The cognitive side of anxiety

Building from a differentiation of the dimensions of cognition (prepostions/content, operations, products, structures), a cognitive component model of anxiety is proposed and described. The model consists of the critical psychopathological features, common psychopathological features, and error variance. Cognitive distortions are differentiated from cognitive deficiencies. Specific critical features, such as schematic content and functioning, temporal distortions, and task-irrelevant thought, are described and are considered aspects of cognitive functioning relatively specific to anxiety. Common features, such as self-absorption, automatic processing, capacity limitations, and cognitive asymmetry, are also described but are considered aspects of dysfunctional cognition associated with anxiety as well as some other related psychopathologies. Questions requiring additional research are noted.The order of the authors was randomly determined. Appreciation is expressed to David Barlow for his helpful comments on this paper.     

Group cognitive/anxiety management

A report on recent clinical work in group anxiety management was carried out by nurse therapists whilst undertaking the Joint Board of Clinical Nursing Studies Course 650, Adult Behavioural Psychotherapy (Short Term) in the Plymouth area, England. The group treatments described were based upon a three systems model of anxiety, and aimed to modify cognitive, behavioural and physiological deficits and excesses. The methods used and some collation of measures is shown, followed by discussion of the difficulties encountered. This discussion will relate to: the uses of measures; style of presentation of material, particularly in relation to cognitive change; and adaptability and scope of such groups.     

聚焦解决模式对白内障手术患者焦虑水平的影响

目的探讨聚焦解决模式对白内障手术患者焦虑水平的影响。方法2016年11月至2017年4月选取河南省人民医院日间病房就诊的白内障手术患者100例,按照随机数字表分为干预组和对照组,各50例。对照组实施白内障常规护理,干预组在对照组的基础上于术前1 d、术日早晨、术后1 w应用聚焦解决模式对患者进行心理指导。比较两组患者不同时间段焦虑水平差异。结果两组患者术前焦虑水平比较差异无统计学意义(P>0.05),术日早晨、术后1 w两组患者在焦虑值比较,差异均有统计学意义(均P<0.05)。结论聚焦解决模式有助于缓解白内障手术患者焦虑水平。     

抑郁和焦虑与老年认知障碍患者认知水平的相关性分析

目的：探讨老年认知障碍患者抑郁和焦虑评估的临床价值，分析老年认知功能减退的可能影响因素。方法：筛选2019年6月至2021年11月期间在复旦大学附属华山医院老年医学科门诊就诊的可疑认知障碍老年人群，检测其认知水平、抑郁和焦虑评分及相关生化指标。按照认知水平分为3组：非认知障碍组、轻度认知障碍组（MCI）及痴呆组。完成认知水平测试（MMSE+MoCA)及焦虑和抑郁评估（PHQ-9+GAD-7），同时完成甲状腺功能、梅毒/艾滋病血清标志物、血同型半胱氨酸（HCY）、叶酸、维生素B12、自身免疫性脑炎抗体等血液生化学检查及尿液阿尔兹海默相关神经丝蛋白（AD7c-NTP）检测。结果：共入组242例可疑老年认知障碍患者，其中非认知障碍组37例，MCI组62例，痴呆组143例，三组人群抑郁检出人数分别为12例（32.4%）、30例（48.4%）和82例(57.3%)，焦虑检出人数分别为10例(27.0%)、24例（38.7%）和72例（50.3%），非认知障碍组和痴呆组之间具有显著差异；三组人群之间甲状腺功能、梅毒/艾滋病血清标志物、自身免疫性脑炎抗体异常率均无明显差异；三组人群之间HCY、叶酸、AD7c-NTP异常率具有显著性差异，但维生素B12异常率无显著性差异；多元Logistics回归分析显示，与非认知障碍组比较，MCI组与年龄和GAD-7评分呈正相关；痴呆组与年龄、HCY水平、PHQ-9和GAD-7评分等危险因素之间存在正相关；痴呆组与MCI组比较，GAD-7评分明显增高(p＜0.05)，而两组年龄、HCY、叶酸和PHQ-9评分之间无明显差异。结论：老年认知障碍患者易伴抑郁、焦虑等不良情绪，抑郁和焦虑情绪与年龄、认知功能及HCY和叶酸水平之间存在一定相关性。以上研究提示门诊接诊可疑老年认知障碍患者时，有必要对患者进行认知功能评估的同时完善抑郁和焦虑评估。     

看图对话教育模式对首诊糖尿病患者认知及焦虑的影响

目的探讨看图对话教育模式对首诊糖尿病患者认知及焦虑的影响。方法将2011年6月至2013年6月入住我院内分泌科的154例首诊为2型糖尿病的患者按入院先后顺序分为两组,对照组（n=78）采用传统健康教育模式进行健康教育,观察组（n=76）采用看图对话教育模式进行健康教育,比较两组患者对糖尿病知识的认识及焦虑变化情况。结果观察组对糖尿病知识的认知评分高于对照组,焦虑评分低于对照组,差异有统计学意义（P〈0．05）。结论看图对话教育模式在提高首诊糖尿病患者对糖尿病知识的认识,降低糖尿病患者的负性情绪方面较传统健康教育模式更有优势。     

Trait anxiety and children's state anxiety,cognitive behaviors,and performance under stress

Sixty-seven fourth-grade children anticipated and then performed a mathematics task in either a high or a low stress condition. While the children anticipated performing the task, measures of seven cognitive behaviors were obtained by means of both a Think Aloud procedure and a questionnaire. Measures of trait and state anxiety and task performance were also obtained. Trait anxiety was found to be related to state anxiety and the cognitive behaviors of preoccupation, and for females, justification of positive attitude. The performance of high but not low trait-anxious children was found to be affected by levels of stress. This finding aids in reconciling discrepancies in previous research concerning children's trait anxiety and performance.The authors wish to thank Verlin Gilbert, principal of Deerfield School, and John Lowther, principal of Broken Arrow School, Lawrence, Kansas, for their generous assistance with this project.     

艾司西酞普兰联合认知疗法治疗广泛性焦虑障碍对照研究

目的：探讨艾司西酞普兰联合认知疗法治疗广泛性焦虑障碍的临床疗效和安全性。方法将60例广泛性焦虑障碍患者随机分为两组,每组30例,均口服艾司西酞普兰治疗,研究组在此基础上联合认知疗法治疗,观察8周。于治疗前后采用汉密顿焦虑量表、临床疗效总评量表中疗效总评量表评定临床疗效。结果治疗2周末起两组汉密顿焦虑量表、临床疗效总评量表中疗效总评量表评分均较治疗前显著降低（P＜0．01）,研究组显著低于对照组（P＜0．01）。两组不良反应发生率比较差异无显著性（P＞0．05）。结论艾司西酞普兰联合认知疗法治疗广泛性焦虑障碍疗效显著,优于单用艾司西酞普兰治疗。     

A cognitive learning model of clinical nursing leadership

Cognitive modeling of competencies is important to facilitate learning and evaluation. Clinical nursing leadership is considered a competency, as it is a "complex know-act" that students and nurses develop for the quality of care of patients and their families. Previous research on clinical leadership describes the attributes and characteristics of leaders and leadership, but, to our knowledge, a cognitive learning model (CLM) has yet to be developed. The purpose of our research was to develop a CLM of the clinical nursing leadership competency, from the beginning of a nursing program to expertise. An interpretative phenomenological study design was used 1) to document the experience of learning and practicing clinical leadership, and 2) to identify critical-learning turning points. Data was gathered from interviews with 32 baccalaureate students and 21 nurses from two clinical settings. An inductive analysis of data was conducted to determine the learning stages experienced: awareness of clinical leadership in nursing; integration of clinical leadership in actions; active leadership with patient/family; active leadership with the team; and, embedded clinical leadership extended to organizational level and beyond. The resulting CLM could have significant impact on both basic and continuing nursing education.     

The role of cognitive mediators in heterosocial anxiety: A test of self-efficacy theory

The present study examined the ability of the self-efficacy construct to account for motoric, self-report, and physiological responses evidenced in the treatment of a clinically prevalent fear, and the accuracy of the theory in predicting generalization effects and perseverance when confronted with obstacles and aversive events. Prior to and immediately after treatment, heterosocially anxious males completed ratings of efficacy expectations and several self-report inventories, and participated in a role-play assessment that provided estimates of motoric and physiological responses to simulated heterosocial encounters. Perceived efficacy was found to be a sensitive indicator of self-reports of anxiety, of motoric performance on targeted and generalization tasks, and of the degree of coping behavior displayed in the face of mildly aversive stimuli. Contrary to the theoretical contentions, no correspondence was obtained between performance change and fluctuations in efficacy strength from pre- to posttreatment assessments, nor was any systematic relationship detected between efficacy and arousal. Problematic features associated with conducting adequate tests of the validity of certain predictions espoused by self-efficacy theory are discussed.     

Trait anxiety and Children's cognitive behaviors in an evaluative situation

The study was conducted to investigate the cognitive behaviors of high and low trait-anxious children under stress. Six categories of cognitive behavior were inferred from a Think Aloud procedure that took place while 30 4th-grade children anticipated taking an important arithmetic test. The children's trait anxiety scores from Spielberger's State-Trait Anxiety Inventory for Children were found to be related to the extent to which the children responded to the stressful situation with the cognitive behaviors of preoccupation, justification of positive attitude, and derogation of other. These results parallel those found with adults and suggest that there is a continuity from at least elementary school years to adulthood in some of the cognitive behaviors exhibited by high and low trait-anxious individuals under stress. Only a longitudinal study, however, can fully assess this notion. The Think Aloud procedure for assessing children's cognitive behaviors was found to have considerable utility.     

The rapid resolution of depression and anxiety symptoms after lower limb amputation

OBJECTIVE: To ascertain the course of depressive and anxiety symptoms shortly after amputation and again after a period of inpatient rehabilitation. DESIGN AND SETTINGS: A cohort study in inpatients admitted to a rehabilitation ward after lower limb amputation. SUBJECTS: One hundred and five successive admissions over a one-year period. INTERVENTIONS: Nil. MAIN MEASURES: Hospital Anxiety and Depression Scale (HADS) on admission and discharge with correlation to demographic and patient features. RESULTS: At admission, 28 (26.7%) and 26 (24.8%) patients had symptoms of depression and anxiety respectively. This dropped to 4 (3.8%) and 5 (4.8%) by time of discharge, a mean of 54.3 days later. These reductions were statistically significant, as was the association between patients having symptoms of both depression and anxiety (P < 0.001). Patient stay was longer in those with symptoms (depression, P < 0.03; anxiety P < 0.001). There was no association with level of amputation, success of limb-fitting, age or gender. Depressive symptoms were associated with presence of other medical conditions (P < 0.01) and anxiety scores with living in isolation (P < 0.05). CONCLUSION: Depression and anxiety are commonly reported after lower limb amputation and previously thought to remain high for up to 10 years. We have found that levels of both depression and anxiety resolve rapidly. It is possible that a period of rehabilitation teaching new skills and improving patient independence and mobility may modify the previous bleak outlook of amputees. This positive finding may be useful in the rehabilitation of even the most distressed of amputees.     

A functional model of cognitive rehabilitation in occupational therapy

Persons who sustain cerebral injuries often have cognitive impairments. Occupational therapists are active in providing cognitive rehabilitation that aims to minimize the effects of cognitive deficits in their clients' lives. This paper presents a brief review of the literature in the area of cognitive rehabilitation including major characteristics of existing occupational therapy models related to the treatment of people who need cognitive rehabilitation. A model of cognitive rehabilitation is proposed that emphasizes functional components of occupational therapy in different rehabilitation settings. This model, called the Functional Model of Cognitive Rehabilitation, supports the use of activities in naturalistic settings in treatment, in order to enable those with cognitive impairments to fulfill their occupational roles.     

重症抑郁症病人认知功能与焦虑的关系

目的 :探讨重症抑郁症病人的认知功能性失调与焦虑障碍的关系。方法 :对24例伴有严重焦虑障碍和21例不伴有严重焦虑障碍的重症抑郁症病人在入院治疗前及常规药物治疗后 ,分别同时应用功能失调状况评定量表“DAS”、HAMD抑郁量表及Beck抑郁自评量表“BDI”进行测评与对照研究。结果 :常规药物治疗后两组患者抑郁症状严重程度(HAMD总分)明显减轻或消失 ,疗效显著(P<0.01)。但是认知功能改善存在较大差异。不伴焦虑的抑郁症在药物治疗后其认知障碍的严重程度随着抑郁症状的减少也明显减轻 ,而伴有焦虑的抑郁症病人在药物治疗后 ,尽管抑郁症状已明显减少或消失 ,但其认知障碍依然存在。结论 :伴有焦虑的抑郁症病人 ,认知障碍更突出、顽固。因而在治疗过程中 ,必须将药物和认知行为治疗相结合 ,这样才能获得长期的疗效并能预防复发。     

认知行为治疗对脑卒中病人抑郁及焦虑的影响

脑卒中是由急性脑血管循环障碍引起的持续性大脑半球或脑干局灶性神经功能缺陷,不仅导致病人运动、感觉、语言功能的障碍,而且对病人的心理也有较大的损害。患病后病人对生活无兴趣、厌烦、抑郁、伤感、焦虑不安,这些不良心理反应影响疾病的康复,严重者可引起脑血管病的再发甚至死亡。多数研究认为抑郁与认知功能有关,认知行为治疗产生于20世纪     

A conceptual model of children''s cognitive adaptation to physical disability

Increasing numbers of children are being required to adapt to lifelong illness and disability. While numerous studies exist on theories of adaptation, reaction to illness, and children's concepts of self and of illness, an integrated view of children's ability to conceptualize themselves, their disabilities and possible adaptations has not been formulated. In this article an attempt has been made to integrate models of adaptation to disability and knowledge about children's cognitive development using Piagetian theory of cognitive development and Crate's stages of adaptation to chronic illness. This conceptually integrated model can be used as a departure point for studies to validate the applicability of Piaget's theory to the development of the physically disabled child and to clinically assess the adaptational stages available to the child at various developmental stages.     

认知治疗对广泛性焦虑症患者疗效分析

目的观察认知治疗对广泛性焦虑症患者的临床疗效。方法将60例广泛性焦虑症患者随机分为治疗组和对照组各30例,两组均给予抗焦虑药物治疗,治疗组联合认知治疗。分别于治疗前及治疗第2w、第6w末采用汉密顿焦虑量表及副反应量表评定疗效及不良反应。结果治疗后两组患者的汉密顿焦虑量表总分、精神焦虑分及躯体焦虑分较治疗前显著降低（P〈0．05或0．01）;治疗6w末治疗组汉密顿焦虑量表总分及躯体焦虑分较对照显著降低（P〈0．05,显效率显著高于对照组,且不良反应较少。结论认知治疗可以提高广泛性焦虑症患者的临床疗效。