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创伤后应激障碍中情感刺激注意偏向现象 及其机制的研究
其他题名Attention Bias towards Emotional Stimuli in Posttraumatic Stress Disorder (PTSD)
王日出
学位类型博士
导师张建新
2014-05
学位授予单位中国科学院研究生院
学位授予地点北京
学位专业医学心理学
关键词创伤后应激障碍 注意偏向 情绪信息 行为实验 眼动研究
摘要创伤后应激障碍(Posttraumatic Stress Disorder,  PTSD)是一种由于暴露于极端事件而导致的复杂性心理及精神疾患,在创伤人群中有较高的流行率,并可对精神、健康、生活等多方面造成长期的负面影响。对于情感刺激的注意偏向是PTSD 的一种重要认知特点,并与 PTSD 互相影响,造成症状的维持。PTSD 中的注意偏向多表现为对创伤相关刺激、威胁刺激、痛苦刺激的注意偏向,以及对积极刺激的注意偏离,不同的理论对注意偏向提出了不同的假设,但目前结论并不统一。本研究旨在对注意偏向研究中最具争议性的三个问题进行探讨:对不同情绪信息的注意偏向是否与 PTSD 的认知图式一致?对情绪信息的注意偏向是利于注意还是干扰注意?注意的不同阶段是否有不同的注意偏向表现?
本研究选取了三个 2008 汶川地震极重灾区的独立样本作为被试,在地震 5年半后,对长期PTSD对创伤群体注意偏向的影响进行了研究。本研究包括三个部分,分别采用问卷研究、行为实验(情绪Stroop 任务、任务点探测)、眼动实验,基于刺激情绪类型、反应发生时间等因素影响,从注意的空间加工和时间加工着手,讨论创伤后应激障碍的情感信息加工特征。
首先,研究一从宏观角度和微观角度测量了 PTSD个体是否对特定情绪的信息存在注意偏向。问卷研究(实验 1a)结果显示与创伤控制组相比,PTSD组被试报告了更多对消极信息的注意、更少对积极自我信息的注意,说明PTSD个体存在对情绪一致性信息注意偏向的认知图式。使用情绪 Stroop 任务(实验 1b)发现,只有 PTSD被试在积极、消极、创伤相关中性词汇的颜色命名中出现情绪Stroop 效应,说明积极、消极、创伤相关中性对注意产生影响。
第二,本研究考察了对于情绪信息的注意偏向是有利于注意还是妨碍注意。研究二是用点探测实验范式,通过控制情绪图片呈现时间,选择 200ms、 500ms、1000ms 三个时间窗口对注意的阶段进行检测(实验 2a、2b、2c) 。结果显示在200ms 时,PTSD被试对创伤威胁刺激存在注意偏向,为注意偏向利于注意提供了证据。研究还发现在创伤威胁图片呈现500ms、创伤中性图片呈现 1000ms 时,PTSD被试对探针的反应速度更慢,提示创伤相关信息妨碍了后续任务。
最后,本研究使用眼动追踪的方法,对于创伤人群注意偏向的时序变化进行了研究。警觉-回避模型认为注意偏向发生在前期,之后采取回避的策略以防止威胁信息的进一步加工,注意维持模型认为注意偏向发生在后期,注意难以从刺激上解脱。研究三发现 PTSD个体早期对威胁刺激更多的关注,后期创伤相关刺激出现回避(实验 3a),对面孔信息表现出在早期普遍性地注意、后期对负性表情的回避(实验 3b) ,为警觉-回避假设提供了证据。
本研究发现在地震五年半后,相当一部分极重灾区受灾者仍表现出严重的PTSD症状,提出对高危人的心理健康需要持续关注。本研究具有理论和实践两方面的意义。在理论方面,本研究深入探讨了在中国自然灾难受灾人群中,慢性PTSD的认知加工过程和特异性的注意特点;从行为的层面区分大脑不同神经网络(积极情感网络、消极情感网络和恐惧网络) ,为基于维度而非临床症状的诊断导向提供证据, 在临床方面,本研究探讨注意偏向作为 PTSD软体征的可能性,为开发简便、经济的筛查易感和高危群体的方法;并为设定靶向治疗提供依据,完善现有的治疗方案,如注意矫正治疗、行为激活治疗等。

其他摘要Posttraumatic stress disorder (PTSD) is a complicated psychological and psychiatric syndrome caused by exposure to extreme life-threatening event(s). PTSD is one of the most common mental disorders among traumatized population, and it has negative, long-term impacts on mental health, physical health, daily functions and psychosocial life of the affected individuals. Cognitive theories claim that attentional bias towards affective stimuli is one pathological characteristic of PTSD, and attentional bias may contribute to the etiology and progression of PTSD. PTSD individuals may exhibit attentional bias towards trauma-related, general threat and dysphoric stimuli, as well as attentional bias away from positive stimuli. However, evidence in the existing literature is inconsistent,. Theories from different schools have suggested different phenomena of attentional bias in PTSD. This study intended to address three main theoretical conflicts in attentional bias studies: if the attentional bias towards certain types of affects consists with the cognitive schema of PTSD? Does attentional bias facilitate or interference with attention? Does the same of different patterns of attentional bias exist in the time course of attention process?  
The present research investigated the attentional bias among three independent samples of adult survivors of Wenchuan Earthquake five and a half years after the disaster. Using survey, behavioral experiments (emotional Stroop and dot-probe task) and eye-tracking methods, the study investigated the attentional bias towards various affective stimuli along the time course, to explore the information process of affective information in PTSD.
Study 1 examined if attentional bias exists towards various affective stimuli from macro and micro levels. Results of survey showed that compared to trauma-controls, PTSD group reported paying more attention towards negative information, and less attention towards positive self-related information, which indicated the cognitive schema of attention towards mood congruent information. Results of emotional Stroops study showed only PTSD group exhibited Stroop effect in naming the color of positive, negative, and trauma-relevant words, which indicated positive, negative and trauma-relevant inform influenced attention.  
Study 2 investigated if attentional bias facilitates or interferences with information process. Using a series of dot-probe tasks with different presenting time of emotional stimuli, we studied the attentional bias at three time windows along the attention process. The results showed that PTSD group exhibit attentional bias towards trauma-negative pictures, which supported the facilitating attention hypothesis. The results also showed reaction was delayed after 500ms presentation of trauma-related negative pictures, as well as 1000ms presentation of trauma-related neutral pictures, which supported the interference hypothesis.  
Finally, using eye-tracking methods, Study 3 investigated the trajectory of attentional bias. Vigilance-avoidance hypothesis claims that PTSD individuals exhibit exaggerated attention towards threating stimuli at an early stage, and subsequently avoid the stimuli to prevent further information process of the threating stimuli. Attention-maintain hypothesis claims that PTSD individuals have no difference in attending to affective information but have difficult to disengage from the stimuli, and attentional bias occurs at a late stage of attention. Results of eye-tracking experiments indicated that PTSD showed early attentional bias towards threating pictures, and later avoidance from threating pictures (experiment 3a), as well as a general heightened early attention towards facial information, and later avoidance away from negative facial emotions. The result provided evidence to support vigilance-avoidance hypothesis.   
The study showed that significant portion of earthquake survivors in hard-hit regions exhibit severe PTSD symptoms, and suggested continuous care for high-risk groups. The results of the current research have the following theoretical significance and clinical implications. Theoretically, the results of current study contributes to the current understanding of the cognitive process, with an emphasis on the heterogeneous characteristic of attentional bias of chronic PTSD individuals with a cultural relevance to Chinese people; differentiate functional networks of negative affect, positive affect and stress reaction at behavioral level from a cognitive view, provide empirical support to the dimensional orientation of research in mental disorders over the traditional symptom-based categorical diagnosis. Clinically, the results of the study suggested that attentional bias may be one possible endophenotypical markers of PTSD, which may be applied to the development of cost-efficient screening tool for vulnerable and high-risk groups; provide reliable evidence for target interventions and inform the improvement direction of existing therapies of PTSD, such as attention modification therapy and behavioral activation therapy etc.  
学科领域创伤心理学
语种中文
文献类型学位论文
条目标识符http://ir.psych.ac.cn/handle/311026/19716
专题健康与遗传心理学研究室
作者单位中国科学院心理研究所
推荐引用方式
GB/T 7714
王日出. 创伤后应激障碍中情感刺激注意偏向现象 及其机制的研究[D]. 北京. 中国科学院研究生院,2014.
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