意外创伤者创伤早期认知加工机制及其心理干预模式的实证研究

To assess posttraumatic cognitive processes and establish the psychological intervention model in the early stage of trauma treatment among accidentally injured patients, , this research will be conducted under the guidance of theories of positive psychology and cognitive psychology,and will be based on the experimental psychology and psychometric methods. Qualitative research will be conducted to explore the patients' character of cognitive processing and their basic need of physicopsychological rehabilitation; The proper evaluation tools suitable for early assessment of patients' cognitive procesing will be introduced, translated, and cultually modifed; 2 x 2 mixed design of dot-probe paradigm tests will be used to analyze the character and differences of tacit cognitive processing among patiens with high and low level of PTG. Futhermore, the interrelation between tacit and explicit cognitive processing will be analyzed to find out the cognitive mechnism of accidentally injured patients in early stage of traumatic experience; An operable model of psychological intervention in the early traumatic treatment stage will be developed for the clinical nurses to implement in accidentally injured patients. Delphi method and expert group meeting will be employed to prove the scientificalness and universality of the established model and the subsequent modification will be applied to form a pratical version of psychological intervention model to be test in the clinical empirical research. Randomized control trail (RCT) design will be used to verify the effectiveness of the established model to improve patients' cognitive processing and PTG. Futher modification will be made according to the practical experience to improve the model to make it as acceptable and popular in clinical setting as possible. The research aims to prevent patients from the maladaption such as "Emotional shock" and "Compensation Neurosis" to let them make good use of the optimal rehabiliation period, as well as to promote the level of PTG in patients during their treatment in hospital so as to alleviates the burdens of families and the society.

以意外创伤者为对象，积极心理学、认知加工理论、实验心理学相关理论为先导，实验心理学及心理测量技术为支撑，聚焦伤者创伤早期的认知加工，以质性研究探索伤者认知加工特点和身心康复需求；汉化和修订适用于我国创伤者认知加工的测评工具；采用2×2混合设计的点探测实验范式，分析创伤后PTG水平两极的伤者内隐认知加工的特点及差异，进一步分析其外显、内隐认知加工的内在联系，以揭示伤者创伤早期认知加工机制；构建适合临床护士实施、可操作性强的"意外创伤者院内救治阶段心理干预模式"；以Delphi法、专家会议论证干预模式的科学性和普适性；采用随机对照方法开展实证研究以验证促进伤者认知加工及创伤后成长的心理干预模式之效用；不断完善干预模式并将其推广应用。研究旨在避免伤者创伤早期因"情绪休克"、"赔偿神经症"等应对不良而错失最佳康复时机；促进伤者康复期"创伤后成长"，为减少伤者心理残障及其所致家庭、社会重负提供依据。

本项目基于近年意外创伤高发、高致残等消耗大量卫生资源，且“意外创伤者可因严重心理残障而自毁人生或造成其家庭或社会重负（如‘5.12’汶川大地震幸存者灾后不堪心理重负而自杀等）”，针对伤者常因创伤早期陷入“情绪休克”、“赔偿神经症”等影响其身心康复，甚至躯体复原却遗留危及家庭和谐、有悖于“促进社会和谐”发展目标的严重心理障碍等。提出“聚焦并探索伤者认知加工特点、汉化修订适用于我国伤者认知加工的测评工具、揭示伤者创伤早期认知加工机制、构建伤者院内救治/康复阶段心理干预模式并验证其效用”等主要研究内容。现象学研究获得伤者康复早期两大认知加工方式（建构性、非建构性）所含8个认知加工内容；汉化修订的“简体中文版事件相关反刍性沉思问卷（C-ERRI）”施测450个样本证实心理测量学特征较好；202名伤者的大样本“点探测实验”发现“目的性反刍性沉思伤者对正性情绪图片的注意偏向及其指向性（此为相关研究的新结果、有望探明其学术价值）”；结构方程模型揭示了认知加工在伤者PTG过程中的作用机制，即伤者的目的性反刍性沉思、认知重评在其自我表露与PTG间的中介作用；修订并完善了“意外创伤者的心理干预模式”和“聚焦伤者认知加工特点的心理干预方案”（自我表露干预和认知行为干预）；完成了项目既定的伤者心理干模式的实证研究及其量性、质性的效果评价；证实伤者的自我表露干预（个体和团体）和认知-行为团体干预均可增加其目的性沉思、减少其侵入性沉思、提高其PTG水平，如伤者认为干预方案契合其身心康复需求，体会到获益感、参与感及赞同感。本项目的理论及工具性成果已纳入“十二五”国家级重点规划本科教材（国内首个甄别伤者外显认知加工的工具等）和全国研究生规划教材（干预方案等），40余次应邀与近7000同行交流；相关成果惠及2014年昆山“8.2”特大爆炸事故重伤者及其亲属连续18个多月身心康复过程的心理干预实践等，C-ERRI已被国内学者用于癌症、血透、冠心病等患者的认知测评。

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