British Journal of Clinical Psychology最新文献

Objectives: Patients with obsessive-compulsive disorder (OCD) face multiple barriers when accessing treatment and rarely receive best-practice cognitive behaviour therapy (CBT) when they seek help. Remote treatments, such as internet-delivered CBT (ICBT), enhance access to evidence-based treatments. To date, no known studies have examined the reasons individuals seek remote treatment over traditional in-person treatment for OCD. Thus, the aim of the current study was to examine the treatment histories of individuals who completed ICBT for OCD and their reasons for seeking ICBT.

Methods: One hundred and sixty-six participants (M_age = 33.88; SD = 13.41, 71.7% female) were included in the study.

Results: Almost three-quarters of the sample had previously spoken to a health professional about their OCD symptoms. General practitioners were the most frequently consulted health professionals initially (41.7%), while psychologists were the most frequently consulted overall (81.7%). Supportive counselling (74.2%) and medication (72.5%) were the most common forms of treatment ever received. Of those who had received CBT for OCD, only 20.0% (12.5% of the overall sample) likely received best-practice CBT. The most frequently endorsed reasons for seeking ICBT over in-person treatment related to having no access to face-to-face treatment in the community (25.9%) and having found previous face-to-face treatment unhelpful (24.1%). Group differences in reasons for seeking ICBT over face-to-face treatment emerged based on geographical location, OCD severity and presence of comorbid depressive symptoms.

Conclusions: Evidence-based treatment for OCD is underutilized in the community highlighting the need to develop and disseminate evidence-based remote treatments for OCD.

Background: Although multiple qualitative studies have explored participants' experiences of behavioural activation (BA) for unipolar depression, none have investigated the experiences of BA in people with bipolar depression. This is of particular interest because qualitative studies concerning the experience of receiving therapy can help inform the theory of change underpinning the intervention.

Aim: The purpose of this study was to explore the experiences and perspectives of individuals with bipolar disorder who received a course of one-to-one BA for bipolar depression. We sought to explore participants' experience of the effects of BA therapy, both proximally and distally.

Method: Semi-structured interviews were conducted with nine individuals meeting research diagnostic criteria for bipolar I or II disorder who had received up to 20 sessions of BA adapted for bipolar depression. Thematic analysis using a framework approach was used to explore and describe the experiences of participants.

Results: Participants' perspectives on the impact of therapy were categorized under four subthemes: client behaviour inside and outside sessions, changes in clients' perspectives, the impact on symptoms and impact on life and functioning.

Conclusions: Participants' accounts of the impact of therapy were broadly consistent with the theory underpinning a behavioural approach. Participants described a central role for perspective change, and particularly increased acceptance of the self and mood states, as facilitating behavioural changes and more distal benefits. Process evaluations embedded in future trials may include quantitative measures of key processes described by our participants, as well as those clearly implied by the behavioural theory of depression.

Objectives: The aim was to extend previous work on the identity disruption model (IDM) of adult psychological distress. According to the IDM, aversive childhood experiences (ACEs) disrupt the development of identity, resulting in an unclear sense of self and a reliance on external sources of self-definition, leading to psychological distress in adulthood. In line with this model, self-concept clarity (SCC) in parallel with self-esteem (SE) and intolerance of uncertainty (IU) has been shown to mediate the relationship between childhood adversity and depression and anxiety. The current study examined if SCC, SE and IU mediated the influence of childhood adversity on depression, anxiety and hypomania.

Methods: A community sample of 159 adults completed online measures of childhood adversity, self-esteem, self-concept clarity, intolerance of uncertainty, depression, anxiety and hypomania. Structured equation modelling using bias corrected bootstrapping was used to test the mediation model.

Results: Direct effects of childhood adversity were found for depression and anxiety, but not hypomania. The influence of ACEs on depression and anxiety was mediated by self-concept clarity and self-esteem. Self-concept clarity also mediated the influence of ACEs on hypomania, which is an important novel finding. The indirect effect of childhood adversity via intolerance of uncertainty was limited to anxiety.

Conclusions: Results suggest that the identity disruption model generalizes to hypomania. The clinical implications are that interventions to improve clarity of the self-concept might be useful in reducing psychopathology.

Introduction: Mental imagery is a defining criterion within current OCD diagnoses, and yet little has been written about how this is experienced. This study aimed to investigate how people with a diagnosis of OCD experience imagery, to better understand how this might contribute to the condition.

Methods: This research employed Interpretative Phenomenological Analysis (IPA) and used semi-structured interviews. An expert-by-experience was involved in the study design. Eight adults with an OCD diagnosis were purposively sampled from NHS mental health services and interviewed about their experience of imagery. Interviews were transcribed and analysed in accordance with IPA guidelines. A reflexive log and audit trail were maintained during the research process to enhance quality control and to support the analytical process.

Results: Six superordinate themes were found: Submersion in intense and multifaceted imagery; Overwhelming, uncontrollable imagery; Imagery is explosive and expansive; Imagery involves past memories and future fears; People respond to imagery as if it is real; Therapy shifts imagery.

Conclusions: This study highlights the intensity of OCD-related imagery experienced by people with OCD and the significance of this imagery in their everyday lives. All participants experienced imagery related to their OCD, demonstrating its importance in the phenomenology of the condition. Images relating to past experiences and images of future fears were identified. Clinicians should routinely seek to include imagery in assessment, formulation, and individual treatment plans for those with OCD.

Objectives: Clinical heterogeneity is a major problem in mental health, referring to wide clinical variability among people with the same diagnosis. In bipolar disorders (BD), an heterogeneity was found both in global remission (symptomatic and functional) and in personal recovery during euthymia. This heterogeneity is a challenge for clinicians, who have to adapt their care to the individuals' characteristics. This preliminary study aimed at identifying profiles of experiences during euthymia by considering global remission (manic and depressive symptomatology, and functional impairment) and personal recovery, and exploring personal and contextual correlates associated with the heterogeneity of experiences.

Methods: A convenience sample of 58 participants in euthymia of BD was recruited. Data were collected using self-report questionnaires. Consistent with a person-oriented approach, clustering was performed to identify profiles by simultaneously considering symptomatology, functional impairment, and personal recovery. Associations between the identified profiles and socio-demographic, clinical, and family characteristics were explored using analysis of variance, Fisher's exact tests, and post hoc tests.

Results: Five profiles were identified when considering both global remission and personal recovery: adverse experience (20.69%), slightly adverse experience (22.41%), unbalanced experience (10.34%), positive experience (22.14%), and hyperthymic positive experience (24.14%). Among the correlates, only current family functioning was significantly associated with the identified profiles through cohesion, communication, and satisfaction dimensions.

Conclusions: These results highlight that personal recovery and family dynamics of people with BD should be more considered in the clinical practice to better understand their experience during euthymia and adapt therapeutic care accordingly.

Objectives: Hoarding difficulties (HD) affect many people and cause upset and danger for the person, as well as friends and family. Previous research found that people with HD feel less adequately socially supported compared with individuals with obsessive compulsive disorder (OCD). This study used the perspective of those offering support to infer whether people with HD view their support differently, or if there is a gap in support quality compared with those with OCD.

Design: The design was cross-sectional, comparing those supporting OCD with those supporting HD.

Methods: An online questionnaire was completed by 116 people offering support (POS) to people with these conditions. Support quality was measured using an adapted, proxy version of the Revised Norbeck Social Support Questionnaire. The research hypothesized that POS(HD) would not differ on support ratings compared with POS(OCD); or that POS(HD) would report comparatively lower ratings across support components. Secondary analysis investigated group differences in stigmatized attitudes and associative stigma; internalized stigma by virtue of having a connection to a stigmatized individual.

Results: POS(HD) rated their wish to support and the perceived success as significantly lower. Public stigma was rated more highly by POS(HD) relative to POS(OCD) and associative stigma felt more acutely by POS(HD).

Conclusions: Motivation to support was significantly lower in the HD group with associative stigma a significant predictive factor. Further research involving dyads is needed to investigate what is causing this shortfall in support. Clinical research for HD interventions should also examine how involving POS could enhance treatment outcomes.

Objective: Generalized anxiety disorder (GAD) is a persistent mental health condition that results in significant individual and economic burden. The uptake of evidence-based treatment is low, with many individuals with GAD citing cost as one of the key barriers. Brief treatments, which are typically more cost effective than standard length treatments, have the potential to make treatment more accessible to patients with GAD. Despite evidence demonstrating the efficacy of brief treatments for a range of anxiety disorders, there are currently no such studies examining brief Internet videoconferencing-delivered cognitive behavioural therapy (VCBT) interventions for patients with diagnosed GAD. The current study aims to examine the preliminary efficacy and acceptability of brief VCBT for GAD.

Method: The authors adopted an open trial design with 36 participants (77.8% female; M_age = 36.81 years; SD = 12.25) to examine the preliminary efficacy of a brief five-session VCBT intervention delivered remotely.

Results: Large pre-treatment to post-treatment effects were seen on the primary outcome measure, the Generalized Anxiety Disorder Questionnaire-7 item (GAD-7; d = 1.13; 95% CI: .62-1.61) and treatment effects increased at 3-month follow-up (d = 1.58; 95% CI: 1.04-2.10). Participants rated the intervention as highly acceptable with 92% reporting that they were satisfied with the treatment.

Conclusion: These results provide preliminary support for the viability of brief remotely delivered CBT treatment in managing GAD symptoms.

Objectives: Self-guided internet-delivered cognitive behaviour therapy (ICBT) is an effective treatment for obsessive-compulsive disorder (OCD); however, there is little research investigating who dropouts of treatment. Therefore, the aim of this study was to conduct an exploratory study of predictors of dropout in self-guided ICBT for OCD. Given that definitions of dropout vary across ICBT studies, we conceptualized dropout in multiple ways: (1) early dropout (proportion of participants who did not complete the pre-treatment questionnaires); (2) proportion of participants who did not commence the intervention; (3) proportion of participants who did not complete the treatment; and (4) proportion of participants who did not complete the post-treatment questionnaires.

Method: This was a secondary data analysis of 323 participants with OCD symptoms who provided a successful screening assessment to commence an ICBT intervention. Binary logistic regression was used to predict dropout based on a number of exploratory variables.

Results: Early dropout was predicted by the country of the participant (participants in the United Kingdom and India being more likely to dropout), as well as shorter symptom duration (explaining 7% of the variance). Medication use predicted non-completion of the intervention with those taking medication for OCD being less likely to complete the treatment (explaining 3% of the variance). Completion of the post-treatment questionnaires was predicted by higher contamination symptoms, lower depressive symptoms and higher pre-treatment conscientiousness (explaining 13% of the variance). There were no significant predictors of treatment commencement.

Conclusions: The study provides important preliminary information concerning which patients with OCD may be more likely to drop out of a self-guided ICBT intervention.

Objectives: Body dissatisfaction is a public health concern, prevalent among women. This study aims to investigate the efficacy of a 2-week online functionality-focused intervention combined with psychoeducation on improving body image among young women at both high and low risk of Body Image Disorders (BIDs).

Design: A randomized controlled trial was conducted among young women at high risk and low risk of developing BIDs.

Methods: In total, 231 young women (n = 64 at high risk of BIDs) were randomized into: experimental (n = 113) and waitlist (n = 118) groups. The experimental group underwent the intervention at baseline (T0) for 15 days (T1), while the waitlist group started the intervention at T1 for 15 days (T2). Participants completed questionnaires about body and functionality appreciation, eating disorders (EDs) risk and extreme body dissatisfaction at baseline, 15 days from baseline and 30 days from baseline.

Results: Mixed linear models revealed enhancements in body and functionality appreciation post-intervention for women at both high risk and low risk of BIDs. Reductions in EDs risk and body dissatisfaction were observed in participants at high risk.

Conclusions: The intervention proves to be useful in promoting a positive body image (i.e. body and functionality appreciation) in women at both high and low risk of BIDs, while the results concerning the risk of developing EDs and extreme body dissatisfaction are more nuanced.

Objectives: The ability to interpret facial expressions accurately is important to adaptive social functioning. Social anxiety disorder is associated with a biased interpretation of facial emotions. This study aimed to demonstrate the effects of feedback training on modifying interpretation bias in individuals with high social anxiety.

Methods: A total of 451 university students were screened, and 69 participants with high social anxiety were randomly assigned to either a training (n = 37) or a control (n = 32) group. Participants completed pre-questionnaires on social anxiety and depression symptoms, then performed a single session of experiment, followed by post-questionnaires on social anxiety symptoms. In the experiment, participants viewed an ambiguous facial expression and rated the intensity on a continuous scale. The training group received feedback that presented their ratings alongside the actual intensity, allowing them to accurately assess their emotional perception bias through trial-by-trial feedback. The control group received no feedback.

Results: The training group showed a significant reduction in interpretation bias for happy and angry faces after the experiment, while the control group did not. However, although the training group's social anxiety symptoms decreased post-experiment, the difference was not statistically significant compared to the control group.

Conclusions: These findings provide preliminary evidence that the feedback training targeting dimensional ratings of emotions may be a promising option for correcting interpretation bias in individuals with high social anxiety. Future research could implement multiple sessions of training to potentially reduce both interpretation bias and social anxiety symptoms and verify the long-term effects.