Journal of Clinical Psychology最新文献

Based on the repertory grid technique, we developed Explore Your Meanings (EYME), a digital platform that helps patients explore identity values and internal conflicts using virtual reality (VR). EYME was part of a research project treating depression in young adults, including 10 weekly, 1-h sessions aimed at changing personal constructs-cognitive schemas that shape how individuals interpret reality. We present the case of Mary, a 21-year-old woman diagnosed with persistent major depressive disorder and social phobia. Early sessions with EYME revealed key implicit dilemmas in Mary's worldview, such as feeling that she had to be selfish (an undesired personal characteristic) to become smarter and more self-confident (desired pole). As Mary visualized these constructs in VR, she began to recognize her identity conflicts and strengths, ultimately helping her to improve her negative self-image. Interventions focused on reframing these constructs, particularly around "intelligence" and introducing "emotional intelligence," which helped Mary adopt a more nuanced view of herself. A key session involved a two-chair dialog between her "critical" and "emotional" selves, facilitating the integration of polarized aspects of her personality. In subsequent sessions, EYME reinforced these changes, with Mary reinterpreting behaviors like being "selective" as protective rather than negative. By the end of therapy, she no longer met the criteria for depression or social phobia, and her psychological distress had normalized.

Background: Extended-duration exposure therapy, in which treatment is delivered over a single prolonged session or cluster of long-duration sessions, is a highly efficacious and efficient treatment for anxiety disorders such as specific phobias. Despite this, little is known about the use of extended-duration exposure therapy in clinical practice.

Methods: In the present study we investigated the perceptions and use of extended-duration exposure therapy amongst a sample of Australian psychologists via a survey, and the Therapist Beliefs about Exposure Scale. Additionally, we compared theoretical understanding of exposure therapy, and therapy delivery strategies (using a case study vignette), between psychologists who deliver exposure therapy via an extended-duration mode, versus the more traditional multi-session mode.

Results: Extended-duration exposure therapy is widely underutilised, and this is associated with negative beliefs about exposure therapy in general, as well as several practical barriers. There were no differences in the reported theoretical mechanisms of exposure therapy between those who do and do not use extended-duration exposure therapy. However, psychologists who use extended-duration exposure therapy reported greater use of strategies with demonstrated efficacy (e.g., more intense delivery) and less use of therapy-interfering strategies (e.g., distress reduction techniques) relative to those who do not use extended-duration exposure therapy.

Conclusion: These findings identify potential mechanisms accounting for extended-duration exposure therapy's efficiency and point to strategies that may increase the uptake of extended-duration exposure therapy in clinical practice.

Eating disorders (EDs) are highly prevalent among transgender and nonbinary (TNB) adults, and internalized transnegativity is a key risk factor for ED symptomatology. Although extant literature has established that self-compassion protects against EDs among the cisgender population, research among TNB adults is nascent. The current study sought to identify whether internalized transnegativity and components of self-compassion (i.e., self-warmth and self-coldness) were independently associated with ED symptomatology, and whether the components of self-compassion moderated the relation between internalized transnegativity and ED symptomatology. An international sample of 127 TNB adults aged between 18 and 69 years (M = 32.24, SD = 11.12) completed the Transgender Identity Survey, the Self-Compassion Scale, and the Screen for Disordered Eating via an online survey. Simple linear regression models were run, followed by moderation analyses. Internalized transnegativity and self-coldness were associated with ED symptomatology, but self-warmth was not. Self-warmth and self-coldness did not moderate the relation between internalized transnegativity and ED symptomatology. The results highlight that self-coldness and, to a lesser extent, internalized transnegativity account for a significant portion of the variance in ED symptomatology among TNB adults. Although these effect sizes were small, they have important clinical implications. Future research should take alternative analytical approaches to examine how self-warmth, self-coldness, and internalized transnegativity are related to ED symptomatology among TNB adults.

Introduction and aims: Existing therapies for Anorexia Nervosa (AN) have limited effectiveness, necessitating the development of novel therapies and interventions. Hypothesizing and targeting clear mechanisms of change within treatment offer potential opportunities to improve them. The SPEAKS program aimed to develop, trial, and evaluate a therapy which targets key emotional and social factors known to be relevant in the development and maintenance of AN. The aim of the present study is to explore therapist and client experiences of change processes during the SPEAKS intervention, and what supported or inhibited these.

Method: Semi-structured interviews were conducted with sixteen female clients (in age range of 18-49) and six therapists; topic guides explored perceptions of client change processes. Thematic analysis was conducted on the data by two researchers.

Results: Two themes and six sub-themes were developed from the data. These were: "the impact on the eating disorder," "change processes" ("emotional change" and "changing the self"), and "facilitators of and barriers to change processes" ("therapeutic relationship," "clients' emotional engagement," "online delivery," and "therapist lacking flexibility"). "Emotional change" involved an enhanced capacity for clients to tune-in more, acknowledge, listen to, and express how they felt, and "Changing the self" represented a shift in how clients related to themselves, particularly the more vulnerable parts of themselves.

Discussion: The findings of the present study provide support for the hypothesized mechanisms of change inherent within the SPEAKS therapy approach. This supports the robustness and validity of the intervention and lends support for further investigation of its effectiveness.

Clinical trial registration: The study was registered according to the guidelines of the International Standard Randomized Controlled Trial Number Register (ISRCTN No. 11778891).

Objectives: A major characteristic of health anxiety is the tendency to attribute benign bodily sensations to serious illnesses. This has been supported by empirical research in non-clinical samples, and samples of individuals diagnosed with Hypochondriasis. However, no study to date has explored symptom attribution styles of individuals with the DSM-5 diagnosis of Illness Anxiety Disorder.

Methods: Sixty-one participants, including a clinical Illness Anxiety Disorder (n = 35) and healthy control (n = 26) sample, completed self-report measures of health anxiety and an Attribution Task, whereby they were presented with eight common bodily sensations and asked to generate possible explanations for them.

Results: Results showed that relative to healthy controls, participants with Illness Anxiety Disorder overall were more likely to make more serious, 'catastrophic' somatic attributions to symptoms, and less likely to generate non-threatening normalising explanations. These results also extended to their initial attributions, conceptualised as the 'jumping to conclusions' bias, and as an exploratory index of flexibility, they were also found to make less attributions overall compared to healthy controls.

Conclusions: Findings provide support for the cognitive behavioural theory of health anxiety, and highlight the importance of assessing and addressing symptom attributions with clients with illness anxiety disorder.

Objective: Single-item questionnaire assessments may be summarily dismissed by some, but it is unclear if this is warranted. We suggest here that the answer to that question depends on their reliability and construct validity. Reliability of a single-item index cannot be assessed via indices like coefficient alpha, but it can be addressed otherwise; construct validity can be assessed as it would be with any other quantitative index.

Methods: In 489 patients with mood and anxiety disorders, we examined the Beck Depression Inventory Item 9's (BDI-Item 9) test-retest coefficient, and its validity, in part via invariance analyses. More specifically regarding invariance analyses, we determined whether a covariance structure including a multi-item assessment of suicidal ideation was invariant with a similar structure using a single-item assessment of suicidal ideation instead.

Results: Reasonably supportive evidence emerged for the reliability and construct validity of this specific one-item index.

Conclusions: The BDI-Item 9 can reliably assess suicidal ideation when data lack multi-item assessments.

Borderline personality disorder (BPD) is associated with a high risk of suicide. Despite several risk factors being known, identifying vulnerable patients in clinical practice remains a challenge so far. The current study aimed at predicting suicide attempts among BPD patients during disorder-specific psychotherapeutic interventions exploiting machine learning techniques. The study took into account several potential predictors relevant to BPD psychopathology: emotion dysregulation, temperamental and character factors, attachment style, impulsivity, and aggression. The sample included 69 patients with BPD who completed the Temperament and Character Inventory, Attachment Style Questionnaire, Difficulties in Emotion Regulation Scale, Barratt Impulsiveness Scale, and Aggression Questionnaire at baseline and after 6 months of psychotherapy. To detect future suicide attempts, baseline questionnaires were entered as predictors into an elastic net penalized regression, whose predictive performance was assessed through nested fivefold cross-validation. At the same time, 5000 iterations of a non-parametric bootstrap were used to determine predictors' robustness. The elastic net model discriminating BPD suicide attempters from non-attempters reached a balanced accuracy of 64.09% and an area under the receiver operating curve of 70.44%. High preoccupation with relationships, harm avoidance, and reward dependence, along with low motor impulsiveness, verbal aggression, cooperativeness, and self-transcendence were the most contributing predictors. Our findings suggest that interpersonal vulnerability and internalizing factors are the strongest predictors of future suicide attempts in BPD. Machine learning on self-report psychological scales may be helpful to identify individuals at suicidal risk, potentially helping clinical settings to develop individualized preventive strategies.

The present study was designed to test the hypothesis that interpersonal emotion regulation leads to increased difficulties in intrapersonal emotion regulation, which in turn, leads to general psychological distress utilizing a three-wave cross-lagged panel design. Undergraduate students rated self-report measurements of interpersonal emotion regulation, difficulties in intrapersonal emotion regulation, and psychological distress at baseline (T1, N = 369) and two follow-up waves (T2 and T3), each separated by 3 months. The results indicated that although some lagged correlations between interpersonal emotion regulation strategies and difficulties in intrapersonal emotion regulation were significant, interpersonal emotion regulation strategies did not prospectively predict difficulties in intrapersonal emotion regulation. Notably, difficulties in intrapersonal emotion regulation significantly predicted psychological distress in subsequent waves. Additionally, psychological distress at T1 predicted distress at T3 through difficulties in intrapersonal emotion regulation at T2. This study is significant as it is the first to test the interpersonal emotion regulation model in a longitudinal design. However, the hypothesized pathway where interpersonal emotion regulation contributes to psychological distress through difficulties in intrapersonal emotion regulation, was not supported.

Up to a third of service members and Veterans experience disordered eating. Disordered eating can be maintained through negative reinforcement of painful and unpleasant emotions such as guilt, shame, sadness, and hostility. Hostility is a negative emotion that may be particularly relevant for service members and Veterans, yet hostility's relation to disordered eating remains understudied. Further, variability in emotions may be particularly relevant, given that variability in emotions is often a stronger predictor of psychopathology than mean levels. Thus, the goal of the present study was to assess a potential bidirectional relationship between disordered eating symptoms and individuals' variability of hostility, stress, anxiety, sadness, and shame. Participants (N = 94, M_age = 32.2, 75.8% men; 81.8% White) completed 30 days of ecological momentary assessment (EMA) with four assessments per day along with baseline and follow-up measures including the Eating Pathology Symptom Interview (EPSI), which assessed eight disordered eating symptom domains. Hierarchical regressions revealed that higher baseline levels of Binge Eating and Excessive Exercise predicted greater intraindividual hostility variability. Further, more hostility variability predicted higher Cognitive Restraint at 1-month follow-up. Baseline disordered eating symptoms were not associated with intraindividual variability in stress, anxiety, sadness, or shame. However, greater intraindividual variability in shame predicted higher Muscle Building at 1-month follow-up. Hostility variability was the only emotion that was predicted by, and predictive of, disordered eating symptoms. These findings suggest that hostility may be a relevant treatment target for service members with disordered eating.