In the context of the legacy of deficit-focused research and application of theoretical models in research on minoritized groups that are underrepresented in the literature, we explored the strengths-based literature among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people of color to develop a more inclusive and relevant understanding of how posttraumatic growth (PTG) occurs in this population. Our intersectional PTG model is tailored to the experiences of LGBTQ+ people of color that builds upon previous models of PTG, intersectionality theory, and empirical findings of trauma and PTG among LGBTQ+ people of color. Our intersectional PTG model incorporates the unique intrapersonal, interpersonal, institutional, and cultural factors that are unique to this population and contribute to PTG. We challenge the limited scope of Criterion A traumatic events and emphasize empirical findings that support that LGBTQ+ people of color often experience posttraumatic stress after oppression and discrimination. Our model also recognizes the impact of intersecting risk factors, such as gendered racism, that may occur on various levels. Our model acknowledges that LGBTQ+ people of color have often demonstrated PTG in the face of adversity. Intrapersonal factors such as cognitive flexibility, interpersonal factors such as social support, and institutional and cultural factors such as identity-related activism are identified as key contributors to resilience. We discuss practice implications, highlighting that clinicians should recognize limitations of traditional trauma frameworks and adopt culturally sensitive approaches when working with LGBTQ+ people of color. Overall, our model provides a foundation for strengths-based interventions and research, emphasizing resiliency and potential for PTG in this population.
{"title":"Moving beyond vulnerability and focusing on resilience: An intersectional posttraumatic growth model for LGBTQ+ people of color.","authors":"Caterina Obenauf, Dawn M Szymanski, Gina P Owens","doi":"10.1002/jclp.23745","DOIUrl":"https://doi.org/10.1002/jclp.23745","url":null,"abstract":"<p><p>In the context of the legacy of deficit-focused research and application of theoretical models in research on minoritized groups that are underrepresented in the literature, we explored the strengths-based literature among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people of color to develop a more inclusive and relevant understanding of how posttraumatic growth (PTG) occurs in this population. Our intersectional PTG model is tailored to the experiences of LGBTQ+ people of color that builds upon previous models of PTG, intersectionality theory, and empirical findings of trauma and PTG among LGBTQ+ people of color. Our intersectional PTG model incorporates the unique intrapersonal, interpersonal, institutional, and cultural factors that are unique to this population and contribute to PTG. We challenge the limited scope of Criterion A traumatic events and emphasize empirical findings that support that LGBTQ+ people of color often experience posttraumatic stress after oppression and discrimination. Our model also recognizes the impact of intersecting risk factors, such as gendered racism, that may occur on various levels. Our model acknowledges that LGBTQ+ people of color have often demonstrated PTG in the face of adversity. Intrapersonal factors such as cognitive flexibility, interpersonal factors such as social support, and institutional and cultural factors such as identity-related activism are identified as key contributors to resilience. We discuss practice implications, highlighting that clinicians should recognize limitations of traditional trauma frameworks and adopt culturally sensitive approaches when working with LGBTQ+ people of color. Overall, our model provides a foundation for strengths-based interventions and research, emphasizing resiliency and potential for PTG in this population.</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307761","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}
Complex Posttraumatic Stress Disorder (CPTSD) is a condition resulting from exposure to chronic, interpersonal traumatic events, in which some form of control or power dynamics existed. Its clinical picture includes the main symptom clusters of posttraumatic stress disorder, accompanied by dysregulated emotion, problems in interpersonal relationships, and difficulties in identity integration. In addition, both clinical work and research have shown CPTSD to include highly distressing and complicated psychological phenomena, such as identification with the aggressor, various forms of dissociation, self‐harm and self‐destructive behaviors, and more. Due to this highly complex and multilayered clinical picture, the treatment of CPTSD poses a significant clinical challenge to therapists. In this special issue of In Session, we present a series of case studies, each representing a different therapeutic approach to CPTSD (e.g., skills training for affective and interpersonal regulation, Eye Movement Desensitization and Reprocessing, psychodynamic, integrative psychotherapy). These cases also represent a wide variety of patient populations, as well as different types of underlying traumatic events. Together, they reveal the breadth of clinical possibilities currently available to trauma therapists encountering cases of CPTSD. They also highlight the challenges and dilemmas that clinicians often face when treating this condition, as well as ways to overcome those.
{"title":"Introduction to In Session special issue: Psychotherapy for complex PTSD","authors":"Danny Horesh, Yael Lahav","doi":"10.1002/jclp.23739","DOIUrl":"https://doi.org/10.1002/jclp.23739","url":null,"abstract":"Complex Posttraumatic Stress Disorder (CPTSD) is a condition resulting from exposure to chronic, interpersonal traumatic events, in which some form of control or power dynamics existed. Its clinical picture includes the main symptom clusters of posttraumatic stress disorder, accompanied by dysregulated emotion, problems in interpersonal relationships, and difficulties in identity integration. In addition, both clinical work and research have shown CPTSD to include highly distressing and complicated psychological phenomena, such as identification with the aggressor, various forms of dissociation, self‐harm and self‐destructive behaviors, and more. Due to this highly complex and multilayered clinical picture, the treatment of CPTSD poses a significant clinical challenge to therapists. In this special issue of <jats:italic>In Session</jats:italic>, we present a series of case studies, each representing a different therapeutic approach to CPTSD (e.g., skills training for affective and interpersonal regulation, Eye Movement Desensitization and Reprocessing, psychodynamic, integrative psychotherapy). These cases also represent a wide variety of patient populations, as well as different types of underlying traumatic events. Together, they reveal the breadth of clinical possibilities currently available to trauma therapists encountering cases of CPTSD. They also highlight the challenges and dilemmas that clinicians often face when treating this condition, as well as ways to overcome those.","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142265744","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}
Karen S. Mitchell, Kelsey N. Serier, Brian N. Smith, Dawne Vogt
ObjectiveTrauma exposure, particularly interpersonal trauma, is prevalent among individuals with eating disorders (EDs), and trauma exposure and the subsequent development of posttraumatic stress disorder have been associated with poorer outcomes for ED treatment. To our knowledge, there are no published investigations of trauma exposure among individuals with avoidant/restrictive food intake disorder (ARFID), a new diagnosis introduced by the Diagnostic and Statistical Manual of Mental Disorders‐5. We investigated associations between trauma exposure and ARFID profiles in a sample of U.S. military veteran men and women.MethodParticipants in this cross‐sectional study included 1494 veterans randomly selected from the population of post‐9/11 veterans who had separated from military service within the previous 18 months. They completed a survey assessing EDs, including the Nine Item ARFID Screen and trauma exposure.ResultsResults revealed that 9.8% of the sample exceeded cutoffs for any ARFID profile, with the picky eating profile being the most common. Trauma exposure was prevalent among participants who exceeded cutoffs for ARFID, particularly the picky eating profile.DiscussionFindings highlight the importance of addressing EDs, including ARFID, in veterans. It will be important to examine the extent to which trauma and trauma‐related disorders impact treatment outcomes for individuals with ARFID.
{"title":"Associations between avoidant/restrictive food intake disorder profiles and trauma exposure in veteran men and women","authors":"Karen S. Mitchell, Kelsey N. Serier, Brian N. Smith, Dawne Vogt","doi":"10.1002/jclp.23743","DOIUrl":"https://doi.org/10.1002/jclp.23743","url":null,"abstract":"ObjectiveTrauma exposure, particularly interpersonal trauma, is prevalent among individuals with eating disorders (EDs), and trauma exposure and the subsequent development of posttraumatic stress disorder have been associated with poorer outcomes for ED treatment. To our knowledge, there are no published investigations of trauma exposure among individuals with avoidant/restrictive food intake disorder (ARFID), a new diagnosis introduced by the <jats:italic>Diagnostic and Statistical Manual of Mental Disorders‐5</jats:italic>. We investigated associations between trauma exposure and ARFID profiles in a sample of U.S. military veteran men and women.MethodParticipants in this cross‐sectional study included 1494 veterans randomly selected from the population of post‐9/11 veterans who had separated from military service within the previous 18 months. They completed a survey assessing EDs, including the Nine Item ARFID Screen and trauma exposure.ResultsResults revealed that 9.8% of the sample exceeded cutoffs for any ARFID profile, with the picky eating profile being the most common. Trauma exposure was prevalent among participants who exceeded cutoffs for ARFID, particularly the picky eating profile.DiscussionFindings highlight the importance of addressing EDs, including ARFID, in veterans. It will be important to examine the extent to which trauma and trauma‐related disorders impact treatment outcomes for individuals with ARFID.","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142216820","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}
Aleksandra Kaurin, Julia Asbrand, Hendrik Mann, Claudia Calvano
Clinical psychologists are increasingly urged to recognize and understand the significance of societal factors such as marginalization experiences, within themselves and among the individuals and communities they serve. At the same time, there is a dearth of research in the field to guide this pursuit, and especially so in European contexts. We conducted an online survey (N = 646) to assess the social identities of clinical psychologists (graduate and trainees) in Germany and their incorporation of societal challenges in therapy and training. Overall, our sample was demographically rather homogenous and privileged: Clinical psychologists tended to be white (91%), nonmigrant (77.6%), female (74.5%), cis-gender (93.8%), heterosexual (75.4%), able-bodied (56.0%), and grew up in families with an academic background (68%). Although the majority of participants expressed a tendency to contemplate their identity when it came to their psychotherapeutic practices and believed that discussing societal challenges in therapy was pertinent, only a small proportion (~5%) reported actively introducing related subjects during therapy sessions or taking them into account during initial case conceptualization (~8%). The majority of participants indicated a lack of coverage of related topics in standard clinical psychological curricula. Greater perceived competence in addressing these topics was linked to clinicians initiating discussions about marginalization or discrimination in therapy. We explore the implications for future training aimed at fostering equitable, effective, and diversity-sensitive therapeutic practices.
{"title":"Clinical psychology, social identities and societal challenges: Implications for diversity-sensitive practice and training.","authors":"Aleksandra Kaurin, Julia Asbrand, Hendrik Mann, Claudia Calvano","doi":"10.1002/jclp.23736","DOIUrl":"https://doi.org/10.1002/jclp.23736","url":null,"abstract":"<p><p>Clinical psychologists are increasingly urged to recognize and understand the significance of societal factors such as marginalization experiences, within themselves and among the individuals and communities they serve. At the same time, there is a dearth of research in the field to guide this pursuit, and especially so in European contexts. We conducted an online survey (N = 646) to assess the social identities of clinical psychologists (graduate and trainees) in Germany and their incorporation of societal challenges in therapy and training. Overall, our sample was demographically rather homogenous and privileged: Clinical psychologists tended to be white (91%), nonmigrant (77.6%), female (74.5%), cis-gender (93.8%), heterosexual (75.4%), able-bodied (56.0%), and grew up in families with an academic background (68%). Although the majority of participants expressed a tendency to contemplate their identity when it came to their psychotherapeutic practices and believed that discussing societal challenges in therapy was pertinent, only a small proportion (~5%) reported actively introducing related subjects during therapy sessions or taking them into account during initial case conceptualization (~8%). The majority of participants indicated a lack of coverage of related topics in standard clinical psychological curricula. Greater perceived competence in addressing these topics was linked to clinicians initiating discussions about marginalization or discrimination in therapy. We explore the implications for future training aimed at fostering equitable, effective, and diversity-sensitive therapeutic practices.</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143084","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}
Francesco Gazzillo, David Kealy, Eleonora Fiorenza, Marta Rodini
Guilt and shame are emotions that, albeit subjectively negative, help humans adapt to their social environment. However, in some cases, there are pathogenic beliefs, shaped over the lifespan that sustain them and make them a source of psychopathological suffering. In this paper we will first briefly show how Control-Mastery Theory (CMT) considers several types of pathogenic beliefs shaped by traumatic experiences that underly chronic feelings of guilt and shame. We then focus on a clinical case of Livia, a 28 year-old woman with relational and academic problems suffering mainly from two such types of pathogenic beliefs: burdening guilt and disloyalty guilt. We describe how a) Livia was driven by adverse and traumatic experiences to form some of these pathogenic beliefs, b) how she tested the therapist in order to discover whether he would disconfirm these beliefs, and c) how the therapist was able to successfully pass these tests and provide her with new and healthier interpersonal experiences. The case of Livia will highlight therapists' ability to accurately formulate patients' goals, pathogenic beliefs-including types of guilt- and shame-related beliefs-and traumas. Moreover, the case will illustrate how therapists can pass patients' tests and adopt the right attitude to help patients disprove their pathogenic beliefs and overcome problematic experiences of guilt and shame.
内疚和羞愧是一种情绪,尽管主观上是负面的,但有助于人类适应社会环境。然而,在某些情况下,在人的一生中会形成一些致病信念,这些信念支撑着它们,并使它们成为精神病理学痛苦的根源。在本文中,我们将首先简要说明控制-掌握理论(Control-Mastery Theory,CMT)是如何看待由创伤经历形成的几种致病信念的,这些信念是长期内疚感和羞耻感的基础。然后,我们将重点讨论利维亚的一个临床案例,她是一名 28 岁的女性,在人际关系和学业方面都有问题,主要是受到两种致病信念的困扰:负担型内疚和不忠型内疚。我们描述了 a) 利维亚是如何在不利和创伤经历的驱使下形成其中一些致病信念的;b) 她是如何测试治疗师,以发现治疗师是否会否定这些信念的;c) 治疗师是如何成功通过这些测试,并为她提供新的、更健康的人际体验的。利维亚的案例将强调治疗师准确制定患者目标、致病信念(包括与内疚和羞耻相关的信念类型)和创伤的能力。此外,该案例还将说明治疗师如何通过患者的测试,采取正确的态度,帮助患者推翻其致病信念,克服内疚和羞耻的问题体验。
{"title":"Passing tests and using one's attitude to help patients overcome their pathogenic feelings of guilt and shame.","authors":"Francesco Gazzillo, David Kealy, Eleonora Fiorenza, Marta Rodini","doi":"10.1002/jclp.23738","DOIUrl":"https://doi.org/10.1002/jclp.23738","url":null,"abstract":"<p><p>Guilt and shame are emotions that, albeit subjectively negative, help humans adapt to their social environment. However, in some cases, there are pathogenic beliefs, shaped over the lifespan that sustain them and make them a source of psychopathological suffering. In this paper we will first briefly show how Control-Mastery Theory (CMT) considers several types of pathogenic beliefs shaped by traumatic experiences that underly chronic feelings of guilt and shame. We then focus on a clinical case of Livia, a 28 year-old woman with relational and academic problems suffering mainly from two such types of pathogenic beliefs: burdening guilt and disloyalty guilt. We describe how a) Livia was driven by adverse and traumatic experiences to form some of these pathogenic beliefs, b) how she tested the therapist in order to discover whether he would disconfirm these beliefs, and c) how the therapist was able to successfully pass these tests and provide her with new and healthier interpersonal experiences. The case of Livia will highlight therapists' ability to accurately formulate patients' goals, pathogenic beliefs-including types of guilt- and shame-related beliefs-and traumas. Moreover, the case will illustrate how therapists can pass patients' tests and adopt the right attitude to help patients disprove their pathogenic beliefs and overcome problematic experiences of guilt and shame.</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072973","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}
Raffaele Popolo, Giancarlo Dimaggio, Angus MacBeth, Paolo Ottavi, Antonella Centonze
Individuals diagnosed with Complex PTSD (C-PTSD) have experienced repeated and often prolonged traumatic events. From a therapeutic perspective this can lead to difficulties in emotion regulation within-session, challenges with patient-therapist attunement, and impaired coregulation of emotions during therapeutic interactions. As a result, frequent therapeutic alliance ruptures can emerge, which in turn pose challenges for symptom-focused work. We describe a case study involving a 38-year-old woman presenting with C-PTSD, dissociation, anxiety and borderline and dependent personality disorder traits. We explore how difficulties in attunement and emotion regulation during therapy were mostly attributable to (i) maladaptive ideas regarding the self and others; and (ii) difficulties in recognizing both her own mental states and those of her therapist. For instance, the patient believed that the therapist was distant and critical; which she held to be fact rather than reflective of a mental state. We show how the therapist addressed these difficulties, incorporating repair of the therapeutic alliance, which enabled a return to symptom focused work. The case description offers guidance on how to maintain a dual focus on therapeutic alliance alongside symptoms when treating C-PTSD (with or without comorbidity).
被诊断为复杂性创伤后应激障碍(C-PTSD)的患者经历过反复且经常是长时间的创伤事件。从治疗的角度来看,这可能会导致治疗过程中的情绪调节困难、患者与治疗师之间的默契面临挑战,以及治疗互动过程中的情绪核心调节受损。因此,治疗联盟可能会频繁破裂,这反过来又给以症状为中心的工作带来了挑战。我们描述了一个案例研究,该案例涉及一名 38 岁的女性,她患有 C 型创伤后应激障碍、解离症、焦虑症以及边缘型和依赖型人格障碍。我们探讨了在治疗过程中,调适和情绪调节方面的困难如何主要归因于(i)关于自我和他人的适应不良观念;以及(ii)难以认识到自己和治疗师的心理状态。例如,患者认为治疗师是疏远的、挑剔的;她认为这是事实,而不是心理状态的反映。我们展示了治疗师如何解决这些困难,修复治疗联盟,从而恢复以症状为中心的工作。案例描述为我们提供了指导,帮助我们在治疗 C 型创伤后应激障碍(无论有无合并症)时,如何保持对治疗联盟和症状的双重关注。
{"title":"Management of the therapeutic relationship in a patient with Complex PTSD and Personality Disorder.","authors":"Raffaele Popolo, Giancarlo Dimaggio, Angus MacBeth, Paolo Ottavi, Antonella Centonze","doi":"10.1002/jclp.23737","DOIUrl":"https://doi.org/10.1002/jclp.23737","url":null,"abstract":"<p><p>Individuals diagnosed with Complex PTSD (C-PTSD) have experienced repeated and often prolonged traumatic events. From a therapeutic perspective this can lead to difficulties in emotion regulation within-session, challenges with patient-therapist attunement, and impaired coregulation of emotions during therapeutic interactions. As a result, frequent therapeutic alliance ruptures can emerge, which in turn pose challenges for symptom-focused work. We describe a case study involving a 38-year-old woman presenting with C-PTSD, dissociation, anxiety and borderline and dependent personality disorder traits. We explore how difficulties in attunement and emotion regulation during therapy were mostly attributable to (i) maladaptive ideas regarding the self and others; and (ii) difficulties in recognizing both her own mental states and those of her therapist. For instance, the patient believed that the therapist was distant and critical; which she held to be fact rather than reflective of a mental state. We show how the therapist addressed these difficulties, incorporating repair of the therapeutic alliance, which enabled a return to symptom focused work. The case description offers guidance on how to maintain a dual focus on therapeutic alliance alongside symptoms when treating C-PTSD (with or without comorbidity).</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017623","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}
Marta Tironi, Simone Charpentier Mora, Marianna Liotti, Alice Fiorini Bincoletto, Annalisa Tanzilli, Donatella Cavanna, Vittorio Lingiardi, Anna Maria Speranza, Guido Giovanardi, Fabiola Bizzi
Introduction: Adverse childhood experiences (ACEs) are psychosocial factors acknowledged as significant contributors to health consequences later in adolescence, including psychological maladjustment. The research suggests that, at a transdiagnostic and transtheoretical level, working on restoring epistemic trust (ET), mentalized affectivity (MA), and reflective functioning (RF) in adolescents with ACEs assumes a central role in the therapeutic process. However, there are still few studies that attempted to investigate the specific role of these sociocognitive factors in the detrimental positive association between levels of experienced ACEs during childhood and psychological maladjustment in nonclinical adolescents.
Methods: A community sample of 306 Italian cisgender adolescents (61.4% assigned females at birth; age range 13-19 years old; Mage = 16.1, SD = 1.64) self-reported ACEs (Childhood Trauma Questionnaire-Short Form), psychological maladjustment (Strengths and Difficulties Questionnaire), ET (Epistemic Trust, Mistrust and Credulity Questionnaire), MA (Brief-Mentalized Affectivity Scale for Adolescence), and RF (Reflective Functioning Questionnaire). A multiple mediation regression analysis has been performed to explore the association between ACEs and psychological maladjustment through the interaction with socio-cognitive factors.
Results: ACEs are positive predictors of psychological maladjustment later in adolescence. Regardless of gender differences, epistemic mistrust and credulity, processing and expressing emotions, and uncertainty about mental states mediated this association, while epistemic trust, identifying emotions, and certainty about mental states did not configure as significant mediators.
Conclusion: Findings suggest that ET disruptions and deficits in RF are risk factors, while MA is a protective factor within the link between ACEs and psychological maladjustment in adolescence. These links help to specify the role of sociocognitive factors in the development of mental problems in adolescents who have been exposed to adverse experiences in childhood.
{"title":"Adverse childhood experiences and psychological maladjustment in adolescence: The protective role of epistemic trust, mentalized affectivity, and reflective functioning.","authors":"Marta Tironi, Simone Charpentier Mora, Marianna Liotti, Alice Fiorini Bincoletto, Annalisa Tanzilli, Donatella Cavanna, Vittorio Lingiardi, Anna Maria Speranza, Guido Giovanardi, Fabiola Bizzi","doi":"10.1002/jclp.23733","DOIUrl":"https://doi.org/10.1002/jclp.23733","url":null,"abstract":"<p><strong>Introduction: </strong>Adverse childhood experiences (ACEs) are psychosocial factors acknowledged as significant contributors to health consequences later in adolescence, including psychological maladjustment. The research suggests that, at a transdiagnostic and transtheoretical level, working on restoring epistemic trust (ET), mentalized affectivity (MA), and reflective functioning (RF) in adolescents with ACEs assumes a central role in the therapeutic process. However, there are still few studies that attempted to investigate the specific role of these sociocognitive factors in the detrimental positive association between levels of experienced ACEs during childhood and psychological maladjustment in nonclinical adolescents.</p><p><strong>Methods: </strong>A community sample of 306 Italian cisgender adolescents (61.4% assigned females at birth; age range 13-19 years old; M<sub>age</sub> = 16.1, SD = 1.64) self-reported ACEs (Childhood Trauma Questionnaire-Short Form), psychological maladjustment (Strengths and Difficulties Questionnaire), ET (Epistemic Trust, Mistrust and Credulity Questionnaire), MA (Brief-Mentalized Affectivity Scale for Adolescence), and RF (Reflective Functioning Questionnaire). A multiple mediation regression analysis has been performed to explore the association between ACEs and psychological maladjustment through the interaction with socio-cognitive factors.</p><p><strong>Results: </strong>ACEs are positive predictors of psychological maladjustment later in adolescence. Regardless of gender differences, epistemic mistrust and credulity, processing and expressing emotions, and uncertainty about mental states mediated this association, while epistemic trust, identifying emotions, and certainty about mental states did not configure as significant mediators.</p><p><strong>Conclusion: </strong>Findings suggest that ET disruptions and deficits in RF are risk factors, while MA is a protective factor within the link between ACEs and psychological maladjustment in adolescence. These links help to specify the role of sociocognitive factors in the development of mental problems in adolescents who have been exposed to adverse experiences in childhood.</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889377","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}
Objective: Disrupted interoception has been found in individuals with body image concerns and related psychiatric conditions (i.e., eating disorders, body dysmorphic disorder). However, few studies have explored the role of interoception in the relationship between body image concern and self-objectification (SO). As components of the bodily self, interoception and body image may also contribute to the fostering of self-consciousness.
Methods: The current study estimated the network model of body image concern, adaptive and maladaptive interoceptive sensibility (IS), self-consciousness, and SO, with data from 743 neurotypical adults. The centrality of nodes and the robustness of the network were verified.
Results: Our network showed that interoception correlated with certain characteristics of body image concern (BIC) with varying strength and different directions. The most central node described beliefs of BIC, namely, negative evaluation toward appearance. Self-objectification and maladaptive IS presented the highest bridge centrality. Interoception also linked BICs with SO and self-consciousness.
Conclusion: Findings suggested that SO, adaptive and maladaptive interoception might be the targets of intervention for individuals with BIC, specifically for those with high levels of appearance-related negative self-evaluations.
目的在有身体形象问题和相关精神疾病(如进食障碍、身体畸形障碍)的人身上,我们发现了内感知障碍。然而,很少有研究探讨内感知在身体形象问题与自我物化(SO)之间的关系中的作用。作为身体自我的组成部分,内感知和身体形象也可能有助于培养自我意识:本研究利用 743 名神经畸形成年人的数据,估算了身体形象关注、适应性和适应不良的内感知敏感性(IS)、自我意识和自我客体化的网络模型。结果表明,我们的网络显示,内感知与身体形象相关性与自我意识相关性呈正相关:我们的网络显示,内感知与关注身体形象(BIC)的某些特征相关,其强度和方向各不相同。最中心的节点描述了体像关注的信念,即对外表的负面评价。自我物化和适应不良的 IS 的桥中心度最高。内感知也将BIC与SO和自我意识联系在一起:研究结果表明,SO、适应性和适应不良的内感知可能是对 BIC 患者进行干预的目标,特别是对那些与外貌相关的负面自我评价水平较高的患者。
{"title":"A network analysis of body image concern, interoceptive sensibility, self-consciousness, and self-objectification.","authors":"Ning Zhang, Han-Xue Yang","doi":"10.1002/jclp.23734","DOIUrl":"https://doi.org/10.1002/jclp.23734","url":null,"abstract":"<p><strong>Objective: </strong>Disrupted interoception has been found in individuals with body image concerns and related psychiatric conditions (i.e., eating disorders, body dysmorphic disorder). However, few studies have explored the role of interoception in the relationship between body image concern and self-objectification (SO). As components of the bodily self, interoception and body image may also contribute to the fostering of self-consciousness.</p><p><strong>Methods: </strong>The current study estimated the network model of body image concern, adaptive and maladaptive interoceptive sensibility (IS), self-consciousness, and SO, with data from 743 neurotypical adults. The centrality of nodes and the robustness of the network were verified.</p><p><strong>Results: </strong>Our network showed that interoception correlated with certain characteristics of body image concern (BIC) with varying strength and different directions. The most central node described beliefs of BIC, namely, negative evaluation toward appearance. Self-objectification and maladaptive IS presented the highest bridge centrality. Interoception also linked BICs with SO and self-consciousness.</p><p><strong>Conclusion: </strong>Findings suggested that SO, adaptive and maladaptive interoception might be the targets of intervention for individuals with BIC, specifically for those with high levels of appearance-related negative self-evaluations.</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855658","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}
Radically open dialectical behaviour therapy (RO DBT) is a transdiagnostic treatment, originally developed as a variant of dialectical behaviour therapy (DBT), that emerged as a novel treatment approach for those presenting with excessive or maladaptive overcontrol. Despite RO DBT's growing popularity among clinicians as a treatment for chronic depression, personality disorders and eating disorders, to date, no systematic review has been conducted to summarise the evidence on this therapy. Therefore, the aim of this study was to systematically review the literature to provide a current and comprehensive summary of the available evidence on the clinical applications and efficacy of RO DBT. Articles were included if they were original research studies that described the use of RO DBT in the treatment of any psychological disorder, condition or symptom, published in the English language in a peer-reviewed journal. Four electronic databases were searched, and screening, selection, risk of bias assessment and data extraction were all conducted by two independent reviewers. Fourteen articles were included in this review, including two qualitative articles, one case study, five case series studies, four quasi-experimental studies, and two articles describing one randomized control trial. Findings indicated there is emerging evidence for the use of RO DBT in both adolescents and adults, for disorders characterized by excessive self-control, such as anorexia nervosa and autism, as well as for treatment-resistant depression. While RO DBT shows promise as a treatment for disorders of overcontrol, further research is needed. This review outlines current gaps and identifies areas for future research.
{"title":"Applications and efficacy of radically open dialectical behavior therapy (RO DBT): A systematic review of the literature.","authors":"Amaani H Hatoum, Amy L Burton","doi":"10.1002/jclp.23735","DOIUrl":"https://doi.org/10.1002/jclp.23735","url":null,"abstract":"<p><p>Radically open dialectical behaviour therapy (RO DBT) is a transdiagnostic treatment, originally developed as a variant of dialectical behaviour therapy (DBT), that emerged as a novel treatment approach for those presenting with excessive or maladaptive overcontrol. Despite RO DBT's growing popularity among clinicians as a treatment for chronic depression, personality disorders and eating disorders, to date, no systematic review has been conducted to summarise the evidence on this therapy. Therefore, the aim of this study was to systematically review the literature to provide a current and comprehensive summary of the available evidence on the clinical applications and efficacy of RO DBT. Articles were included if they were original research studies that described the use of RO DBT in the treatment of any psychological disorder, condition or symptom, published in the English language in a peer-reviewed journal. Four electronic databases were searched, and screening, selection, risk of bias assessment and data extraction were all conducted by two independent reviewers. Fourteen articles were included in this review, including two qualitative articles, one case study, five case series studies, four quasi-experimental studies, and two articles describing one randomized control trial. Findings indicated there is emerging evidence for the use of RO DBT in both adolescents and adults, for disorders characterized by excessive self-control, such as anorexia nervosa and autism, as well as for treatment-resistant depression. While RO DBT shows promise as a treatment for disorders of overcontrol, further research is needed. This review outlines current gaps and identifies areas for future research.</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759002","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}
Objective: The primary objective of the present study is to validate the Difficulty in Emotion Regulation Scale-Short Form (DERS-SF) in a sample of Italian adolescents. Additionally, we aim to evaluate its factorial structure by examining the contribution of each subscale (i.e., Nonacceptance, Clarity, Awareness, Goals, Impulse, Strategy) on the general factor using bi-factor models by replicating a past study.
Method: The sample comprises N = 704 adolescents aged 11-17 years (M = 13.38, SD = 1.37; 53.12% females). To establish external validity, correlation and path analyses were conducted between the DERS-SF sub-scales, the total score, and measures of internalizing and externalizing symptoms, as well as Problematic Smartphone Use (PSU). Measurement invariance was tested comparing males versus females and pre-adolescents and adolescents.
Results: Overall, results supported the multidimensional nature of the DERS-SF, confirming its original six-factor structure. However, bi-factor models analysis revealed that the Awareness subscale should be excluded when calculating the total score. Furthermore, findings indicated that the Strategy subscale variance is largely accounted for by the general factor rather than the specific subscale. In terms of external validity, significant positive associations between the DERS-SF sub-scales, the total score, and PSU, internalizing and externalizing symptoms were observed. Measurement invariance was supported.
Conclusions: Altogether, findings support the validity of the DERS-SF among Italian Adolescents and provide insights relevant to the understanding of the multifaceted facets of emotion regulation, emphasizing its relevance as a transdiagnostic process.
{"title":"Validation of the Difficulties in Emotion Regulation Scale-Short Form in a sample of Italian adolescents.","authors":"Elisa Mancinelli, Manuela Cottu, Silvia Salcuni","doi":"10.1002/jclp.23732","DOIUrl":"https://doi.org/10.1002/jclp.23732","url":null,"abstract":"<p><strong>Objective: </strong>The primary objective of the present study is to validate the Difficulty in Emotion Regulation Scale-Short Form (DERS-SF) in a sample of Italian adolescents. Additionally, we aim to evaluate its factorial structure by examining the contribution of each subscale (i.e., Nonacceptance, Clarity, Awareness, Goals, Impulse, Strategy) on the general factor using bi-factor models by replicating a past study.</p><p><strong>Method: </strong>The sample comprises N = 704 adolescents aged 11-17 years (M = 13.38, SD = 1.37; 53.12% females). To establish external validity, correlation and path analyses were conducted between the DERS-SF sub-scales, the total score, and measures of internalizing and externalizing symptoms, as well as Problematic Smartphone Use (PSU). Measurement invariance was tested comparing males versus females and pre-adolescents and adolescents.</p><p><strong>Results: </strong>Overall, results supported the multidimensional nature of the DERS-SF, confirming its original six-factor structure. However, bi-factor models analysis revealed that the Awareness subscale should be excluded when calculating the total score. Furthermore, findings indicated that the Strategy subscale variance is largely accounted for by the general factor rather than the specific subscale. In terms of external validity, significant positive associations between the DERS-SF sub-scales, the total score, and PSU, internalizing and externalizing symptoms were observed. Measurement invariance was supported.</p><p><strong>Conclusions: </strong>Altogether, findings support the validity of the DERS-SF among Italian Adolescents and provide insights relevant to the understanding of the multifaceted facets of emotion regulation, emphasizing its relevance as a transdiagnostic process.</p>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141544880","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}