Clinical psychology & psychotherapy最新文献

Steven J. Lynn (1946–2024) was a prolific researcher who explored a wide array of topics in clinical psychology. He and his co-authors emphasized the importance of researching the side effects of psychological interventions. In the current studies (Study 1, N = 58; Study 2, N = 64), we examined clinicians' perspectives on side effects. A slight majority of clinicians in both studies reported familiarity with the topic (Study 1: n = 30, 51%; Study 2: n = 39, 61%). Those who claimed familiarity were more likely to discuss side effects with their patients compared with those who acknowledged a lack of knowledge. In Study 2, we found significant variation among clinicians regarding what constitutes avoidable, unavoidable or nonexistent side effects, and their views did not align with those of patients. This divergence may explain why a considerable number of clinicians refrain from discussing side effects with patients, despite patients' right to be fully informed about the potential benefits and risks of their treatment. Our findings underscore the need for clear guidelines that define the full spectrum of side effects and offer strategies for effective communication with patients. The first step in developing such guidelines is to raise awareness among professionals about the topic, which can be effectively achieved by engaging in the work of Steven J. Lynn and his co-authors, whose insights remain highly relevant.

This study explores the relationship between social camouflaging and pragmatic competence in adults diagnosed with autism spectrum disorder (ASD) and borderline personality disorder (BPD), with a particular focus on gender. It is based on the hypothesis that camouflaging contributes to under or misdiagnosis, especially in women and gender-diverse individuals. A total of 225 adults participated in a cross-sectional online survey, completing the Camouflaging Autistic Traits Questionnaire (CAT-Q) and the Pragmatic Awareness Questionnaire (PAQ). Participants were grouped based on clinical diagnosis (ASD or BPD) and self-identified gender (women, men and gender-diverse). Among women, no significant differences in camouflaging scores were found between the ASD and BPD groups, suggesting the use of similar adaptation strategies that may obscure clinical differentiation. In contrast, among men, camouflaging and pragmatic deficits were more distinctly associated with autistic traits. No substantial differences were observed among gender-diverse participants, highlighting the influence of contextual and identity-related factors. Findings emphasize the importance of integrating detailed pragmatic assessments and adopting gender-sensitive approaches in the differential diagnosis of ASD and BPD. Such strategies may help reduce misdiagnosis and improve recognition of autistic traits, particularly in populations that tend to camouflage more effectively.

Background: BD is a chronic, cyclical condition marked by severe mood instability and significant impairment. Although pharmacological and psychotherapeutic interventions have demonstrated efficacy, challenges remain in preventing relapse and sustaining long-term euthymia. This study evaluates a CBT-based intervention designed to reduce symptom severity and recurrence by targeting three core maintenance factors: intolerance of anergic states, addiction to mania, and meta-emotional problems.

Method: Four individuals diagnosed with BD participated in a one-year CBT intervention tailored to address these key vulnerabilities. Assessments were conducted at baseline, post-treatment, and at 18- and 24-month follow-ups, measuring depression, mania, quality of life, and personality functioning. Changes were evaluated with RCI and repeated measures ANOVA.

Results: All four patients showed a marked reduction in depressive symptoms at the end of treatment and at the 24-month follow-up, with a large effect size (η² = 0.83). Improvements were also observed in the quality of life and maladaptive personality traits over time. Notably, euthymia was maintained throughout the follow-up period, with no recurrence of manic episodes or new affective cycles.

Conclusion: Despite limitations, these preliminary findings suggest that this three-goal CBT intervention targeting core maintenance factors in bipolar disorder may promote sustained clinical improvements, increase long-term stability, and reduce reliance on medication.

Adolescence is a critical developmental period during which obsessive-compulsive disorder (OCD) frequently emerges. This study examined cognitive models of OCD, the associations between stressful life events (SLEs) and symptom severity, and the unique challenges faced by adolescents living with OCD symptoms. Two indirect pathways were tested: one involving SLEs and the other perceived stress, with both pathways including inferential confusion and obsessional beliefs as mediators. A sample of adolescents presenting with OCD symptoms completed validated measures assessing stress, obsessive beliefs, inferential confusion, and symptom severity. Results indicated that inferential confusion showed a significant indirect association between perceived stress and OCD symptom severity, whereas obsessional beliefs did not emerge as significant mediators. These findings suggest that inferential confusion represents an important cognitive factor associated with OCD symptoms in youth and may be especially salient under conditions of elevated stress. They also underscore the value of further investigating interventions that address inferential confusion in early OCD-focused treatments for adolescents.

Childhood parental affection and abuse may shape vulnerability to generalized anxiety disorder (GAD) and major depressive disorder (MDD) in adulthood through personal mastery and perceived constraints. This three-wave 18-year longitudinal study tested whether sense-of-control dimensions mediated the effects of early parental experiences on later GAD and MDD symptoms (N = 3294; 54.9% women; mean age = 45.6 years, SD = 11.4, range = 20-74 years; 89.7% White compared to African American, Asian/Pacific Islander, Native American and other). Structural equation models showed that lower parental affection and higher abuse at Time 1 predicted greater perceived constraints at Time 2 (Cohen's d = -0.396 to 0.510), which in turn predicted greater GAD and MDD severity at Time 3 (d = 0.463 to 0.754). Perceived constraints significantly mediated the links between childhood parental experiences and adult symptom severity for both GAD (d = -0.269-0.319; percentage mediated: 30.0%-69.2%) and MDD (d = -0.343-0.422; 11.0%-44.9%), whereas mastery did not. Mediated effects were somewhat stronger for maternal (11.4%-69.2%) than paternal (11.0%-51.5%) experiences. These findings underscore perceived constraints as a critical mechanism linking childhood parental experiences to later anxiety and depression. Interventions that address maladaptive beliefs about sense of control may improve long-term outcomes for adults exposed to early adversity.

With gaming's increasing prevalence, understanding the psychological functioning of individuals across a range of internet gaming disorder (IGD) severity is crucial. This study replicates and extends Bonnaire and Baptista's (2019) research on DSM-5 IGD in European young adults, examining alexithymia, anxiety, maladaptive personality traits and interpersonal problems with a US sample. A diverse group of 205 young adults (mean age = 20.41, 73% female) completed an anonymous survey assessing IGD using the Internet Gaming Disorder Scale-Short Form (IGDS9-SF; Pontes and Griffiths 2015), gaming type, alexithymia, anxiety, maladaptive personality traits and interpersonal problems. IGDS9-SF effectively distinguished normal gamers (IGD criteria = 0) from risky gamers (IGD criteria = 1-6), with the latter showing significantly greater pathology across all measures (p < 0.01). While gaming type showed no overall significant differences, gamers who preferred more role-playing platforms trended toward reporting more interpersonal problems than gamers preferring action games (p = 0.059). Overall IGD severity was also significantly correlated with greater pathology on all measures (p < 0.001). Specifically, disinhibition (impulsivity and poor self-control) and socially avoidant interpersonal problems emerged as the strongest unique predictors of IGD severity, suggesting that interventions targeting impulsivity, interpersonal functioning and social skills may be particularly useful in the treatment of IGD issues. Findings underscore IGD's connections to emotional, personality and interpersonal factors, informing clinical assessment and treatment.

Diagnosing behavioural problems in adolescents often relies on subjective reports from parents or caregivers. Systemic theory emphasizes the need for multiple perspectives, including those of the adolescent. This study examined the alignment between adolescents' and parents' perceptions of behavioural problems in ADHD and non-ADHD groups and explored how family cohesion and flexibility explain the severity of externalizing and internalizing behaviours from both perspectives. Participants included 214 adolescents diagnosed with ADHD and their parents (adolescents: Mage = 11.24, SD = 0.91, 75.23% boys; parents: Mage = 41.92, SD = 6.43, 84.11% mothers) and 514 adolescents without ADHD and their parents (adolescents: Mage = 11.34, SD = 0.75, 51.56% boys; parents: Mage = 42.29, SD = 5.58, 87.55% mothers), from 18 cities in southern Poland. The variables were measured using the ASEBA instruments (Child Behaviour Checklist, Youth Self Report) and the Family Adaptation and Cohesion Evaluation Scales. Data were analysed using Actor-Partner Interdependence Models to examine actor and partner associations within adolescent-parent dyads. More boys were diagnosed with ADHD, showing slightly more externalizing problems than girls. Lower family flexibility predicted externalizing behaviours, with parent-rated flexibility linked to parent-rated behaviours, and adolescent-rated flexibility linked to adolescent-rated behaviours. Adolescent-rated family cohesion rated by adolescents predicted fewer externalizing behaviours as reported by parents in the ADHD group and by adolescents in the non-ADHD group. Internalizing behaviours were linked to family flexibility and cohesion, regardless of the actor (adolescent or parent). The predominance of actor effects indicates that each informant's perception of family functioning is uniquely linked to their own reports of symptoms; given only moderate parent-adolescent agreement, these perspectives appear complementary rather than redundant. Assessing behavioural problems requires data from both parents and adolescents, as family cohesion and flexibility significantly impact adolescent functioning. Trial Registration: ClinicalTrials.gov identifier: NCT04574414.

Impaired metacognition, the capacity to understand one's own and others' mental states, has gained increasing attention in psychosis research. Different conceptualizations, psychological treatments and assessment methods have emerged; however, there is a lack of consensus regarding the appropriate tools for clinical and research use. This systematic review had two aims: (1) to compile and organize available assessment tools and (2) to propose an index of metacognitive domains and processes. Instruments were categorized according to authorship, year of use in psychosis, outcomes assessed, language/version, administration time and type of Clinical Outcome Assessment (ClinRO, PRO or PerfO). We identified 42 studies that used 31 instruments. The tools were classified into four domains: Metacognitive Awareness, Metacognitive Capacity, Neurometacognition and Social Metacognition. Our findings highlight the diversity of the available measures and propose a framework for aligning instruments with specific reflective processes. This work represents a practical and theoretical first step toward building consensus and facilitating both the use of available tools according to practical needs and the development of an agreed-upon definition and components of metacognition.

People are at increased risk of suicide following discharge from inpatient mental health units. Understanding the reasons for this increased risk is important for reducing the number of people who die by suicide. Whilst reviews of quantitative research have identified risk factors, no reviews of the qualitative literature exist which could provide more nuanced explanations of elevated suicide risk during the post-discharge period. This systematic review is the first to meta-synthesise qualitative research on experiences of suicidality after being discharged from inpatient mental health units. We searched PsycINFO, MEDLINE, Web of Science, PubMed and ProQuest using relevant search terms. We identified 29 studies that met inclusion criteria and were included in the review. We analysed the data using thematic synthesis and identified five analytic themes: (1) Feeling prepared for the transition home, (2) Returning from safety to everyday hardship, (3) The need for connection and understanding, (4) Feeling neglected by the system, (5) Taking the reins on recovery. This review indicates that reducing post-inpatient discharge suicides could be achieved through collaborative discharge preparation, immediate and intensive post-discharge support, and empowering service-user recovery.

Despite substantial research on the physiological and psychological effects of the menstrual cycle (MC) on somatic and mental health, its impact on psychotherapy remains largely overlooked. Importantly, MC follows a recurring pattern of inflammatory activity. Emotional states, mood, cognitive functioning and sleep patterns fluctuate across the MC, affecting overall functioning and well-being. Additionally, hormonal shifts across the cycle are linked to the exacerbation of psychiatric symptoms, particularly in premenopausal women who exhibit heightened sensitivity to normal changes in sex steroid levels. However, MC-related hormonal fluctuations and inflammatory processes are rarely considered in psychotherapeutic settings. This exploratory mixed-methods study examined how MC-related fluctuations influence clients' psychotherapy experiences. In an online survey setting, a total of N = 425 female clients completed the Client Satisfaction Questionnaire-8 (CSQ-8) and the WHO Well-Being Index (WHO-5), alongside qualitative questions on symptom and therapy experiences. Most participants received cognitive-behavioural (35.5%), psychodynamic (14.4%), systemic (9.4%) or humanistic (6.8%) therapy, while 33.9% were unsure of their therapy orientation, mostly in outpatient settings. Quantitative findings revealed reduced therapy satisfaction during premenstrual and perimenstrual phases compared with other phases. Qualitative data highlighted symptom exacerbation during these phases, negatively affecting emotional states, therapeutic participation, cognitive functioning and perceptions of therapy's necessity and effectiveness. Participants reported that the open discussion of the MC in therapy improved treatment outcomes. They advocated for individualized consideration of MC-related factors in therapy planning. These findings underscore the need for more personalized clinical approaches that integrate MC-related dynamics into psychotherapy to optimize treatment outcomes.