Journal of Clinical Psychology最新文献

Objectives

Adverse childhood experiences (ACEs) are established risk factors for developing depression in adulthood, although the mechanisms of this association are yet to be fully elucidated. In this study, we tested whether insomnia (i.e., difficulties in sleep onset and maintenance) can mediate the association between ACEs and adult depressive symptoms, and whether loneliness and hair cortisol, reflecting hypothalamic-pituitary-adrenal axis activity, can act as moderators.

Methods

We analyzed data of 1593 participants (64.7% female) aged 65.25 ± 8.15 from the English Longitudinal Study of Ageing (ELSA) across three waves of data collection. ACEs were retrospectively assessed in 2008–2009 (wave 4), insomnia symptoms, loneliness, and hair cortisol in 2012–2013 (wave 6), while depressive symptoms were assessed in 2014–2015 (wave 7).

Results

After accounting for health-related confounders and baseline values, conditional process analysis showed that insomnia symptoms exerted a mediating role between ACEs (ACEs total, parental bonding, and household dysfunction) and depressive symptoms, with a stronger effect in lonely older adults. Hair cortisol did not moderate the association between ACEs and insomnia symptoms.

Conclusion

Results are consistent with the view of insomnia as a mechanism linking ACEs to depressive symptoms later in life. Elderly experience of loneliness may further increase the mediatory role of insomnia between ACEs and depression.

Objective

To investigate the reciprocal relationships between patient interpersonal behavior (IB), therapist competence, and the alliance within- and between-persons.

Methods

A secondary analysis was conducted of a randomized controlled trial with 67 cognitive behavior therapists and 114 patients with depression. The therapists evaluated their patients' IB, and they both judged the alliance. Pre- and post-treatment, the patients indicated their general levels of interpersonal problems. Every fourth session, independent raters judged the patients' IB and therapists' competence. Random-intercept cross-lagged panel analyses were calculated.

Results

First, intraindividual deviations in patient IB were associated with deviations in therapist competence or the alliance (within-person); and patients with generally more positive IB experienced not only better alliances but also more competent therapists (between-person). Second, the perspective of the evaluating person and the time interval were decisive, as significant cross-lagged effects between patients' IB in one session and the alliance in subsequent sessions (and vice versa) only occurred from the therapist perspective, but not when the patient perspective was considered. Third, patients with more interpersonal problems before treatment did not show more negative IB, nor did they experience poorer alliances or less competent therapists.

Conclusion

The study supports the idea that patient IB is as an important part of both therapeutic competence and the alliance. However, therapists and raters may be prone to evaluation bias, interpreting negative patient IB as a sign of poor alliance or competence (and vice versa). Finally, the extent of interpersonal problems before treatment does not substantially influence the three process variables.

Trial Registration: https://clinicaltrials.gov/study/NCT02479594.

Objective

Telehealth psychotherapy (TH) has become widespread since the COVID-19 pandemic and has generally proven to be equally effective and acceptable as in-person (IP) treatment. However, it is unclear how TH and IP client characteristics and service utilization compare in routine practice post-pandemic.

Methods

Individual psychotherapy clients (N = 22,710) receiving routine treatment at 72 university counseling centers from 2021 to 2023 reported on their demographic and clinical characteristics, while service utilization was determined through chart review.

Results

Compared to IP clients, TH clients were more likely to identify as cisgender women, Hispanic/Latinx, and bisexual and were less likely to live with roommates. TH and IP clients reported roughly equivalent symptom severity at the beginning of treatment, but TH clients were less likely to report recent suicidal ideation and more likely to have a history of past psychotherapy and psychiatric medication use. Regarding service utilization, TH clients scheduled slightly more psychotherapy appointments yet attended a lower percentage of appointments, but these differences were small. Exploratory analyses on matched samples of TH and IP clients did not detect differences in pre- to posttreatment symptom reduction.

Conclusion

In routine practice, TH and IP psychotherapy appear to facilitate access to care for slightly different client populations, are associated with similar utilization patterns, and produce similar outcomes in university counseling post-COVID-19. Clinical systems may best serve a diverse public by offering both TH and IP services. Policy-level (e.g., equitable reimbursement for TH) and administrative support are needed to facilitate continued access to both modalities.

Objectives

Thousands of Veterans file claims for military sexual trauma (MST)-related posttraumatic stress disorder (PTSD) disability through the Department of Veterans Affairs' (VA) Veterans Benefits Administration (VBA) annually to receive covered healthcare benefits and monthly nontaxable compensation for MST-related conditions. Although 72% of MST claims in 2021 were granted, prior reporting found other claims had been erroneously denied due to issues around VA staff not ordering disability exams for claims and not gathering necessary evidence on behalf of claimants. The present study explores decision-making processes around evidence-gathering for MST-related disability claims through interviews with VA staff who develop, rate, and evaluate MST disability claims (n = 21).

Methods

Interviews occurred from October 2021 to January 2024 and were analyzed using rapid qualitative methods and inductive coding, revealing themes of ambiguity, beliefs, and discretion. Participants described MST “markers” (e.g., behavioral events or patterns indicating effects of MST) as difficult to reliably identify and demonstrated disagreements about what constituted a marker. Within this ambiguity, factors that shaped participants' decision-making included beliefs about the MST and its impacts, the veracity of Veteran PTSD and/or MST claims, and the role of VA staff. Participants' judgments appeared to depend in part on their beliefs about sexual assault myths and the trustworthiness of Veterans: those who endorsed sexual assault myths or believed Veterans often lie were more likely to approach MST claims with skepticism.

Conclusion

Future policy and programming around MST claims processing should focus on reducing ambiguity and impacts of beliefs on discretion and objectivity.

Objectives

Misophonia is characterized by an aversion to specific sounds, such as chewing and breathing. These “trigger” sounds can elicit negative emotional reactions, physiological stress, and cognitive impairments in people with misophonia. Despite its impact, misophonia lacks formal diagnostic classification, largely due to challenges in conceptualization and assessment. One of the few psychometrically robust self-report measures for misophonia (the MisoQuest) was originally developed and evaluated in Polish. The current study evaluated the utility of the English language version of the MisoQuest, including assessment of its criterion validity using cognitive performance as an outcome.

Methods

A total of 139 participants (44 people with misophonia and 95 controls) completed the MisoQuest, the Selective Sound Sensitivity Syndrome Scale (S-Five), the Generalized Anxiety Disorders Scale, and the Sensory Hypersensitivity Scale. Participants then completed either a Stroop task or reading comprehension task in the presence/absence of triggering sounds. A subset of participants retook the MisoQuest after 5 weeks.

Results

The MisoQuest showed excellent internal consistency and strong test-retest reliability. Additionally, MisoQuest scores strongly correlated with S-Five scores, supporting convergent validity, and moderately correlated with measures of generalized anxiety and sensory hypersensitivity, indicating some overlap while supporting discriminant validity. Higher MisoQuest scores predicted poorer reading comprehension performance when trigger sounds were present, supporting criterion validity. However, MisoQuest scores showed no significant relationship with Stroop task performance.

Conclusion

These findings support the MisoQuest as a reliable and useful measure of misophonia in English-speaking individuals and suggest its scores may relate to clinically relevant outcomes.

Objective

Many post-9/11 veterans struggle with psychological symptoms as they transition to civilian life. Adverse childhood experiences, combat exposure, and deployment characteristics are factors associated with symptoms. This study examined changes in the predictive power of these factors over the first 3 years of the military-to-civilian transition among post-9/11 veterans.

Methods

This was a longitudinal survey study in which six waves of data were collected over 3 years.

Results

The associations between combat, ACEs, deployment characteristics, and psychological symptoms were complex, not static, not always linear, and differed between male and female veterans. The number of deployments was associated with fewer psychological symptoms at baseline for both genders. For males, longer deployments at baseline predicted worse mental health, while more deployments were associated with improving mental health over time.

Conclusion

Temporal explorations of veteran mental health are needed to gain insights into how and when psychological problems develop and change over time. Veterans need a robust support network to prevent mental health problems as they transition to civilian life.