Clair Cassiello-Robbins, Lorie A. Ritschel, Kirk D. Mochrie, Becca Edwards-Powell, Kathryn Byars
The advent of multiple transdiagnostic treatments in recent decades has advanced the field of clinical psychology while also raising questions for clinicians and patients about how to decide between treatments and how to best deliver a chosen treatment. The purpose of this paper is to review two prominent transdiagnostic treatments that target emotion dysregulation: dialectical behaviour therapy and the unified protocol for transdiagnostic treatment for emotional disorders. First, we review the theoretical underpinnings, research support and proposed mechanisms of action for these treatments. Next, we discuss patient and therapist variables that might indicate which treatment is more appropriate for a given patient and discuss decision-making guidelines to help make this determination with an emphasis on complex patients who may present with risk and/or clinical comorbidities. Finally, we discuss areas for future research that can help further ensure we work to match patients to the treatment that is most likely to benefit them.
{"title":"The Unified Protocol or Dialectical Behaviour Therapy? Considerations for Choosing Between Two Evidence-Based Transdiagnostic Psychotherapies for Complex Patients","authors":"Clair Cassiello-Robbins, Lorie A. Ritschel, Kirk D. Mochrie, Becca Edwards-Powell, Kathryn Byars","doi":"10.1002/cpp.3051","DOIUrl":"10.1002/cpp.3051","url":null,"abstract":"<div>\u0000 \u0000 <p>The advent of multiple transdiagnostic treatments in recent decades has advanced the field of clinical psychology while also raising questions for clinicians and patients about how to decide between treatments and how to best deliver a chosen treatment. The purpose of this paper is to review two prominent transdiagnostic treatments that target emotion dysregulation: dialectical behaviour therapy and the unified protocol for transdiagnostic treatment for emotional disorders. First, we review the theoretical underpinnings, research support and proposed mechanisms of action for these treatments. Next, we discuss patient and therapist variables that might indicate which treatment is more appropriate for a given patient and discuss decision-making guidelines to help make this determination with an emphasis on complex patients who may present with risk and/or clinical comorbidities. Finally, we discuss areas for future research that can help further ensure we work to match patients to the treatment that is most likely to benefit them.</p>\u0000 </div>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mehdi Akbari, Mohammad Seydavi, Elahe Zamani, Shiva Jamshidi, Mark H. Freeston
<div> <section> <h3> Background</h3> <p>Intolerance of uncertainty (IU) is widely accepted as a transdiagnostic vulnerability factor for a range of mental health problems. It is considered a transsituational vulnerability factor associated with a range of responses to different stressful life situations. The aim of this systematic review and meta-analysis is to examine the association between IU and specific psychological responses to the COVID-19 pandemic and the moderators of this relationship drawn from IU research and other studies on COVID-19.</p> </section> <section> <h3> Method</h3> <p>The studies included were as follows: (i) English-language articles published in peer-reviewed journals or thesis/dissertations; (ii) reporting specific psychological impacts of COVID-19; (c) reporting IU; (iii) case-control studies, prospective cohort studies, experimental studies and cross-sectional studies of large populations and (iv) reporting correlation coefficients between the variables of interest. Studies on participants with a diagnosis of neurological and/or organic impairment were excluded. The databases searched were Google Scholar, PubMed, ScienceDirect, and ProQuest, up until 31 December 2022. The risk of bias was assessed using the Risk of Bias Utilized for Surveys Tool (ROBUST, Nudelman et al., 2020). Sensitivity analysis was conducted using the one-study remove method, and studentized residuals and Cook's distance were examined. A random effects model was used.</p> </section> <section> <h3> Results</h3> <p>We examined the association between IU and COVID-19-related psychological impacts across 85 studies from 22 countries (<i>N</i> = 69,997; 64.95% female; mean sample age, 32.90 ± 9.70). There was no evidence of publication bias. We found a medium and positive association between IU and COVID-19-related psychological impacts (<i>N</i> = 69,562, <i>r</i> = 0.35, <i>k</i> = 89, 95% CI [0.32, 0.37]), which was independent of the IU measure used or whether the psychological impact was measured in relation to the virus alone or broader aspects of the pandemic. It was also independent of severity, publication year, sample type and size, study quality, age and sample levels of anxiety, depressive symptoms, stress, mental well-being and social support. However, the observed association varied significantly between countries and country income levels (stronger among low-incomes) and across genders (stronger among males) and was stronger for measures with greater reliability and more items, but lower among samples with more people who had been exposed to COVID-19.</p> </section> <section> <h3> Conclusions</h3> <p>The findings support
背景：对不确定性的不容忍（IU）被广泛认为是一系列心理健康问题的跨诊断易感因素。它被认为是一种与对不同生活压力情境的一系列反应相关的跨情境易感因素。本系统综述和荟萃分析旨在研究 IU 与 COVID-19 大流行的特定心理反应之间的关系，以及从 IU 研究和 COVID-19 的其他研究中得出的这种关系的调节因素：纳入的研究如下(i) 在同行评审期刊上发表的英文文章或论文/学位论文；(ii) 报告 COVID-19 带来的具体心理影响；(c) 报告 IU；(iii) 大量人群的病例对照研究、前瞻性队列研究、实验研究和横断面研究；(iv) 报告相关变量之间的相关系数。不包括对被诊断患有神经和/或器质性损伤的参与者进行的研究。搜索的数据库包括谷歌学术、PubMed、ScienceDirect 和 ProQuest，截止日期为 2022 年 12 月 31 日。使用 "调查偏倚风险工具"（ROBUST，Nudelman 等人，2020 年）对偏倚风险进行了评估。使用剔除一项研究的方法进行了敏感性分析，并检查了学生化残差和库克距离。采用随机效应模型：我们研究了 22 个国家 85 项研究中 IU 与 COVID-19 相关心理影响之间的关系（N = 69,997; 64.95% 为女性；平均样本年龄为 32.90 ± 9.70）。没有证据表明存在发表偏差。我们发现，IU 与 COVID-19 相关心理影响之间存在中等程度的正相关（N = 69,562, r = 0.35, k = 89, 95% CI [0.32, 0.37]），这与所使用的 IU 测量方法无关，也与心理影响是仅针对病毒还是针对大流行的更广泛方面进行测量无关。它也与严重程度、发表年份、样本类型和规模、研究质量、年龄以及样本的焦虑、抑郁症状、压力、心理健康和社会支持水平无关。然而，所观察到的关联性在不同国家和国家收入水平（低收入者更强）以及不同性别（男性更强）之间存在显著差异，可靠性更高和项目更多的测量指标的关联性更强，但在有更多人接触过 COVID-19 的样本中关联性较低：结论：研究结果表明，IU 是一种与大流行期间的认知、行为和痛苦反应有关的高阶跨情境脆弱性因素。研究的局限性包括：资料来源仅限于英语，依赖于使用新系统编码的多种测量方法，以及不同研究之间存在不同的偏倚风险。研究考虑了全球范围内重大情景压力因素心理后果管理方面的影响，但国家和社会经济层面的差异也对地区或社区层面的不同或局部压力因素产生了影响。
{"title":"Intolerance of Uncertainty as a Situational Vulnerability Factor in the Context of the Pandemic: A Systematic Review and Meta-Analysis of COVID-19-Related Psychological Impacts","authors":"Mehdi Akbari, Mohammad Seydavi, Elahe Zamani, Shiva Jamshidi, Mark H. Freeston","doi":"10.1002/cpp.3046","DOIUrl":"10.1002/cpp.3046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Intolerance of uncertainty (IU) is widely accepted as a transdiagnostic vulnerability factor for a range of mental health problems. It is considered a transsituational vulnerability factor associated with a range of responses to different stressful life situations. The aim of this systematic review and meta-analysis is to examine the association between IU and specific psychological responses to the COVID-19 pandemic and the moderators of this relationship drawn from IU research and other studies on COVID-19.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>The studies included were as follows: (i) English-language articles published in peer-reviewed journals or thesis/dissertations; (ii) reporting specific psychological impacts of COVID-19; (c) reporting IU; (iii) case-control studies, prospective cohort studies, experimental studies and cross-sectional studies of large populations and (iv) reporting correlation coefficients between the variables of interest. Studies on participants with a diagnosis of neurological and/or organic impairment were excluded. The databases searched were Google Scholar, PubMed, ScienceDirect, and ProQuest, up until 31 December 2022. The risk of bias was assessed using the Risk of Bias Utilized for Surveys Tool (ROBUST, Nudelman et al., 2020). Sensitivity analysis was conducted using the one-study remove method, and studentized residuals and Cook's distance were examined. A random effects model was used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We examined the association between IU and COVID-19-related psychological impacts across 85 studies from 22 countries (<i>N</i> = 69,997; 64.95% female; mean sample age, 32.90 ± 9.70). There was no evidence of publication bias. We found a medium and positive association between IU and COVID-19-related psychological impacts (<i>N</i> = 69,562, <i>r</i> = 0.35, <i>k</i> = 89, 95% CI [0.32, 0.37]), which was independent of the IU measure used or whether the psychological impact was measured in relation to the virus alone or broader aspects of the pandemic. It was also independent of severity, publication year, sample type and size, study quality, age and sample levels of anxiety, depressive symptoms, stress, mental well-being and social support. However, the observed association varied significantly between countries and country income levels (stronger among low-incomes) and across genders (stronger among males) and was stronger for measures with greater reliability and more items, but lower among samples with more people who had been exposed to COVID-19.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings support","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
According to the self-medication hypothesis, worriers use substances to cope with their symptoms; however, some published results have challenged this hypothesis. The aim of this study is to show if worry increases the risk of SUD when it is negatively appraised by negative metacognitive beliefs.
Method
We recruited three samples: 68 patients with a severe AUD, 27 patients dependent on eating and 42 control participants. We used the Yale Food Addiction Scale-2, the Metacognitions Questionnaire-65, the UPPS-P Impulsive Behaviour Scale and the Anxiety Thoughts Inventory.
Results
We confirmed a direct effect of worries and metaworry on alcohol (AUD) and eating addiction (EA), but our multivariate analyses revealed that metacognitive beliefs and metaworry are the most robust predictors of alcohol and eating addiction.
Discussion
We reported substance-related differences in the relationship between worry and addiction. AUD is related to the metacognitive activity set in motion by worries while EA is associated with a maladaptive form of worry (meta-worry) where worries are negatively interpreted.
{"title":"Role of Worry in Addiction: Implication of Metacognitive Beliefs and Type 2 Worry","authors":"Priscillia Improvisato, Raphaël Trouillet, Sophie Schuldiner, Amandine Luquiens, Tristan Hamonnière, Hélène Donnadieu, Pascal Perney","doi":"10.1002/cpp.3048","DOIUrl":"https://doi.org/10.1002/cpp.3048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>According to the self-medication hypothesis, worriers use substances to cope with their symptoms; however, some published results have challenged this hypothesis. The aim of this study is to show if worry increases the risk of SUD when it is negatively appraised by negative metacognitive beliefs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We recruited three samples: 68 patients with a severe AUD, 27 patients dependent on eating and 42 control participants. We used the Yale Food Addiction Scale-2, the Metacognitions Questionnaire-65, the UPPS-P Impulsive Behaviour Scale and the Anxiety Thoughts Inventory.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We confirmed a direct effect of worries and metaworry on alcohol (AUD) and eating addiction (EA), but our multivariate analyses revealed that metacognitive beliefs and metaworry are the most robust predictors of alcohol and eating addiction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>We reported substance-related differences in the relationship between worry and addiction. AUD is related to the metacognitive activity set in motion by worries while EA is associated with a maladaptive form of worry (meta-worry) where worries are negatively interpreted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cpp.3048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142099994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Previous reviews have examined empirical evidence of the relationship between therapists' internalized relational models, including therapists' attachment styles and Sullivan's notion of introject, and the therapeutic relationship. This review expands upon previous reviews by examining the effect of therapists' internalized relational models on the treatment process (e.g., therapeutic alliance and countertransference) and treatment outcomes (e.g., symptoms and functioning) more broadly. Our systematic search identified 42 empirical studies measuring therapist's internalized relational models, defined as therapist attachment style (i.e., the way the therapist relates to others) and/or introject (i.e., the way the therapist relates to themselves), in relation to therapy process and outcome, including 35 studies on attachment, nine studies on introject and two that examined both constructs. A rigorous quality assessment was conducted; two studies were rated as ‘moderate’, and 40 were rated as ‘weak’ in quality. Based on the study findings, it appears that more securely attached therapists may have stronger working alliances and more positive therapeutic processes with their patients. Contrary to expectations, therapist attachment security does not appear to impact treatment outcomes. Therapists who relate to themselves in a more affirming way may have stronger working alliances and better treatment outcomes, but very few studies have addressed this question thus far. More rigorous research, especially on the effect of therapists' introject, is needed. Therapists may consider the potential impact of their internalized relational models on the working alliance and other treatment processes that influence therapeutic outcomes.
{"title":"The Role of Therapists' Attachment and Introject in Their Treatment Process and Outcome: A Systematic Review","authors":"Sarah J. Horne, Siyu Liu, Katie Aafjes-van Doorn","doi":"10.1002/cpp.3043","DOIUrl":"https://doi.org/10.1002/cpp.3043","url":null,"abstract":"<div>\u0000 \u0000 <p>Previous reviews have examined empirical evidence of the relationship between therapists' internalized relational models, including therapists' attachment styles and Sullivan's notion of introject, and the therapeutic relationship. This review expands upon previous reviews by examining the effect of therapists' internalized relational models on the treatment process (e.g., therapeutic alliance and countertransference) and treatment outcomes (e.g., symptoms and functioning) more broadly. Our systematic search identified 42 empirical studies measuring therapist's internalized relational models, defined as therapist attachment style (i.e., the way the therapist relates to others) and/or introject (i.e., the way the therapist relates to themselves), in relation to therapy process and outcome, including 35 studies on attachment, nine studies on introject and two that examined both constructs. A rigorous quality assessment was conducted; two studies were rated as ‘moderate’, and 40 were rated as ‘weak’ in quality. Based on the study findings, it appears that more securely attached therapists may have stronger working alliances and more positive therapeutic processes with their patients. Contrary to expectations, therapist attachment security does not appear to impact treatment outcomes. Therapists who relate to themselves in a more affirming way may have stronger working alliances and better treatment outcomes, but very few studies have addressed this question thus far. More rigorous research, especially on the effect of therapists' introject, is needed. Therapists may consider the potential impact of their internalized relational models on the working alliance and other treatment processes that influence therapeutic outcomes.</p>\u0000 </div>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142099999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chris Hoeboer, Laura Wienen, Mary Smiddy, Steven van der Werff, Marija Maric, Edith Tjoa, Lucie Timmers, Maartje Schoorl
Background
Narrative exposure therapy (NET) has shown promising outcomes for treating posttraumatic stress disorder (PTSD) in refugees and veterans. Its effectiveness in patients with PTSD following childhood trauma is, however, still unknown.
Aims
We investigated whether NET is an effective treatment for patients with PTSD following childhood trauma.
Method
We studied treatment outcomes of nine adult patients in an outpatient setting. An AB single-case series design was used with a baseline of 4 weeks prior to treatment. Participants filled in weekly online questionnaires to assess their PTSD symptoms (using the Posttraumatic Diagnostic Scale [PDS]) and their experienced quality of life (using the Manchester Short Assessment of Quality of Life [MANSA]). Data were analysed visually and using a mixed-effect model.
Results
Results revealed no significant reduction of PTSD symptoms during NET treatment, nor an increase in quality of life, as compared to baseline.
Conclusions
The results of our study do not underscore the effectiveness of NET treatment for patients with PTSD following childhood trauma. Further research is needed to study the effectiveness of NET in this population.
背景叙事暴露疗法（NET）在治疗难民和退伍军人的创伤后应激障碍（PTSD）方面取得了良好的效果。然而，它对童年创伤后应激障碍患者的治疗效果尚不清楚。 目的 我们研究了NET是否能有效治疗儿童创伤后应激障碍患者。 方法 我们研究了门诊环境中九名成年患者的治疗效果。采用 AB 单病例系列设计，治疗前 4 周为基线。参与者每周填写一次在线问卷，评估他们的创伤后应激障碍症状（使用创伤后诊断量表 [PDS]）和生活质量（使用曼彻斯特生活质量简短评估 [MANSA]）。采用混合效应模型对数据进行直观分析。 结果 结果显示，与基线相比，NET 治疗期间创伤后应激障碍症状没有明显减轻，生活质量也没有提高。 结论 我们的研究结果并没有强调 NET 治疗对儿童创伤后应激障碍患者的有效性。需要进一步研究NET对这一人群的有效性。
{"title":"Effectiveness of Narrative Exposure Therapy for Treatment of PTSD Following Childhood Trauma: A Single-Case Series Design","authors":"Chris Hoeboer, Laura Wienen, Mary Smiddy, Steven van der Werff, Marija Maric, Edith Tjoa, Lucie Timmers, Maartje Schoorl","doi":"10.1002/cpp.3044","DOIUrl":"https://doi.org/10.1002/cpp.3044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Narrative exposure therapy (NET) has shown promising outcomes for treating posttraumatic stress disorder (PTSD) in refugees and veterans. Its effectiveness in patients with PTSD following childhood trauma is, however, still unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We investigated whether NET is an effective treatment for patients with PTSD following childhood trauma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We studied treatment outcomes of nine adult patients in an outpatient setting. An AB single-case series design was used with a baseline of 4 weeks prior to treatment. Participants filled in weekly online questionnaires to assess their PTSD symptoms (using the Posttraumatic Diagnostic Scale [PDS]) and their experienced quality of life (using the Manchester Short Assessment of Quality of Life [MANSA]). Data were analysed visually and using a mixed-effect model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Results revealed no significant reduction of PTSD symptoms during NET treatment, nor an increase in quality of life, as compared to baseline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The results of our study do not underscore the effectiveness of NET treatment for patients with PTSD following childhood trauma. Further research is needed to study the effectiveness of NET in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cpp.3044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142099995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. C. van den Berg, E. ten Bloemendal, A. T. Hendrickson, M. Di Simplicio, M. Voncken, G. Aalbers, G. P. J. Keijsers
Introduction
Bipolar disorder is a severe mental health problem with limited treatment success. There is a call for improving interventions, requiring an increased understanding of factors driving mood instability. One promising avenue is to study temporal associations between factors that appear relevant according to the emotional amplifier model of Holmes are changes in mood, anxiety and mental imagery.
Methods
The current study used data from a recent RCT for a secondary analysis which applied a network analysis approach to explore temporal associations between weekly measurements of mania, depression, anxiety and mental imagery measured during 32 weeks in two randomised groups (N = 55) receiving either imagery-focused cognitive therapy (ImCT) or group psychoeducation (PE).
Results
Both negative intrusive mental imagery and anxiety appeared central in the network analyses, driving changes in both mania and depression, but only in the PE group. In the ImCT group, only anxiety was driving changes in mania and depression.
Conclusion
Although exploratory, findings suggest that prior increases in anxiety and negative intrusive mental imagery might be associated with subsequent increases in depression and mania symptoms in patients with bipolar disorder. Anxiety might in turn increase negative intrusive imagery and associated negative emotions. Although more research is needed, results are in line with the emotional amplifier model and stress that future interventions with a focus on anxiety and imagery might help to improve psychosocial therapies for patients with bipolar disorder. In addition, this study suggests that a network approach is a helpful and feasible way to study mood instability, anxiety and mental imagery to increase our understanding of mechanisms underpinning mood instability.
{"title":"Exploring Temporal Relationships Between Anxiety, Mood and Mental Imagery in Patients With Bipolar Disorder: A Network Analysis","authors":"K. C. van den Berg, E. ten Bloemendal, A. T. Hendrickson, M. Di Simplicio, M. Voncken, G. Aalbers, G. P. J. Keijsers","doi":"10.1002/cpp.3050","DOIUrl":"https://doi.org/10.1002/cpp.3050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Bipolar disorder is a severe mental health problem with limited treatment success. There is a call for improving interventions, requiring an increased understanding of factors driving mood instability. One promising avenue is to study temporal associations between factors that appear relevant according to the emotional amplifier model of Holmes are changes in mood, anxiety and mental imagery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The current study used data from a recent RCT for a secondary analysis which applied a network analysis approach to explore temporal associations between weekly measurements of mania, depression, anxiety and mental imagery measured during 32 weeks in two randomised groups (<i>N</i> = 55) receiving either imagery-focused cognitive therapy (ImCT) or group psychoeducation (PE).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both negative intrusive mental imagery and anxiety appeared central in the network analyses, driving changes in both mania and depression, but only in the PE group. In the ImCT group, only anxiety was driving changes in mania and depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although exploratory, findings suggest that prior increases in anxiety and negative intrusive mental imagery might be associated with subsequent increases in depression and mania symptoms in patients with bipolar disorder. Anxiety might in turn increase negative intrusive imagery and associated negative emotions. Although more research is needed, results are in line with the emotional amplifier model and stress that future interventions with a focus on anxiety and imagery might help to improve psychosocial therapies for patients with bipolar disorder. In addition, this study suggests that a network approach is a helpful and feasible way to study mood instability, anxiety and mental imagery to increase our understanding of mechanisms underpinning mood instability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cpp.3050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christina Madsen, Nina Reinholt, Mikkel Arendt, Anita Eskildsen, Anne Bryde, Morten Hvenegaard, Stig Poulsen, Sidse Arnfred
Introduction
In psychotherapy, having a reliable tracking tool is vital for effective treatment. We have validated the Danish version of the ‘Overall Depression Severity and Impairment Scale’ (ODSIS), which is used in the Unified Protocol for Emotional Disorders (UP) and other cognitive behavioural therapies. This five-item self-rating scale is expected to correspond closely to the gold-standard Beck Depression Inventory-II (BDI-II), but also to self-rating scales addressing daily functioning and well-being.
Methods
Internal consistency is assessed using Cronbach's alpha and McDonald's omega. Criterion validity is explored through Pearson's correlation coefficient with BDI-II, the Work and Social Adjustment Scale (WSAS), the Five-Item World Health Organization Well-Being Index (WHO-5) and scatter plots, and an optimal cut-off score is determined using a receiver operating characteristic curve. The study included 340 respondents: 234 from a recent clinical trial, 56 psychiatric patients from inpatient/outpatient units and 50 healthy volunteers.
Results
ODSIS demonstrates strong internal consistency (Cronbach's alpha: 0.887–0.956, McDonald's omega: 0.888–0.957). Correlations with BDI-II, WSAS and WHO-5 highlight its strong criterion validity (BDI-II: 0.847, WSAS: 0.751, WHO-5: 0.771). The optimal cut-off score (> 7.5) for detecting depression shows great sensitivity (0.862) and specificity (0.731).
Conclusion
The Danish version of ODSIS proves to be a reliable instrument for quantification of a combination of depression level and functional impairment from the symptoms. Its high correlation with established BDI-II makes it a brief and handy tool for repeated measurement in clinical and research settings.
{"title":"Validation of the Danish Version of the Overall Depression Severity and Impairment Scale (ODSIS): A Reliable Instrument for Assessing Depression Symptoms and Functional Impairment","authors":"Christina Madsen, Nina Reinholt, Mikkel Arendt, Anita Eskildsen, Anne Bryde, Morten Hvenegaard, Stig Poulsen, Sidse Arnfred","doi":"10.1002/cpp.3049","DOIUrl":"https://doi.org/10.1002/cpp.3049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In psychotherapy, having a reliable tracking tool is vital for effective treatment. We have validated the Danish version of the ‘Overall Depression Severity and Impairment Scale’ (ODSIS), which is used in the Unified Protocol for Emotional Disorders (UP) and other cognitive behavioural therapies. This five-item self-rating scale is expected to correspond closely to the gold-standard Beck Depression Inventory-II (BDI-II), but also to self-rating scales addressing daily functioning and well-being.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Internal consistency is assessed using Cronbach's alpha and McDonald's omega. Criterion validity is explored through Pearson's correlation coefficient with BDI-II, the Work and Social Adjustment Scale (WSAS), the Five-Item World Health Organization Well-Being Index (WHO-5) and scatter plots, and an optimal cut-off score is determined using a receiver operating characteristic curve. The study included 340 respondents: 234 from a recent clinical trial, 56 psychiatric patients from inpatient/outpatient units and 50 healthy volunteers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ODSIS demonstrates strong internal consistency (Cronbach's alpha: 0.887–0.956, McDonald's omega: 0.888–0.957). Correlations with BDI-II, WSAS and WHO-5 highlight its strong criterion validity (BDI-II: 0.847, WSAS: 0.751, WHO-5: 0.771). The optimal cut-off score (> 7.5) for detecting depression shows great sensitivity (0.862) and specificity (0.731).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The Danish version of ODSIS proves to be a reliable instrument for quantification of a combination of depression level and functional impairment from the symptoms. Its high correlation with established BDI-II makes it a brief and handy tool for repeated measurement in clinical and research settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cpp.3049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Banafsheh Mohajerin, Alireza Shamsi, Richard Howard
Background
Those with cooccurring antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are reported to be highly psychopathic and to represent a severe challenge to treatment efforts. In a sample of such individuals, the effects of two treatments, mentalization-based therapy (MBT) and the unified protocol (UP), were investigated on three outcomes: (i) the psychopathy trait domains of meanness, boldness and disinhibition proposed by the triarchic psychopathy model (TPM); (ii) antisocial and borderline symptom severity; and (iii) the severity of their common features including impulsivity, anger expression and self-harm.
Methods
Of 163 individuals with BPD + ASPD screened for eligibility, 55 were randomized to MBT treatment and 53 to UP treatment. Outcomes of treatment were assessed at 6-month intervals to 36 months.
Results
Short-term reductions were seen following both treatments in traits of psychopathy, antisocial and borderline personality symptom severity, anger dysregulation, impulsivity and self-harm, but both treatment groups showed almost complete relapse of symptoms at the 36-month follow-up. UP had more durable effects than MBT.
Conclusions
Despite being a considerably shorter treatment, UP was at least as effective as MBT and in some respects superior. Remission of symptoms was not achieved by either treatment in the long term. Psychopathy and borderline/antisocial comorbidity with which it is associated are to some extent remediable through psychotherapy, but only in the short term.
Clinical Implications
Patients with high levels of impulsivity and disinhibition are likely to relapse following psychotherapy and should be closely monitored after treatment.
{"title":"A Randomized Controlled Trial Comparing Mentalization-Based Therapy With the Unified Protocol in the Treatment of Psychopathy and Comorbid Borderline + Antisocial Personality Disorders","authors":"Banafsheh Mohajerin, Alireza Shamsi, Richard Howard","doi":"10.1002/cpp.3047","DOIUrl":"10.1002/cpp.3047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Those with cooccurring antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are reported to be highly psychopathic and to represent a severe challenge to treatment efforts. In a sample of such individuals, the effects of two treatments, mentalization-based therapy (MBT) and the unified protocol (UP), were investigated on three outcomes: (i) the psychopathy trait domains of meanness, boldness and disinhibition proposed by the triarchic psychopathy model (TPM); (ii) antisocial and borderline symptom severity; and (iii) the severity of their common features including impulsivity, anger expression and self-harm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Of 163 individuals with BPD + ASPD screened for eligibility, 55 were randomized to MBT treatment and 53 to UP treatment. Outcomes of treatment were assessed at 6-month intervals to 36 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Short-term reductions were seen following both treatments in traits of psychopathy, antisocial and borderline personality symptom severity, anger dysregulation, impulsivity and self-harm, but both treatment groups showed almost complete relapse of symptoms at the 36-month follow-up. UP had more durable effects than MBT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite being a considerably shorter treatment, UP was at least as effective as MBT and in some respects superior. Remission of symptoms was not achieved by either treatment in the long term. Psychopathy and borderline/antisocial comorbidity with which it is associated are to some extent remediable through psychotherapy, but only in the short term.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Implications</h3>\u0000 \u0000 <p>Patients with high levels of impulsivity and disinhibition are likely to relapse following psychotherapy and should be closely monitored after treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Impact Message Inventory-Circumplex (IMI-C) is a two-dimensional measure of patient-induced countertransference. Surprisingly, in a replication study of its circumplex structure, Hafkenscheid and Timmerman could retrieve a third dimension, in addition to the basic dimensions of Affiliation and Control. They tentatively interpreted this preliminary third dimension as representing ‘reactance’ (oppositional and uncooperative patient behaviours), with ‘active’ and ‘passive’ as polarities. This provisional interpretation was no more than plausible and was partly speculative. Therefore, a more systematic empirical approach to the meaning embedded in the third dimension is required. The present empirical study tests the hypothesis that the preliminary third dimension might represent aversiveness rather than reactance. A panel of IMI-C users (N = 100) independently judged all 56 items of the instrument in terms of the general (i.e., without taking a specific patient in mind) emotional undertone enclosed in the item formulations using a forced choice three point scale format: ‘positive emotional undertone’ (+), ‘neutral’ (o) and negative (aversive) undertone (−). Overall, IMI-C users appeared to evaluate the formulations of items constituting the preliminary third dimension as intrinsically more aversive (negative emotional connotation), compared to the group of IMI-C items not included in this preliminary third dimension. However, the original octants of the IMI-C could be discriminated in terms of aversiveness as well. Anyhow, clinical interpretations of IMI-C profiles may benefit from an examination of the aversiveness component, enclosed within the items and octants themselves, irrespective of the specific patients judged with the instrument.
{"title":"The Impact Message Inventory-Circumplex (IMI-C): Exploring the Aversiveness Component of Therapists' Covert Reactions to Patients' Interpersonal Communications","authors":"Anton Hafkenscheid","doi":"10.1002/cpp.3045","DOIUrl":"10.1002/cpp.3045","url":null,"abstract":"<p>The Impact Message Inventory-Circumplex (IMI-C) is a two-dimensional measure of patient-induced countertransference. Surprisingly, in a replication study of its circumplex structure, Hafkenscheid and Timmerman could retrieve a third dimension, in addition to the basic dimensions of Affiliation and Control. They tentatively interpreted this preliminary third dimension as representing ‘reactance’ (oppositional and uncooperative patient behaviours), with ‘active’ and ‘passive’ as polarities. This provisional interpretation was no more than plausible and was partly speculative. Therefore, a more systematic empirical approach to the meaning embedded in the third dimension is required. The present empirical study tests the hypothesis that the preliminary third dimension might represent aversiveness rather than reactance. A panel of IMI-C users (<i>N</i> = 100) independently judged all 56 items of the instrument in terms of the general (i.e., without taking a specific patient in mind) emotional undertone enclosed in the item formulations using a forced choice three point scale format: ‘positive emotional undertone’ (+), ‘neutral’ (o) and negative (aversive) undertone (−). Overall, IMI-C users appeared to evaluate the formulations of items constituting the preliminary third dimension as intrinsically more aversive (negative emotional connotation), compared to the group of IMI-C items not included in this preliminary third dimension. However, the original octants of the IMI-C could be discriminated in terms of aversiveness as well. Anyhow, clinical interpretations of IMI-C profiles may benefit from an examination of the aversiveness component, enclosed within the items and octants themselves, irrespective of the specific patients judged with the instrument.</p>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cpp.3045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marc Molendijk, Charlotte Baart, Jan Schaffeld, Zeynep Akçakaya, Charlotte Rönnau, Marike Kooistra, Rianne de Kleine, Celina Strater, Louise Mooshammer
Objective
The number of forced migrants has been rising for years. Many forced migrants suffer from post-traumatic stress disorder (PTSD), depression, and/or anxiety and need treatment. Here, we evaluate the effectiveness of psychological interventions (CBT, EMDR, expressive/art, mindfulness, mixed elements, NET and psychoeducation) in reducing symptoms of PTSD, depression, and anxiety in forced migrants.
Design and Data Sources
Systematic searches in PubMed and Web of Science and searches of preprint servers and grey literature were performed (final search date: 1 September 2023). Random-effects frequentist and Bayesian meta-analyses were used for data synthesis.
Results
We included 84 studies on treatment effects in adults (pooled N = 6302) and 32 on children and adolescents (pooled N = 1097). Our data show a reduction in symptoms of PTSD, depression and anxiety symptoms in both adults and child/adolescent forced migrants. Pooled pre- to post-treatment effects (effect size Cohen's d) ranged from −1.03 to −0.26 for PTSD, from −0.91 to −0.11 for depression and from −0.91 to −0.60 for anxiety, without there being differences in outcome per study design (i.e., RCT comparison vs. non-RCT comparison vs. single arm treatment study). Treatment effects remained evident over follow-up, and not a single type of treatment stood out as being superior to other treatment types. Structural differences in populations (e.g., regarding country of origin) over studies, however, could have hampered the validity of the comparisons between study characteristics such as treatment type.
Conclusion
Our findings support the effectiveness of psychological treatment in adult and child/adolescent forced migrants.
{"title":"Psychological Interventions for PTSD, Depression, and Anxiety in Child, Adolescent and Adult Forced Migrants: A Systematic Review and Frequentist and Bayesian Meta-Analyses","authors":"Marc Molendijk, Charlotte Baart, Jan Schaffeld, Zeynep Akçakaya, Charlotte Rönnau, Marike Kooistra, Rianne de Kleine, Celina Strater, Louise Mooshammer","doi":"10.1002/cpp.3042","DOIUrl":"https://doi.org/10.1002/cpp.3042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The number of forced migrants has been rising for years. Many forced migrants suffer from post-traumatic stress disorder (PTSD), depression, and/or anxiety and need treatment. Here, we evaluate the effectiveness of psychological interventions (CBT, EMDR, expressive/art, mindfulness, mixed elements, NET and psychoeducation) in reducing symptoms of PTSD, depression, and anxiety in forced migrants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Data Sources</h3>\u0000 \u0000 <p>Systematic searches in PubMed and Web of Science and searches of preprint servers and grey literature were performed (final search date: 1 September 2023). Random-effects frequentist and Bayesian meta-analyses were used for data synthesis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 84 studies on treatment effects in adults (pooled <i>N</i> = 6302) and 32 on children and adolescents (pooled <i>N</i> = 1097). Our data show a reduction in symptoms of PTSD, depression and anxiety symptoms in both adults and child/adolescent forced migrants. Pooled pre- to post-treatment effects (effect size Cohen's <i>d</i>) ranged from −1.03 to −0.26 for PTSD, from −0.91 to −0.11 for depression and from −0.91 to −0.60 for anxiety, without there being differences in outcome per study design (i.e., RCT comparison vs. non-RCT comparison vs. single arm treatment study). Treatment effects remained evident over follow-up, and not a single type of treatment stood out as being superior to other treatment types. Structural differences in populations (e.g., regarding country of origin) over studies, however, could have hampered the validity of the comparisons between study characteristics such as treatment type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings support the effectiveness of psychological treatment in adult and child/adolescent forced migrants.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cpp.3042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141994246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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