Journal of Psychosomatic Research最新文献_第10页

The relationship between fear of disease progression and social isolation in stroke patients: The mediating role of self-perceived burden and self-disclosure 脑卒中患者疾病进展恐惧与社会孤立的关系：自我感知负担和自我表露的中介作用。

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2025-11-17 DOI: 10.1016/j.jpsychores.2025.112455

Yujing Gu , Honggan Wang , Yun Zhao , Zhaodi Liao , Jun Xie

Aim

Post-stroke sequelae, such as motor dysfunction, may reduce patients' participation in social activities, thereby increasing their risk of social isolation. Previous studies have linked fear of disease progression with social isolation, yet the underlying mechanisms of this association remain unclear. To develop effective intervention strategies, it is essential to explore the contributing factors related to social isolation in depth.

Methods

This study aimed to investigate the mediating roles of self-perceived burden and self-disclosure in the relationship between fear of disease progression and social isolation among stroke patients. A total of 342 inpatients from neurology departments were surveyed using a self-designed demographic questionnaire, the Generalized Alienation Scale (GAS), Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Self-Perceived Burden Scale (SPBS), and Distress Disclosure Index (DDI). A parallel mediation model was constructed, and descriptive statistics, difference tests, Spearman correlation analysis, hierarchical multiple regression, and mediation effect analysis were conducted.

Results

Fear of disease progression was positively associated with social isolation (c = 0.275). It was positively related to self-perceived burden (a1 = 0.598) and negatively related to self-disclosure (a2 = −0.412). Both mediators were significantly associated with social isolation (b1 = 0.188; b2 = −0.099). Significant indirect effects were found through self-perceived burden (a1b1 = 0.113) and self-disclosure (a2b2 = 0.041). The direct effect remained significant (c' = 0.121), indicating partial mediation.

Conclusion

Self-perceived burden and self-disclosure simultaneously mediate the impact of fear of disease progression on social isolation, offering new insights for healthcare professionals aiming to prevent social isolation among stroke survivors.

目的：脑卒中后的后遗症，如运动功能障碍，可能会减少患者参与社会活动，从而增加其社会孤立的风险。先前的研究将对疾病进展的恐惧与社会孤立联系起来，但这种联系的潜在机制尚不清楚。为了制定有效的干预战略，必须深入探讨与社会孤立有关的促成因素。方法：本研究旨在探讨脑卒中患者疾病进展恐惧与社会孤立的关系中自我知觉负担和自我表露的中介作用。采用自行设计的人口统计问卷、广义疏离感量表（GAS）、进展恐惧简易问卷（FoP-Q-SF）、自我感知负担量表（SPBS）和痛苦披露指数（DDI）对342例神经内科住院患者进行调查。构建平行中介模型，进行描述性统计、差异检验、Spearman相关分析、层次多元回归和中介效应分析。结果：对疾病进展的恐惧与社会孤立呈正相关（c = 0.275）。与自我感知负担呈正相关（a1 = 0.598），与自我表露呈负相关（a2 = -0.412）。两种中介因子均与社会隔离显著相关（b1 = 0.188; b2 = -0.099）。自我感知负担（a1b1 = 0.113）和自我表露（a2b2 = 0.041）间接影响显著。直接影响仍然显著（c' = 0.121），表明部分中介作用。结论：自我认知负担和自我披露同时介导疾病进展恐惧对社会隔离的影响，为医疗保健专业人员预防脑卒中幸存者的社会隔离提供了新的见解。

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引用次数: 0

Acute and chronic fatigue after COVID-19: The impact of depression and somatic distress COVID-19后急性和慢性疲劳：抑郁和躯体窘迫的影响

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2025-11-17 DOI: 10.1016/j.jpsychores.2025.112456

Kamiar K. Rückert , Julia Petersen , Philipp S. Wild , Thomas Münzel , Jochem König , Karl J. Lackner , Isabel Heinrich , Julia Weinmann-Menke , Christian Dresel , Marc Bodenstein , Michael Kreuter , Felix Rausch , Manfred E. Beutel , Jasmin Ghaemi Kerahrodi

Objective

Fatigue is the most frequent and burdensome symptom following COVID-19. The contribution of biopsychosocial factors remains unclear, particularly with respect to symptom duration. This exploratory study investigated the prevalence of acute and chronic fatigue after COVID-19 and examined biopsychosocial correlations.

Methods

Cross-sectional data from 452 participants of the Gutenberg Post-COVID Study were analyzed. All individuals had a previous Sars-CoV-2 infection. Participants were categorized into three groups (1) no fatigue during assessment, (2) fatigue lasting 1–<6 months at assessment, and (3) fatigue lasting 6 months or more at assessment. Fatigue was assessed using the Chalder Fatigue Questionnaire (CFQ) and classified as acute (<6 months) or chronic (≥ 6 months). The modified PHQ-9 (mPHQ-9, excluding the fatigue item) measured depressivity. SSD-12 measured the somatic symptom burden. Associations were examined using multivariable regression analyses.

Results

51.6 % reported no fatigue, 13.9 % showed acute fatigue, 34.5 % displayed chronic fatigue. Vaccination status was not associated with fatigue. The severity of the infection was associated with acute fatigue. No significant associations were observed with chronic fatigue. When psychological variables (mPHQ-9, SSD-12) were introduced, associations with somatic pre-morbid conditions disappeared, except for body mass index. Higher levels of depressiveness and somatic distress increased the likelihood of both forms of fatigue, while lower social status was associated specifically with chronic fatigue.

Conclusion

Depressiveness and somatic distress are strongly linked to post-COVID fatigue, particularly its chronic form. These findings underscore the importance of a biopsychosocial framework and the need for interdisciplinary treatment approaches in post-COVID care.

目的：疲劳是新冠肺炎患者最常见和最繁重的症状。生物心理社会因素的作用尚不清楚，特别是在症状持续时间方面。本探索性研究调查了COVID-19后急性和慢性疲劳的患病率，并检查了生物心理社会相关性。方法对452名古腾堡后研究参与者的横断面数据进行分析。所有人以前都感染过Sars-CoV-2。参与者被分为三组(1)在评估时没有疲劳，(2)在评估时持续1 - 6个月的疲劳，(3)在评估时持续6个月或更长时间的疲劳。使用Chalder疲劳问卷（CFQ）评估疲劳，并将其分为急性（≤6个月）和慢性（≥6个月）。改进后的PHQ-9 （mPHQ-9，不包括疲劳项）测量了压抑度。SSD-12测量躯体症状负担。结果51.6%的患者无疲劳，13.9%表现为急性疲劳，34.5%表现为慢性疲劳。接种疫苗状态与疲劳无关。感染的严重程度与急性疲劳有关。与慢性疲劳无显著关联。当引入心理变量（mPHQ-9, SSD-12）时，除了体重指数外，与躯体病前状况的关联消失了。较高水平的抑郁和躯体压力增加了两种形式疲劳的可能性，而较低的社会地位与慢性疲劳特别相关。结论抑郁和躯体窘迫与covid - 19后疲劳密切相关，尤其是慢性疲劳。这些发现强调了生物心理社会框架的重要性以及在covid - 19后护理中采用跨学科治疗方法的必要性。

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引用次数: 0

Do we still need Engel's biopsychosocial model? 我们还需要恩格尔的生物心理社会模型吗？

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2025-11-16 DOI: 10.1016/j.jpsychores.2025.112451

Fiammetta Cosci

引用次数: 0

Type D personality and metabolic syndrome severity jointly predict 2-year MACE after acute coronary syndrome: A prospective cohort study D型人格和代谢综合征严重程度共同预测急性冠脉综合征后2年MACE：一项前瞻性队列研究

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2025-11-16 DOI: 10.1016/j.jpsychores.2025.112453

Bingji Huang , Jiaxin Shi , Mengru Sun , Hui Tao , Wenpei Liu , Bo Yu , Yini Wang , Ping Lin

Objective

To determine whether Type D personality and higher metabolic syndrome (MetS) severity jointly associate with 2-year major adverse cardiac events (MACE) after acute coronary syndrome (ACS).

Methods

This prospective cohort study included 5441 patients diagnosed with ACS between May 2021 and May 2023. Type D personality was assessed, and an age-sex-ethnicity-specific MetS scoring model (MetS score) was used to evaluate metabolic syndrome severity at baseline. MACE were analyzed after a 2-year follow-up period.

Results

During the 2-year follow-up period, 518 patients developed MACE. A nonlinear association was observed between MetS score and MACE risk (p for nonlinearity = 0.025). Compared with the Type D(−)/Low MetS risk group, the Type D(+)/High MetS risk group exhibited the highest risk of MACE (HR: 2.331, 95 % CI: 1.810–3.002). Subgroup analyses further revealed a pronounced sex difference: the association was strongest among women, with the Type D(+)/High MetS risk group showing the highest risk (HR: 3.505, 95 % CI: 2.092–5.872), whereas men in the same group also demonstrated elevated risk, though to a lesser degree (HR: 2.065, 95 % CI: 1.544–2.761).

Conclusion

Type D personality and higher MetS severity were jointly associated with increased 2-year MACE risk after ACS, with sex-specific patterns. These findings support integrated psychosocial and metabolic risk management, particularly among women with high MetS severity.

目的探讨D型人格与高代谢综合征（MetS）严重程度是否与急性冠脉综合征（ACS）术后2年主要心脏不良事件（MACE）相关。该前瞻性队列研究纳入了2021年5月至2023年5月诊断为ACS的5441例患者。对D型人格进行评估，并使用年龄、性别、种族特异性代谢综合征评分模型（MetS评分）来评估代谢综合征的基线严重程度。随访2年后对MACE进行分析。结果2年随访期间，518例患者发生MACE。在MetS评分和MACE风险之间观察到非线性关联（非线性p = 0.025）。与D型(−)/低MetS风险组相比，D型(+)/高MetS风险组MACE风险最高（HR: 2.3331, 95% CI: 1.810-3.002）。亚组分析进一步揭示了显著的性别差异：这种关联在女性中最强，D型(+)/高MetS风险组的风险最高（HR: 3.505, 95% CI: 2.092-5.872），而同一组的男性也表现出风险升高，尽管程度较低（HR: 2.065, 95% CI: 1.544-2.761）。结论D型人格和较高的MetS严重程度与ACS后2年MACE风险增加相关，且存在性别差异。这些发现支持综合的社会心理和代谢风险管理，特别是对MetS严重程度高的妇女。

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引用次数: 0

Machine learning-based prediction of delirium in older patients with chronic kidney disease requiring intensive care: A hospital-based retrospective cohort study 需要重症监护的老年慢性肾病患者谵妄的机器学习预测：一项基于医院的回顾性队列研究。

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2025-11-15 DOI: 10.1016/j.jpsychores.2025.112454

Chia-Rung Wu , Yung-Chun Chang , Victoria Tranyor , Shu-Tai Shen Hsiao , Shu-Liu Guo , Shu-Chuan Lin , Sen-Kuang Hou , Hsiao-Yean Chiu

Objectives

Delirium is a common complication in intensive care units (ICUs), especially among older adults with chronic kidney disease (CKD). It is associated with increased mortality and prolonged hospitalization. Machine learning (ML)-based models can help predict delirium. In this study, we developed an ML-based delirium prediction model for critically ill older patients with CKD.

Methods

This retrospective cohort study included patients aged ≥65 years admitted to the ICU between January 2021 and November 2023. Delirium was assessed every 8 h throughout the ICU stay using the Intensive Care Delirium Screening Checklist (ICDSC) and defined as a score of ≥4. Eight ML models were compared in terms of the area under the receiver operating characteristic curve (AUROC), accuracy, F1-score, specificity, and recall.

Results

This study included 895 patients, of whom 55.3 % developed delirium. The random forest model outperformed others (F1-score: 0.891; specificity: 0.911; recall: 0.864; accuracy: 0.885; precision: 0.923; AUROC: 0.950). Backward feature selection achieved an F1-score of 0.892 and an AUROC of 0.953, identifying 14 key predictors of delirium: physical restraint use, low Glasgow Coma Scale score, high white blood cell count, hypernatremia, fever, advanced age, hypoalbuminemia, hypercalcemia, low hemoglobin, high Acute Physiology and Chronic Health Evaluation II (APACHE II) score, hyperkalemia, mechanical ventilation, sedation, and elevated C-reactive protein.

Conclusion

Our ML model demonstrated good performance in predicting delirium in critically ill older adults with CKD, suggesting potential value for early identification. Future studies may explore integration into hospital systems to support delirium prevention strategies.

目的：谵妄是重症监护病房（icu）常见的并发症，尤其是老年慢性肾脏疾病（CKD）患者。它与死亡率增加和住院时间延长有关。基于机器学习（ML）的模型可以帮助预测谵妄。在这项研究中，我们开发了一种基于ml的老年CKD危重患者谵妄预测模型。方法：本回顾性队列研究纳入了2021年1月至2023年11月期间入住ICU的年龄≥65岁的患者。在ICU住院期间，每8小时使用重症监护谵妄筛查清单（ICDSC）评估谵妄，并将其定义为≥4分。比较8种ML模型在受试者工作特征曲线下面积（AUROC）、准确度、f1评分、特异性和召回率方面的差异。结果：本研究共纳入895例患者，其中55.3%出现谵妄。随机森林模型优于其他模型（F1-score: 0.891，特异性：0.911，召回率：0.864，准确度：0.885，精密度：0.923,AUROC: 0.950）。后向特征选择的f_1评分为0.892，AUROC为0.953，确定了谵妄的14个关键预测因素：肢体限制使用、格拉斯哥昏迷评分低、白细胞计数高、高钠血症、发热、高龄、低白蛋白血症、高钙血症、低血红蛋白、急性生理和慢性健康评估II （APACHE II）评分高、高钾血症、机械通气、镇静和c反应蛋白升高。结论：我们的ML模型在预测老年CKD危重患者谵妄方面表现良好，提示早期识别的潜在价值。未来的研究可能会探索整合到医院系统，以支持谵妄预防策略。

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引用次数: 0

Belief in telomeres and religious belief 对端粒的信仰和宗教信仰。

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2025-11-14 DOI: 10.1016/j.jpsychores.2025.112452

Zakaria A. Almsherqi, Manoor Prakash Hande

引用次数: 0

Personalised and standardised wafer-based open-label placebos reduce perceived stress among university students: A three-arm randomised controlled trial 个性化和标准化的基于薄片的开放标签安慰剂减轻大学生的感知压力：一项三组随机对照试验。

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2025-11-12 DOI: 10.1016/j.jpsychores.2025.112450

Johannes C. Fendel , Corinna Ketter , Paulina Liese , Dimitri Nalezinski , Magdalena Schiele , Frederic Linßen , Stefan Schmidt

Background

Open-label placebos (OLPs) are placebos administered transparently, without deception that can nonetheless yield beneficial effects. We tested a novel OLP delivery format—printed edible wafers, with or without individualised coaching-based personalisation, in highly stressed university students.

Methods

In this superiority randomised controlled trial, N = 137 highly stressed university students were randomly assigned for three weeks to a personalised OLP (personalised printed image, label, desired effects) a standardised OLP (standardised for stress reduction), or a waitlist control. The primary objective was to test whether the personalised OLP reduces perceived stress compared to waitlist. Secondary objectives included examining whether the standardised OLP also improves outcomes relative to control and whether personalisation yields incremental benefits. Assessments were conducted at baseline, post-intervention, and at a three-month follow-up. The primary outcome was perceived stress; secondary outcomes included anxiety, depression, sleep, well-being, and life satisfaction; moderators were treatment expectancy (TE) and general self-efficacy (GSE).

Results

Both OLP arms reduced perceived stress vs. waitlist; these effects were maintained at follow-up. Anxiety decreased only in the personalised arm. The OLP arms did not differ significantly. In the standardised arm, lower GSE predicted larger depressive-symptom reductions and higher TE predicted greater well-being gains (vs. waitlist).

Conclusions

Wafers may be a versatile OLP delivery method with potential for mechanism-guided refinement and targeted personalisation in preventive and clinical contexts.

Trial registration

https://osf.io/8afdz.

背景：开放标签安慰剂（olp）是一种透明的安慰剂，没有欺骗，但仍然可以产生有益的效果。我们在压力很大的大学生中测试了一种新颖的OLP递送形式——打印的可食用硅片，有或没有个性化指导。方法：在这项优势随机对照试验中，N = 137名压力很大的大学生被随机分配到个性化OLP（个性化印刷图像、标签、期望效果）、标准化OLP（标准化减压）或候补组，为期三周。主要目的是测试与等候名单相比，个性化的OLP是否减少了感知压力。次要目标包括检查标准化的OLP是否也相对于控制改善了结果，以及个性化是否产生了增量效益。评估分别在基线、干预后和三个月随访时进行。主要结果是感知压力；次要结局包括焦虑、抑郁、睡眠、幸福感和生活满意度；调节因子为治疗期望（TE）和一般自我效能（GSE）。结果：与等候名单组相比，两组均降低了感知压力；这些效果在随访中保持不变。焦虑只在个性化治疗组中有所减少。OLP组没有显著差异。在标准化组中，较低的GSE预示着更大的抑郁症状减轻，而较高的TE预示着更大的幸福感（与等候组相比）。结论：晶圆片可能是一种多功能的OLP输送方法，在预防和临床环境中具有机制指导的改进和针对性个性化的潜力。试验注册：https://osf.io/8afdz。

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引用次数: 0

Empowering adolescents and young adults with somatoform disorders: A longitudinal pilot randomized controlled trial of a parent-focused mindfulness-based training versus support groups 授权青少年和年轻人与躯体形式障碍：纵向试点随机对照试验，以父母为中心的正念为基础的训练与支持团体。

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2025-11-12 DOI: 10.1016/j.jpsychores.2025.112448

Alexander Lassner , Rosemarie Ahnert , Jenny Dahringer , Irina Papazova , Michael Frühwald , Alkomiet Hasan , Sophie-Kathrin Greiner

Background

In childhood somatoform disorders develop and persist through bio-psycho-social processes including family variables, substantially impacting the development of children, their school attendance, and well-being. Although intensive interdisciplinary pain treatment (IIPT) has demonstrated effectiveness, maintaining long-term outcomes remains challenging, particularly given children's increased risk of developing affective disorders. Since family dynamics influence disorder development and persistence, this study aimed to investigate the potential added value of addressing parents within the therapeutic process.

Method

This monocentric longitudinal pilot randomized controlled trial (RCT) (N = 31) investigated adjunct parent-focused interventions (mindfulness vs. support group) for families of children with somatoform disorders enrolled in IIPT. We assessed children's empowerment, pain related disability, affective pain perception, pain characteristics and parental catastrophizing at admission, discharge, and six-month follow-up. Regression models and repeated-measures ANOVAs evaluated intervention effects.

Results

Multiple regression analysis identified older age as predictor of empowerment at baseline (β = 0.63, p < .01). IIPT plus parental intervention showed lasting treatment effects. Group allocation had no effect on empowerment, pain disability, affective pain perception, or parental catastrophizing, but allocation to the support group (B = -2.49, p = .009) and male sex (B = -2.29, p = .008) predicted greater reduction in average pain intensity.

Conclusions

This pilot RCT showed no superiority of the parent-focused mindfulness group over the support group when combined with IIPT. Yet, both interventions may enhance treatment efficacy, with some evidence suggesting additional benefits of the support group intervention in reducing average pain intensity. Further research is needed to examine underlying mechanisms and establish optimal parent intervention approaches in paediatric pain treatment.

背景：儿童躯体形式障碍通过包括家庭变量在内的生物-心理-社会过程发展和持续，极大地影响儿童的发展，他们的上学率和福祉。尽管强化跨学科疼痛治疗（IIPT）已证明有效，但保持长期疗效仍然具有挑战性，特别是考虑到儿童发展为情感障碍的风险增加。由于家庭动态影响障碍的发展和持续，本研究旨在探讨在治疗过程中解决父母问题的潜在附加价值。方法：本单中心纵向先导随机对照试验（RCT）（N = 31）调查了以父母为中心的辅助干预措施（正念vs.支持小组）对参加IIPT的躯体形式障碍儿童家庭的影响。我们在入院、出院和六个月的随访中评估了儿童的赋权、疼痛相关残疾、情感疼痛感知、疼痛特征和父母的灾难化。回归模型和重复测量方差分析评估干预效果。结果：多元回归分析确定年龄是基线授权的预测因子（β = 0.63, p）。结论：该试点RCT显示，当结合ipt时，以父母为中心的正念组没有优于支持组。然而，两种干预措施都可以提高治疗效果，一些证据表明支持小组干预在降低平均疼痛强度方面有额外的好处。需要进一步的研究来检查潜在的机制和建立最佳的父母干预方法在儿科疼痛治疗。

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引用次数: 0

What role does social activity play in the relationship between hearing loss and cognitive decline or mental health in older adults: A systematic review and meta-analysis 社会活动在老年人听力损失与认知能力下降或心理健康之间的关系中扮演什么角色：一项系统回顾和荟萃分析。

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2025-11-11 DOI: 10.1016/j.jpsychores.2025.112449

Jing Li, Liu Sun, Yuan-Yuan Zhao, Han-Ting Wang, Jun-E Liu

Objective

Hearing loss is a global public health concern among older adults, associated with cognitive decline and other mental health disorders. Social activity has been proposed as a potential pathway linking hearing loss and mental outcomes. This systematic review aimed to clarify the dual mediating and moderating roles of social activity in the links between hearing loss and mental health outcomes.

Methods

We searched five databases up to April 23, 2025, for empirical studies examining the role of social activity in the relationship between hearing loss and mental health. Data were synthesized using random-effects meta-analysis or best-evidence synthesis.

Results

Nineteen studies (11 longitudinal, 8 cross-sectional) were included, covering cognitive function (n = 12), depressive symptoms (n = 4), and positive emotional outcomes (n = 3). Meta-analysis showed a small but significant mediating effect of social activity on the hearing loss–cognitive decline link (estimate = −0.004, 95 % CI: −0.007 to −0.001), and a significant moderating effect (estimate = 0.087, 95 % CI: 0.050 to 0.124), with stronger negative effects among those with lower social activity. Best-evidence synthesis provided moderate support for mediation with depressive symptoms and positive emotional outcomes, and limited evidence for a moderating effect on depressive symptoms.

Conclusion

This review highlights the dual role of social activity in mediating and moderating the association between hearing loss and mental health in older adults. These findings underscore the importance of promoting social activity as a potential target for interventions. Further research is needed to validate these findings and identify effective strategies to enhance social activity.

目的：听力损失是一个全球性的老年人公共卫生问题，与认知能力下降和其他精神健康障碍有关。社会活动被认为是联系听力损失和心理结果的潜在途径。本系统综述旨在阐明社会活动在听力损失和心理健康结果之间的双重中介和调节作用。方法：我们检索了截至2025年4月23日的5个数据库，对社会活动在听力损失和心理健康之间的关系中的作用进行了实证研究。数据采用随机效应荟萃分析或最佳证据综合。结果：纳入19项研究（11项纵向研究，8项横断面研究），涵盖认知功能（n = 12）、抑郁症状（n = 4）和积极情绪结果（n = 3）。荟萃分析显示，社交活动对听力损失-认知能力下降的影响虽小，但具有显著的中介作用（估计= -0.004,95% CI: -0.007至-0.001），并具有显著的调节作用（估计= 0.087,95% CI: 0.050至0.124），在社交活动较低的人群中，负面影响更强。最佳证据综合为抑郁症状和积极情绪结果的调解提供了适度支持，对抑郁症状的调节作用的证据有限。结论：本综述强调了社会活动在老年人听力损失和心理健康之间的中介和调节中的双重作用。这些发现强调了促进社会活动作为干预的潜在目标的重要性。需要进一步的研究来验证这些发现，并确定有效的策略来加强社会活动。

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引用次数: 0

Impact of treatment credibility and expectancy on cognitive behavioral therapy for insomnia outcomes among cancer survivors 治疗可信度和期望对癌症幸存者失眠的认知行为治疗结果的影响。

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research

Pub Date : 2025-11-10 DOI: 10.1016/j.jpsychores.2025.112447

Brianna George , Joshua Tulk , Josée Savard , Joshua A. Rash , Christopher Quinn-Nilas , Melanie Seal , Robin Urquhart , John Thoms , Kara Laing , Sheila N. Garland

Objectives

Cognitive Behavioral Therapy for Insomnia (CBT-I) can effectively improve insomnia among cancer survivors. This secondary analysis explored what factors were associated with higher beliefs about credibility and expectancy and examined the impact of perceived treatment credibility and expectancy on outcomes.

Methods

As part of a randomized waitlist-controlled trial, cancer survivors (N = 132) with insomnia received 7 weekly virtual sessions of CBT-I. Credibility and expectancy beliefs were assessed at baseline for insomnia and perceived cognitive impairment (PCI) using the Credibility Expectancy Questionnaire. We examined which factors were associated with greater credibility and expectancy beliefs and whether credibility and expectancy moderated change in symptoms. Semi-structured interviews explored patient perceptions.

Results

Only younger age was associated with higher pre-treatment expectations for both insomnia and PCI (p = 0.009; p = 0.008). The magnitude of expectancy for insomnia and cognitive functioning were similar. Neither beliefs about credibility nor expectancy acted as moderators of change in symptoms of insomnia (p = 0.972; p = 0.502) or PCI (p = 0.143; p = 0.283), respectively. Qualitative results suggest credibility and expectancy can be optimized by: 1) promoting an understanding of sleep; 2) setting appropriate pre-treatment beliefs that foster optimism and mitigate skepticism; 3) promoting consistent engagement with treatment; and 4) fostering positive therapeutic relationships.

Conclusion/implications

CBT-I is effective regardless of pre-existing beliefs and expectations. While these factors may play a role in the decision to pursue CBT-I, our results suggest that clients are likely to see benefits if they engage in the therapy.

目的：认知行为治疗失眠（CBT-I）能有效改善癌症幸存者的失眠。这一次要分析探讨了哪些因素与可信度和期望的较高信念相关，并检查了感知治疗可信度和期望对结果的影响。方法：作为一项随机候补对照试验的一部分，患有失眠的癌症幸存者（N = 132）接受了每周7次的CBT-I虚拟治疗。使用可信度期望问卷评估失眠症和知觉认知障碍（PCI）的可信度和期望信念。我们研究了哪些因素与更高的可信度和期望信念有关，以及可信度和期望是否会减缓症状的变化。半结构化访谈探讨了患者的看法。结果：只有年龄越小，治疗前对失眠和PCI的期望越高（p = 0.009; p = 0.008）。对失眠症和认知功能的预期程度是相似的。对可信度和期望的信念都不是失眠症状变化的调节因子（p = 0.972; p = 0.502）或PCI （p = 0.143; p = 0.283）。定性结果表明，可信度和期望可以通过以下方式优化：1)促进对睡眠的理解；2)设定适当的预处理信念，培养乐观情绪，减轻怀疑情绪；3)促进持续参与治疗；4)培养积极的治疗关系。结论/启示：CBT-I无论预先存在的信念和期望如何都是有效的。虽然这些因素可能在决定进行CBT-I的过程中发挥作用，但我们的结果表明，如果客户参与治疗，他们可能会看到好处。

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引用次数: 0