詹紫薇 王夢(mèng)夢(mèng) 索濤 蔣艷菊
摘 ?要 ?當(dāng)前抑郁逐漸低齡化使得青少年的情緒失調(diào)問題備受關(guān)注。情緒調(diào)節(jié)能力作為情緒穩(wěn)定的關(guān)鍵因素, 能夠幫助青少年對(duì)自身情緒狀態(tài)進(jìn)行有效管理; 而調(diào)節(jié)情緒的動(dòng)態(tài)性和多階段加工過程等特性則是情緒調(diào)節(jié)的重要組成部分, 對(duì)其研究有利于系統(tǒng)地闡明抑郁青少年情緒失調(diào)的特征及原因。擴(kuò)展過程模型將情緒調(diào)節(jié)過程分為識(shí)別、選擇和執(zhí)行三個(gè)階段, 強(qiáng)調(diào)階段之間相互影響的關(guān)系, 還原了情緒調(diào)節(jié)的動(dòng)態(tài)過程。基于該模型對(duì)抑郁青少年在情緒調(diào)節(jié)三階段的特征進(jìn)行梳理, 結(jié)果發(fā)現(xiàn)其在各階段均存在缺陷。考慮到三階段的整體性和連續(xù)性, 為了明確抑郁青少年情緒失調(diào)是哪一階段的受損或中斷對(duì)后續(xù)階段產(chǎn)生了影響、影響的程度如何以及采用指導(dǎo)性的干預(yù)是否可以改變這種影響, 未來(lái)研究可以: 1)通過腦電技術(shù)與漂移擴(kuò)散模型相結(jié)合的方式還原情緒調(diào)節(jié)的動(dòng)態(tài)變化過程; 2)更為全面地研究不同抑郁癥狀水平青少年的特點(diǎn); 3)關(guān)注情緒反應(yīng)性異常的雙重性, 更為系統(tǒng)地揭示抑郁青少年情緒失調(diào)的原因, 以此來(lái)探究抑郁青少年情緒失調(diào)的干預(yù)路徑和舉措。
關(guān)鍵詞 ?抑郁, 情緒調(diào)節(jié), 青少年, 擴(kuò)展過程模型
分類號(hào) ?B844; R395
1 ?引言
抑郁包括抑郁傾向和抑郁癥(何振宏, 張丹丹, 2018)。其中, 抑郁癥作為抑郁障礙的典型代表, 又稱重度抑郁障礙(Major Depressive Disorder, MDD) (American Psychiatric Association, 2013)。與其他精神障礙一樣, 抑郁癥有其相應(yīng)的形成過程:從完全健康發(fā)展到抑郁癥, 中間往往會(huì)經(jīng)歷抑郁傾向(Depressive Tendency), 也被稱為閾下抑郁(Subthreshold Depression, SubD), 個(gè)體在這一階段會(huì)表現(xiàn)出抑郁癥狀但達(dá)不到臨床診斷的標(biāo)準(zhǔn)(Judd et al., 1994)。值得注意的是, 若不能及時(shí)對(duì)
這部分群體加以適當(dāng)調(diào)整, 則很容易發(fā)展為抑郁癥。近年來(lái), 由于人們承受的壓力不斷增多, 負(fù)面情緒持續(xù)積累而得不到排解, 出現(xiàn)抑郁傾向的人群數(shù)量也在逐年增加, 且所涉及人群的年齡有趨低化傾向。研究表明, 青少年中抑郁傾向的群體規(guī)模出現(xiàn)緩慢上升的態(tài)勢(shì)(王夢(mèng)陽(yáng), 2021)。據(jù)《中國(guó)國(guó)民心理健康發(fā)展報(bào)告(2019~2020)》顯示, 2020年青少年的抑郁檢出率為24.6%, 其中輕度抑郁的檢出率為17.2%, 重度抑郁的檢出率為7.4%。而最新發(fā)布的《2022國(guó)民抑郁癥藍(lán)皮書》中更是發(fā)現(xiàn)18歲以下的抑郁癥患者占總?cè)藬?shù)的30%。可見青少年抑郁問題的嚴(yán)重性與緊迫性。然而, 青少年期不僅是個(gè)體抑郁問題的高發(fā)期(侯金芹, 陳祉妍, 2016), 也是干預(yù)的最佳時(shí)期(Ahmed et al., 2015), 因此要抓住這個(gè)關(guān)鍵時(shí)期及時(shí)做出合理調(diào)整。
青少年時(shí)期(11~18歲, Sawyer et al., 2012)發(fā)生的一系列生理、認(rèn)知、情感和社會(huì)性變化使這
一過渡時(shí)期成為情緒調(diào)節(jié)發(fā)展的重要時(shí)期。首先, 從發(fā)展的角度來(lái)看, 青少年時(shí)期個(gè)體伴隨著劇烈的生理和身體變化, 獨(dú)立的欲求日益增強(qiáng), 同時(shí)周圍充斥著學(xué)業(yè)和就業(yè)壓力以及波動(dòng)的社會(huì)關(guān)系, 而這些挑戰(zhàn)往往伴隨著強(qiáng)烈的情緒反應(yīng)和巨大的壓力(Casey et al., 2010); 其次, 在認(rèn)知方面, 情緒調(diào)節(jié)所需的執(zhí)行功能和行為決策能力都在青少年時(shí)期得到迅速發(fā)展(Dumontheil, 2014), 但青少年時(shí)期前額葉區(qū)域的發(fā)展落后于邊緣結(jié)構(gòu), 如杏仁核、腹側(cè)紋狀體和眶額葉皮層(Somerville & Casey, 2010), 這導(dǎo)致青少年的情緒調(diào)節(jié)能力相對(duì)較弱。綜上, 或許是因?yàn)檫@一階段增強(qiáng)的情感反應(yīng)以及調(diào)節(jié)能力尚未成熟, 共同導(dǎo)致了青少年更容易受到情緒失調(diào)的影響(Ahmed et al., 2015)。另外, 國(guó)內(nèi)青少年抑郁情緒發(fā)展軌跡的研究也表明, 男女生的抑郁情緒在10~19歲時(shí)段皆呈線性增長(zhǎng)趨勢(shì)(侯金芹, 陳祉妍, 2016), 青少年期儼然已經(jīng)成為了個(gè)體情緒問題尤其是抑郁發(fā)生的高危期。
抑郁的核心癥狀主要體現(xiàn)在兩個(gè)方面:心境低落和快感缺失(趙參參 等, 2017; Aldao et al., 2010), 即抑郁個(gè)體在調(diào)節(jié)消極和積極情緒時(shí)均存在缺陷且調(diào)節(jié)的效果較差。情緒調(diào)節(jié)(Emotion Regulation)是指?jìng)€(gè)體試圖改變自己擁有何種情緒、何時(shí)擁有這些情緒及如何體驗(yàn)與表達(dá)這些情緒的過程(Gross, 2015)。早期經(jīng)典的情緒調(diào)節(jié)過程模型(The Emotion Regulation Process Model)認(rèn)為情緒調(diào)節(jié)可以發(fā)生在情緒產(chǎn)生的任何階段, 并提出了五類分別作用于不同情緒產(chǎn)生階段的情緒調(diào)節(jié)策略(Gross, 1998)。但究其本質(zhì), 該模型描述的僅僅是情緒產(chǎn)生, 而非整個(gè)情緒調(diào)節(jié)的過程。實(shí)際上, 情緒調(diào)節(jié)是一個(gè)動(dòng)態(tài)的過程, 它賦予個(gè)人經(jīng)驗(yàn)以內(nèi)在意義, 并通過生理、認(rèn)知和行為成分的共同協(xié)作來(lái)表達(dá)情緒(Waters & Thompson, 2014)。但目前有關(guān)抑郁青少年情緒調(diào)節(jié)的研究大多僅集中于其在某一階段的特征, 例如選擇何種調(diào)節(jié)策略以及使用調(diào)節(jié)策略的頻率是怎樣的(張少華 等, 2020)。如此將情緒調(diào)節(jié)的完整過程割裂開來(lái)進(jìn)行單獨(dú)研究, 不僅忽視了情緒調(diào)節(jié)過程性和動(dòng)態(tài)性的特點(diǎn), 也無(wú)法系統(tǒng)全面地還原抑郁青少年調(diào)節(jié)情緒的整個(gè)過程所具有的特征。因此, 為了更深入地探究抑郁青少年情緒失調(diào)的特征和原因, 需要結(jié)合情緒調(diào)節(jié)的最新理論模型對(duì)抑郁與健康青少年在整個(gè)情緒調(diào)節(jié)過程中存在的差異進(jìn)行梳理。
2 ?情緒調(diào)節(jié)的擴(kuò)展過程模型
情緒調(diào)節(jié)的擴(kuò)展過程模型(The Extended Process Model, EPM)是在經(jīng)典的情緒調(diào)節(jié)過程模型的基礎(chǔ)上提出了時(shí)間動(dòng)態(tài)和情境因素對(duì)情緒調(diào)節(jié)過程的影響(Gross, 2015)。它將情緒調(diào)節(jié)定義為一個(gè)動(dòng)態(tài)的、多階段的過程, 在這個(gè)過程中, 情緒調(diào)節(jié)策略是隨著時(shí)間的推移而實(shí)施和監(jiān)測(cè)的, 以實(shí)現(xiàn)個(gè)體的調(diào)節(jié)目標(biāo)(黃于飛 等, 2022; Gross, 2015; Lincoln et al., 2022; Sheppes et al., 2015)。在這個(gè)框架中, 情緒的產(chǎn)生和調(diào)節(jié)被建模為兩個(gè)不同但相互作用的過程。當(dāng)外部或內(nèi)部環(huán)境刺激被感知和評(píng)價(jià)為與目標(biāo)相一致時(shí), 情緒產(chǎn)生作為一級(jí)評(píng)價(jià)系統(tǒng)運(yùn)行, 并產(chǎn)生情緒反應(yīng)。隨著時(shí)間的推移, 情緒反應(yīng)會(huì)反饋到內(nèi)外環(huán)境中, 并影響隨后的情緒過程。當(dāng)情緒反應(yīng)與個(gè)體的目標(biāo)不一致時(shí), 又會(huì)激活一個(gè)與情緒產(chǎn)生過程進(jìn)行交互的二級(jí)評(píng)價(jià)系統(tǒng), 即情緒調(diào)節(jié)(Gross, 2015)。因此, 情緒產(chǎn)生的目標(biāo)是環(huán)境中的特定刺激, 而情緒調(diào)節(jié)的目標(biāo)是情緒產(chǎn)生的過程。
EPM不僅解釋了個(gè)體情緒調(diào)節(jié)如何開始以及具體的策略如何選擇和實(shí)施, 而且還指出個(gè)體未能成功地適應(yīng)情緒時(shí)情緒調(diào)節(jié)過程在何時(shí)失敗(McRae & Gross, 2020; Sheppes et al., 2015)。具體來(lái)說(shuō), 該模型將情緒調(diào)節(jié)概念化為一系列的評(píng)估階段:識(shí)別(Identification stage)、選擇(Selection stage)和執(zhí)行階段(Implementation stage), 且每一個(gè)階段都包括感知、評(píng)估和動(dòng)作三個(gè)子步驟(Lincoln et al., 2022)。整個(gè)情緒調(diào)節(jié)從識(shí)別階段開始, 該階段決定了后期情緒調(diào)節(jié)的方向, 其本質(zhì)上是情緒調(diào)節(jié)目標(biāo)確立的過程。個(gè)體需要調(diào)動(dòng)情感意識(shí)和清晰度等技能的參與(感知子步驟), 根據(jù)當(dāng)前情緒與目標(biāo)情緒狀態(tài)之間的差異、先前的經(jīng)驗(yàn)以及調(diào)節(jié)能否帶來(lái)好處來(lái)決定是否對(duì)該情緒進(jìn)行調(diào)節(jié)。此外, 整個(gè)步驟又需要自我效能感的參與(評(píng)估子步驟), 在得到積極評(píng)估結(jié)果后才會(huì)激活目標(biāo)來(lái)調(diào)節(jié)情緒(動(dòng)作子步驟)。情緒調(diào)節(jié)目標(biāo)的激活引發(fā)了選擇階段, 個(gè)體會(huì)根據(jù)可用資源、情緒的質(zhì)量和數(shù)量以及特定策略的成本和收益, 對(duì)可用策略進(jìn)行感知和評(píng)估, 并從多種情緒調(diào)節(jié)策略中選擇適合的策略。因此, 選擇階段決定了個(gè)體如何在已確定的方向上有效地改變情緒(Sheppes et al., 2015)。據(jù)此, 個(gè)體想要達(dá)到的情緒狀態(tài)(情緒調(diào)節(jié)目標(biāo))和改變情緒所采用的方法(情緒調(diào)節(jié)策略)為執(zhí)行階段情緒調(diào)節(jié)結(jié)果的產(chǎn)生創(chuàng)造了條件(李紅 等, 2019)。選定的總體戰(zhàn)略的激活會(huì)誘發(fā)執(zhí)行階段, 而執(zhí)行階段要做的則是在個(gè)體選擇情緒調(diào)節(jié)策略之后, 依據(jù)具體的情境, 將策略轉(zhuǎn)換成適當(dāng)?shù)淖硬呗赃M(jìn)行情緒調(diào)節(jié)(McRae et al., 2012)。
實(shí)際情況中, 以上三個(gè)階段會(huì)相互作用產(chǎn)生影響:由特定評(píng)估階段產(chǎn)生的行為都是下一次評(píng)估階段的情境, 誘導(dǎo)產(chǎn)生新的評(píng)估階段。這也體現(xiàn)了整個(gè)評(píng)估系統(tǒng)動(dòng)態(tài)性的重要特點(diǎn)。在成功調(diào)節(jié)情緒的情況下, 以上過程會(huì)再次循環(huán), 只有當(dāng)個(gè)體的目標(biāo)狀態(tài)與改變后的情境之間的差距低于一定的閾限值, 即達(dá)到個(gè)體的調(diào)節(jié)目標(biāo)(例如, 個(gè)體不再感到厭惡), 評(píng)估系統(tǒng)的循環(huán)才會(huì)停止, 可見這是一個(gè)連續(xù)的、迭代的過程(Williams et al., 2018)。相反, Sheppes等(2015)也描述了情緒調(diào)節(jié)缺陷可能出現(xiàn)的不同階段:情緒調(diào)節(jié)可能在識(shí)別階段受損(例如, 當(dāng)對(duì)情緒狀態(tài)的理解有誤甚至被歪曲時(shí)或以往的經(jīng)驗(yàn)導(dǎo)致情緒調(diào)節(jié)的自我效能感較低時(shí)), 這可能導(dǎo)致情緒調(diào)節(jié)啟動(dòng)失效; 在選擇階段的缺陷(例如, 可用策略的代表性不足, 對(duì)適應(yīng)不良策略的高估)可能導(dǎo)致選擇無(wú)效的策略; 在執(zhí)行階段的失敗(例如, 錯(cuò)誤評(píng)估具體的調(diào)節(jié)策略)可能導(dǎo)致最終的情緒調(diào)節(jié)效果不良甚至無(wú)效。
實(shí)際上, EPM表明了認(rèn)知靈活性在調(diào)節(jié)情緒過程中起到重要作用(Genet & Siemer, 2011; Ochsner & Gross, 2007)。作為執(zhí)行功能的組成部分, 認(rèn)知靈活性是指?jìng)€(gè)人根據(jù)目標(biāo)和不斷變化的情境需求改變思想和行為的能力(Meiran, 2010)。有研究發(fā)現(xiàn), 在處理情緒材料時(shí), 認(rèn)知靈活性可以預(yù)測(cè)個(gè)體在負(fù)性情緒和正性情緒誘導(dǎo)下被指示調(diào)節(jié)情緒時(shí)的認(rèn)知重評(píng)效果(Malooly et al., 2013)。具體而言, 當(dāng)被指示減弱負(fù)性情緒時(shí), 注意力會(huì)從處理消極材料的情感方面更有效地轉(zhuǎn)移到非情感方面, 當(dāng)被指示增強(qiáng)正性情緒時(shí), 注意力會(huì)從處理積極材料的非情感方面更有效地轉(zhuǎn)移到情感方面, 同時(shí)整個(gè)過程又與認(rèn)知重評(píng)的自我效能感相關(guān)(Grol & de Raedt, 2020; Malooly et al., 2013)。
同時(shí), EPM也體現(xiàn)了情緒調(diào)節(jié)的多階段加工過程和動(dòng)態(tài)性, 對(duì)于探究個(gè)體情緒調(diào)節(jié)的特征具有重要的理論價(jià)值和實(shí)踐意義。然而, 對(duì)以往的情緒調(diào)節(jié)研究文獻(xiàn)進(jìn)行梳理時(shí), 僅發(fā)現(xiàn)幾篇與EPM相關(guān)的文獻(xiàn)。比如, 有研究者模擬了EPM監(jiān)控階段的動(dòng)態(tài)情緒調(diào)節(jié)過程, 結(jié)果發(fā)現(xiàn), 當(dāng)負(fù)性情緒較高時(shí)個(gè)體會(huì)監(jiān)控他們的情緒調(diào)節(jié)有效性, 并選擇轉(zhuǎn)換情緒調(diào)節(jié)的策略, 這也在一定程度上支持了EPM的概念化(Murphy & Young, 2020); 還有研究基于EPM理論探究了軀體癥狀障礙患者情緒調(diào)節(jié)的動(dòng)態(tài)調(diào)節(jié)過程, 詳細(xì)區(qū)分了患者的情緒調(diào)節(jié)變化, 為改進(jìn)適合這些患者的治療干預(yù)措施提供了幫助(Schnabel et al., 2022); Hughes等(2020)基于EPM探討了人格特質(zhì)與情緒調(diào)節(jié)三階段之間的關(guān)系, 并指出未來(lái)研究需要進(jìn)一步使用EPM進(jìn)行文獻(xiàn)整合; 在對(duì)壓力心態(tài)和壓力重估進(jìn)行研究的基礎(chǔ)上, Crum等(2020)結(jié)合EPM提出了壓力優(yōu)化的綜合理論模型:將壓力優(yōu)化作為一種干預(yù)手段, 引導(dǎo)個(gè)體靈活地識(shí)別、選擇和實(shí)施與優(yōu)化壓力反應(yīng)目標(biāo)一致的調(diào)節(jié)策略, 以實(shí)現(xiàn)有價(jià)值的目標(biāo)。
基于EPM, 本文對(duì)抑郁青少年情緒調(diào)節(jié)的三個(gè)階段的特征進(jìn)行詳細(xì)梳理, 提出未來(lái)的研究應(yīng)該著重探究情緒調(diào)節(jié)各階段之間關(guān)系。這不僅為探索抑郁對(duì)青少年情緒調(diào)節(jié)的影響機(jī)制提供新的視角, 也為抑郁青少年情緒失調(diào)的干預(yù)提供新的思路和理論基礎(chǔ)。
3 ?抑郁青少年的情緒調(diào)節(jié)
結(jié)合情緒調(diào)節(jié)的定義和EPM可知, 情緒調(diào)節(jié)實(shí)際上是一個(gè)動(dòng)態(tài)的多階段加工過程, 并且其中包含的各個(gè)評(píng)估階段雖彼此分離卻也相互影響(Gross, 2015)。因此, 本文結(jié)合EPM所劃分的三階段, 對(duì)抑郁青少年情緒調(diào)節(jié)的相關(guān)研究進(jìn)行梳理, 旨在通過還原情緒的調(diào)節(jié)過程, 更好地探究抑郁青少年情緒調(diào)節(jié)的特征。
3.1 ?情緒調(diào)節(jié)目標(biāo)的確立
識(shí)別階段是指當(dāng)環(huán)境中某個(gè)要素激活個(gè)體情緒產(chǎn)生的評(píng)價(jià)系統(tǒng)后, 個(gè)體對(duì)情緒進(jìn)行感知和評(píng)估(消極或積極), 并且決定是否需要調(diào)節(jié)以及向著何種方向(向上或是向下)調(diào)節(jié), 從而確定具體的行動(dòng)目標(biāo)(黃于飛 等, 2022)。然而, 在這一階段, 抑郁青少年表現(xiàn)出對(duì)信息的負(fù)性認(rèn)知加工偏向, 具體包括注意偏向、解釋偏向和記憶偏向等(Beck, 2008)。
4.2 ?研究癥狀水平的全面性
回顧以往有關(guān)抑郁青少年情緒調(diào)節(jié)的研究發(fā)現(xiàn), 存在觀點(diǎn)和結(jié)論不一致的現(xiàn)象, 這使得這些研究缺乏統(tǒng)一性和對(duì)比性。比如, Timbremont等(2008)認(rèn)為當(dāng)前抑郁、從未抑郁和抑郁康復(fù)的青少年在記憶偏向方面并不存在顯著差異, 但也有研究認(rèn)為抑郁程度不同可能會(huì)造成個(gè)體注意(劉和珺, 楊海波, 2019)、解釋(Klein et al., 2018)和記憶等方面的偏向(Smith et al., 2018), 同時(shí)在情緒調(diào)節(jié)策略的使用頻率(張少華 等, 2020)和使用效果(Shapero et al., 2018)也產(chǎn)生差異。因此, 采用指導(dǎo)性認(rèn)知重評(píng)策略對(duì)改善抑郁青少年的情緒調(diào)節(jié)能力是否有效尚且存在異議, 或許正是因?yàn)楦黜?xiàng)研究所針對(duì)的抑郁癥狀其嚴(yán)重程度不同。基于EPM提出的情緒調(diào)節(jié)三階段之間是先因后果、相互影響的關(guān)系, 對(duì)于抑郁青少年情緒調(diào)節(jié)效果的研究有必要將研究對(duì)象的抑郁程度考慮在內(nèi)。同時(shí), 考慮到當(dāng)下具有一定抑郁癥狀但不滿足抑郁癥診斷標(biāo)準(zhǔn)的青少年所占比例較大, 且這部分群體發(fā)展為抑郁癥的風(fēng)險(xiǎn)較高, 因此應(yīng)加大對(duì)這一群體的關(guān)注力度和研究深度。只有如此, 才能有效地進(jìn)行及時(shí)干預(yù), 防止其癥狀的進(jìn)一步加深。
4.3 ?情緒反應(yīng)性異常的雙重性
結(jié)合上述理論和研究發(fā)現(xiàn), 在識(shí)別階段, 有關(guān)抑郁青少年對(duì)不同效價(jià)刺激調(diào)節(jié)目標(biāo)的確立的觀點(diǎn)并不一致, 具體表現(xiàn)為情緒不敏感理論中有關(guān)調(diào)節(jié)負(fù)性刺激的觀點(diǎn)與負(fù)性增強(qiáng)假說(shuō)相互矛盾, 而涉及調(diào)節(jié)正性刺激的觀點(diǎn)卻與正性衰減假說(shuō)相一致(Bylsma, 2020; Bylsma et al., 2008; Rottenberg et al., 2005); 在策略選擇階段, 張少華等(2020)也發(fā)現(xiàn)情緒調(diào)節(jié)策略的使用可能會(huì)受所調(diào)節(jié)情緒效價(jià)的影響, 具體來(lái)講, 當(dāng)調(diào)節(jié)負(fù)性情緒時(shí), 青少年的抑郁癥狀與表達(dá)宣泄策略的使用之間呈現(xiàn)顯著正相關(guān), 而當(dāng)調(diào)節(jié)正性情緒時(shí), 卻不存在這種關(guān)系。以上兩階段圍繞所調(diào)節(jié)情緒效價(jià)的不同均存在差異, 而目前有關(guān)抑郁青少年在策略實(shí)施階段的研究大多集中在負(fù)性情緒的減弱調(diào)節(jié)上, 對(duì)于正性情緒調(diào)節(jié)的研究卻較少(王曉霞 等, 2015; van Kleef et al., 2022), 因此無(wú)法全面地揭示抑郁青少年正性情緒的調(diào)節(jié)效果是否以及如何受到前兩階段的影響。實(shí)際上, 從抑郁癥的雙重情緒觀點(diǎn)出發(fā), 抑郁青少年情緒失調(diào)主要表現(xiàn)為兩方面, 即抑郁青少年的情緒反應(yīng)性異常具有雙重性特征:持續(xù)的低落情緒和快樂喪失, 而后者對(duì)應(yīng)的正是其在正性情緒的增強(qiáng)調(diào)節(jié)方面效果不佳(Hayes et al., 2015)。考慮到正性情緒對(duì)個(gè)體的心理健康、社會(huì)功能等也具有重要意義, 未來(lái)針對(duì)抑郁青少年情緒失調(diào)的研究也應(yīng)加強(qiáng)對(duì)正性情緒調(diào)節(jié)的關(guān)注, 以此更大程度的還原抑郁青少年情緒調(diào)節(jié)的特征, 探尋干預(yù)的最佳方法。
4.4 ?干預(yù)措施的可行性
盡管由于各研究所涉及的被試抑郁程度不同導(dǎo)致研究結(jié)果無(wú)法進(jìn)行有效對(duì)比, 但總的來(lái)說(shuō), 當(dāng)給予抑郁個(gè)體指導(dǎo), 使他們了解有效的情緒調(diào)節(jié)策略及其使用方法之后, 他們也能夠采用認(rèn)知重評(píng)策略對(duì)負(fù)性情緒進(jìn)行一定程度的調(diào)節(jié)(張闊 等, 2016; Hajcak et al., 2010; Shapero et al., 2018)。目前針對(duì)抑郁個(gè)體傾向于選擇非適應(yīng)性策略的缺陷, 臨床心理學(xué)家們也提出了不少認(rèn)知治療方法, 其中, 認(rèn)知行為療法(Cognitive Behavior Therapy, CBT)是最常用的方法, 此法對(duì)輕度抑郁具有較好的療效, 其治療的重點(diǎn)是識(shí)別和修改消極思想, 通過認(rèn)知重組和行為訓(xùn)練將功能失調(diào)的認(rèn)知轉(zhuǎn)變?yōu)楦哂羞m應(yīng)性的認(rèn)知(Spinhoven et al., 2018)。就核心理念而言, 認(rèn)知重評(píng)策略的訓(xùn)練與CBT具有異曲同工之處。基于情緒調(diào)節(jié)過程性和動(dòng)態(tài)性的特點(diǎn), 如果對(duì)抑郁癥患者提供認(rèn)知重評(píng)的指導(dǎo)訓(xùn)練, 即指導(dǎo)抑郁癥患者在策略的選擇階段選擇適應(yīng)性策略調(diào)節(jié)自身情緒, 將幫助他們更有效地識(shí)別負(fù)性想法和信念, 改善其對(duì)負(fù)性事件的反應(yīng)和評(píng)價(jià), 從而提高其情緒調(diào)節(jié)的效果和環(huán)境適應(yīng)能力。另外, 已有研究表明, 認(rèn)知重評(píng)的指導(dǎo)性干預(yù)也可以減弱兒童和青少年的負(fù)性情緒體驗(yàn)(劉文 等, 2020)。因此, 未來(lái)研究可以通過使用認(rèn)知重評(píng)策略的指導(dǎo)性干預(yù), 探究其對(duì)青少年情緒調(diào)節(jié)的影響程度, 為今后的干預(yù)提供新思路。
參考文獻(xiàn)
程利, 袁加錦, 何媛媛, 李紅. (2009). 情緒調(diào)節(jié)策略: 認(rèn)知重評(píng)優(yōu)于表達(dá)抑制. 心理科學(xué)進(jìn)展, 17(4), 730?735.
鄧欣媚. (2014). 青少年情緒調(diào)節(jié)增強(qiáng)調(diào)節(jié)與減弱調(diào)節(jié)的發(fā)展及其神經(jīng)機(jī)制 (碩士學(xué)士論文). 華東師范大學(xué), 上海.
韓冰雪, 賈麗萍, 朱國(guó)輝, 王苗苗, 盧國(guó)華. (2020). 不同狀態(tài)抑郁癥患者對(duì)情緒面孔的注意偏向. 中國(guó)健康心理學(xué)雜志, 28(6), 819?824.
何振宏, 張丹丹. (2018). 抑郁個(gè)體對(duì)社會(huì)反饋的加工: 研究現(xiàn)狀及存在問題. 心理科學(xué), 41(1), 237?243.
侯金芹, 陳祉妍. (2016). 青少年抑郁情緒的發(fā)展軌跡: 界定亞群組及其影響因素. 心理學(xué)報(bào), 48(8), 957?968.
黃徐姝, 羅躍嘉. (2010). 情緒調(diào)節(jié)方法的分類和效果. 中國(guó)臨床心理學(xué)雜志, 18(4), 526?529.
黃于飛, 史攀, 陳旭. (2022). 依戀對(duì)情緒調(diào)節(jié)過程的影響. 心理科學(xué)進(jìn)展, 30(1), 77?84.
李紅, 楊小光, 鄭文瑜, 王超. (2019). 抑郁傾向?qū)€(gè)體情緒調(diào)節(jié)目標(biāo)的影響——來(lái)自事件相關(guān)電位的證據(jù). 心理學(xué)報(bào), 51(6), 637?647.
劉和珺, 楊海波. (2019). 抑郁個(gè)體對(duì)情緒信息的注意偏向. 心理學(xué)通訊, 2(2), 116?123.
劉文, 張妮, 于增艷, 張靖宇, 車翰博. (2020). 情緒調(diào)節(jié)與兒童青少年心理健康關(guān)系的元分析. 中國(guó)臨床心理學(xué)雜志, 28(5), 1002?1008.
莫李澄, 郭田友, 張?jiān)垃帲?徐鋒, 張丹丹. (2021). 激活右腹外側(cè)前額葉提高抑郁癥患者對(duì)社會(huì)疼痛的情緒調(diào)節(jié)能力: 一項(xiàng)TMS研究. 心理學(xué)報(bào), 53(5), 494?504.
賽李陽(yáng). (2016). 青少年采用認(rèn)知重評(píng)策略調(diào)節(jié)積極情緒的行為及神經(jīng)機(jī)制 (博士學(xué)位論文). 華東師范大學(xué), 上海.
孫巖, 薄思雨, 呂嬌嬌. (2020). 認(rèn)知重評(píng)和表達(dá)抑制情緒調(diào)節(jié)策略的腦網(wǎng)絡(luò)分析: 來(lái)自EEG和ERP的證據(jù). 心理學(xué)報(bào), 52(1), 12?25.
王夢(mèng)陽(yáng). (2021). 青少年運(yùn)動(dòng)行為對(duì)抑郁傾向的影響: 基于動(dòng)機(jī)和主觀體驗(yàn)的中介效應(yīng). 體育與科學(xué), 42(6), 78? 85+110.
王曉霞, 蔣成剛, 李靜, 馮正直. (2015). 抑郁癥患者對(duì)正性情緒圖片增強(qiáng)和減弱認(rèn)知重評(píng)的fMRI研究. 中國(guó)臨床心理學(xué)雜志, 23(4), 615?620.
于騰旭, 劉文, 劉方. (2019). 基于強(qiáng)化學(xué)習(xí)視角的情緒調(diào)節(jié)研究及展望. 心理技術(shù)與應(yīng)用, 7(3), 183?192.
張闊, 王春梅, 王敬欣. (2016). 抑郁癥患者認(rèn)知重評(píng)和分心情緒調(diào)節(jié)的有效性: ERPs研究. 心理學(xué)探新, 36(3), 245?250.
張萍, 趙參參, 李鵬, 張文海, 魏青, 劉強(qiáng), 李紅. (2017). 青少年抑郁的心理影響因素及其神經(jīng)機(jī)制. 心理研究, 10(1), 78?83.
張少華, 桑標(biāo), 劉影, 潘婷婷. (2020). 不同抑郁癥狀青少年日常情緒調(diào)節(jié)策略使用的差異. 心理科學(xué), 43(6), 1296? 1303.
趙參參, 張萍, 張文海, 李紅. (2017). 青少年抑郁及其自動(dòng)情緒調(diào)節(jié)的研究概述. 心理科學(xué), 40(2), 415?420.
朱永澤, 毛偉賓, 王蕊. (2014). 負(fù)性偏向的神經(jīng)機(jī)制. 心理科學(xué)進(jìn)展, 22(9), 1393?1403.
Ahmed, S. P., Bittencourt-Hewitt, A., & Sebastian, C. L. (2015). Neurocognitive bases of emotion regulation development in adolescence. Developmental Cognitive Neuroscience, 15, 11?25.
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217?237.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5?) (5th ed.). American Psychiatric Publishing.
Ao, X., Mo, L., Wei, Z., Yu, W., Zhou, F., & Zhang, D. (2020). Negative bias during early attentional engagement in major depressive disorder as examined using a two- stage model: High sensitivity to sad but bluntness to happy cues. Frontiers in Human Neuroscience, 14, Article 593010. doi: 10.3389/fnhum.2020.593010
Beck, A. T. (2008). The evolution of the cognitive model of depression and its neurobiological correlates. American Journal of Psychiatry, 165(8), 969?977.
Beck, A. T., & Weishaar, M. E. (1989). Cognitive Therapy. In A. Freeman, K. M. Simon, L. E. Beutler, & H. Arkowitz (Eds.), Comprehensive handbook of cognitive therapy (pp. 21?36). Plenum Press.
Bylsma, L. M. (2020). Emotion context insensitivity in depression: Toward an integrated and contextualized approach. Psychophysiology, 58(2), e13715.
Bylsma, L. M., Morris, B. H., & Rottenberg, J. (2008). A meta-analysis of emotional reactivity in major depressive disorder. Clinical Psychology Review, 28(4), 676?691.
Casey, B. J., Duhoux, S., & Cohen, M. M. (2010). Adolescence: What do transmission, transition, and translation have to do with it? Neuron, 67(5), 749?760.
Crum, A. J., Jamieson, J. P., & Akinola, M. (2020). Optimizing stress: An integrated intervention for regulating stress responses. Emotion, 20(1), 120?125.
Delaney, P. F., Barden, E. P., Smith, W. G., & Wisco, B. E. (2020). What can directed forgetting tell us about clinical populations? Clinical Psychology Review, 82(2), Article 101926. doi: 10.1016/j.cpr.2020.101926
Dumontheil, I. (2014). Development of abstract thinking during childhood and adolescence: The role of rostrolateral prefrontal cortex. Developmental Cognitive Neuroscience, 10, 57?76.
Ehring, T., Tuschen-Caffier, B., Schnülle, J., Fischer, S., & Gross, J. J. (2010). Emotion regulation and vulnerability to depression: Spontaneous versus instructed use of emotion suppression and reappraisal. Emotion, 10(4), 563?572.
Etkin, A., Büchel, C., & Gross, J. J. (2015). The neural bases of emotion regulation. Nature Reviews Neuroscience, 16(11), 693?700.
Everaert, J., Bronstein, M. V., Castro, A. A., Cannon, T. D., & Joormann, J. (2020). When negative interpretations persist, positive emotions don't! Inflexible negative interpretations encourage depression and social anxiety by dampening positive emotions. Behaviour Research and Therapy, 124, Article 103510. doi: 10.1016/j.brat.2019.103510
Everaert, J., Podina, I. R., & Koster, E. H. W. (2017). A comprehensive meta-analysis of interpretation biases in depression. Clinical Psychology Review, 58, 33?48.
Genet, J. J., & Siemer, M. (2011). Flexible control in processing affective and non-affective material predicts individual differences in trait resilience. Cognition & Emotion, 25(2), 380?388.
Goldin, P. R., McRae, K., Ramel, W., & Gross, J. J. (2008). The neural bases of emotion regulation: Reappraisal and suppression of negative emotion. Biological Psychiatry, 63(6), 577?586.
Grol, M., & de Raedt, R. (2020). The link between resting heart rate variability and affective flexibility. Cognitive, Affective, & Behavioral Neuroscience, 20(4), 746?756.
Gross, J. J. (1998). Antecedent- and response-focused emotion regulation: Divergent consequences for experience, expression, and physiology. Journal of Personality and Social Psychology, 74(1), 224?237.
Gross, J. J. (2010). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39(3), 281?291.
Gross, J. J. (2015). Emotion regulation: Current status and future prospects. Psychological Inquiry, 26(1), 1?26.
Hajcak, G., MacNamara, A., & Olvet, D. M. (2010). Event- related potentials, emotion, and emotion regulation: An integrative review. Developmental Neuropsychology, 35(2), 129?155.
Hankin, B. L., Gibb, B. E., Abela, J. R. Z., & Flory, K. (2010). Selective attention to affective stimuli and clinical depression among youths: Role of anxiety and specificity of emotion. Journal of Abnormal Psychology, 119(3), 491?501.
Hayes, A. M., Yasinski, C., Barnes, J. B., & Bockting, C. L. H. (2015). Network destabilization and transition in depression: New methods for studying the dynamics of therapeutic change. Clinical Psychology Review, 41, 27?39.
He, Z., Liu, Z., Zhao, J., Elliott, R., & Zhang, D. (2020). Improving emotion regulation of social exclusion in depression-prone individuals: A tDCS study targeting right VLPFC. Psychological Medicine, 50(16), 2768?2779.
Heilman, R. M., & Miclea, M. (2015). The contributions of declarative knowledge and emotion regulation in the Iowa gambling task. Cognition, Brain, Behavior, 19(1), 35?53.
Holt, R. J., Graham, J. M., Whitaker, K. J., Hagan, C. C., Ooi, C., Wilkinson, P. O., ... Suckling, J. (2016). Functional MRI of emotional memory in adolescent depression. Developmental Cognitive Neuroscience, 19, 31?41.
Hughes, D. J., Kratsiotis, I. K., Niven, K., & Holman, D. (2020). Personality traits and emotion regulation: A targeted review and recommendations. Emotion, 20(1), 63?67.
Jankowski, K. F., Batres, J., Scott, H., Smyda, G., Pfeifer, J. H., & Quevedo, K. (2018). Feeling left out: Depressed adolescents may atypically recruit emotional salience and regulation networks during social exclusion. Social Cognitive & Affective Neuroscience, 13(8), 863?876.
Judd, L. L., Rapaport, M. H., Paulus, M. P., & Brown, J. L. (1994). Subsyndromal symptomatic depression: A new mood disorder? The Journal of Clinical Psychiatry, 55(Suppl. 4), 18?28.
Klein, A. M., de Voogd, L., Wiers, R. W., & Salemink, E. (2018). Biases in attention and interpretation in adolescents with varying levels of anxiety and depression. Cognition & Emotion, 32(7), 1478?1486.
Krompinger, J. W., Moser, J. S., & Simons, R. F. (2008). Modulations of the electrophysiological response to pleasant stimuli by cognitive reappraisal. Emotion, 8(1), 132?137.
Kross, E., & Ayduk, O. (2011). Making meaning out of negative experiences by self-distancing. Current Directions in Psychological Science, 20(3), 187?191.
Langeslag, S. J. E., & van Strien, J. W. (2010). Comparable modulation of the late positive potential by emotion regulation in younger and older adults. Journal of Psychophysiology, 24(3), 186?197.
Levens, S. M., & Gotlib, I. H. (2010). Updating positive and negative stimuli in working memory in depression. Journal of Experimental Psychology: General, 139(4), 654?664.
Lincoln, T. M., Schulze, L., & Renneberg, B. (2022). The role of emotion regulation in the characterization, development and treatment of psychopathology. Nature Reviews Psychology, 1, 272?286.
Malooly, A. M., Genet, J. J., & Siemer, M. (2013). Individual differences in reappraisal effectiveness: The role of affective flexibility. Emotion, 13(2), 302?313.
Mathews, A., & MacLeod, C. (2005). Cognitive vulnerability to emotional disorders. Annual Review of Clinical Psychology, 1(1), 167?195.
McRae, K., Ciesielski, B., & Gross, J. J. (2012). Unpacking cognitive reappraisal: Goals, tactics, and outcomes. Emotion, 12(2), 250?255.
McRae, K., & Gross, J. J. (2020). Emotion regulation. Emotion, 20(1), 1?9.
Meiran, N. (2010). Task switching: Mechanisms underlying rigid vs. flexible self-control. In R. R. Hassin, K. N. Ochsner, & Y. Trope (Eds.), Self control in society, mind, and brain (pp. 202?220). Oxford University Press.
Milders, M., Bell, S., Platt, J., Serrano, R., & Runcie, O. (2010). Stable expression recognition abnormalities in unipolar depression. Psychiatry Research, 179(1), 38?42.
Murphy, J. W., & Young, M. A. (2020). Monitoring processes in extended emotion regulation. Cognition & Emotion, 34(5), 1059?1067.
Nesse, R. M. (2000). Is depression an adaptation? Archives of General Psychiatry, 57(1), 14?20.
Ochsner, K. N., & Gross, J. J. (2007). The neural architecture of emotion regulation. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 87?109). The Guilford Press.
Ochsner, K. N., & Gross, J. J. (2008). Cognitive emotion regulation: Insights from social cognitive and affective neuroscience. Current Directions in Psychological Science, 17(2), 153?158.
Ochsner, K. N., Silvers, J. A., & Buhle, J. T. (2015). Functional imaging studies of emotion regulation: A synthetic review and evolving model of the cognitive control of emotion. Annals of the New York Academy of Sciences, 1251(1), E1?E24.
Orchard, F., Pass, L., & Reynolds, S. (2016). ‘It was all my fault: Negative interpretation bias in depressed adolescents. Journal of Abnormal Child Psychology, 44(5), 991?998.
Platt, B., Kadosh, K. C., & Lau, J. Y. F. (2013). The role of peer rejection in adolescent depression. Depression & Anxiety, 30(9), 809?821.
Platt, B., Waters, A. M., Schulte-Koerne, G., Engelmann, L., & Salemink, E. (2017). A review of cognitive biases in youth depression: Attention, interpretation and memory. Cognition & Emotion, 31(3), 462?483.
Ratcliff, R., Smith, P. L., Brown, S. D., & McKoon, G. (2016). Diffusion decision model: Current issues and history. Trends in Cognitive Sciences, 20(4), 260?281.
Rottenberg, J., Gross, J. J., & Gotlib, I. H. (2005). Emotion context insensitivity in major depressive disorder. Journal of Abnormal Psychology, 114(4), 627?639.
Sawyer, S. M., Afifi, R. A., Bearinger, L. H., Blakemore, S.-J., Dick, B., Ezeh, A. C., & Patton, G. C. (2012). Adolescence: A foundation for future health. The Lancet, 379(9826), 1630?1640.
Sch?fer, J. ?., Naumann, E., Holmes, E. A., Tuschen-Caffier, B., & Samson, A. C. (2017). Emotion regulation strategies in depressive and anxiety symptoms in youth: A meta- analytic review. Journal of Youth and Adolescence, 46(2), 261?276.
Schnabel, K., Petzke, T. M., & Witth?ft, M. (2022). The emotion regulation process in somatic symptom disorders and related conditions: A systematic narrative review. Clinical Psychology Review, 97, 102196.
Seo, H., & Oemisch, M. (2020). Decoding emotion: The amygdala-prefrontal cortex pathway for emotion regulation of children. Biological Psychiatry, 88(7), 517?519.
Shapero, B. G., Stange, J. P., McArthur, B. A., Abramson, L. Y., & Alloy, L. B. (2018). Cognitive reappraisal attenuates the association between depressive symptoms and emotional response to stress during adolescence. Cognition & Emotion, 33(3), 524?535.
Sheppes, G., Suri, G., & Gross, J. J. (2015). Emotion regulation and psychopathology. Annual Review of Clinical Psychology, 11(1), 379?405.
Smith, E. M., Reynolds, S., Orchard, F., Whalley, H. C., & Chan, S. W. Y. (2018). Cognitive biases predict symptoms of depression, anxiety and wellbeing above and beyond neuroticism in adolescence. Journal of Affective Disorders, 241, 446?453.
Somerville, L. H., & Casey, B. J. (2010). Developmental neurobiology of cognitive control and motivational systems. Current Opinion in Neurobiology, 20(2), 236?241.
Spinhoven, P., Klein, N., Kennis, M., Cramer, A. O. J., Siegle, G., Cuijpers, P., ... Bockting, C. L. (2018). The effects of cognitive-behavior therapy for depression on repetitive negative thinking: A meta-analysis. Behaviour Research and Therapy, 106, 71?85.
Stretton, J., Walsh, N. D., Mobbs, D., Schweizer, S., van Harmelen, A.-L., Lombardo, M., ... Dalgleish, T. (2021). How biopsychosocial depressive risk shapes behavioral and neural responses to social evaluation in adolescence. Brain and Behavior, 11(5), Article e02005. doi: 10.1002/ brb3.2005
Timbremont, B., Braet, C., Bosmans, G., & van Vlierberghe, L. (2008). Cognitive biases in depressed and non-depressed referred youth. Clinical Psychology & Psychotherapy, 15(5), 329?339.
Van Kleef, R. S., Marsman, J.-B. C., van Valen, E., Bockting, C. L. H, Aleman, A., & van Tol, M.-J. (2022). Neural basis of positive and negative emotion regulation in remitted depression. NeuroImage: Clinical, 34, 102988.
Warren, S. L., Zhang, Y., Duberg, K., Mistry, P., Cai, W., Qin, S., ... Menon, V. (2020). Anxiety and stress alter decision- making dynamics and causal amygdala-dorsolateral prefrontal cortex circuits during emotion regulation in children. Biological Psychiatry, 88(7), 576?586.
Waters, S. F., & Thompson, R. A. (2014). Children's perceptions of the effectiveness of strategies for regulating anger and sadness. International Journal of Behavioral Development, 38(2), 174?181.
Westen, D., & Blagov, P. S. (2007). A clinical-empirical model of emotion regulation: From defense and motivated reasoning to emotional constraint satisfaction. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 373? 392). The Guilford Press.
Williams, I. A., Levita, L., & Reuber, M. (2018). Emotion dysregulation in patients with psychogenic nonepileptic seizures: A systematic review based on the extended process model. Epilepsy & Behavior, 86, 37?48.
Yamamoto, T., & Shimada, H. (2012). Cognitive dysfunctions after recovery from major depressive episodes. Applied Neuropsychology Adult, 19(3), 183?191.
“A continuous process” and “three stages”: An analysis of the etiology
of emotional dysregulation in depressed adolescents
ZHAN Ziwei1, WANG Mengmeng2, SUO Tao1, JIANG Yanju1
(1 Faculty of Education, Henan University, Kaifeng 475004, China)
(2 School of Business, NingboTech University, Ningbo 315100, China)
Abstract: Currently, depression is increasingly prevalent among children and adolescents, thereby raising concerns about emotional dysregulation in this population. The pivotal role of emotional regulation ability in maintaining emotional stability and effectively managing one's emotional state during adolescence is becoming more apparent. Understanding the dynamic nature of emotion regulation and its multi-stage processing is crucial for comprehensively elucidating the characteristics and causes of emotional dysregulation in depressed adolescents. To capture the dynamic nature of emotion regulation, the extended process model divides the emotion regulation process into three stages: identification stage, selection stage, and implementation stage, highlighting their mutual influence. Building upon this model, our study examines the characteristics of depressed adolescents across these three stages of emotion regulation, revealing deficiencies within each stage. Given the interconnectedness and continuity between these stages, future research can systematically investigate which specific impairments or disruptions in emotional dysregulation affect subsequent stages among depressed adolescents; to what extent they do so; and whether directive interventions can mitigate such effects. To achieve this goal more comprehensively, we propose employing the following methods: 1) integrating EEG technology with drift diffusion models to reconstruct the dynamic process of emotion regulation; 2) conducting a comprehensive investigation on individuals with varying degrees of depressive symptoms during adolescence; 3) focusing on dual aspects of abnormal emotional reactivity to explore intervention pathways and measures targeting emotional dysregulation in depressed adolescents.
Keywords: depression, emotion regulation, adolescents, the extended process model