Journal of Clinical Psychology最新文献

This study analyzed data from the Military Health and Well-being Project (MHWBP) to examine the influence of combat exposure on suicidal behavior among U.S. military personnel with combat experience, focusing on the moderated effects of moral injury and stigma. Data from 1,495 service members were analyzed, revealing significant correlations among the variables. The Process Macro was employed to assess the impact of moral injury and stigma on suicidal behavior. Furthermore, moderated moderation analyses were conducted, revealing that combat experience had a stronger relationship on suicidal behavior among individuals with high levels of moral injury and stigma. These findings shed light on the interacting factors through which combat exposure affects suicidal behavior among military personnel and are discussed in terms of their implications, limitations, and future research directions.

Guilt and shame can be very relevant when treating personality disorders. Understanding how they block the patients' capacity to figure out they can fulfill their wishes is central for a fine-grained case formulation, and for counteracting their contribution to symptom and goal fulfillment. To this purpose we will describe how Metacognitive Interpersonal Therapy, delivered in a combined individual and an open-group format, addressed pathological emotions of shame and guilt in the case of Martina, a woman suffering from Borderline PD with avoidant and dependent traits. We show how the therapists adopted a combined individual and group format, working through the therapeutic alliance, using experiential techniques such as guided imagery, rescripting, body work, and role-play. Through this process, Martina came to realize that her core problem was related to a core self-idea of being "shattered" and "harmful" which she held as true and that made her impossible to access the very idea of deserving to be treated. Therapy helped her figure out the origins of these ideas which generated intense guilt and shame and to process them until she was able to contact a sense of self-confidence and dignity, and finally to pursue her own wishes.

The current study examined suicide and violent crime data for 100 large municipalities in the United States. Suicide occurred more often when high school graduation rates were lower, but paradoxically, better income inequality rates predicted higher suicide, though this is consistent with international economic data. The frequency of mental distress predicted suicide as expected. Communities with higher proportions of black residents were more resilient to suicide, and why this is may be worth exploring in future research.

Objective: This study aimed to examine patient satisfaction and treatment outcomes of a 34-week Group Schema Day Treatment (GSDT) program combined with individual Schema Therapy, for individuals with cluster B and C personality disorders.

Method: A naturalistic design was utilized with 39 adult patients (mean age = 33.95; SD = 10.83; 62% female) primary diagnosed with personality disorders from clusters B and C. The therapy outcome measures were assessed before the start of treatment (T0), 8 weeks (T1) and 26 weeks in treatment (T2), and between the first and second follow-up (T3).

Results: Significant positive change was observed in overall patient satisfaction, with effect sizes for the treatment satisfaction domains (information, shared decision, satisfaction of therapists, overall satisfaction and treatment mark) ranging from -0.36 to 0.98 (Cohen's d). Significant reductions were observed in psychological symptoms, personality disorder severity, and dysfunctional schemas, with effect sizes (Cohen's d) ranging from 0.77 to 0.87. Increase in healthy modes showed a smaller effect size of 0.24. The dropout rate was 17.9%.

Conclusions: The findings suggest that GSDT is generally well-accepted by patients who report high satisfaction with the treatment. It could be potentially effective in treating mixed cluster B and C personality disorders. Further randomized controlled trials are recommended to better understand the relationship between patient satisfaction and treatment outcomes, as well as to assess cost-effectiveness.

Objective: Misophonia often co-occurs with emotional disorders in youth, indicating that these conditions may share underlying risk factors, such as distress intolerance and anxiety sensitivity. However, the specific relationships between misophonia severity, distress intolerance, and anxiety sensitivity have not been formally explored. Understanding how these transdiagnostic risk factors impact misophonia severity and related impairment could offer valuable insights into misophonia phenomenology and identify key therapeutic targets for affected youth.

Methods: This study examined the impacts of distress intolerance and anxiety sensitivity on misophonia severity during treatment in youth (N = 43) randomized to either a 10-week course of the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A; N = 29) or psychoeducation/relaxation training (PRT; N = 14). Youth completed self-report measures at 0-, 5-, and 10-weeks post-enrollment.

Results: Greater distress intolerance and anxiety sensitivity were both associated with greater misophonia symptom severity at pre-treatment. Distress intolerance, but not anxiety sensitivity, improved significantly across treatment course. Compared to youth receiving PRT, youth receiving UP-C/A exhibited greater improvements in distress intolerance across treatment, and indirect effect estimates indicated that improvement in distress intolerance was a mechanism through which the UP-C/A elicited change in misophonia symptom severity.

Conclusion: Preliminary findings support distress intolerance as a mechanism of symptom change in transdiagnostic cognitive-behavioral treatment for youth misophonia. Future large-scale trials are warranted to further investigate distress intolerance and other transdiagnostic factors as treatment targets for misophonia.

Suicidal thoughts and behaviors (STBs) are a public health concern, particularly among Veterans, who experience elevated rates of STBs. Social integration is negatively associated with STBs, such that high social integration is correlated with low rates of STBs. Much of the literature has studied marital status as a social relationship that may protect individuals from STBs. Although largely unstudied, it has long been assumed that social integration moderates the link between marital status and STBs. Thus, in a sample of Veterans (N = 1469; Military Health and Well-Being Project), we tested our hypotheses that (1) social integration varies by marital status (single vs. married vs. domestic partnership vs. divorced vs. widowed), (2) social integration is negatively associated with STBs (i.e., lifetime suicidal ideation, past year suicidal ideation, suicidal ideation communication, and likelihood of suicide attempt), (3) STBs vary based on marital status, and (4) social integration moderates the cross-sectional link between marital status and STBs. Results indicated that (1) marital status was associated with social integration, such that married people reported greater social integration than people who were single; (2) social integration was negatively associated with all four STBs (r's < - 0.09, p < 0.001); (3) STBs varied based on marital status such that married people reported fewer STBs than people who were in a domestic partnership, single, widowed, or divorced, and (4) social integration did not moderate the link between marital status and STBs. Findings indicate that factors external to marital status may contribute to the link between social integration and STBs.

Objectives: Effective treatments are available for major depressive disorder; however, treatment efficacy is less pronounced in real-life settings compared to research. One reason for this discrepancy may be that treatment outcomes assessed in research do not fully reflect domains important to treatment recipients: clients and their informal caregivers. Moreover, studies often struggle to assess the impact of process-related factors on treatment success. More research incorporating client and informal caregiver perspectives is therefore needed to identify what they consider essential for a successful treatment.

Methods: Group Concept Mapping was employed to elicit insights from clients and informal caregivers regarding their experiences with depression treatment. Twenty-one participants brainstormed in response to the statement: "Successful depression treatment requires…". Subsequently, 32 participants sorted the identified factors into meaningful groups and rated their importance to treatment success.

Results: Participants generated 79 unique responses in the brainstorm. They sorted these responses into 10 clusters: "The client", "Treatment process", "Treatment organisation", "Interaction client clinician", "The clinician", "Clinician's adherence to good practice", "Drug treatment", "Pre-condition", "Supporting activities", and "Supportive work and home life". Most clusters were considered important.

Conclusion: These findings support the idea of using multivariate and multimodal models for understanding treatment success. Participants attributed the therapeutic alliance as more clinician-driven than client-driven. A combination of factors related to treatment organization, treatment elements, and guideline adherence emerged as a core concept to successful treatment. Recommendations include increasing clinician awareness of perceptions of the therapeutic alliance and utilizing the findings to guide treatment discussions.

Objectives: The goal of this study was to characterize a sample of individuals with opioid use disorder (OUD) reporting perceived social isolation (PSI) using latent profile analyses.

Methods: Individuals with OUD reporting PSI (n = 125) were recruited for a clinical trial to address PSI. Measures assessing PSI, quantity of social interactions, perceived social support, and opioid use were used to create latent profiles. Additional characteristics including other substance use, substance use consequences, depression, anxiety, belongingness, and burdensomeness were assessed to differentiate the profiles.

Results: Latent profile analyses revealed 3 profiles, each of which reported high PSI and low quantity of social interactions as well as low perceived social support but varied based on days using opioids. Profile 1 (n = 36; labeled Low Frequency Use) had less frequent opioid use with few social interactions and lower perceived social support. Profile 2 (n = 17; Occasionally Abstinent) used opioids daily, had few social interactions, and had higher perceived social support. Profile 3 (n = 72; Frequent Use) used opioids daily. Low Frequency Use participants engaged in polysubstance use on less days and were more diverse in gender and race.

Conclusions: This study identified three classes of individuals with OUD and elevated PSI that were differentiated primarily by frequency of opioid use, while all classes reported high loneliness and low social support. Although exploratory, outcome analyses suggested that the classes were clinically meaningful, with differences in polysubstance use and drug consequences, and warrant replication in larger samples.

Over the past three decades, rigorous empirical research has highlighted both cumulative and non-additive effects of childhood trauma, which are intricately intertwined with the broader developmental and psychosocial context. Latent class analysis has proven useful in identifying at-risk groups, thereby informing the design of targeted prevention and early-intervention efforts. Extending prior research to highly complex, high-risk children and families receiving intensive home-based treatment (IHBT), this study analyzed archival data from 10,301 Connecticut families enrolled in the Intensive In-Home Child & Adolescent Psychiatric Service (IICAPS) from May 2014 to February 2020. The objective was to identify clusters of child traumatic events alongside familial and community-level adversities that predict treatment engagement within this marginalized and hard-to-reach population. Using latent class analysis (LCA), four classes emerged: (1) Unspecified Adversity (69% probability of membership across the sample); (2) High Family Adversity (13%); (3) High Child Trauma & Family Adversity (11%); and (4) High Child Trauma (7%). Relative to the Unspecified Adversity group (reference class), all other groups exhibited lower odds of completing treatment. These findings hold implications for developing targeted assessment and intervention strategies to enhance treatment engagement and outcomes for underserved youth in intensive home-based programs.

Objectives: Mental health service users are responsible and autonomous individuals who can comprehend their own illness and recovery and therefore engage healthcare professionals in their care. Studies have demonstrated how service users feel more dignified, safe, and respected during mental health treatment when they are listened to by their caregivers and included in treatment decision-making. The physical space and design of mental health facilities, as well as the approach to care and treatment, have been found to have positive implications for service users' treatment and recovery, both in contemporary and historical settings. Thus, understanding service user perspectives is necessary because these experiences may shed light on best treatment practices.

Methods: The current study engages interview data produced by public safety professionals-who are often exposed throughout the course of their service and duties to potentially psychologically traumatic events-who were receiving inpatient care for trauma and, in some circumstances, substance misuse at Edgewood Health Network's Guardians Gateway facility. Framed through the sociology of mental health literature, we qualitatively explore how these service users experienced the physical and psychological aspects of the treatment space.

Results: We found their experiences of recovery at this facility led to new conceptions of mental health treatment, including overcoming stigma, personal growth, and encouragement to try new activities and programs tailored to their individualized mental health needs.

Conclusion: We discuss how their lived experiences provide novel insights into best care practices for public safety personnel in Canada.