the 9-week intervention. Intention-to-treat analysis was used, and missing data were imputed by the Expectation-Maximization method. Between-group differences were determined by analysis of covariance with control for baseline score and regression to the mean.ResultsNo significant difference in depressive symptoms between the ICBT and the DF group at the follow-up was found, [F(1,47)=1.63, P=.21] and Cohen´s d=0.26. Secondary within-group analysis of depressive symptoms showed that such symptoms decreased significantly in the ICBT group from baseline to the follow-up (baseline M=10.8, standard deviation [SD]=5.7 vs follow-up M=8.6, SD=4.6, t(24)=2.6, P=.02, Cohen´s d=0.43), whereas in the DF group, there was no significant change (baseline M=10.6, SD=5.0, vs follow-up M=9.8, SD=4.3, t(24)=0.93, P=.36. Cohen´s d=0.18). With regard to CAQ and QoL no significant differences were found between the groups (CAQ [d(1,47)=0.5, P=.48] and QoL [F(1,47)=2.87, P=.09]). In the ICBT group in the CAQ subscale of fear, a significant within-group decrease was shown (baseline M=1.55 vs follow-up M=1.35, P=.04). In the ICBT group, the number of logins to the Web portal correlated significantly with improvement in depressive symptoms (P=.02), whereas higher age (P=.01) and male sex (P=.048) were associated with less change in depressive symptoms. This study is underpowered because of difficulties in the recruitment of patients.ConclusionsGuided ICBT adapted for persons with HF and depressive symptoms was not statistically superior to participation in a Web-based DF. However, within the ICBT group, a statically significant improvement of depressive symptoms was detected.ClinicalTrialClinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01681771","term_id":"NCT01681771"}}NCT01681771; https://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT01681771","term_id":"NCT01681771"}}NCT01681771 (Archived by WebCite at http://www.webcitation.org/6ikzbcuLN)     

高三学生学习压力与学业自我效能感的相关研究

目的了解高三学生学习压力和学业自我效能感现状,分析其原因及相关性。方法采用学业自我效能感量表和学习压力量表对云南省南涧一中2009级高三学生进行学习压力与学业自我效能感的评定。结果 1高三学生学习能力自我效能感存在性别(t=2.764,P=0.007)、班内名次(F=4.390,P=0.003)等统计学差异,学习行为自我效能感无性别(t=-0.009,P=0.993)、班级(t=0.958,P=0.340)、城乡(t=1.183,P=0.239)、班内排名(F=0.842,P=0.502)等统计学差异;215.3%的高三同学认为学习压力非常大,38.7%的同学认为学习压力较大,38.7%的同学认为学习压力一般,3.6%的同学认为没有学习压力,3.6%的同学对学习压力持不确定态度,学习压力无性别(t=-0.343,P=0.732)、城乡(t=0.956,P=0.341)、班内不同名次段(F=1.199,P=0.315)、班级(t=0.384,P=0.702)统计学差异;3学习压力与学习能力自我效能感有统计学意义的负相关(r=-0.340,P=0.000),学习压力与学习行为自我效能感有无统计学意义的正相关(r=0.012,P=0.904);4当学习压力量表评分均分小于2时,学业自我效能感达到最佳水平(学业自我效能感得分M=3.5),班级排名中下的学生学习压力最大(学习压力得分M=3.1)。结论学习压力与学习能力自我效能感有显著负相关,老师、父母在严格要求的同时,应通过正确归因、奖励、情感支持等方式疏导高三学生的学习压力,提高学生的学习能力自我效能感。     

Patient expectations and postoperative depression,anxiety, and psychosocial adjustment after temporal lobectomy: A prospective study

This study examined the effects of patient expectations on short-term postoperative psychological adjustment after surgery Tor epilepsy. Twenty-seven subjects (17 operative, 10 nonoperative controls) agreed to participate. A prospective longitudinal design assessed whether changes in psychosocial functioning had occurred at a mean of 7 weeks after surgery relative to the presurgical assessment. The study also examined the relation between postoperative psychosocial adjustment and preoperative patient expectations. It was found that seizure-free outcomes were associated with significant declines in depression and anxiety. Patients who exhibited preoperative optimistic expectations had lower levels of postoperative depression and anxiety, as long as they were rendered seizure-free. Conversely, those who had optimistic preoperative expectations but were not rendered seizure-free postsurgically continued to exhibit moderate to high levels of depression and anxiety. The theoretical significance of optimistic expectations and their effects on individual self-efficacy arc discussed to support the notion that postsurgical adjustment is related to personal coping, even in those patients who are seizure free after surgery.     

Parents of Children with Cancer: A Longitudinal Study of Emotional Distress, Coping Style, and Marital Adjustment Two and Twenty Months After Diagnosis

Evaluated emotional distress, coping style, and marital adjustmentin 84 parents (42 couples) of children with cancer 2 monthsafter diagnosis and again about 20 months after diagnosis. Asexpected, mothers' mean state anxiety and trait anxiety scoresdecreased to near normal levels over time. Fathers' scores werelower initially and did not change. Neither mothers' nor fathers'mean marital adjustment scores changed over time. Marital adjustmentat treatment follow-up was predicted by depression and the spouse'smarital satisfaction in mothers, and depression, child healthstatus, and spouse's marital satisfaction in fathers. In contrastto findings obtained 2 months after diagnosis, coping stylewas not related to marital adjustment at follow-up. Resultsare discussed in terms of possible gender differences in therole of social support in marital adjustment and the stabilityversus situational specificity of coping styles.     

Distress tolerance and symptoms of depression: A review and integration of literatures

Distress tolerance has emerged as a transdiagnostic risk factor for psychopathology but has received little theoretical attention in the depression literature. Evidence strongly suggests that individuals who have trouble tolerating distress display greater symptoms of depression, however. The lack of overlap between literatures is an important oversight, as the depression literature provides unique perspectives that have yet to be addressed in the distress tolerance literature. The current review thus (1) integrates findings from different literatures on distress tolerance and symptoms of depression, (2) discusses how this synthesis can inform clinical science and burgeoning distress tolerance treatments, (3) outlines important gaps in the distress tolerance and depression literatures, and (4) describes how they may be addressed by incorporating recent theoretical advances.