Objective:To explore the experience of receiving manualcognitive behavior therapy for insomnia（CBTI）from the perspective of patients.Methods:Patients with insomnia combined with anxiety and depression were recruited and treated individually for 8 weeks according to the structured treatment manual.Semi-structured interviews related with the patient′s experiences were conducted at the end of the 2nd, 4th, and 8th treatments, respectively.A qualitative thematic analysis of the interview results was conducted, then related themes of the patient′s experience during treatment were extracted.Results:Patients′ experiences of treatment were diverse and different.The related themes of “treatment experience” revolve around 4 aspects, namely treatment form, treatment content, treatment process, and therapists.There were positive and negative experiences in all aspects.The frequencies of patients′ positive experiences at the end of the 2nd, 4th, and 8th treatments were 58.9%,69.8%,and 63.5%,respectively.The frequency of negative experiences was highest at the end of the second treatment, reaching 25%,and decreased to 9.6% at the end of the 4th and 8th treatments.Conclusion:In the process of manual CBTI treatment, the negative experience gradually decreases with the progress of treatment, and the positive experience gradually increases.Manual CBTI needs to enhance the individualization of treatment and the diversification of treatment forms, and pay attention to the emotional problems of patients and their difficulties in the implementation of core technologies.

Objective:The current study aims to explore the factors related to the efficacy of cognitive behavior therapy for insomnia (CBT-I) from the perspective of patients and to provide references for more effective implementation of CBT-I.Methods:Using qualitative research methods, 21 insomnia patients with depression/anxiety were treated with CBT-I for 8 consecutive times. Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Scale (HAMD 17), and Hamilton Anxiety Scale (HAMA) were assessed at baseline and the end of the 8th week of treatment. The paired sample t-test was conducted. Semi-structured interviews were performed at week 2, week 4, and week 8 respectively and thematic analysis was used to code and analyze the interview data. Results:Compared with baseline data, the symptoms of insomnia (13.6±2.0 vs. 6.9±2.4), depression (14.6±5.5 vs. 5.0±3.6), and anxiety (17.2±3.4 vs. 5.3±3.9) were significantly improved after 8 weeks of CBT-I treatment ( t=-3.31, -3.19, -2.94, all P<0.01). The patient factors influencing the efficacy of CBT-I were treatment expectation and approval, motivation, compliance, and internalization of treatment content. The therapist factors were professionalism, well-directed, treatment style, supervision, and giving hope. Conclusion:Compliance and high levels of participation of the patients can benefit the treatment efficacy of CBT-I. Therapists should have sufficient experience, stimulate patients′ motivation, improve patients′ compliance, and carry out adequate psychological education in the early stage to increase the efficacy of CBT-I.

目的 研究失眠认知行为治疗(cognitive behavior therapy-insomnia,CBTI)中睡眠卫生教育、睡眠限制、刺激控制、放松训练以及认知疗法五大技术的疗效相关因素及治疗感受.方法 纳入21例失眠伴焦虑、抑郁症状患者开展连续8次CBTI,采用匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)量表评估睡眠症状,运用质性研究方法,分别于第2、4、8次治疗后对患者进行关于治疗技术及自身感受的半结构式访谈,采用主题分析法对访谈资料进行编码和分析.结果 患者治疗后PSQI总分下降(13.55±1.97 vs.6.91±2.43,P<0.05).患者访谈表明CBTI五大技术对失眠症状均有改善效果.疗效相关因素包括:养成良好睡眠习惯,减少无效躺床时间,规律作息,建立正向联结,改变不良认知等.患者治疗感受包括:前期体验糟糕,难以离开床,需要长期坚持等.结论 CBTI治疗中的五大技术对睡眠均有帮助,患者会产生负面感受,需重视患者情绪变化及在执行过程中的困难.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">临床心理评估中的治疗性效应受到国外心理学工作者的重视,在研究中得以证实并临床实践应用。本文介绍临床心理评估中治疗性评估（Therapeutic Assessment,TA）的提出与发展、特点、实施步骤,目前研究状况及应用范围等内容,探讨了治疗性效应的机制,启发我国当前心理评估及临床实践重视治疗性效应。</span>

目的:探讨简化认知行为疗法对改善紧急心理应激反应的效果.方法:招募自愿参加的普通群众,分为对照组(支持性心理组)和干预组(简化认知行为疗法组),采用线上问卷评估和干预的方式,于干预前后各进行一次患者健康问卷—抑郁症状群量表(PHQ—9)、广泛性焦虑量表(GAD—7)、正性负性情绪量表(PANNS)和应激评价测量(SAM)的测定,以评价干预效果.结果:完成2周干预51例患者(对照组25例,干预组26例).两组在人口学资料差异无统计学意义(t年龄=-1.263,P年龄=0.212;x2性别=0.293,P性别=0.775;x2受教育程度=0.180,P受教育程度=0.981;x2学习工作状态=2.353,P学习工作状态=0.308);基线评估时,两组在抑郁(t=1.508,P=0.138)、焦虑(t=1.281,P=0.206)、正性负性情绪(t正性=-0.945,P 正性=0.349;t负性=1.085,P 负性=0.283)、应激评价测量中自控性、威胁性、利害性、不可控性、他控性维度得分差异无统计学意义,在应激评价量表中挑战性维度得分差异有统计学意义(t=-2.663,P=0.011);两周末,两组在抑郁(t=2.851,P=0.006)、焦虑(t=3.376,P=0.001)和正性负性情绪(F正性=4.449,P正性=0.040;F负性=7.544,P负性=0.008)得分差异有统计学意义,应激评价测量中各维度差异无统计学意义.组内比较结果显示,对照组、干预组的抑郁(t对=5.859,P 对＜0.001;t 干=5.39-,P 干＜0.001)、焦虑(t 对=5.532,P 对＜0.001;t干=5.360,P 干＜0.001)、正性负性情绪评分(t对正性=-3.394,P对正性=0.002;t对负性=3.147,PP对负性=0.004;t干正性=-4.156,P干正性＜0.001;t干负性=4.662,PP干负性＜0.001;)在治疗前后差异均有统计学意义.结论:简化认知行为疗法可有效缓解新型冠状病毒肺炎疫情下公众的焦虑抑郁情绪,提高个体的正性情绪.

目的:探讨简化认知行为治疗对轻中度抑郁障碍患者压力知觉的影响,为相关研究提供参考.方法:纳入符合ICD-10中轻、中度抑郁发作标准的被试,根据随机原则分为对照组(药物+支持心理组)和干预组(药物+简化认知行为组),采用盲法评估,于干预前后各进行一次17项汉密顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)和中文版压力知觉量表(CPSS)的测定,以评价干预效果.结果:完成8周干预65例患者(对照组33例,干预组32例).两组在人口学资料差异无统计学意义(P>0.05);基线评估时,两组在抑郁、焦虑和压力知觉得分差异无统计学意义(P>0.05);8周末,两组在抑郁、焦虑和压力知觉得分差异有统计学意义(P<0.05),干预组得分均低于对照组.组内比较结果显示,对照组、干预组的抑郁、焦虑、压力知觉评分在治疗前后差异均有统计学意义(P<0.05).结论:药物+支持性心理治疗和药物+简化认知行为治疗2种干预方式均有助于改善轻中度抑郁障碍患者的压力知觉,药物+简化认知行为治疗方式的干预效果优于药物+支持下心理治疗方式.

目的 比较简化认知行为治疗(SCBT)联合药物、支持性心理治疗(SP)联合药物以及单纯药物治疗3种干预方式对抑郁症患者生活质量的影响.方法 采用随机对照试验设计,将120例抑郁症患者随机分配至SCBT+药物组、SP+药物组和单纯药物组,进行8周治疗,12周随访.采用健康状况调查问卷从8个维度评估患者生活质量.结果 纳入统计分析94例,3组分别为34例、32例、28例.3组在社会人口学资料、发病形式、病程、抑郁程度等方面差异无统计学意义(P>0.05).基线时,3组在生理机能、一般健康状况和社会功能方面差异有统计学意义(P<0.05),单纯药物组得分较低;干预结束时,SCBT+药物组在一般健康状况上得分高于SP+药物组(F=3.695,P=0.026),在精神健康上得分高于单纯药物组(F=8.409,P<0.05);12周末,SCBT+药物组在生理职能上得分高于单纯药物组(F=3.606,P=0.028),在一般健康状况上得分高于SP+药物组(F=4.762,P=0.009),在精力维度(F=4.725,P=0.010)和精神健康维度(F=12.066,P<0.05)上得分高于另外两组.组内比较结果显示,SCBT+药物组在生活质量8个维度上差异均有统计学意义(P<0.05);SP+药物组及单纯药物组在3个维度差异有统计学意义(P<0.05).结论 SCBT联合药物治疗、SP联合药物治疗和单纯药物治疗均能有效改善抑郁症患者生活质量,SCBT联合药物治疗在改善抑郁症患者生理职能、一般健康状况、精力和精神健康方面效果更好.

目的 探讨团体简化认知行为疗法(G-SCBT)对援鄂一线医护人员焦虑抑郁状态的改善作用.方法 运用G-SCBT,通过微信对67例处于疗养期间的援鄂一线医护人员完成心理干预,干预包括4次,每次一小时.干预前后使用广泛性焦虑量表(GAD-7)和一般抑郁症状群量表(PHQ-9)评估援鄂一线医护人员的焦虑抑郁状态.结果 干预后,援鄂一线医护人员的GAD-7和PHQ-9评分低于干预前(P均<0.05).与干预前比较,男性组PHQ-9评分低,女性组GAD-7和PHQ-9评分低(P均<0.05);低龄组GAD-7和PHQ-9评分低(P均<0.05);初级职称组GAD-7评分低,中级职称组GAD-7和PHQ-9评分低(P<0.05);护理组GAD-7和PHQ-9评分低(P<0.05);支援武汉组GAD-7和PHQ-9评分低(P<0.05);支援时间<40 d组GAD-7和PHQ-9评分低(P均<0.05).结论 G-SCBT能有效缓解援鄂一线医护人员的总体焦虑抑郁状态,改善程度与性别、年龄、职称、职业、支援地及支援时间有关.

跨期选择(Intertemporal Choice)是人们对发生在未来的不同时间点或时间段的获利或损失进行决策与权衡.国外已有研究者将跨期选择应用于精神障碍研究,国内这方面研究尚处于起步阶段.跨期选择的测量指标可以客观测量精神障碍患者对未来的贴现率.探讨跨期选择方式能否成为鉴别精神障碍种类或判断其病程发生发展及严重程度的特异性工具,对临床研究具有启示意义.

A patient with major depressive disorder was treated by using case formulation procedure,which was constructed according to the framework of the simplified cognitive behavioral therapy( SCBT). Twelve sessions of SCBT was conducted during five stages. The Hamilton Depression Rating Scale( HAMD-17), Patient Health Questionnaire 9-Item depression module( PHQ-9),and Hamilton Anxiety Scale( HAMA) were used to measure the symptom change, and the general improvement was evaluated with questionnaires from the therapist and the client. The emotional status and the negative automatic thoughts were significantly improved after the therapy. In addition,both the therapist and the patient considered the treatment outcome as good. The present study implicates that it is effective to treat depression under the SCBT framework.

Brief Cognitive Behavior Therapy( BCBT) may solve the problem of technology promotion in traditional cognitive behavior therapy,with high cost-effectiveness,so in recent years,BCBT has been popularized and developed in western medical institutions. The existing researches on the treatment of depression with BCBT are still less and limited,and the research design and quality should be further improved.