Journal of Clinical Psychology最新文献

Obsessive-compulsive disorder (OCD) is a profoundly heterogeneous condition, encompassing a wide spectrum of symptom presentations, from contamination fears to sexual obsessions, moral scrupulosity, and pathological doubt. While cognitive-behavioral therapy (CBT) incorporating exposure and response prevention (ERP) and challenging of dysfunctional obsessive beliefs remains the gold standard treatment, a growing body of literature has drawn attention to the limitations of traditional approaches. These include high drop-out rates, partial or nonresponse, and difficulty in addressing trauma-related or value-conflicted obsessional content through traditional fear-based exposure hierarchies. Continual refinement and innovation of psychotherapeutic approaches to OCD is therefore essential, not only for enhancing clinical efficacy, but also for increasing engagement, retention and meaning in therapy. This issue of Journal of Clinical Psychology: In Session brings together five in-depth clinical case studies, each exemplifying a distinct yet complementary advance in the treatment of OCD. Taken together, these cases provide a rich, practice-based insight into the diversity, complexity, and personalization of effective therapy, challenging us to expand our understanding of what constitutes successful treatment for OCD.

Background: Given their modifiable nature, understanding the intrapersonal factors involved in the cessation of non-suicidal self-injury (NSSI) is needed to inform existing therapeutic approaches and explore novel avenues for supporting individuals with NSSI. This study aimed to examine the relative contributions of and interactions among intrapersonal factors (self-concept, emotion regulation, and cognitive flexibility) in distinguishing between ceased and current NSSI.

Methods: Two hundred and two adults aged 18-71 years (M = 31.50, SD = 11.23; 74.75% female) were surveyed to compare facets of self-concept, emotion regulation, and cognitive flexibility that contributed most to discriminating those who had ceased NSSI for at least 1 year from those who continued. These intrapersonal factors were also explored as potential indirect pathways between identity and NSSI status.

Results: Significant differences between ceased and current NSSI groups were observed across all intrapersonal factors, with moderate to large effects. Most differences persisted after accounting for psychological distress. Less identity fragmentation, greater emotional clarity, internal locus of control, self-liking, access to emotion regulation strategies, and impulse control contributed most to discriminating NSSI cessation after accounting for psychological distress. The relationship between lack of identity and NSSI status operated indirectly through lack of emotional clarity and self-liking.

Conclusions: Having a coherent sense of identity, emotional clarity, internal locus of control, self-liking, access to emotion regulation strategies, and managing impulsivity relate to NSSI cessation. These modifiable factors denote several promising intervention opportunities and should be considered in the design of NSSI-specific treatments.

This paper presents an integrative therapeutic paradigm for treating individuals experiencing a psychological crisis following a romantic breakup, often viewed as both profound and life-altering. Conceptualizing the breakup experience as involving elements of loss, trauma, and relational rupture, the proposed model integrates principles and interventions drawn from grief-and-loss therapies, trauma-informed approaches, and key principles from relational psychodynamic psychotherapy, as well as humanistic approaches. Based on the common factors model of psychotherapy integration, the model's core principle is the dialectical and ongoing oscillation between two primary therapeutic channels. One focuses on emotion regulation, resource-strengthening, and functional support; the other emphasizes processing the breakup through narrative construction, meaning-making, and reintegration of self-states. The model outlines the clinical considerations that guide the oscillation between these therapeutic channels. In addition, it details the interventions relevant to each channel, in the spirit of the eclectic approach to psychotherapy integration. Two clinical case studies illustrate the model's application and demonstrate how its principles can adapt to various clinical presentations. The paper concludes by mapping the key principles and interventions presented, emphasizing the therapist's role as an active and subjective participant in the therapeutic process.

Background: Self-disclosure of suicidal thoughts and behaviors (STBs) is integral for risk assessment and intervention. However, limited research elucidates the nuanced characteristics of first disclosure experiences for bisexual individuals, who are disproportionately impacted by suicide yet remain underrepresented in the literature. This study examined the features, motivations, and outcomes of an initial STB disclosure among heterosexual and bisexual individuals.

Methods: Self-report data from 259 adults (M_age = 35.40 years; 35.09% bisexual) with a history of STB disclosure recruited through Amazon Mechanical Turk (mTurk) were analyzed with univariate and non-parametric tests and binary logistic regression models.

Results: Compared to heterosexuals, bisexual participants reported a higher prevalence of suicidal behavior disclosure, seeking formal disclosure recipients, and disclosing through online platforms. They were also more motivated to address physical safety concerns and obtain professional help and more frequently engaged in help-seeking behaviors post-disclosure. On average, both groups rated disclosure as helpful, with heterosexual individuals reporting it as more helpful. There was a significant main effect of help-seeking encouragement from recipients in predicting post-disclosure help-seeking engagement.

Conclusions: These findings underscore the necessity of considering the impact of sexual orientation differences in initial STB disclosure processes, which may set the benchmark for subsequent disclosure and help-seeking trajectories.

Objectives: Many forms of psychiatric treatment include social experiences as part of treatment. Patients often have both formal and informal opportunities to interact with their peers while receiving treatment in settings such as residential, inpatient, and partial hospital levels of care. However, patients' perceptions of these formal and informal social encounters are not routinely assessed in clinical care or clinical research, and the extent to which these social experiences are related to positive or negative outcomes during treatment is unclear.

Methods: The authors developed a 19-item self-report measure of social experiences during treatment, with input from stakeholders comprised of former patients at the study site. 470 adults receiving psychiatric treatment at a partial hospitalization program then completed this novel measure, the "Fellow Travelers in Treatment" Scale, alongside symptom and personality measures. These measures were used to test the factor structure of the new Scale, and the hypothesis that more positive and more frequent social interactions would be associated with less post-treatment depression and anxiety symptoms. We also assessed whether more frequent and more positive social interactions with peers were related to established measures of extraversion and social anxiety. Finally, we conducted exploratory analyses of symptoms and frequency of specific social behaviors.

Results: Exploratory factor analysis (EFA) yielded a 3-factor solution for the measure, with domains of learning from others, frequency of social contact, and respect from peers; in addition, a separate set of items not included in the factor analysis assessed frequency of specific social behaviors. Broadly, these subscales showed the expected relationships with extraversion, social anxiety, and social support. Mostly consistent with hypotheses, higher levels of respect from peers and learning from peers were associated with lower depression and anxiety scores; however, frequency of social contact was unrelated to symptom measures.

Conclusion: Results of this preliminary study illustrate the potential value of assessing patients' social experiences with peers during acute treatment, and demonstrate that peer social interactions are a significant correlate of treatment outcome. Future research is needed to further establish the validity of this novel measure.

Objectives: This study aimed to evaluate the stress levels of patients who watched or did not watch videos about their disease and surgical procedure on social media before periodontal surgery.

Methods: A total of 250 patients given a questionnaire before periodontal surgery were included. The patients were categorized according to whether they watched the video, the type of surgery, whether they were knowledgeable about the disease, and whether they had remaining questions. The Visual Analog Scale (VAS), Perceived Stress Scale (PSS), Beck Anxiety Inventory (BAI), and Modified Dental Anxiety Scale (MDAS) scores were measured.

Results: Patients who watched informational videos reported significantly higher VAS scores than those who did not. Among viewers, patients who reported increased fear exhibited significantly higher VAS, PSS, BAI, and MDAS scores than both nonviewers and viewers who reported reduced fear. VAS scores were significantly higher for gingivectomy and biopsy procedures compared to flap surgery. PSS scores were also significantly higher for mucogingival surgery and biopsy than for flap surgery. Lack of knowledge about gingival disease was associated with significantly higher PSS scores, and patients with unanswered or partially answered questions showed higher VAS, BAI, and MDAS scores. There were significant positive correlations among all anxiety scales.

Conclusions: Patients' stress levels were influenced both by the type of surgical procedure to be performed and by their level of knowledge about the disease; however, watching videos before surgery was found to further increase their stress. To prevent patients from postponing dental treatments, the procedures to be performed should be explained, and it should be emphasized that watching videos on the Internet may cause unnecessary anxiety.

Exposure and response prevention (ERP) remains the gold-standard psychotherapy for obsessive-compulsive disorder (OCD), yet real-world care is limited by dropout, partial response, relapse, and phenotypes that strain habituation-centric protocols. This commentary synthesizes five case reports that upgrade ERP not by replacing it, but by refining how inhibitory learning is taught and enacted. In the first case study by ref, Acceptance and Commitment Therapy (ACT) with values-based exposure shifted the goal from distress reduction to values-consistent action under aversive private events, boosting motivation and generalization. In the second case (ref), VR-assisted avatar therapy externalized the OCD voice", boosting insight and resistance to compulsions and thereby unlocking ERP. In the third case (ref), addressing mental contamination, imagery rescripting reframed shame and disgust. In the fourth case (ref), ERP was tuned to emphasize clear expectancy violations and to vary contexts. In the fifth and final case study by ref., the focus was on "innovative moments" during ERP. Noticing and amplifying these small, natural shifts ("exceptions") kept the client engaged and helped solidify new response patterns. Together, these vectors suggest a next wave of OCD care: precise personalization of ERP's mechanism (expectancy violation/inhibitory learning), process targets (motivation, insight, psychological flexibility and non-fear emotions like shame and disgust), and format (tech-assisted delivery), evaluated with mechanism-linked outcomes. Rather than "more ERP," the field should engineer better operating conditions for ERP-one explicit prediction, one values-anchored action, and one reinforced micro-gain at a time.

Aim: To evaluate the psychometric properties of the 10-item Clinical Outcomes in Routine Evaluation (CORE-10) in terms of change sensitivity and to develop clinical resources to support its use in routine practice for the Argentine adult population. Specifically, it explored the differentiation between clinical and non-clinical groups using traditional and data-driven approaches to determine clinical cut-off scores.

Method: Two independent samples were included: a cross-sectional sample (n = 637) composed of individuals from the general population and patients initiating therapy, and a longitudinal clinical sample (n = 148) assessed session-by-session. Psychometric analyses included factor structure, internal consistency, and convergent and divergent validity. Sensitivity to change was assessed through standardized effect sizes and mixed-effects modeling. Clinical cut-off scores were estimated using therapy status and data-driven clustering methods.

Results: The CORE-10 showed good internal consistency and a unidimensional factor structure with excellent fit. Strong concurrent and acceptable divergent validity were found. Moderate internal responsiveness was observed, and longitudinal analyses confirmed a significant reduction in CORE-10 scores over time. Clustering methods outperformed traditional therapy-status classifications, yielding more consistent and interpretable groupings. The optimal cut-off score derived from K-Means clustering was 1.39 (SD = 0.36; 95% CI [1.36, 1.42]). The reliable change index values were comparable to previous studies.

Discussion: The CORE-10 is a reliable and valid tool for monitoring psychological distress and change in Argentine psychotherapy settings. Beyond supporting its psychometric robustness, this study contributes practical, data-informed resources to improve clinical decision-making and routine outcome monitoring.

Objective: Theory of mind (ToM), the ability of mental state attribution, is an important aspect of social cognition. The autism-psychosis diametrical model suggests that there is an opposite impact of autistic traits and psychotic-like experiences (PLE) upon ToM, with autistic traits associated with under-mentalizing and PLE linked to over-mentalizing. This exploratory study aimed to examine the diametrical model at both subclinical and clinical levels.

Method: We recruited 240 college students (Study 1), 28 patients with chronic schizophrenia and their demographically-matched controls (Study 2). The animated shapes task was used to assess ToM ability. This task was a non-verbal task involving the interpretation of geometric figure interactions in random and ToM conditions. All participants completed the Community Assessment of Psychic Experiences (CAPE) and the Autism-Spectrum Quotient (AQ) to measure PLE and autistic traits. The positive symptom subscale (PANSS-P) and the dimensional autism severity score (PAUSS) of the PANSS were additionally used to assess the severity of positive symptoms and autistic phenotypes in clinical populations.

Results: Patients with chronic schizophrenia demonstrated a mixed pattern of ToM impairment, combining over-mentalizing for random movements and under-mentalizing for movements involving mental state. Correlational analysis preliminarily suggested that regardless of diagnostic status, PLE was associated with over-mentalizing, that is, more intentionality attribution to random movement. Autistic-like symptoms among patients were related to less intentionality with less appropriate answers in ToM condition. However, the interaction of the two symptoms, or the co-occurrence of PLE and autistic traits had no significant beneficial effect on ToM performances.

Discussion: Autistic traits and positive psychotic symptoms may have differential effects on mentalizing, but there is no support that ToM impairments would be attenuated in individuals with mixed symptom expressions.

Objective: Metacognition refers to the awareness and regulation of one's cognitive processes, including self-monitoring, planning, and controlling thoughts. In individuals with attention deficit hyperactivity disorder (ADHD), although research is limited, deficits in metacognitive skills are commonly observed, which contribute to difficulties in attention, task completion, and self-regulation. The aim of this study is to identify metacognitive characteristics in adolescents diagnosed with ADHD and to explore the relationship between these characteristics and the metacognitions of their parents.

Methods: The study included 107 adolescents, aged 12-18 years, who were newly diagnosed with ADHD, as well as 100 healthy control participants. A sociodemographic form, The Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime version for DSM-5 (K-SADS-PL DSM-5), Metacognitions Questionnaire for Children (MCQ-C) were applied, while their parents completed the Metacognitions Questionnaire-30 (MCQ-30), Turgay DSM-IV Disruptive Behavior Disorders Rating Scale Form (T-DSM-IV-S) and the Adult ADHD Self-Report Scale for DSM-5 (ASRS-5). Based on ASRS-5 scores, parents were categorized into two groups: those at increased risk of ADHD (ASRS ≥ 14) and those at low risk of ADHD (ASRS < 14). Group differences were examined using multivariate analyses (MANCOVA/MANOVA), while associations between adolescent and parental variables were assessed using correlation analyses.

Results: In adolescents with ADHD, scores on the negative meta-worry, superstitious, punishment and responsibility beliefs and cognitive monitoring subscales -as well as the MCQ-C total score- were significantly higher compared to the control group, while no difference was found for positive meta-worry, regardless of subtype. On the parental MCQ-30, all subscale and total scores were significantly higher in the ADHD group. Parents categorized as being at increased risk of ADHD had significantly higher MCQ-30 total scores compared to those at low risk. Furthermore, the severity of ADHD symptoms in adolescents, particularly inattention and hyperactivity-impulsivity, was positively and weakly correlated with the MCQ-C total score. In addition, a weak negative correlation was observed between adolescents' positive meta-worry and parents' cognitive confidence.

Conclusion: Our study suggests that metacognitive impairment is prevalent among adolescents with ADHD and their parents. Enhancing metacognitive awareness in individuals with ADHD may facilitate their adaptation to treatment and preparedness for alternative forms of therapeutic intervention.