Although family-based interventions are effective for adolescents with anorexia nervosa (AN), they often neglect the intense emotional burden faced by parents, which may limit their full therapeutic impact. This study aimed to pilot the CAREFREE parent-focused schema coaching programme and evaluate its feasibility, acceptability and preliminary effects on parental emotion regulation, parent–child interaction and adolescent AN outcomes. A three-tiered non-concurrent multiple baseline design was employed. Participants were Iranian mothers (M = 44.7 years, SD = 2.19) of female adolescents with AN (M = 15.16 years, SD = 5.54) enrolled in the 12-week online CAREFREE intervention. Outcomes were assessed at four time points using validated measures of parental difficulties in emotion regulation (DERS-16), parent–child interaction (PACHIQ-R) and adolescent percentage of median body mass index (%mBMI), alongside weekly visual analogue scales (VAS) assessing parental guilt, anger management, empathy and emotional presence. Feasibility, acceptability, and intervention fidelity were evaluated. Data were analysed in R software using visual inspection, non-overlap indices and linear mixed-effects modelling. Significant improvements were observed in all parental outcomes, including guilt, anger management, empathy, emotional presence, difficulties in emotion regulation and parent–child interaction, with effects maintained at follow-up. Adolescents' %mBMI significantly increased, whereas no significant changes were found in their body image-related outcomes. Feasibility and acceptability were supported by acceptable completion rates and high parent satisfaction. The CAREFREE intervention was feasible and acceptable and showed promising effects on parental functioning and adolescent weight outcomes. However, future research should incorporate direct adolescent-focused components, and larger controlled trials are required to more rigorously assess the intervention's impact.
Trial Registration: Iranian Registry of Clinical Trials: IRCT20220714055467N1
{"title":"Parent-Focused Group Schema Coaching; CAREFREE (Carers Programme for Fluency in Resonance and Empowerment in Eating Disorders) Intervention for Parents of Adolescents With Anorexia Nervosa: A Multiple Baseline Design","authors":"Fatemeh Seifi, Javad Molazadeh, Abdulaziz Aflakseir, Changiz Rahimi Taghanaki, Susan Simpson","doi":"10.1002/cpp.70157","DOIUrl":"https://doi.org/10.1002/cpp.70157","url":null,"abstract":"<div>\u0000 \u0000 <p>Although family-based interventions are effective for adolescents with anorexia nervosa (AN), they often neglect the intense emotional burden faced by parents, which may limit their full therapeutic impact. This study aimed to pilot the CAREFREE parent-focused schema coaching programme and evaluate its feasibility, acceptability and preliminary effects on parental emotion regulation, parent–child interaction and adolescent AN outcomes. A three-tiered non-concurrent multiple baseline design was employed. Participants were Iranian mothers (M = 44.7 years, SD = 2.19) of female adolescents with AN (M = 15.16 years, SD = 5.54) enrolled in the 12-week online CAREFREE intervention. Outcomes were assessed at four time points using validated measures of parental difficulties in emotion regulation (DERS-16), parent–child interaction (PACHIQ-R) and adolescent percentage of median body mass index (%mBMI), alongside weekly visual analogue scales (VAS) assessing parental guilt, anger management, empathy and emotional presence. Feasibility, acceptability, and intervention fidelity were evaluated. Data were analysed in R software using visual inspection, non-overlap indices and linear mixed-effects modelling. Significant improvements were observed in all parental outcomes, including guilt, anger management, empathy, emotional presence, difficulties in emotion regulation and parent–child interaction, with effects maintained at follow-up. Adolescents' %mBMI significantly increased, whereas no significant changes were found in their body image-related outcomes. Feasibility and acceptability were supported by acceptable completion rates and high parent satisfaction. The CAREFREE intervention was feasible and acceptable and showed promising effects on parental functioning and adolescent weight outcomes. However, future research should incorporate direct adolescent-focused components, and larger controlled trials are required to more rigorously assess the intervention's impact.</p>\u0000 <p><b>Trial Registration:</b> Iranian Registry of Clinical Trials: IRCT20220714055467N1</p>\u0000 </div>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":"32 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matteo Aloi, Marianna Rania, Elvira Anna Carbone, Renato de Filippis, Ettore D'Onofrio, Lavinia Rotella, Daria Quirino, Susan Simpson, Cristina Segura-Garcia
Early maladaptive schemas (EMSs) are stable cognitive-emotional patterns central to the psychopathology of eating disorders (EDs) and obesity. This study used a schema therapy–informed network analysis to explore the structure and significance of EMSs in people with anorexia nervosa (AN, n = 129), bulimia nervosa (BN, n = 124), binge-eating disorder (BED, n = 166), and obesity (n = 152). Networks were modelled using the Young Schema Questionnaire (YSQ-S3), with expected influence as the main centrality, in a final sample of 571 patients. In AN, the most central schemas were Defectiveness/Shame, Negativity/Pessimism, and Subjugation, reflecting self-criticism, hopelessness, and submission. BN showed a similar pattern with high centrality for Subjugation, Defectiveness/Shame, and Negativity/Pessimism. In BED, central EMSs included Subjugation, Social Isolation, Negativity/Pessimism, and Abandonment, emphasizing loneliness and emotional vulnerability. The obesity group showed dominant roles for Negativity/Pessimism, Social Isolation, Subjugation, and Mistrust/Abuse, indicating patterns of mistrust, hopelessness, and relational avoidance. Negativity/Pessimism and Subjugation were central across all groups, highlighting their transdiagnostic relevance. Interestingly, Social Isolation appeared prominently in BED and obesity, possibly associated with earlier experiences of bullying and rejection. These findings underscore the clinical value of targeting central EMSs in schema therapy, offering a network-based framework to guide individualized interventions across EDs and obesity.
早期适应不良图式（EMSs）是稳定的认知-情绪模式，是饮食失调（EDs）和肥胖的精神病理的核心。本研究采用图式治疗为基础的网络分析，探讨神经性厌食症（AN, n = 129）、神经性贪食症（BN, n = 124）、暴食症（BED, n = 166）和肥胖症（n = 152）患者的EMSs结构及其意义。使用Young图式问卷（YSQ-S3）对网络进行建模，以预期影响为主要中心性，最终样本为571例患者。在AN中，最核心的图式是缺陷/羞耻、消极/悲观和征服，反映了自我批评、绝望和屈服。BN表现出类似的模式，在征服、缺陷/羞耻和消极/悲观方面具有较高的中心性。在BED中，主要的EMSs包括征服、社会孤立、消极/悲观和遗弃，强调孤独和情感脆弱。肥胖组表现出消极/悲观、社会孤立、征服和不信任/虐待的主导作用，表明不信任、绝望和关系回避的模式。消极/悲观和征服是所有群体的中心，突出了它们的跨诊断相关性。有趣的是，社会孤立在BED和肥胖中表现突出，可能与早期的欺凌和拒绝经历有关。这些发现强调了在图式治疗中针对中心EMSs的临床价值，提供了一个基于网络的框架来指导ed和肥胖的个性化干预。
{"title":"Early Maladaptive Schemas as Core Therapeutic Targets in Eating Disorders and Obesity: A Schema Therapy–Informed Network Analysis","authors":"Matteo Aloi, Marianna Rania, Elvira Anna Carbone, Renato de Filippis, Ettore D'Onofrio, Lavinia Rotella, Daria Quirino, Susan Simpson, Cristina Segura-Garcia","doi":"10.1002/cpp.70153","DOIUrl":"https://doi.org/10.1002/cpp.70153","url":null,"abstract":"<p>Early maladaptive schemas (EMSs) are stable cognitive-emotional patterns central to the psychopathology of eating disorders (EDs) and obesity. This study used a schema therapy–informed network analysis to explore the structure and significance of EMSs in people with anorexia nervosa (AN, <i>n</i> = 129), bulimia nervosa (BN, <i>n</i> = 124), binge-eating disorder (BED, <i>n</i> = 166), and obesity (<i>n</i> = 152). Networks were modelled using the Young Schema Questionnaire (YSQ-S3), with expected influence as the main centrality, in a final sample of 571 patients. In AN, the most central schemas were Defectiveness/Shame, Negativity/Pessimism, and Subjugation, reflecting self-criticism, hopelessness, and submission. BN showed a similar pattern with high centrality for Subjugation, Defectiveness/Shame, and Negativity/Pessimism. In BED, central EMSs included Subjugation, Social Isolation, Negativity/Pessimism, and Abandonment, emphasizing loneliness and emotional vulnerability. The obesity group showed dominant roles for Negativity/Pessimism, Social Isolation, Subjugation, and Mistrust/Abuse, indicating patterns of mistrust, hopelessness, and relational avoidance. Negativity/Pessimism and Subjugation were central across all groups, highlighting their transdiagnostic relevance. Interestingly, Social Isolation appeared prominently in BED and obesity, possibly associated with earlier experiences of bullying and rejection. These findings underscore the clinical value of targeting central EMSs in schema therapy, offering a network-based framework to guide individualized interventions across EDs and obesity.</p>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":"32 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cpp.70153","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alba Palazón-Llecha, Joan Trujols, Mercè Madre, Santiago Duran-Sindreu, Francesca Batlle, Núria Mallorquí-Bagué
Objective
Traditional treatment approaches in cocaine use disorder (CUD) still report high rates of poor outcomes. Emotion regulation (ER) is a transdiagnostic factor that may contribute to the initiation and maintenance of CUD, strengthening addiction severity. A deeper understanding of ER in this population is crucial for improving treatment outcomes. This study explores whether ER difficulties at treatment entry predict addiction severity and withdrawal symptom severity after discharge in patients with CUD. Secondarily, it examines whether withdrawal symptom severity mediates the relationship between ER difficulties and relapse.
Methods
A total of 70 CUD patients underwent a 14-day inpatient detoxification. At admission, cocaine use–related variables and ER questionnaires (DERS and ERQ) were registered. After discharge, addiction severity (SDS), craving (WCS), cocaine withdrawal symptom severity (CSSA) and relapse were recorded. Multiple linear regression and mediation analysis were conducted to address the primary and secondary aims, respectively. This study draws on data from a larger randomized clinical trial.
Results
Impulse control difficulties and nonacceptance of emotional responses predicted SDS, and nonacceptance of emotional responses predicted CSSA. However, mediation analyses showed no indirect effect of DERS total score on relapse through the effect of the mediating variable CSSA.
Conclusion
ER screening at hospitalization admission may optimize treatment by identifying high-risk CUD patients. Third-generation therapies targeting ER skills may enhance outcomes by helping patients manage emotional distress, potentially reducing addiction severity and withdrawal symptoms. Because of mixed results and the exploratory nature of this study, further research on the ER role in this context is needed.
{"title":"The Predictive Value of Emotion Regulation in Cocaine Use Disorder Severity: Psychotherapeutic Implications During Hospitalization for Detoxification","authors":"Alba Palazón-Llecha, Joan Trujols, Mercè Madre, Santiago Duran-Sindreu, Francesca Batlle, Núria Mallorquí-Bagué","doi":"10.1002/cpp.70155","DOIUrl":"https://doi.org/10.1002/cpp.70155","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Traditional treatment approaches in cocaine use disorder (CUD) still report high rates of poor outcomes. Emotion regulation (ER) is a transdiagnostic factor that may contribute to the initiation and maintenance of CUD, strengthening addiction severity. A deeper understanding of ER in this population is crucial for improving treatment outcomes. This study explores whether ER difficulties at treatment entry predict addiction severity and withdrawal symptom severity after discharge in patients with CUD. Secondarily, it examines whether withdrawal symptom severity mediates the relationship between ER difficulties and relapse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 70 CUD patients underwent a 14-day inpatient detoxification. At admission, cocaine use–related variables and ER questionnaires (DERS and ERQ) were registered. After discharge, addiction severity (SDS), craving (WCS), cocaine withdrawal symptom severity (CSSA) and relapse were recorded. Multiple linear regression and mediation analysis were conducted to address the primary and secondary aims, respectively. This study draws on data from a larger randomized clinical trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Impulse control difficulties and nonacceptance of emotional responses predicted SDS, and nonacceptance of emotional responses predicted CSSA. However, mediation analyses showed no indirect effect of DERS total score on relapse through the effect of the mediating variable CSSA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ER screening at hospitalization admission may optimize treatment by identifying high-risk CUD patients. Third-generation therapies targeting ER skills may enhance outcomes by helping patients manage emotional distress, potentially reducing addiction severity and withdrawal symptoms. Because of mixed results and the exploratory nature of this study, further research on the ER role in this context is needed.</p>\u0000 \u0000 <p><b>Trial Registration:</b> ClinicalTrials.gov; ID: NCT05207228.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":"32 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cpp.70155","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Schizotypy provides a theoretically grounded framework for investigating psychosis proneness, reflecting a multidimensional structure that parallels the positive, negative and disorganized symptoms of schizophrenia. Alexithymia, a trait characterized by difficulties in identifying (DIF) and describing feelings (DDF) and a tendency towards externally oriented thinking (EOT), has been robustly linked to schizophrenia. Despite these associations, the relationship between alexithymia and schizotypy remains underexplored. Moreover, given that both constructs are closely associated with negative affect, it is critical to account for this potential confound to estimate their associations accurately.
Method
We employed a cross-sectional design in a non-clinical sample to examine the associations among the dimensions of alexithymia, negative affect and schizotypy. Network models were estimated using Spearman correlations and the EBICglasso method to capture conditionally independent associations.
Results
The sample (N = 420) was predominantly female (n = 314), with ages ranging from 18 to 37 years (M = 28.72, SD = 4.52). More than half (n = 232) reported receiving mental health treatment, and 127 participants self-reported a personal history of psychosis. DIF and negative schizotypy emerged as central to different clusters in the network. Specifically, DIF served as a bridge linking positive and disorganized schizotypy dimensions to anxiety and stress, whereas negative schizotypy was a central bridge connecting DDF and EOT to depression. These estimates were psychometrically stable.
Conclusion
Our findings suggest DIF and negative schizotypy as plausible mechanisms of change facilitating emotional attunement and resilience against distress due to unusual self-experiences.
{"title":"Alexithymia as a Bridge Between Negative Affect and Schizotypy: A Cross-Sectional Network Model","authors":"Ercan Ozdemir, Angus MacBeth, Helen Griffiths","doi":"10.1002/cpp.70156","DOIUrl":"10.1002/cpp.70156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Schizotypy provides a theoretically grounded framework for investigating psychosis proneness, reflecting a multidimensional structure that parallels the positive, negative and disorganized symptoms of schizophrenia. Alexithymia, a trait characterized by difficulties in identifying (DIF) and describing feelings (DDF) and a tendency towards externally oriented thinking (EOT), has been robustly linked to schizophrenia. Despite these associations, the relationship between alexithymia and schizotypy remains underexplored. Moreover, given that both constructs are closely associated with negative affect, it is critical to account for this potential confound to estimate their associations accurately.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We employed a cross-sectional design in a non-clinical sample to examine the associations among the dimensions of alexithymia, negative affect and schizotypy. Network models were estimated using Spearman correlations and the EBICglasso method to capture conditionally independent associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The sample (<i>N</i> = 420) was predominantly female (<i>n</i> = 314), with ages ranging from 18 to 37 years (<i>M</i> = 28.72, SD = 4.52). More than half (<i>n</i> = 232) reported receiving mental health treatment, and 127 participants self-reported a personal history of psychosis. DIF and negative schizotypy emerged as central to different clusters in the network. Specifically, DIF served as a bridge linking positive and disorganized schizotypy dimensions to anxiety and stress, whereas negative schizotypy was a central bridge connecting DDF and EOT to depression. These estimates were psychometrically stable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings suggest DIF and negative schizotypy as plausible mechanisms of change facilitating emotional attunement and resilience against distress due to unusual self-experiences.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":"32 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cpp.70156","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The study investigated the relationship between early maladaptive schemas (EMS), gaming disorder (GD) and alcohol use disorder (AUD) symptoms. Previous studies did not address the possible relationship between AUD and GD symptoms, which could lead to an incomplete understanding of the relationship between EMS and these disordered behaviours. The current study addressed this research gap by testing the relationship between AUD, GD symptoms and EMS.
Methods
The study included 1054 participants (565 females, M = 22.96 years, SD = 2.52) who reported playing video games and consuming alcohol within the past 12 months. Participants completed the Young Schema Questionnaire (YSQ-S3), Gaming Disorder Test (GDT) and Problem Drinking Scale (PDS). Seemingly Unrelated Regression (SUR) analysis was used to model the relationships between EMS, GD and AUD symptoms while controlling for gender, age, gaming hours and alcohol consumption frequency.
Results
AUD symptoms were positively associated with dependence/incompetence, vulnerability to harm or illness, self-punitiveness and entitlement/grandiosity schemas and negatively related to social isolation/alienation and insufficient self-control/self-discipline schemas. GD symptoms were positively related to enmeshment and subjugation schemas and negatively associated with unrelenting standards and pessimism/negativism schemas. Significant differences were found between GD and AUD symptoms in their associations with specific EMS, suggesting distinct psychological pathways.
Conclusions
The findings highlighted the differential roles of EMS in AUD and GD symptoms. The results suggest that EMS contribute uniquely to addictive behaviours and underscore the importance of considering schema-based interventions. Future research should further explore the mediating role of parenting styles in the development of AUD and GD symptoms.
{"title":"Early Maladaptive Schemas and Gaming and Alcohol Use Disorder Symptoms","authors":"Andrzej Cudo, Dorota Mącik","doi":"10.1002/cpp.70152","DOIUrl":"10.1002/cpp.70152","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The study investigated the relationship between early maladaptive schemas (EMS), gaming disorder (GD) and alcohol use disorder (AUD) symptoms. Previous studies did not address the possible relationship between AUD and GD symptoms, which could lead to an incomplete understanding of the relationship between EMS and these disordered behaviours. The current study addressed this research gap by testing the relationship between AUD, GD symptoms and EMS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study included 1054 participants (565 females, M = 22.96 years, SD = 2.52) who reported playing video games and consuming alcohol within the past 12 months. Participants completed the Young Schema Questionnaire (YSQ-S3), Gaming Disorder Test (GDT) and Problem Drinking Scale (PDS). Seemingly Unrelated Regression (SUR) analysis was used to model the relationships between EMS, GD and AUD symptoms while controlling for gender, age, gaming hours and alcohol consumption frequency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>AUD symptoms were positively associated with dependence/incompetence, vulnerability to harm or illness, self-punitiveness and entitlement/grandiosity schemas and negatively related to social isolation/alienation and insufficient self-control/self-discipline schemas. GD symptoms were positively related to enmeshment and subjugation schemas and negatively associated with unrelenting standards and pessimism/negativism schemas. Significant differences were found between GD and AUD symptoms in their associations with specific EMS, suggesting distinct psychological pathways.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings highlighted the differential roles of EMS in AUD and GD symptoms. The results suggest that EMS contribute uniquely to addictive behaviours and underscore the importance of considering schema-based interventions. Future research should further explore the mediating role of parenting styles in the development of AUD and GD symptoms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":"32 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cristina Zarbo, Maciej Stolarski, Donato Martella, Elena Toffol, Giovanni de Girolamo, for the DIAPASON consortium
Objectives
The time perspective dimensions and balanced time perspective (BTP) may play a crucial role in the therapeutic process of individuals with schizophrenia spectrum disorders (SSDs). This study aimed to investigate the relationship between BTP, working alliance (WA) and psychiatric symptomatology in individuals with SSD.
Methods
A total of 313 residential patients with SSD were recruited from 98 residential facilities in Italy. Clinicians completed the Brief Psychiatric Rating Scale (BPRS) and the Brief Negative Symptom Scale (BNSS), while patients completed the Zimbardo Time Perspective Inventory (ZTPI) and the Working Alliance Inventory–Short Form (WAI). Deviation from Balanced Time Perspective–revised (DBTP-r) was applied as an estimate of unbalanced TP. Statistical analyses included Pearson correlations and mediation models. Age, sex, illness duration and years of education were controlled in mediation analyses.
Results
DBTP-r showed significant negative correlations with WAI total and positive correlations with BPRS and BNSS. ZTPI-Present Fatalistic negatively correlated with WAI-Goal. The WAI partially mediated the effect of DBTP-r on both BPRS and BNSS, while DBTP-r partially mediated the impact of WAI on both BPRS and BNSS.
Conclusions
BTP played a dual role, acting both as a contributing factor to and a result of the WA. The present-fatalistic TP emerged as a key factor in shaping WA concerning therapeutic goals. Findings underscore the importance of considering (B)TP as both a potential resource and a therapeutic target in treating SSD.
{"title":"Time Perspective Matters for Working Alliance in Schizophrenia Care: Insights From the DiAPAson Project","authors":"Cristina Zarbo, Maciej Stolarski, Donato Martella, Elena Toffol, Giovanni de Girolamo, for the DIAPASON consortium","doi":"10.1002/cpp.70151","DOIUrl":"10.1002/cpp.70151","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The time perspective dimensions and balanced time perspective (BTP) may play a crucial role in the therapeutic process of individuals with schizophrenia spectrum disorders (SSDs). This study aimed to investigate the relationship between BTP, working alliance (WA) and psychiatric symptomatology in individuals with SSD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 313 residential patients with SSD were recruited from 98 residential facilities in Italy. Clinicians completed the Brief Psychiatric Rating Scale (BPRS) and the Brief Negative Symptom Scale (BNSS), while patients completed the Zimbardo Time Perspective Inventory (ZTPI) and the Working Alliance Inventory–Short Form (WAI). Deviation from Balanced Time Perspective–revised (DBTP-r) was applied as an estimate of unbalanced TP. Statistical analyses included Pearson correlations and mediation models. Age, sex, illness duration and years of education were controlled in mediation analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>DBTP-r showed significant negative correlations with WAI total and positive correlations with BPRS and BNSS. ZTPI-Present Fatalistic negatively correlated with WAI-Goal. The WAI partially mediated the effect of DBTP-r on both BPRS and BNSS, while DBTP-r partially mediated the impact of WAI on both BPRS and BNSS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>BTP played a dual role, acting both as a contributing factor to and a result of the WA. The present-fatalistic TP emerged as a key factor in shaping WA concerning therapeutic goals. Findings underscore the importance of considering (B)TP as both a potential resource and a therapeutic target in treating SSD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":"32 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ó. Peris-Baquero, J. D. Moreno, L. Martínez-García, J. Pérez González, J. Osma
Dropout, defined as the unilateral discontinuation of treatment before achieving goals or completing a set number of sessions, affects a large number of individuals. Additionally, many individuals do not experience an improvement of symptoms after treatment. This study has explored the profile of individuals who drop out or do not respond favourably to the Unified Protocol (UP) applied in group format. This is a secondary analysis of a RCT that involved 277 participants (78.3% women) diagnosed with emotional disorders who received 12-weekly group sessions at specialized mental health units. Socio-demographic variables, personality, anxiety and depression symptoms and emotional regulation were analysed at baseline, post-treatment and 12-month follow-up. Fewer emotional regulation difficulties at baseline predict higher dropout rates at post-treatment, with 28.9% of participants (n = 80) receiving fewer than six sessions. Additionally, 46.0% of participants showed no change in the severity of depressive symptoms, and 56.8% showed no change in anxiety symptoms post-treatment. At the 12-month follow-up, 31.1% of participants maintained the same severity level for depressive symptoms and 49.5% for anxiety symptoms. Higher baseline anxiety and emotional dysregulation and lower extraversion predicted higher depressive symptoms at post-treatment, and higher baseline anxiety predicted higher depressive symptomatology at the 12-month follow-up. Higher baseline depression and emotional dysregulation predicted higher post-treatment anxiety, and depression also predicted higher anxiety at the 12-month follow-up. Additionally, high baseline depression predicted higher neuroticism and emotional dysregulation and lower extraversion after treatment and at the 12-month follow-up (for neuroticism and extraversion). Finally, high baseline emotional dysregulation predicted higher neuroticism post-treatment, whereas high baseline maladjustment predicted lower emotional dysregulation at post-treatment. Emotional dysregulation, neuroticism, extraversion and especially baseline depression and anxiety symptoms are key factors associated with dropouts and treatment response when applying the UP in group format. Considering these variables may improve attendance and treatment outcomes.
{"title":"Defining the Profile of People With Emotional Disorders That Drop Out or Do Not Respond to Treatment After Receiving the Unified Protocol in Group Format","authors":"Ó. Peris-Baquero, J. D. Moreno, L. Martínez-García, J. Pérez González, J. Osma","doi":"10.1002/cpp.70154","DOIUrl":"10.1002/cpp.70154","url":null,"abstract":"<div>\u0000 \u0000 <p>Dropout, defined as the unilateral discontinuation of treatment before achieving goals or completing a set number of sessions, affects a large number of individuals. Additionally, many individuals do not experience an improvement of symptoms after treatment. This study has explored the profile of individuals who drop out or do not respond favourably to the Unified Protocol (UP) applied in group format. This is a secondary analysis of a RCT that involved 277 participants (78.3% women) diagnosed with emotional disorders who received 12-weekly group sessions at specialized mental health units. Socio-demographic variables, personality, anxiety and depression symptoms and emotional regulation were analysed at baseline, post-treatment and 12-month follow-up. Fewer emotional regulation difficulties at baseline predict higher dropout rates at post-treatment, with 28.9% of participants (<i>n</i> = 80) receiving fewer than six sessions. Additionally, 46.0% of participants showed no change in the severity of depressive symptoms, and 56.8% showed no change in anxiety symptoms post-treatment. At the 12-month follow-up, 31.1% of participants maintained the same severity level for depressive symptoms and 49.5% for anxiety symptoms. Higher baseline anxiety and emotional dysregulation and lower extraversion predicted higher depressive symptoms at post-treatment, and higher baseline anxiety predicted higher depressive symptomatology at the 12-month follow-up. Higher baseline depression and emotional dysregulation predicted higher post-treatment anxiety, and depression also predicted higher anxiety at the 12-month follow-up. Additionally, high baseline depression predicted higher neuroticism and emotional dysregulation and lower extraversion after treatment and at the 12-month follow-up (for neuroticism and extraversion). Finally, high baseline emotional dysregulation predicted higher neuroticism post-treatment, whereas high baseline maladjustment predicted lower emotional dysregulation at post-treatment. Emotional dysregulation, neuroticism, extraversion and especially baseline depression and anxiety symptoms are key factors associated with dropouts and treatment response when applying the UP in group format. Considering these variables may improve attendance and treatment outcomes.</p>\u0000 </div>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":"32 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anam Mehmood, Shuyue Xu, Sultan Mehmood Siddiqi, Li Zhang, Gan Huang, Zhen Liang, Yongjie Zhou
Nonsuicidal self-injury (NSSI) is increasingly conceptualized as an addiction-like behaviour characterized by dysregulated emotional and cognitive processes. Guided by the I-PACE model, this study investigated how person-level vulnerabilities interact with affective, mental and executive functioning to maintain NSSI in clinically depressed adolescents (N = 167, aged 12–18, M = 15.37 ± 1.75 years). Results revealed strong addiction-like patterns. Childhood trauma, depression and rumination demonstrated significant associations with NSSI frequency (r = 0.59–0.61), while resilience and self-esteem served as protective factors (r = −0.53 to −0.55). A hierarchical regression model explained 69% of variance, with trauma (OR = 1.12), depressive severity (OR = 1.11), rumination (OR = 1.11) and resilience (OR = 0.90) emerging as key predictors. Mediation analyses demonstrated how these factors operate in the addictive chain. Childhood trauma and borderline traits lead to affective dysregulation, which drives cognitive deficits that ultimately undermine resilience and increase NSSI risk (β = −0.28 and −0.24). These findings support the use of an addiction framework to conceptualize NSSI, while highlighting resilience-focused interventions as critical for breaking these maladaptive cycles.
{"title":"Exploration of Nonsuicidal Self-Injury as an Addiction-Like Behaviour in Depressed Adolescents in the light of the I-PACE Model","authors":"Anam Mehmood, Shuyue Xu, Sultan Mehmood Siddiqi, Li Zhang, Gan Huang, Zhen Liang, Yongjie Zhou","doi":"10.1002/cpp.70147","DOIUrl":"10.1002/cpp.70147","url":null,"abstract":"<div>\u0000 \u0000 <p>Nonsuicidal self-injury (NSSI) is increasingly conceptualized as an addiction-like behaviour characterized by dysregulated emotional and cognitive processes. Guided by the I-PACE model, this study investigated how person-level vulnerabilities interact with affective, mental and executive functioning to maintain NSSI in clinically depressed adolescents (<i>N</i> = 167, aged 12–18, M = 15.37 ± 1.75 years). Results revealed strong addiction-like patterns. Childhood trauma, depression and rumination demonstrated significant associations with NSSI frequency (<i>r</i> = 0.59–0.61), while resilience and self-esteem served as protective factors (<i>r</i> = −0.53 to −0.55). A hierarchical regression model explained 69% of variance, with trauma (OR = 1.12), depressive severity (OR = 1.11), rumination (OR = 1.11) and resilience (OR = 0.90) emerging as key predictors. Mediation analyses demonstrated how these factors operate in the addictive chain. Childhood trauma and borderline traits lead to affective dysregulation, which drives cognitive deficits that ultimately undermine resilience and increase NSSI risk (<i>β</i> = −0.28 and −0.24). These findings support the use of an addiction framework to conceptualize NSSI, while highlighting resilience-focused interventions as critical for breaking these maladaptive cycles.</p>\u0000 </div>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":"32 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Siri Omvik, Arnheid Kvamme, Jörg Assmus, Elfrida Kvarstein, Geir Pedersen, Kjell-Einar Zahl
Introduction
Avoidant personality disorder (AvPD) is a prevalent condition characterized by low self-esteem and social withdrawal. Nonetheless, targeted psychotherapy remains limited. This study aimed to examine short-term metacognitive interpersonal therapy in group (MIT-G) tailored for AvPD and to compare the outcomes of patients receiving this treatment with patients participating in outpatient group therapies within specialized mental health services for personality disorders (representing best available practice).
Methods
The study had a quasi-experimental design and included 56 patients with AvPD who participated in MIT-G. The comparison group was derived from the Norwegian Network for Personality Disorders (N = 154). Assessments for the MIT-G group were conducted before and after treatment and at a 6-month follow-up. Outcome measures included personality functioning, alexithymia, symptoms of anxiety and depression, work/social functioning and group relationships.
Results
Significant, moderate improvements were found across all outcome measures in the MIT-G group. Enhancement in personality functioning was greater, and group relationships, specifically regarding group cohesion and perceptions of positive work, were rated more satisfactory than in the comparison group.
Conclusions
The findings suggest that MIT-G contributes to significant clinical improvements among patients with AvPD. The greater enhancement of personality functioning may link to better group relationships. Limitations include the nonrandomised design, unable to draw causal inferences.
{"title":"Metacognitive Interpersonal Therapy in Group for Avoidant Personality Disorder—A Comparison With Best Available Practice","authors":"Siri Omvik, Arnheid Kvamme, Jörg Assmus, Elfrida Kvarstein, Geir Pedersen, Kjell-Einar Zahl","doi":"10.1002/cpp.70149","DOIUrl":"10.1002/cpp.70149","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Avoidant personality disorder (AvPD) is a prevalent condition characterized by low self-esteem and social withdrawal. Nonetheless, targeted psychotherapy remains limited. This study aimed to examine short-term metacognitive interpersonal therapy in group (MIT-G) tailored for AvPD and to compare the outcomes of patients receiving this treatment with patients participating in outpatient group therapies within specialized mental health services for personality disorders (representing best available practice).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study had a quasi-experimental design and included 56 patients with AvPD who participated in MIT-G. The comparison group was derived from the Norwegian Network for Personality Disorders (<i>N</i> = 154). Assessments for the MIT-G group were conducted before and after treatment and at a 6-month follow-up. Outcome measures included personality functioning, alexithymia, symptoms of anxiety and depression, work/social functioning and group relationships.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant, moderate improvements were found across all outcome measures in the MIT-G group. Enhancement in personality functioning was greater, and group relationships, specifically regarding group cohesion and perceptions of positive work, were rated more satisfactory than in the comparison group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings suggest that MIT-G contributes to significant clinical improvements among patients with AvPD. The greater enhancement of personality functioning may link to better group relationships. Limitations include the nonrandomised design, unable to draw causal inferences.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":"32 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In recent years, nonssuicidal self-injury (NSSI) has emerged as a critical public health issue among Chinese adolescents. However, the mechanisms contributing to NSSI behaviours remain underexplored. This study examines the roles of parent–adolescent communication, anxiety and emotional intelligence in NSSI behaviours among adolescents diagnosed with depressive disorders. A cross-sectional survey was conducted with 263 Chinese adolescents diagnosed with depressive disorders. Participants completed questionnaires assessing parent–adolescent communication, anxiety, emotional intelligence and NSSI behaviours. (1) Parent–adolescent communication was significantly negatively associated with both anxiety (r = −0.425, p < 0.01) and NSSI behaviours (r = −0.47, p < 0.01) among adolescents with depressive disorders. (2) Anxiety partially mediated the association between parent–adolescent communication and NSSI, while emotional intelligence moderated the link between anxiety and NSSI. The findings suggest that positive parent–adolescent communication not only directly lowers the likelihood of NSSI but also indirectly reduces NSSI behaviours by alleviating anxiety. Furthermore, emotional intelligence plays a crucial moderating role in the association between anxiety and NSSI behaviours, highlighting its importance in developing effective prevention and intervention strategies for adolescents with depressive disorders. These findings offer theoretical insights for designing culturally sensitive mental health interventions.
近年来，非自杀性自伤（NSSI）已成为中国青少年中一个重要的公共卫生问题。然而，导致自伤行为的机制仍未得到充分探讨。本研究旨在探讨亲子沟通、焦虑和情绪智力在抑郁症青少年自伤行为中的作用。对263名被诊断为抑郁症的中国青少年进行了横断面调查。参与者完成了评估亲子沟通、焦虑、情绪智力和自伤行为的问卷。(1)抑郁障碍青少年的焦虑（r = - 0.425, p < 0.01）和自伤行为（r = - 0.47, p < 0.01）与亲子沟通呈显著负相关。(2)焦虑在亲子沟通与自伤之间起部分中介作用，而情绪智力在焦虑与自伤之间起调节作用。研究结果表明，积极的亲子沟通不仅可以直接降低自伤的可能性，还可以通过缓解焦虑间接减少自伤行为。此外，情绪智力在焦虑和自伤行为之间的关系中起着至关重要的调节作用，突出了它在制定有效的预防和干预策略对青少年抑郁症的重要性。这些发现为设计具有文化敏感性的心理健康干预措施提供了理论见解。
{"title":"Parent–Child Communication and NSSI in Depressed Adolescents: The Role of Anxiety and Emotional Intelligence","authors":"Yiran Ge, Xinyu Xi, Ziyan Wang, Yanping Wang, Yifan Wang, Xingguang Wang, Jiajia Yang, Youdong Li","doi":"10.1002/cpp.70124","DOIUrl":"https://doi.org/10.1002/cpp.70124","url":null,"abstract":"<div>\u0000 \u0000 <p>In recent years, nonssuicidal self-injury (NSSI) has emerged as a critical public health issue among Chinese adolescents. However, the mechanisms contributing to NSSI behaviours remain underexplored. This study examines the roles of parent–adolescent communication, anxiety and emotional intelligence in NSSI behaviours among adolescents diagnosed with depressive disorders. A cross-sectional survey was conducted with 263 Chinese adolescents diagnosed with depressive disorders. Participants completed questionnaires assessing parent–adolescent communication, anxiety, emotional intelligence and NSSI behaviours. (1) Parent–adolescent communication was significantly negatively associated with both anxiety (<i>r</i> = −0.425, <i>p</i> < 0.01) and NSSI behaviours (<i>r</i> = −0.47, <i>p</i> < 0.01) among adolescents with depressive disorders. (2) Anxiety partially mediated the association between parent–adolescent communication and NSSI, while emotional intelligence moderated the link between anxiety and NSSI. The findings suggest that positive parent–adolescent communication not only directly lowers the likelihood of NSSI but also indirectly reduces NSSI behaviours by alleviating anxiety. Furthermore, emotional intelligence plays a crucial moderating role in the association between anxiety and NSSI behaviours, highlighting its importance in developing effective prevention and intervention strategies for adolescents with depressive disorders. These findings offer theoretical insights for designing culturally sensitive mental health interventions.</p>\u0000 </div>","PeriodicalId":10460,"journal":{"name":"Clinical psychology & psychotherapy","volume":"32 5","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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