Journal of Clinical Psychology最新文献

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.

Problematic emotion management is a core symptom of personality disorders and does not tend to improve spontaneously with age. Systems Training for Emotional Predictability and Problem Solving (STEPPS), a treatment program targeting emotional intensity difficulties, has been found to be effective for younger adults with borderline personality disorder. After a pilot study and a Delphi study, STEPPS was adjusted for older adults to better suit this population. The aim of present study was to evaluate first outcomes (e.g., level of improvement) of the adjusted STEPPS Older Adults (STEPPS-OA). A total of 52 patients, with a mean age of 67 years (range: 60-80), participated in this proof-of-concept study with pre-, mid-, and post-treatment measurement points. A total number of 38 patients completed the treatment; 14 patients (27%) dropped out. A majority of the patients (58%) had borderline personality disorder. After treatment, patients reported significantly decreased borderline personality disorder severity and symptomatic distress. Furthermore, there was a significant improvement of adaptive emotion regulation strategies and all personality functioning factors. Finally, some maladaptive personality traits (i.e., Disinhibition and Negative Affectivity) decreased significantly. Results of this proof-of-concept study indicate STEPPS-OA is a promising treatment option for managing emotional intensity difficulties for older adults with personality disorders.

Shame is a fundamental human affect that plays a central role in social regulation and psychopathology. In some individuals with antisocial personality disorder (ASPD), chronic and pathological shame-shaped by early experiences of abuse, neglect, and attachment disruption-may contribute to difficulties in affect regulation, mentalization, and interpersonal functioning, and is frequently implicated in violent and antisocial behavior. The authors describe a long-term, psychodynamically informed mentalization-based treatment (MBT) group for men with ASPD. The paper focuses on shame as a clinically organizing affect, examining how unmentalized experiences of shame and humiliation may precipitate transient collapses in mentalization, paranoia, and violent acting out. Drawing on detailed clinical material, the authors consider the developmental origins of pathological shame in early attachment relationships and explore the technical challenges of working therapeutically with profound shame states in a group context. It is proposed that addressing both individual and collective experiences of shame within a stable therapeutic group can foster a sense of safety, support the restoration of mentalizing capacity, and reduce vulnerability to violent behavior. The paper aims to extend existing mentalization-based formulations of ASPD by foregrounding shame as a central affective process within long-term group treatment.

Objective: Digital interventions designed to prevent development of chronic pain and comorbid mental health symptoms, specifically targeting the acute injury recovery period, are in the early stages of development. The evidence-based PTSD Coach mobile application is a free resource offering cognitive-behavioral interventions to self-manage posttraumatic symptoms; it is used widely in varied populations, and it is feasible and acceptable to injured Emergency Department patients. However, patients' subjective experience and feedback regarding optimizing the app are lacking.

Methods: We conducted a qualitative study in which we recruited and interviewed 18 acutely injured adult patients (5 men; 13 women) at-risk for persistent pain and psychological problems. Participants were instructed to use PTSD Coach for at least 1 week; during the interview, participants discussed post-injury needs and challenges, their experience with the app, and general perceptions of its suitability to address post-injury distress.

Results: Favorable feedback centered on the variety of user-friendly tools to help manage symptoms, ability to increase awareness of symptoms and identify and cope with distressing reminders of the trauma, and on facilitating openness and linking to resources for mental health treatment. Suggestions for improvement included: increased personalization through app onboarding, text messages and other notifications to prompt use, having voice-overs to read content to participants, and linkages to in-person mental healthcare if needed.

Conclusion: These findings support PTSD Coach as a potential self-management tool to prevent the chronicity of maladaptive psychological reactions to injury and highlight features that may improve its utility for this unique underserved population.

This case study presents the treatment of a young adult with severe mental contamination (MC), a subtype of obsessive-compulsive disorder (OCD) characterized by internal feelings of dirtiness triggered by trauma-related emotions rather than physical contaminants. The patient, Federico, exhibited intense shame and disgust linked to a bullying episode, leading to compulsive rituals and functional impairments. Treatment integrated emotion regulation training, Imagery Rescripting (ImRs), and behavioral experiments, targeting dysfunctional beliefs about emotions. ImRs allowed reprocessing of the traumatic memory and reshaping of self-related meanings of impurity and unworthiness. Behavioral experiments tested and modified catastrophic appraisals of emotional experiences, fostering tolerance of distress without compulsive neutralization. By the end of treatment, Federico's Y-BOCS-II score fell from 42 to 15 (-64%) and his VOCI-MC score from 50 to 9 (-82%), with stability at 3-month follow-up. Follow-up confirmed the stability of gains and increased emotional autonomy. This case supports the utility of combining trauma-focused cognitive techniques and behavioral experiments in MC, particularly when compulsions are maintained by unprocessed emotional memories rather than concrete contamination threats. It highlights the need for individualized interventions in which ImRs may serve as a central component in treating MC symptoms.

Dialectical behavior therapy (DBT) is an extensively studied treatment for borderline personality disorder (BPD), with skills use being one of the hypothesized mechanisms of change. Research has previously been hindered by the absence of an appropriate tool to measure skills use, leading to the development of the DBT Ways of Coping Checklist (DBT-WCCL). The DBT-WCCL aims to assess DBT skills use (DSS) as well as dysfunctional coping (DCS), which can be divided into dysfunctional coping in general (DCS1) and blaming others (DCS2). This study evaluated the Dutch version of the DBT-WCCL by examining (1) the dimensional structure and measurement invariance across BPD and non-clinical samples, (2) psychometric properties (reliability and validity), and (3) sensitivity to change. A total of 204 participants diagnosed with BPD and 103 non-clinical controls completed the Dutch DBT-WCCL along with instruments assessing emotion regulation and BPD manifestations. First, when including all DBT-WCCL items, the hypothesized two-factor and three-factor models were not tenable due to substantial content overlap. When factor analyses included only items representing DBT skills or dysfunctional coping, support was found for three subscales (DSS, DCS1, and DCS2). Partial measurement invariance was established only for the DSS subscale. Reliability and known-group validity were satisfactory for all scales, while inconclusive results were found for the concurrent validity of the DSS subscale. Finally, the DBT-WCCL proved to be sensitive to change. In conclusion, our findings largely support the use of the Dutch DBT-WCCL, but warrant caution when comparing samples on dysfunctional coping.

Trial Registration: The BOOTS study was registered in the Overview of Medical Research in the Netherlands (NL-OMON21337).

Objective: This systematic review and meta-analysis aim to evaluate the efficacy of acupuncture in reducing anxiety by synthesizing evidence from randomized controlled trials (RCTs).

Methods: A comprehensive search was conducted across six databases-AMED, CINAHL, CENTRAL, Embase, Ovid MEDLINE, and PubMed-for RCTs published in English up to January 22, 2025. Eligible studies included patients with anxiety complications and compared RCTs comparing manual acupuncture (MA) with sham acupuncture (SA) or usual care or wait list control (UC/WLC) were included if anxiety was assessed as the primary outcome using validated measures. SMDs with 95% CIs were calculated using a random-effects model, and heterogeneity was assessed using I² and REML. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 (RoB 2) tool.

Results: A total of 20 RCTs with 1462 participants were included. MA significantly reduced anxiety at post-treatment compared to SA (SMD = -1.06, 95% CI: -1.74 to -0.39, p = 0.0005, I² = 94%) and UC/WLC (SMD = -1.35, 95% CI: -2.26 to -0.44, p = 0.00006, I² = 59%). The effect was maintained at follow-up when compared to SA (SMD = -0.78, 95% CI: -1.21 to -0.35, p < 0.00001) but not significant compared to UC/WLC (SMD = -0.60, 95% CI: -1.68 to 0.49, p = 0.12). RoB assessment showed low risk in 14 studies, while others had unclear allocation concealment and blinding issues. Seventy-nine adverse events were reported, mainly transient discomfort, minor bleeding, or localized pain, with no severe events.

Conclusion: MA effectively reduces anxiety symptoms in the short term, with effects sustained at follow-up when compared to SA but not UC/WLC. Further research is needed to confirm long-term efficacy and standardize methodologies. Acupuncture remains a promising, safe, and minimally invasive therapy for chronic anxiety.

Clinical trial registration: The review protocol was preregistered on the International Prospective Register of Systematic Reviews (PROSPERO; CRD420250621404) and can be accessed at https://www.crd.york.ac.uk/PROSPERO/view/CRD420250621404.

Objectives: Intolerance of uncertainty (IU) is a cognitive vulnerability factor that plays a role in obsessive compulsive disorder (OCD). Most research has looked at IU at an omnibus level. This paper aimed to investigate the two dimensions of IU, prospective and inhibitory IU, and their relation to overall OCD symptom severity, as well as the severity of obsessions and compulsions.

Method: Fifty-nine individuals with OCD completed measures of OCD symptom severity and IU at pre- and post- group cognitive behavioral therapy (CBT).

Results: IU and OCD symptoms, and their dimensions, all reduced over the CBT treatment. At the start of treatment, only prospective IU was associated with compulsion symptom severity. In contrast, at the end of treatment, prospective and inhibitory IU were associated with compulsion symptom severity, and inhibitory IU was associated with obsession symptom severity. Baseline IU, prospective and inhibitory IU were not associated with post OCD symptom severity scores, when controlling for pre-treatment OCD severity levels. Change in prospective IU was associated with changes in OCD symptom severity, and change in compulsions, but not change in obsessions. The results cannot speak to causal or temporal predictions, or directionality of the relationship between IU and OCD.

Conclusion: These findings underscore the dynamic relationship between the IU dimensions and OCD symptoms, and highlights prospective IU as a potential important target in CBT for OCD to achieve reductions in compulsions and overall OCD symptom severity.