Behaviour Research and Therapy最新文献_第10页

Mechanisms of change in cognitive functional therapy: A longitudinal mediation analysis of the RESTORE clinical trial for disabling chronic low back pain 认知功能治疗改变的机制：对慢性腰痛致残RESTORE临床试验的纵向中介分析

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-09-03 DOI: 10.1016/j.brat.2025.104853

Robert Schütze , Bernard Liew , J.P. Caneiro , Peter O'Sullivan , Peter Kent , Mark Hancock , Jan Hartvigsen , Kieran O'Sullivan , Alison McGregor , Amity Campbell , Stephanie Attwell , Anne Smith

Chronic low back pain (CLBP) is an urgent global health priority given its high prevalence and impact as the leading cause of disability. While several efficacious treatments exist, most have modest effects. Improving outcomes requires a better understanding of treatment mechanisms to enable optimisation. This study explored the mechanisms of cognitive functional therapy (CFT), a biopsychosocial intervention with large, durable effects for adults with disabling CLBP. A longitudinal mediation analysis was performed on data from the RESTORE multisite clinical trial comparing CFT (n = 327) to usual care (n = 165). Mediators (self-efficacy, fear, catastrophising, and pain intensity) were specified based on behavioural theories underlying CFT and previous research. The joint mediation of treatment effects on disability (Roland Morris Disability Questionnaire) and pain intensity (numerical rating scale), were examined using a counterfactual framework for mediation analysis. As hypothesised, earlier changes in self-efficacy, fear, catastrophising, and pain intensity mediated improvements in disability at the end of treatment and at 12-month follow-up, explaining up to 61 % of the effect. Similarly, self-efficacy, fear, and catastrophising mediated the effect of CFT on pain intensity, explaining up to 62 % of the effect. Results are consistent with previous CLBP mediation research highlighting self-efficacy, fear, and catastrophising as likely common mechanisms among effective biopsychosocial treatments. CFT demonstrates large, durable, and clinically important effects on these mechanisms. Findings shed light for clinicians and researchers on how CFT works, although the role of other mechanisms such as movement changes requires further exploration, along with research analysing how different treatment components activate these mechanisms.

慢性腰痛（CLBP）是一个紧迫的全球卫生优先事项，因为它的高患病率和影响作为残疾的主要原因。虽然有几种有效的治疗方法，但大多数效果一般。改善结果需要更好地了解治疗机制以实现优化。本研究探讨了认知功能治疗（CFT）的机制，这是一种对成人致残性CLBP具有大而持久效果的生物心理社会干预。对RESTORE多地点临床试验的数据进行纵向中介分析，比较CFT （n = 327）和常规治疗（n = 165）。调节因子（自我效能、恐惧、灾难化和疼痛强度）是根据CFT的行为理论和先前的研究来指定的。采用反事实框架进行中介分析，考察了治疗效果对残疾（Roland Morris残疾问卷）和疼痛强度（数值评定量表）的联合中介作用。正如假设的那样，在治疗结束和12个月的随访中，自我效能、恐惧、灾难和疼痛强度的早期变化介导了残疾的改善，解释了高达61%的效果。同样，自我效能、恐惧和灾难化介导了CFT对疼痛强度的影响，解释了高达62%的影响。结果与先前的CLBP调解研究一致，强调自我效能、恐惧和灾难化可能是有效的生物心理社会治疗中的共同机制。CFT对这些机制具有巨大、持久和重要的临床作用。研究结果为临床医生和研究人员揭示了CFT的工作原理，尽管其他机制（如运动变化）的作用需要进一步探索，以及分析不同治疗成分如何激活这些机制的研究。

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引用次数: 0

A multilevel machine learning algorithm to predict session-by-session outcome for patients receiving cognitive-behavioural therapy 一种多层机器学习算法，用于预测接受认知行为治疗的患者的每次治疗结果

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-09-03 DOI: 10.1016/j.brat.2025.104848

Juan Martín Gómez Penedo , Alice E. Coyne , Manuel Meglio , Marjolein Fokkema , Rebekka Wassmann , Wolfgang Lutz , Julian Rubel

Aims

New innovations in predictive models, such as machine learning, could enhance the effectiveness of measurement-based care systems by generating more accurate session-by-session psychotherapy outcome predictions. In this study, we developed a tree-based model that integrates the strengths of multilevel and machine learning models to predict patients’ trajectories of clinical improvement during cognitive-behavioural therapy (CBT).

Methods

We used a sample of 1008 outpatients who were treated at a CBT university clinic in Germany. The total sample was randomly divided into a training (2/3 of the sample) and a test (remaining 1/3) set. Grounded on patient demographic and clinical information at baseline, we developed a generalized linear mixed model tree algorithm to predict patients' session-by-session outcome change during the first ten sessions. Results: The best-fitting model in the training set identified 10 groups of patients based on their presenting characteristics and improvement trajectories. In the test set, the algorithm resulted in a correlation of 0.65 between the observed and predicted values for the outcome variable (cross-validation R² = 0.42). Developing failure boundaries based on the tree-based approach allowed us to correctly identify 67.6 % of the test set patients who did not reliably improve within the first 15 sessions of treatment. Discussion: This study provides preliminary support for the integration of multilevel and machine learning models via generalized linear mixed model trees. The algorithms developed could help support routine implementation of precision mental health care strategies by informing therapists’ treatment planning and session-by-session responsiveness for different patient subgroups.

预测模型的新创新，如机器学习，可以通过产生更准确的心理治疗结果预测来提高基于测量的护理系统的有效性。在这项研究中，我们开发了一个基于树的模型，该模型整合了多层次和机器学习模型的优势，以预测患者在认知行为治疗（CBT）期间的临床改善轨迹。方法采用1008例在德国一所CBT大学诊所接受治疗的门诊患者作为样本。总样本随机分为训练集（样本的2/3）和测试集（剩余的1/3）。基于基线的患者人口统计和临床信息，我们开发了一种广义线性混合模型树算法来预测患者在前10次治疗期间每次治疗的结果变化。结果：训练集中的最佳拟合模型根据患者的表现特征和改善轨迹确定了10组患者。在测试集中，该算法得出结果变量的观测值与预测值之间的相关系数为0.65（交叉验证R2 = 0.42）。基于基于树的方法开发的失败边界使我们能够正确识别在前15次治疗中没有可靠改善的67.6%的测试集患者。讨论：本研究通过广义线性混合模型树为多层模型和机器学习模型的集成提供了初步支持。所开发的算法可以通过告知治疗师的治疗计划和对不同患者亚组的逐次响应，帮助支持精确精神卫生保健策略的常规实施。

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引用次数: 0

Corrigendum to "Intolerance of uncertainty enhances adolescent fear generalization in both perceptual-based and category-based tasks: fNIRS studies" [Behaviour Research and Therapy 183 (2024) 104650]. “对不确定性的不容忍增强了青少年在基于感知和基于类别的任务中的恐惧泛化：fNIRS研究”[行为研究与治疗183(2024)104650]的更正。

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-09-01 Epub Date: 2025-07-03 DOI: 10.1016/j.brat.2025.104811

Xiao Zhou, Lihui Huang, Benjamin Becker, Haoran Dou, Jinxia Wang, Xukai Zhang, Ying Mei, Hong Li, Yi Lei

引用次数: 0

Introduction to special issue honoring Dianne L. Chambless (1948-2023). 纪念黛安娜·l·钱伯斯（1948-2023）的特刊简介。

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-09-01 Epub Date: 2025-07-09 DOI: 10.1016/j.brat.2025.104822

Alyson K Zalta, Thomas Rodebaugh, Jedidiah Siev

引用次数: 0

Identifying the active ingredients of cognitive-behavioural therapy: Conceptualisation, methods and evidence. 识别认知行为疗法的有效成分：概念化、方法和证据。

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-09-01 Epub Date: 2025-06-10 DOI: 10.1016/j.brat.2025.104802

Edward R Watkins

引用次数: 0

Extinction learning and return of fear in a large sample of children and adolescents with and without anxiety disorders 在有和没有焦虑症的儿童和青少年的大样本中，消除学习和恐惧的回归

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-08-30 DOI: 10.1016/j.brat.2025.104850

Tabea Flasinski , Silvia Schneider , Verena Pflug , Michael W. Lippert , Jürgen Margraf , Hanna Christiansen , Alfons O. Hamm , Tina In-Albon , Susanne Knappe , Jan Richter , Marcel Romanos , Brunna Tuschen-Caffier , Dirk Adolph

Anxiety disorders are the most prevalent mental health problems in childhood and adolescence, highlighting the importance to study their underlying mechanisms. One key process in fear reduction, particularly in exposure-based cognitive behavioral therapy, is extinction learning. While extensively studied in adults, its role in youth remains underexplored. The aim of the present study was to examine fear extinction learning and return of fear in a large sample of children and adolescents (N = 274; age range 8–16 years, M = 11.07, SD = 2.22; 55.8 % female) with separation anxiety disorder, social anxiety disorder, and specific phobia (n = 217) in comparison to non-anxious controls (n = 57). All children participated in a 2-day fear conditioning paradigm. Fear acquisition, extinction, and reinstatement were assessed using subjective (valence, arousal, contingency) and psychophysiological (startle) indicators of emotional reactivity. Successful differential fear acquisition could be observed in both groups. Extinction learning was also successful as the fear response to the CS+ decreased. Contradicting previous findings suggesting impairment in extinction in children with anxiety disorders, we could not find differences in fear extinction learning between anxious and non-anxious children and adolescents; both groups learned to inhibit their fear response when the CS+ no longer predicted the occurrence of the aversive outcome. Further research is needed to disentangle the role of fear extinction learning within childhood anxiety disorders and determine whether children with anxiety disorders generally do not show deficits in extinction learning or whether this deficit is limited to disorder specific stimuli.

焦虑障碍是儿童和青少年最普遍的心理健康问题，因此研究其潜在机制非常重要。减少恐惧的一个关键过程，特别是在基于暴露的认知行为疗法中，是消退学习。虽然在成人中进行了广泛的研究，但其在青少年中的作用仍未得到充分探讨。本研究的目的是在一个大样本的儿童和青少年（N = 274；年龄范围8-16岁，M = 11.07, SD = 2.22； 55.8%女性）分离焦虑障碍，社交焦虑障碍和特定恐惧症（N = 217）与非焦虑对照组（N = 57）的比较中检验恐惧消退学习和恐惧回归。所有儿童都参加了为期两天的恐惧条件反射范式。使用情绪反应的主观（效价、唤醒、偶然性）和心理生理（惊吓）指标评估恐惧获得、消退和恢复。两组均可观察到成功的差异恐惧习得。随着对CS+的恐惧反应的减少，灭绝学习也取得了成功。与先前的研究结果相反，我们没有发现焦虑儿童和非焦虑儿童和青少年在恐惧消退学习方面存在差异；当CS+不再预测厌恶结果的发生时，两组都学会了抑制他们的恐惧反应。需要进一步的研究来解开恐惧消退学习在儿童焦虑障碍中的作用，并确定患有焦虑障碍的儿童是否通常没有表现出消退学习的缺陷，或者这种缺陷是否仅限于障碍特定的刺激。

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引用次数: 0

A pilot randomized controlled trial of cognitive restructuring for PTSD and alcohol misuse following recent sexual assault: Initial efficacy and feasibility 近期性侵后PTSD和酒精滥用认知重构的随机对照试验：初步疗效和可行性

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-08-28 DOI: 10.1016/j.brat.2025.104847

Michele A. Bedard-Gilligan , Cynthia A. Stappenbeck , Heidi J. Ojalehto , Emily R. Dworkin , Jennifer M. Cadigan , Tracy Simpson , Debra L. Kaysen

Sexual assault is a pervasive problem, particularly for US college women. Although many recover naturally, a significant minority develop posttraumatic stress disorder (PTSD) or alcohol misuse. Intervening acutely can prevent chronic psychopathology from developing. This study tested the efficacy of a newly developed one-session + four coaching call intervention (BRITE) adapted from Cognitive Processing Therapy (CPT), an evidence-based treatment for chronic PTSD. Individuals over 18, who identified as female, with symptoms of PTSD and alcohol misuse were recruited within 10 weeks of sexual assault for a RCT comparing BRITE to symptom monitoring. Participants (N = 57) were young (M = 21.63 years) and predominately White (61.4 %). PTSD and alcohol use were assessed at baseline, weekly for 5 weeks, and at 3-month follow-up by masked evaluators. Participants assigned to BRITE reported significantly less PTSD symptoms (d = 2.69; 95 % CI: 1.92, 3.45) than symptom monitoring (d = 1.19; 95 % CI: 0.59, 1.79), when comparing baseline vs. 3-month follow-up. For alcohol misuse, participants reported fewer drinks per drinking day from baseline to 3-month follow-up in BRITE (d = 0.63 (95 % CI: 0.05, 1.20) and symptom monitoring (d = 0.13; 95 % CI: −0.42, 0.69) although the group difference was not significant. There was a similar pattern for other alcohol use outcomes (i.e., heavy episodic drinking frequency, alcohol use consequences). Pilot findings support this newly developed, brief, and accessible cognitive approach for promoting acute recovery with a vulnerable population.

Clinical trials registration

NCT02808468.

性侵犯是一个普遍存在的问题，尤其是对美国女大学生而言。尽管许多人会自然康复，但有相当一部分人会患上创伤后应激障碍（PTSD）或酒精滥用。急性干预可以预防慢性精神病理的发展。本研究测试了一种新开发的一疗程+四次辅导电话干预（BRITE）的疗效，该干预方法改编自认知处理疗法（CPT），是一种治疗慢性创伤后应激障碍的循证疗法。在性侵犯发生后的10周内，研究人员招募了18岁以上、有创伤后应激障碍和酒精滥用症状的女性，进行了一项比较BRITE和症状监测的随机对照试验。参与者（N = 57）为年轻人（M = 21.63岁），主要为白人（61.4%）。创伤后应激障碍和酒精使用在基线、每周5周和3个月的随访中由匿名评估者进行评估。与基线和3个月随访相比，BRITE组的受试者报告的PTSD症状（d = 2.69; 95% CI: 1.92, 3.45）明显少于症状监测组（d = 1.19; 95% CI: 0.59, 1.79）。对于酒精滥用，受试者报告从基线到3个月的BRITE随访(d = 0.63 （95% CI: 0.05, 1.20）和症状监测（d = 0.13; 95% CI: - 0.42, 0.69）中每天饮酒的饮酒量减少，尽管组间差异不显著。其他酒精使用结果也有类似的模式（即，严重的间歇性饮酒频率，酒精使用后果）。试点结果支持这种新开发的、简短的、可访问的认知方法，以促进弱势群体的急性康复。临床试验注册编号nct02808468。

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引用次数: 0

The effect of behavioral rehearsal in the training of clinical psychology students in cognitive therapy for social anxiety disorder: A randomized controlled trial 行为预演在临床心理学学生社交焦虑障碍认知治疗训练中的效果：一项随机对照试验

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-08-26 DOI: 10.1016/j.brat.2025.104849

Jon Fauskanger Bjaastad , Kjersti Lillevoll , Asle Hoffart , Toril Sørheim Nilsen , Jane Kjoteroe , Peter Prescott , Jan Ivar Røssberg , David M. Clark , Kitty Dahl , Catharina Elisabeth Arfwedson Wang , Veronica Lorentzen

Objective

The present study investigated the effects of including behavioural rehearsal (i.e., expert demonstration followed by role-playing treatment components) in the training of clinical psychology students in cognitive therapy for social anxiety disorder.

Method

A randomized controlled design was used where fifth year clinical psychology students (N = 94, M age = 26.2 years, SD = 3.81) were randomized to behavioural rehearsal or a bona fide control training condition (expert demonstration and discussions), as part of a 16-h training course in cognitive therapy for social anxiety disorders. Videotapes (N = 94) of participants role-playing therapists after training were rated for therapist competence (primary outcome measured by three competence variables) by raters who were unaware of the training condition allocation. Secondary outcomes (therapists’ self-efficacy, therapist worry levels and satisfaction with training) were collected by self-report at post-training and at 6-month follow-up.

Results

Participants in the behavioural rehearsal condition achieved higher competence scores compared to the control condition. Differences between groups were found for all three competence variables, with large effect sizes (d = 1.23–1.40, 95 % CI [.78, 1.85]). Large between-group effect sizes were also found for all individual items of competence (d = .80–1.22, 95 % CI [.38, 1.66]). No effects were found for secondary outcomes.

Conclusions

The results suggest that inclusion of behavioural rehearsal in training leads to higher competence among clinical psychology students when delivering cognitive therapy for social anxiety disorder. Training providers should consider incorporating behavioural rehearsal in cognitive therapy training.

目的探讨行为预演（专家示范+角色扮演治疗）在临床心理学专业学生社交焦虑障碍认知治疗训练中的效果。方法采用随机对照设计，将临床心理学五年级学生（N = 94， M年龄= 26.2岁，SD = 3.81）随机分为行为排练和真实对照训练条件（专家演示和讨论），作为16小时社交焦虑障碍认知治疗培训课程的一部分。参与者在训练后扮演治疗师的录像带（N = 94）由不知道训练条件分配的评分者评定治疗师的能力（主要结果由三个能力变量衡量）。次要结果（治疗师的自我效能感、焦虑水平和培训满意度）在培训后和6个月随访时通过自我报告收集。结果行为预演条件下被试的胜任力得分高于对照组。三个能力变量均存在组间差异，且效应量较大（d = 1.23-1.40, 95% CI）。78年,1.85])。所有能力单项的组间效应量也很大（d = 0.80 - 1.22, 95% CI）。38岁,1.66])。未发现对次要结局有影响。结论临床心理学专业学生在进行社交焦虑障碍认知治疗时，将行为预演纳入训练可提高其能力。培训提供者应考虑将行为预演纳入认知治疗培训。

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引用次数: 0

Unpaired unconditional stimuli during fear extinction at full and reduced intensity reduce re-acquisition 在恐惧完全消退和强度降低时，非配对无条件刺激会减少再习得

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-08-24 DOI: 10.1016/j.brat.2025.104846

Ottmar V. Lipp , Luke J. Ney , Camilla C. Luck , Allison M. Waters , Michelle G. Craske

Presenting unpaired unconditional stimuli (US) during extinction has been shown to reduce the contextual renewal of conditional fear and to slow re-acquisition. The present study investigated whether this reduced return of fear is also observed if the intensity of the US presented during extinction is lower than that presented during acquisition. Three groups of participants (N = 121) were trained in a differential fear conditioning procedure that employed habituation, acquisition, extinction, renewal test, and re-acquisition phases. To induce renewal, the context was changed during extinction training in an ABA design. Group Standard received no US presentations during extinction training whereas group Unpaired received five unpaired USs during extinction at the physical intensity used during acquisition. The intensity of the unpaired USs was halved in group Reduced. Electrodermal responses in the three groups did not differ during habituation, acquisition, extinction or the renewal test where no renewal was observed in any group. However, significant differential electrodermal responses were observed on the first block of re-acquisition training after standard extinction, but not after unpaired extinction regardless of US intensity. This suggests that unpaired US presentations can strengthen extinction learning even if presented at a reduced intensity. This finding opens the possibility of translating the unpaired US extinction approach into applied settings.

在灭绝期间呈现不配对的无条件刺激（US）已被证明可以减少条件恐惧的情境更新并减缓重新获得。本研究调查了如果在消失期间呈现的美国强度低于在获得期间呈现的强度，是否也会观察到这种减少的恐惧回归。三组参与者（N = 121）接受了不同恐惧条件反射程序的训练，包括习惯化、习得、消退、更新测试和再习得阶段。为了诱导更新，在ABA设计中，在消光训练期间改变上下文。标准组在消光训练期间没有接受任何美国演示，而未配对组在消光训练期间以习得期间使用的物理强度接受了5个未配对的美国演示。未配对的USs强度在减少组减半。在习惯化、获得、消失或更新测试中，三组的皮肤电反应没有差异，在任何组中都没有观察到更新。然而，在标准消失后的第一个区域观察到显著差异的皮肤电反应，而在非配对消失后，无论美国强度如何，都没有观察到显著差异。这表明，即使以较低的强度呈现，未配对的美国呈现也能加强消退学习。这一发现开启了将非配对美国灭绝方法转化为应用环境的可能性。

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引用次数: 0

Extinction, avoidance, and generalization: Fear learning processes and their relations with anxious and depressive traits 消退、回避和泛化：恐惧学习过程及其与焦虑和抑郁特征的关系

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-08-22 DOI: 10.1016/j.brat.2025.104841

Lu Leng , Tom Beckers , Bram Vervliet

Research shows anxious individuals exhibit slower extinction (EXT), more avoidance (AVO), and broader generalization (GEN) in Pavlovian fear conditioning, potentially contributing to maladaptive anxiety (chronic, avoidant, overgeneralized). However, studies typically focused on one of these processes, it remains unclear (1) whether the deficits in each process reflect separate or the same vulnerability factors; (2) whether deficits in any of these processes is more detrimental; (3) whether deficits in these processes cluster into distinct profiles that form an unique detrimental factor. Additionally, despite the high comorbidity rate with anxiety, the role of depression in these processes is surprisingly understudied. The current study tested EXT-AVO-GEN processes in the same individuals measuring both anxiety and depressive traits. To avoid the arbitrary selection of any indices for EXT-AVO-GEN processes, multiple index operationalizations were employed to ensure robust findings. Results showed small to no correlations, both among EXT-AVO-GEN processes and their correlations with personality characteristics. Cluster analysis identified no distinct profiles, and if such profiles were nonetheless forced to emerge, they were not associated with the anxious or depressive traits. According to these findings, EXT-AVO-GEN are likely to be independent processes and their deficits seem to have different underlying drivers. Therefore, studying EXT-AVO-GEN processes in combination may not offer additional comprehension about pathological fear development. Linear mixed-effects models, however, revealed stronger correlations between EXT-AVO-GEN and anxiety/depression, suggesting that they may be more sensitive in detecting individual differences compared to indices, as they capture trial-by-trial dynamics, which indices often fail to fully account for.

研究表明，焦虑个体在巴甫洛夫恐惧条件反射中表现出较慢的消退（EXT）、更多的回避（AVO）和更广泛的泛化（GEN），这可能导致适应不良焦虑（慢性、回避型、过度泛化）。然而，研究通常集中在这些过程中的一个，目前尚不清楚(1)每个过程中的缺陷是否反映了单独或相同的脆弱性因素；(2)这些过程中的缺陷是否更有害；(3)这些过程中的缺陷是否聚集成不同的轮廓，形成独特的有害因素。此外，尽管焦虑的合并症发生率很高，但令人惊讶的是，抑郁在这些过程中的作用尚未得到充分研究。目前的研究测试了同一个人的ext - avoo - gen过程，同时测量了焦虑和抑郁特征。为了避免任意选择EXT-AVO-GEN过程的任何指标，采用了多个指标操作化来确保稳健的结果。结果显示，EXT-AVO-GEN过程及其与人格特征的相关性很小或没有相关性。聚类分析没有发现明显的特征，即使这些特征是被迫出现的，它们也与焦虑或抑郁特征无关。根据这些发现，EXT-AVO-GEN可能是独立的过程，它们的缺陷似乎有不同的潜在驱动因素。因此，联合研究EXT-AVO-GEN过程可能无法提供对病理性恐惧发展的额外理解。然而，线性混合效应模型揭示了ext - avoo - gen与焦虑/抑郁之间更强的相关性，这表明与指数相比，它们在检测个体差异方面可能更敏感，因为它们捕获了逐个试验的动态，而指数通常无法完全解释这一点。

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引用次数: 0