Clinical psychology & psychotherapy最新文献

This is the first critical review to assess the clinimetric properties, particularly the sensitivity (i.e., the ability to detect changes in clinical trials and yield clinical distinctions that may demarcate major prognostic and therapeutic differences), and to determine the clinical utility of instruments of illness denial in patients with medical disorders. A comprehensive search of the literature was performed on several databases. Patient-reported outcome measures and clinician-rated instruments of illness denial were identified and analysed. The findings indicate that the Acceptance and Action Diabetes Questionnaire and the Denial of Illness Scale can be used as screening tools to early detect diabetes and stroke patients at increased risk for clinical complications. The Diagnostic Criteria for Psychosomatic Research and the Levine Denial of Illness Scale are transdiagnostic instruments that are particularly suitable to identify the maladaptive manifestations of illness denial and its affective, behavioural and cognitive components. The Illness Denial Questionnaire, particularly the eight-item version of the instrument, is another transdiagnostic measure that may be better suited for the evaluation of illness denial severity. The Denial of Cancer Interview can be used for a longitudinal monitoring of illness denial, whereas the Hackett–Cassem Denial Scale is recommended to assess the degree of illness denial in individuals with cardiac disorders. The use of instruments such as the Cardiac Denial of Impact Scale, the Denial Questionnaire and the Havik and Mæland Denial Scale, which were found to have considerable prognostic utility, may help patients promptly recognize and respond to life-threatening diseases.

This study tested a 10-week multidisciplinary schema therapy inpatient treatment protocol for patients with personality disorders, including two individual and two group sessions per week, supportive sessions with nurse cotherapists, as well as art, music, sports group and individual body therapy. Twenty patients with specific or mixed PD participated. A concurrent multiple baseline design was used with randomly assigned baselines between 4 and 10 weeks. After baseline and admission, a 2-week attention control phase without interventions was followed by a 10-week treatment protocol and a 3-month follow-up without treatment. The primary outcomes were three dysfunctional negative idiosyncratic beliefs (NIB) as well as two positive beliefs regarding emotional-acceptance and self-acceptance (PB) assessed daily. The secondary outcomes were standard psychometric instruments assessed five times during the trial: a symptom checklist (SCL90R), a depression inventory (BDI2), a questionnaire to assess life satisfaction (FLZ), the number of PD-diagnoses (SCID2) as well as Young's Schema Questionnaire (YSQ3) and the Schema Mode Inventory (SMI). Data were analysed with mixed regression. The primary outcomes confirmed that treatment brought substantial improvements (NIB d = 1.36; PB d = 1.29) and that these improved further (NIB d = 1.63; PB d = 2.19) at follow-up. Similarly, the secondary outcomes showed that treatment led to substantial improvements both in negative (depression, symptom severity in general as well as PD symptoms, dysfunctional schemas and modes) and in positive (life satisfaction, functional modes) domains. This indicates that the ST programme did not only bring about a reduction of problems but also an increase in adaptive functioning and happiness.

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.

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.

Sleep disturbances are common in bereavement, especially among those with prolonged grief disorder (PGD). While cross-sectional and longitudinal studies have linked PGD with poor sleep, the directionality and timing of these effects remain unclear. In the present study, we employed a 14-day ecological momentary assessment (EMA) protocol to examine the day-to-day associations between sleep and grief in a sample of 46 traumatically bereaved adults (M_age = 56.0, 78% female, Med_{time since loss} = 3.8 years). PG symptoms were assessed 5×/day and sleep quality each morning via a smartphone app. Linear mixed models were used to examine within-person, lagged effects of sleep quality on PG levels and vice versa. Results indicated that PG symptoms did not predict sleep quality the following night. However, lower sleep quality was associated with increased PG severity during the day (controlling for previous-day PG levels), although this effect was no longer significant in sensitivity analyses restricted to participants with more complete sleep data (≥ 50%). Exploratory post hoc analyses indicated that sleep quality was most strongly associated with PG levels in the morning, with the effect being attenuated later in the day. Altogether, these findings provide tentative support for a night-to-day, sleep-to-grief pathway, although both small effect sizes and variability in results underscore the need for replication in larger samples. While preliminary, these findings suggest that poor sleep may contribute to the exacerbation of PG symptoms in the short term, highlighting the need for further research into the temporal dynamics and potential causal mechanisms linking sleep and grief.

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.