Behaviour Research and Therapy最新文献_第7页

The unique impacts of attentional control and experiential avoidance on PTSD symptomatology: Moderation of nonlinear effects 注意控制和经验回避对PTSD症状的独特影响：非线性效应的调节。

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-12-01 Epub Date: 2025-11-02 DOI: 10.1016/j.brat.2025.104908

Lucas Marinack, Alexandria F. Sowers, Robert A. Kaya, Alicia R. Bachtel, Jenna L. Mohr, Joshua D. Clapp

Whereas attentional control has been proposed as a broad-based protective factor for PTSD, data suggest that elevated control may be paradoxically associated with increased symptoms, particularly in the presence of other risk factors. The current study examined the unique and interactive effects of attentional shifting (i.e., the transfer of attention across stimuli) and attentional focusing (i.e., the maintenance of attention on relevant targets) with experiential avoidance on posttrauma symptom clusters, accounting for potential nonlinearities in the influence of shifting and focusing dimensions. Shifting models in survivors of heterogeneous trauma (N = 252; 75 % female; 85.7 % White/Non-Hispanic) identified shifting as a moderator of the linear effect of experiential avoidance on CAPS-5 arousal-reactivity (β = −.16, p = .008), with experiential avoidance holding positive associations with arousal-reactivity through shifting scores reaching 2/3SD above the mean. Focusing models, by contrast, identified experiential avoidance as a moderator of the quadratic effect (x²) of focusing on CAPS-5 intrusions (β = .13, p = .010). Data failed to support effects of focusing at low levels of experiential avoidance (-1SD). A curvilinear effect of focusing emerged at average experiential avoidance, however, suggesting reductions in traumatic intrusions with increased focusing to mean values in the sample. At high experiential avoidance (+1SD), intrusions decreased with increases in focusing through average levels, but rebounded in response to focusing capabilities extending beyond the sample mean. Results are consistent with previous research suggesting nonlinearities in the effects of attentional control on posttrauma functioning and point to the importance of specific attentional processes in understanding avenues of risk and resilience.

虽然注意力控制被认为是创伤后应激障碍的一个广泛的保护因素，但数据表明，控制水平的提高可能与症状的增加相矛盾，特别是在存在其他风险因素的情况下。目前的研究考察了注意转移（即跨刺激的注意转移）和注意聚焦（即对相关目标的注意维持）与经验回避对创伤后症状集群的独特和相互作用，说明了转移和聚焦维度影响的潜在非线性。异质性创伤幸存者的移位模型（N = 252； 75%为女性；85.7%为白人/非西班牙裔）发现移位是经验回避对cap -5唤醒反应性线性效应的调节因子（β = - 0.16, p = 0.008），通过移位得分高于平均值2/3SD，经验回避与唤醒反应性保持正相关。相比之下，聚焦模型发现，经验回避是聚焦于cap -5入侵的二次效应（x2）的调节因子（β = 0.13, p = 0.010）。数据无法支持低水平的经验回避（-1SD）下的聚焦效应。然而，在平均经验回避中出现了聚焦的曲线效应，这表明随着样本中聚焦的增加，创伤性侵入的减少达到了平均值。在高经验回避（+1SD）水平下，干扰随着聚焦能力的增加而减少，但当聚焦能力超出样本平均值时，干扰会反弹。结果与先前的研究一致，表明注意控制对创伤后功能的影响呈非线性，并指出了特定注意过程在理解风险和恢复途径中的重要性。

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引用次数: 0

Changing maladaptive trauma-related cognitions and emotional activation during trauma-focused cognitive behavior therapy: Thematic content and relationships with posttraumatic stress symptoms 在以创伤为中心的认知行为治疗中改变适应不良的创伤相关认知和情绪激活：主题内容及其与创伤后应激症状的关系

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-12-01 Epub Date: 2025-11-05 DOI: 10.1016/j.brat.2025.104910

Marianne Skogbrott Birkeland , Silje Mørup Ormhaug , Adele M. Hayes , Tine K. Jensen

Background

Changing maladaptive trauma-related cognitions may be crucial in trauma-focused cognitive behaviour therapy (TF-CBT). We identified common maladaptive cognitions during TF-CBT's trauma narration and processing phase and examined their relationship with trauma type and post-traumatic stress symptoms (PTSS). We also assessed whether maladaptive trauma-related cognitions (overgeneralization, assimilation), more balanced and functional cognitions (accommodation), and negative emotions during this phase of TF-CBT were associated with PTSS.

Methods

Adolescents exposed to multiple types of traumas (N = 87, mean age = 15.8 years, 78.3 % girls) received TF-CBT. The Change and Growth Experiences (CHANGE) coding system measured maladaptive trauma-related cognitions, accommodated beliefs, and negative emotions during the trauma narration and processing phase. We then categorized the maladaptive cognitions from the CHANGE coding according to predefined topics. Mixed-effects analyses were used to assess relationships between maladaptive cognitions, accommodation, in-session negative emotion, and PTSS.

Results

Maladaptive trauma-related cognitions primarily concerned trust, esteem, and guilt. Sexual violence was associated with trust, esteem, intimacy, and guilt cognitions. Trust and esteem-related cognitions significantly predicted higher levels of PTSS at posttreatment. Higher levels of maladaptive cognitions and negative in-session emotion also predicted higher posttreatment PTSS. Low in-session negative emotion appeared to amplify the negative impact of maladaptive cognitions on PTSS at posttreatment. Accommodation showed no association with PTSS.

Conclusions

Maladaptive trauma-related cognitions, particularly related to trust and esteem, were common and associated with higher levels of PTSS at posttreatment. Low emotional engagement during trauma processing may potentiate the negative effects of maladaptive cognitions on PTSS. Results suggest both emotional processing and cognitive change are important treatment pathways for youth with PTSS.

背景：改变不适应的创伤相关认知可能是创伤聚焦认知行为治疗（TF-CBT）的关键。我们确定了TF-CBT创伤叙述和处理阶段常见的适应不良认知，并研究了它们与创伤类型和创伤后应激症状（PTSS）的关系。我们还评估了在TF-CBT的这一阶段，与创伤相关的不适应认知（过度概括、同化）、更平衡和功能性的认知（适应）以及负面情绪是否与创伤后应激障碍有关。方法：多类型创伤暴露青少年（87例，平均年龄15.8岁，78.3%为女孩）接受TF-CBT治疗。变化与成长体验（Change）编码系统测量创伤叙事和加工阶段的创伤相关认知、适应信念和负面情绪。然后，我们根据预定义的主题对CHANGE编码中的不良认知进行分类。混合效应分析用于评估不适应认知、适应、会话中的负面情绪和创伤后应激障碍之间的关系。结果：创伤相关认知适应不良主要涉及信任、尊重和内疚。性暴力与信任、尊重、亲密和内疚认知有关。信任和自尊相关认知显著预测治疗后ptsd水平升高。更高水平的适应不良认知和负面情绪也预示着更高的治疗后创伤后应激障碍。治疗过程中的低负性情绪似乎放大了治疗后ptsd患者适应不良认知的负性影响。住宿与ptsd无关联。结论：与创伤相关的认知适应不良，特别是与信任和尊重相关的认知，是常见的，并且与治疗后较高水平的创伤后应激障碍有关。创伤处理过程中的低情绪投入可能会增强创伤后应激障碍患者适应不良认知的负面影响。结果表明情绪加工和认知改变是青少年创伤后应激障碍的重要治疗途径。

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引用次数: 0

Joy beyond fear: Positive emotions after exposure in patients with anxiety disorders and their link to threat expectancy and treatment outcome 超越恐惧的快乐：焦虑障碍患者暴露后的积极情绪及其与威胁预期和治疗结果的联系

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-12-01 Epub Date: 2025-09-30 DOI: 10.1016/j.brat.2025.104880

Thomas Borchert , Ingmar Heinig , Volker Arolt , Christina Bartnick , Udo Dannlowski , Jürgen Deckert , Katharina Domschke , Thomas Fydrich , Stephan Goerigk , Alfons O. Hamm , Maike Hollandt , Jürgen Hoyer , Tilo Kircher , Katja Koelkebeck , Ulrike Lueken , Jürgen Margraf , Peter Neudeck , Paul Pauli , Jan Richter , Winfried Rief , Andre Pittig

Exposure-based CBT is effective in treating anxiety disorders, but individual responses vary substantially, underlining the need to identify and boost mechanisms underlying exposure. In this study, the role of positive emotions occurring after exposure was examined. In an analysis of 8416 exposure records of 648 anxiety patients undergoing exposure therapy, the degree of positive emotions hope and joy occurring after exposure exercises, their predictors, and their role regarding treatment success were investigated. Positive emotions after exposure were medium to high and increased slightly across repeated exposure exercises. They were associated with exposure-related learning indicators (i.e., expectancy violation and change as well as the prediction-error learning rate) and were mainly predicted by adjusted threat expectancy assessed after completing exposure, controlling for baseline depressive symptoms and affect. Higher positive emotions independently predicted better treatment outcome beyond learning indicators, and partially mediated the association between learning indicators and treatment outcome. These findings indicate that positive emotions are partly associated with successful learning during exposure but seem to have a unique contribution to overall treatment success, underlining the need to strengthen positive emotions via different possible means.

基于暴露的CBT在治疗焦虑症方面是有效的，但个体的反应差异很大，这强调了识别和促进暴露机制的必要性。本研究考察了暴露后积极情绪的作用。通过对648例接受暴露治疗的焦虑患者的8416份暴露记录的分析，探讨了暴露练习后出现的积极情绪、希望和喜悦的程度、影响因素及其对治疗成功的作用。暴露后的积极情绪是中等到高的，在重复的暴露练习中略有增加。它们与暴露相关的学习指标（即期望违反和改变以及预测错误学习率）有关，主要通过完成暴露后评估的调整威胁期望来预测，控制基线抑郁症状和影响。高的积极情绪独立地预测了学习指标之外更好的治疗结果，并部分介导了学习指标与治疗结果之间的关联。这些发现表明，积极情绪在一定程度上与暴露期间的成功学习有关，但似乎对整体治疗成功有独特的贡献，强调了通过不同可能的手段加强积极情绪的必要性。

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引用次数: 0

Positive emotion up-regulation in the wake of a cognitively demanding task: An event-related potential study 认知要求任务后的积极情绪上调：一项事件相关电位研究。

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-12-01 Epub Date: 2025-11-12 DOI: 10.1016/j.brat.2025.104920

Tara Driskill , Brandon K. Watanabe , Annmarie MacNamara

Although positive emotion up-regulation via reappraisal increases electrocortical and subjective response to pictures, little is known about how situational factors may moderate its success. For instance, emotion regulation must at times be performed shortly after a cognitively demanding event. Here, we set out to determine whether positive emotion up-regulation would be compromised if performed after a difficult math task (hard math; n = 39) versus after an easy math task (easy math; n = 39). After randomly assigning participants to groups, we assessed reappraisal's effectiveness using the late positive potential (LPP) as a measure of picture salience and picture ratings. Results showed that positive emotion up-regulation via reappraisal was unaffected by math difficulty. Nonetheless, participants who had just completed a hard math task showed smaller LPPs overall, compared to those who had completed the easy math task. In contrast to prior work, across both math groups, reappraisal was only effective for neutral and not positive pictures. Therefore, recent prior cognitive demand does not appear to compromise reappraisal of neutral pictures, yet it remains possible that any recent demanding task (i.e., either high or low load) may compromise up-regulation for stimuli that are closer to ceiling – i.e., positive stimuli. Results are discussed in the context of a situation-specific approach to emotion regulation and the utility of positive emotion up-regulation in everyday life. Findings also suggest possible a mechanism underlying blunted response to stimuli, as has been observed in some forms of internalizing psychopathology.

虽然通过重新评价的积极情绪上调增加了皮层电反应和对图片的主观反应，但关于情境因素如何调节其成功却知之甚少。例如，情绪调节有时必须在认知要求较高的事件发生后不久进行。在这里，我们着手确定在完成困难的数学任务（难数学，n = 39）和简单的数学任务（容易数学，n = 39）后进行的积极情绪上调是否会受到损害。在将参与者随机分配到小组后，我们使用晚期正电位（LPP）作为图像显著性和图像评级的测量来评估重评价的有效性。结果表明，通过重评价的正向情绪上调不受数学难度的影响。尽管如此，与完成简单数学任务的参与者相比，刚刚完成困难数学任务的参与者总体上表现出较小的lpp。与之前的研究相反，在两个数学组中，重新评价只对中性图片有效，对积极图片无效。因此，最近的先验认知需求似乎不会损害对中性图片的重新评估，然而，任何最近的要求任务（即，高负荷或低负荷）都可能损害对接近上限的刺激的上调-即积极刺激。研究结果在情境特定的情绪调节方法和积极情绪上调在日常生活中的效用的背景下进行了讨论。研究结果还表明，对刺激的迟钝反应可能存在一种机制，正如在某些形式的内化精神病理学中所观察到的那样。

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引用次数: 0

Pavlovian bias instigates suboptimal choices in humans 巴甫洛夫偏见促使人类做出次优选择。

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-12-01 Epub Date: 2025-10-26 DOI: 10.1016/j.brat.2025.104906

Luigi A.E. Degni , Claudio Danti , Gianluca Finotti , Francesca Starita , Giuseppe di Pellegrino , Sara Garofalo

Value-based decisions are often biased by Pavlovian cues in the environment, but it remains unclear how such biases affect optimal decision-making in humans. To address this, we used a novel variant of the Pavlovian-to-Instrumental Transfer (PIT) paradigm. Participants first learned to prefer a richer option (70 % reward probability) over a poorer one (30 %) in order to maximize rewards. A baiting rule was implemented, whereby each option's reward probability increased the longer it was not selected, rendering reward matching (i.e., aligning choice proportions with reward probabilities) a close approximation of the optimal strategy. Pavlovian cues predictive of either option were then introduced during decision-making. Results showed that Pavlovian bias disrupted optimal behavior, impairing reward maximization under both nominal extinction and rewarded conditions. This effect was replicated in an independent sample. In a third experiment, weakening the cue-outcome association during Pavlovian learning reduced the bias, suggesting a causal role of cue predictiveness. Together, these findings demonstrate that Pavlovian cues can produce maladaptive choice patterns, with implications for understanding and potentially mitigating behaviors linked to impulsivity and addiction.

基于价值的决策常常受到环境中巴甫洛夫线索的影响，但目前尚不清楚这种偏见如何影响人类的最佳决策。为了解决这个问题，我们使用了巴甫洛夫-工具迁移（PIT）范式的一种新变体。参与者首先学会了选择更富的选项（70%的奖励概率），而不是更差的选项（30%），以获得最大的奖励。我们执行了一个诱饵规则，即每个选择的奖励概率随着时间的延长而增加，从而呈现出奖励匹配（即将选择比例与奖励概率对齐）是最优策略的近似值。然后在决策过程中引入预测两种选择的巴甫洛夫线索。结果表明，巴甫洛夫偏见破坏了最优行为，损害了名义灭绝和奖励条件下的奖励最大化。这种效应在一个独立的样本中得到了重复。在第三个实验中，在巴甫洛夫学习过程中，减弱线索-结果的关联减少了偏见，表明线索预测的因果作用。总之，这些发现表明，巴甫洛夫线索可以产生不适应的选择模式，这对理解和潜在地减轻与冲动和成瘾有关的行为有影响。

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引用次数: 0

Context-dependent memory in social anxiety: Effects of social and non-social information 社交焦虑中的情境依赖记忆：社会和非社会信息的影响

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-12-01 Epub Date: 2025-10-22 DOI: 10.1016/j.brat.2025.104901

Liav Sommerfeld , Tom Zalmenson , Amit Lazarov , Yair Bar-Haim

Social anxiety is characterized by persistent fear of social situations and has been associated with information processing biases, including aberrant memory for social information. Although social situations are rich in contextual cues, little is known about context-dependent memory processes in social anxiety. Here, context-dependent memory was studied in participants with high vs. low social anxiety. We tested whether contextual congruency between encoding and retrieval influences memory for social (faces) versus non-social (houses) stimuli. Participants (N = 231; high social anxiety n = 118, low social anxiety n = 113) completed a recognition memory task of either faces or houses presented against colored backgrounds. During a recognition test, old stimuli were presented with either encoding-congruent or incongruent background colors, along with new stimuli. Participants were asked to make old/new judgments. Memory performance was measured using sensitivity (d') scores. A significant three-way interaction between group, task, and congruency indicated that individuals with high social anxiety showed enhanced context-dependent memory specifically for faces, but not for houses. No such effect was observed in individuals with low social anxiety. These findings indicate that individuals with high social anxiety demonstrate an enhanced and specific context-dependent memory effect for social stimuli. This domain-specific memory enhancement suggests that memory biases in social anxiety manifest, at least in part, through differential processing of contextual information.

社交焦虑的特征是对社交情境的持续恐惧，并与信息处理偏见有关，包括对社交信息的异常记忆。尽管社交情境具有丰富的情境线索，但人们对社交焦虑中的情境依赖记忆过程知之甚少。在这里，情境依赖记忆在高和低社交焦虑的参与者中进行了研究。我们测试了编码和检索之间的上下文一致性是否影响社会（面孔）和非社会（房屋）刺激的记忆。参与者（N = 231，高社交焦虑者N = 118，低社交焦虑者N = 113）完成了在有色背景下的面孔或房屋的识别记忆任务。在识别测试中，将旧刺激与编码一致或不一致的背景颜色以及新刺激一起呈现。参与者被要求做出新旧判断。记忆表现用灵敏度（d'）评分来衡量。群体、任务和一致性之间显著的三向交互作用表明，高社交焦虑个体对面孔的情境依赖记忆增强，而对房屋的情境依赖记忆没有增强。在低社交焦虑的个体中没有观察到这种影响。这些发现表明，高社交焦虑个体对社会刺激表现出增强的特定情境依赖记忆效应。这种特定领域的记忆增强表明，社交焦虑中的记忆偏差至少在一定程度上是通过对上下文信息的不同处理而表现出来的。

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引用次数: 0

Does the structure of dynamic symptom networks depend on baseline psychopathology in students? 动态症状网络的结构是否依赖于学生的基线精神病理？

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-12-01 Epub Date: 2025-10-16 DOI: 10.1016/j.brat.2025.104888

A. Jover Martínez , Lotte H.J.M. Lemmens , Eiko I. Fried , Jonas M.B. Haslbeck , Anne Roefs

Network theory conceptualizes mental disorders as systems of dynamic interactions among symptoms and other variables, and proposes that people with psychopathology have distinct networks as compared to healthy people. However, this idea is rarely investigated, and networks are mostly estimated on cross-sectional data. Importantly, as network theory is specified on the within-person level, it is necessary to estimate networks based on intensive time-series data. This study estimated contemporaneous and temporal transdiagnostic networks on time-series data of participants with different levels of psychopathology. 192 university students completed an Ecological Momentary Assessment (EMA) protocol. A newly developed bootstrap method was used to compare the multi-level Vector Autoregressive (mlVAR) effects between groups. Network connectivity did not differ between groups. Only a few edges differed significantly between groups, with small effect sizes. These results suggest that networks of groups of people with different levels of psychopathology might not differ. Explanations and implications for these results, such as the impact of focusing on heterogeneous groups instead of homogeneous groups or individuals, the relevance of node levels, and methodological and analytical decisions, are discussed.

网络理论将精神障碍概念化为症状和其他变量之间动态相互作用的系统，并提出精神病理患者与健康人相比具有不同的网络。然而，这种想法很少被调查，网络大多是根据横截面数据估计的。重要的是，由于网络理论是在个人层面上规定的，因此有必要基于密集的时间序列数据来估计网络。本研究估计了不同精神病理水平的参与者在时间序列数据上的同期和时间跨诊断网络。192名大学生完成了生态瞬时评估（EMA）协议。采用一种新开发的自举方法比较了组间多级向量自回归（mlVAR）效应。两组之间的网络连接没有差异。两组之间只有少数边缘有显著差异，效应量很小。这些结果表明，不同精神病理水平的人群之间的网络可能没有差异。讨论了这些结果的解释和含义，例如关注异质群体而不是同质群体或个人的影响，节点级别的相关性以及方法和分析决策。

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引用次数: 0

Differential effectiveness of dialectical behavioural therapy and schema therapy in patients with borderline personality disorder: a secondary analysis of a randomised clinical trial 辩证行为疗法和图式疗法在边缘型人格障碍患者中的差异疗效：一项随机临床试验的二次分析

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-12-01 Epub Date: 2025-10-23 DOI: 10.1016/j.brat.2025.104899

Nele Assmann , Tim Kaiser , Philipp Herzog , Arnoud Arntz , Jan Philipp Klein , Eva Fassbinder , Anja Schaich

Background

Borderline personality disorder (BPD) can be treated successfully with specific psychological treatments, but there is no clear evidence of superiority of one specific treatment at the group level. Due to high heterogeneity in BPD, individual patients might benefit differently from specific treatments.

Methods

Based on a randomised trial comparing 18 months of dialectical behaviour therapy (DBT) and schema therapy (ST) for BPD, differential effectiveness was examined using causal forest analyses. Baseline variables on BPD criteria, general psychopathology, traumatic childhood experiences, rejection sensitivity, level of functioning, coping skills, schemas and medication were included to predict the Borderline Personality Disorder Severity Index (BPDSI-IV) during treatment and follow-up (24 and 30 months after start of treatment).

Results

A subgroup was identified that benefited significantly more from DBT compared to ST. This group showed a significantly greater reduction in symptoms post treatment (post-treatment difference of 5.79 BPDSI points, SMD = 0.65, p = .028), but no longer at follow-up (p = .771). The group that showed better results with DBT displayed a pattern of specific baseline characteristics: higher levels of functioning, less frequent emotional neglect and sexual abuse, more severe anxiety symptoms and more pronounced schema ’failure to achieve’. No pattern of variables was identified associated with a superiority of ST.

Conclusion

Moderators of the short-term effect of DBT versus ST were found. However, this moderator effect was no longer significant at follow-up. Identifying patient characteristics associated with differential treatment effect might be a promising way to improve BPD treatment outcomes faster.

Retrospectively registered (German Clinical Trials Register: DRKS00011534) without protocol changes.

边缘型人格障碍（BPD）可以通过特定的心理治疗成功治疗，但没有明确的证据表明一种特定的治疗方法在群体水平上具有优势。由于BPD的高度异质性，个体患者可能从特定治疗中获益不同。方法基于一项比较18个月辩证行为疗法（DBT）和图式疗法（ST）治疗BPD的随机试验，使用因果森林分析来检验差异效果。在治疗和随访期间（治疗开始后24个月和30个月），包括BPD标准、一般精神病理学、创伤性童年经历、排斥敏感性、功能水平、应对技能、图式和药物治疗等基线变量来预测边缘型人格障碍严重程度指数（BPDSI-IV）。结果发现有一个亚组从DBT中获益明显多于st，该组治疗后症状的减轻明显更大（治疗后BPDSI点差异为5.79,SMD = 0.65, p = 0.028），但在随访时不再如此（p = 0.771）。在DBT中表现出较好结果的那一组表现出特定的基线特征模式：更高的功能水平，更少的情感忽视和性虐待，更严重的焦虑症状和更明显的“失败”模式。没有发现与ST的优势相关的变量模式。结论：发现了DBT与ST的短期效果的调节因子。然而，这种调节效应在随访中不再显著。识别与不同治疗效果相关的患者特征可能是更快改善BPD治疗结果的有希望的方法。回顾性注册（德国临床试验注册：DRKS00011534），未更改方案。

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引用次数: 0

Implementing Adjunct Trauma-Focused Imagery Rescripting in Inpatient Treatment for patients who are underweight with comorbid eating disorders and PTSD: Therapist Challenges and the Supporting Role of Peer Group Supervision 在体重过轻合并进食障碍和创伤后应激障碍的住院治疗中实施创伤聚焦图像辅助处方：治疗师的挑战和同伴团体监督的支持作用。

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-12-01 Epub Date: 2025-11-07 DOI: 10.1016/j.brat.2025.104912

Marieke C. ten Napel-Schutz , Simona Karbouniaris , Suzanne H.W. Mares , Tineke A. Abma , Arnoud Arntz

Background

Trauma-focused therapies like Imagery Rescripting (ImRs) are seldom offered to patients who are underweight with comorbid eating disorders (uED) and PTSD, due to doubts about their emotional and cognitive capacities. However, high rates of PTSD comorbidity in this group highlight the need for tailored trauma interventions. This study examines therapists’ experiences applying ImRs in this population, with a focus on specific challenges and how Peer Group Supervision sessions (PGSs) supported treatment delivery.

Method

A qualitative thematic analysis was conducted using 11 semi-structured therapist interviews and 32 PGS recordings. Data were analyzed, summarized and classified within a thematic framework.

Results

Therapists initially used PGSs to validate their application of ImRs. Over time, PGSs facilitated skills development through role-play, peer exchange, and reflective dialogue. Four main themes emerged: 1) determining the right moment to start rescripting; 2) challenges specific to uED; 3) topics related to ImRs sessions in which patients had to rescript; 4) the therapists' progress.

Conclusion

With appropriate protocol modifications and PGSs, ImRs appears both feasible and valuable for uED patients with PTSD. This study aims to inform the feasibility of applying ImRs in this population, with a focus on specific challenges and practical suggestions that supported treatment delivery.

Trial registration

International Clinical Trials Registry Platform (ICTRP) (NTR6094), registered 09/23/2016.

背景：由于对体重过轻并伴有共病性饮食失调（uED）和创伤后应激障碍（PTSD）的患者的情绪和认知能力存在怀疑，像意象处方（ImRs）这样以创伤为重点的治疗很少被提供给他们。然而，在这一群体中，高比率的创伤后应激障碍合并症突出了量身定制的创伤干预的必要性。本研究考察了治疗师在这一人群中应用ImRs的经验，重点关注具体挑战以及同伴小组监督会议（pgs）如何支持治疗交付。方法：采用11次半结构化治疗师访谈和32次PGS录音进行定性专题分析。在专题框架内对数据进行了分析、总结和分类。结果：治疗师最初使用pgs来验证其ImRs的应用。随着时间的推移，PGSs通过角色扮演、同伴交流和反思对话促进了技能的发展。出现了四个主要主题：1)确定开始改写的合适时机；2) uED特有的挑战；3)与患者必须开处方的ImRs会议相关的主题；4)治疗师的进展。结论：通过适当的方案修改和pgs， ImRs对uED合并PTSD患者是可行和有价值的。本研究旨在告知在这一人群中应用ImRs的可行性，重点关注支持治疗交付的具体挑战和实际建议。试验注册：国际临床试验注册平台（ICTRP）（NTR6094），注册于2016年9月23日。

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引用次数: 0

Imagery Rescripting: an update of the treatment protocol 图像改写：治疗方案的更新。

IF 4.5 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy

Pub Date : 2025-12-01 Epub Date: 2025-11-10 DOI: 10.1016/j.brat.2025.104913

Arnoud Arntz

Imagery Rescripting (ImRs) is a transdiagnostic technique to treat aversive memories of real (traumatic) experiences, or of aversive fantasies, such as nightmares and future projections. ImRs is getting increasingly popular, and can be used either as a standalone treatment or as part of treatment packages consisting of different techniques. It has been more than 25 years ago that a detailed treatment protocol of Imagery Rescripting (ImRs) was published (Arntz, A., & Weertman, A. (1999). Treatment of childhood memories; theory and practice. Behaviour Research and Therapy, 37(8), 715–740). New clinical and research insights have led to changes in the protocol, and large scale studies are based on this updated protocol. The most important changes include that it is now strongly recommended that the therapist does the rescripting in the first sessions, while the patient does the rescripting during the later sessions; and that the rescripting should start at the most difficult moment of the memory (the “hotspot”). Moreover, a standard series of questions helps to deepen the emotional processing, while specific ingredients of the rescripting help to increase the impact of the corrective experience offered by the technique. This paper presents and discusses the updated protocol as it has been developed and tested in the treatment of childhood trauma. It also offers solutions for possible problems that can be encountered in clinical practice, and discusses variations of the technique, including how to apply it to adulthood trauma's, to nightmares, and to a range of disorders and clinical problems, including pathological grief, and feared future catastrophes. It is explained that the working mechanism does not rely on installing false memories, and how therapists can prevent that false memories are installed. Finally, the paper provides a set of practical appendices including a treatment rationale and a handout that can be given to patients.

意象重塑（ImRs）是一种跨诊断技术，用于治疗真实（创伤）经历或厌恶幻想（如噩梦和未来预测）的厌恶记忆。磁共振成像越来越受欢迎，既可以作为单独的治疗方法，也可以作为由不同技术组成的治疗方案的一部分。早在25年前，一份详细的图像改写（ImRs）治疗方案就已出版（Arntz, a ., & Weertman, a .(1999)）。童年记忆的治疗；理论与实践。行为研究与治疗，37(8),715-740)。新的临床和研究见解导致了方案的变化，大规模的研究是基于这一更新的方案。最重要的变化包括，现在强烈建议治疗师在第一次治疗中进行重新处方，而患者在随后的治疗中进行重新处方；重写应该从记忆中最困难的时刻（“热点”）开始。此外，一系列标准的问题有助于加深情绪处理，而重写的具体成分有助于增加技术提供的纠正体验的影响。本文提出并讨论了更新的协议，因为它已经开发和测试在治疗儿童创伤。它还为临床实践中可能遇到的问题提供了解决方案，并讨论了该技术的各种变体，包括如何将其应用于成人创伤，噩梦以及一系列疾病和临床问题，包括病理性悲伤和对未来灾难的恐惧。它解释了工作机制不依赖于安装错误记忆，以及治疗师如何防止错误记忆的安装。最后，本文提供了一套实用的附录，包括治疗原理和讲义，可以给病人。

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