心理干预英文文献4
健康心理学英语文献
SCIENCE WATCHAgainst doctors' ordersNew research reveals why smoking's so easy to start and so hard to quit. By Michael PriceMonitor staffPrint version: page 34Almost a quarter of men and one-fifth of women in the United States smoke cigarettes, according to the American Heart Association. And although it'swell-known to be a deadly habit—to the tune of around 400,000 deaths annually—more than700,000 people a year start up. Despite multimillion-dollar antismoking campaigns targeted at children, almost all new smokers are youths.What accounts for the glaring gap between message and behavior? New research suggests that early attitudes about smoking and early experimentation may give smoking enough of a foothold to become a lifelong addiction—and smoking may actually spur brain changes that make people resistant to antismoking messages. Add it all up and you've got a habit that's easy to start and painfully difficult to stop.Just one puffThat's the reason early prevention is the best policy, says Joseph DiFranza, MD, an addictions researcher at the University of Massachusetts Medical School in Worcester, Mass.His study in the May Addictive Behaviors (Vol. 33, No. 5) suggests that smoking only one cigarette can spur a loss of autonomy, which occurs when a person either has to make an effort not to smoke again or experiences discomfort when not smoking. His analysis of 30,000 teenage smokers in New Zealand, the largest study of teenage smoking to date, found that many teens reported at least minor symptoms of addiction, and those symptoms increased for everycigarette they smoked. By the time a person smokes 100 cigarettes, DiFranza says, 95 percent report addiction symptoms."It only takes a handful of cigarettes for the average person to become addicted," he says.His research challenges the prevailing view that people have to smoke every day to become addicted, DiFranza says. "Kids who don't smoke every day don't consider themselves to be smokers," he says, "but they have the cravings and withdrawal symptoms."Warning kids about the realities of addiction is a mission that Judy Andrews, PhD, shares in her lab and in her life. Andrews, a psychologist at the Oregon Research Institute in Eugene, Ore., recalls a time when her then-3-year-old daughter exclaimed, "Eww, gross!" as a smoker passed by. She knew her daughter had a decidedly negative opinion of smoking, but she wondered how children's opinions change over time.In the 15 years since that day, Andrews has become an expert on children's feelings toward substance abuse. She's found that children as young as 7 have strong opinions about smoking, which are informed by TV, family and peers.Andrews's latest research in the March Psychology of Addictive Behavior (Vol. 22, No. 1) suggests that these early attitudes predict whether someone becomes a smoker. She and her colleagues tested about 700 elementary school students in Oregon, second through fifth grade, by showing them images of people smoking and asking whether they thought kids who smoke are exciting, cool, neat and popular.Seven years later, the participants who had positive social images of smoking when they were children were 30 percent to 40 percent more likely to have smoked a cigarette in the past year.That statistic resonates with Andrews."I've got a teenage daughter in high school," she says, "so I take my research home." She's also taking her research to the classroom in the form of an antismoking program aimed at fifth-graders. In it, she tries to counter positive social images with negative ones, showing children unattractive pictures of people smoking and asking them, "Is this cool? Would this make you popular?" It's too early to tell how successful it will be, Andrews says, but early indications hint that children in the program indeed profess a less positive social image of smoking."At a young age, you can change kids' attitudes a lot easier than in 12th grade when they think they know everything," she says.Tough habitYet smoking may engender changes in the brain that make smokers resistant to the very antismoking messages Andrews and her colleagues promote, according to a paper in press in Nature Neuroscience by Baylor College of Medicine neuroscientist Read Montague, PhD. His findings suggest that smokers don't learn from mistakes as well as nonsmokers.In his research, Montague used fMRI to measure the brain activity of smokers and nonsmokers while they played an investment game with predetermined outcomes. The researchers specifically looked for two brain activity patterns known to be important to learning: experiential and fictive learning signals. Experiential learning takes place when investors adjust their behavior when their earning expectations don't match their actual earnings. Fictive learning occurs when investors compare what they actually earned with what they hypothetically would have earned had they invested differently. Together, these signals help guide decision-making in most people.In this experiment, Montague and his colleagues teased apart these learning methods by developing algorithms to measure the impact of each signal in each betting situation. They found that although both smokers and nonsmokerslearned from experiential signals, only the nonsmokers responded to the fictive signals. But when the researchers consulted the fMRI images taken throughout the study, they found that the fictive learning signals were indeed occurring in smokers' brains—they just weren't using those signals to guide their behavior."Both learning signals show up in the brain," Montague says, "but the smokers only use the experiential signal in making their choices."Somewhere in their thought processes, smokers were discarding fictive learning as a decision-making strategy.Montague suspects that the increased dopamine in the brains of smokers interferes with the reinforcement learning process that would otherwise let them learn from their mistakes, "leaving smokers guided only by immediate or experiential rewards and uninfluenced by fictive learning signals," he notes.A surfeit of dopamine could help explain why smokers who are faced with a barrage of information about the ill effects of their habits don't up and quit, he notes.Another suspect in the brain is the thalamus, according to a 2007 study in Neuropsychopharmacology (Vol. 32, No. 12) by psychiatry professor Jed Rose, PhD, at Duke University Medical Center."The thalamus is an important but incredibly neglected brain structure," Rose says.His research into the thalamus looks to end that neglect. One of the jobs of the thalamus is to adjust the brain's responses to various stimuli, a process known as thalamic sensory gating, he explains. If the brain is getting more than it needs of some stimulus, the thalamus turns the knob down so the brain doesn't get overstimulated. Rose's study suggests that nicotine makes this process work even better, allowing the brain to block out even more of the unpleasant stimuli than normal, making the smoker calm and relaxed.Quitting smoking, then, makes a smoker less able to cope with these stressful situations because the smoker is used to the enhanced calm provided by nicotine, the study says. They can't just light up and tune out anymore.For these reasons and more, tobacco is "the most persistent drug of addiction," says Steven Grant, PhD, chief of the clinical neuroscience branch of the National Institute on Drug Abuse, and its cultural acceptability and legality serve to make it that much more dangerous. But understanding exactly how nicotine gains an early foothold in the brain, he says, will allow researchers to develop medicines and therapies that finally snuff it out.。
大学生心理健康问题外文文献最新译文
大学生心理健康问题外文文献最新译文XXX。
as evidenced by the high-profile cases of XXX students at Virginia Tech and Northern XXX。
these incidents are not representative of the broader public health XXX students as they are among same-aged non-students。
and the number and XXX。
they are not XXX illness.One of the major XXX。
lack of knowledge about available resources。
and XXX must work to ce these barriers XXX and support for mental health.XXX students is the lack of resources available on XXX form of counseling or mental health services。
these resources are often overburdened and underfunded。
This can lead to long wait times for appointments and limited access to specialized care。
To address this issue。
colleges and XXX and services.It is also XXX college students。
such as those from XXX or those with pre-existing mental health ns。
心理调节的英语作文翻译
心理调节的英语作文翻译Title: The Importance of Psychological Regulation。
Psychological regulation is a fundamental aspect of maintaining mental well-being in the face of life's challenges. It encompasses a range of strategies and techniques aimed at managing emotions, thoughts, and behaviors to promote overall psychological health. In this essay, we will delve into the significance of psychological regulation and explore various methods individuals can employ to cultivate resilience and emotional balance.First and foremost, psychological regulation plays a pivotal role in coping with stress and adversity. Life is replete with obstacles and setbacks, and how we respond to these challenges greatly influences our psychological state. By developing effective regulation skills, individuals can better navigate difficult circumstances without succumbingto overwhelming negative emotions such as anxiety, depression, or anger. Instead of feeling powerless in theface of adversity, they can adopt a proactive approach, utilizing strategies like cognitive reframing, mindfulness, and relaxation techniques to manage stress and maintain a sense of inner calm.Furthermore, psychological regulation is essential for fostering healthy relationships and social interactions. Emotions are contagious, and our ability to regulate them influences the quality of our interactions with others. People who struggle to regulate their emotions may experience difficulties in communication, empathy, and conflict resolution, leading to strained relationships and social isolation. On the contrary, individuals who possess strong regulation skills are better equipped to express themselves assertively, empathize with others' perspectives, and navigate interpersonal conflicts constructively. By cultivating emotional intelligence and regulation, individuals can cultivate deeper connections and fostermore fulfilling relationships.Moreover, psychological regulation is closelyintertwined with self-awareness and personal growth.Through introspection and self-reflection, individuals can gain insight into their emotions, triggers, and behavioral patterns. This heightened self-awareness enables them to identify areas for improvement and develop tailored strategies for self-regulation. Whether it involves setting boundaries, practicing self-compassion, or seeking support from others, individuals can take proactive steps towards personal growth and fulfillment. By embracing discomfort and embracing the process of self-discovery, they can cultivate resilience and adaptability in the face of life's inevitable challenges.In addition, psychological regulation is instrumentalin promoting mental health and well-being across the lifespan. From childhood to old age, individuals encounter various stressors and transitions that demand adaptive coping mechanisms. By teaching children and adolescents effective regulation skills, we can equip them with the tools they need to navigate the complexities of life and build a strong foundation for mental health. Similarly, as adults and seniors, prioritizing self-care and psychological well-being becomes increasingly important inmaintaining overall health and quality of life. Whether through therapy, meditation, hobbies, or social support, individuals can proactively manage their mental health and cultivate a sense of fulfillment and purpose.In conclusion, psychological regulation is a multifaceted concept that holds profound implications for individuals' mental health, relationships, and overallwell-being. By honing regulation skills and adopting adaptive coping strategies, individuals can navigate life's challenges with resilience, maintain healthy relationships, foster personal growth, and promote lifelong mental health. As we continue to navigate the complexities of the human experience, prioritizing psychological regulation remains essential for cultivating a fulfilling and balanced life.。
英文心理学文献
136Journal of Personality Disorders, 25(2), 136–169, 2011© 2011 The Guilford PressFrom University of Arizona College of Medicine and Sunbelt Collaborative, Tucson, AZ (A. E. S., D. S. B.); Texas A&M University, College Station, TX (L. C. M.); University of Notre Dame, South Bend, IN (L. A. C.); Menninger Clinic and Baylor College of Medicine, Houston, TX (J. M. O.); Mayo Clinic College of Medicine, Rochester, MN (R. D. A.); University of Minnesota, Minneapolis, MN (R. F. K.); University of Amsterdam, Amsterdam, NL (R. V.); University of Illinois at Chicago, Chicago, IL (C. C. B.); and Mt. Sinai School of Medicine, New York, NY (L. J. S.)Address correspondence to Andrew E. Skodol, MD, Sunbelt Collaborative, 6340 N. Campbell Ave., Suite 130, Tucson, AZ 85718; E-mail: askodol@.Personality DisorDer tyPes ProPoseD for DsM-5Andrew E. Skodol, MD, Donna S. Bender, PhD,Leslie C. Morey, PhD, Lee Anna Clark, PhD, John M. Oldham, MD, Renato D. Alarcon, MD, Robert F. Krueger, PhD,Roel Verheul, PhD, Carl C. Bell, MD, and Larry J. Siever, MDThe Personality and Personality Disorders Work Group has proposedfive specific personality disorder (PD) types for DSM-5, to be rated on adimension of fit: antisocial/psychopathic, avoidant, borderline, obses-sive-compulsive, and schizotypal. Each type is identified by core im-pairments in personality functioning, pathological personality traits,and common symptomatic behaviors. The other DSM-IV-TR PDs andthe large residual category of personality disorder not otherwise speci-fied (PDNOS) will be represented solely by the core impairments com-bined with specification by individuals’ unique sets of personality traits.This proposal has three main features: (1) a reduction in the number ofspecified types from 10 to 5; (2) description of the types in a narrativeformat that combines typical deficits in self and interpersonal function-ing and particular configurations of traits and behaviors; and (3) a di-mensional rating of the degree to which a patient matches each type.An explanation of these modifications in approach to diagnosing PDtypes and their justifications—including excessive co-morbidity amongDSM-IV-TR PDs, limited validity for some existing types, lack of speci-ficity in the definition of PD, instability of current PD criteria sets, andarbitrary diagnostic thresholds—are the subjects of this review.The Personality and Personality Disorder Work Group has proposed five specific personality disorder (PD) types for DSM-5, to be rated on a dimen-sion of fit: antisocial/psychopathic, avoidant, borderline, obsessive-compul-sive, and schizotypal. Each type is identified by core impairments in personality functioning, pathological personality traits, and common symptomatic behaviors. Each is derived from—though not identical to—TYPES PROPOSED 137 the corresponding DSM-IV-TR PD. The other DSM-IV-TR PDs and the large residual category of PDNOS will be represented solely by the core impairments combined with specification by individuals’ unique sets of personality traits, and a diagnosis of personality disorder trait-specified (PDTS) will be given. See Table 1, DSM-5 Borderline Personality Disorder Type with Matching Scale, for an example of a type description and the rating scale. See Krueger et al. in this issue for a description and discus-sion of the personality trait structure proposed for DSM-5.1The proposal for the specified PD types in DSM-5 has three main fea-tures: (1) a reduction in the number of specified types from 10 to 5; (2) description of the types in a narrative format that combines typical defi-cits in self and interpersonal functioning and particular configurations of traits and behaviors; and (3) a dimensional rating of the degree to which a patient matches each type. The justifications for these modifications in approach to diagnosing PD types include excessive co-morbidity among DSM-IV-TR PDs, limited validity for some existing types, lack of specificity in the definition of PD, instability of current PD criteria sets, and arbitrary diagnostic thresholds.2Considerable research has shown excessive co-occurrence among PDs diagnosed using the categorical system of the DSM (Clark, 2007; Oldham, Skodol, Kellman, Hyler, & Rosnick, 1992; Zimmerman, Rothchild, & Chel-minski, 2005). In fact, most patients diagnosed with PDs meet criteria for more than one. Some DSM-IV-TR PDs that rarely occur in the absence of other Axis I and II disorders also have little evidence of validity. The cur-rent DSM-IV-TR general criteria for PD3 were not empirically based and are not sufficiently specific, so they may apply equally well to other types of mental disorders (e.g., schizophrenia). PD diagnoses have been shown in longitudinal follow-along studies to be significantly less stable over time than their definition in DSM-IV-TR implies (e.g., Grilo et al., 2004). Final-ly, all of the PD categories have arbitrary diagnostic thresholds (i.e., the number of criteria necessary for a diagnosis). A reduction in the number of types is expected to reduce co-morbid PD diagnoses by eliminating less valid types. The requirement of core impairments in self and interpersonal functioning helps to distinguish personality pathology from other disor-1. Since the posting of proposed changes by the Personality and Personality Disorders Work Group on the APA’s DSM-5 Website () in early 2010, revisions of the proposal have been made. Most relevant to this article, the type descriptions have been edited to bemore concise and the type ratings have been separated from trait ratings, with the intention of determining these relationships empirically in the DSM-5 Field Trials. Core impairments in personality functioning represented by the Levels of Personality Functioning have been simplified and the levels, type, and trait ratings have been incorporated into revised General Criteria for Personality Disorder.2. The authors of this article requested an opportunity to see and respond to the specific comments and critiques made by other contributors to this special issue, to ensure that their concerns were addressed. The editor of the journal and those of this special issue denied our request.3. Briefly, “An enduring pattern of inner experience and behavior manifested in two or more of the following: cognition, affectivity, interpersonal functioning, and impulse control.”138 SKODOL ET AL.ders. The addition of specific traits to behavioral PD criteria is anticipated to increase diagnostic stability. And, the use of a dimensional rating of the types recognizes that personality psychopathology occurs on continua.nUMBer anD sPeCifiCation of tyPesFive specific PDs are being recommended for retention in DSM-5: anti-social/psychopathic, borderline, schizotypal, avoidant, and obsessive-compulsive. Space limitations preclude a complete justification for the five PDs retained, but each DSM-IV-TR PD was the subject of a literature review performed by Work Group members and advisors. Antisocial/ psychopathic, borderline, and schizotypal PDs have the most extensive empirical evidence of validity and clinical utility (e.g., Chemerinski, Trieb-wassen, Roussos, & Siever, under review; New, Triebwasser, & Charney, 2008; Patrick, Fowles, & Krueger, 2009; Skodol, Siever, et al., 2002; Skodol, Gunderson, Pfohl, et al., 2002; Siever & Davis, 2004). In contrast, there are almost no empirical studies focused explicitly on paranoid, schizoid, or histrionic PDs.The DSM-IV-TR PDs not represented by a specific type (paranoid, schiz-taBle 1. Borderline Personality Disorder type with Matching scaleIndividuals who resemble this personality disorder type have an impoverished and/or unstable self-structure and difficulty maintaining enduring and fulfilling intimate relationships. Self-concept is easily disrupted under stress, and often associated with the experience of a lack of identity or chronic feelings of emptiness. Self-appraisal is filled with loathing, excessive criticism, and despondency. There is sensitivity to perceived interpersonal slights, loss or disappointments, linked with reactive, rapidly changing, intense, and unpredictable emotions. Anxiety and depression are common. Anger is a typical reaction to feeling misunderstood, mistreated, or victimized, which may lead to acts of aggression toward self and others. Intense distress and characteristic impulsivity may also prompt other risky behaviors, including substance misuse, reckless driving, binge eating, or dangerous sexual encounters.Relationships are often based on excessive dependency, a fear of rejection and/or abandonment, and urgent need for contact with significant others when upset. Behavior may sometimes be highly submissive or subservient. At the same time, intimate involvement with another person may induce fear of loss of identity as an individual—psychological and emotional engulfment. Thus, interpersonal relationships are commonly unstable and alternate between excessive dependency and flight from involvement. Empathy for others is significantly compromised, or selectively accurate but biased toward negative elements or vulnerabilities. Cognitive functioning may become impaired at times of interpersonal stress, leading to concrete, black-and-white, all-or-nothing thinking, and sometimes to quasi-psychotic reactions, including paranoia and dissociation.Instructions: Rate the patient’s personality using the 5-point rating scale shown below. Circle the number that best describes the patient’s personality.5 Very Good Match: patient exemplifies this type4 Good Match: patient significantly resembles this type3 Moderate Match: patient has prominent features of this type2 Slight Match: patient has minor features of this type1 No Match: description does not applyTYPES PROPOSED 139 oid, histrionic, narcissistic, and dependent), the Appendix PDs (depressive and negativistic), and the residual category of PDNOS will be diagnosed as PD trait-specified (PDTS) and will be represented by mild impairment or greater on the Levels of Personality Functioning (Table 2) continuum (Bender, Maeg, & Skodol, under review), combined with descriptive speci-fication of patients’ personality trait profiles. In general, these PDs are in contrast to the above proposed types, which are structurally more com-plex and represent combinations of multiple traits from across different higher order trait domains. Thus, the proposed types represent a consid-eration of types as particularly salient configurations or interactions of traits—in contrast to the remaining disorders, which can be largely mod-eled using fewer traits, often from a single, specific trait domain.In the following sections, we highlight literature relevant to the retention vs. deletion of DSM-IV-TR PDs as specified types in DSM-5. Most DSM-IV-TR PDs suffer from the problem of excessive co-occurrence with other PDs (i.e., poor discriminative validity), but the relative weight of evidence of clinical utility and external validity favors retention of some of these disor-ders more than others. For most PDs, neurobiological and/or genetic datataBle 2. levels of Personality functioning1Self:1. I dentity: Experience of oneself as unique, with boundaries between self and others;coherent sense of time and personal history; stability and accuracy of self-appraisal and self-esteem; capacity for a range of emotional experience and its regulation2. S elf-direction: Pursuit of coherent and meaningful short-term and life goals; utilizationof constructive and prosocial internal standards of behavior; ability to productively self-reflectInterpersonal:1. E mpathy: Comprehension and appreciation of others’ experiences and motivations;tolerance of differing perspectives; understanding of social causality2. I ntimacy: Depth and duration of connection with others; desire and capacity for closeness;mutuality of regard reflected in interpersonal behaviorIn applying these dimensions, self and interpersonal difficulties should not be better understood as a norm within an individual’s dominant cultural.Self and Interpersonal Functioning ContinuumPlease indicate the level that most closely characterizes the patient’s functioning in the self and interpersonal realms:_____ No Impairment_____ Mild Impairment_____ Moderate Impairment_____ Serious Impairment_____ Extreme Impairment1The original full scale with definitions of terms and detailed definitions of scale points is provided elsewhere (see Skodol, Bender, et al., 2011).140 SKODOL ET AL. are sparse and findings are nonspecific (as is also the case for most Axis I disorders).ANTISOCIAL/PSYCHOPATHICThe median prevalence of ASPD across 12 epidemiological studies is 1.1%, roughly average for PDs in the community (Torgersen, 2009). Individuals with ASPD in the community have been found to have significantly- reduced quality of life, but not to the degree of individuals with avoidant PD (AVPD) or several other PDs (Cramer, Torgersen, & Kringlen, 2006). Individuals with ASPD have been found to have problems with status and wealth and with successful intimate relationships (Ulrich, Farrington, & Coid, 2007), but not with psychosexual dysfunction (Zimmerman & Cory-ell, 1989). ASPD was also associated with poor quality of life in the NESARC (Grant et al., 2004) and with moderate dysfunction on the GAFS (Crawford et al., 2005). In two large clinical populations (combined N = 1975) diag-nosed with semi-structured PD interviews, the prevalence of ASPD was 3.9%, making it one of the less-commonly found PDs in clinical settings (Stuart et al., 1998; Zimmerman, Rothchild, & Chelminski, 2005).ASPD is one of the most frequently studied PDs, however. The construct of ASPD is widely accepted, although there are controversies about spe-cific aspects of the disorder. In general, the core features include egocen-trism, callousness, exploitation, immorality, aggressiveness, hostility, impulsiveness, irresponsibility, criminality, sadism, risk behaviors, and fearlessness. With respect to current models of psychopathy (Patrick et al., 2009), the proposed prototype for antisocial/psychopathic PD includes both traits related to a disinhibition component (i.e., traits corresponding most directly to the adult features of DSM-IV-TR antisocial PD) and traits related to the construct of meanness (i.e., traits related to callousness/ lack of remorse, conning/manipulativeness, and predatory aggression). There is abundant evidence that the impulsive-antisocial (disinhibited-externalizing) and affective-interpersonal (boldness-meanness) compo-nents of psychopathy substantially co-occur, but differ in terms of their neurobiological correlates and etiologic determinants (e.g., see Moffit, 2005; Patrick, 2006), which provides a strong foundation for formulating and testing questions in relation to distinctive antisocial and psychopath-ic PD trait profiles, both within ASPD and across other PDs and other mental disorders (Edens, Marcus, Lilienfeld, & Poythress, 2006; Rutter, 2005).Due to its history, well-established validity, obvious importance in fo-rensic settings, and relationships to other types of psychopathology (e.g., alcohol and substance use disorders, see Compton, Conway, Stinson, Col-liver, & Grant, 2005), and other problems (e.g., poor physical health, ob-sesity, see Goldstein et al., 2008), a revised construct of ASPD that in-cludes psychopathic personality features has been recommended for retention in DSM-5.TYPES PROPOSED 141 BORDERLINEBPD has been found to occur in 1.6% of the general population, about av-erage for PDs in the community (Torgersen, 2009). BPD has been found to be associated with moderate reductions in quality of life in the community (Cramer, Torgersen, & Kringlen, 2006). However, when examined in rela-tionship to a broader concept of dysfunction that included reduced quality of life, problems with other people, number of lifetime Axis I disorders, and treatment-seeking, BPD was the most dysfunctional PD (Torgersen, 2009). In the Collaborative Longitudinal Personality Disorders Study (CLPS), pa-tients with BPD have been found to have significantly more impairment at work, in social relationships, and at leisure than patients with either less severe types, such as obsessive-compulsive PD, or with major depressive disorder in the absence of PD (Skodol, Gunderson, McGlashan, et al., 2002) and functional impairment in BPD was stable over two years of follow-up (Skodol et al., 2005). Borderline personality disorder was associated with poor functioning in the Ulrich and colleagues study (2007) and with psy-chosexual dysfunction in the study by Zimmerman & Coryell (1989). Per-sons in the community with BPD have also been found to have the poorest functioning as measured by the GAFS (Crawford et al., 2005). In two large clinical populations, the prevalence of BPD was 12.7%, making it one of the three most common PDs in clinical settings (Stuart et al., 1998; Zimmer-man et al., 2005). In several other, smaller clinical epidemiological studies based on semi-structured interview assessments, BPD was always found to be one of the two most common PDs (Zimmerman et al., 2005). Borderline PD is also one of the most studied of the BPDs, second only to ASPD with respect to number of publications in the DSM era. DSM-IV-defined BPD has been shown to identify a cohesive class of subjects, in spite of internal heterogeneity. Fossati et al. (1999) carried out a latent structure analysis of DSM-IV BPD criteria, which supported the hypothe-sis that BPD is a unidimensional construct and that patients with BPD represent a distinct, cohesive disorder, yet one with dimensionally distrib-uted temperamental characteristics. Johansen, Karterud, Pedersen, Gude, and Falkum (2004) examined the prototype validity of the DSM-IV border-line construct and concluded that the current criteria fit the prototype model well, with unstable relationships representing the criterion with highest diagnostic efficiency and chronic feelings of emptiness the lowest. Ryder, Costa, and Bagby (2007) utilized the SCID II to evaluate 203 pa-tients with DSM-IV-defined personality disorders, focusing on convergent validity, divergent validity, relation to general personality traits, and as-sociation with functional impairment, as measured by the GAFS. Of the 10 DSM-IV personality disorders, only BPD criteria were satisfactory on all four evaluation standards, and the majority of BPD criteria were asso-ciated with impairment. Grilo et al. (2001), using data from the CLPS, studied four DSM-IV personality disorder criteria sets to evaluate internal consistency, intercriterion overlap, and diagnostic efficiency. They found142 SKODOL ET AL. that criteria for the specific PDs studied (schizotypal, borderline, avoidant, and obsessive-compulsive) correlated better with each other within each set, than with criteria for other PDs. Also from the CLPS data, Sanislow et al. (2002) carried out a confirmatory factor analysis of DSM-IV criteria for BPD. They reported that the diagnostic criteria for BPD reflect a statistically coherent construct, composed of three primary components—disturbed re-latedness, behavioral dysregulation, and affective dysregulation.There are a multitude of family, twin, adoption, genetic, neurobiological, and imaging studies that have shed light on the distinctiveness of BPD (e.g., see Goodman, New, Triebwasser, Collins, & Siever, 2010) and on basic mechanisms underlying its core psychopathology. Originally, two prominent features were singled out—affect dysregulation and impulsive aggression (Coccaro & Siever, 2009). Neurocognitive studies have focused on tasks related to symptoms seen in BPD, such as cognitive and behav-ioral disinhibition, related to impulsivity and emotional processing and have found deficits in behavioral control (e.g., Bazanis et al., 2002) and abnormalities in emotional information processing (e.g., Donegan et al., 2003). Published evidence suggests that there is an abnormality in seroto-nergic function underlying the impulsive aggressive symptoms of BPD re-lated to specific genetic risk factors, but the precise molecular nature of this abnormality is not yet clear. Bender and Skodol (2007) posited that BPD reflects fundamental disturbances in self and other representations, a proposal conceptually akin to theory-based views of borderline intrapsy-chic structure. Gunderson and Lyons-Ruth (2008) proposed a gene-envi-ronment developmental model to support their view that interpersonal hy-persensitivity represents a third core endophenotype, and a number of research groups have identified the interpersonal realm as a key area of disturbance in borderline patients. Leihener et al. (2003), for example, sug-gested that there are two distinct subtypes of patients with BPD, autono-mous and dependent, reflecting two different trait patterns of interpersonal behavior. Stanley and Siever (2010) reviewed neurobiological studies of at-tachment and affiliation and hypothesized that altered neuropeptide func-tion may underlie the interpersonal domain of BPD. Livesley (2008), draw-ing from empirical studies of the phenotypic structure and genetic architecture of personality, described core self and interpersonal pathology in patients with BPD, accompanied by a set of four types of traits: emo-tional, interpersonal, cognitive, and self-harm.The proposed BPD prototype includes characteristic core disturbances in self and interpersonal functioning, coupled with manifestations of emo-tional, behavioral, and cognitive dysregulation (See Tables 1 & 4). Treat-ment and naturalistic studies of other mental disorders demonstrate the negative prognostic impact of BPD co-occurrence and underscore the clin-ical utility of the diagnosis (e.g., Grilo et al., 2005; Grilo et al., 2010). A complete review of the literature on the validity of BPD is beyond the scope of this paper, but a wealth of data have accumulated on this most clinical-ly-salient PD being recommended for retention in DSM-5.TYPES PROPOSED 143 SCHIZOTYPALSchizotypal PD (STPD) was added as a specific PD in DSM-III, to encom-pass the attenuated schizophrenia-like symptoms observed in the relatives of patients with schizophrenia (Spitzer, Endicott, & Gibbon, 1979). Without inclusion of such nonpsychotic individuals in the original Danish Adoption Studies of Schizophrenia, no genetic effects would have been found (Kety, 1983). STPD is one of the less-common PDs (median prevalence 0.9%) found in general population studies (Torgersen, 2009), but one of the most studied PDs. STPD is also one of the DSM-IV PDs most strongly associated with reduced quality of life in the community (Cramer et al., 2006). Indi-viduals in the community with STPD have also been found to have signifi-cant problems in achievement and in interpersonal relationships by Ulrich and collaegues (2007) and the 3rd lowest GAFS scores among the PDs by Crawford et al. (2005). STPD is also rare in clinical populations (1.9%; Stu-art et al., 1998; Zimmerman, Rothchild, & Chelminski, 2005). However, patients with STPD have been found to have significantly more impairment at work, in social relationships, and at leisure than patients with either less-severe PD types, such OCPD, or with major depressive disorder in the absence of PD (Skodol, Gunderson, McGlashan, et al., 2002).The criteria of STPD reflect both positive psychotic-like manifestations and negative deficit-like manifestations, and both have been validated by numerous neurochemical, psychophysiological, neuropsychological, and structural and functional imaging studies. For example, the psychotic-like symptoms of STPD correlate with elevated levels of the dopamine (DA) me-tabolite homovanillic acid (HVA), which are higher than in other PDs but lower than in schizophrenia (Siever & Davis, 2004). Moreover, smaller vol-umes of striatal structures (e.g., caudate and putamen) in STPD com-pared to schizophrenia results in lower striatal DA release mediated by amphetamine (Abi-Dargham, Mawlawi, & Lombardo, 2002; Siever et al., 2002) or by physiological stressors in individuals with STPD (Mitropoulou et al., 2004). Such findings have been hypothesized to result in signifi-cantly lower vulnerability to frank psychosis in patients with STPD com-pared to those with schizophrenia, and to account for the relatively low rate of progression of STPD to schizophrenia. The negative manifestations and cognitive deficits of STPD have also been related to external validators (Holohan & O’Driscoll, 2005).The study of STPD has increased knowledge about pathophysiological factors that give rise to schiozophrenia, but also about differences that result in more readily reversible cognitive and social deficits (Fossati, Raine, Carretta, Leonardi, & Maffei, 2003; Mata, Mataix-Cols, & Peralta, 2005) and in decreased vulnerability to psychosis in STPD (Raine, 2006). The clinical implications of these differences are recognized by research groups who use individuals with STPD in studies assessing compensatory processes that provide buffers against schizophrenia in vulnerable indi-viduals. Despite its phenomenological similarities to schizophrenia, STPD144 SKODOL ET AL.is regarded by those who study it as a distinct disorder whose core fea-tures more resemble the maladaptive patterns of a personality disorder than the overt breaks from reality characteristic of psychotic disorders. It is recommended that STPD be retained as a PD type, not a variant of schizophrenia, in DSM-5.AVOIDANTThe median prevalence of AVPD in 12 epidemiological studies was 1.7%, making it one of the most prevalent PDs in the community (Torgersen, 2009). Avoidant personality disorder has also been found to be the PD most strongly associated with reduced quality of life in the community, as mea-sured by subjective well-being, self-realization, relation to friends, social support, negative life events, relation to family of origin, and neighborhood quality (Cramer, Torgersen, & Kringlen, 2006). AVPD has been found to be associated with problems with status and wealth and with successful inti-mate relationships (Ulrich et al., 2007) and with a high frequency of psycho-sexual dysfunction (Zimmerman & Coryell, 1989). Grant et al. (2004) found that individuals with AVPD had among the highest levels of impairment in functioning in the NESARC. Crawford et al. (2005) found that persons in the community with AVPD had the second lowest (to BPD) level of function-ing as measured by the GAFS. In two large clinical samples, AVPD was the single most frequently occurring PD (20.4%; Stuart et al., 1998; Zimmer-man et al., 2005) and one of the two most common PDs (with BPD, see above) in several other smaller clinical samples. AVPD was found to have moderate levels of functional impairment in the CLPS, between that of the severe PDs, such as STPD and BPD, and OCPD, and greater impairment than for MDD without PD (Skodol, Gunderson, McGlashan, et al., 2002). Much of the literature on AVPD is focused on its discrimination from social phobia (SP), and specifically if it can simply be considered a severe form of generalized social phobia (GSP). Although the conclusions drawn from many studies and reviews suggest that AVPD and GSP differ only quantitatively, but not qualitatively, a closer look at these studies indi-cates a more complex picture. Alden, Laposa, Taylor, and Rider (2002) noted that studies of social phobia/AVPD comorbidity typically examined a sample of patients, all of whom were included because they had one of these diagnoses, for overlap with the other. Such studies reliably find that many—though far from all—patients with AVPD also have social phobia. They reported an average comorbidity rate of 42% for SP in AVPD, with somewhat higher rates for GSP, figures far lower than would be expected if AVPD were simply a more severe form of SP. These studies do typically find that, among patients with social phobia, those with comorbid AVPD are more severe on a variety of indices.Other studies (e.g., Jansen, Arntz, Merckelbach, & Mersch, 1994) exam-ined the specificity of the AVPD/SP relationship by studying co-morbidity of AVPD with other anxiety disorders and found modest rates of co-occur-。
心理健康著作文献及作者
心理健康著作文献及作者英文回答：References on Mental Health.Books.The Feeling Good Handbook by David D. Burns Acognitive-behavioral therapy (CBT) workbook for overcoming depression, anxiety, and other mental health issues.Mind Over Mood by Dennis Greenberger and Christine A. Padesky Another CBT workbook that teaches skills for managing depression and anxiety.The Mindfulness and Acceptance Workbook for Anxiety by John P. Forsyth and Georg H. Eifert A mindfulness-based workbook for reducing anxiety.Overcoming Traumatic Stress: A Workbook for Survivorsby Mary A. Main A guide to understanding and healing from trauma.The Dialectical Behavior Therapy Skills Workbook by Matthew McKay, Jeffrey C. Wood, and Jeffrey Brantley A DBT workbook for managing emotions, relationships, and otherlife challenges.Articles."The Impact of Childhood Trauma on Adult Mental Health: A Systematic Review" by Julia M. Ford, Elizabeth A. Chapman, and Veena Lakdawalla A review of research on the long-term effects of childhood trauma on mental health."Evidence-Based Treatments for Anxiety Disorders" by Scott L. Rauch, Alan J. Lang, and John S. March A summaryof the evidence for various treatments for anxiety disorders."The Efficacy of Mindfulness-Based Interventions for Depressive Disorders" by Maria A. Piet and Willem Kuyken Areview of research on the effectiveness of mindfulness-based interventions for depression."The Emerging Role of Transcranial MagneticStimulation (TMS) in the Treatment of Depression" by Daniel Blumberger, Sarah Jacobson, and David Fedele A discussionof the potential of TMS as a treatment for depression."The Role of Social Media in Mental Health: A Systematic Review" by Christina L. Eichstaedt, Oscar A. Deschaine, and Andrew P. Merchant A review of research onthe relationship between social media use and mental health.中文回答：心理健康书籍及作者。
心理干预英文文献1
Psychological Intervention and Antidepressant Treatment in Smoking CessationSharon M.Hall,PhD;Gary L.Humfleet,PhD;Victor I.Reus,MD;Ricardo F.Mun˜oz,PhD;Diane T.Hartz,PhD;Roland Maude-Griffin,BABackground:Sustained-release bupropion hydrochlo-ride and nortriptyline hydrochloride have been shown to be efficacious in the treatment of cigarette smoking. It is not known whether psychological intervention in-creases the efficacy of these antidepressants.This study compared both drugs with placebo.It also examined the efficacy of these2drugs and placebo with and without psychological intervention.Methods:This was a2(medical management vs psycho-logical intervention)ϫ3(bupropion vs nortriptyline vs pla-cebo)randomized trial.Participants were220cigarette smokers.Outcome measures were biologically verified ab-stinence from cigarettes at weeks12,24,36,and52.Results:Psychological intervention produced higher 7-day point-prevalence rates of biochemically verified ab-stinence than did medical management alone.With the use of point-prevalence abstinence,both nortriptyline and bupropion were more efficacious than placebo.On rates of1-year continuous abstinence,the2drugs did not dif-fer from each other or from placebo.Psychological in-tervention did not differ from medical management alone on rates of1-year continuous abstinence.Conclusions:Both nortriptyline and bupropion are ef-ficacious in producing abstinence in cigarette smokers. Similarly,psychological intervention produces better ab-stinence rates than simple medical management.Both drugs,and psychological intervention,have limited ef-ficacy in producing sustained abstinence.The data also suggest that combined psychological intervention and an-tidepressant drug treatment may not be more effective than antidepressant drug treatment alone.Arch Gen Psychiatry.2002;59:930-936T HE ANTIDEPRESSANTS bupro-pion hydrochoride and nor-triptyline hydrochloride areuseful adjuncts in the treat-ment of tobacco depen-dence.A multicenter bupropion trial re-ported1-year continuous abstinence rates of24%for300mg/d,18%for150mg/d, 14%for100mg/d,and10%for placebo.The difference from placebo was significant in the150-and300-mg/d groups.1A trial com-paring bupropion and nicotine patch re-ported1-year continuous abstinence rates of36%for bupropion and nicotine patch, 33%for bupropion alone,16%for nico-tine patch alone,and15%for placebo.Bu-propion alone or with nicotine patch re-sulted in significantly higher abstinence rates than did patch alone or placebo.2Our group reported1-year continuous abstinence rates of24%for nortriptyline and12%for pla-cebo.3A second study reported that14%of patients receiving nortriptyline and3%of patients receiving placebo were abstinent6 months after treatment.4Nicotine replacement treatment (NRT)is usually more effective when pro-vided with psychosocial treatment.5,6The impact of psychosocial interventions in an-tidepressant treatment for cigarette smok-ing is unknown.Antidepressants and NRT differ in ease of use,mode of administra-tion,adverse effects,and effects on mood and withdrawal symptoms,all of which might contribute to differences in the role of psychosocial interventions.Antidepressant studies have in-volved either psychotherapy or counsel-ing or extensive contact with project staff, including physician reinforcement for quit-ting smoking,1,2multiple episodes of brief counseling by“research staff,”1,2group meetings,3,4and psychotherapy.3Accord-ing to the Agency for Health Care Policy and Research guidelines7,8available at the time this study was conducted,a more typi-cal practice-based medical management (MM)protocol would entail physician ad-vice to quit smoking and,at most,1to3 brief follow-up visits,and perhaps a refer-From the Department of Psychiatry,University of California,San Francisco (Drs Hall,Humfleet,Reus, Mun˜oz,and Hartz);and Edina, Minn(Mr Maude-Griffin).ral to a smoking cessation group.Antidepressant efficacy in such a context may differ from that obtained from more extensive psychotherapy.One important question is the effect of psychological intervention(PI)when added to antidepressant therapy.A second question is the relative efficacy of the2 drugs.On the basis of the extant literature,we deemed differences in efficacy between bupropion and nortrip-tyline unlikely,and we did not predict differences be-tween the2.We did expect,however,that both would produce higher abstinence rates than placebo.Thus,the following hypotheses were proposed:(1) Abstinence rates will be higher in participants receiving active antidepressant treatment,whether bupropion or nortriptyline,during a52-week period,than for those re-ceiving placebo.(2)Independent of drug,abstinence rates will be higher for participants receiving PI than for those receiving MM alone.(3)Active drug conditions com-bined with PI will be more efficacious than the other ex-perimental conditions in producing abstinence.SUBJECTSSmokers of10or more cigarettes per day were recruited by ad-vertising,public service announcements,and flyers.After tele-phone screening,potential participants were invited to an ori-entation meeting.Interested individuals completed an informed consent and were invited to a baseline assessment including a physical examination,electrocardiogram,and blood draws.The sections of the Structured Clinical Interview for DSM-IV9that diagnose depression,dysthymia,and bipolar disorder were ad-ministered by master’s-level clinicians.Participants were as-sessed on demographic variables and mood by paper-and-pencil measures and interviews administered by research staff.Exclusionary criteria included cardiovascular disease,hy-perthyroidism,seizure or bulimia,use of a monoamine oxi-dase inhibitor within2weeks,severe allergies including aller-gies to either experimental drug,life-threatening disease,bipolar disease,current major depressive disorder(MDD),pregnancy or lactation,use of levodopa,migraines,previous treatment for cigarette smoking with nortriptyline or bupropion,treatment for alcohol or other drug use within6months,psychiatric hos-pitalization within1year,use of any psychiatric medication, suicidal or psychotic symptoms,and current NRT use.PROCEDURESParticipants were stratified by number of cigarettes smoked,sex, and history of depression vs no history,and randomly as-signed to1of the6experimental cells in a3(bupropion vs nor-triptyline vs placebo)ϫ2(MM alone vs MM+PI).Assessments were at baseline and at weeks12(end of treat-ment),24,36,and52.Participants were coded as nonsmoking if they reported smoking no cigarettes,not even a puff,during the previous7days,had expired carbon monoxide levels of10ppm or less,and had urinary cotinine levels of60ng/mL or less.10Ad-verse effects were assessed by checklist at baseline and weeks1, 2,3,and6.At52weeks,participants indicated which drug they believed they had received and its perceived helpfulness.MEASURESNegative affect was assessed with the Profile of Mood States (POMS).11On the basis of the Structured Clinical Interview for DSM-IV,participants were classified as positive or negative for MDD.We also administered the Fagerstrom Test for Nicotine Dependence12and a adverse effects scale we developed that includes the adverse effects reported for both bupropion and nortriptyline.COUNSELING INTERVENTIONSMedical ManagementMedical management was developed from the1996Agency for Health Care Policy and Research guidelines7and from the MM condition in the Collaborative Depression Trials.13Medical man-agement included advice to stop smoking,antidepressant medi-cation,adverse effects monitoring,and educational materials. It did not introduce complex or time-consuming interven-tions that would be impractical in primary care.Physicians were5licensed psychiatric and internal medi-cine residents.Participants were provided written information about smoking cessation(Freedom From Smoking).14During week1,the physician reviewed the treatment rationale and pre-scription instructions,discussed behavioral factors important to smoking cessation,and established a quit date during week5. This session lasted10to20minutes.Five-minute visits were scheduled during weeks2,6,and11,during which participants were queried about cessation progress.The physician re-sponded briefly to questions and provided encouragement.Ad-vice about specific quitting strategies was not offered.Psychological InterventionAll participants participated in the MM sessions previously de-scribed.In addition,they participated in5group sessions.Providers were3master’s-level counselors,the most com-mon smoking treatment provider in the health care organiza-tions we consulted.The group intervention was an adaptation of an intervention described in detail elsewhere3,15-17and is avail-able from the first author(S.M.H.).The first90-minute ses-sion was during week4.Sessions2and3were during week5; sessions4and5were during weeks7and11,respectively.Group size ranged from3to11.The intervention provided health-related information for mood management and smoking ces-sation,and discussion of cessation.A core element was the de-velopment of a quit-smoking plan and weekly modification of it.Methods used included monitoring of cigarette use and af-fective states;paper-and-pencil exercises focusing on health-related information,motivation to quit,and decreasing relapse-related thoughts;informational handouts;and brief didactic presentations.PHARMACOLOGIC INTERVENTIONSMedication was placebo controlled and double blind.The sus-tained-release properties of bupropion rest on the formula-tion of the tablet’s coating;placebo bupropion was not avail-able.We encapsulated both drugs to maintain the patency of the bupropion formulation and to provide a blinded drug.All participants received capsules that were identical in number and appearance.The University of California,San Francisco Drug Prod-uct Services prepared medication capsules.For nortriptyline, lactose placebo and active drug were encapsulated in pow-dered form.For bupropion,Wellbutrin SR tablets(Glaxo Well-come Inc,Research Triangle Park,NC)or similar-sized pla-cebo tablets were inserted into lactose-filled capsules.All capsules were secured with a gelatin mixture to prevent opening.Nortriptyline drug dose was titrated for each participant until a therapeutic serum level(50-150ng/mL)was obtained.All participants assigned to active nortriptyline hydrochloride received25mg/d for3days,followed by50mg/d for4days. At the end of the week,serum levels of nortriptyline were as-sessed.Dosage was increased to75mg/d if a therapeutic se-rum level had not been reached.At week4,serum levels were assessed again and,if necessary,drug dosage was increased to 100mg/d.At week6,serum levels were assessed to determine final dose.At the end of week12,drug dose was decreased by 25mg every2days,with the final drug administration being 25mg over3days.Whenever a dose was titrated for a partici-pant receiving active drug,the dose was titrated for a partici-pant receiving placebo.Titration was performed by a physi-cian who had no contact with participants or clinical staff.The mean nortriptyline blood level for participants abstinent at week 6was59.9ng/mL(SD,25.2ng/mL).We report only blood lev-els for abstinent participants,since nicotine is known to result in lowered nortriptyline levels.18Daily nortriptyline hydro-chloride dosages at week7were as follows:50mg/d,n=2;75 mg/d,n=26;100mg/d,n=25,and125mg/d,n=5.Bupropion hydrochloride dosage began at150mg/d for the first3days.The dosage was increased to300mg/d,where it remained until week12,when the dose was decreased to150 mg for3days,then discontinued.Dose reductions occurred if participants reported unpleasant adverse effects.Mean bupro-pion blood level for abstinent subjects was36.0ng/mL.At week 7,all participants receiving bupropion were receiving300mg/d.Participants returned pill bottles at each clinic visit.Pills were counted and number of pills taken was recorded.If a pa-tient failed to return a bottle,he or she was asked to call clinic staff with the pill count.STATISTICAL METHODSThe principal data analysis method was a generalized linear model(GLM),a generalization of the classic linear model that computes estimates by means of likelihood functions instead of least squares.A GLM allows use of repeated measurements when there are missing data,without dropping participants with data missing or assuming that missing data equate to smok-ing.19-21We used SAS PROC MIXED version6.12software(SAS Institute Inc,Cary,NC).When abstinence was the dependent variable,we also used the GLIMMIX Macro for SAS(SAS In-stitute Inc),which interacts with PROC MIXED to modify it so that it is appropriate for dichotomous data.22A single GLM was used to evaluate the3hypotheses.Abstinence status at weeks 12,24,38,and52were the dependent variables.The design was a2(active drug vs placebo)ϫ2(MM vs MM/PI)ϫ2(MDD history vs no history)model with assessment entered as a re-peated variable.Since no interactions of assessment with in-dependent variables were predicted,these interactions were dropped from the final model when no significant effects emerged.Since we performed a single test for each hypoth-esis,the hypothesis-wise error rate was held at P=.05.We evaluated effects of sex and its interaction with the3 design variables on abstinence rates at weeks12to52by means of3GLM models computed with the GLIMMIX Macro.We used a parallel procedure to compare the3drug conditions(bupro-pion,nortriptyline,and placebo).Effect sizes are expressed as odds ratios and confidence intervals.Analysis of variance and2tests were used to evaluate base-line differences among treatment conditions,continuous ab-stinence rates,and the rate of occurrence of adverse effects.Tests were2-tailed,with PϽ.05,all comparisons.RESULTSPARTICIPANT CHARACTERISTICS Demographic,smoking,and psychiatric characteristics of participants in each experimental condition are given in Table1.There were no significant differences be-tween conditions at baseline.ATTRITIONFigure1shows participant flow from first telephone con-tact to week52.Smokers(N=220)were randomly as-signed to1of3pharmacologic treatments(nortripty-line,bupropion,or placebo)and1of2counseling treatments(MM or PI).A history of MDD was present in33%of the participants.Because of a medical emer-gency,it was necessary to break the blind for1partici-pant,who was receiving placebo drug.Thus,the usable sample(N=219)consisted of122men and97women.Thirty-seven participants(17%)failed to complete treatment:15for personal reasons,12because of per-ceived medication adverse effects(bupropion,6;nor-triptyline,3;placebo,3),1because of an unrelated medi-cal condition,and9for undisclosed reasons.There were no significant differences between psychological treat-ment conditions(21[N=219]=1.37,P=.24)or diag-*MM indicates medical management;PI,psychological intervention;POMS,Profile of Mood States;and MDD,major depressive disorder.†Mean(SD).nostic categories(21[N=219]=3.19,P=.07)in treat-ment dropout.There were significant differences between the drug conditions(22[N=219]=7.29,P=.03;bupro-pion,15.1%[n=11];nortriptyline,10.0%[n=7];pla-cebo,26.0%[n=19]).The rate for placebo was signifi-cantly greater than the rate for nortriptyline(21[N=219]= 6.74,P=.009),but not for bupropion(21[N=219]=2.69, P=.10).The2active drugs did not differ from one an-other(21[N=219]=1.01,P=.31).The mean number of counseling sessions attended was3.58(SD,1.61).The percentages and numbers of participants for whom we were unable to collect smoking data were as follows:week12,15%(n=33);week26,16%(n=35); week36,17%(n=38);and week52,19%(n=42),with no significant differences between drug,psychological treatment,or diagnostic categories.ABSTINENCEMain effects for drug,psychological treatment condi-tion,and assessment time were each significant at PϽ.05 (Table2).There were no other significant effects.Nei-ther main effects for MDD diagnosis nor the interaction of this variable with other variables was significant.Thus, both the first and second hypotheses—that active drug would be more effective than placebo(Figure2)and that the PI would be more effective than MM alone (Figure3)—were supported.The lack of a significant interaction between drug and PI condition indicated lack of support for the hypothesis that active medication plus PI would be the most efficacious condition.We did not hypothesize a difference in efficacy be-tween the2active drugs.None was found(21[N=126] =1.88,P=.17).The interaction of bupropion vs nortriptyline with diagnosis fell short of traditional levels of significance (21[N=126]=3.39,P=.07).There were few differ-ences between the2drugs for participants without a history of depression,but there were higher abstinence rates for bupropion than nortriptyline for participants with a history of depressive disorder.For example,with missing data omitted,the52-week abstinence rate for participants without a history of MDD was27%for nor-triptyline and24%for bupropion(20%with missing data coded as smoking for both drugs),whereas for par-ticipants with a history of MDD,the52-week absti-nence rate was16%for nortriptyline(13%with missing data coded as relapsed)and38%for bupropion(33% with missing data coded as relapsed).Continuous absti-nence rates for the1-year period were20.7%for bupro-pion,13.2%for nortriptyline,and11.8%for placebo (22[N=162]=1.96,P=.38).For the2psychosocial conditions,they were13%for MM and18%for PI (22[N=162]Ͻ1).Main effects for sex approached significance (21[N=189]=2.68,P=.10),favoring better abstinence rates for men when compared with women.Abstinence rates for men were as follows:week12,44%;week24, 29%;week36,26%;and week52,24%.For women,these rates were as follows:week12,41%;week24,20%;week 36,28%;and week52,23%.For all analyses,there were no differences in sig-nificance when the data were reanalyzed with missing data coded as smoking.With missing data coded as smok-ing,continuous abstinence rates were as follows:bupro-pion,16.4%;nortriptyline,9.6%;and placebo,8.2% (22[N=219]=2.80,P=.25);and MM,10%,and PI,13% (22[N=219]Ͻ1).Figure1.Attrition flow chart.ECG indicates electrocardiogram;MM,medical management;and PI,psychological intervention.Asterisk indicates n=219,because the blind was broken for1female subject in the group receiving placebo and PI.Fifty-four participants,or 25%of the sample,re-ported using out-of-study NRT (n=34)or bupropion dur-ing follow-up (15in the bupropion group,14in the nor-triptyline group,and 25in the placebo group).Placebo recipients were more likely than active-drug recipients to use nonstudy pharmacological therapies (21[N=219]=5.42,P =.20).Of the 54subjects who reported use of extrastudy medications,however,only 14were abstinent at the time of the report,and they were distributed fairly equally across the treatment conditions.At week 24,1partici-pant who reported out-of-study medication was absti-nent (nortriptyline condition);at week 36,1abstinent participant in each of the antidepressant conditions and 2in the placebo condition were using out-of-study medi-cations.At week 52,the out-of-study medication count was 4in the bupropion group,2in the nortriptyline group,and 3in the placebo group.MAINTENANCE OF THE BLINDAs part of the informed consent procedures,partici-pants were informed about the adverse effects of each drug.It is not surprising that participants receiving active drug*Main effects for drug (21[N =189]=10.76,P =.001;odds ratio [OR],4.3;95%confidence interval [CI],1.83-10.00),psychological treatment condition (21[N =189]=8.53,P =.004;OR,3.32;95%CI,1.31-8.41),and assessment time (23[N =189]=20.46,P Ͻ.001;OR,0.98;95%CI,0.97-0.99)were significant at P Ͻ.05.†Numbers in parentheses represent percentages of subjects who were abstinent if those with missing data were coded as smoking.100608090705030104020012243652Assessment Week % A b s t i n e n tNortriptyline Hydrochloride Bupropion Hydrochloride PlaceboFigure 2.Seven-day point-prevalence abstinence rates by pharmacologic intervention.100608090705030104020012243652Assessment Week% A b s t i n e n tPlacebo + MM Drug + MMPlacebo + PI Drug + PI Figure 3.Seven-day point-prevalence abstinence rates by psychological intervention (PI)and drug.MM indicates medical management.were more likely to guess that they had received active drug(87%)than placebo participants were to believe they were receiving active drug(67%;21[N=160]=9.06, P=.003;odds ratio,3.29;95%confidence interval, 1.48-7.30).Of the active drug participants who were able to correctly guess their assignment to active or placebo drug,49%of the nortriptyline recipients and58%of the bupropion recipients correctly guessed drug assign-ment(21[N=96]Ͻ1,P=.35).Thus,bupropion recipi-ents were no more likely than nortriptyline participants to correctly identify which drug they had received.ADVERSE EFFECTSOf the potential adverse effects(dry mouth,rash,weight gain,light-headedness,shaky hands,constipation,blurry vision,sexual problems,difficulty in urinating,racing heart,swollen legs,chest pain or pressure,shortness of breath,weight loss,headaches,agitation,nausea or vom-iting,dizziness,difficulty sleeping,and sweating),post-baseline endorsement rates differed between nortripty-line and placebo on the following:(1)dry mouth: nortriptyline,72%;placebo,33%(21[N=131]=19.71, PϽ.001;odds ratio,5.16;95%confidence interval,2.45-10.86);and(2)constipation:nortriptyline,32%;pla-cebo,14%(21[N=131]=5.91,P=.02;odds ratio,2.87; 95%confidence interval,1.20-6.85).Bupropion did not differ from placebo on any item.As predicted,bupropion and nortriptyline were more ef-ficacious than placebo in producing abstinence when mea-sured by point-prevalence abstinence during the course of a year.Similarly,PI was more efficacious than MM alone.The hypothesis that PI would add to antidepres-sant treatment was not supported.As has been the case in other recent studies(eg,Hall et al3),MDD did not pre-dict failure to quit smoking.The equivalent effectiveness of bupropion and nortriptyline,a generic drug,and nortriptyline’s much lower cost,suggest that it might be a useful alternative to bupropion for some smokers.The drugs have differ-ent adverse effect and risk profiles,however.Nortripty-line has been shown to be related to an increased rate of serious cardiac events in patients with ischemic heart disease.23The present study does not indicate whether it is the content of the PI or increased contact that increases ab-stinence.Visual inspection of data values in Figure3sug-gests potential differences between MM-placebo,and the remaining3conditions(MM–active drug,MM/PI–placebo,and MM/PI–active drug)at weeks12,24,and 52.The PI did not increase abstinence rates when added to the active drug;it may bring abstinence rates in the placebo condition to about the same level as active drug. Additional research in the role of psychological treat-ment with antidepressants is warranted.The interac-tion of drug with history of MDD did not reach statisti-cally significant levels(P=.07).Inspection of the data suggests potential superiority of bupropion for smokers with a history of MDD,but virtually no difference in pa-tients without a history of MDD.The effect may warrant further examination in a study designed to address this question.Abstinence rates in the present study were lower than those reported in earlier work with nortriptyline3 and bupropion.1,2This difference may reflect the chang-ing nature of participants entering smoking treatment trials.Smokers in the present study smoked fewer ciga-rettes,were less likely to have a partner or spouse,were more likely to be blue collar or service workers,and were less likely to be white.A recent study24has shown decreasing abstinence rates in smoking cessation studies during the past25years.The authors of that study attribute this to increasing difficulty in quitting ciga-rettes among individuals who continue to smoke despite current pressures.Although nortriptyline and bupropion were signifi-cantly more efficacious than placebo when point-prevalence rates were compared,this was not the case when1-year continuous abstinence rates were evalu-ated.Also,as the modest week24and52abstinence rates indicate,the field must continue to seek more effica-cious treatments.Two recent clinical trials,both with ac-ceptable rigor,one published in199625and the second in1999,2failed to find differences between placebo and active NRT.Recent reviews of NRT effectiveness have sug-gested decreasing efficacy of nicotine patch,but not nico-tine gum,since they were introduced in the1980s.26As the population of smokers changes,interventions may experience a declining efficacy.Given the information provided to participants as part of the informed consent procedures,it is not sur-prising that they were able to correctly guess which drug they had received.Indeed,in studies of drugs with detectable effects that report the maintenance of the blind,participants are often able to correctly guess which drug they received.27-29Nevertheless,given the complex blinding procedures we used because a placebo bupropion sustained-release capsule was unavailable,it was reassuring that the bupropion recipients were no more likely than the nortriptyline recipients to guess their drug.To our knowledge,this is the first clinical trial to report the use of out-of-study medication during the fol-low-up period.We found a high rate of such use(54pa-tients[25%of the sample]),but only14of these54par-ticipants were abstinent.Recoding these abstinent participants as smoking does not change the overall find-ings.They represent less than6%of the sample and were fairly equally distributed across conditions.Neverthe-less,given the increasing availability of smoking cessa-tion medications,we recommend that studies routinely report these data to better understand outcomes and the processes of abstinence and relapse.The results of the present study are limited by the select nature of the sample resulting from the need to meet both criteria necessary to complete the research,such as availability during the course of the year,and medical exclusionary criteria.Submitted for publication July20,2001;final revision re-ceived November12,2001;accepted December11,2001.This study was supported by grants R01DA02538and 2P50DA09253from the National Institute on Drug Abuse, Bethesda,Md,and grant R01CA71378from the National Cancer Institute,Bethesda.We thank Kevin Delucchi,PhD,for his statistical con-sultation and Heather Kenna for manuscript preparation.Corresponding author and reprints:Sharon M.Hall, PhD,University of California,San Francisco,401Parnas-sus Ave,Box0984,San Francisco,CA94143-0984(e-mail:smh@).1.Hurt RD,Sachs DPL,Glover ED,Offord KP,Johnston JA,Dale LC,Khayralla MA,Schroeder DR,Glover PN,Sullivan R,Croghan IT,Sullivan PM.A comparison of sustained-release bupropion and placebo for smoking cessation.N Engl J Med.1997;337:1195-1202.2.Jorenby DE,Leischow SJ,Nides MA,Rennard SI,Johnston JA,Hughes AR,SmithSS,Muramoto ML,Daughton DM,Doan K,Fiore MC,Baker TB.A controlled trial of sustained-release bupropion,a nicotine patch,or both for smoking cessa-tion.N Engl J Med.1999;340:685-691.3.Hall SM,Reus VI,Mun˜oz RF,Sees KL,Humfleet G,Hartz DT,Frederick S,Triffle-man E.Nortriptyline and cognitive-behavioral therapy in the treatment of ciga-rette smoking.Arch Gen Psychiatry.1998;55:683-690.4.Prochazka AV,Weaver MJ,Keller RT,Fryer GE,Licari PA,Lofaso D.A randomizedtrial of nortriptyline for smoking cessation.Arch Intern Med.1998;158:2035-2039.5.Hughes J,Gust S,Skoog K,Keenan R,Fenwick J.Symptoms of tobacco with-drawal:a replication and extension.Arch Gen Psychiatry.1991;48:52-59.6.Fiore MC,Jorenby DE,Baker TB,Kenford SL.Tobacco dependence and the nico-tine patch:clinical guidelines for effective use.JAMA.1992;268:2687-2694. 7.Fiore MC,Bailey WC,Cohen SJ.Smoking Cessation Clinical Practice GuidelinesNo.18.Rockville,Md:Public Health Service,Agency for Health Care Policy and Research,US Dept of Health and Human Services;1996.Publication96-0692.8.Fiore MC.A clinical practice guideline for treating tobacco use and dependence:a US Public Health Service report.JAMA.2000;283:3244-3254.9.First M,Gibbons M,Spitzer R,Williams J.Structured Clinical Interview for DSM-IV:Users Guide.New York:Biometrics Research Dept,New York State Psychi-atric Institute;1996.10.Jarvis MJ,Tunstall-Pedeo H,Feyerabend C,Vesy C,Saloojee parison oftests used to distinguish smokers from non-smokers.Am J Public Health.1987;77:1435-1483.11.McNair DM,Lorr M,Droppleman LF.Manual for the Profile of Mood States.SanDiego,Calif:Educational&Instructional Testing Service;1981.12.Payne T,Smith P,McCracken L,McSherry WC,Antony M.Assessing nicotinedependence:a comparison of the Fagerstrom Tolerance Questionnaire(FTQ)withthe Fagerstrom Test for Nicotine Dependence(FTND)in a clinical sample.Ad-dict Behav.1994;19:307-317.13.Fawcett J,Epstein P,Fiester SJ,Elkin I,Autry JH.Clinical management—imipramine/placebo administration manual:NIMH Treatment of Depression Col-laborative Research Program.Psychopharmacol Bull.1987;23:309-324.14.American Lung Association.Freedom From Smoking.New York,NY:AmericanLung Association;1993.15.Hall SM,Munoz RF,Reus VI.Cognitive-behavioral intervention increases absti-nence rates for depressive-history smokers.J Consult Clin Psychol.1994;62: 141-146.16.Hall SM,Tunstall C,Rugg D,Jones RT,Benowitz H.Nicotine gum and behav-ioral treatment in smoking cessation.J Consult Clin Psychol.1985;53:256-258.17.Hall SM,Tunstall CD,Ginsberg D,Benowitz NL,Jones RT.Nicotine gum andbehavioral treatment:a placebo controlled trial.J Consult Clin Psychol.1987;55:603-605.18.Linnoila M,George L,Guthrie S,Leventhal B.Effects of alcohol consumptionand cigarette smoking in antidepressant levels of depressed patients.Am J Psy-chiatry.1981;138:841-842.19.McCullagh P,Nelder JA.Generalized Linear Models.2nd ed.London,England:Chapman Hall;1989.20.Gibbons RD,Hedeker D,Waternaux C,Davis JM.Random regression models:acomprehensive approach to the analysis of longitudinal psychiatric data.Psy-chopharmacol Bull.1988;24:438-443.21.Gibbons RD,Hedeker D,Elkin I,Waternaux C,Kraemer H,Greenhouse JB,Shea TM,Imber SD,Sotsky SM,Watkins JT.Some conceptual and statistical issues in analysis of longitudinal psychiatric data.Arch Gen Psychiatry.1993;50:739-750.22.Little RC,Milliken GA,Stroup WW.SAS System for Mixed Models.Cary,NC:SAS Institute Inc;1996.23.Roose SP,Laghrissi-Thode F,Kennedy JS,Nelson JC,Bigger JT,Pollock BG,Gaffney A,Narayan M,Finkel MS,McCafferty J,Gergel parison of parox-etine and nortriptyline in depressed patients with ischemic heart disease.JAMA.1998;279:287-291.24.Irvin JE,Brandon TH.The increasing recalcitrance of smokers in clinical trials.Nicotine Tob Res.2000;2:79-84.25.Hall SM,Munoz RF,Reus VI,Sees KL,Duncan C,Humfleet GL,Hartz D.Moodmanagement and nicotine gum in smoking treatment:a therapeutic content and placebo-controlled study.J Consult Clin Psychol.1996;64:1003-1009.26.Fox BJ,Welsh SK,Fiore MC,Baker TB.Have nicotine patch and nicotine gumlost their efficacy over time?Paper presented at:7th Annual Meeting of the So-ciety for Research on Nicotine and Tobacco;March2001;Seattle,Wash. 27.Moscucci M,Byrne L,Weintraub M,Cox C.Blinding,unblinding,and the pla-cebo effect:an analysis of patients’guesses of treatment assignment in a double-blind clinical trial.Clin Pharmacol Ther.1987;41:259-265.28.Ney P,Collins C,Spensor C.Double blind:double talk or are there ways to dobetter research?Med Hypotheses.1986;21:119-126.29.Rabkin J,Markowitz J,Stewart J,McGrath P,Harrison W,Quitkin F,Klein D.How blind is blind?assessment of patient and doctor medication guesses in a placebo-controlled trial of imipramine and phenelzine.Psychiatry Res.1986;19: 75-86.。
心理和情绪调节的英语作文
心理和情绪调节的英语作文Psychological and Emotional RegulationMaintaining a healthy emotional well-being is crucial for our overall quality of life. Emotions play a significant role in shaping our perceptions, decision-making, and interactions with others. However, sometimes our emotions can become overwhelming or difficult to manage, leading to various challenges in our personal and professional lives. This is where the importance of psychological and emotional regulation comes into play.Psychological and emotional regulation refer to the ability to recognize, understand, and manage our emotions effectively. It involves a set of cognitive and behavioral strategies that help us maintain a balanced emotional state, cope with stress, and respond to challenging situations in a constructive manner. By developing these skills, we can enhance our resilience, improve our relationships, and achieve greater personal and professional success.One of the key aspects of psychological and emotional regulation is self-awareness. Understanding our own emotional patterns, triggers, and reactions is the foundation for effective emotional management.This involves regularly checking in with ourselves, reflecting on our feelings, and identifying the underlying causes of our emotional experiences. By developing this self-awareness, we can better anticipate and prepare for situations that may evoke strong emotions, allowing us to respond in a more thoughtful and adaptive way.Another important component of psychological and emotional regulation is emotion regulation strategies. These are specific techniques and approaches that we can use to manage our emotions in the moment. Some common strategies include deep breathing exercises, progressive muscle relaxation, cognitive reframing, and mindfulness practices. By incorporating these strategies into our daily lives, we can learn to calm our minds, reduce the intensity of our emotions, and respond more effectively to challenging situations.Effective communication and interpersonal skills also play a crucial role in psychological and emotional regulation. Being able to express our feelings and needs clearly, and to listen and empathize with others, can help us navigate social interactions more effectively. This, in turn, can enhance our relationships, reduce conflicts, and foster a greater sense of emotional support and understanding.It is important to note that psychological and emotional regulation is not about suppressing or ignoring our emotions. Rather, it is aboutdeveloping a healthy and adaptive relationship with our emotions. This involves acknowledging and validating our feelings, while also learning to manage them in a way that aligns with our values and goals.Furthermore, seeking professional support, such as counseling or therapy, can be immensely helpful for individuals who are struggling with significant emotional challenges or mental health concerns. Mental health professionals can provide personalized guidance, coping strategies, and support to help individuals develop more effective emotional regulation skills.In conclusion, psychological and emotional regulation is a crucial aspect of our overall well-being. By cultivating self-awareness, practicing emotion regulation strategies, and developing effective communication skills, we can enhance our ability to navigate the ups and downs of life with greater resilience and emotional balance. Investing in our emotional well-being can lead to improved relationships, better decision-making, and a greater sense of fulfillment and life satisfaction.。
英文心理学文献
ORIGINAL PAPERDevelopmental trajectories of child to adolescent externalizing behavior and adult DSM-IV disorder:results of a 24-year longitudinal studyJoni Reef •Sofia Diamantopoulou •Inge van Meurs •Frank C.Verhulst •Jan van der EndeReceived:1November 2009/Accepted:22September 2010/Published online:10October 2010ÓThe Author(s)2010.This article is published with open access at AbstractObjective Childhood externalizing behavior is found to be relatively persistent.Developmental pathways within types of externalizing behavior have been recognized from childhood to adolescence.We aimed to describe the pre-diction of adult DSM-IV disorders from developmental trajectories of externalizing behavior over a period of 24years on a longitudinal multiple birth cohort study of 2,076children.This has not been examined yet.Methods Trajectories of the four externalizing behavior types aggression,opposition,property violations,and sta-tus violations were determined separately through latent class growth analysis (LCGA)using data of five waves,covering ages 4–18years.Psychiatric disorders of 1,399adults were assessed with the CIDI.We used regression analyses to determine the associations between children’s trajectories and adults’psychiatric disorders.Results All externalizing behavior types showed signifi-cant associations with disruptive disorder in adulthood.In all antisocial behavior types high-level trajectories showed the highest probability for predicting adult disorders.Par-ticularly the status violations cluster predicted many dis-orders in adulthood.The trajectories most often predicted disruptive disorders in adulthood,but predicted also anxi-ety,mood,and substance use disorders.Conclusions We can conclude that an elevated level of externalizing behavior in childhood has impact on the long-term outcome,regardless of the developmental course of externalizing behavior.Furthermore,different types ofexternalizing behavior (i.e.,aggression,opposition,prop-erty violations,and status violations)were related to dif-ferent adult outcomes,and children and adolescents with externalizing behavior of the status violations subtype were most likely to be affected in adulthood.Keywords Externalizing behavior ÁDSM-IV ÁDevelopmental pathwaysIntroductionIt is well established in the literature that externalizing behavior in childhood and adolescence is associated with a wide range of poor concurrent and longitudinal outcomes [1].Regarding longitudinal outcomes,studies report that children and adolescents with externalizing behavior problems are at risk for a wide range of disorders in adulthood that include:disruptive behavior [2–7],mood and anxiety problems [8–11],and substance use and abuse [5,9,12].However,because externalizing behavior is an umbrella concept encompassing several different kinds of behavior,Frick et al.[13]performed a meta-analysis of 44published studies and empirically divided externalizing behavior into four types:aggression (e.g.,fights,bullies),oppositionality (e.g.,temper,stubborn),property violations (e.g.,lies,cruel to animals),and status violations (e.g.,substance use,run-away).To our knowledge,only two studies have examined the adult outcome of types of externalizing behavior prob-lems as suggested by Frick and colleagues [13].These studies underline the need to distinguish between types of externalizing behavior,that is,they report that status viola-tions predict substance use and social impairment,that op-positionality only predicts social impairment,whereasJ.Reef ÁS.Diamantopoulou ÁI.van Meurs ÁF.C.Verhulst ÁJ.van der Ende (&)Department of Child and Adolescent Psychiatry,Erasmus Medical Center -Sophia Children’s Hospital,P.O.Box 3060,3000CB Rotterdam,The Netherlands e-mail:jan.vanderende@erasmusmc.nlSoc Psychiatry Psychiatr Epidemiol (2011)46:1233–1241DOI 10.1007/s00127-010-0297-9property violations and aggression predict both substance use and risky sexual behavior[15,16].Regarding development of externalizing behavior,pre-vious studies have provided evidence for variation in developmental trajectories of externalizing behavior in childhood and adolescence with most studies identifying four to six distinctive trajectories[17–19].Developmental trajectories describe changes in both the level and the growth or decline of behaviors over time[20].It is important to know which change in level and growth across age may be considered normative for children and ado-lescents.Because from both theoretical and clinical per-spective,it is indispensable to understand normal development for defining abnormal behavior at any age point.In the previous study that examined the development of the four externalizing behavior types suggested by Frick et al.[13]from early childhood up to young adulthood(i.e., from age4to age18)the following developmental tra-jectories were identified:three trajectories for aggression ranging from very low to high,six trajectories for oppo-sitionality ranging from very low to high and including a trajectory where oppositionality increased in adolescence, and four trajectories for property and status violation ranging from low to high[21].Considering these different developmental trajectories of externalizing behavior that groups of children follow,it is important to examine groups of children that follow developmental trajectories that vary in level and shape,because an average developmental trajectory that describes expected development for most children may be considered insufficient.In the current study,we determined distinctive groups of individuals who are more likely to follow one developmental trajectory than another,within each type of externalizing behavior.In the study by Bongers et al.[21],status violations was the only externalizing behavior type that increased with age, whereas the remaining types primarily showed a persisting or decreasing course.In a more recent study by Bongers et al.[15],in which the relation of both level and growth of externalizing problems,as suggested by Frick et al.[13],to adult outcomes was examined,primarily the level of the trajectories was found to be predictive.Children with high-level trajectories of opposition and status violations reported more impaired social functioning,regardless of the direction, or growth,or decline of these high-level trajectories.How-ever,in the study by Timmermans et al.[16]both the level and growth of opposition,aggression,and property viola-tions were related to poor adolescent outcomes such as risky sexual behavior and substance use.In this latter study only the level of status violations predicted later negative out-comes.Hence,findings are inconclusive as to how devel-opmental trajectories of these externalizing behavior types are related to other long-term outcomes,and further research on this issue is needed.In this study,we aimed to investigate associations between childhood externalizing behavior and adult psy-chopathology.We examined the prediction of adult DSM-IV disorders from developmental trajectories of the four types of externalizing behavior suggested by Frick et al.[13](i.e.,opposition,aggression,property violations,and status violations)over a period of24years in a longitudi-nal,multiple birth cohort study of2,076children from the general population.Because studies have reported prog-nostic differences between the four types of childhood externalizing behavior as suggested by Frick et al.[13],we investigated the linkage between childhood externalizing behavior and adult psychopathology,distinguishing these types of externalizing behavior.In addition,although pre-vious studies reported outcomes for the four externalizing behavior types up to young adulthood(i.e.,age18in the study by Timmermans et al.[16];up to age30in the study by Bongers et al.[15]),knowledge about their outcome beyond young adulthood is lacking.Therefore,we aimed to extend thefindings of Bongers et al.[15],which are based on a previous wave of the current study,by examining the prediction of developmental trajectories in middle adult-hood(i.e.,from age28to40years).Based on earlierfindings,we expect that an elevated level of externalizing behavior in childhood has impact on the long-term outcome,in addition to the developmental course of externalizing behavior[5,8,11,15,22,23]. Furthermore,we expect that different types of externalizing behavior(i.e.,aggression,opposition,property violations, and status violations)are related to different adult out-comes[15,16].Finally,according to the fact that the oppositional and status violations type consist of more reactive and nondestructive behaviors,these types of problems are expected to develop into emotional problems. Because the property violations and aggression type consist of proactive,destructive behaviors,these types are expec-ted to develop into behavior problems in adulthood [24,25].Because behavior problems of the status violations type have been found to increase with age[21],we expect that this type is associated with most adult problems. MethodsSampleIn1983,a sample of2,600children aged4–16years was randomly selected from the general population of the Dutch province of Zuid-Holland.A hundred children of each gender and age were drawn from the municipal reg-isters listing all residents in the province A total of2,447 parents of child participants could be reached,of whom 2,076(84.8%)completed the Child Behavior Checklist(CBCL)on their child.Parents were interviewed at 2-year intervals until 1991and the participants themselves were interviewed in 2006and 2007when they were 28–40years old.We approached all participants from the original sample,except 23who had died,10who were intellectu-ally disabled,and 48who had requested to be removed from the sample at an earlier stage of the study [26].We reached 1,791of the 1,995participants,452refused and 1,339respondents provided information for determining DSM-IV diagnoses,see Fig.1.The response rate in the seventh data collection was 66%(1,339of 2,043).To investigate selective attrition,we performed logistic regression analyses to look at associations between age,gender,socio-economic status (SES),and Total Problems Score of participants in 1983,and participation in 2006and 2007.SES was scored on a six-step scale of parental occupation [27]with 1=lowest SES.Total Problems Score was calculated by summing 118of the specific item scores on emotional and behavioral problems in the CBCL.Although age,gender,and SES had significant influence on participation at follow-up,the differences were small.Participation was more likely when participants were women (51.1%for dropouts versus 53.7%for participants;OR =1.33;CI 1.11–1.60;p \0.002),if they were younger (mean age at baseline was 10.2years for dropouts and 9.8years for participants;OR =0.97;CI 0.95–1.00;p \0.026),and had a higher SES (3.4for dropouts and 3.7for participants;OR =1.12;CI 1.06–1.19;p \0.000).No influence on participation was found for Total Problems Score.MeasurementsExternalizing behavior trajectoriesFrom 1983to 1991the CBCL was used to obtain stan-dardized parent reports of children’s problem behaviors.Externalizing behavior trajectories were based on assess-ment with the CBCL.The CBCL is a rating scale intended for completion by parents of 4–18-year-old children;it contains 120items covering behavioral or emotional problems that have occurred during the past 6months.The items are scored on a three-point scale:0(not true ),1(somewhat or sometimes true ),and 2(very true or oftentrue ).The reliability and validity of the CBCL [28]have been confirmed for the Dutch version [29].We selected 21externalizing behavior items of the CBCL,corresponding to items that Frick et al.[13]used for the classification of antisocial behavior into four types which are:aggression,opposition,property violations,and status violations (Table 1).The structure of the four types was confirmed with confirmatory factor analyses.The average goodness-of-fit index (GFI)across time 1–time 5was 0.92for males and 0.96for females [21].Trajectories of externalizing behavior for ages 4–18years were identified in a previous study on the Zuid-Holland data (see Fig.2)[21].A semi-parametric,group-based approach [20]was used to determine developmental trajectories of the four externalizing behavior types.The trajectories were based on the first five waves of this study.Table 1Item description of the four externalizing behavior types Frick cluster Child behavior checklist itemAggressionCruelty,bullying,or meanness to others Gets in many fights Physically attacks people Threatens peopleOppositionArgues a lot Disobedient at home Disobedient at school Stubborn,sullen,or irritable Sulks a lot Teases a lotTemper tantrums or hot temperProperty violations Cruel to animalsLying or cheating Sets fires Steals at home Steals outside the home VandalismStatus violationsRuns away from home Swearing or obscene language Truancy,skips schoolUses alcohol or drugs for not medical purposesCBCL items to which the content showed a good match to the description provided by the authors of the types [13]that were clustered to form four types of externalizing behaviorFor every child,a trajectory was determined within each externalizing behavior type.Within the behavior types,the best possible number of groups with different develop-mental trajectories was estimated and selected using the Bayesian information criterion [20].We used a Zero-Inflated Poisson (ZIP)distribution for estimating the trajectories.Estimation using a ZIP distribution addresses both non-normality and the abundance of zeros typically found in distributions of externalizing behavior [20,21].The largest probability for each individual indicated the trajectory that best matched to that individual’s behavior over time.With these probabilities,each child was assigned to the trajectory of each externalizing type that best described their individual developmental trajectory.Therefore,each child could be classified at the same time in,for example,a high-level trajectory for opposition and a low-level trajectory for aggression.There were equal amounts of younger and older children classified in each trajectory,since there were no age effects in the assignment of the individuals to the trajectories.The child’s trajectory group classifications were used in further analyses.Three trajectories were found for the externalizing behavior type aggression:a ‘near zero’trajectory,a ‘low decreasers’trajectory,and a ‘high decreasers’trajectory.Six trajectories were found for the behavior type opposition:a ‘near zero’trajectory,a ‘low decreasers’trajectory,a ‘medium decreasers’trajectory,an ‘adolescent increasers’trajectory,a ‘high persisters’trajectory,and a ‘high decrea-sers’trajectory.Four trajectories were found for property violations:a ‘near zero’trajectory,a ‘low decreasers’trajectory,a ‘high persisters’trajectory,and an ‘extremely high persisters’trajectory.Because the ‘extremely high persisters’group of property violations consisted of only two participants,this group was combined with the ‘high persisters’group.In status violations,a ‘near zero’trajec-tory,an ‘adolescent decreasers’trajectory,a ‘medium increasers’trajectory,and a ‘high increasers’trajectory was found.The number of individuals within each trajectory can be found in Table 2.The items of the CBCL can be scored on two general scales:internalizing behavior (i.e.,anxiety and depression)and externalizing behavior (i.e.,delinquent andaggressiveFig.2Developmental trajectories in childhood antisocial behavior types.Group-based developmental trajectories of aggression,oppo-sition,property violations,and status violations.The y axis representsthe raw syndrome scores.(From Bongers et al.[21];reprinted with permission of Blackwell Publishing.)Ado adolescencebehavior).In this study,we used internalizing and exter-nalizing scores measured at time1in1983.To investigate selective attrition,all dropouts and par-ticipants were compared with respect to their1983scale scores,using analysis of variance(ANOVA)and adjusting for age and gender.No significant difference was found between participants with missing assessments and partic-ipants with assessments in allfive waves,on any of the CBCL scales(see Bongers et al.[21]for further details about the analysis).Composite International Diagnostic InterviewThe computerized version of the Composite International Diagnostic Interview(CIDI;[30]and three sections of the Diagnostic Interview Schedule(DIS)for DSM-IV diagnoses [31]were used to obtain diagnoses of mental disorder in the 12months prior to the interview(past year diagnoses).The CIDI and DIS are fully structured interviews to allow administration by lay interviewers and scoring of DSM-IV [32]by computer.Good reliability and validity have been reported for the CIDI[33].Because information concerning disruptive disorders in adulthood(oppositional defiant, antisocial personality disorder,and ADHD)was lacking in this version of the CIDI,sections of the DIS covering these disorders were administered.Because the cell sizes for specific disorders were small for the majority of diagnoses, we constructed the following groupings of DSM-IV cate-gories:(1)anxiety disorders,consisting of generalized anx-iety disorder,obsessive–compulsive disorder,panic disorder,agoraphobia,social phobia,specific phobia,or any anxiety disorder;(2)mood disorders,consisting of major depressive episode,bipolar disorder,dysthymia,or any mood disorder;(3)substance abuse/dependence,consisting of alcohol abuse/dependence,drug abuse/dependence,or both;(4)disruptive disorders,consisting of oppositional defiant disorder,antisocial personality disorder,ADHD, attention deficit only,hyperactivity only,or any disruptive disorder;and(5)any disorder,consisting of any of the above disorders or other disorders such as bulimia nervosa,soma-tization,conversion,pain disorder,hypochondriasis,and brief psychotic disorder.Statistical analysesLogistic regression analysesTo investigate associations between childhood externaliz-ing developmental trajectories in childhood and psycho-pathology in adulthood,we performed multiple logistic regression analyses for each externalizing behavior type separately.We tested whether associations existed between the trajectories in the four externalizing behavior types and DSM-IV disorders at follow-up.The regression analyses included gender,age,and SES at follow-up as covariates. Because the associations between the trajectories of externalizing behavior and adult disorders might be con-founded by associations with internalizing and externaliz-ing behavior,we added two more covariates.We added internalizing and externalizing scores assessed with the CBCL at time1to the regression analyses to adjust for their effects on the associations.In this way,we determined whether the trajectories predicted adult psychiatric disor-ders over and above comorbid general internalizing and externalizing behavior.For all models,wefirst determined whether there were interaction effects of sex or age with the separate trajectories.No significant interaction effects were found.The‘near zero’trajectory of each type was used as reference group in each regression analysis. ResultsIn the multiple regression analyses,many associations were found between childhood externalizing developmental trajectories and adult disorders(Table3).All four exter-nalizing types predicted later disruptive disorders.BesidesTable2Number of participants in the developmental trajectoriesDevelopmental trajectory N Percentage oftotal sample Percentage malesAggressionNear zero1,47371.041.7 Medium decreasers44421.465.3High decreasers1597.770.4 OppositionNear zero1487.143.9Low decreasers49123.744.6 Medium decreasers67432.550.3 Adolescence increasers125 6.041.6High decreasers50324.253.5High persisters135 6.553.3 Property violationsNear zero1,54874.645.4Low decreasers42120.356.3High persisters107 5.271.0 Status violationsNear zero1,05250.743.7 Adolescence increasers48523.446.8 Medium increasers51424.860.5High increasers25 1.272.0 Number of individuals within each trajectory,percentage of indi-viduals within each trajectory of the total sample,and percentage of males within each trajectory of the total sampledisruptive disorders,the oppositional type was also asso-ciated with anxiety disorders in adulthood.The trajectories in the status violations type also predicted substance abuse/ dependence,anxiety,and mood disorder.Primarily high-level trajectories in the types predicted problems,but also medium-level trajectories were highly predictive.DiscussionThis study examined the relations between childhood tra-jectories of four distinctive types of externalizing behavior and DSM-IV disorders in adulthood in a longitudinal general-population sample that included males and femalesTable3Associations between developmental trajectories of child externalizing problems and disorders in adulthood Predictors N DSM-IV disorders at follow-upAny disorder N=356OR(95%CI)Disruptive disorderN=121OR(95%CI)Substance abuse/dependence N=120OR(95%CI)Anxiety disorderN=183OR(95%CI)Mood disorderN=36OR(95%CI)AggressionHigh decreasers82 2.4(2.1–5.1)Low decreasers275Near zero982Sex(male) 3.3(2.1–5.1) 2.9(1.9–4.5)0.4(0.3–0.6)0.3(0.2–0.8) SES0.9(0.8–1.0)General externalizingGeneral internalizingOppositionalHigh persisters73 3.1(1.3–7.5) 4.6(1.2–17.7) 3.1(1.1–9.6)High decreasers315 2.3(1.2–4.3)Ado increasers89Medium decreasers426Low decreasers334Near zero102Sex(male) 3.7(2.4–5.7) 3.0(1.9–4.5)0.4(0.3–0.6)0.3(0.1–0.7) SES0.9(0.8–1.0)General externalizingGeneral internalizingProperty violationsHigh persisters55 2.3(1.3–4.3) 3.8(1.8–8.2)Low decreasers276 1.3(1.0–1.8) 1.6(1.0–2.6)Near zero1,008Sex(male) 3.3(2.2–5.1) 2.8(1.9–4.3)0.4(0.3–0.6)0.3(0.1–0.7) SESGeneral externalizingGeneral internalizingStatus violationsHigh increasers15 3.8(1.3–11.1)11.7(3.4–40.2)7.1(1.1–47.1) Medium increasers309 1.9(1.4–2.6) 1.7(1.1–2.8) 2.3(1.4–3.8) 1.6(1.1–2.5)Ado increasers320 2.8(1.1–7.1) Near zero695Sex(male) 3.3(2.2–5.1) 2.7(1.8–4.2)0.4(0.3–0.6)0.3(0.1–0.7) SESGeneral externalizingGeneral internalizingOdds ratios(95%confidence interval)are derived from multiple logistic regression analysis.Near zero groups were reference groups in the regression analyses.Only significant results are presentedAdo adolescenceaged4–16years assessed at six time periods.All four types of externalizing behavior(i.e.,aggression,opposition, property violations,and status violations)in childhood, showed associations with disruptive behavior in adulthood. Children displaying externalizing behavior of the opposi-tional type(e.g.,arguing,disobedience,temper tantrums) also showed anxiety disorder in adulthood.Children in trajectories of the status violation type(e.g.,runaway, truancy,drug,and alcohol use)showed primarily substance use,anxiety,and mood disorder in adulthood.Furthermore, we found that children who are in high-level externalizing behavior trajectories are most at risk to suffer from disor-ders in adulthood,that is,both internalizing and external-izing disorders.This24-year follow-up study is unique in prospectively examining the adult outcomes of different developmental trajectories in four childhood types of externalizing behavior,in a large general-population sam-ple of1,399children.Consistent with results of previous longitudinal studies in the general population that investigated the long-term continuity of early externalizing behavior[5,14,34],we can conclude that children with externalizing behavior are at increased risk for adverse outcomes in adulthood. Moreover,even after24years,children in all subtypes of externalizing behavior are at increased risk to suffer from internalizing and externalizing adult disorders.In addition, our study emphasizes the need to distinguish between the subtypes of externalizing behavior because we found dif-ferences between the predictive values of the different types of externalizing behavior.Of the four types of externalizing behavior,aggression(mainly including physical aggression)showed the least associations with adult psychopathology,whereas opposition and property violations mainly predicted adult disruptive disorder.The status violations subtype was the weakest predictor for later disruptive behavior.However,children with behavior problems of this type showed substance use, anxiety,and mood disorder in adulthood.In a study that investigated which subtypes of externalizing behavior accounted for substance use[16],it was also found that status violations predicts substance use in late adolescence. In our study,we found that even up to middle adulthood, strong associations were found between status violations and substance use.Studies that investigated the comor-bidity between alcohol,drugs,and internalizing disorders reported that‘self medication’with alcohol or drugs was associated with an increased likelihood of anxiety disorders [35,36].This verifies ourfinding of anxiety and substance use disorder in adulthood being related to status violations. Furthermore,another possible explanation for ourfinding of associations between childhood externalizing behavior types and adult internalizing disorders could be that the status violations and oppositional type comprise behaviors that are more reactive,nondestructive,and affective behaviors,and entail negative emotionality(e.g.,anger, runaway,rule breaking),in contrast to aggression and property violations types that primarily comprise proactive and violent behaviors that are offensive and instrumental (e.g.,bullying,vandalism).Proactive and reactive aggres-sions are two distinct subtypes of externalizing behavior and they have been found to differ in adult outcome. Proactive individuals tend to bully and be very unemo-tional,whereas reactive individuals show impulsive,angry responses to aversive events,particularly perceived by interpersonal threat[24,25].In accordance with previous findings on reactive and proactive aggressive behavior,we found that children with more reactive,nondestructive externalizing problems(i.e.,status violations and opposi-tional)suffer from later internalizing problems[25,37].Because externalizing behaviors are expected to change largely in level and growth during childhood and adoles-cence[5,38],and are therefore best described from a developmental point of view[39],we explored outcomes of trajectories of behavior in the current study,taking into account the developmental change through childhood and adolescence.We used LCGA to analyze trajectories of externalizing behavior,because this method is well adapted for modeling growth of phenomena within a population in which population members are not following a common developmental process of growth or decline.Consequently, we were able to report unique associations between dis-tinctive developmental trajectories within every external-izing behavior type and adult internalizing and externalizing outcomes.In accordance withfindings of previous studies that investigated development of externalizing behavior,we found that children in high-level externalizing trajectories are most likely to suffer from adult problems[5,8,11,15, 22,23].Children in the most severe,high-level trajectory of opposition and property violations were almost four to five times more likely than children not displaying these problems to suffer from any disruptive behavior in adult-hood.Findings of a study that investigated continuity of externalizing behavior up to the age of32show that externalizing individuals in a severe‘life-course-persistent’trajectory suffered from the most mental health problems [5].In a review of conduct disorder and its outcomes in general population studies it was found that increasing severity of externalizing behavior was associated with an increasing risk of an emotional disorder in adulthood[11]. What this study adds to the literature is that we extend the abovefindings by confirming that high levels of external-izing behavior in childhood and adolescence are linked to poor outcomes in adulthood even up to age40.However,it should be noted that children in both low-and high-level trajectories of property violations showed。
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
12 Notkola V, Punsar S, Karvonen MJ, Haapakoski J. Socioeconomic conditions in childhood and mortality and morbidity caused by coronary heart disease in adulthood in rural Finland. Soc Sci Med 1985;21:517-23. 13 Notkola V. Living conditions in childhood and coronary heart disease in adulthood. Commentationes Scientiarum Socialium 1985;29:15-119. 14 Hawthorne VM, Fry JS. Smoking and health: the association between smoking behaviour, total mortality and cardiorespiratory disease in west central Scotland. J Epidemiol Community Health 1978;32:260-6. 15 Ebi-Kryston KL, Hawthorne VM, Rose G, Shipley MJ, Gillis CR, Hole DJ, et al. Breathlessness, chronic bronchitis and reduced pulmonary function as predictors of cardiovascular disease mortality among men in England, Scotland and the United States. IntJEpidemiol 1989;18:84-8. 16 Davey Smith G, Shipley M, Hole DJ, Hart CL, Watt GCM, Gillis CR, et al. Explaining male mortality differentials between the West of Scotland and the South of England [abstract]. J Epidemiol Community Health 1995;49:54 1. 17 Marshall G, Rose D, Newby H, Vogler C. Social class in modern Britain. London: Unwin Hyman, 1988. 18 Goldthorpe JH. Social mobility and class structure in modern Britain. Oxford: Clarendon, 1980. 19 Hole DJ, Watt GCM, Davey Smith G, Hart CL, Gillis CR, Hawthorne VM. Impaired lung function and mortality risk in men and women: findings from the Renfrew and Paisley prospective population study. BMJ 1996;313:71 1-5. 20 Office of Population Censuses and Surveys. Classification of occupations 1966. London: HMSO, 1966. 21 Glass DV. Social mobility in Britain. London: Routledge, 1954. 22 Erikson R, Goldthorpe JH. The constant flux: a study of class mobility in industrial societies. Oxford: Clarendon, 1993. 23 Reid I. Social class differences in Britain. 3rd ed. London: Fontana, 1989. 24 Armitage P. Statistical methods in medical research. Oxford: Blackwell, 1971. 25 Hawthorne VM, Watt GC, Hart CL, Hole DJ, Davey Smith G, Gillis CR. Cardiorespiratory disease in men and women in urban Scotland: baseline characteristics of the Renfrew/Paisley (Midspan) study population. Scot Med_a 1995;40:102-7. 26 Woodward M, Shewry MC, Cairns W, Smith S, Tunstall-Pedoe H. Social status and coronary heart disease: results from the Scottish heart health study. Prev Med 1992;21:136-48. 27 Shaper AG, Pocock SJ, Walker M, Cohen NM, Wale CJ, Thomson AG. British regional heart study: cardiovascular risk factors in middle aged men in 24 towns. BMJ 1981;283:179-86. 28 Marmot MG, Rose G, Shipley MJ, Hamilton PJ. Employment grade and coronary heart disease in British civil servants. .7 Epidemiol Community Health 1978;32:244-9. 29 Marmot MG, Davey Smith G, Stansfeld S, Patel C, North F, Head J, et al. Health inequalities among British civil servants: the Whitehall II study. Lancer 1991;337:1387-93. 30 Payne G. Mobility and change in modern society. London: Macmillan, 1987. 31 Fox AJ, Collier PF. Low mortality rates in industrial cohort studies due to selection for work and survival in industry. BryPrev Soc Med 1976;9:1805. 32 Braddon FEM, Rogers B, Wadsworth MEJ, Davies JMC. Onset of obesity in a 36 year birth cohort study. BMJ 1986,293:299-303. 33 Power C, Moynihan C. Social class and changes in weight-for-height between childhood and early adulthood. Inty Obesity 1988;12:445-53.
need to be qualified strongly by recognising that our cross sectional data preclude any analysis of changes in risk factors. Our conclusions are suggestive and need to be tested with longitudinal data; however, we are not aware of any longitudinal data sets that contain measures of the relevant risk factors at different stages of life, including childhood. The data of the west of Scotland collaborative study were collected in the early 1970s. It would be useful to establish whether risk factors for cardiovascular disease are still related in the same way to father's and own social class. Although coronary heart disease is less prevalent in women than in men, any study of the current situation should include women.
1 Barker DJP, ed. Fetal and infant origins of aduk disease. London: BMJ Publishing, 1992. 2 Barker DJP, Martyn CN. The maternal and fetal origins of cardiovascular disease. J Epidemiol Community Health 1992;46:8-1 1. 3 Forsdahl A. Living conditions in childhood and subsequent development of risk factors for arteriosclerotic heart disease: the cardiovascular survey in Finmark 1974-75. J Epidemiol Community Health 1978;32:34-7. 4 Wadsworth MEJ, Cripps HA, Midwinter RA, Colley JRT. Blood pressure at age 36 years and social and familial factors. BMJ 1985;291:1534-8. 5 Bartley M, Power C, Blane D, Davey Smith G, Shipley M. Birthweight and later socioeconomic disadvantage: evidence from the 1958 British cohort study. BMJ 1994;309:1475-8. 6 Kaplan GA, Salonen JT. Socioeconomic conditions in childhood and ischaemic heart disease during middle age. BMJ 1990;301:1121-3. 7 Lynch JW, Kaplan GA, Cohen RD, Kauhanen J, Wilson TW, Smith NL, et al. Childhood and adult socioeconomic status as predictors of mortality in Finland. Lancet 1994;343:524-7. 8 Gliksman MD, Kawachi I, Hunter D, Colditz GA, Manson JAE, Stampfer MJ, et al. Childhood socioeconomic status and risk of cardiovascular disease in middle aged US women: a prospective study. J Epidemiol Community Health 1995;49:10-5. 9 Brunner E, Davey Smith G, Marmot M, Canner R, Beksinska M, O'Brien J. Childhood social circumstances and psychosocial and behavioural factors as determinants of plasma fibrinogen. Lancet 1996;347:1008-13. 10 Burr ML, Sweetnam PM. Family size and paternal unemployment in relation to myocardial infarction. J Epidemiol Community Health 1980;34: 93-5. 11 Arnesen E, Forsdahl A. The Tromso heart study: coronary risk factors and their association with living conditions during childhood. J Epidemiol Community Health 1985;39:210-4.