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抑郁和焦虑中的跨诊断机制:沉思和注意力控制的作用。

Transdiagnostic mechanisms in depression and anxiety: The role of rumination and attentional control.

作者信息

Hsu Kean J, Beard Courtney, Rifkin Lara, Dillon Daniel G, Pizzagalli Diego A, Björgvinsson Thröstur

机构信息

Behavioral Health Partial Program, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States.

Behavioral Health Partial Program, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States.

出版信息

J Affect Disord. 2015 Dec 1;188:22-7. doi: 10.1016/j.jad.2015.08.008. Epub 2015 Aug 28.

Abstract

BACKGROUND

Deficits in attentional control have been hypothesized to cause rumination, suggesting that the relationships between attentional control and clinical symptoms may be mediated in part by rumination. However, to date, no clinical study has examined these constructs transdiagnostically in a path analysis model.

METHODS

Fifty-one adults presenting for treatment completed measures of self-reported attentional control, rumination, and depression and anxiety symptoms. A bias-corrected path analysis-based approach was employed to test whether indirect (i.e., mediating) effects of rumination were significantly associated with the direct effects of attentional control on depression and anxiety symptoms. Separate models for depression and anxiety symptoms were tested along with reverse models using attentional control as a proposed mediator.

RESULTS

The relationship between attentional control and clinical symptomatology (i.e., both depression and anxiety symptoms) was mediated by rumination. Poor attentional control was associated with more rumination and consequently more severe symptoms of depression and anxiety. The reverse relationship (i.e., attentional control mediating the relationship between rumination and depression or anxiety symptoms) was not significant.

LIMITATIONS

Study design did not allow testing of temporal precedence for the mediation models. All constructs were assessed via self-report.

CONCLUSIONS

Attentional control appears to impact depression and anxiety symptoms through rumination. The pathway between poor attentional control and emotion dysregulation via rumination suggests that interventions targeting attentional control may decrease maladaptive ruminative processes, leading to improved emotion regulation and reduced clinical symptomatology. Future studies should examine the stability of this mediational relationship over time (and in the face of targeted interventions).

摘要

背景

有假设认为注意力控制缺陷会导致反复思考,这表明注意力控制与临床症状之间的关系可能部分由反复思考介导。然而,迄今为止,尚无临床研究在路径分析模型中对这些构念进行跨诊断检验。

方法

51名寻求治疗的成年人完成了自我报告的注意力控制、反复思考以及抑郁和焦虑症状的测量。采用基于偏差校正路径分析的方法来检验反复思考的间接(即中介)效应是否与注意力控制对抑郁和焦虑症状的直接效应显著相关。分别对抑郁和焦虑症状模型以及以注意力控制为假定中介的反向模型进行了检验。

结果

注意力控制与临床症状(即抑郁和焦虑症状)之间的关系由反复思考介导。注意力控制不佳与更多的反复思考相关,进而与更严重的抑郁和焦虑症状相关。反向关系(即注意力控制介导反复思考与抑郁或焦虑症状之间的关系)不显著。

局限性

研究设计不允许对中介模型的时间先后顺序进行检验。所有构念均通过自我报告进行评估。

结论

注意力控制似乎通过反复思考影响抑郁和焦虑症状。注意力控制不佳与通过反复思考导致的情绪失调之间的路径表明,针对注意力控制的干预措施可能会减少适应不良的反复思考过程,从而改善情绪调节并减轻临床症状。未来的研究应考察这种中介关系随时间(以及面对针对性干预时)的稳定性。

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