Clinical psychology & psychotherapy最新文献

Self-guided digital mental health apps often show high attrition, highlighting the need to understand engagement beyond behavioural metrics. The Homework Rating Scale-Mobile Application (HRS-MA) was developed to assess cognitive, emotional and attitudinal aspects of engagement. This study evaluated its psychometric properties. The HRS-MA was integrated into the MoodMission app and administered after 30 days of use, alongside additional self-report measures. Data from 2100 users were analysed for reliability, construct, convergent, divergent and predictive validity. The HRS-MA showed excellent internal consistency (Cronbach's α = 0.90; McDonald's ω = 0.94). Factor analyses supported a two-factor structure-engagement and difficulty and obstacles. The measure demonstrated strong convergent and divergent validity and modest predictive validity. A derived coefficient of psychological effort, representing the interaction between engagement and perceived barriers, significantly predicted symptom reduction, particularly in depression. The HRS-MA is a psychometrically sound tool for capturing cognitive and attitudinal dimensions of engagement in digital interventions. It complements behavioural indicators by offering a more comprehensive view of user experience and effort, providing researchers and developers with a valuable framework for optimizing mental health app design and evaluation.

The current study aimed to estimate the prevalence of clinically significant depression and anxiety symptoms in young adults with DSM-5-confirmed specific learning disorders (SLDs) in Saudi Arabia and to develop machine learning (ML) models to identify individuals at elevated risk. In this cross-sectional study, 439 young adults were recruited via online advertisements. They underwent structured clinical interviews administered by licensed psychologists or psychiatrists to confirm their SLD diagnosis in accordance with DSM-5 criteria. Depression and anxiety were assessed using validated self-report measures (BDI-II ≥ 20 for depression; BAI ≥ 16 for anxiety). Clinically significant depression was observed in 175 of 439 participants (39.9%), and clinically significant anxiety in 151 of 439 participants (34.4%). Recursive feature elimination identified key predictors for depression (SLD severity, female gender, burnout and attention-deficit/hyperactivity disorder [ADHD]) and anxiety (insomnia, age, SLD subtype, ADHD, and SLD severity). Four supervised ML algorithms (logistic regression, random forests, extreme gradient boosting [XGBoost], and support vector machine [SVM]) were tuned using 10-fold cross-validation within the training set and evaluated on a held-out test set (30% stratified split). These results indicate that depression and anxiety are highly prevalent among Saudi young adults with clinically confirmed SLD, and ML models can accurately identify those at the highest risk. Findings highlight SLD severity, insomnia and comorbid ADHD as key factors for early intervention in educational and clinical settings.

Schema therapy is effective for older adults with personality disorders, but the Young Schema Questionnaire (YSQ) may be too lengthy for use in geriatric mental health care. This study evaluated the construct validity of the YSQ-L2 in adults aged 35-97 years receiving residential or outpatient geriatric, psychiatric or medical care and developed a shorter form for this population. Data from 214 participants from Dutch nursing homes and outpatient services were analysed using Item Response Theory across 16 YSQ-L2 subscales. Each subscale was reduced to five items based on discrimination, difficulty, Differential Item Functioning for cognitive status and face validity. Most items showed adequate discrimination and coverage, whereas the Enmeshment scale had limited sensitivity and the Social Undesirability scale was excluded. The resulting 75-item YSQ-GeMS showed strong concordance with the original, providing a psychometrically robust and efficient tool for schema assessment in geriatric mental health care.

Mental imagery has been identified as a key feature of the onset, maintenance and treatment of psychological disorders. Research on the role of mental imagery in body dysmorphic disorder (BDD), a condition hallmarked by negative sensory appraisals of the self, has been increasingly recognised in theoretical perspectives and psychological interventions. However, the scope and implications of this work have not yet been reviewed. This systematic review sought to identify the characteristics and proposed mechanisms of imagery in BDD, synthesising qualitative and quantitative data using Meta-Integration. Quality was assessed using the Mixed Methods Appraisal Tool. Thirty-seven studies were identified among 33 publications. Study quality was mixed with significant methodological heterogeneity. Mental imagery in BDD is consistently reported to be vivid, emotionally intense, recurrent and important in the maintenance and potentially the onset of BDD. These findings concur with theoretical frameworks of BDD (and other related conditions) which highlight the causal role of imagery and encourage the use of imagery-based interventions. Crucial areas for future work include stronger causal tests, unpacking mechanisms, attention to individual differences and intersectionality and exploring the potential for imagery-based approaches for innovations in treatment and prevention across the lifespan, particularly in adolescence when BDD first develops.

Parents of children newly diagnosed with autism spectrum disorder (ASD) often experience substantial posttraumatic stress symptoms (PTSS), which may interact with work-related stress differently in mothers and fathers. Understanding these parent-specific patterns is crucial, as they influence family functioning, caregiving and child development. This study used a network approach to compare the structure and bridging pathways linking PTSS and work-related stress in mothers versus fathers of children newly diagnosed with ASD in Saudi Arabia. In a cross-sectional dyadic design, 150 mother-father dyads (150 families; N = 300 parents: 150 mothers and 150 fathers) of children clinically diagnosed with ASD by qualified specialists (child psychiatrists, developmental paediatricians, neurologists or clinical psychologists) within the past 12 months completed an online survey (April 2024-September 2025). PTSS were assessed using the 22-item Impact of Event Scale-Revised (IES-R; diagnosis-related index event), and work-related stress was measured using an eight-item scale. Symptom networks were estimated separately for mothers and fathers, and bridge indices were calculated to identify nodes linking the PTSS and work-stress communities. Network structures were then compared using the Network Comparison Test (NCT). The overall network structure differed between mothers and fathers (p = 0.003), while global connectivity did not (p = .116). No specific edge or centrality differences remained significant after multiple-comparison correction. Descriptively, bridging differed by parent group: In mothers, sleep difficulty and avoidance of talking about the event were the most prominent PTSS bridge nodes, alongside work-stress nodes reflecting underutilization of skills and work-family interference. In fathers, low influence/control over work tasks and avoidance of talking about the event were the most prominent bridge nodes, with additional bridging contributions from work-family interference and insufficient appreciation/rewards. PTSS and work-related stress formed distinct but interconnected communities in both mothers and fathers, with different bridge pathways linking domains. Interventions may benefit from targeting the domain 'interfaces' that differ by parent role (e.g., sleep-related PTSS in mothers and perceived work control in fathers), alongside work-family spillover in both groups.

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.

This study aimed to evaluate the factor structure, internal consistency and concurrent validity of the Italian version of the Metacognitions about Smoking Questionnaire (MSQ), utilizing the framework of the Self-Regulation Executive Function model. A total of 532 smokers completed the Italian-translated version of the MSQ, the Fagerstrom Test for Nicotine Dependence, the Severity Dependence Scale, the Depression Anxiety and Stress Scale-21. To test the factorial structure of the MSQ, a series of confirmatory factor analyses (CFAs) were run; correlational analyses and structural equation modelling (SEMs) approaches were undertaken to evaluate the concurrent validity. The 12-item MSQ with four factors was confirmed: positive metacognitions about cognitive regulation (PM-CR), positive metacognitions about emotional regulation (PM-ER), negative metacognitions about uncontrollability (NM-U) and negative metacognitions about cognitive interference (NM-CI). The MSQ showed an overall satisfactory fit index (TLI = 0.949, CFI = 0.963, RMSEA = 0.082 [0.064–0.101]). Internal consistency was satisfactory. MSQ factors are associated with higher nicotine/cigarette dependence and emotional distress, supporting the concurrent validity of the tool. Specific metacognitions about smoking were associated with different clinical outcomes related to smoking. A higher engagement on PM-CR and on NM-U was positively associated with nicotine/cigarette dependence. A higher engagement on PM-ER and NM-CI was associated with greater emotional distress. The 12-item Italian version of the MSQ could be a promising tool to assess specific metacognitions about smoking in both research and clinical contexts. Metacognitions about smoking may be a suitable therapeutic target to reduce the levels of nicotine/cigarette dependence and emotional distress among smokers.