The cover image is based on the Research Article Social communication and restricted, repetitive behavior as assessed with a diagnostic tool for autism (ADOS-2) in women with anorexia nervosa by Emma Saure et al., https://doi.org/10.1002/jclp.23700.
The cover image is based on the Research Article Social communication and restricted, repetitive behavior as assessed with a diagnostic tool for autism (ADOS-2) in women with anorexia nervosa by Emma Saure et al., https://doi.org/10.1002/jclp.23700.
Personality disorders (PD) are based not just on maladaptive ideas about self and others, they also are grounded on embodied patterns of behaviors and reactions to interpersonal stressors. There is growing interest in working with the body and through the body so to address automatisms that lead to suffering and dysfunctional social action. In this issue of the Journal of Clinical Psychology: In-Session the use of art and psychomotor therapies for these patients was explored by seven different clinical perspectives. Patients described presented with different PD and associated symptoms. The arts and psychomotor therapies deployed in personality disorder treatment are: (visual) art therapy, music therapy, drama therapy, dance (movement) therapy, and psychomotor therapy making psychotherapeutic use of the different modalities: art, music, play, role-play, performance, improvisation, dance, body awareness and movement. Interventions provide kinesthetic, sensory, perceptual, and symbolic opportunities to invite alternative modes of meaning-making, accessing own needs and wishes, and communicating them to others. In this commentary we summarize some of the different topics covered by the clinical-based papers, including working mechanisms of arts and psychomotor therapies, the importance of bottom-up emotion regulation processes, how to treat trauma in the presence of a PD, how to integrate art and psychomotor therapies in a fine-grained formulation and how to understand the process of change. Although there is a need for more empirical research, we hope this issue makes a solid case that clinicians can effectively include art and psychomotor therapies when treating the full range of PD.
The use of intensive time sampling methods, such as ecological momentary assessment (EMA), has increased in clinical, and specifically suicide, research during the past decade. While EMA can capture dynamic intraindividual processes, repeated assessments increase participant burden, potentially resulting in low compliance. This study aimed to shed light on study-level and psychological variables, including suicidal ideation (SI), that may predict momentary prompt (i.e., prompt-to-prompt) completion. We combined data from three EMA studies examining mental health difficulties (N = 103; 10,656 prompts; 7144 completed), using multilevel models and machine learning to determine how well we can predict prompt-to-prompt completion and which variables are most important. The two most important variables in prompt-to-prompt completion were hours since the last prompt and time in study. Psychological variables added little predictive validity; similarly, trait-level SI demonstrated a small effect on prompt-to-prompt completion. Our study showed how study-level characteristics can be used to explain prompt-to-prompt compliance rates in EMA research, highlighting the potential for developing adaptive assessment schedules to improve compliance.
Internet-delivered cognitive-behavioral therapy (ICBT) is an effective treatment for obsessive-compulsive disorder (OCD). ICBT can be delivered in a self-guided or clinician-guided format. While a literature is emerging on the predictors of response to clinician-guided ICBT, there is a lack of research examining the predictors of response to self-guided ICBT. The aim of the present study was to examine predictors of outcome in a large sample of participants with OCD who commenced a self-guided ICBT intervention. One hundred and fifty-seven participants (Mage = 34.82; SD = 10.49; 78% female) were included in the study. Regression analyses were conducted to determine clinical and demographic predictors of (1) posttreatment symptom severity and (2) a clinically meaningful treatment response for both the intention-to-treat (ITT) and completer samples. The regression models significantly predicted posttreatment outcome for both the ITT (F(8, 148) = 15.844, p < .001) and completer sample (F(8, 101) = 5.929, p < .001), explaining 46% and 34% of the variance respectively. Higher baseline OCD severity, younger age, experiencing higher contamination or symmetry symptoms, and a history of past treatment were all found to be significantly associated with higher posttreatment severity in the ITT sample. In the completer sample only higher baseline OCD severity and severity of harm-related obsessions and checking compulsions was significantly associated with higher posttreatment severity. When predicting treatment response the regression models for both the ITT and completer sample were nonsignificant.
Dialectical behavior therapy (DBT) is an evidence-based treatment for people with emerging borderline personality disorder (BPD). In “real world” clinical settings, standard DBT is resource intensive. Emerging evidence suggests that group-based DBT skills training alone can lead to promising outcomes. This hybrid type 1 effectiveness-implementation trial directly compared the effectiveness of an 8-week group DBT-skills training program and a 16-week DBT-informed program including individual treatment and group-based skills training.
This pragmatic trial employed a staggered, parallel-groups design. We recruited 104 participants, aged 16–25 years, with emotion dysregulation or emerging BPD symptoms. Participants were randomized to receive either program at a youth mental health service located in the Gold Coast, Australia. Data was collected via online surveys at baseline, 8-week, 16-week, and 24-week follow-up. Mixed effect linear models compared groups on the primary outcomes of emotion dysregulation and BPD symptoms, and secondary outcomes of suicidal ideation, coping skills, depression, anxiety, and stress.
Across groups there were significant and sustained improvements relating to emotion dysregulation, BPD symptoms, stress, depression, and emotion-focused coping; but not suicide risk, anxiety, or task-focused coping. There was no significant time by group differences between the 8-week and 16-week interventions on any primary or secondary outcome.
The more intensive mode of delivering DBT was not more effective than the brief group-based skills training. Both interventions resulted in significant improvements across both primary and most secondary outcomes. These results have implications for clinical practice regarding length and intensity of DBT treatment in young people.
Quality of life (QOL) is a multidimensional construct including emotional well-being, life satisfaction, and physical health. Individuals with posttraumatic stress disorder (PTSD) consistently report low QOL, highlighting the importance of assessing the effectiveness of first-line PTSD treatments (e.g., exposure-based therapies) on QOL. This meta-analysis examined the efficacy of exposure therapy for PTSD on QOL compared to control conditions (e.g., waitlist, medication, treatment-as-usual) at posttreatment and follow-up (ranging from 1 month to 2 years).
Building on a previous meta-analysis of exposure-based therapy for PTSD, we searched PsycINFO and Medline in December 2021, July 2022, and March 2023 to include randomized controlled trials of exposure-based treatments for adult PTSD assessing QOL. We screened 295 abstracts for initial eligibility; 20 articles met inclusion criteria and were included (N = 2729 participants). Risk of bias was evaluated using the Cochrane Risk of Bias tool 2.0.
At posttreatment, exposure-based therapies showed a medium effect on QOL relative to control conditions (k = 25, g = 0.67). This effect was not observed at follow-up for the small subset of studies with follow-up data (k = 8, g = 0.16). At posttreatment, effect size varied significantly as a function of the control condition (p < .0001). There were no differences in QOL effects across exposure therapies at posttreatment or follow-up (p = .09).
Exposure therapy was associated with greater improvement in QOL compared to control conditions at posttreatment. Exposure was not superior to control conditions at follow-up, and the longer-term impact of exposure on QOL is unclear. The implications of these findings are discussed, along with the need for more PTSD treatment studies to examine QOL outcomes at posttreatment and follow-up.
We aim to uncover the hot topics and development trends in clinical psychology research in the United States.
Utilizing bibliometric analysis, we examined clinical psychology papers published in the United States from 2010 to 2022 in the Web of Science database, employing citation analysis, content analysis, author analysis, and journal analysis.
Our analysis revealed a significant increase in clinical psychology research, notably catalyzed by the 2019 COVID-19 pandemic. This surge was particularly evident in studies addressing mental disorders such as PTSD, anxiety, and suicidal behaviors, as well as psychological trauma related to issues like family conflict, elder abuse, and collective trauma. Furthermore, there was a distinct shift towards studying diverse populations, including gender and racial minorities, mothers, and adolescents. Therapeutic approaches, such as mindfulness-based practices and AI-assisted technologies, also gained prominence.
This study represents the first large-scale bibliometric analysis in the field of clinical psychology in the United States. Our findings suggest that the COVID-19 pandemic highlights the importance of studying psychological issues linked to major events. Also, researchers are increasingly focusing on minority groups. This trend, along with the use of new technologies like big data and artificial intelligence, guides future research in clinical psychology.
The works in this review suggest that the changing landscape of clinical psychology, especially post-COVID-19. The increased research post-pandemic emphasizes addressing psychological trauma arising from societal issues like family conflicts, elder abuse, and collective trauma. A positive shift towards inclusivity is evident in research, focusing on diverse groups like gender minorities, racial minorities, mothers, and adolescents. Additionally, the amplified focus on mental disorders like PTSD, anxiety, and suicidal behaviors during the pandemic stresses the need for tailored interventions and support systems. Exploring innovative methods such as mindfulness-based practices and AI-assisted technologies showcases the field's adaptability in mental health interventions.
Clinical high-risk of psychosis (CHRp) samples can be heterogeneous, consisting essentially of people with not only psychotic-like experiences but also nonspecific symptoms that may reflect common mental disorders such as depression, anxiety, or substance abuse pathologies. Few studies have attempted to analyze and understand psychosis risk in relation to both environmental (ER) and psychopathological risk (PsR) factors. This study aimed to determine the clinical risk of psychosis in adolescents.
A representative sample of 1824 Spanish adolescents from the general population was evaluated using different scales to thoroughly examine the possible interaction of CHRp with various ER and PsR factors. Partial correlations were calculated to assess the relationships between the variables. A series of hierarchical linear regression models were then used to obtain a CHRp predictor model.
The CHRp predictor model indicated that PsR was the most significant determining factor, explaining 22% of the total associated variance of CHRp. However, the ER factor also emerged as a significant predictor of high-risk psychosis (accounting for 9% of the variance).
A predictive model for CHRp in adolescents was found, in which common psychological problems were presented as more determinant risk factors than ER disruptors. Furthermore, certain transdiagnostic processes, such as psychological inflexibility, may play a central role in the development of mental health problems, including psychosis. Specifying the mechanisms underlying the emergence of CHRp in adolescence is the key to optimizing the focus of preventive therapeutic interventions in these early stages.
Attachment theory has served as an influential framework for understanding psychopathology, partly due to reliable assessment methodology. The influence of insecure attachment on attitudes toward the body and the impact this might have for the development of psychopathology is however less well elucidated.
A total of 123 adolescents (35 with borderline personality disorder or BPD, 25 with other personality disorders [OPD] and 63 comprising a normative control group) were interviewed with the Adult Attachment Interview (AAI) and the Mirror Interview (MI). The MI questions respondents about how they feel about their bodies, as they look in the mirror.
The AAIs from the Borderline group were predominantly insecure-preoccupied and unresolved. These adolescents had significantly lower levels of a positive and integrated sense of self and body than the other groups. Regression results revealed a high loving relationship with fathers, low involving anger with father, high coherence of mind, slight derogation of mother & low levels of unresolved loss uniquely and additively predicted 55% of variance in the summary score assigned to MI responses, that is, the summary score for a Positive and Integrated Body Representation (PIBR).
Unfavorable attachment experiences and current states of mind regarding attachment may give rise to problems with establishing PIBRs, and thus play a role in the development of psychopathology, especially BPD.
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