Clinical psychology & psychotherapy最新文献

There is evidence that emotion regulation plays a role in the aetiology and maintenance of OCD, but knowledge about what impacts emotion dysregulation is limited. Attachment style is related to both emotion regulation and OCD symptoms, but the link between them has not been thoroughly studied. Examining emotion dysregulation within the context of OCD through an attachment theory framework may lead to a better understanding of the aetiology and maintenance of OCD. In the present study, we combined theoretically and empirically derived knowledge to examine the mediating role of emotion regulation between attachment dimensions (avoidance and anxiety) and OCD symptoms. One-hundred seventy-nine individuals with OCD were assessed with Experiences in Close Relationships-Revised (ECR-R), Difficulties in Emotion Regulation Scale (DERS) and Yale-Brown Obsession Compulsion Scale (Y-BOCS), and mediation analyses were conducted. Our results indicate that the association between OCD and attachment anxiety/avoidance was mediated by emotion dysregulation. The primary limitation of our study is that data are cross-sectional and, therefore, we cannot infer anything about the causal direction of these relationships. A second limitation of the study is that two of the three measures were derived from self-reported questionnaires, which may be prone to biassed reporting. Our results suggest that insecure attachment is important in OCD when taking emotion regulation into account. Thus, clinical interventions for OCD may improve by targeting attachment and difficulties related to emotion regulation. However, our findings are based on cross-sectional data that preclude conclusions relating to causal influence.

Caregivers of young people with borderline personality disorder (BPD) or BPD features experience significant burden and distress and often lack effective coping strategies. A family environment of pervasive invalidation can contribute to the disorder and work against effective coping. Consequently, some psychotherapy interventions for young people with BPD or BPD features aim to incorporate caregivers in treatment to varying degrees. This review synthesised results of existing studies that included caregivers in psychotherapy alongside their young person and that examined caregiver outcomes using quantitative measures. The review and literature search were conducted in accordance with PRISMA guidelines. Searches of five databases returned a total of 2988 articles, of which 10 met inclusion criteria and only two of which were RCTs. Seven used a dialectical behaviour therapy approach, two used brief psychoeducation, and one was an online social group. Articles examined changes in caregivers regarding treatment feasibility and satisfaction, emotion communication, perceived knowledge of BPD and caregiver mental health, burden and stress. Although there are few studies and results are limited by considerable methodological limitations, results suggest that including caregivers in treatment alongside young people, even in a brief capacity, may improve caregiver outcomes on several measures. Inclusion of caregivers is conceptually particularly pertinent for BPD for young people, and this review reveals important clinical implications and clear future research directions.

Many trauma-affected voice hearers report comorbid posttraumatic stress and voices (auditory verbal hallucinations) that are directly (voices repeat phrases spoken by perpetrators) or indirectly (voice content and trauma are thematically similar) related to their trauma. Models of PTSD and positive symptoms of psychosis are insufficient in explaining the comorbidity between PTSD and voices, and interventions based on these models have limited effectiveness in treating voices. This study presents a model that generates novel research into the factors underlying trauma-related voices that may inform effective interventions. Maintaining factors from existing models of PTSD and positive symptoms were combined into an integrative model of trauma-related voices. Theorised relationships between factors were used to identify possible differential pathways to direct and indirect voices. An integrative, trauma-related voices (TRV) model was developed that identifies multiple causal pathways to trauma-related voices. A future research agenda is proposed to test novel hypotheses based on the integrative model. The TRV model is a practical tool for complex case conceptualisation and generates novel hypotheses that may inform more effective treatments. Future studies are needed to test elements of the TRV model and should recruit transdiagnostic samples with diverse posttraumatic stress and voice hearing symptoms.

Although clinician-supported computer-assisted cognitive-behaviour therapy (CCBT) is well established as an effective treatment for depression and anxiety, less is known about the specific interventions used during coaching sessions that contribute to outcomes. The current study used artificial intelligence (AI) to identify specific components of clinician-supported CCBT and correlated those scores with therapy outcomes. Data from a randomized clinical trial comparing clinician-supported CCBT with treatment as usual in a primary care setting were utilized. Participants (n = 95) engaged in CCBT with coaching sessions. The primary outcome was the Patient Health Questionnaire (PHQ-9), with Generalized Anxiety Disorder (GAD-7), Satisfaction with Life Scale (SWLS) and Automatic Thoughts Questionnaire (ATQ) ratings as secondary outcomes, which were assessed at 12 weeks (post), 3- and 6-month follow-up. The Lyssn system utilized AI technology to code CBT techniques and common general psychotherapeutic techniques. After controlling for initial ratings, 13 Lyssn-variables were observed to be significantly associated with reducing anxiety on the GAD-7 after 12 weeks of treatment. Among the most effective CBT interventions for anxiety included the use of guided discovery, understanding, interpersonal effectiveness and agenda setting. The most beneficial intervention was the proportion of open questions across all variables. Lyssn did not identify any CBT-specific interventions significantly associated with PHQ-9, SWLS or ATQ. Therapist use of CBT-specific techniques was significantly associated with reduction of anxiety symptoms after 12 weeks, but such gains were not observed at follow up. Therapist use of open questions was observed to be the most impactful technique contributing to treatment outcomes.