| Based on the concerns of the popularity and severity of adjustment disorder (AD) among college freshmen, the insufficiency of clinical researches on AD, and the lack of objectivity in current college psychotherapy practices, the purpose of this research is to establish an effective model for diagnosis and intervention among college freshmen with AD.Study I:The screening study with the methods of the systematic review (SR), the interview, and the random controlled trial.Purpose:Based on the dimensions of stressors, vulnerabilities, and symptoms, develop an objective and effective tool for screening AD among college freshmenSteps:(1) The problems lying in the symptomatology diagnosis of AD were first analyzed.Then A SR was done to determine the stressors which college freshmen might have experienced and this work also provided an interview outline which focused on "individual needs".(2) 214 college freshmen took part in the focus group interview, among which 54 students were choosen as AD suspects and joined in the in-depth interview for the next round.37 AD individuals were selceted out through the interview by means of CCMD-3. By comparing the information from AD group with normal freshman group, specific descriptions which present the features of stressors of AD group were proposed and therefore a semi-structure screening scale for AD among college freshmen was invented.(3) An independent and blind diagnosis trial was conducted to test both reliability and validity of this scale. Results and conclusions:(1) Effective perspective of screening AD among college freshmen is to evaluate the adaption to change, including "the expectation to change has realized or not", "unexpected change has occurred or not", and"whether the sense of meaning is lost or not". From this perspective, coping strategies and their effects, as well as satisfaction could be interviewed. The vulnerabilities and symptoms should be evaluated through the observation and conversation process.(2) Effective points of screening AD among college freshmen involve interpersonal relationships, performance and achievement, life routines, and values. The interpersonal relationships include dorm relationships, classmate relationships, family relationships, romantic relationships, etc. The dependent level on relationships established before and after college entrance should be compared and evaluated. The ability to set goals and conduct the schedule is the basic consideration in appraising life routines and performance and achievement.(3) The semi-structure screening scale for AD among college freshmen has better inter-rater reliability and sensitivity to freshmen’s psychological problems than CCMD-3.StudyⅡ:The psychological intervention research for AD freshmen with the methods of SR and experiments.Purpose:Explore and test the efficiency of psychological intervention strategies for college freshmen with AD.Steps:(1) The common problems in clinical researches were reviewed, and the study was designed in an efficiency-improving manner. (2) An SR was conducted on AD psychological intervention experiments researches. On the basis of the SR results, intervention strategies were made. (3) Group intervention therapies were carried out, including three experimental groups with different psychotherapy programs and one matched group.Results and conclusions:(1) AD among freshmen has a mechanism of self-cure. The less severe the symtoms is, the faster the improvement is.(2) The intervention strategies from SR can enhance the improvement.(3) With the denfense of group members going down, the symptoms may deteriorate a little after the first session.(4) After intervention programs finished and great improvement has been made, fluctuations may occur and stay at an acceptable range.(5) Therapy alliance could lower down defense level of members and therefore produce more credible self-evaluated information.(6) Cognitive-behavioral therapy shows the best efficiency in curing AD and restraining the symptoms fluctuations.(7) Brief dynamic therapy shows the best effect in enhance mood symptoms.(8) Cognitive-behavioral strategies raise the ablitily more significantly of emotion regulation in both anxiety and depression.(9) The component of autogenic training and systematic desensitization could promote self-esteem higely efficiently.(10) Therapy relationship with high quality and frequent interpersonal fedback practices reduce social isolation experience in the largest scale.(11) Group therapies are effective to bring down social isolation experience of AD freshmen who come from peseant families.(12) Intervention strategies aimed on "raising emotion arousal level and improving emotion regulation" are especially effective to female AD freshmen.(13) To enhance the self-esteem level proves the best way of psychological intervention with AD freshmen who have economic difficulties. Points of innovation:(1) Testing and providing clinical data on the basis of the relevant proof collection and analysis under an evidence-based framwork is the first try in psychotherapy research field at board.(2) screening AD among college freshmen on the dimensions of stressors, vulnerabilities, and symptoms is an innovation and enlargement of diagnosis of AD under traditional one-dimension symptomatology conceptuation.(3) Broadening the design of independent and blind diagosis trial from medical research into the psychological disorder research can increase the objectivity of screening tools used for mental disorders.(4) Proposing an intervention guide for college freshmen with AD based on dividing intervention strategies into components, evaluating each component’s efficacy, and taking the populaton diversity into consideration, is a breakthrough of psychological intervention work in current college at board. |
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