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본 연구는 사회불안 경향의 대학생을 대상으로 주의편향 수정훈련을 실시하고, 피드백 제공 여부에 따라 주의편향의 수정 및 사회불안 증상 개선 효과를 비교하였다. 사회불안 경향의 대학생 45명을 선발하여 피드백을 포함한 주의편향 수정훈련(ABM-F)집단(n=14), 피드백을 포함하지 않은 주의편향 수정훈련 (ABM-N)집단(n=15), 통제집단(n=14)에 할당하였다. 주의편향 수정의 효과는 주의편향점수(ABS)와 사회불안, 우울 수준의 변화를 통해 확인하였다. 훈련은 총 4회로 구성되었으며, ABM-F집단은 주의편향 수정훈련에서 피드백을 제공받았으며, ABM-N집단은 피드백을 포함하지 않았다. 그 결과 주의편향 수정훈련 집단은 통제집단에 비해 사회적 상호작용 불안, 사회적 회피 및 불편감, 부정적 평가에 대한 두려움이 유의하게 감소되었다. 이는 주의편향 수정훈련이 사회불안 증상 감소에 효과적이라는 것을 시사한다. 반면 주의편향 점수와 우울 점수에서는 ABM-F집단만이 유의미한 감소를 나타내었다. 이는 주의편향 수정훈련에서 피드백을 포함하는 것이 피드백을 포함하지 않는 것보다 효과적일 수 있음을 시사한다. 마지막으로 본 연구의 시사점과 제한점에 대해 논의하였다.

본 연구는 사회불안 경향 대학생들을 대상으로 심상재구성 훈련의 효과를 알아보고자 하였다. 이를 위해, 사회불안 수준이 높은 37명의 대학생을 선발하여 심상재구성 단독 집단, 인지재구성이 포함된 심상재구성 집단, 통제집단 중 하나에 무선할당 하였고, 훈련 집단은 각기 총 3회의 훈련이 실시되었다. 연구결과, 훈련을 실시한 두 집단은 통제집단과 비교하여 사회불안, 사후반추사고, 부정적 평가에 대한 두려움의 유의한 감소를 보였다. 두 훈련 집단 간 효과를 비교한 결과, 두 집단 모두 사전에 비해 사후에 부정심상의 선명함, 고통, 믿음, 빈도 수준의 감소를 보였다. 그러나 심상재구성 단독 집단의 경우 3회의 훈련 기간에 걸쳐 뚜렷한 감소 경향성이 나타났지만, 인지재구성이 포함된 심상재구성 집단은 인지재구성 시행 회기 이후 원 점수로 되돌아갔다. 이러한 결과는 심상재구성 훈련이 사회불안 경향이 있는 대학생의 사회불안을 감소시키는데 효과적이며, 특히 심상재구성 단독 훈련은 부정적 자기 심상과 연관된 과거기억을 재구성시킴으로써 지속적으로 사회불안을 유발시키는 심상 및 기억의 감소에 더 효과적임을 시사한다. 마지막으로 본 연구의 시사점과 제한점에 대해 논의하였다.

Recently, psychopathology studies have focused on the high level of comorbidity between anxiety and depression and have begun searching for shared psychological mechanisms that exist between the diagnoses. In this study, we investigated the effects of maladaptive self-focused attention and rumination on social anxiety and depression as common factors. To test this, we examined maladaptive self-focused attention, rumination, social anxiety, and depression among 531 undergraduate students and analyzed these data through structural equation modeling. Major findings of the study were twofold. First, maladaptive self-focused attention and rumination showed a significant positive correlation with social anxiety and depression. Second, maladaptive self-focused attention affected social anxiety and depression directly but it also affected social anxiety and depression via rumination. The results of this study indicated that maladaptive self-focused attention and rumination are common risk factors for social anxiety and depression. Several implications of these results and limitations of the study are discussed.

본 연구는 대학생들을 대상으로 사회불안을 수행 불안과 상호작용 불안으로 세분화하여 우울에 미치는 영향을 확인하고, 사회불안과 우울의 관계에서 고통 감내력과 회피대처의 매개효과를 검증하고자 하였다. 이를 위해 경북지역 대학생 350명을 대상으로 수행 불안, 상호작용 불안, 우울, 고통 감내력, 회피대처 질문지를 실시하였다. 수집된 자료를 바탕으로 수행 불안 및 상호작용 불안이 우울에 미치는 영향에서 고통 감내력과 회피대처의 매개효과를 구조모형을 통해 분석하였다. 연구결과 첫째, 수행 불안, 상호작용 불안, 회피 대처 및 우울은 정적상관을 나타냈으며, 고통 감내력은 나머지 측정변인들과 부적상관을 나타냈다. 둘째, 구조방정식 분석 결과, 고통 감내력은 수행 및 상호작용 불안과 회피대처 사이를 부분 매개하는 것으로 나타났다. 또한, 회피대처가 우울에 미치는 직접적인 영향이 통계적으로 유의한 것으로 나타났다. 상호작용 불안은 고통 감내력과 회피대처를 매개로 우울에 간접적인 영향을 미치는 것으로 나타났으나, 수행 불안은 우울에 대한 간접효과가 통계적으로 유의하지 않은 것으로 나타났다. 이러한 연구결과를 바탕으로 상담의 실제 및 추후연구 방향에 대한 시사점을 논하였다.

Additional file 1: Table S1. Chemical airborne exposure-related lung function. Table S2. Comparison of characteristics and exposure index based on 4 lung function phenotype (FVC (A) and corrected DLco (B)) in HDLI survivors.

Analysis of various parameters in the novel tank test. (A, B) Number of entries to the middle or top zone of the tank. (C) Freezing duration. Duration of freezing time (seconds) was measured in every minute. KO zebrafish show reduced freezing behavior, compared to that of WT zebrafish. (D, E) Total distance moved (cm) and mean velocity (cm/s). No significant difference was detected between WT and KO fish. Number of fish used in this assay: n = 8 for WT fish, n = 8 for KO fish, respectively. Data are presented as mean ± SEM. * p

Number of transit movements of tester fish at each zone boundary. (A-C) 3 cases of each transit movements were analyzed: movement “I” to “II” (A), “II” to “III” (B), and “III” to “IV” zone (C). Number of tester fish used in this assay: n = 30 for WT and n = 30 for KO. Data are presented as mean ± SEM. * p

Number of transit movements of tester fish at each zone boundary. (A-C) 3 cases of each transit movements were analyzed: movement “I” to “II” (A), “II” to “III” (B), and “III” to “IV” zone (C). Number of tester fish used in this assay: n = 30 for WT and n = 30 for KO. Data are presented as mean ± SEM. * p

Schematic illustration of the social interaction assay with different separation materials. (A-F) Two kinds of materials were used for the separator: metal mesh (A, B, and E) and a clear acrylic plate (C, D, and F). (B, D) Changes of duration time for tester fish, when added to a different number of fish (1–5 fish) as the social cue group, was analyzed in 4 different zones between 6 and 10 min. Multiple trials (n = 5) were performed for each group size. (E, F) Detailed information for duration time for tester fish in different zones over the course of 15 min. Data are presented as mean ± SEM. (PDF 1033 kb)

Analysis of various parameters in social interaction assay. (A, B) Video tracking of WT and dyrk1aa KO zebrafish in the social interaction assay. Dashed lines indicate position of a separator and a transparent acrylic plate was used in this experiment. Red lines show tracking of swim movement of WT and KO zebrafish. Fish were tracked every minute for 15 min during the social interaction assay. In this experiment, 3 fish were used as the social cue group in left side and 1 tester fish in right side. (C-F) Duration time for WT and dyrk1aa KO zebrafish in each zone; very close zone “I” (C), close zone “II” (D), far zone “III” (E), and very far zone “IV” (F). (G, H) Total distance moved (cm) and mean velocity (cm/s) are no different in both WT and KO fish during the test. Data were collected from video tracking for 15 min and every minute was analyzed. Number of tester fish used in the assay: n = 30 for WT and n = 30 for KO. Data are presented as mean ± SEM. * p

Characterization of early neural development and larval behavioral tests in WT and dyrk1aa KO fish. (A-F) Whole-mount in situ hybridization analysis with various molecular markers at 24 hpf (A, B, lateral view) and 48 hpf (C-F, rostral dorsal view): sox2, neural stem cell marker; neurog1, neuronal determination marker; and cyclin D1, cell proliferation marker. Anterior is to the left. Number of fish used for the analysis: 1) after sox2 staining and photography, each embryo was genotyped for WT (5/19) and KO homozygote (3/19); 2) for neurog1, it was WT (6/16) and KO homozygote (4/16); and 3) for cyclin D1, WT (3/16) and KO homozygote (5/16), respectively. (G) Locomotion response to dark flashes in WT and dyrk1aa KO larvae at 6 dpf. Movement distance was measured by video tracking analysis (cm per every 10 s). With light-on in 30 s-intervals, zebrafish larvae showed a freezing response (yellow box in the graph). However, they showed a startle response to light-off dark condition (gray box). The number of fish used for this assay: n = 14 for WT (+/+), n = 25 for heterozygote (+/−), and n = 9 for KO homozygote (−/−). (H) Circadian rhythms in WT and dyrk1aa KO larvae between 5 and 7 dpf. Circadian rhythms of locomotor activity under LD (day-night) cycles were measured. Both WT and dyrk1aa KO larvae display a similar pattern of locomotor activity in daytime or nighttime. The number of fish used for this assay: n = 11 for control heterozygote (+/−), and n = 13 for KO homozygote (−/−). Data are presented as mean ± SEM. (PDF 1219 kb)

Social cohesion in different group sizes and water depths in the shoaling assay. (A) Schematic illustrations of the method to measure the distances between individual fish in the shoaling assay. Different numbers of fish were used as a group, ranging from 3 to 7. Social cohesion was represented as a mean distance of individual fish in the group. (B, C) Mean distance between individuals (cm) in a fish group represents the degree of social cohesion. The mean distance for social cohesion was analyzed in 2 different conditions; 1) different group sizes (B) and 2) water depths and volume (C). Number of trials for each experiment: n = 7. Data are presented as mean ± SEM. (PDF 1086 kb)

Comparison of brain size in WT and dyrk1aa KO fish. (A) Relative size of brain compartments in KO fish brain was shown as a ratio, compared to those in WT fish brain. Also, body length (cm) of WT and KO fish used for this analysis was constant. Tel, Telencephalon; TeO, Tectum Opticum; CCe, Corpus Cerebelli. Number of dissected brains: n = 13 for WT fish and n = 13 for KO fish. (B) Percent of TeV space in the total brain. Mean value for the TeV sizes was measured in relative sections of multiple brain samples. Number of fish used for this assay: n = 6 for WT fish and n = 5 for KO fish. Data are presented as mean ± SEM. * p

Comparison of brain size in WT and dyrk1aa KO fish. (A) Relative size of brain compartments in KO fish brain was shown as a ratio, compared to those in WT fish brain. Also, body length (cm) of WT and KO fish used for this analysis was constant. Tel, Telencephalon; TeO, Tectum Opticum; CCe, Corpus Cerebelli. Number of dissected brains: n = 13 for WT fish and n = 13 for KO fish. (B) Percent of TeV space in the total brain. Mean value for the TeV sizes was measured in relative sections of multiple brain samples. Number of fish used for this assay: n = 6 for WT fish and n = 5 for KO fish. Data are presented as mean ± SEM. * p

Presence of neuromodulator producing cells in the brain of WT and dyrk1aa KO zebrafish. (A-H) Expression of oxt, th, vglut2.2, and gad1b in the brain of WT and dyrk1aa KO zebrafish at adult stages. In situ hybridization revealed dyrk1aa KO fish show unchanged neuromodulator-producing cells in the brain. (A, B) oxt, oxytocinergic marker. (C, D) vglut2.2, glutamatergic marker. (E, F) th1, dopaminergic marker. (G, H) gad1b, GABAergic marker. Anterior to the top and ventral view. Scale bars: 0.2Â mm. (PDF 1051 kb)

Analysis of various parameters in the novel tank test. (A, B) Number of entries to the middle or top zone of the tank. (C) Freezing duration. Duration of freezing time (seconds) was measured in every minute. KO zebrafish show reduced freezing behavior, compared to that of WT zebrafish. (D, E) Total distance moved (cm) and mean velocity (cm/s). No significant difference was detected between WT and KO fish. Number of fish used in this assay: n = 8 for WT fish, n = 8 for KO fish, respectively. Data are presented as mean ± SEM. * p