Clinical psychology & psychotherapy最新文献

The process-based approach assumes that transdiagnostic psychological processes are involved in the onset and maintenance of mental disorders. Case conceptualization is used to identify such psychological processes and to individualize the intervention accordingly. This approach is fundamentally different from syndrome-based approaches in which standardized treatments are administered for psychiatric diagnoses or symptoms. In the current case, we proposed a process-based conceptualization and treatment for a woman with concomitant problematic substance use and emotional symptoms. Our idiosyncratic process-based conceptualization showed that for this person, substance abuse consisted in a maladaptive coping strategy to deal with repetitive negative thinking and poor emotion regulation skills, for which we decided to use a mindfulness-based intervention. Treatment comprised 8 weeks of individually delivered mindfulness-based cognitive therapy sessions. A comprehensive assessment of psychiatric symptoms and psychological processes was conducted at baseline, post-intervention and 3-month follow-up. The post-treatment assessment revealed that psychological processes targeted by the intervention were improved, together with the mindfulness trait. At the symptom-based level, we observed a significant reduction in substance abuse and emotional symptoms. Treatment gains were maintained at follow-up. From a process-based perspective, this result implies that the intervention successfully targeted the psychological processes underlying the presenting symptoms. Adopting a process-based approach rather than symptom- or syndrome-based approaches is a valuable alternative in the conceptualization and treatment of complex cases presenting with multiple comorbidities.

Posttraumatic stress disorder (PTSD) is a significant issue for a substantial proportion of Australian ex-service personnel. In addition to the functional impact on individuals, PTSD can have a significant impact on intimate partner relationships. Research has demonstrated that practicing compassion and self-compassion may be an important component of psychological therapy for survivors of trauma, while also demonstrating benefits to intimate relationships. This pilot study aimed to investigate the utility of a Compassionate Mind Training intervention for ex-service personnel with PTSD and their partners. An uncontrolled, within-subjects, longitudinal design was utilized with assessment at pre-intervention, post-intervention and 3-month follow-up. Twenty-four participants attended 12 biweekly group sessions. Self-report measures of compassion, quality of life and psychological symptoms were administered at each time point. Findings demonstrated a significant reduction in fears of compassion and PTSD symptoms for ex-service personnel at 3-month follow-up and a reduction in depressive symptoms and increase in quality-of-life and social safeness at post-intervention. Additionally, significant reductions in anxiety, stress, external shame and self-criticism at 3-month follow-up were found, and couples reported significant increases in relationship satisfaction. Findings from this pilot study demonstrate promising outcomes, warranting further investigation in a larger randomized controlled trial of Compassionate Mind Training for ex-service personnel and their partners.

Although studies have shown that client feedback can improve treatment outcome, little is known about which factors might possibly moderate the effects of such feedback. The present study investigated potential therapist variables that might influence whether frequent client feedback is effective, including the Big Five personality traits, internal/external feedback propensity and self-efficacy. Data from two previous studies, a quasi-experimental study and a randomized controlled trial, were combined. The sample consisted of 38 therapists and 843 clients (55.4% females, mean age = 42.05 years, SD = 11.75) from an outpatient mental health institution. The control condition consisted of cognitive-behavioural therapies combined with low frequency monitoring of clients' symptoms. In the experimental condition, high-intensity (i.e., frequent) client feedback as an add-on to treatment as usual was provided. Outcomes were measured as adjusted post-treatment symptom severity on the Symptom Checklist-90 and drop out from treatment. The final model of the multilevel analyses showed that therapists with higher levels of self-efficacy had poorer treatment outcomes, but when high-intensity client feedback was provided, their effectiveness improved. Furthermore, higher self-efficacy was associated with a higher estimation of therapists' own effectiveness, but therapists' self-assessment of effectiveness was not correlated with their actual effectiveness. The results of this study might indicate that therapists with high levels of self-efficacy benefit from client feedback because it can correct their biases. However, for therapists with low self-efficacy, client feedback might be less beneficial, possibly because it can make them more insecure. These hypotheses need to be investigated in future research.

Previous studies have reported childhood emotional maltreatment (CEM) to be associated with specific obsessive–compulsive (OC) symptoms, but maladaptive coping, which may be the underlying mechanism in this relationship, has not been evaluated yet. Thus, the present study aimed to examine the effects of CEM on the OC symptoms of responsibility for harm and unacceptable thoughts, as well as obsessive–compulsive disorder (OCD) severity, through maladaptive coping, including cognitive avoidance, experiential avoidance and emotional suppression in OCD patients (n = 360). The results showed that CEM had direct effects, as well as indirect effects via cognitive and experiential avoidance and emotional suppression, on responsibility for harm and unacceptable thoughts. In addition, the indirect effect of CEM on OCD severity was significantly mediated by the roles of cognitive avoidance and experiential avoidance. The present study adds new literature to evidence indicating the role of early childhood events in developing and maintaining OCD in which adverse maladaptive coping related to unpleasant childhood abuse plays an important role in OCD. More precisely, OCD patients who experience a history of CEM may further use maladaptive coping to cope with their distress and subsequently experience responsibility for harm, unacceptable thoughts and severe OCD.

Cyberbullying is becoming increasingly widespread as individuals use technology more widely and frequently. Recent studies have shown a growing vulnerability for cyberbullying and cybervictimization, particularly in the adolescent population. We argue that dysfunctional metacognitions, which have been found to be prominent in various psychiatric disorders, may also play a role in predicting cyberbullying and cybervictimization over and above a variety of established factors including daily Internet use, social media use, depression and anxiety. For this purpose, we recruited 121 adolescents diagnosed with major depressive disorder (MDD) and 122 adolescents diagnosed with anxiety disorders (AD) from the child and adolescent psychiatric department of ‘Çankırı State Hospital’ along with age and gender matched healthy controls (n = 120). Participants completed the DSM-5 Depression and Anxiety Severity Scales, the Social Media Disorder Scale (SMDS), the Metacognitions Questionnaire for Children (MCQ-C) and the Revised Cyberbullying Inventory-II (RCBI-II). Cybervictimization scores were found to be higher in the MDD and AD groups when compared with healthy controls. Cyberbullying scores in the MDD group were higher than healthy controls. Additionally, the Superstition, Punishment and Responsibility subdimension of the MCQ-C was a significant predictor of cybervictimization in the AD group while controlling for daily Internet use, social media use and anxiety. However, metacognitions were not associated with cyberbullying in the MDD and AD groups, as well as with cybervictimization in the MDD group. We concluded that dysfunctional metacognitions may be a preventive therapeutic target in reducing the impact of cyberbullying in adolescents with AD.

Studies have previously demonstrated that anxious attachment shapes the association between childhood traumatic experiences and somatic pain; however, it remains unclear how this relationship is influenced by anxious attachment in patients with depression. This study investigated how anxious attachment influences the relationship between childhood traumatic experiences and pain symptoms in depressed patients from a social psychological perspective. A total of 139 adult patients with depression participated in this study; the level of depression was assessed by a psychiatric professional. Childhood trauma, pain symptoms, and attachment dimensions were tested by various questionnaires. The moderating role of anxious attachment in the trauma-pain association was examined using the PROCESS Model 1. Our findings showed that in depressed patients, childhood maltreatment had a significant positive impact on the severity of pain ratings. Moreover, anxious attachment influenced the relationship between childhood trauma and pain symptoms. Our study indicated that anxious attachment is not necessarily a negative outcome for depressed patients; moderate levels of anxious attachment alleviate childhood trauma-related pain symptoms in individuals with highly traumatic experiences. Understanding the traumatic experiences and attachment styles of depressed patients with pain complaints can help to develop intervention strategies.

Individuals who experience problems with anger represent a heterogeneous group. Identifying clinically relevant subtypes of anger may advance treatment research. In the current study, latent profile analysis (LPA) was conducted to explore if distinct subtypes of anger could be identified within a sample of individuals seeking treatment for maladaptive anger (N = 538; 55.4% females; mean age = 39.78, SD = 12.28). Furthermore, the utility of the empirical classification was examined based on differences in usage of emotion regulation strategies (cognitive reappraisal, expressive suppression, mindful emotion awareness and relaxation) across subtypes. Four anger profiles were identified in the best-fitted LPA model: Low Anger (n = 153, 28.4%), Anger In (n = 91, 16.9%), Moderate Anger (n = 193, 35.9%) and High Anger (n = 101, 35.5%). Results from the multinominal regression revealed that the use of emotion regulation differed across all profiles. Participants from the High Anger and Anger In profiles exhibited distinct patterns of dysfunctional emotion regulation. The results add to the increasing amount of evidence demonstrating a link between emotion regulation strategies and maladaptive anger. Clinical implications on how to tailor treatments for individuals with maladaptive anger are discussed.