社交焦虑障碍“团体实证认知行为疗法”的构建

本研究拟在传统社交焦虑障碍团体认知行为疗法的基础上构建新治疗模式——"团体实证认知行为疗法(Empirical Group Cognitive-Behavioral Therapy,EGCBT)",模式鼓励来访者以科学研究的方式深入调研治疗关系以外"第三方"他人对社交焦虑相关问题的观念,进行认知取证,同时强调来访者对自我"正面和负面评价恐惧"内容进行实证检验。"团体实证认知行为疗法"注重利用"第三方"视角的真实信息为社交焦虑个体认知合理化提供更客观的依据,在传统认知行为治疗的基础上丰富实证模块及增强治疗模块间的递进关系。     

心理创伤者的叙事疗法治疗个案报告

受到后现代主义、社会建构主义和结构主义叙事论影响的心理治疗学[1],在1980年Michael White和David Epston编写的《故事、知识、权力—叙事治疗的力量》出版后,诞生了一种新的治疗方法—叙事疗法[2],即倾听来访者的问题故事,从中找出其"闪光事件",以唤醒被封存的内在积极力量,重构人生故事,促使认知改变[3].叙事疗法要先对充满"问题"的故事叙说(串联"主线故事"),再利用问题外化和解构,将问题与人分离,使故事"由薄到厚",同时挖掘"闪光事件",最后重构一个积极有力量的故事[4].叙事疗法可用于不同年龄的个体,并适用于由现实生活事件所引起的如受虐经历、暴力事件、婚姻冲突及创伤后应激障碍的治疗[5].本文通过1例因儿童期受虐及生活事件所致心理创伤者的治疗,探讨叙事疗法在特殊情景下的应用技术和治疗效果.     

行为疗法治疗精神分裂症个案的过程分析:语言反应模式角度

目的:关注行为疗法治疗精神分裂症患者过程中治疗师和来访者的言语行为,来探讨(1)行为治疗过程中,参与者双方语言反应模式的类别及其变化;(2)治疗师何种语言反应模式能引起来访者的认知-情感探索,初步从言语行为层面来探索来访者如何形成并维持新的行为模式。方法:本研究为观察性研究。采用立意抽样法获取一例精神分裂症来访者的行为治疗过程的视频音频资料,将其整理为会谈脚本,使用定性分析与定量分析结合的方法来研究该案例行为治疗的过程。结果:本案例行为治疗过程中,治疗师运用较多的解释、反映、建议和确认等语言反应模式,而来访者则运用较多的揭露、承认等语言反应模式。治疗师探索式反映的语言反应模式,能够较多地引起来访者的认知-行为探索和情感探索。结论:在本案例行为治疗的不同时期,治疗师和来访者语言反应模式的主要类别不同,在言语行为层面,治疗师探索式反映的语言反应模式能较多地引起来访者的认知-情感探索,提高其治疗参与度,有利于来访者形成并维持新的行为模式。但来访者的治疗性改变究竟是如何产生的,尚需进一步的研究。     

可能性区域技术——坦然面对糟糕可能,争取最好结果

认知疗法不给来访者讲大道理,也不是教给他正确的思想。认知疗法是让来访者学会正确的认知方式。认知治疗中的许多认知技术就是教会来访者正确的认知方式。一旦来访者掌握这些技术,他的认知观念就改变了;观念改变了,情绪和行为也就相应改善了。从本期开始我们邀请认知行为疗法专家郭召良博士以连载的形式介绍30种认知治疗技术。有兴趣的同行可以关注。     

社交恐惧严重心理问题咨询报告一例

本案例介绍了运用认知行为治疗对一例社交恐惧严重心理问题学生进行心理咨询的过程。该来访者的父母严苛的教养方式,负性生活事件和不合理的信念及应对方式与其社交恐惧有较大的关系。在建立良好咨询关系的基础上,运用认知行为治疗的行为技术和认知技术帮助来访者改善适用不良的不合理认知和行为,从而改善来访者的恐惧情绪和回避社交行为,取得了较好的咨询效果。     

选择不同收费水平的来访者的咨询效能与咨询满意

根据Strong提出的社会影响力理论(social influ ence theory),心理咨询是一个人际影响力的过程,只有当来访者认为咨询师具有专业性和吸引力并值得依赖时,才会在咨询过程中产生咨询效能[1].已有研究发现,咨询师的收费高低可能会影响来访者对其咨询效能的知觉[2-3],不过与来访者的咨询满意之间似乎没有直接的关系[4].本研究以来访者的角度为出发点,检验这些选择不同收费水平的来访者对咨询师的咨询效能的知觉及和咨询满意之间的差异.     

认知行为疗法“和而不同 兼收并蓄”之案例研究——以家庭与叙事心理治疗为视角

<正>本文通过案例分析从家庭和叙事心理治疗视角探讨认知行为疗法"和而不同兼收并蓄"性。在以认知行为疗法对来访者的认知、情绪、行为等问题进行咨询过程中,结合家庭和叙事心理治疗的理念和技巧对来访者的中间信念和核心信念进行工作,最终来访者发展出适应性的核心信念和中间信念,情绪明显好转,人际关系得到改善,其症状及总体功能均有明显改善,咨询达到了预期目标。1问题的提出20世纪60年代初,时任宾夕法尼亚大学精神病学助理教授的医学博士阿伦·贝克发展出认知行为疗法(CBT,以下同),这是心理健康领域里的一场革命。从20世纪80年代起     

催眠状态下认知行为疗法的案例分析

<正>认知行为疗法(CBT)是一种通过系统的程序达到一系列的目标的改善不良情感,适应不良行为和认知内容的心理治疗方法。它的主要着眼点放在来访者的不合理的认知问题上,而不仅仅是问题本身,通过患者自己改变自己对事情的认知来达到治疗的目的~([1])。CBT疗法的核心就在于对认知的改变,不同的理论构建了很多的方法,然而这种对于认知的改变往往是困难的,认知的形成需要一个长期的过程,在此过程中往往受到人格,环境,以及特定的情绪的影响。所以固有的认知一旦形成是顽固的,它所涉及到的不单单是认知本身,还要受到性格等其他因素的制约。因此治疗师往往会布置家庭作业,要改变     

人际交往问题的认知行为疗法的咨询一例

<正>本研究主要报告了咨询师采用认知行为疗法、合理情绪疗法等帮助其解决人际交往障碍。改变来访者认知方式,引导来访者重新认识自我和掌握一定的人际交往技巧,树立人际交往的自信心,学习构建人际支撑系统的原则与方法,经过5次咨询和心理辅导,来访者认知观念与行为方式有了明显改变,成功地达到了"认知重建"的目的,有效地解决了来访者的心理问题。1一般资料1.1人口学资料来访者(万某),女,汉族,24岁,研二,身高1.55 m,体态     

青春期性困扰心理咨询一例

<正>本案例是关于青少年在青春期出现的性困扰而引发的一般心理问题的咨询案例报告。笔者详细叙述了对一名被性问题困扰的青少年进行资料收集、评估诊断以及心理咨询的过程,并扼要论述了行为认知治疗的原理,介绍使用了行为控制、认知调节疗法,帮助来访者学习掌控自己的行为和念头,学习积极的人际交往方法,并运用到生活中去,咨询效果显著。1一般资料1.1人口学资料:来访者,男,大二学生,父母亲都是军人,在     

Improved bronchodilation with levalbuterol compared with racemic albuterol in patients with asthma

Background: Racemic albuterol is an equal mixture of (R)-albuterol (levalbuterol), which is responsible for the bronchodilator effect, and (S)-albuterol, which provides no benefit and may be detrimental. Objective: We sought to compare 2 doses of a single enantiomer, levalbuterol (0.63 mg and 1.25 mg), and equivalent amounts of levalbuterol administered as racemic albuterol with placebo in patients with moderate-to-severe asthma. Methods: This was a randomized, double-blind, parallel-group trial. Three hundred sixty-two patients 12 years of age or older were treated with study drug administered by means of nebulization 3 times daily for 28 days. The primary endpoint was peak change in FEV₁ after 4 weeks. Results: The change in peak FEV₁ response to the first dose in the combined levalbuterol group was significantly greater compared with the combined racemic albuterol group (0.92 and 0.82 L, respectively; P = .03), with similar but nonsignificant results after 4 weeks (0.84 and 0.74 L, respectively). Improvement in FEV₁ was similar for levalbuterol 0.63 mg and racemic albuterol 2.5 mg and greatest for levalbuterol 1.25 mg. Racemic albuterol 1.25 mg demonstrated the weakest bronchodilator effect, particularly after chronic dosing. The greatest increase in FEV₁ was seen after levalbuterol 1.25 mg, especially in subjects with severe asthma. All active treatments were well tolerated, and β-adrenergic side effects after administration of levalbuterol 0.63 mg were reduced relative to levalbuterol 1.25 mg or racemic albuterol 2.5 mg. At week 4, the predose FEV₁ value was greatest in patients who received levalbuterol or placebo when compared with those who received racemic albuterol. The difference was more evident and was statistically significant in patients who were not receiving inhaled corticosteroids. Conclusion: Levalbuterol appears to provide a better therapeutic index than the standard dose of racemic albuterol. These results support the concept that (S)-albuterol may have detrimental effects on pulmonary function. (J Allergy Clin Immunol 1998;102:943-52.)     

Infectious diseases and immunological markers associated with patients with non-Hodgkin lymphoma treated with rituximab

Background: The use of rituximab (RTX) is increasing, even in developing countries. It has become the first-line therapy or adjuvant to chemotherapy (CHOP; cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone) for various diseases, including B cell lymphoma and autoimmune diseases.

Aim: We describe the infectious diseases and immunological markers associated with RTX treatment of patients with non-Hodgkin lymphoma (NHL).

Methods: Serum immunoglobulins were determined before and after intravenous immunoglobulin (IVIg) administration. Pneumo-23IgG-specific anti-pneumococcal antibodies were evaluated before and after vaccination. Immunophenotyping and lymphocyte proliferation were determined in the course of the treatment.

Results: Seven patients were followed and median age was 56.0?±?5.0?years (range, 41.9–71.6?years). At baseline, the mean level of IgG was 333.7?±?40.8?and IgM 40.9?±?11.3?mg/dL, respectively; immunoglobulin A and E (IgA and IgE) were under the limit of detection. Two patients had reduced or absent B cells and T cell subsets were at normal levels in five patients. All patients failed to mount an efficient post-vaccination immune response against hepatitis B virus, tetanus, diphtheria and against the 23-valent pneumococcal polysaccharide vaccine. During RTX/CHOP treatment, human-IgG-immunoglobulin (IVIg) therapy was introduced in six patients after recurrent infections, including community-acquired pneumonia (85.7%), chronic sinusitis (85.7%) and gastroenteritis (42.9%).

Conclusion: Poor response against pneumococcal vaccines increases the susceptibility of respiratory diseases in these patients. In patients with NHL treated with RTX, the benefits achieved with IVIg replacement for the control of recurrent infectious diseases is of paramount importance. Clinicians dealing with monoclonal antibodies against cancer therapy, especially RTX, should be aware of the increasing risks for symptomatic induced hypogammaglobulinemia and respiratory infections.     

Establishing Safety with Patients with Dissociative Identity Disorder

Abstract

The incidence of self-mutilation and suicidality among patients with dissociative disorders is quite high. It is necessary for clinicians working with this population to be adept at dealing with safety problems. This article presents a sequence of basic steps that can be used when helping dissociative patients establish safety, a discussion of the functions of self-destructiveness, and an overview of specific experiences and thinking patterns that contribute to self-destructiveness among dissociative patients.     

Gynecomastia with marked cellular atypia associated with chemotherapy

Gynecomastia is a common benign male breast disease, which may exhibit mild cellular atypia in cytology specimens. However, marked cytologic atypia can be seen in gynecomastia superimposed by chemotherapy. The case described in this report demonstrated severe cytologic atypia of gynecomastia mimicking carcinoma in a patient treated with chemotherapy for acute leukemia. A distinct cytologic feature helpful in avoiding the diagnostic error is described, namely, atypical cells admixed with bland ductal cells and appearing at a different plane. The importance of applying strict diagnostic criteria in breast cytology and clinical correlation is also emphasized.     

Intervention with epinephrine in hypotension associated with mastocytosis

The occurrence of the episodes of vasodilatory hypotension can be a life-threatening manifestation of systemic mastocytosis. This article describes the reversal by epinephrine of episodes of severe hypotension in two hospitalized patients with mastocytosis. Recognition of the efficacy of epinephrine in hypotension associated with mastocytosis can be important when other methods fail to restore hemodynamic stability.     

Satellite RNA associated with bamboo mosaic potexvirus shares similarity with satellites associated with sobemoviruses

Summary A putative nonstructural protein encoded by a satellite RNA associated with bamboo mosaic potexvirus shares 46% identity with the capsid protein of satellite virus of panicum mosaic sobemovirus. The sequence similarity among satellite plant viruses which have no apparent relationship implies a common origin.