The analysis and interpretation of cognitive interviews for instrument development

Cognitive interviews assess respondents' understanding of questionnaire items and are increasingly used to improve instrument design. Although investigators have described the contributions of cognitive interviews for instrument development, few guidelines are available for analyzing data from cognitive interviews when they are used for that purpose. In this article we address the development and application of analytic strategies for summarizing, interpreting, and using data from cognitive interviews that were conducted during the process of creating a measure of parental management of childhood chronic conditions. We discuss the contribution of cognitive interviews to establishing content validity and address the importance of developing standardized guidelines for analyzing and interpreting cognitive interviews in order to maximize their usefulness for instrument development.     

Dimensions of cognitive therapy for depression: A confirmatory analysis of session ratings

Two previous studies of the dimensionality of cognitive therapy (CBT) have arrived at different structures. While one study found separate behavioral and cognitive components, the other found two different cognitive components, concrete and abstract. The main aim of the present study was to test whether either of these structures could be replicated. Ratings were made of therapist behaviors in 112 sessions of treatment using two subscales from the Collaborative Study Psychotherapy Rating Scale (CSPRS). Two principal components were extracted from the intercorrelations of the items of the cognitive therapy subscale and rotated to maximum congruence with targets based on the previous solutions. The significance of the fit was evaluated by rotating the same matrix of loadings to 5,000 random permutations of each target. The fit to the model consisting of behavioral and cognitive components was highly significant but the model with two kinds of cognitive component could not be confirmed. An additional exploratory analysis, which included the Facilitative Conditions subscale of the CSPRS, revealed a third component reflecting collaborative structure. The identification of a replicable structure is offered as an aid to the discovery of the crucial ingredients of CBT.We should like to express our appreciation to the raters Steve Bamford, Mike Osborn, Samantha Jones, Joanna Teuton, Kim Morsley, Cailzie Dunn, Rema Laver, and Louise Hall for their dedicated work throughout this study, and to the therapists Michael Barkham, Gillian Hardy, and Shirley Reynolds. We are grateful to John Reddon for providing a copy of his program PROCRUS. We should also like to thank Bill Stiles, Clara Hill and Kevin O'Grady for discussions of sampling and statistical analysis.     

A sadly neglected cognitive element in depression

The models of depression hypothesized by leading cognitive-behavioral theorists—especially those of Beck, Lewinsohn, Rehm, and Seligman—are analyzed and it is shown that they probably explain how people make themselves appropriately sad, regretful, disappointed, and annoyed when they suffer major losses and inconveniences. These models, however, do not explain why many people with similar losses and inconveniences also make themselves inappropriately depressed and self-hating. It is hypothesized that the rational-emotive therapy (RET) model of depression has a crucial cognitive and philosophic element—the inclusion of absolutistic, dogmatic shoulds, oughts, and musts—that differentiates people's appropriate feelings of sadness from their inappropriate feelings of depression, and that therefore appreciably adds to our understanding of the causative factors in depression. This neglected theory of depression is examined and discussed.     

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.     

计算机认知功能训练联合脑循环治疗对社区老年轻度认知功能障碍的疗效观察

目的:分析计算机认知功能训练联合脑循环治疗对社区老年轻度认知障碍的疗效。方法:选取在上海市宝山区淞南镇社区卫生服务中心体检或就诊的120例老年轻度认知功能障碍患者(脱落7例),用随机数字表法将患者分为4组。对照组(T0组,30例)给予健康宣教及危险因素控制干预,治疗组分为3组(T1组28例、T2组27例、T3组28例),在T0组干预基础上,分别采用计算机认知功能训练、脑循环治疗、计算机认知功能训练联合脑循环治疗,12周后比较各组治疗前后认知功能变化。结果:治疗后,T1、T2、T3组蒙特利尔认知评估量表(MoCA)总分明显高于T0组及治疗前(P<0.05),其中T3组MoCA总分、计算及延迟回忆评分明显高于T1、T2组(P<0.05);T1、T2、T3组日常生活能力评定量表(ADL)、工具性日常生活能力量表(IADL)评分较治疗前及T0组明显降低(P<0.05),T3组ADL、IADL评分均低于其他治疗组(P<0.05)。结论:计算机认知功能训练联合脑循环治疗能有效改善社区老年轻度认知功能障碍,提高患者生活质量。     

认知护理对老年患者全身麻醉术后认知障碍的影响

目的：观察认知护理疗法对老年全身麻醉手术患者术后认知功能障碍的影响。方法：将60例老年手术患者随机分为对照组和治疗组分别采用单纯药物治疗和联合认知护理疗法，并用MMSE和HDS评价术后认知功能障碍的发生情况。结果：术后3d、7d，两组患者MMSE评分和HDS评分均有不同程度的降低（P＜0．01）；但对照组下降更明显，两组MMSE评分和HDS评分有显著性差异（P＜0．05）。结论：认知护理疗法能减少老年全身麻醉手术患者术后认知功能障碍的发生。     

Clients' perceptions of therapeutic helpfulness in cognitive and marital therapy for depression

Twenty women who received marital therapy and 11 women who received cognitive therapy for co-occurring depression and marital discord reported the most helpful aspects of therapy. The verbatim responses of clients were coded into 12 response categories, and the responses of clients in the two therapies were compared to assess whether they reported similar or different therapy factors as most helpful. Clients who received marital therapy reported that the most helpful aspects of therapy were relationship-focused or interpersonal, while clients who received cognitive therapy reported that the most helpful elements were intrapersonal. The client reports are discussed in relation to independent ratings of therapist behavior and the intended impact of the treatments.This research was supported in part by NIMH grant MH 38390. We thank Lawrence P. Riso for his aid in category assignment and Michele Cascardi, Jennifer Christian, and Lloyd Goldsamt for their judgments of therapist behaviors. Dr. Steven Beach and Dr. Evelyn Sandeen coordinated various aspects of the overall research project from which these data were obtained. We are grateful to Susan O'Leary for her editorial feedback.     

以倾听技巧为基础的认知疗法对脑出血患者心境状态及认知功能的干预效果

目的 探究以倾听技巧为基础的认知疗法对脑出血患者心境状态及认知功能的干预效果。方法 选取我院2017年5月～2019年1月脑出血患者92例,依据建档顺序分组,各46例。对照组采取常规护理,研究组在对照组基础上给予以倾听技巧为基础的认知疗法。比较两组健康知识掌握程度、心境状态[焦虑(SAS)、抑郁(SDS)]评分、认知功能(MMSE)评分、应对方式(MCMQ)评分及护理服务满意度。结果 经Ridit检验可知,研究组健康知识掌握程度优于对照组(P＜0.05);出院后3个月,研究组SAS、SDS评分低于对照组(P＜0.05);研究组出院后3个月MMSE评分高于对照组,MCMQ量表中屈服、回避评分低于对照组,面对评分高于对照组(P＜0.05);研究组护理服务满意度93.48%高于对照组73.91%(P＜0.05)。结论 以倾听技巧为基础的认知疗法应用于脑出血患者可显著强化健康知识掌握情况,改善心境状态与认知功能,还可调节应对方式,提高护理服务满意度。     

Group cognitive behavioural therapy for schizophrenia: a systematic review of the literature

There are a growing number of studies which have evaluated group-based cognitive behavioural therapy (CBGT) for individuals with psychosis. This is at least partly driven by the need to maximize access to this evidence-based treatment which has still to be widely disseminated. In this paper we present a systematic review of trials which have evaluated the efficacy CBGT. Five controlled trials were identified, the results showed some improvements in specific areas of symptomatology such as social phobia and depression. However, methodological weaknesses of the studies compromised the confidence with which a cause and effect relationship can be established. CBGT may enable a greater number of individuals to be seen by a small group of trained therapists but whether this is an effective treatment remains to be established. In addition, whether therapists delivering cognitive behavioural therapy in a group format require a higher level of skill than those facilitating the intervention on an individual basis remains an empirical question. The finding that a short psycho-education group treatment reduced positive and negative symptoms is also worthy of further investigation given the difficulties reported in disseminating evidence-based psychosocial interventions for this client group.     

Can computerized cognitive training reverse the diagnosis of HIV‐associated neurocognitive disorder? A research protocol

Nearly 50% of adults with HIV have some form of HIV‐associated neurocognitive disorder (HAND), ranging from subtle to symptoms that interfere with everyday functioning and quality of life. HAND is diagnosed when a person performs more than 1 standard deviation below his or her normative mean on standardized measures in two or more cognitive domains (e.g., attention, speed of processing, verbal memory, executive functioning). As adults age with HIV, they are more likely to develop comorbidities such as cardiovascular disease, hypertension, and insulin resistance that may further contribute to poorer cognitive functioning and HAND. Certain computerized cognitive training programs may be able to improve specific cognitive domains in those with HIV. Such programs may be effective in changing the diagnosis of HAND in cognitively vulnerable adults. In this article, we describe the design and methods of TOPS—the Training On Purpose Study. In this on‐going experimental study, 146 older adults (50+) with HAND are randomized to either: (i) an Individualized‐Targeted Cognitive Training group, or (ii) a no‐contact control group. This study targets those cognitive domains in which participants experience a deficit and trains participants with the corresponding computerized cognitive training program for that domain. An Individualized Targeted Cognitive Training approach using cognitive‐domain‐specific cognitive training programs may offer symptom relief to those individuals diagnosed with HAND, which may actually reverse this diagnosis. Given that these cognitive training programs are commercially available, this approach represents a potential paradigm shift in how HAND is considered and treated.     

The use of cognitive behavioural therapy with people with schizophrenia

• ? The role of cognition as one aspect of the stress-vulnerability model of schizophrenia is discussed, and the use of cognitive therapy reviewed.
• ? A holistic approach to the development of schizophrenia is explored.
• ? The stress vulnerability model is explained and the way in which individuals suffering from schizophrenia are vulnerable to attentional, perceptual and cognitive difficulties, are discussed.
• ? Using case examples, it is demonstrated that the use of cognitive behavioural techniques can be used by nurses to effectively reduce client problems associated with schizophrenia.

     

认知行为治疗在癌痛病人心理支持中的应用

[目的]探讨认知行为治疗在癌痛病人心理支持中的应用。[方法]对56例癌病病人通过换位思考法、教育引导法、医患互信法进行有针对性的认知行为治疗。[结果]经认知行为治疗，56例病人止痛有效率达96％，止痛效果和生活质量得到提高。[结论]认知行为治疗可消除癌痛病人的负性情绪，提高病人的止痛效果和生活质量。     

计算机辅助认知功能训练对脑卒中后认知功能障碍患者血清神经功能相关指标及生活能力的影响

目的：探讨计算机辅助认知功能训练（CACR）对脑卒中后认知功能障碍患者血清神经功能相关指标及生活能力的影响。方法：将80例脑卒中后认知功能障碍患者随机划分入对照组和观察组各40例,所有患者均接受常规治疗,在此基础上对照组实施作业疗法,观察组在对照组基础上开展CACR。于干预前、干预3个月后对2组采用简易精神状态评价量表（MMSE）评定认知功能,采用改良Barthel指数（MBI）评定生活能力,并检测2组血清视锥蛋白样蛋白-1（VILIP-1）、胶质纤维酸性蛋白（GFAP）、神经元特异性烯醇化酶（NSE）水平。结果：干预后,2组MMSE、MBI评分和干预前相比均明显增高（P＜0.05）,且观察组均明显高于照组（P＜0.05）;干预后2组血清视锥蛋白样蛋白-1（VILIP-1）、胶质纤维酸性蛋白（GFAP）、神经元特异性烯醇化酶（NSE）水平和干预前相比均明显降低（P＜0.05）,且观察组均明显低于对照组（P＜0.05）。结论：对脑卒中后认知障碍患者实施CACR结合作业疗法干预,可有效下调血清VILIP-1、GFAP、NSE表达,明显改善患者认知功能,显著提高生活能力。     

Application of the cognitive therapy model to initial crisis assessment

This article provides a background to the development of cognitive therapy and cognitive therapeutic skills with a specific focus on the treatment of a depressive episode. It discusses the utility of cognitive therapeutic strategies to the model of crisis theory and initial crisis assessment currently used by the Community Assessment & Treatment Team of Waitemata District Health Board on the North Shore of Auckland, New Zealand. A brief background to cognitive therapy is provided, followed by a comprehensive example of the use of the Socratic questioning method in guiding collaborative assessment and treatment of suicidality by nurses during the initial crisis assessment.     

舍曲林联合认知行为疗法对抑郁症患者认知功能的影响

目的 探讨舍曲林联合认知行为疗法对抑郁症患者认知功能的影响.方法 将60例抑郁症患者按照随机数字表法分为研究组与对照组,各30例.两组均给予舍曲林治疗,研究组联合认知行为疗法治疗,观察治疗全程.干预前后采用抑郁自评量表及汉密顿抑郁量表评定两组的抑郁状况,采用威斯康星卡片分类测验评定患者的执行功能.结果 干预后两组抑郁自...     

怀旧治疗对老年轻度认知障碍患者认知功能的影响

目的探讨怀旧治疗对老年轻度认知障碍（MCI）患者认知功能的影响。方法选取40例老年MCI患者随机分为实验组20例和对照组20例,对照组给予常规护理,实验组在此基础上进行为期4个月的怀旧治疗干预,用简易智能状态检查量表（MMSE）、蒙特利尔认知评估量表（MOCA）、日常生活能力评分量表（ADL）评价干预效果。结果4个月后,实验组和对照组MMSE、MOCA、ADL评分比较差异均有统计学意义（P〈0．05）;对照组3项评分与干预前比较,差异无统计学意义（P〉0．05）;实验组MOCA、ADL评分均优于干预前,差异有统计学意义（P〈0．05）,MMSE评分与干预前比较,差异无统计学意义（P〉0．05）。结论怀旧治疗能改善老年MCI患者的认知功能。     

Determinants of change in cognitive therapy for depression

We explored the processes of change in cognitive therapy of depression in a sample of 25 adult outpatients. Raters blind to treatment outcome listened to audiotapes of sessions and rated items that pertained to (a) the therapist-offered facilitative conditions (warmth, empathy, etc.); (b) the patient—therapist relationship (the helping alliance); and (c) the therapist's adherence to the methods of cognitive therapy. Adherence separated into two factors in a factor analysis. One factor, representing concrete, symptom-focused methods of cognitive therapy, predicted subsequent symptom reduction when assessed early in treatment, but not later. The other factor, representing less focused, more abstract discussions, did not predict improvement. Neither did facilitative conditions nor the helping alliance predict change that occurred after the rated session. However, later in treatment, the helping alliance was predicted by prior symptom reduction. Methods used to discern the temporal relations of in-session behavior to outcome are highlighted.We wish to thank Aaron T. Beck and the therapists, staff, and patients at the Center for Cognitive Therapy, without whose cooperation this project would not have been possible.Portions of this paper were presented at the 21st Annual AABT Convention, Boston, November 1987, and at the 19th annual meeting of the Society for Psychotherapy Research, Santa Fe, New Mexico, June 1988.This research was supported in part by a grant from the Biomedical Research Foundation of the University of Pennsylvania, and by the Foundation for Cognitive Therapy and Research.     

Factors associated with changing cognitive function in older adults: implications for nursing rehabilitation.

This article reviews the significant effects of aging on cognitive function. As people age, brain tissue volume decreases, white matter hyperintensities increase, and associated deficits are seen in working memory, attention, and executive function. Comorbidities include hypertension, diabetes, and cardiovascular risk factors. Another factor that affects cognitive function is the presence of apolipoprotein E-4, which is negatively correlated with cognitive function. In addition, decreased serum levels of endogenous sex hormones are related to changes in cognitive function, but hormone replacement therapy may be detrimental. Improved cognition has been associated with moderate alcohol intake, regular exercise, and exposure to novel stimuli. This article also examines research evaluating brain-plasticity-based training and rehabilitation to reverse losses in sensory, cognitive, and motor processing. Rehabilitation nursing strategies for dealing with the decline of cognitive function include educating patients and developing a program about lifestyle changes that will enhance cognitive stimulation; minimizing risks for and effects of hypertension, diabetes, and cardiovascular disease; recognizing and accommodating sensory deficits; and maintaining awareness of current research outcomes to guide evidence-based practice.