Clinical psychology & psychotherapy最新文献

This study examined whether clients with more impaired interpersonal functioning benefit more from alliance rupture–repairs. Accordingly, we investigated if a client's level of interpersonal functioning moderates the relationship between alliance rupture patterns and psychotherapy outcomes. Data from 514 adults in outpatient psychotherapy were analysed. Treatments were classified into three rupture patterns: no rupture (57.8%), unrepaired rupture (32.8%) or repaired rupture (9.3%). Multilevel modelling examined the interaction between rupture patterns and interpersonal functioning in predicting the rate of symptom change. A significant interaction between the repaired rupture pattern and interpersonal functioning was found. Clients with more impaired interpersonal functioning showed steeper symptom improvement following repaired ruptures compared with clients with better interpersonal functioning. This effect persisted only in longer treatments (more than seven sessions). Clients with significant interpersonal difficulties benefit more from rupture–repair processes. Results contribute a step towards personalized treatment and validate the notion that different patterns of alliance development may benefit different clients.

Natural disasters disproportionately affect mental health in low- and middle-income countries (LMICs), where access to specialised trauma-focused treatments is limited. Although cognitive processing therapy (CPT) is wellsupported by evidence, its use in post-disaster settings remains underexplored. This pilot randomised controlled trial evaluated the feasibility, acceptability, and preliminary effectiveness of telehealth-delivered CPT among earthquake-affected adults in Türkiye. Thirty-six participants with elevated post-traumatic stress disorder (PTSD) symptoms were randomised to either telehealth-delivered CPT or a treatment-as-usual (TAU) control group. Outcomes included PTSD (PCL-5), depression (PHQ-9), anxiety (GAD-7), psychological distress (K10), and well-being (WHO-5), assessed at baseline, post-treatment, and 1-month follow-up. CPT was feasible and acceptable, with high treatment completion rates (88.8%). At 1-month follow-up, the CPT group showed greater reductions in PTSD symptoms relative to TAU (adjusted mean difference = −21.812, 95% CI −29.07, −14.54, p < 0.001, d = 1.63). CPT also led to improvements in depression (adjusted mean difference = −3.15, 95% CI −6.19, −0.11, p = 0.045, d = 0.59), anxiety (adjusted mean difference = −2.54, 95% CI −4.98, −0.10, p = 0.046, d = 0.58), distress (adjusted mean difference = −7.62, 95% CI −11.66, −3.55, p < 0.001, d = 1.07) and well-being (adjusted mean difference = 4.57, 95% CI 1.62, 7.51, p = 0.014, d = 0.82). These findings suggest that telehealth-delivered CPT is a feasible, acceptable, and potentially effective intervention for post-disaster mental health care in LMIC settings. To our knowledge, this is the first trial to adapt and evaluate CPT for post-disaster care in an LMIC context.

This study aims to identify the profiles of post-traumatic symptoms observed in children and adolescents aged 7 to 17 who were traumatised by experiencing the February 6 earthquakes, which are referred to as the disaster of the century in Türkiye and were centred in Kahramanmaraş, and to reveal the extent to which these identified profiles differ in terms of post-traumatic cognitions, trauma-related safety behaviour, depression, anxiety and well-being. In this context, data were collected from 282 children and adolescents residing in the earthquake-affected areas and analysed using latent profile analysis to determine the structure of post-traumatic symptoms. The analyses revealed five profiles: CPTSD, Avoidance, Disturbance in Self-Organization, Mild CPTSD and a low symptoms class. It was observed that the CPTSD profile displayed the highest levels of trauma symptoms, post-traumatic cognitions and depression compared to the other groups. In contrast, the low symptoms profile demonstrated the lowest levels of trauma-related difficulties. No significant differences were observed across profiles in terms of anxiety, safety behaviours or well-being, and no gender differences emerged between groups. These findings indicate that post-traumatic symptom structures in children and adolescents are heterogeneous, with post-traumatic cognitions and depression particularly elevated among those in the CPTSD profile.

This study aimed to expand the applicability of the three-dimensional psychological pain model for suicide prediction in clinical practice. A total of 548 psychiatric patients were recruited, of whom 56.9% had major depressive disorder, 28.5% bipolar disorder, 14.6% substance use disorder and 28.1% a history of suicide attempt (SA). Centrality measures and bridge factors were analyzed to map the close connections among psychological pain, severity of symptoms and SAs through network analysis. Joint profiles of psychological pain and depressive symptoms, and their associations with SA were also tested through latent profile and receiver operating characteristic curve analyses. Emotional and cognitive manifestations of depressive symptoms emerged as the top two most central nodes in each patient group. Importantly, pain avoidance showed the strongest direct and positive associations with SA, significantly surpassing depressive symptoms. Pain avoidance acted as the most prominent bridge variable with the highest bridge expected influence, mediating the relationship between depressive symptoms and SAs. Patients in the pain-avoidance and depressive symptoms class were approximately four times (OR = 3.47–4.63) as likely to report SA as those in the other two classes. Pain avoidance displayed superior performance (AUC = 0.77) than depressive symptoms in accurately identifying suicide attempters with these three psychiatric disorders. Compared to depression, pain avoidance is a more proximal trigger of SAs in patients with psychiatric disorders characterized by emotional and behavioural control deficits. Pain avoidance may bridge the gap between depressive symptoms and a risk of SA in such clinical populations.

Research on different aspects of mentalizing is essential for understanding the mechanisms underlying personality disorders (PDs) and for informing psychotherapy approaches, in which mentalizing is considered a key mechanism of change. This study aimed to explore whether self- and other-mentalizing, in interaction with attachment insecurity, differentially explain Criteria A (level of personality functioning) and B (maladaptive traits) of the Alternative Model for Personality Disorders in the DSM-5. Our sample consisted of 109 participants (54% female, 41% male and 5% nonbinary). We used the Structured Clinical Interview for DSM-5 Personality Disorders, a Movie for the Assessment of Social Cognition, the Reflective Functioning Questionnaire, the Experiences in Close Relationships—Revised, the Self and Interpersonal Functioning Scale and the Personality Inventory for DSM-5. Regression analyses show that self-mentalizing deficits uniquely predict both Criterion A domains (self and interpersonal functioning) and all five maladaptive traits, while other-mentalizing is relevant only to interpersonal functioning. Explained variance (adjusted R²) ranges from 55% to 18%. Additionally, mentalization moderates the relationship between insecure attachment and personality pathology (interpersonal functioning, Negative Affectivity and Detachment), mainly with greater mentalization deficits linked to more severe personality dysfunction under heightened attachment insecurity. Our findings authorize mentalizing as a crucial factor in PD, supporting the potential value of mentalization-focused interventions in addressing both the severity and the ‘flavour’ of PD. Notably, our findings suggest a hierarchy within self- and other-mentalizing, indicating that self- mentalizing plays a more foundational role in PD. Through a comprehensive, multimethod assessment of mentalization, this study offers a refined understanding of its role in psychopathology, providing valuable insights that could guide the development of more targeted therapeutic interventions.

Personal stigma in psychosis, encompassing perceived and internalised stigma, poses a significant barrier to recovery and well-being. This study investigates the effectiveness of Individualised Metacognitive Training (MCT+) in reducing personal stigma among individuals with recent-onset psychosis, with a focus on sex-specific outcomes and the predictive roles of self-certainty, self-esteem and quality of life (QoL). A randomised controlled trial was conducted across multiple Spanish clinical sites, comparing MCT+ with treatment as usual. Participants were assessed at baseline, post-treatment and 6-month follow-up using validated measures of stigma, cognitive insight, QoL and self-esteem. Robust linear mixed models revealed that MCT+ significantly reduced perceived stigma over time, with QoL emerging as a strong predictor of perceived stigma levels. However, no significant effects were observed for internalised stigma, although self-certainty was positively associated with its severity. Exploratory analyses suggested potential sex differences in stigma trajectories, with males showing greater improvements in internalised stigma. These findings highlight the nuanced impact of metacognitive interventions on stigma and underscore the importance of tailoring treatments to individual psychosocial and cognitive profiles. Future research should explore gender-sensitive adaptations of MCT+ and the inclusion of targeted self-stigma modules to enhance intervention efficacy.