Journal of Clinical Psychology最新文献

Objective: There is increasing interest in the impact of endometriosis on body image, however, there is minimal understanding of the presence and nature of disordered eating. As body image dissatisfaction is elevated in this population and a risk factor for eating disorders, it is likely that disordered eating is also elevated which has important clinical implications for prevention and intervention. The current study aimed to explore the relationships between endometriosis, body image flexibility, eating disorder psychopathology, negative affect, and self-criticism using a mixed-methods design.

Method: People (n = 179) with endometriosis, over the age of 18 years, and living in Australia were recruited using social media. Quantitative measures included the Body Image Acceptance and Action Questionnaire, Eating Disorder Examination Questionnaire 7-item Short Form, Depression Anxiety and Stress Scales, and the Inadequate Self subscale of the Forms of Self-Criticising/Attacking and Self-Reassuring Scale. Participants were also asked two open-ended questions that enabled reflexive thematic analysis of the impact endometriosis has on body image and eating, using Braun and Clarke's six phase process.

Results: Participants were mostly female, heterosexual, White, and had a mean age of 30. The sample demonstrated high levels of eating disorder psychopathology, negative affect, and self-criticism, and low body image flexibility. Thematic analysis yielded three main themes, that were highly consistent with quantitative findings: Body disappointment, Food as an enemy, and Stolen identity and joy.

Conclusions: This study highlights the need for prevention and intervention efforts focused on reducing eating disorder psychopathology and body image concerns experienced by individuals with endometriosis.

Objective: The present study assessed program feasibility and satisfaction among recent-era veterans who participated in Mindfulness to Manage Moral Injury (MMMI), a live facilitated web-based 7-week mindfulness-based program targeting moral injury among veterans.

Method: In total, 56 post-9/11 veterans were recruited with 28 randomized to the MMMI condition and 28 to the Education and Support (ES) condition. Most participants identified as being White (71.4%), male (66.1%), and had a reported mean age of 41.50 years (Median = 39.50, SD = 9.26).

Results: Among the 56 participants, 82.1% attended at least one treatment session and 44.6% completed all seven sessions. There were no significant differences in the average number of sessions attended between the MMMI (M = 4.79, SD = 2.70) and the ES (M = 4.68, SD = 2.84) conditions, t(54) = 0.145, p = 0.87. Regarding randomization, there were no statistically significant differences on almost all demographic (i.e., years in military, gender, ethnicity) characteristics and baseline scores on all outcomes across treatment conditions, thus ensuring randomization was adequately met. Of the 56 who consented, 41 (73.21%) completed most study components (i.e., completed baseline and follow-up surveys, at least 1 weekly survey, and attended at least one treatment session). Regarding treatment satisfaction, individuals in the MMMI condition reported higher treatment satisfaction (Cohen's d = 0.66).

Conclusions: Preliminary findings suggest MMMI is feasible and acceptable and may be able to reach veterans who may not seek traditional Veterans Affairs Medical Center care or who prefer a web-based program. Given its promise for the treatment of moral injury among veterans, MMMI warrants additional large-scale clinical-trial testing.

One of many challenges in group supervision is the question of how to keep every participant engaged and fully available for learning. This paper describes a group supervision structure that uses Deliberate Practice (DP) to involve every participant in the group through the development of therapeutic skills intended to enhance the effectiveness of their work with clients. A case example illustrates how this process unfolded in the context of therapy with a specific client, conducted by a psychiatrist undergoing psychotherapy training in a deliberate practice supervision group. Analysis of video recordings of group supervision sessions and notes on solitary deliberate practice are used to illustrate how a DP structure engaged all participants in the group, while also facilitating the clinical development of the supervised psychiatrist and enhancing patient outcomes. A DP approach to group supervision enables participants to learn from each other's cases, through the deployment of flexible activities that engage all members of the group while also providing personalized skills training.

Psychotherapy supervision research has led to mixed, often disappointing results as to its effects on clinicians' skills acquisition and final treatment outcomes. Put simply, it is unclear if traditional supervision methods reliably increase therapist effectiveness. To answer this longstanding challenge, Deliberate Practice (DP) is now increasingly being recognized by leading authors and researchers as an effective method for enhancing therapists' skills. Despite this growing agreement about the potential advantages of DP methods, there remains a shortage of research, guidelines and real-world case presentations for their implementation in clinical supervision. In this introductory paper, we present an issue of the Journal of Clinical Psychology: In Session that showcases diverse modalities and approaches through which DP can be integrated into clinical supervision. To set the stage, this paper presents the major definitions, research evidence, and potential benefits and challenges of a DP-informed psychotherapy supervision. We highlight that while available research is promising, much is still needed to elevate the promise of DP into an evidence-based learning method that reliable increases therapist's skills and outcomes. As such, we conclude with a call encouraging clinicians, trainers and researchers alike to experiment with the methods here described and contribute to this exciting new development in the field.

Obsessive-compulsive disorder (OCD) is a debilitating condition prevalent in up to 2.3% of the population, yet obsessive-compulsive symptoms are commonly misidentified by mental health professionals, adversely impacting treatment recommendations. This study examined OCD misidentification rates across two different types of obsessions, the influence of misidentification on treatment recommendation, and attitudes associated with clinicians' decisions surrounding the diagnosis of OCD and treatment recommendations in a sample of 110 licensed psychologists. Results showed that over one-third (35.0%) of participants incorrectly diagnosed two vignettes, representing symptoms of sexual orientation OCD (SO-OCD) and symmetry. Of those who correctly diagnosed the vignettes, about half of participants (symmetry = 55.4%; SO-OCD = 47.1%) recommended exposure and response prevention (ERP) as the primary treatment choice. Participants who endorsed greater client empowerment were more likely to misdiagnose the SO-OCD vignette (t(108) = 2.97, p = 0.004). Less experience with evidence-based practice and negative attitudes toward evidence-based practice were associated with the choice of treatment other than ERP (t(71) = -2.98, p = 0.004 and t(72) = 3.40, p < 0.001, respectively). Elevated OCD misdiagnosis and its adverse impact on treatment recommendations, as well as knowledge of factors contributing to misdiagnosis and mistreatment, imply the need for greater education and training.

While consensus on the importance of deliberate practice (DP) in psychotherapy increases, clarification of key elements in DP supervision is yet to be seen. An international collaboration between researchers, authors, supervisors, and therapists has proposed a method for DP supervision and created a training program for DP supervisors. This has led to a six-step overview model for DP and the DP Supervisor Competency Rating Scale (Vaz, Rousmaniere and Husby, 2023). DP in the context of supervision has concrete steps and requires specific supervisor skills. This article illustrates these with a case study consisting of twelve sessions with a trained DP supervisor and a supervisee that is a seasoned clinical psychologist. Annotated session transcripts provide a step-by-step qualitative representation of the collaborative process in identifying client challenge, therapist deficit and actionable learning goals as well as the in-session behavioral rehearsal. The article presents the DP-supervision overall trajectory, as well as both supervisee's and supervisor's input on the process. It discusses the importance of integrating conceptual, conditional, and procedural knowledge in therapist development, and claims that the same is true for DP-supervisor development. Finally, the need for empirical investigation of the proposed key elements in DP supervision is emphasized.

While body experience is a key focus of treatment in psychomotor therapy (PMT), research has largely overlooked this important topic. In this study we explored three domains of body experience-body satisfaction, body attitude, and interoceptive awareness-in individuals with mental disorders in a clinical sample receiving PMT. We expected these patients to have a more negative body experience than nonclinical controls, with PTSD, mood disorders, personality disorders, and sex negatively affecting all three domains of body experience. The study involved 235 participants aged 18-59 with various mental disorders that were referred to PMT between 2008 and 2017 at a mental health center in the Netherlands. They completed questionnaires on all three of the body experience domains of interest. One sample t-tests revealed that patients had significantly greater negative body satisfaction and body attitude than nonclinical control samples obtained from the literature, with no significant difference in interoceptive awareness. Regression analyses within the patient sample revealed that female patients and patients with mood disorders or PTSD, displayed more negative body satisfaction than patients with other mental disorders. Additionally, female patients and patients with mood disorders displayed more negative body attitude. Although the total patient group and controls had comparable interoceptive awareness, only PTSD had significantly lower interoceptive awareness. Age and personality disorders did not predict differences on any domain of body experience. This research demonstrates that body experience is disturbed in patients with mental disorders who received PMT, and that there are disorder-specific disturbances on domains of body experience domains.

Introduction: With a global increase in adolescent suicidal thoughts and behaviors (STBs), this study addresses the need for enhanced advocacy initiatives within psychiatric inpatient settings.

Methods: This study, conducted in the Midwest region of the United States, sampled a diverse group of healthcare professionals from psychiatric hospitals, including nurses, nurse practitioners, therapists, techs, and psychologists. Specifically, this study used reflexive thematic analysis to gather insights into the existing state of advocacy efforts, focusing on their alignment with the needs of adolescent patients and barriers to effective implementation.

Results: Preliminary findings revealed a significant gap in hospital-wide advocacy programs tailored to the needs of adolescents facing STBs. Participants stressed the need for more personalized, dynamic advocacy strategies that go beyond traditional models, suggesting a move toward integrated, patient-driven approaches.

Conclusion: This study details several limitations with current psychiatric inpatient care practices, stressing the need for a paradigm shift toward more effective advocacy and suicide prevention strategies. Our results advocate for an approach that actively involves patients in their care journey.

Treating people who have experienced deep and prolonged developmental trauma, that is, complex post-traumatic stress disorder (cPTSD), can be challenging given the complexity and severity of their presentations. The main features of complex post-traumatic stress disorder, that is, affective and behavioral dysregulation, altered self-experience and identity disturbances, relational difficulties, negative self-concepts, and negative pathogenic beliefs, are, at the same time, therapeutic goals and obstacles to treatment. Therefore, clinicians must be aware of these difficulties in order to identify them and be ready to treat them when they arise during therapy with the same client. For this reason, the clinical cases presented in this issue of the Journal of Clinical Psychology: In Session provide a very useful overview of how to deal with these manifestations from the perspective of different models of psychotherapy. This commentary, after briefly reviewing the clinical features and therapeutic difficulties of these clients, offers a critical summary of the commonalities and differences between the various approaches presented by the clinical cases in this special issue. The purpose is to help the reader navigate the key aspects of treating the pathogenetic processes involved in cPTSD and to identify the different therapeutic tools that may be applicable to the different clinical presentations.

Objective: Emotion intolerance and perfectionism are two maintaining mechanisms to eating disorder symptomology. However, it is unclear how these mechanisms relate to one another. This study explored whether perfectionism is a vulnerability factor for facets of restrictive eating in the context of body-related emotions.

Methods: Female undergraduate students (N = 148) completed questionnaires assessing baseline levels of self-critical perfectionism and personal standards perfectionism. Participants then engaged in an ecological momentary assessment protocol where body-related emotion intolerance and restrictive eating facets (cognitive restraint and behavioral restriction) were assessed over 10 consecutive days. Multilevel modeling and simple slopes analysis were used to explore these moderated relationships. Within-person (Level 1 body-related emotion intolerance) and between-person (Level 2 perfectionism dimensions) relationships were examined.

Results: Based on the analyses, both self-critical and personal standards perfectionism dimensions interacted with body-related emotion intolerance to predict increases in restrictive eating facets.

Conclusion: These findings indicate that personal standards perfectionism, though conceptualized as the less maladaptive dimension of perfectionism, should not be ignored when conceptualizing and intervening with restrictive eating. Recommendations are provided on how to refine treatment targets to be more attuned with situations that elicit body-related emotion intolerance.