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Internet delivered guided cognitive behavioral self-help for panic disorder: An open trial and benchmarking study 互联网为恐慌障碍提供引导认知行为自助:一项公开试验和基准研究
Q3 PSYCHIATRY Pub Date : 2022-03-01 DOI: 10.1016/j.jbct.2021.12.005
Asher Y. Strauss , Asala Halaj , Dina Zalaznik , Isaac Fradkin , Benjamin A. Katz , Elad Zlotnick , Snir Barzilay , Gerhard Andersson , David Daniel Ebert , Jonathan D. Huppert

An open trial of a therapist-guided internet cognitive-behavioral therapy (ICBT) for panic disorder with and without agoraphobia (PD/A) was conducted. Ninety adults diagnosed with PD/A were treated using ICBT adapted from a face to face (FTF) protocol. Results were benchmarked against two FTF samples, one at the same research site using the same protocol and another from a large cognitive-behavioral therapy (CBT) study. In addition, effects were compared to mean aggregated estimates from four meta-analyses. Attrition rates and therapist time were also examined to facilitate cost-effectiveness analyses and inform policy makers. Both full intent-to-treat and completer samples were used when analyzing data. Overall, results suggest that within-group effects for ICBT (0.88 to 1.7) are similar to the effects found in the benchmarking samples and to effects across meta-analytic studies. Effects were larger for symptoms assessed by an independent evaluator compared to self-report measures. Treatment gains continued to increase 3 months after post treatment and were maintained at 6 month and 1 year follow-up. However, attrition rates in ICBT were twice as large (46%) compared to the FTF sample, possibly due to a more conservative definition of attrition used here compared to previous reports. Therapist time in ICBT was reduced by a factor of three (14 min/week) compared to FTF, suggesting that treatment effects can be maintained even when reducing therapist time. Taken together, these findings suggest good short and long-term efficacy and time efficiency along with greater attrition for ICBT, allowing for dissemination and enhancing accessibility to quality, evidence-based treatment in the community.

采用网络认知行为疗法(ICBT)治疗伴或不伴广场恐怖症(PD/ a)的临床试验。90名被诊断为PD/A的成年人采用面对面(FTF)方案的ICBT治疗。结果以两个FTF样本为基准,一个来自同一研究地点,使用相同的协议,另一个来自大型认知行为疗法(CBT)研究。此外,将效果与四项荟萃分析的平均汇总估计值进行比较。还检查了损失率和治疗师时间,以促进成本效益分析并为决策者提供信息。在分析数据时,使用了完全意向处理和完井样本。总体而言,结果表明,ICBT的组内效应(0.88至1.7)与基准样本中的效应和跨荟萃分析研究的效应相似。与自我报告相比,由独立评估者评估的症状效果更大。治疗后3个月治疗收益继续增加,并在6个月和1年的随访中保持不变。然而,与FTF样本相比,ICBT的流失率是前者的两倍(46%),这可能是由于与之前的报告相比,这里使用的流失率定义更为保守。与FTF相比,ICBT的治疗时间减少了三倍(14分钟/周),这表明即使减少了治疗时间,治疗效果也可以保持。综上所述,这些研究结果表明,ICBT具有良好的短期和长期疗效和时间效率,并具有更大的耗损性,从而可以在社区中传播并提高对高质量循证治疗的可及性。
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引用次数: 1
Avoidance of negative emotional contrast from worry and rumination: An application of the Contrast Avoidance Model 从忧虑和反刍中避免负面情绪对比:对比回避模型的应用
Q3 PSYCHIATRY Pub Date : 2022-03-01 DOI: 10.1016/j.jbct.2021.12.007
Hanjoo Kim , Michelle G. Newman

According to the Contrast Avoidance model (CAM), worry causes increased and sustained negative affect and such negative affect enables avoidance of a future sharp increase in negative emotion. However, only pathological worriers (vs. controls) view worry as a positive coping strategy to avoid a negative emotional contrast (NEC). We examined if rumination, which is another type of repetitive negative thought, would function similarly. Individuals with self-reported symptoms of pure generalized anxiety disorder (GAD; n = 90), pure depression (MDD; n = 85), and non-anxious/non-depressed controls (HC; n = 93) were randomly assigned to conditions where they were asked to worry, ruminate, or relax. Emotional and physiological changes were measured during worry and subsequent exposure to fearful and sad videos. We also assessed participant group differences in preference for worry or rumination as a strategy to cope with negative affect during the negative emotional video exposures. Consistent with CAM, regardless of the group, both worry and rumination enabled avoidance of NEC. Whereas worry led to greater avoidance of a fear contrast, rumination led to greater avoidance of a sadness contrast. On the other hand, relaxation enhanced NEC. Skin conductance also indicated patterns in line with CAM. In the subjectively perceived preference, the GAD group reported a greater preference for worry in coping with a fear contrast than HC. However, such a salient pattern was not found for the MDD group. Treatment implications of these findings are discussed.

根据对比回避模型(CAM),担忧会导致持续增加的负面情绪,而这种负面情绪可以避免未来负面情绪的急剧增加。然而,只有病理性忧虑者(相对于对照组)将忧虑视为避免消极情绪对比的积极应对策略(NEC)。我们研究了反刍,这是另一种重复的消极思想,是否也有类似的作用。自我报告有纯粹广泛性焦虑障碍(GAD)症状的个体;n = 90),单纯抑郁(MDD;n = 85),非焦虑/非抑郁对照组(HC;N = 93)被随机分配到不同的环境中,分别被要求担心、沉思或放松。研究人员测量了在担心和随后观看恐惧和悲伤视频期间的情绪和生理变化。我们还评估了在负面情绪视频暴露期间,参与者群体在选择担忧或反刍作为应对负面影响策略方面的差异。与CAM一致的是,无论在哪个组,忧虑和反刍都能避免NEC。相比之下,担忧会导致对恐惧的更大回避,而沉思则会导致对悲伤的更大回避。另一方面,松弛增强了NEC。皮肤电导也显示了与CAM一致的模式。在主观感知偏好方面,广泛性焦虑症组在应对恐惧对比时比HC组更倾向于担忧。然而,在重度抑郁症组中没有发现这种显著的模式。讨论了这些发现的治疗意义。
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引用次数: 13
Associations between improvements in aversive reactions to negative emotions and increased quality of life in the unified protocol 在统一方案中,改善对负面情绪的厌恶反应与提高生活质量之间的关系
Q3 PSYCHIATRY Pub Date : 2022-03-01 DOI: 10.1016/j.jbct.2021.12.001
Sohayla A. Elhusseini , Lauren E. Cravens, Matthew W. Southward, Shannon Sauer-Zavala

Emotional disorders are thought to be maintained by the transaction between frequent experiences of strong, negative emotions (i.e., neuroticism) and aversive reactions to those emotions. The Unified Protocol (UP) is an efficacious treatment for transdiagnostic emotional disorders designed to target specific forms of aversive reactivity to negative emotions. In addition to symptom change, the UP has also been shown to lead to increases in quality of life. However, it remains unclear which specific mechanisms targeted in the UP are related to improvements in quality of life. We explored the relations between changes in five aspects of aversive reactivity included in the UP (i.e., non-acceptance of emotions, [lack of] mindfulness, cognitive rigidity, behavioral avoidance, and anxiety sensitivity) and overall quality of life during treatment. Person-specific regression slopes revealed that improvements in emotional non-acceptance, behavioral avoidance, and mindfulness were each significantly associated with increases in quality of life over the six sessions of treatment. Although in the expected direction, improvements in anxiety sensitivity and cognitive flexibility were not significantly associated with increases in quality of life. These findings generally suggest a model of equifinality in which improvements in most aspects of aversive reactivity are similarly related to changes in quality of life.

Clinical trials registration number

NCT04584879.

情绪障碍被认为是通过频繁经历强烈的负面情绪(即神经质)和对这些情绪的厌恶反应之间的交易来维持的。统一协议(UP)是一种有效的治疗跨诊断性情绪障碍的方法,旨在针对特定形式的负面情绪的厌恶反应。除了症状的改变,UP也被证明可以提高生活质量。然而,目前尚不清楚UP中针对的具体机制与生活质量的改善有关。我们探讨了在治疗过程中,厌恶反应的五个方面(即不接受情绪、缺乏正念、认知僵化、行为回避和焦虑敏感性)的变化与整体生活质量之间的关系。个体特定的回归斜率显示,情绪不接受、行为回避和正念的改善都与六个治疗阶段生活质量的提高显著相关。尽管在预期的方向上,焦虑敏感性和认知灵活性的改善与生活质量的提高没有显著的联系。这些发现通常表明了一种均衡模型,在这种模型中,厌恶反应的大多数方面的改善与生活质量的变化相似。临床试验注册号:bernct04584879。
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引用次数: 2
Acceptability of telehealth CBT during the time of COVID-19: Evidence from patient treatment initiation and attendance records COVID-19期间远程医疗CBT的可接受性:来自患者治疗开始和出勤记录的证据
Q3 PSYCHIATRY Pub Date : 2022-03-01 DOI: 10.1016/j.jbct.2022.01.001
Kristy Cuthbert, E. Marie Parsons, Lisa Smith, Michael W. Otto

The COVID-19 pandemic provided unique conditions for examining outpatient psychotherapy clinics’ rapid transition to telehealth. The current study utilized data from a large, specialty CBT clinic to investigate attendance and treatment engagement changes when services were provided via telehealth versus in-person. Results indicate that, following a complete transition to telehealth services, clinic referrals were maintained. Further, telehealth treatment appeared to be entirely acceptable as assessed by a decreased missed visit rate of telehealth appointments compared to in-person appointments. Given the elimination of commuting times, telehealth has the potential to address disparities in care linked to physical distance from the clinic and/or differential ability to take time off work for appointments.

COVID-19大流行为检查门诊心理治疗诊所向远程医疗的快速过渡提供了独特的条件。目前的研究利用了一家大型专业CBT诊所的数据,调查了通过远程医疗和面对面提供服务时出勤率和治疗参与度的变化。结果表明,在完全过渡到远程保健服务后,诊所转诊得以维持。此外,与现场预约相比,远程保健预约的错过率有所下降,由此评估,远程保健治疗似乎完全可以接受。由于消除了通勤时间,远程保健有可能解决与诊所的物理距离和/或请假预约的不同能力有关的护理差异。
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引用次数: 7
Concurrent and prospective links between sleep disturbance and repetitive negative thinking: Specificity and effects of cognitive behavior therapy for insomnia 睡眠障碍与重复性消极思维之间的并发和前瞻性联系:失眠认知行为治疗的特异性和效果
Q3 PSYCHIATRY Pub Date : 2022-03-01 DOI: 10.1016/j.jbct.2021.12.003
Rebecca C. Cox, Bunmi O. Olatunji

Sleep and circadian rhythm disturbance are increasingly recognized in anxiety-related disorders; however, the links between sleep and circadian rhythms and specific transdiagnostic processes evident in these disorders and their treatment have not been delineated. The present study examined the associations between chronotype, insomnia symptoms, and repetitive negative thinking (RNT) using a two-study approach. Study 1 examined concurrent and prospective associations between chronotype, insomnia symptoms, and RNT in a community sample. Study 2 then examined change in RNT following cognitive behavior therapy for insomnia (CBTI). The findings of Study 1 showed that evening chronotype and higher insomnia symptoms were concurrently associated with higher RNT in the community sample; however, only eveningness prospectively predicted increased RNT over 5 months, controlling for depression symptoms. Study 2 found that RNT decreased following CBTI, and decreased eveningness and insomnia symptoms were associated with decreased RNT, controlling for change in depression symptoms. Together these findings highlight the role of sleep and circadian rhythms in RNT. The implications for conceptualizing the etiology and treatment of anxiety-related disorders characterized by RNT are discussed.

睡眠和昼夜节律障碍在焦虑相关障碍中越来越被认识到;然而,睡眠和昼夜节律之间的联系以及在这些疾病及其治疗中明显的特定的跨诊断过程尚未被描述。本研究采用两项研究的方法研究了睡眠类型、失眠症状和重复性消极思维(RNT)之间的关系。研究1在一个社区样本中检验了睡眠类型、失眠症状和RNT之间的并发和前瞻性关联。研究2随后检查了失眠认知行为治疗(CBTI)后RNT的变化。研究1的结果显示,在社区样本中,夜间睡眠类型和较高的失眠症状与较高的RNT同时相关;然而,在控制抑郁症状的情况下,只有傍晚性前瞻性地预测了5个月后RNT的增加。研究2发现,cbt后RNT下降,夜性和失眠症状的减少与RNT下降有关,控制了抑郁症状的变化。总之,这些发现强调了睡眠和昼夜节律在RNT中的作用。本文讨论了以RNT为特征的焦虑相关障碍的病因和治疗的意义。
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引用次数: 1
Non-pharmacological interventions for depression among survivors of adverse childhood experiences: A meta-analysis 儿童期不良经历幸存者抑郁症的非药物干预:荟萃分析
Q3 PSYCHIATRY Pub Date : 2021-12-01 DOI: 10.1016/j.jbct.2021.05.001
Shaimaa Mosad Elrefaay , Susan Wang , Mijung Park

Adverse childhood experiences (ACEs) are associated with various mental health problems such as depression, anxiety, drug abuse, and suicide-related behaviors. Yet, it is largely unknown if non-pharmacological interventions are beneficial in improving mental health among ACEs survivors. The purposes of the current meta-analysis were to: (1) evaluate the efficacy of non-pharmacological interventions in reducing depressive symptom severity among those exposed to ACEs, and, (2) estimate the pooled effect size of these interventions. We searched PubMed, CINAHL, and PsycINFO for randomized controlled trials of psychological interventions for depression among ACEs survivors. Two reviewers independently extracted article data and evaluated the quality of studies using the Cochrane risk-of-bias criteria. We estimated the pooled effect sizes using a random-effects model. We also performed sensitivity tests using a meta-regression and sub-group analyses. Using the pooled data of 1624 individuals from 20 unique RCTs, we found that non-pharmacological intervention had a medium to large effect size in reducing depressive symptom severity compared to control conditions (Hedges’ g = 0.714, 95% CI [0.46, 0.97]). Such efficacy was sustained over the shorter-term follow-up (0 to 6 months; Hedges’ g = 0.23, 95% CI [0.04, 0.49]). Although there was an indication that the efficacy may be sustained in the longer term (12 months or more; Hedges’ g = 0.53, 95% CI: [−0.17, 1.22]), this finding was not statistically significant. Cognitive approaches had a larger effect size than noncognitive interventions. In conclusion, non-pharmacological interventions are efficacious options for treating depression among individuals with a history of adverse childhood experiences.

不良童年经历(ace)与各种心理健康问题有关,如抑郁、焦虑、药物滥用和自杀相关行为。然而,非药物干预是否有利于改善ace幸存者的心理健康在很大程度上是未知的。本荟萃分析的目的是:(1)评估非药物干预措施在降低ace暴露者抑郁症状严重程度方面的效果,(2)估计这些干预措施的综合效应大小。我们检索了PubMed、CINAHL和PsycINFO中关于ace幸存者抑郁症心理干预的随机对照试验。两位审稿人独立提取文章数据,并使用Cochrane偏倚风险标准评估研究质量。我们使用随机效应模型估计合并效应大小。我们还使用元回归和亚组分析进行了敏感性测试。使用来自20个独特随机对照试验的1624个个体的汇总数据,我们发现与对照条件相比,非药物干预在减轻抑郁症状严重程度方面具有中等到较大的效应(Hedges ' g = 0.714, 95% CI[0.46, 0.97])。这种疗效在短期随访(0至6个月;对冲系数g = 0.23, 95% CI[0.04, 0.49])。虽然有迹象表明这种疗效可以持续更长时间(12个月或更长时间;Hedges的g = 0.53, 95% CI:[- 0.17, 1.22]),这一发现没有统计学意义。认知干预比非认知干预具有更大的效应量。总之,对于有不良童年经历的个体,非药物干预是治疗抑郁症的有效选择。
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引用次数: 3
Dissociating compulsive washing and hoarding tendencies through differences in comorbidities and the content of concerns 通过合并症和关注内容的差异分离强迫性洗涤和囤积倾向
Q3 PSYCHIATRY Pub Date : 2021-12-01 DOI: 10.1016/j.jbct.2021.05.003
Tingting Liu, Joshua M. Ackerman, Stephanie D. Preston

Clinical compulsive washing and hoarding are intercorrelated and share comorbidities even though they are distinct and appear to manifest through opposing extremes of cleanliness and disorder (respectively). We attempted to resolve this paradox by testing five hypotheses in online, non-clinical samples (Nstudy 1 = 123, Nstudy 2 = 177, Nstudy 3 = 217). We replicated the intercorrelation of washing and hoarding tendencies in all studies, despite observing non-clinical individual differences. Both washing and hoarding were associated with anxiety, depression, and fears of social rejection and failure, but they were also distinguishable. Compulsive washing was associated with greater anxiety, disgust, perceptions of infection vulnerability, and the desire to organize a cluttered space, whereas hoarding was associated with reduced concerns about germs and full or cluttered spaces and higher concerns about assault, threats to safety, and insects. A third study tested and confirmed the hypothesis that washing and hoarding may be related because they are adaptive in combination during stressful conditions, like a global pandemic. During COVID-19, washing and hoarding tendencies were even more strongly interrelated, and disease-avoidant behaviors like wearing a mask and avoiding people increased with washing tendencies but decreased with hoarding tendencies. Overlapping psychopathological states can be distinguished even in non-clinical samples through psychopathological profiles and the content of concerns—that shift with one's context. Treatment may benefit from not only working to cease undesirable behaviors but also from ameliorating root fears and anxieties that are dissociable by condition and individual but not always linked to the behavioral expression.

临床强迫性洗涤和囤积是相互关联的,尽管它们是截然不同的,似乎表现为清洁和混乱的对立极端(分别),但它们有共同的合并症。我们试图通过在线非临床样本(Nstudy 1 = 123, Nstudy 2 = 177, Nstudy 3 = 217)检验五个假设来解决这一悖论。尽管观察到非临床个体差异,我们在所有研究中重复了洗涤和囤积倾向的相互关系。洗衣服和囤积都与焦虑、抑郁、害怕社会排斥和失败有关,但它们也是可区分的。强迫性洗涤与更大的焦虑、厌恶、易受感染的感觉以及整理杂乱空间的愿望有关,而囤积与减少对细菌和满或杂乱空间的担忧有关,而与对攻击、安全威胁和昆虫的更高担忧有关。第三项研究测试并证实了洗衣和囤积可能相关的假设,因为它们在压力条件下(如全球大流行)具有适应性。在COVID-19期间,洗涤和囤积倾向之间的相关性更加强烈,戴口罩和躲避人等疾病回避行为随着洗涤倾向的增加而增加,但随着囤积倾向的减少而减少。即使在非临床样本中,重叠的精神病理状态也可以通过精神病理概况和关注的内容来区分-随着一个人的背景而变化。治疗不仅可以从停止不良行为中获益,还可以从改善根源恐惧和焦虑中获益,这些恐惧和焦虑与条件和个人分离,但并不总是与行为表达有关。
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引用次数: 2
Lost in translation? Cultural adaptation of treatment content for Japanese internet-based cognitive therapy for social anxiety disorder 迷失在翻译中?日本基于网络的社交焦虑障碍认知疗法治疗内容的文化适应
Q3 PSYCHIATRY Pub Date : 2021-12-01 DOI: 10.1016/j.jbct.2021.05.004
Naoki Yoshinaga , Graham R. Thew , Osamu Kobori , Yuta Hayashi , David M. Clark

Studies that look to disseminate psychological therapies in different countries often discuss whether and how much cultural adaptation may be required. However, most do not provide sufficient descriptions of how language translation and cultural adaptations were performed, and rarely give examples of specific changes. This makes it hard to understand how much the adapted treatment differs from the original, causing difficulty when comparing studies. This study aimed to describe the translation and cultural adaptation process used to generate a Japanese version of a UK-developed online psychological therapy for social anxiety. It aimed to evaluate the translated and adapted content with a case series of Japanese patients. Following translation and back-translation, incorporating cultural adaptations where appropriate, the new Japanese content was reviewed and a list of adaptations collated and categorised. The Japanese treatment material was then evaluated using a guided self-study approach with six Japanese patients with social anxiety. Four categories of adaptation were identified: Linguistics and Metaphors, Social Systems, Social Behaviours, and Familiarity. Assigning instances of adaptation into these categories showed good interrater reliability (0.78). The Japanese materials showed excellent treatment efficacy (pre-post Hedges’ g = 2.31). Patient feedback highlighted areas of strength, and further suggestions to improve suitability for Japanese settings. The clinical outcomes observed suggest that the translation and adaptation procedures were effective. Ways of further improving the adaptation based on patient feedback were identified. It is hoped that the translation procedure and adaptation categories described in this study may help other clinicians/researchers working to disseminate both online or in-person psychological therapies cross-culturally.

寻求在不同国家传播心理疗法的研究经常讨论是否需要以及在多大程度上需要文化适应。然而,大多数没有提供语言翻译和文化适应是如何进行的充分描述,很少给出具体变化的例子。这使得很难理解改编后的治疗方法与最初的治疗方法有多大不同,这在比较研究时造成了困难。本研究旨在描述翻译和文化适应过程,用于生成英国开发的社交焦虑在线心理治疗的日文版。它旨在通过一系列日本患者的病例来评估翻译和改编的内容。在翻译和反翻译之后,在适当的情况下结合文化改编,审查了新的日语内容,并整理和分类了改编清单。然后对六名日本社交焦虑患者使用指导自学方法对日本治疗材料进行评估。适应分为四类:语言学和隐喻、社会系统、社会行为和熟悉度。将适应实例划分为这些类别显示出良好的判读信度(0.78)。日本材料表现出良好的处理效果(前后Hedges的g = 2.31)。患者反馈强调了优势领域,并提出了进一步的建议,以提高对日本环境的适应性。观察到的临床结果表明,翻译和适应过程是有效的。确定了基于患者反馈进一步改进适应性的方法。希望本研究中描述的翻译程序和适应类别可以帮助其他临床医生/研究人员跨文化传播在线或面对面的心理治疗。
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引用次数: 2
A possible shared dysregulation of sleep and eating in bipolar disorders? 双相情感障碍患者可能存在共同的睡眠和饮食失调?
Q3 PSYCHIATRY Pub Date : 2021-12-01 DOI: 10.1016/j.jbct.2021.08.001
Elaine Tian , Clément Bourguignon , Serge Beaulieu , Kai-Florian Storch , Outi Linnaranta

Problems with sleep and eating are common among patients with a bipolar disorder (BD). While learning to control rhythms is a common and evidence based aim of psychotherapy, no naturalistic study has explored correlations between sleep and eating rhythms. Consenting BD patients (n = 75) completed hourly charts of mood and eating occasions for two weeks. Sleep was calculated based on periods of inactivity derived from actigraphy recordings (≥ 10 days). In addition to conventional sleep onset/offset, we calculated center of daily inactivity [CenDI] as a measure of sleep phasing, and consolidation of inactivity [ConDI] as a measure of sleep fragmentation. The regularity of eating patterns was assessed by quantifying the stability of eating events with regard to timing [ITIM] and intervals [IINT]. Sleep timing variability and fragmentation was robustly associated with eating irregularity, despite several other factors thought to mask this chronobiological association in humans with a psychiatric illness. Future work should confirm whether this relationship is causal, bidirectional and/or consequence of a shared dysregulation. The finding provides a theoretical framework for therapeutic interventions in improving outcome in BD. Our novel dimensional measures for sleep and eating patterns could serve as helpful tools for biofeedback and diagnostic and intervention assessment.

睡眠和饮食问题在双相情感障碍(BD)患者中很常见。虽然学习控制节奏是心理治疗的一个共同目标,也是基于证据的目标,但没有一项自然主义的研究探索了睡眠和饮食节奏之间的相关性。同意BD患者(n = 75)在两周内完成每小时的情绪和饮食情况图表。根据活动记录仪记录的不活动时间(≥10天)计算睡眠时间。除了常规的睡眠开始/偏移,我们还计算了每日不活动中心(CenDI)作为睡眠阶段的衡量标准,以及不活动巩固(ConDI)作为睡眠碎片化的衡量标准。通过量化进食时间(ITIM)和间隔(IINT)的稳定性来评估进食模式的规律性。睡眠时间的可变性和碎片化与饮食不规律密切相关,尽管还有其他一些因素被认为掩盖了精神疾病患者的这种时间生物学关联。未来的工作应该确认这种关系是否是因果关系、双向关系和/或共同失调的结果。这一发现为改善双相障碍的治疗干预提供了理论框架。我们对睡眠和饮食模式的新维度测量可以作为生物反馈、诊断和干预评估的有用工具。
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引用次数: 1
Susceptibility to eating disorders is associated with cognitive inflexibility in female university students 女大学生饮食失调易感性与认知不灵活性相关
Q3 PSYCHIATRY Pub Date : 2021-12-01 DOI: 10.1016/j.jbct.2021.05.002
Corrado Caudek , Claudio Sica , Silvia Cerea , Ilaria Colpizzi , Debora Stendardi

The inability to learn from and adapt to changing feedback in our environment may be etiologically linked to eating disorders (EDs). However, previous investigations on this issue have shown conflicting results. In the current study with a non-clinical sample of female students, we investigated the relation between cognitive inflexibility (CI) and vulnerability to EDs by using a modified version of the probabilistic reversal learning (PRL) task, which requires participants to adapt their response strategy according to changes in stimulus-reward contingencies. We found that females vulnerable to EDs in the general population showed an impaired PRL performance, also after controlling for comorbidity. However, our results also show that the ED construct comprises separate dimensions, which affect contingency learning in opposite manners: some individuals vulnerable to EDs showed impaired contingency learning; others used unimpaired contingency learning skills to pursue self-harming goals. Such results point to the necessity of an appropriate assessment of CI in order to better apply individualized treatment.

无法从环境中不断变化的反馈中学习和适应可能与饮食失调(EDs)的病因有关。然而,先前对这一问题的调查显示出相互矛盾的结果。本研究以非临床女生为研究对象,采用改进后的概率逆转学习(PRL)任务,研究认知不灵活性(CI)与EDs易感性之间的关系,PRL任务要求参与者根据刺激-奖励偶然性的变化调整自己的反应策略。我们发现,在控制了合并症后,普通人群中易患ed的女性的PRL表现也受到损害。然而,我们的研究结果也表明,ED结构包括不同的维度,它们以相反的方式影响权变学习:一些易受ED影响的个体表现为权变学习受损;其他人则使用未受损的应急学习技能来追求自我伤害的目标。这些结果表明,为了更好地应用个体化治疗,有必要对CI进行适当的评估。
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引用次数: 0
期刊
Journal of Behavioral and Cognitive Therapy
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