道家认知疗法治疗焦虑性神经症的理论与临床研究
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摘要
第一部分 精神超脱量表的编制与信度效度检验
目的 编制用于测量焦虑性神经症患者投入超脱程度的量表，并进行信度效度检验。
方法 1、基于道家认知疗法的理论基础，经过查阅文献、专家咨询和小组讨论，初步确定了十三个条目组成精神超脱量表的初稿；
2、对152名大学生进行了预试验，以检验量表的内容效度；三个月后对此样本进行重测，以检验量表的重测信度；
3、对社区样本进行量表测试，包括精神超脱量表、情感平衡量表与A型行为量表，据此进行了同质信度、结构效度和实证效度检验；
4、对76名焦虑性神经症患者(包括广泛性焦虑症、惊恐障碍、强迫症与恐惧症)进行量表测试，包括精神超脱量表、A型行为量表、艾森克人格问卷和症状自评量表，并与76名与之配对的正常对照(来自社区样本)比较，以进一步检验量表的实证效度。
结果 1、根据预试验结果进行项目分析，删除一个条目后组成12个条目的正式量表；
2、因素分析将量表分为两个因子；各条目与总分相关在0.291～0.581之间，各因子分及其因子所属条目相关在0.337～0.655之间；量表总分与情感平衡量表得分、A型行为量表总分显著相关；量表及各因子的α系数分别为：0.6486，0.6498，0.4139；重测信度为0.5247，0.6735，0.3890；
3、患者组的量表总分低于正常对照组，量表的方差则高于正常对照组。患者组精神超脱量表总分与A型行为和SCL-90呈显著的负相关(r=-0.312，-0.306，P＜0.05)，方差则与SCL-90总分和EPQ量表的N分呈正相关，与EPQ量表的P分呈负相关(r=0.373，0.424，-0.339，P＜0.05)。
结论 精神超脱量表具有较好的信度和效度，符合心理测量学的要求。
Part I The Development, Reliability, and Validity Examination of Involvement-Detachment Scale
Objective: To develop a scale for the evaluating of involvement and detachment of anxiety disorder patients and to examine the reliability and validity of the scale.
Methods: a. The primary Involvement-Detachment Scale (IDS) that included 13 items was developed based on the theory of Daoistic Cognitive Therapy, experts counseling, and group discussion.
b. Preliminary test was carried out in 152 college students who were re-examined after 3 months to examine the content validity and stability coefficients.
c. A community sample was tested by IDS, affective scale, and type A behavior scale to examine the internal consistency, construction validity, and empirical validity of IDS.
d. 76 anxiety disorder patients who met one of the diagnostic criteria of general anxiety disorder, panic disorder, obsessive-compulsive disorder, and phobic disorder of CCMD-3 were tested by IDS, SCL-90, EPQ, and type A behavior scale and the results were compared with those of 76 normal paired controls derived from the community sample for the further examination of empirical validity of IDS.
Results: a. One item was excluded based on the results of item analysis. Then the formal version of IDS was consisted of 12 items.
b. Two factors were extracted in the factor analysis. The correlations between the items and the scale ranged from 0.297-0.581 and the correlations between the factors and there composites ranged from 0.337-0.655. The correlations between the IDS and the affective scale, type A behavioral scale were statistically significant. The stability coefficients and Cronbach's a coefficients of IDS and the two factors were 0.5247, 0.6735, 0.3890 and 0.6486, 0.6498, 0.4139, respectively.
c. Score of IDS of patients was statistically significant lower than that of the controls while the standard deviation was higher. The score of
IDS of patients was negatively correlated to the score of type A behavior scale and SCL-90 (r=-0.312, -0.306, P<0.05), and the standard deviation of IDS was positively correlated to the scores of SCL-90 and N score of EPQ and negatively correlated to the P score of EPQ (r=0.373, 0.424, -0.339, P<0.05).
Conclusion: The reliability and validity of IDS are good and meet the psychometric standard.
目的 编制用于测量焦虑性神经症患者投入超脱程度的量表，并进行信度效度检验。
方法 1、基于道家认知疗法的理论基础，经过查阅文献、专家咨询和小组讨论，初步确定了十三个条目组成精神超脱量表的初稿；
2、对152名大学生进行了预试验，以检验量表的内容效度；三个月后对此样本进行重测，以检验量表的重测信度；
3、对社区样本进行量表测试，包括精神超脱量表、情感平衡量表与A型行为量表，据此进行了同质信度、结构效度和实证效度检验；
4、对76名焦虑性神经症患者(包括广泛性焦虑症、惊恐障碍、强迫症与恐惧症)进行量表测试，包括精神超脱量表、A型行为量表、艾森克人格问卷和症状自评量表，并与76名与之配对的正常对照(来自社区样本)比较，以进一步检验量表的实证效度。
结果 1、根据预试验结果进行项目分析，删除一个条目后组成12个条目的正式量表；
2、因素分析将量表分为两个因子；各条目与总分相关在0.291～0.581之间，各因子分及其因子所属条目相关在0.337～0.655之间；量表总分与情感平衡量表得分、A型行为量表总分显著相关；量表及各因子的α系数分别为：0.6486，0.6498，0.4139；重测信度为0.5247，0.6735，0.3890；
3、患者组的量表总分低于正常对照组，量表的方差则高于正常对照组。患者组精神超脱量表总分与A型行为和SCL-90呈显著的负相关(r=-0.312，-0.306，P＜0.05)，方差则与SCL-90总分和EPQ量表的N分呈正相关，与EPQ量表的P分呈负相关(r=0.373，0.424，-0.339，P＜0.05)。
结论 精神超脱量表具有较好的信度和效度，符合心理测量学的要求。
Part I The Development, Reliability, and Validity Examination of Involvement-Detachment Scale
Objective: To develop a scale for the evaluating of involvement and detachment of anxiety disorder patients and to examine the reliability and validity of the scale.
Methods: a. The primary Involvement-Detachment Scale (IDS) that included 13 items was developed based on the theory of Daoistic Cognitive Therapy, experts counseling, and group discussion.
b. Preliminary test was carried out in 152 college students who were re-examined after 3 months to examine the content validity and stability coefficients.
c. A community sample was tested by IDS, affective scale, and type A behavior scale to examine the internal consistency, construction validity, and empirical validity of IDS.
d. 76 anxiety disorder patients who met one of the diagnostic criteria of general anxiety disorder, panic disorder, obsessive-compulsive disorder, and phobic disorder of CCMD-3 were tested by IDS, SCL-90, EPQ, and type A behavior scale and the results were compared with those of 76 normal paired controls derived from the community sample for the further examination of empirical validity of IDS.
Results: a. One item was excluded based on the results of item analysis. Then the formal version of IDS was consisted of 12 items.
b. Two factors were extracted in the factor analysis. The correlations between the items and the scale ranged from 0.297-0.581 and the correlations between the factors and there composites ranged from 0.337-0.655. The correlations between the IDS and the affective scale, type A behavioral scale were statistically significant. The stability coefficients and Cronbach's a coefficients of IDS and the two factors were 0.5247, 0.6735, 0.3890 and 0.6486, 0.6498, 0.4139, respectively.
c. Score of IDS of patients was statistically significant lower than that of the controls while the standard deviation was higher. The score of
IDS of patients was negatively correlated to the score of type A behavior scale and SCL-90 (r=-0.312, -0.306, P<0.05), and the standard deviation of IDS was positively correlated to the scores of SCL-90 and N score of EPQ and negatively correlated to the P score of EPQ (r=0.373, 0.424, -0.339, P<0.05).
Conclusion: The reliability and validity of IDS are good and meet the psychometric standard.
引文
1．J．S．Beck著，翟书涛 等译．认知疗法：基础与应用．北京：中国轻工业出版
社，2001
2. Krantzs S, Hammen C. Assessment of cognitive bias in depression. Journal of Abnormal Psychology, 1979, 88(6): 611-619
3. Harrell TH, Ryon NB. Cognitive-behavioral assessment of depression: clinical validation of the automatic thoughts questionnaire. Journal of Consulting Clinical Psychology, 1983, 51(5): 721-725
4．杨德森 主编．行为医学(第二版)．湖南：湖南科学技术出版社，1998，80-120．
5. Xiao S, Young D, Zhang H. Taoistic cognitive psychotherapy for neurotic patients: a preliminary clinical trial. Psych Clin Neuroscin. 1998. Dec, 52, sup: S238-241.
6．王征宇，症状自评量表(SCL-90)，上海精神医学，1984，2(2)：68-70
7．汪向东，王希林，马弘 编．心理卫生评定量表手册(增订版)．北京：中国心理卫生杂志社，1999，P79．
8．龚耀先．艾森克人格问卷．长沙：湖南医学院，1983
9．张伯源．心血管病人的心身反应特点的研究Ⅱ．对冠心病人的行为类型特征的探讨，心理学报，1985，3：314-321
10. Hopkins KD, Stanley JC, Hopkins BR. Educational and psychological measurement and evaluation. Prentice-hall, Inc. 1990, 143-164.
11．谬小春，竺培梁译．心理测量．浙江大学出版社．1998．
12．杨德森，张亚林，肖水源，等。中国道家认知疗法介绍。中国神经精神疾病杂志，2002，28(2)，152
13. Schulz H, Lang K, Lotz-Rambaldi W, et al. Analysis of premature termination in inpatient psychosomatic rehabilitation based on epidemiologic data from two hospital companies. Psychother Psychosom Med Psychol 1999; 49 (9-10): 326-36
14. Chiesa M, Drahorad C, Longo S. Early termination of treatment in personality disorder treated in a psychotherapy hospital. Quantitative and qualitative study. Br J Psychiatry 2000; 177:107-11
15. Morlino M, Martucci G, Musella V, et al, Patients dropping out of treatment in Italy. Acta Psychiatr Scand 1995; 92(1): 1-6
16．徐兰，张建新，肖春玲。对社交困难者的综合心理治疗。中国临床心理学杂志，2002，10：287-289
17. Swett C Jr, Noones J. Factors associated with premature termination from outpatient treatment. Hosp Community Psychiatry 1989; 40(9):947-51
18. Edlund MJ, Wang PS, Berglund PA, et al. Dropping out of mental health treatment: patterns and predictors among epidemiological survey respondents in the United States and Ontario. Am J Psychiatry 2002; 159(5):845-51
19. Chisholm SM, Crowther JH, Ben-Porath YS. Selected MMPI-2 scales' ability to predict premature termination and outcome from psychotherapy. J Pers Assess 1997; 69(1): 127-44
20. Frayn DH. Assessment factors associated with premature psychotherapy termination. Am J Psychother 1992; 46(2):250-61
21．金华，吴文源，张明源。中国正常人SCL-90评定结果的初步分析。中国神经精神疾病杂志，1986，12：260-262
22. Calrk DM, Salkovskis P, Hackmann A, et al. A comparison of cognitive therapy, applied relaxation, and imipramine in the treatment of panic disorder. Br J Psychiatry, 1994, 164:759-769
23. Margraf J, Schneider S: Outcome and active ingredients of cognitive-behavioral treatments for panic disorder. Paper presented at American Association for Behavior Therapy Conference, 1991, New York
24. Magraf J, Barlow D, Clark D, et al. Psychological treatment of panic. Behav Res Ther, 1993, 31: 1-8
25. Mavissakalian MR, Perel JM. Duration of imipramine therapy and relapse in panic disorder with agoraphobia. J Clin Psychopharmacol, 2002, 22:294-9
26. Otto MW, Pollack MH, Meltzer-Brody S, et al. Cognitive-behavioral therapy for benzodiazepine discontinuation in panic disorder patients. Psychopharmacol Bull, 1992, 28:123-130
27. Bruce TJ, Spiegel DA, Gregg SF, et al. Predictors of alprazolam discontinuation with and without cognitive behavior therapy in panic disorder. Am J Psychiatry, 1995, 152:1156-60
28. Bruce TJ, Spiegel DA, Hegel MT. Cognitive-behavioral therapy helps prevent relapse and recurrence of panic disorder following alprazolam discontinuation: a long-term follow-up of the Peoria and Dartmouth studies. J Consult Clin Psychol, 1999, 67:151-6
29. Whittal ML, Otto MW, Hong JJ. Cognitive-behavior therapy for discontinuation of SSRI treatment of panic disorder: a case series. Behav Res Ther, 2001, 39:939-45
30. Schmidt NB, Wollaway-Bickel K, Trakowski JH, et al. Antidepressant discontinuation in the context of cognitive behavioral treatment for panic disorder. Behav Res Ther, 2002, 40:67-73
31. Stein MB, Ron Norton G, Walker JR, et al. Do selective serotonin re-uptake inhibitors enhance the efficacy of very brief cognitive behavioral therapy for panic disorder? A pilot study. Psychiatry Res, 2000, 94:191-200
32. Barlow DH, Gorman JM, Shear MK, et al. Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA, 2000, 283:2529-36
33. Hohagen F, Winkelmann G, Rasche-Ruchle H, et al. Combination of behaviour therapy with fluvoxamine in comparison with behaviour therapy and placebo. Results of a multicentre study. Br J Psychiatry Suppl, 1998, 35:71-8
34. O'Connor K, Todorov C, Robillard S, et al. Cognitive-behaviour therapy and medication in the treatment of obsessive-compulsive disorder: a controlled study. Can J Psychiatry, 1999, 44:64-71
35. Loerch B, Graf-Morgenstern M, Hautzinger M, et al. Randomised placebo controlled trial of moclobemide, cognitive-behavioural therapy and their combination in panic disorder with agoraphobia. Br J Psychiatry, 1999, 174:205-12
36. van Balkom AJ, de Haan E, van Oppen P, et al. Cognitive and behavioral therapies alone versus in combination with fluvoxamine in the treatment of obsessive compulsive disorder. J Nerv Ment Dis, 1998, 186:492-9
37．曾文星。从文化的角度谈中国人的心理治疗。见曾文星主编：华人的心理与治疗，P660-661，1996，台湾：桂冠图书公司
社，2001
2. Krantzs S, Hammen C. Assessment of cognitive bias in depression. Journal of Abnormal Psychology, 1979, 88(6): 611-619
3. Harrell TH, Ryon NB. Cognitive-behavioral assessment of depression: clinical validation of the automatic thoughts questionnaire. Journal of Consulting Clinical Psychology, 1983, 51(5): 721-725
4．杨德森 主编．行为医学(第二版)．湖南：湖南科学技术出版社，1998，80-120．
5. Xiao S, Young D, Zhang H. Taoistic cognitive psychotherapy for neurotic patients: a preliminary clinical trial. Psych Clin Neuroscin. 1998. Dec, 52, sup: S238-241.
6．王征宇，症状自评量表(SCL-90)，上海精神医学，1984，2(2)：68-70
7．汪向东，王希林，马弘 编．心理卫生评定量表手册(增订版)．北京：中国心理卫生杂志社，1999，P79．
8．龚耀先．艾森克人格问卷．长沙：湖南医学院，1983
9．张伯源．心血管病人的心身反应特点的研究Ⅱ．对冠心病人的行为类型特征的探讨，心理学报，1985，3：314-321
10. Hopkins KD, Stanley JC, Hopkins BR. Educational and psychological measurement and evaluation. Prentice-hall, Inc. 1990, 143-164.
11．谬小春，竺培梁译．心理测量．浙江大学出版社．1998．
12．杨德森，张亚林，肖水源，等。中国道家认知疗法介绍。中国神经精神疾病杂志，2002，28(2)，152
13. Schulz H, Lang K, Lotz-Rambaldi W, et al. Analysis of premature termination in inpatient psychosomatic rehabilitation based on epidemiologic data from two hospital companies. Psychother Psychosom Med Psychol 1999; 49 (9-10): 326-36
14. Chiesa M, Drahorad C, Longo S. Early termination of treatment in personality disorder treated in a psychotherapy hospital. Quantitative and qualitative study. Br J Psychiatry 2000; 177:107-11
15. Morlino M, Martucci G, Musella V, et al, Patients dropping out of treatment in Italy. Acta Psychiatr Scand 1995; 92(1): 1-6
16．徐兰，张建新，肖春玲。对社交困难者的综合心理治疗。中国临床心理学杂志，2002，10：287-289
17. Swett C Jr, Noones J. Factors associated with premature termination from outpatient treatment. Hosp Community Psychiatry 1989; 40(9):947-51
18. Edlund MJ, Wang PS, Berglund PA, et al. Dropping out of mental health treatment: patterns and predictors among epidemiological survey respondents in the United States and Ontario. Am J Psychiatry 2002; 159(5):845-51
19. Chisholm SM, Crowther JH, Ben-Porath YS. Selected MMPI-2 scales' ability to predict premature termination and outcome from psychotherapy. J Pers Assess 1997; 69(1): 127-44
20. Frayn DH. Assessment factors associated with premature psychotherapy termination. Am J Psychother 1992; 46(2):250-61
21．金华，吴文源，张明源。中国正常人SCL-90评定结果的初步分析。中国神经精神疾病杂志，1986，12：260-262
22. Calrk DM, Salkovskis P, Hackmann A, et al. A comparison of cognitive therapy, applied relaxation, and imipramine in the treatment of panic disorder. Br J Psychiatry, 1994, 164:759-769
23. Margraf J, Schneider S: Outcome and active ingredients of cognitive-behavioral treatments for panic disorder. Paper presented at American Association for Behavior Therapy Conference, 1991, New York
24. Magraf J, Barlow D, Clark D, et al. Psychological treatment of panic. Behav Res Ther, 1993, 31: 1-8
25. Mavissakalian MR, Perel JM. Duration of imipramine therapy and relapse in panic disorder with agoraphobia. J Clin Psychopharmacol, 2002, 22:294-9
26. Otto MW, Pollack MH, Meltzer-Brody S, et al. Cognitive-behavioral therapy for benzodiazepine discontinuation in panic disorder patients. Psychopharmacol Bull, 1992, 28:123-130
27. Bruce TJ, Spiegel DA, Gregg SF, et al. Predictors of alprazolam discontinuation with and without cognitive behavior therapy in panic disorder. Am J Psychiatry, 1995, 152:1156-60
28. Bruce TJ, Spiegel DA, Hegel MT. Cognitive-behavioral therapy helps prevent relapse and recurrence of panic disorder following alprazolam discontinuation: a long-term follow-up of the Peoria and Dartmouth studies. J Consult Clin Psychol, 1999, 67:151-6
29. Whittal ML, Otto MW, Hong JJ. Cognitive-behavior therapy for discontinuation of SSRI treatment of panic disorder: a case series. Behav Res Ther, 2001, 39:939-45
30. Schmidt NB, Wollaway-Bickel K, Trakowski JH, et al. Antidepressant discontinuation in the context of cognitive behavioral treatment for panic disorder. Behav Res Ther, 2002, 40:67-73
31. Stein MB, Ron Norton G, Walker JR, et al. Do selective serotonin re-uptake inhibitors enhance the efficacy of very brief cognitive behavioral therapy for panic disorder? A pilot study. Psychiatry Res, 2000, 94:191-200
32. Barlow DH, Gorman JM, Shear MK, et al. Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA, 2000, 283:2529-36
33. Hohagen F, Winkelmann G, Rasche-Ruchle H, et al. Combination of behaviour therapy with fluvoxamine in comparison with behaviour therapy and placebo. Results of a multicentre study. Br J Psychiatry Suppl, 1998, 35:71-8
34. O'Connor K, Todorov C, Robillard S, et al. Cognitive-behaviour therapy and medication in the treatment of obsessive-compulsive disorder: a controlled study. Can J Psychiatry, 1999, 44:64-71
35. Loerch B, Graf-Morgenstern M, Hautzinger M, et al. Randomised placebo controlled trial of moclobemide, cognitive-behavioural therapy and their combination in panic disorder with agoraphobia. Br J Psychiatry, 1999, 174:205-12
36. van Balkom AJ, de Haan E, van Oppen P, et al. Cognitive and behavioral therapies alone versus in combination with fluvoxamine in the treatment of obsessive compulsive disorder. J Nerv Ment Dis, 1998, 186:492-9
37．曾文星。从文化的角度谈中国人的心理治疗。见曾文星主编：华人的心理与治疗，P660-661，1996，台湾：桂冠图书公司