Journal of Clinical Psychology最新文献

Personality disorders (PDs) are enduring and inflexible patterns of cognitions, emotions, interpersonal functioning or impulse control that lead to significant distress or impairments with an impact on a broad range of personal and social situations (American Psychiatric Association, 2013; National Center for Health Statistics, 2015).

Even though PDs are difficult to treat, both outcome studies and meta-analyses have shown that verbal psychotherapy is effective for reducing PD pathology, though its effectiveness is often incomplete (Budge et al., 2013; Cristea et al., 2017; Stoffers-Winterling et al., 2012, 2022). For example, their symptoms and psychosocial functioning remain impaired even after treatment (Chakhssi et al., 2021; Keuroghlian et al., 2013; Smits et al., 2020), and act as a risk factor for relapse, occurrence or recurrence of symptoms and interpersonal problems. Moreover, state of the art results say that both cognitive and psychodynamic therapies for PD are effective to a similar degree, even if they approach the problems from different angles. Treatments of psychodynamic orientation are mostly focused on changing patterns via conversation only, e.g., Mentalization Based Therapy (Bateman & Fonagy, 2004) and Transference Focused Therapy (Yeomans et al., 2015), though they ask patients to try with and adopt healthy behaviors in between sessions.

Other therapies, mostly from the third wave orientation, such as Dialectical Behavior Therapy (Linehan, 1993), Schema Therapy (Young, 1994) and Metacognitive Interpersonal Therapy (Dimaggio et al., 2020) add an experiential component, which includes mindfulness, skills training and behavioral emotion-regulation strategies, guided imagery and rescripting, role-play and chair work.

As described, PDs feature dysfunctions in multiple domains, e.g., identity problems, problems at work and in romantic relationships, risky behaviors and so on (American Psychiatric Association, 2013). Moreover, core pathology includes multiple elements, such as poor awareness of mental states, poor capacity to regulate emotions, problematic ideas about self and others and resort to maladaptive strategies to cope with psychological pain. Finally, PDs are comorbid with heightened levels of symptom disorders and behavioral problems (e.g., alcohol and substance abuse). We are then facing a complex form of psychopathology for which psychotherapy is only partially effective. It seems therefore necessary to adopt a wide array of strategies to tackle the different problems they present. As a consequence, current psychotherapeutic approaches may benefit from differently oriented therapies than only verbal approaches that may improve upon general treatment efficacy.

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Substance use disorders (SUDs) are highly prevalent and have deleterious effects on one's health and well-being. Inpatient treatment for SUDs reduces patient relapse, which subsequently ameliorates these negative effects on the individual and society. Additionally, those who complete treatment are less likely to relapse compared to those who do not complete treatment. Thus, maintaining patient engagement in treatment and reducing the rates of those leaving against medical advice (AMA) is particularly important. Examining the factors and comorbidities that may contribute to treatment dropout has the potential to identify at-risk patients in need of additional individualized intervention. The current study aimed to examine comorbid anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms as predictors of dropout AMA in a residential substance use treatment population. Results showed that patients with social anxiety were more likely to leave treatment AMA, while those with PTSD were more likely to complete treatment. Findings suggest that PTSD-specific treatment, as offered in this facility, may help with patient retention, while group focused therapy may be distressing to those with social anxiety. Clinical implications of this research may include incorporating evidence-based practice for social anxiety early during inpatient treatment to reduce anxiety such that patients may better engage with SUDs treatment.