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鲁甸震后PTSD 高分青少年注意偏向特点及训练效果
其他题名Attention bias and intervention effects of attentional bias training of teenagers with high PTSD scores survived in Ludian earthquake
周佩灵
学位类型博士
导师张雨青
2016-05
学位授予单位中国科学院研究生院
学位授予地点北京
学位专业心理学
关键词创伤后应激障碍 注意偏向 注意解除困难 注意偏向训练
摘要创伤后应激障碍(Posttraumatic Stress Disorder, PTSD)是个体在目睹或经历创伤事件后表现的一系列身心综合症,在人群中具有较高的发病率,并可对个体的认知功能造成损伤。对于威胁刺激的注意偏向是PTSD 个体的重要认知特点,是PTSD 引发和维持的重要因素。PTSD 个体的注意偏向多表现为对于创伤相关刺激和威胁性刺激的注意偏向,并存在注意定向加速和注意解除困难两种成分。根据警觉—回避假设,焦虑个体对于威胁性刺激的注意偏向存在先定向加速后解除困难的时程特点,而焦虑回避理论则认为焦虑个体一旦注意威胁刺激,便会出现注意力解除困难。目前,PTSD 的注意偏向时程特点,目前尚无一致结论。基于焦虑患者注意偏向的特点,有研究者提出使用注意偏向训练(Attentional bias modification, ABM)的方法对焦虑患者进行干预,并取得良好的干预效果。但注意偏向训练对于PTSD 个体的干预研究较少。本研究旨在对三个问题进行探讨:PTSD 高分青少年对何种类型刺激存在注意偏向?PTSD 青少年注意偏向成分随时间会出现什么变化?注意偏向训练对于PTSD 青少年是否具有干预效果?
本研究选取云南鲁甸地震灾区初中一年级学生作为被试,在地震3 个月后,对慢性PTSD 对于创伤亲历青少年注意偏向的影响以及注意偏向训练的干预效果进行了研究。本研究包含三个部分,采用问卷研究和行为实验相结合的方法,探讨创伤后应激障碍的注意偏向特征、时程特点和注意偏向训练干预效果。
首先,研究一考察了鲁甸PTSD 高低分青少年的注意偏向情况,以及注意偏向的加工偏好。结果显示与PTSD 低分组被试相比,PTSD 高分组被试报告了更多对于威胁刺激的注意偏向,提示注意偏向训练对于PTSD 进行干预的可能性,以及注意偏向训练中使用一般威胁刺激作为呈现材料的效果可能优于地震相关材料。
研究二则考察了鲁甸青少年注意偏向的成分和时程特点。研究采用线索提示任务,通过控制字词刺激材料的呈现时间,选择100ms、500ms、800ms、1000ms、1250ms 五个时间窗口对于注意加工的时间阶段进行检测(实验2a、2b、2c、2d、2e)。结果显示在800-1000ms 时,PTSD 高分被试对威胁刺激存在注意解除困难,此结果与警觉—回避假设不一致,为注意回避假设提供了证据。
最后,研究三使用注意偏向训练方法,用正向引导和负性规避两种方式,对鲁甸地区PTSD 高分青少年进行干预,并在干预完成9 个月后对被试的恢复情况进行追访。结果表明,在干预完成后,正向引导和负性规避两种干预方式都对PTSD 高分个体具有干预效果,而在干预完成9 个月后,负性规避组的恢复情况高于控制组和正向引导组,提示负性规避干预方法具有长时性。本研究的结果提示对于注意偏向加工后期注意解除困难的矫正效果好于对于注意早期阶段的干预。
本研究发现在地震3 个月后,鲁甸地区PTSD 高分个体仍伴随焦虑、抑郁等情绪问题,提出对于创伤易感人群的心理健康需多方面关注。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害受灾青少年中,慢性PTSD 的注意偏向的特异性和时程特点;探讨了注意偏向训练的作用机制。在临床方面,本研究探讨注意偏向训练对PTSD 进行干预的可能性和效果,为开发简便、经济的干预方法提供实践依据。
其他摘要Post-traumatic Stress Disorder (PTSD) refers to a series of physical and mental
syndrome of individuals’ responses to traumatic events. PTSD occurs with a high incidence and may damage individuals’ competence. The major cognitive characteristic of PTSD individual is attention bias to threat stimuli, which is also the crucial factor causing and maintaining PTSD. PTSD individuals’ attention bias mainly performed as attention to traumatic related stimuli and threat stimuli, which includes two factors: facilitated engagement and difficulty in disengaging. According to vigilant-avoidant hypothesis, anxious individuals’ attention bias about threat stimuli has time course in forms of directional acceleration before difficulties engaging. However, according to attention maintenance hypothesis, once anxious individuals paid attention to threat stimuli, difficulty in disengagement appears. For the time course of attention bias about PTSD, there is no unanimous conclusion now. Based on the feature of anxious patients’ attention bias, some researchers propose to intervene anxious individuals by means of attention bias modification (ABM) and then intervention effects obtained. However, there are few studies on ABM intervening PTSD individuals. This study aims at discussing the following questions: What kind of stimuli does high score juveniles of PTSD have attention bias? What changes will the high score juveniles of PTSD be with time? Does the ABM have the intervention effect on PTSD teenagers?
The present research investigated the attentional bias and the effect of ABM among first-year survival students in junior high school in Lu Dian, an earthquake-stricken area in Yunnan Province three months after the earthquake. The current research includes three parts. Using survey, behavioral experiments and attentional bias training, the study investigated the attentional bias towards various affective stimuli along the time course, and explored the effect of ABM.
Study 1 examined features and processing preference of attention bias of teenagers with high scores of PTSD. Results showed that comparing with subjects with low scores of PTSD, subjects with high scores of PTSD reported more attention bias about threat stimuli, implying the possibility of ABM intervening PTSD, and the intervention effects might be better if threat stimuli rather than trauma-related stimuli were presented as stimuli in ABM.
Study 2 investigated components and time course of teenagers’ attention bias in Lu Dian. Using cue-target task with different presenting time of affective stimuli, we studied the attentional bias at five time windows along the attention process. Results showed that subjects of high scores of PTSD have difficulty in disengaging on threat stimuli at 800ms. It is incoherent with the vigilant-avoidant hypothesis, which provides evidence for attentional bias interferes attention.
Finally, study 3 adopts ABM with positive guidance and negative evasion to intervene high score individuals of PTSD in Lu Dian area, and follows-up the recovery situation after 9 months of the intervention. It turns out that both positive guidance and negative evasion have intervention effect on high score individuals of PTSD, while after 9 months of intervention, the recovery situation of negative evasion has long-term effects. The result indicated that corrective effect of attention bias in later period of attention is better than the intervention in early stage of attention.
This study finds that 3 months later the earthquake, high score individuals of PTSD in Lu Dian still have emotional problems as anxiety, depression etc.. It proposes that various attentions are needed on psychological health of trauma susceptible population. This study is of theoretical and practical significance. On theoretical aspect, the study further explores specificity and time course of chronic PTSD attention bias, among affected juveniles of natural disasters in China, and investigated the mechanism of attention bias. In clinical aspect, this study probes the possibility and effect of ABT on intervening PTSD and provides a practical base for developing convenient and economic intervention technique.
学科领域应用心理学
语种中文
文献类型学位论文
条目标识符http://ir.psych.ac.cn/handle/311026/20191
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
周佩灵. 鲁甸震后PTSD 高分青少年注意偏向特点及训练效果[D]. 北京. 中国科学院研究生院,2016.
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