失独父母的创伤后应激障碍与注意偏向的关系及干预
文献类型：学位论文
| 作者 | 布威佐热姆·艾力 |
| 答辩日期 | 2023-06 |
| 文献子类 | 博士 |
| 授予单位 | 中国科学院大学 |
| 授予地点 | 中国科学院心理研究所 |
| 其他责任者 | 刘正奎 |
| 关键词 | 创伤后应激障碍(PTSD 症状网络 注意偏向与注意偏向训练 近 红外脑功能成像技术(fNIRS 失独父母 |
| 学位名称 | 理学博士 |
| 学位专业 | 应用心理学 |
| 其他题名 | Post-traumatic stress disorder and its relationship with attentional bias in bereaved Chinese parents who have lost their only child and intervention |
| 中文摘要 | Everyone will experience joy and loss in their own lives. The death of a loved one (e.g., a parent, spouse, sibling, or child) is inevitably heart-breaking. Losing a child before adulthood is even worse. There has been a remarkable number of parents who have lost their only child, known as Shidu parents. In Chinese culture, a child is vital for generational continuity and plays an important economic and social support role for parents. Losing an only child means the termination of family lines and the loss of a caregiver during the aging process. Moreover, Chinese culture regards the death of a child as a sign of bad luck, which stigmatizing the parents. Therefore, losing an only child is an enormous risk to the parents' mental status, and Shidu parents often exhibit mental problems, including post-traumatic stress disorder (PTSD). Previous studies showed that PTSD symptoms are most common and serious in Shidu parents. PTSD in Shidu parents is particularly worthy of attention, and it is of great significance to explore suitable intervention programs for these parents. Study 1 aims to explore the network structure of PTSD symptoms among Shidu parents. A convenient sampling method was used to conduct a questionnaire survey on 385 Shidu parents. PTSD symptoms were measured by the PTSD Checklist for DSM-5 (PCL-5). The results revealed that nightmares (B2), diminished interest (DS), exaggerated startle (E4), and irritability/anger (E1) were the most central symptoms. The strongest connections emerged between the symptoms of recurrent thoughts (B1) and nightmares (B2), irritability/anger (E1) and reckless/self-destructive behavior (E2), hypervigilance (E3) and exaggerated startle (E4), and concentration problems (ES) and sleep problems (E6). It is suggested that these symptoms may be the best intervention targets. Study 2 aims to explore the internal causes of the key symptoms found in study 1，that is, the attentional bias to emotional stimuli. The characteristics and neural mechanisms of attentional bias and its relationship with PTSD symptoms were explored by using behavioral and neurological research methods. Study 2 contains two sub-studies. Study 2a aims to investigate the time course of attentional bias among Shidu parents, and to examine its relationship with PTSD symptoms. Bereaved participants (n=38) completed a dot-probe task with negative (trauma-related), positive, and ms), moderate (750 ms), and long (1250 ms). The measurement tool for PTSD symptoms was the same in study 1 .The results showed that participants had difficulty in disengaging from both negative and positive stimuli at moderate stimulus exposures (750 ms) and avoidance of negative stimuli at long stimulus exposures (1250 ms). At long stimulus exposures (1250 ms), attentional avoidance of negative stimuli was positively correlated with PTSD symptoms, including nightmares (B2), psychological cue reactivity (B4), negative emotional state (D4), detachment (D6), reckless/self-destructive behavior (E2). Difficulty in disengaging from positive stimuli was negatively correlated with PTSD symptoms, including nightmares (B2), psychological cue reactivity (B4), detachment (D6), restricted affect (D7), and reckless/self-destructive behavior (E2). Study 2b aims to explore the mechanism of attentional bias and its relationship with PTSD symptoms. The convenient sampling method was used to select 28 bereaved peoples who lost their only child as the experimental group and 37 general parents as the control group. The attentional bias to emotional stimuli was measured using a dot-probe paradigm (750 ms for stimulus exposure duration), and the activity of the dorsolateral prefrontal cortex (DLPFC) was measured using a near-infrared brain functional imager (fNIRS). The measurement tool of PTSD symptoms was the same in study 1 .The results showed that both Shidu and general parents showed attentional bias toward and difficulty in disengaging from negative and positive stimuli. The left DLPFC activity decrease when Shidu parents showed difficulty in disengaging from negative and positive stimuli, and the right DLPFC activity decrease when general parents showed attentional bias toward positive stimuli and difficulty in disengaging from negative stimuli. The right DLPFC activity when difficulty in disengaging from negative and positive stimuli was negatively correlated with PTSD symptoms in Shidu parents, that is the greater deactivation of right DLPFC, the higher the symptom level,including avoidance of thoughts (C1), negative beliefs (D2), distorted blame (D3), negative emotional state (D4), restricted affect (D7), irritability/anger (E1), hypervigilance (E3), and exaggerated startle (E4). Based on the results of study 1 and study 2, study 3 used attentional bias training method to intervene PTSD symptoms of Shidu parents, and measured the effects of the intervention on attention bias, PTSD symptoms, and DLPFC activities. A convenient sampling method was used to select 62 bereaved parents who lost their only child, and they were randomly assigned to either attentional bias modification group (ABM), attention control training group (ACT), or attention control geometry-training group (ACG). Participants performed eight biweekly ABM/ACT/ACG sessions for four weeks. Changes in attentional bias, PTSD symptoms, and DLPFC activation were measured at pre, after 3 and 8 times of interventions. Changes in attentional bias and PTSD symptoms were examined a 4-month follow-up. The measurement of DLPFC activity was the same in study 2b, and the measurement tools of attention bias and PTSD symptoms were the same in study 2. The results showed that ABM had immediate intervention effect on attentional bias toward and avoidance of negative and positive stimuli, while ACT and ACG had immediate and long-term (4 months after) intervention effect on attentional bias toward and avoidance of negative and positive stimuli. Enhanced bilateral DLPFC activities were noted for both ACT and ACG conditions, while decreased bilateral DLPFC activities were noted for ABM under showed difficulty in disengaging from negative and positive stimuli. PTSD symptoms decreased following ACT treatment, including recurrent thoughts (B 1)，flashbacks (B3), psychological cue reactivity (B4), physiological cue reactivity (BS), negative beliefs (D2), distorted blame (D3), negative emotional state (D4), hypervigilance (E3), and exaggerated startle (E4), which indicates that the attention control training under emotional conditions has better intervention effects on PTSD symptoms. This paper explored PTSD symptoms, and their potential causes among Shidu parents. The research route was from specific symptoms to cognitive processes, from cognitive processes to neurological functions, and explored the use of attention bias training to intervene in PTSD symptoms. This paper promotes our understanding of the relationship between attentional bias and its neural mechanisms in the field of trauma and PTSD symptoms, which has important theoretical significance. In addition, this paper is helpful in improving the relationship between cognition and affective disorders, pointing out that attentional bias to emotional stimulation (disengagement difficulties and avoidance) can be used as the treatment target of PTSD symptoms, and attentional control training under emotional conditions can be used as an intervention technique for PTSD symptoms. This provides a scientific basis for effective psychological counseling and intervention guidence for parents who have lost their only child and has important practical significance. |
| 英文摘要 | 漫长人生中，每个人都会经历得来的欢喜和失去的痛苦。亲朋好友等重要他人的离世是每个人无法避免的悲伤经历，尤其是白发人送黑发人更是一种悲剧。我国有大量的父母因失去唯一孩子而遭受痛苦，叫失独父母。自古以来，孩子在家庭和父母生活中有重要的价值和作用。受中国传统文化中的“养儿防老”、“传宗接代”和“不孝有三，无后为大”等思想，独生子女的离世给父母带来巨大的痛苦和精神负担，使失独父母出现较严重的心理健康问题，包括创伤后应激障碍(Posttraumatio stross disordor，简称PTSD}。以往研究表明失独父母普遍出现PTSD症状且症状较重。系统探讨并了解失独父母PTSD及其机制基础上，探索适合失独父母干预方案并实施干预有重要意义。 研究1从网络模型视角，旨在探讨失独父母PTSD症状的网络特征。采用方便取样方法对385名失独父母进行问卷调查。使用PCL-5 (The PTSD Checklist forDSM-5)测量PTSD症状。结果显示，高中心性症状为噩梦(B2)、兴趣减退(DS ),惊吓反应过度(E4)和急躁/愤怒(E1)。强联结症状对为侵入性想法(B1)与噩梦(B2)、急躁/愤怒(E1)与鲁莽/自我毁灭性行为(E2)、高警觉(E3)与惊吓反应过度(E4)和注意力问题(ES)与睡眠问题(E6)。高中心性症状和强联结的症状对之间的相互作用在形成和维持PTSD中发挥关键作用。这提示这些核心症状症状应考虑为干预靶点。 研究2从PTSD认知过程视角，旨在探究研究1发现的核心症状其发生的潜在原因，即对情绪刺激的注意偏向。通过采用行为学和神经学的研究方法，探究注意偏向特点和机制及其与PTSD症状的关系。研究2包含两个子研究。 研究2a旨在探究注意偏向成分和时程特点及其与PTSD症状之间的关系。采用方便取样的方法选取38名失独父母。采用点探测范式测量注意偏向。实验材料为负性(创伤相关)、正性和中性图片。刺激呈现时间设置为快速(250 ms),较短(500 ms )、中等(750 ms)和较长(1250 ms )。PTSD症状的测量工具同研究1。结果显示，刺激呈现时间为中等(750 ms)时失独父母对负性和正性图片存在注意解除困难，较长(1250 ms)时只对负性图片存在注意回避。此外，束d激呈现时间较长(1250 ms)时，对负性图片的注意回避与PTSD症状水平呈正相关，症状包括网络模型发现的核心症状，如噩梦(B2)和鲁莽/自我毁灭性行为(E2)以及其他症状，如线索引发情感反应(B4)、消极情感(D4 )和与他人疏离(D6 );对正性图片的注意解除困难与PTSD症状水平呈负相关，症研究2从PTSD认知过程视角，旨在探究研究1发现的核心症状其发生的潜在原因，即对情绪刺激的注意偏向。通过采用行为学和神经学的研究方法，探究注意偏向特点和机制及其与PTSD症状的关系。研究2包含两个子研究。 研究2a旨在探究注意偏向成分和时程特点及其与PTSD症状之间的关系。采用方便取样的方法选取38名失独父母。采用点探测范式测量注意偏向。实验材料为负性(创伤相关)、正性和中性图片。刺激呈现时间设置为快速(250 ms),较短(500 ms )、中等(750 ms)和较长(1250 ms )。PTSD症状的测量工具同研究1。结果显示，刺激呈现时间为中等(750 ms)时失独父母对负性和正性图片存在注意解除困难，较长(1250 ms)时只对负性图片存在注意回避。此外，束d激呈现时间较长(1250 ms)时，对负性图片的注意回避与PTSD症状水平呈正相关，症状包括网络模型发现的核心症状，如噩梦(B2)和鲁莽/自我毁灭性行为(E2)以及其他症状，如线索引发情感反应(B4)、消极情感(D4 )和与他人疏离(D6 );对正性图片的注意解除困难与PTSD症状水平呈负相关，症状包括网络模型发现的核心症状，如噩梦(B2)和鲁莽/自我毁灭性行为(E2)以及其他症状，如线索引发情感反应(B4)、与他人疏离(D6)和情感受限(D7)o 研究2b旨在探讨注意偏向的机制及其与PTSD症状的关系。采用方便取样的方法选取28名失独父母为实验组，37名正常父母为对照组。采用点探测范式 (刺激呈现为750 ms)测量注意偏向，采用近红外脑功能成像技术(fNIRS)测量背外侧前额叶(Dorsolateral prefrontal cortex, DLPFC)的活动。PTSD症状的测量工具同研究1。结果显示，失独父母和正常父母对情绪图片存在注意偏向，表现为定向加速和解除困难。失独父母对负性和正性图片存在注意解除困难时DLPFC激活抑制。正常父母对正性图片存在定向加速时和对负性图片存在注意解除困难时DLPFC激活抑制。失独父母对情绪图片存在注意解除困难时，DLPFC活动程度与PTSD症状水平存在负相关，即激活抑制程度越大，症状水平越高，症状包括网络模型发现的核心症状，如急躁/愤怒(E1)、高警觉(E3)和惊吓反应过度(E4)以及其他症状，如回避想法(C1)、消极信念(D2)、自责/他责(D3)、消极情感(D4 )和情感受限(D7)。总之，研究2表明失独父母对情绪刺激的注意偏向与PTSD症状之间存在相关。DLPFC的激活抑制可以作为注意偏向与PTSD症状的神经标记物。 研究3以研究1和研究2的结果为基础，采用注意偏向训练的干预方法对失独父母PTSD症状进行干预，并测量注意偏向训练对注意偏向、PTSD症状以及DLPFC活动的干预效果。采用方便取样的方法选取62名失独父母并随机分配到注意偏向i)11练组(Attention bias modification, ABM )，注意控制iJ}l练组(Attention control training, ACT)或注意控制几何i)11练组(Attention control geometry-training, ACG)。三组均完成每周2次，连续4周，总共8次的训练任务。干预前、干预3次和8次后分别测量所有被试的注意偏向、PTSD症状以及DLPFC激活状况，干预后的4个月对注意偏向和PTSD症状进行追踪。DLPFC活动测量同研究2b，注意偏向与PTSD症状的测量工具同研究2。结果显示，在基测时三组对情绪图片存在定向加速和注意回避。干预后，ABM组的定向加速和注意回避分数均下降，4个月后恢复到基测水平，即ABM对定向加速和注意回避具有即时干预效果。ACT和ACG组的定向加速和注意回避分数均下降，即ACT和ACG对定向加速和注意回避具有即时和长期干预效果((4个月后)。ACT组的部分PTSD症状显著下降，即ACT对部分PTSD症状具有长期干预效果((4个月后)，症状包括网络模型发现的核心症状，如侵入性想法(B1)、高警觉(E3)和惊吓反应过度(E4)以及其他症状，如闪回(B3)、线索引发情感反应(B4)、线索引发生理反应(BS)、消极信念(D2)、自责/他责(D3)和消极情感(D4)o干预后对情绪图片存在解除困难时，ACT和ACG组的DLPFC激活程度逐渐增强，ABM的DLPFC激活程度逐渐下降。即ACT和ACG增强解除困难时的DLPFC激活。从整体干预效果来看，ACT的干预效果最后，表明了情绪条件下的注意控制训练对PTSD症状的干预作用更好。这为今后在临床应用注意训练对创伤人群进行干预指出了方向。 本文通过三个研究从特定症状走向认知过程，从认知过程走向脑功能，深入探讨失独父母PTSD症状及其发生的潜在原因，并探索性地采用注意偏向训练对PTSD症状进行干预。本文促进了我们对创伤领域中的注意偏向及其机制与PTSD症状之间关系的理解，具有重要的理论意义。此外，本文有助于完善认知与情绪障碍之间的关系，并指出对情绪刺激的注意偏向(解除困难和回避)可以作为PTSD症状的治疗目标，情绪条件下的注意控制训练(ACT)可以作为PTSD症状的干预技术。这为有效指导失独父母创伤反应的心理辅导和干预提供科学依据，具有重要的实践意义。 |
| 语种 | 中文 |
| 源URL | [http://ir.psych.ac.cn/handle/311026/46148]  |
| 专题 | 心理研究所_健康与遗传心理学研究室 |
| 推荐引用方式 GB/T 7714 | 布威佐热姆·艾力. 失独父母的创伤后应激障碍与注意偏向的关系及干预[D]. 中国科学院心理研究所. 中国科学院大学. 2023. |
入库方式： OAI收割
来源：心理研究所
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