健康与遗传心理学研究室知识库

研究生群体面临着科研压力大、成果产出周期长等诸多问题，焦虑水平高于普通人。认知行为治疗被认为是改善焦虑症状最有效的方法之一。借助治疗性隐喻进行认知干预，可以更好传达治疗信息，最大化治疗效应。因此，本论文拟使用治疗性隐喻对研究生焦虑症状进行干预，并将对治疗性隐喻干预焦虑症状的有效性、心理及神经机制进行综合探讨。具体而言，本论文拟先在实验室场景中使用治疗性隐喻对个体进行认知重构任务干预并记录仃叨RI活动，然后在自然场景中进行四次共四周的隐喻认知行为治疗，探索实验室场景中治疗性隐喻激活的脑活动对自然场景焦虑症状改善的预测效应。具体通过以下两个研究进行:

研究一:在实验室条件下，对单个被试使用问答式文本微咨询任务进行单次认知重构干预并同时记录事件相关fMRI活动，探讨治疗性隐喻诱发认知重构对焦虑症状和心理痛苦的干预效果及心理神经机制。选取62名存在轻度及以上焦虑症状的研究生，随机分成两组，一组为隐喻组(n=31);另一组为非隐喻组(n=31)。要求被试在fMRI扫描过程中完成文本微咨询范式进行认知重构干预，隐喻组在问题情境下阅读隐喻解答，非隐喻组阅读非隐喻解答。在扫描前、扫描后及一周后测量各项指标。研究结果发现:干预过程中，相较于非隐喻解答，隐喻组阅读隐喻解答诱发了更强的顿悟体验和更好的记忆再认。隐喻解答诱发了双侧海马、左侧额下回、左侧颗极的活动;与非隐喻组相比，干预后隐喻组被试的一般自我效能感和积极情绪显著提高，心理痛苦水平在干预后和一周追踪显著下降;隐喻任务激活的左侧海马和额下回活动性可以分别预测干预后自我效能感的提升和心理痛苦的缓解。

研究二:在自然情景下，使用四次团体认知行为治疗课程对焦虑症状研究生进行干预，既探索基于治疗性隐喻的团体认知行为治疗课程是否优于非隐喻课程，也观察研究一中治疗性隐喻关联的脑活动对随后的隐喻CBT团体治疗效应的预测效应。被试在研究一基础上流失4人，分组保持不变。对隐喻组(n=28)实施隐喻CBT课程，对非隐喻组(n=30)实施非隐喻CBT课程干预。课程每周一次，共干预四周，分别在干预前、后、一周后、一月和三月后对症状改善指标进行测量。研究结果发现:对隐喻组4次课程评价的数据分析发现，随着课程进行被试焦虑分数逐渐下降，顿悟体验逐渐上升，顿悟体验对焦虑缓解有积极影响;对整个课程干预效果的症状改善数据分析发现，两组在干预后，一般自我效能感、压力知觉、病理性担忧得分下降;仅在隐喻组，个体在认知重构干预后一般自我效能感和压力知觉的改善可以用于预测最长3个月焦虑症状的改善;对隐喻诱发认知重构激活的特异性脑活动预测CBT课程对焦虑症状的改善情况进行分析，发现实验室任务中的顿悟体验分数可以显著预测CBT干预后焦虑症状的改善，海马、额下回和颗极的活动性可以显著预测课程干预后一个月、甚至三个月后焦虑相关症状的改善。

以上证据表明，无论采用实验室认知重构干预还是自然情景的CBT课程干预，治疗性隐喻都对心理痛苦和焦虑症状具有很好的干预效果，且被试在实验室隐喻认知重构中的心理神经活动可以作为预测后续CBT干预效果的预测因子。

Compared with the general population, competing academic, high expectations and uncertain outcomes make graduate student much more likely to experience anxiety symptoms. The efficacy of cognitive behavioural therapy (CBT) for anxiety is empirically supported. The use of metaphors in cognitive restructuring could help the clients acquire the therapy information more easily and maximize the effect of therapy information. This study aimed to examine whether therapeutic metaphor would produce great intervention effect in treating anxiety symptoms among graduate student and its mental and neural mechanism. Specifically, this dissertation was consisted of two studies: first, the fMRI task: metaphor-based micro-counseling dialogues were applied for intervention in laboratory scenes. Then, four sessions of CBT-based metaphorical course were carried out in natural situations, and the regression effect between the therapeutic metaphor-activated brain activity and the improvement of anxiety symptoms in natural scenes was examined in the second study. The details were as followed:

In study 1，in order to examine the intervention effect of therapeutic metaphor in anxiety symptoms and its mental and neural mechanism, metaphor-based micro-counseling dialogues were applied for intervention in laboratory scenes. 62 anxious graduate students were recruited, and randomly divided into two groups. These two groups were respectively received metaphorical restructuring solution (N=31，Metaphor group), literal restructuring solution (N=31，Non-metaphor group) after multiple problem solving scenarios in the process of fMRI scanning. The indicators were measured before, after and one week after the fMRI scanning. The results showed that the metaphor group induced the higher insight experience while reading the metaphorical solutions and had advantages to enhance the long-term memory than non-metaphor group one week after the fMRI task. Compared with non-metaphorical solutions, metaphorical solutions induce higher activity in bilateral hippocampus, left inferior frontal gyrus and right temporal pole. Just after the fMRI task, the general self-efficacy was get improving, the level of mental distress continued to decline within one week after the intervention, and the activation of left hippocampus and left inferior frontal gyrus in the task could predict the improvement of self-efficacy and the relief of psychological distress, respectively.

In study 2: to explore whether group-CBT based therapeutic metaphor was superior to non-metaphorical courses and whether therapeutic metaphor-activated brain activity could be used to predict the improvement of anxiety symptoms, four sessions of CBT-based metaphorical course were carried out in natural situations. Four subjects was dropped put after they finished the study 1，and the grouping remained unchanged. We tried to carry out metaphorical CBT course, non-metaphorical CBT course intervention on metaphor group (n=28) and non-metaphorical group (n=30), respectively. The courses consist of 4 sessions: once

a week, totally four weeks. In this study, the relevant indicators were recorded before, after, one week after, one month after and three months after the intervention. The results showed that along with the course, the anxiety scores gradually decreased, the insight experience gradually increased; only in the metaphor group, the insight experience may had a positive effect on the remission of anxiety. The improvement of general self-efficacy and stress perception could be used to predict the improvement of anxiety symptoms up to 3 months; insight scores in fMRI tasks could predict the changes in anxiety scores after CBT interventions. The activation of the hippocampus, inferior frontal gyrus, and temporal pole during the fMRI task can be used to predict changes in anxiety scores one month after the intervention or even three months.

All the evidence above suggests that therapeutic metaphor was efficient in anxiety symptoms relief whether using cognitive reconstruction fMRI task in laboratory or CBT courses in natural-scene scenario, and the mental and neural indicators in fMRI task could predict the of subsequent CBT intervention effect.