Clinical psychology & psychotherapy最新文献

In this study, we compared the efficacy of schema-focused therapy (SFT) versus the unified protocol (UP) in reducing symptom severity of narcissistic personality disorder (NPD) and its common features. We also compared their ability to reduce grandiose and vulnerable symptoms of NPD. One hundred and fourteen individuals were randomly assigned to these groups. Severity of NPD was significantly reduced to an equivalent degree in both treatment groups across a 12-month follow-up period. SFT group showed significantly greater reduction in measures of narcissistic grandiosity, while UP group showed a significantly greater reduction in narcissistic vulnerability, anger, shame and emotion dysregulation. Patients with a vulnerable presentation showed significantly greater reduction in fear of intimacy and shame severity, while patients with a grandiose presentation showed significantly greater reduction in identity disturbance, anger control and neuroticism. Results suggest that both SFT and UP can play a useful role in mitigating symptoms of NPD.

Substance use disorders (SUDs) are among the leading causes of morbidity and mortality globally. Identification of aetiological factors related to the severity of substance use can offer targets for therapeutic interventions. Role of impulsivity and emotion dysregulation in SUDs is well established. Based on the evidence that the adverse effects of impulsivity on behavioural and mental health outcomes can be mediated by emotion dysregulation, this study explored the possible mediating role of emotion dysregulation in the association between impulsivity and the severity of substance dependence. One hundred treatment-seeking substance users (monosubstance users and polysubstance users) were enrolled. Impulsivity, emotion dysregulation and severity of substance dependence were assessed using the Barratt Impulsiveness Scale-11, the Difficulties Emotion Regulation Scale and the Severity Dependence Scale, respectively. Correlation, mediation and 95% bias-corrected and accelerated (BCa CI) bootstrapped analyses were run. Emotion dysregulation was found to mediate the association between attention impulsivity (indirect effect [BCa CI]: 0.22 [0.11-0.36]), motor impulsivity (indirect effect [BCa CI]: 0.15 [0.08-0.24]), non-planning impulsivity (indirect effect [BCa CI]: 0.11 [0.04-0.18]) and severity of substance dependence. The direct effect of different facets of impulsivity on dependence severity was not significant after accounting for emotion dysregulation. Impulsivity was found to have a significant indirect effect on the severity of substance use through emotion dysregulation. Among substance users, emotion dysregulation may be involved in the association between impulsivity and severity of substance dependence. Emotion dysregulation could be considered a possible therapeutic target to reduce the severity of substance dependence among substance users with impulsive tendencies.

Objective: To investigate the effectiveness of cognitive therapy (CT) and short-term dynamic psychotherapy (STDP) among patients with greater severity, defined in several ways, in a community mental health setting.

Method: Using data from a randomized noninferiority trial, we examined five baseline severity variables as potential moderators of treatment effects: depressive symptoms, interpersonal problems, mental functioning, physical functioning and quality of life. The outcome was a change in depressive symptoms over the course of up to 5 months of treatment. Linear mixed-effects models were implemented to compare slopes of change over time. We hypothesized that CT would be superior to STDP for those with severe depressive symptoms, severe mental and physical functioning and severely impaired quality of life, but STDP would be superior to CT for those with severe interpersonal problems.

Results: There was no evidence of superiority within any of the five severity domains.

Conclusions: Findings inform the comparative effectiveness of CT and STDP among patients with greater severity and extend prior work by incorporating interpersonal, functioning and quality of life severity indicators.

This study examined the association between therapist-level flourishing and burnout with early client dropout. Participants included 141 therapists (M_age = 46.1; 82.8% White; 80.7% female) and 12,988 adult clients (M_age = 37.8; 41.9% White; 62.5% female) using a US-based digital mental health network. Early dropout was operationalised as attending fewer than three sessions. Therapists completed self-report measures of burnout and flourishing. Multilevel logistic regression examined therapist-level predictors of early dropout, accounting for nested client data. Approximately 27.8% of clients dropped out early. Therapists accounted for 9.4% of the variance in client dropout. Therapist flourishing was significantly associated with lower dropout rates (OR = 0.90, 95% CI [0.814, 0.998]), while therapist burnout was not (OR = 1.01, 95% CI [0.758, 1.353]). More years in practice (OR = 1.02, 95% CI [1.013, 1.031]) and larger weekly caseloads (OR = 1.02, 95% CI [1.003, 1.033]) were both significantly linked to higher early dropout rates. Dropout was significantly lower for White clients (OR = 0.827, 95% CI [0.736, 0.929]) and White therapists (OR = 0.711, 95% CI [0.539, 0.938]). Therapist flourishing may support early client retention, while higher caseload, more experience and racial/ethnic disparities are associated with increased dropout. Findings highlight the need for wellness promotion, structural support and culturally responsive practices in psychotherapy.

Objective: This study conducted a preliminary naturalistic effectiveness evaluation of Individualised Metacognitive Therapy (MCT+) delivered via videoconferencing for individuals with bipolar I disorder (BD-I) in a real-world clinical setting in Chile. It also explored how therapist characteristics-specifically mentalisation capacity-influence the therapeutic alliance in digital psychotherapy.

Methods: A longitudinal quantitative case series design was implemented across 14 therapist-patient dyads. Patients received 12 weekly sessions of MCT+ online. Standardised measures assessed anxiety (GAD-7), depression (PHQ-9), metacognitive beliefs (MCQ-30), psychological distress (CORE-10) and quality of life (WHOQOL-BREF). Therapeutic alliance was tracked session-by-session (WAI-S). Therapist mentalisation and attachment were evaluated at baseline (MASC-SP, RFQ-8, ECR-12). Changes in outcome measures were analysed using paired t-tests, effect sizes (Cohen's d), correlations, reliable change indices (RCI) and hierarchical linear modelling (HLM).

Results: Across the intervention, there were significant decreases in anxiety (d = 0.64) and improvements in metacognitive beliefs (d = 0.37). Depression showed a modest improvement (d = 0.34), while changes in quality of life were negligible (d = -0.21). Hierarchical modelling indicated a significant interaction between automatic and controlled mentalisation (b = -0.45, p = 0.008), suggesting that flexible adjustment supported therapeutic alliance development. Attachment style showed no significant associations with the alliance (largest unadjusted effect: ρ = -0.54, p = 0.073; all adjusted ps > 0.99).

Conclusions: Digital MCT+ showed preliminary effectiveness in reducing anxiety and maladaptive metacognitive beliefs among individuals with BD-I, with more limited effects on depression and quality of life. Importantly, therapist mentalisation flexibility-the capacity to shift between automatic and controlled modes, or the mentalisation switch-emerged as a central mechanism for alliance building and engagement in digital contexts, highlighting a key target for clinical training and future research.

Mental disorders affect not only mothers themselves but also their children and partners. Borderline personality disorder (BPD) in particular is thought to impact the mother-child relationship, but comparisons with mothers with other mental disorders are scarce. Many studies use questionnaires without examining if self-report corresponds to observable behaviour. We assessed the perceived mother-child relationship using the Parenting Relationship Questionnaire and the Child Relationship Behaviour Inventory in three groups: (1) mothers with BPD, (2) mothers with anxiety and/or depression and (3) mothers without mental disorders with preschool children. Additionally, mother-child interactions during free-play and structured tasks were video-recorded and coded using the Coding Interactive Behaviour system. Compared with mothers without mental disorders, both clinical groups perceived their relationship with the child, their own parenting skills and their children's behaviour as less positive. Mothers with BPD felt less confident and more frustrated than those with anxiety and/or depression. No significant group differences emerged in observed behaviour (e.g., sensitivity, intrusiveness), and correlations between self-report and observation were low. Overall, mothers with BPD face similar challenges as mothers with anxiety or depressive disorders, but they experience particular distress when it comes to relating to and controlling their child's affect. While mothers in both clinical groups are able to foster positive relationships with their children in a controlled laboratory setting, they find it difficult to maintain these skills permanently (e.g., during negative child affect). Trial Registration: DRKS-ID: DRKS00020460.

Objective: Command hallucinations (CHs) are a subtype of auditory hallucination commonly observed in psychosis and are strongly associated with harmful behaviours towards the self and others. Despite their clinical relevance, no review has synthesised the clinical variables associated with compliance, appeasement and resistance.

Method: A systematic review was conducted to synthesise the existing evidence regarding the clinical correlates of compliance, appeasement and resistance to CHs.

Results: Fifty-six studies were eligible for inclusion. Compliance was associated with cognitive factors (benevolence, omnipotence and omniscience beliefs, perceived consequences of disobedience, perceptions of future compliance and greater attentive awareness), relational factors (social rank, voice identity and voice familiarity), emotional drivers (anger and obligation), behaviours (impulsivity and social isolation), childhood trauma, substance use and overall symptom severity. Appeasement was associated with cognitive factors (perceived dangerousness) and behaviours (avoiding provocation, obeying milder commands or self-harm to protect others). Resistance was associated with cognitive factors (malevolence and omnipotence beliefs, perceived control over the voice and concurrent suicidal ideation) and voice topography factors (high intrusiveness/frequency/volume and low authoritativeness), alongside childhood trauma factors (interpersonal adversities and fearful attachment).

Conclusion: These findings highlight the need for clinical formulations of CHs to attend closely to the factors driving compliance and appeasement, given their strong association with risk. Targeting the cognitive, relational, emotional, behavioural and developmental influences that sustain these responses-and strengthening resistance-promoting factors-may enhance cognitive behavioural therapy for psychosis (CBTp). To support clinical practice, this review also provides Socratic questions to guide the assessment, formulation and intervention of CHs.

Research has investigated the outcomes of compassion-focused therapy for adult populations, with systematic reviews and meta-analyses supporting its effectiveness. Comparatively, the literature investigating compassion-focused interventions for child and adolescent populations is less developed, with fewer empirical studies to date. Most existing literature on compassion interventions has been in a group context. A systematic review was conducted to explore the state of the evidence base for compassion-focused groups used with child and adolescent clinical populations. This narrative synthesis aimed to review the methodological quality and outcomes of the published and unpublished literature. Ovid, Scopus, EBSCO and ProQuest platforms were utilised to search databases with studies from the year 2005 onwards. Nine studies were identified, including 138 participants receiving a compassion-focused intervention aged between 11 and 17 years. There was some evidence to suggest that compassion-focused groups have the potential to increase self-compassion and improve the wellbeing of children and adolescents. However, the outcomes were varied, and methodological concerns limited interpretations of results. Additionally, the heterogeneity between studies made it challenging to synthesise the literature and draw conclusions regarding the effectiveness of these groups for this population. Future research would benefit from higher quality empirical studies comparing compassion-focused groups to other interventions, alongside a greater consistency in valid outcome measure use across research.