Clinical psychology & psychotherapy最新文献

Eye movement desensitisation and reprocessing (EMDR) is a psychological therapy used to treat trauma. While trauma-focused cognitive behavioural therapy (TF-CBT) is often used, EMDR has potential for treating post-traumatic stress disorder (PTSD). Previous research has focused on adult populations, with limited evidence for children and adolescents available. A systematic review was conducted to evaluate the clinical and cost-effectiveness of EMDR for treating or preventing PTSD in children and adolescents. Randomised controlled trials (RCTs) were identified through a comprehensive search of six databases in September 2023. Eligibility criteria were based on the NICE 2018 PTSD guidelines. Data were extracted, and risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Meta-analyses were conducted where appropriate. Of 1220 unique records identified, nine studies met the inclusion criteria. Eight RCTs (n = 794 participants) explored clinical effectiveness, and one study examined cost-effectiveness. Most studies compared EMDR with waitlist/usual care. A meta-analysis demonstrated a significant and large effect size (SMD 1.57 95% CrI = 0.07–3.21) of EMDR treatment (delivered 3 months or more following trauma) compared with waitlist/usual care for children and adolescents with PTSD, in various populations including refugees, and victims of physical and/or sexual violence. Two trials compared EMDR with TF-CBT and found no significant difference between therapies. From the very limited cost-effectiveness evidence available, EMDR was ranked sixth out of 10 interventions. EMDR was demonstrated to be effective in reducing PTSD symptoms in children and adolescents, particularly when compared with waitlist/usual care. However, more high-quality RCTs are needed to establish definitive conclusions. In addition, future research should prioritise within-trial cost-effectiveness analyses to provide a more comprehensive understanding of the cost–benefit profile of EMDR.

Trial Registration: PROSPERO prospective register of systematic reviews: CRD42023463360.

Psychological problems are a common concern among children and adolescents. Identifying distinct profiles of internalizing and externalizing problems offers a comprehensive understanding of the psychological challenges faced by this population. This study aimed to explore mental health profiles in a sample of 5652 Spanish children and adolescents aged 8–16 years, examining differences between these profiles and reference groups. Using the Child and Adolescent Assessment System (SENA) and latent profile analysis (LPA), six profiles were identified among children and seven among adolescents, based on internalizing, externalizing and contextual problems. Among children, the most frequent profiles were ‘moderate problems, low conflict’ and ‘low problems’, while adolescents most commonly exhibited ‘moderate internalizing, low externalizing’ and ‘low problems’ profiles. Significant differences across profiles were linked to emotional regulation, self-esteem and social competence. These findings provide a nuanced perspective on the mental health landscape of Spanish youth, emphasizing the critical role of early detection of emotional difficulties in educational settings. Furthermore, the study offers valuable insights for developing tailored interventions to meet the specific emotional needs of children and adolescents.

Identity diffusion, involving a lack of cohesive personal identity, is a vulnerability factor in affective states—psychache and hopelessness—that often precede suicidality. Traumatic experiences, such as childhood emotional abuse, may limit the capacity to form a stable and coherent sense of self, thereby indirectly heightening the vulnerability to psychache and hopelessness through diffuse identity. The present study examined the relationship between identity diffusion and psychache and hopelessness, along with the indirect effect of perceived childhood emotional abuse. The sample (n = 297) comprised UK-based help-seeking adults recruited online. Eligible participants completed measures of identity diffusion, unbearable psychache, hopelessness and childhood emotional abuse at baseline, with psychache and hopelessness reassessed two months later. Regression analyses revealed that identity diffusion was significantly associated with both psychache and hopelessness over time, even after controlling for baseline levels. Mediation analysis further indicated that identity diffusion had a significant mediating effect on the relationship between childhood emotional abuse and later experiences of psychache and hopelessness. These findings underscore the importance of clinically targeting identity diffusion to help reduce presuicidal affective states, particularly among individuals who experience childhood emotional maltreatment.

Intolerance of uncertainty (IU), cognitive avoidance (CA), positive beliefs about worry (PBW) and a tendency to view everyday problems as threats, termed negative problem orientation (NPO), are cognitive vulnerabilities associated with symptoms of anxiety and depression in adults, with fewer studies examining all four vulnerabilities in youth. In this study, validated measures of IU, CA, PBW and NPO were administered to clinically referred youth with a principal diagnosis of obsessive-compulsive disorder (OCD, n = 86), anxiety disorders (n = 80) or major depression (n = 18) and to non-clinical peers (n = 46). Group differences and the contribution of each vulnerability to internalizing symptom domains were examined. The OCD and anxiety groups did not differ significantly from each other on any vulnerability but had higher scores than non-clinical peers on all vulnerabilities except PBW. Alongside age and sex, IU, CA, PBW and NPO accounted for 52% of the variance in generalized anxiety symptoms, 51% in depression, 48% in panic, 31% in obsessions/compulsions, 29% in separation anxiety and 18% in social anxiety. Structural modelling revealed that IU was associated with all anxiety symptom domains and that NPO was most strongly associated with depression. These findings suggest that IU, CA, PBW and NPO are linked to various internalizing symptom domains in youth and that IU and NPO act as transdiagnostic vulnerabilities and may be important treatment targets.