Journal of Clinical Psychology最新文献

This article presents a case study of a 31-year-old woman with a dual diagnosis of Borderline Personality Disorder (BPD) and Eating Disorder Not Otherwise Specified (EDNOS). Paula received a 12-month Dialectical Behavior Therapy (DBT) outpatient treatment. DBT is considered a transdiagnostic treatment approach to address emotion dysregulation, which shifts the therapy focus traditionally placed only on behavioral change toward including also validation and acceptance and dialectical strategies. DBT addresses eating symptomatology as a dysfunctional form of emotional regulation and has shown promising results regarding its efficacy for the treatment of BPD and EDNOS comorbidity. Given the growing evidence, a standard DBT treatment plan was developed for this case. Specifically, pretreatment and phase 1 of the DBT program are described. During pretreatment and phase 1, individual therapy aims to improve and maintain client's motivation to change and engage in treatment, as well as to establish and prioritize treatment goals. As for group therapy, the main goal of the skills training in DBT is to enhance individual's capability by increasing skillful behavior (mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness skills). Paula received 24 weekly skills training sessions over a year. The results after a 12-month standard DBT treatment showed that Paula no longer met criteria for BPD, she had a significant decrease in difficulties in emotional regulation and impulsiveness and in EDNOS symptomatology. This case study may enhance learning about how to apply a transdiagnostic treatment to address BPD and EDNOS together in clinical practice.

Exposure exercises as seen in cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) are standard in the treatment of obsessive-compulsive disorder (OCD). In the last two decades, additional research has been conducted on acceptance and commitment therapy (ACT) and the ways that exposure exercises are conducted from an ACT model. Empirical support for conducting exposures from an ACT model exists. Group level statistics suggest that ACT with ACT-based exposures is as effective as traditional ERP or CBT. A key component of ACT and values-based exposures is the focus on teaching psychological flexibility to allow for engagement with values-based exposures. In this case study, we present an adult woman with OCD who completed 24 sessions of ACT+ values-based exposures. Client scores on the Y-BOCS decreased from severe levels to mild-moderate levels through treatment. Additionally, the client was more actively engaged in her life and reported greater quality of life at the conclusion of treatment. The goal of this case study is to demonstrate how values-based exposures can be used in the treatment of OCD.

Virtual reality exposure therapy (VRE) has been used in the treatment of combat-related PTSD since the late 1990s and was recently adapted to treat PTSD due to military sexual trauma (MST). With content specifically tailored to MST-related contexts, we present the case study of a military veteran who participated in the open clinical trial examining the feasibility of VRE in the treatment of MST-related PTSD (Loucks et al. 2019). We illustrate VRE's use in activating the trauma memory to facilitate therapeutic emotional processing across sessions and overall symptom reduction. The case study includes common challenges that may occur during VRE and relevant recommendations. The discussion will include lessons learned from the case study and the open clinical trial, recommendations for the flexible application of VRE, and the ongoing developments in the latest version of the VRE system, informed by feedback acquired from the clinicians and patients who experienced it in the initial clinical trial.

Objectives: Compulsive Online Shopping (COS) is considered a technological addiction, characterized by excessive engagement in online shopping behaviors that can cause economic, social, and emotional impairments in an individual's life. Among the theoretical models aimed at conceptualizing addictive behaviors, the metacognitive model has gained increased attention. However, no previous study has investigated the role of metacognitions in COS. The current study was aimed at clarifying the contribution of metacognitions about online shopping as potential mediating variables in the relationship between some well-established psychological correlates (i.e., boredom proneness, impulsivity, materialism, negative affect) and COS.

Methods: A sample of 254 participants (mean age = 34.79 ± 11.45; Females = 84.3%) was recruited using convenience sampling.

Results: The hypothesized model produced a good fit to the data and accounted for 48% of COS variance. All the correlates (i.e., boredom proneness, impulsivity, materialism, and negative affect) were significantly and positively associated with Positive Metacognitions About Emotional And Cognitive Regulation, which in turn predicted COS. Boredom proneness and impulsivity were also positively associated with Negative Metacognitions About Uncontrollability And Cognitive Harm of online shopping, which in turn predicted COS. All the indirect effects were significant.

Conclusions: The present findings add to the argument that the metacognitive model of addictive behaviors may applied to the understanding of COS and open the possibility of applying metacognitive techniques to the treatment of COS.

Objectives: The present study evaluated sex differences in the direct and indirect links between depressive symptoms, coping motives to drink, and alcohol use severity among Latinos who drink.

Methods: A large and diverse panel sample of Latinos, who were strategically sampled to be reflective of the Latino demographics of the state of Texas, completed questionnaires assessing their depressive symptomatology, coping motives to drink, and alcohol use behaviors.

Results: Direct effects were significant in hypothesized directions such that depressive symptoms was positively associated with both coping motives to drink and alcohol use severity, and drinking motives to cope were positively associated with alcohol use severity. Moderator analysis showed that, compared to Latina women, the association of depressive symptoms with both drinking to cope and alcohol use severity was significantly higher among Latino men. Regarding indirect effects, a moderated mediation analysis showed that the indirect effect of depressive symptoms on alcohol use severity through coping motives to drink was statistically significant for both Latino/a men and women; however, the index of moderated mediation showed that this indirect effect was significantly greater among Latino men.

Conclusion: Although both Latino/a men and women may consume alcohol and turn to alcohol to drink with negative affect associated with depressive symptoms, this process may be stronger among Latino men. Findings are discussed considering prior work and implications for practitioners.

Background: Problematic alcohol use is a recognized risk factor for suicidal thoughts and behaviors. Individuals who misuse alcohol and those experiencing suicidal ideation (SI) often exhibit elevated impulsivity, suggesting that impulsivity may be an underlying mechanism. Impulsivity fluctuates considerably within individuals over short periods, particularly among those engaged in episodic heavy drinking, college students, and those with SI. While impulsivity is associated with suicidal thinking at a trait level, its relationship with SI on a momentary level remains relatively unexplored. This study aimed to (a) replicate cross-sectional findings linking impulsivity and SI in those with problematic alcohol use, and (b) extend these findings to examine the momentary associations between impulsivity and SI within this population.

Method: Two independent undergraduate samples were utilized: the first cross-sectional (n = 653) and the second employing ecological momentary assessment (n = 56). All participants screened for problematic alcohol or substance use.

Results: Our results show a unique association between the impulsivity facet of negative urgency and SI. Results also demonstrate an interactive effect of negative affect and "spur of the moment decisions" in predicting concurrent SI, as well as an interaction between negative affect and "saying things without thinking" in prospectively predicting SI.

Conclusions: Findings highlight the saliency of negative urgency, both at the trait and state level in the prediction of SI. Although in need of replication, results indicate that specific aspects of momentary impulsivity may be uniquely linked with SI, and that this relationship may be context dependent.

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.

Treatment efficacy for patients with obsessive-compulsive disorder (OCD) with poor insight is low. Insight refers to a patient's ability to recognize that their obsessions are irrational and that their compulsions are futile attempts to reduce anxiety. This case study presents the first application of virtual reality-assisted avatar therapy for OCD (VRT-OCD) in a patient with contamination OCD and ambivalent insight. Before treatment, the patient was not distanced from the content of his obsessions, which obstructed treatment progress. VRT-OCD aims to enhance insight by creating distance between the patient's functional self and their OCD by means of a virtual avatar, an individually designed visual representation of their OCD. The three-session therapy involved engaging with the avatar, practicing resistance to the OCD, and reinforcing self-esteem based on the patient's values. By learning that his obsessions hindered him from living life according to his values, the patient was motivated to engage in dialog with his avatar and learned to stand up for himself. After treatment, the patient had improved insight (BABS score reduced by 71%) and reduced symptoms (Y-BOCS score reduced by 51%). First results suggest that VRT-OCD may increase insight and empower patients to confront their obsessions, leading to increased motivation to resist their compulsions. This study highlights the feasibility, acceptance, and potential effectiveness of VRT-OCD as a novel therapeutic approach for individuals with OCD.