心智觉知干预述评

近年来,由于公开出版了许多设计良好的以心智觉知(mindfulness)为基础的认知治疗经验性评估,越来越多的研究者和临床心理治疗师对以心智觉知技术为基础的心理治疗感兴趣,他们投入极大的热情学习心智觉知技术并把它整合到治疗当中去.     

觉知疗法改善肾移植患者情绪困扰:个案研究

目的:初步探索觉知疗法对肾移植患者情绪困扰的干预效果。方法:1例肾移植患者接受8周觉知治疗。采用抑郁自评量表、焦虑自评量表、睡眠状况量表和注意觉知量表,在干预前、干预后、干预后1个月对患者实施测评,并收集患者的主观报告。结果:患者经过干预后,其抑郁、焦虑水平下降,睡眠状况改善,觉知度提高,其改善在追踪期获得保持。结论:觉知干预对有效帮助国内肾移植患者进行情绪调节存在一定的可能性,但未来需要更多的实证研究。     

觉知训练对参与者疼痛忍耐度的影响

背景:基于接纳和觉知的疗法被誉为心理疗法的第三潮,该类方法可以显著改善慢性疼痛患者的机体功能和社会功能,减少疼痛对患者生活的影响。目前此类方法对实验室诱发的急性疼痛的干预虽显示出一些积极的效果,但还存在争论。目的:探索觉知训练对健康大学生对实验室诱发的急性疼痛的主观感受、忍耐度,及体验疼痛时心率变化的干预效果。方法:训练组为自愿参加实验的8名首都师范大学学生,对照组为某心理学选修班的7名大学生。对训练组进行8周的觉知训练,在训练前、后采用觉知五因素量表测量训练组和对照组的觉知度,并记录两组冷压实验中的疼痛阈限、疼痛忍耐时间、对疼痛强度的主观评价及心率变化。结果与结论:用非参检验对实验数据进行分析发现,只有训练组在经觉知训练后,觉知五因素量表得分(Z=-2.366;P0.05)和疼痛忍耐度(Z=-2.117;P0.05)显著提高;训练组和对照组的疼痛阈限、疼痛的主观评价和心率指标前、后测差异均无显著性意义(P0.05)。说明觉知训练可在主观疼痛程度不变的情况下增加参与者对急性疼痛的忍耐度,但对应对疼痛时的心率无显著性影响。     

大学生觉知与自我概念、应对方式关系的研究

目的探讨大学生觉知与自我概念、应对方式关系。方法采用五因素觉知量表、田纳西自我概念量表、应付方式问卷对150名大学生被试进行测量。结果①觉知与生理自我、道德自我、家庭自我、社会自我、自我满意、自我行动及自我概念总分存在显著正相关（r=0.330,0.219,0.228,0.256,0.423,0.332和0.331;P〈0.01或〈0.05）;②觉知与问题解决、求助两种成熟型应对方式存在显著正相关（r=0.362和0.208;P〈0.01）,与自责、幻想、退避3种不熟型应对方式存在显著负相关（r=-0.411,-0.315和-0.294;P〈0.01）;③自我概念在觉知与应对方式之间存在部分中介作用（χ2/d f=2.24,CF I=0.98,RM SEA=0.10）。结论大学生的觉知与自我概念、应对方式有关联,觉知既可以通过自我概念间接影响应对方式,也可以直接影响应对方式。     

正念注意觉知量表(MAAS)的修订及信效度检验

目的:修订正念注意觉知量表(Mindful Attention Awareness Scale,MAAS)中文版,考察其在中国大学生样本中的信度和效度。方法:在华北、西北、东南、东北等地区4所高校收集有效数据718份,并在两周后对其中的125人进行重测。结果:探索性因素分析表明,抽取1个因素最为合适,特征根为6.39,累积方差贡献率为45.46%。验证性因素分析显示,单因素模型具有良好的结构效度,TLI=0.904,IFI=0.918,CFI=0.917,RMR=0.067,RMSEA=0.077;Cron-bach’sα系数为0.890,重测信度为0.870;正念注意觉知与焦虑特质负相关、与抑郁情绪负相关、与自尊水平正相关;MAAS得分没有性别差异,有过冥想经验的和没有冥想经验的在MAAS得分上无显著差异。结论:中文版MAAS具有良好的心理测量学指标,适宜在中国大陆使用。     

强迫障碍患者的成人依恋类型及其与压力觉知的关系

目的:调查强迫障碍患者的成人依恋类型和觉知生活压力水平,探索二者的关系.方法:对75名强迫障碍患者及75名健康对照组采用关系测量问卷(RSQ)和知觉生活压力量表(CPSS)进行调查.结果:强迫障碍组的不安全依恋类型比例为84.0％,高于健康对照组(45.3％),其中迷恋型依恋比例为38.7％,淡漠型33.3％,恐惧型12.0％.强迫障碍组CPSS总分(47.24±8.828)高于健康对照组(37.99±7.885),两组在压力紧张感方面具有显著差异(P＜0.01).强迫障碍组的安全型依恋类型与压力的失控感呈负相关,不安全依恋类型与压力的紧张感及失控感呈正相关(淡漠型除外),不安全依恋类型中自我维度与压力的紧张感及失控感呈负相关.结论:强迫障碍组不安全依恋类型比例高于健康对照组,强迫障碍组成人依恋类型对其觉知生活压力具有显著影响.     

威廉姆斯生活技能训练对医学生焦虑、抑郁情绪的影响

目的:探讨威廉姆斯生活技能训练对医学生焦虑、抑郁情绪的影响。方法:将自愿报名参加的82名中南大学湘雅医学院2004级八年制医学生按不同的实习医院分成研究组(n=40)和对照组(n=42)。研究组接受为期8周的威廉姆斯生活技能训练(Williams Life Skills Training,WLST),对照组不采取任何干预措施。最后研究组36人(男15人,女21人)、对照组37人(男15人,女22人)完成了研究。所有被试干预前、后自评完成焦虑自评量表(Self-Rat-ing Anxiety Scale,SAS)和抑郁自评量表(Self-Rating Depression Scale,SDS)。结果:研究组干预后SAS、SDS总分(31.39±4.16,32.69±6.29)均较干预前(34.25±5.91,35.53±6.92)显著降低(P<0.01),对照组SAS和SDS总分前后比较差异均无统计学显著性(P>0.05)。结论:WLST能够有效地降低医学生的焦虑、抑郁水平。     

英语语言训练对恢复期住院精神分裂症患者焦虑抑郁情绪的影响

目的 探讨英语语言训练对恢复期住院精神分裂症患者焦虑、抑郁情绪的影响.方法 应用英语语言训练的方法对50例符合ICD-10精神分裂症诊断标准的恢复期住院精神分裂症患者进行英语的听、说、读、写训练.每日1次,每次训练时间45分钟,为期6周.分别于训练前、训练结束时应用Zung氏焦虑自评量表(SAS)和抑郁自评量表(SDS)对接受训练的患者进行评定.结果 在英语语言训练前和训练结束时,患者SAS及SDS评分分别由(48.19±5.72)和(50.20±5.72)降为(42.91±5.42)和(45.03±6.85),焦虑和抑郁发生率分别由42％和46％降为22％和26％,训练前后两组数据差异显著(P＜0.05).结论 英语语言训练可明显减轻恢复期住院精神分裂症患者的焦虑、抑郁情绪.     

心理干预对心肌梗塞患者抑郁情绪的影响

目的：通过心理干预观察心肌梗塞患者的抑郁情绪，躯体症状，心功能的改变，探讨其临床意义。方法：共收治76例心肌梗塞患者，其中47例合并抑郁情绪，按抽签的方法将其随机分成干预组（n=26)与对照组（n=21)，对照组对予常规药物治疗，干预组则在常规药物治疗的基础上进行健康教育及心理干预，抑郁情绪严重者者服用适量抗抑郁药物治疗，3个月后行Zung氏抑郁自评量表（SDS），汉密顿抑郁量表（HRSD）评估，并对所存在的体症状及心功能进行分析评价。结果：3个月后，干预组SDS评分，HRSD（24项）显著低于对照组（P＜0．01），抑郁指数与对照组相比有明显下降（P＜0．05），干预组与对照组相比，躯体症状明显缓解（P＜0．01），心功能得到有效改善（与对照组相比，心功能分级P＜0．01，LVEFP＜0．05），结论：心肌梗塞患者常合并有抑郁情绪；心理干预不仅有助于心肌梗塞患者抑郁情绪改善，而且有益于患者的躯体症状及心功能恢复。     

A Postpartum Sleep and Fatigue Intervention Feasibility Pilot Study

The purpose of this pilot study was to evaluate the feasibility, acceptability, and cost of a self-management intervention for postpartum fatigue and sleep in socioeconomically disadvantaged urban women. Helping U Get Sleep (HUGS) is a theory-guided intervention developed from the Individual and Family Self-Management Theory. Medicaid-enrolled participants in the United States were recruited from an inpatient postpartum unit. Treatment and attention control interventions were delivered (15 HUGS, 12 comparison) at a week 3 postpartum home visit and 4 follow-up phone calls. Over the 9-week protocol, the HUGS group demonstrated significant improvements in subjective fatigue and subjective sleep disturbance relative to the comparison group. The HUGS intervention was feasible and acceptable, delivered on average, in 100 min and costing US$79 per participant.     

Effectiveness of Step-Wise Intervention Plan for Managing Nelfinavir-Associated Diarrhea: A Pilot Study

Abstract

Purpose: Pilot study to evaluate the effectiveness of a step-wise diarrhea management strategy for nelfinavir-associated diarrhea. Method: HIV-infected adults (CD4 count ≥100 cells/mm³, and no evidence of enteric pathogens) developing symptoms of diarrhea after initiation of nelfinavir for a duration of =1 month were enrolled into this 9-week prospective pilot study. Step-wise interventions, reviewed and adjusted additively at 2-week intervals, included nutritional counseling (± lactase and/or psyllium), calcium carbonate, and loperamide. Outcome measure included stool-form consistency, bowel movement frequency, and incidents of associated morbidity (urgency, incontinence) daily. Patient quality of life was also assessed. Results: Eighteen patients completed the study. Mean daily bowel movement frequency decreased by 32%, from 2.98 to 2.03 (p = .005). Mean daily stool form shifted from a rating of 4.24 to 2.37 (p = .0001), representing a shift to firmer stools. Period prevalence of incontinence (28%) and urgency (33%) decreased to 6% each, respectively. Quality of life ratings relating to gastrointestinal disturbance and overall physical/psychosocial function were improved. Conclusion: The results of this pilot study demonstrated that a step-wise intensified approach may be successful in managing nelfinavir-associated diarrhea and will need to be validated in a larger scale, randomized controlled trial.     

Representativeness of Participants in a Lifestyle Intervention Study in Obese Pregnant Women - the Difference between Study Participants and Non-Participants

ObjectiveTo examine the representativeness of participants attending a lifestyle intervention study addressing obese pregnant women.MethodsRetrospective comparison of baseline data, attendance to oral glucose tolerance test (OGTT) during pregnancy, and pregnancy outcome in eligible women stratified according to study participation. Of 750 eligible women with a self-reported BMI > 30 kg/m², and a live singleton pregnancy, 510 were eligible for inclusion and 425 were randomized to either active intervention (n= 284) or to standard obstetric care (n= 141) including two standard OGTT. The 85 women who declined participation or were excluded due to competing diseases and 240 women who did not respond to the initial invitation received the same standard care.ResultsThe randomized women had similar BMI but a lower parity and age, and were more frequently non-smokers, born in Denmark and married or cohabitating with their partner than the non-participants. Women participating in the trial had a higher compliance to the second OGTT compared to non-participants, also after correcting for age and nationality. There was no difference in pregnancy outcome, i.e., fetal weight and length, gestational age as well as mode of delivery.ConclusionWomen declining participation in a randomized lifestyle intervention study in pregnancy have characteristics indicating they are those who might benefit the most from lifestyle intervention.Key Words: Interventions to increase physical activity, Lifestyle factors, Social determinants, Lifestyle intervention, Pregnancy, Representateviness     

Open-Label Placebo for Major Depressive Disorder: A Pilot Randomized Controlled Trial

No abstract available.     

Predictors of Developmental Outcomes for Medically Fragile Early Intervention Participants

Little is documented about the determinants of developmentaloutcomes for medically fragile infants who receive early intervention.In this controlled longitudinal study 65 premature infants withintraventricular hemorrhage (IVH) were randomly assigned tointervention groups beginning at 3 months adjusted age (Early)or 12 months adjusted age (Delayed). The sample was 65% AfricanAmerican and 35% Caucasian, and over half the youngsters werebeing raised by single mothers. Although cost analyses revealedthat it was almost twice as expensive to begin sensorimotorintervention at the earlier age, annual comprehensive assessmentsrevealed no significant differences in developmental outcomesbased on age at start. Stepwise multiple regression analysesrevealed that Maternal Education and Neonatal Medical Problemswere significant predictors of outcomes at years 1, 3, 5, and7 regardless of age at start. Related findings from other studiesare discussed along with implications for policy and futureresearch.     

A Pilot Study of Subjective Daytime Alertness and Mood in Primary Insomnia Participants Using Ecological Momentary Assessment

This pilot study compared daytime symptom ratings in primary insomniacs (n = 7) and age-matched controls (n = 8). Participants completed sleep diaries and rated their daytime symptoms using a Daytime Symptom Diary (DSD) 4 times per day for 1 week. DSD responses were collapsed into 4 domains: mood, subjective alertness, energy, and concentration. The level and variability of DSD domains, and correlations between the domains and sleep diary characteristics, were examined. Significant Group by Time of Day interactions were observed in values for each DSD domain, with the most consistent group differences occurring in the morning. Coefficients of variation for DSD domains were greater in the insomnia group. Frequent measures of daytime symptoms may be useful outcomes in insomnia studies.     

Web-Based Intervention in Mindfulness Meditation for Reducing Residual Depressive Symptoms and Relapse Prophylaxis: A Qualitative Study

Background

Mindful Mood Balance (MMB) is a Web-based intervention designed to treat residual depressive symptoms and prevent relapse. MMB was designed to deliver the core concepts of mindfulness-based cognitive therapy (MBCT), a group treatment, which, despite its strong evidence base, faces a number of dissemination challenges.

Objective

The present study is a qualitative investigation of participants’ experiences with MMB.

Methods

Qualitative content analysis was conducted via 38 exit interviews with MMB participants. Study inclusion required a current PHQ-9 (Patient Health Questionnaire) score ≤12 and lifetime history ≥1 major depressive episode. Feedback was obtained on specific website components, program content, and administration as well as skills learned.

Results

Codes were assigned to interview responses and organized into four main themes: MBCT Web content, MBCT Web-based group process, home practice, and evidence of concept comprehension. Within these four areas, participants highlighted the advantages and obstacles of translating and delivering MBCT in a Web-based format. Adding increased support was suggested for troubleshooting session content as well as managing time challenges for completing home mindfulness practice. Participants endorsed developing affect regulation skills and identified several advantages to Web-based delivery including flexibility, reduced cost, and time commitment.

Conclusions

These findings support the viability of providing MBCT online and are consistent with prior qualitative accounts derived from in-person MBCT groups. While there is certainly room for innovation in the domains of program support and engagement, the high levels of participant satisfaction indicated that MMB can significantly increase access to evidence-based psychological treatments for sub-threshold symptoms of unipolar affective disorder.     

Preventive Intervention for Urban,Low-Income Preschoolers at Familial Risk for Conduct Problems: A Randomized Pilot Study

Conducted a pilot study to test the feasibility of a prevention program for promoting parenting in families of preschoolers at high risk for behavior problems. Risk status was based on a family history of antisocial behavior and residence in a low-income, urban community. Thirty preschoolers (ages 21/2 to 5) and their parents were randomly assigned to a 1-year, home- and clinic-based intervention or to a no-intervention control condition. Despite families' multiple risk factors, high rates of attendance and satisfaction were achieved. Relative to controls, intervention parents were observed to be significantly more responsive and use more positive parenting practices. Results support the feasibility of engaging high-risk families in an intensive prevention program. The meaningful changes achieved in parenting suggest that a preventive approach is promising for families with multiple risk factors.     

The Computer-Assisted Brief Intervention for Tobacco (CABIT) Program: A Pilot Study

Background

Health care providers do not routinely carry out brief counseling for tobacco cessation despite the evidence for its effectiveness. For this intervention to be routinely used, it must be brief, be convenient, require little investment of resources, require little specialized training, and be perceived as efficacious by providers. Technological advances hold much potential for addressing the barriers preventing the integration of brief interventions for tobacco cessation into the health care setting.

Objective

This paper describes the development and initial evaluation of the Computer-Assisted Brief Intervention for Tobacco (CABIT) program, a web-based, multimedia tobacco intervention for use in opportunistic settings.

Methods

The CABIT uses a self-administered, computerized assessment to produce personalized health care provider and patient reports, and cue a stage-matched video intervention. Respondents interested in changing their tobacco use are offered a faxed referral to a “best matched” tobacco treatment provider (ie, dynamic referral). During 2008, the CABIT program was evaluated in an emergency department, an employee assistance program, and a tobacco dependence program in New Jersey. Participants and health care providers completed semistructured interviews and satisfaction ratings of the assessment, reports, video intervention, and referrals using a 5-point scale.

Results

Mean patient satisfaction scores (n = 67) for all domains ranged from 4.00 (Good) to 5.00 (Excellent; Mean = 4.48). Health care providers completed satisfaction forms for 39 patients. Of these 39 patients, 34 (87%) received tobacco resources and referrals they would not have received under standard care. Of the 45 participants offered a dynamic referral, 28 (62%) accepted.

Conclusions

The CABIT program provided a user-friendly, desirable service for tobacco users and their health care providers. Further development and clinical trial testing is warranted to establish its effectiveness in promoting treatment engagement and tobacco cessation.     

有氧运动干预对师范类大学生抑郁情绪的影响

目的探讨有氧运动对师范类大学生抑郁情绪的影响。方法应用Zung氏"抑郁自评量表"对师范类大学生进行心理评估;对其中有抑郁症状的44例随机分为两组,干预组(n=21)进行有计划的运动处方干预即个体化有氧运动,时间为8周;对照组(n=23)不采用干预措施。观察两组干预前后抑郁情绪变化并进行比较。结果在校大学生抑郁发生率17.81%,有氧运动能够明显改善其不良情绪。干预后干预组抑郁得分SDS(37.58±8.57)与干预前(47.39±9.15)比较差异有统计学意义(t=3.59/P0.01);对照组抑郁得分(44.29±8.76)较干预前(47.34±9.12)有所降低,但差异无统计学意义(t=1.61/P0.05);干预组与对照组干预后SDS相比(37.58±8.57/44.29±8.76),差异有显著统计学意义(t=2.57/P0.01);抑郁指数情形同SDS,干预后两组相比(0.47±0.09/0.55±0.10),差异有显著统计学意义(t=2.79/P0.01)。结论大学生抑郁发生率较高,有氧运动能够明显改善其抑郁状况。