British Journal of Clinical Psychology最新文献_第10页

Predicting optimal treatment allocation for cognitive analytic-guided self-help versus cognitive behavioural-guided self-help 预测认知分析指导自助与认知行为指导自助的最佳治疗分配。

IF 3.1 3区心理学 Q1 PSYCHOLOGY, CLINICAL

British Journal of Clinical Psychology

Pub Date : 2024-10-23 DOI: 10.1111/bjc.12508

Caroline Wojnarowski, Melanie Simmonds-Buckley, Stephen Kellett

Objectives

Given the ubiquity in routine services of low-intensity guided self-help (GSH) psychological interventions, better patient selection for these brief interventions would be organizationally efficient. This study therefore sought to define who would respond best to two different types of GSH for anxiety to enable better future treatment matching.

Methods

The study used outcome data from a patient preference trial (N = 209) comparing cognitive analytic therapy-guided self-help (CAT-GSH) with cognitive behavioural therapy-guided self-help (CBT-GSH). Elastic Net regularization and Boruta random forest variable selection methods were applied. Regression models calculated the patient advantage index (PAI) to designate which GSH was likely the most effective for each patient. Outcomes were compared for those receiving their PAI-indicated optimal and non-optimal GSH.

Results

Lower baseline depression and anxiety severity predicted better outcomes for both types of GSH. Patient preference status was not associated with outcome during either GSH. Sixty-three % received their model indicating optimal GSH and these had significantly higher rates of reliable and clinically significant reductions in anxiety at both post-treatment (35.9% vs. 16.6%) and follow-up (36.6% vs. 19.2%). No single patient with a large PAI had a reliable and clinically significant reduction in anxiety at post-treatment or follow-up when they did not receive their optimal GSH.

Conclusions

Treatment matching algorithms have the potential to support evidenced-based treatment selection for GSH. Treatment selection and supporting patient choice needs to be integrated. Future research needs to investigate the use of the PAI for GSH treatment matching, but with larger and more balanced samples.

目的：鉴于低强度的指导性自助（GSH）心理干预在常规服务中无处不在，更好地选择患者接受这些简短的干预将提高组织效率。因此，本研究试图确定哪些患者对两种不同类型的焦虑症指导自助疗法反应最佳，以便今后更好地进行治疗匹配：研究使用了一项患者偏好试验（N = 209）的结果数据，该试验比较了认知分析疗法指导下的自助（CAT-GSH）和认知行为疗法指导下的自助（CBT-GSH）。应用了弹性网正则化和 Boruta 随机森林变量选择方法。回归模型计算了患者优势指数（PAI），以确定哪种GSH对每位患者最有效。结果比较了接受 PAI 指示的最佳和非最佳 GSH 治疗的患者的疗效：结果：基线抑郁和焦虑严重程度越低，两种 GSH 的疗效越好。患者的偏好状况与两种 GSH 的疗效无关。63%的患者接受了其模型显示的最佳GSH治疗，这些患者在治疗后（35.9%对16.6%）和随访中（36.6%对19.2%）的焦虑程度均有明显的临床显著降低。没有一名PAI较大的患者在治疗后或随访时，如果没有接受最佳的GSH治疗，其焦虑程度都没有得到可靠且有临床意义的缓解：治疗匹配算法有可能支持基于证据的GSH治疗选择。治疗选择和支持患者选择需要结合起来。未来的研究需要调查PAI在GSH治疗匹配中的应用，但需要更大、更均衡的样本。

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引用次数: 0

Intolerance of uncertainty and psychosis: A systematic review 对不确定性的不容忍与精神病：系统综述。

IF 3.1 3区心理学 Q1 PSYCHOLOGY, CLINICAL

British Journal of Clinical Psychology

Pub Date : 2024-10-22 DOI: 10.1111/bjc.12509

Jayne Morriss, Daisy Butler, Lyn Ellett

Objectives

Intolerance of uncertainty, the tendency to interpret and react negatively to uncertainty, is a transdiagnostic risk factor for anxiety, depression and eating-related disorders. Given the high comorbidity between anxiety, depression and schizophrenia-spectrum diagnoses (SSDs), there is potential for intolerance of uncertainty to play a role in modulating psychosis symptoms. To address this gap in our understanding, we conducted the first prospectively registered systematic review on intolerance of uncertainty and psychotic symptoms in both people with SSDs and in the general population.

Methods

Four databases were searched (PsycINFO, Medline, Web of Science and PubMed), which identified ten studies with a total of 1503 participants that measured intolerance of uncertainty and psychosis symptoms.

Results

Key findings suggest the following: (1) Intolerance of uncertainty was associated with total negative psychotic symptoms with small–medium effect sizes; (2) intolerance of uncertainty was higher in individuals with an ‘at-risk’ mental state for psychosis compared to controls; (3) higher intolerance of uncertainty was associated with more individual psychotic symptoms related to delusions and paranoia within clinical and nonclinical samples; and (4) there was mixed evidence for a relationship between intolerance of uncertainty and auditory hallucinations and intolerance of uncertainty and total positive symptoms in clinical samples.

Conclusions

Overall, these findings highlight that intolerance of uncertainty may be an important transdiagnostic dimension and potential treatment target for psychotic symptoms such as delusions and paranoia in people with SSDs.

研究目的对不确定性的不容忍，即对不确定性做出负面解释和反应的倾向，是焦虑症、抑郁症和饮食相关障碍的一个跨诊断风险因素。鉴于焦虑症、抑郁症和精神分裂症谱诊断（SSDs）之间的高度共病性，不确定性不容忍有可能在调节精神病症状方面发挥作用。为了弥补我们认识上的这一不足，我们首次对不确定性不耐受与精神分裂症患者和普通人群的精神病症状进行了前瞻性系统回顾：我们检索了四个数据库（PsycINFO、Medline、Web of Science和PubMed），发现了10项研究，共有1503人参与，这些研究测量了不确定性不容忍度和精神病症状：主要发现如下(结果：主要研究结果表明：（1）不确定性不容忍度与总体负面精神病症状相关，且具有中小效应量；（2）与对照组相比，精神病 "高危 "精神状态个体的不确定性不容忍度更高；（3）在临床和非临床样本中，不确定性不容忍度越高，与妄想和偏执相关的个体精神病症状越多；以及（4）在临床样本中，不确定性不容忍度与幻听之间的关系以及不确定性不容忍度与总体积极症状之间的关系存在混合证据：总之，这些研究结果突出表明，不确定性不耐受可能是一个重要的跨诊断维度，也是治疗 SSD 患者妄想和偏执等精神病性症状的潜在目标。

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引用次数: 0

Implicit associations with non-suicidal self-injury: Examination in a clinical sample by borderline personality symptomatology 非自杀性自伤的隐性关联：通过边缘型人格症状对临床样本进行检查。

IF 3.1 3区心理学 Q1 PSYCHOLOGY, CLINICAL

British Journal of Clinical Psychology

Pub Date : 2024-10-07 DOI: 10.1111/bjc.12506

Stephanie Jarvi Steele, Nigel M. Jaffe, Claire A. Kelly, Thröstur Björgvinsson, Lance P. Swenson

Objectives

We examine correlates and predictors for implicit associations with non-suicidal self-injury (NSSI) with the Self-Injury Implicit Association Test (SI-IAT) in a treatment-seeking sample. We also examine group differences in the SI-IAT among those with low/none, moderate and high/clinically significant borderline personality disorder (BPD) symptomatology in a treatment-seeking sample.

Methods

Participants (N = 111; 58% female; 89% White; M_age = 30.25) completed the SI-IAT and self-report measures at two time points.

Results

Higher BPD symptom scores were significantly, positively correlated with implicit identification with NSSI, and predicted NSSI identity when controlling for depression indices, history of NSSI and other covariates. With Time 1 SI-IAT scores entered as a covariate, BPD scores no longer significantly predicted Time 2 SI-IAT scores. Individuals with moderate and high/clinically significant symptom counts of BPD had higher/stronger implicit associations with NSSI identity than those with no/low BPD symptoms.

Conclusions

Individuals with symptoms of BPD may implicitly identify with NSSI more than other clinical groups; examination of implicit assessments in BPD in future research is needed to further explore implicit identification with NSSI in this patient group to further understand both cross-sectional and prospective relations.

研究目的：我们通过自伤内隐联想测验（SI-IAT）研究了寻求治疗样本中与非自杀性自伤（NSSI）内隐联想的相关性和预测因素。我们还研究了寻求治疗样本中低度/无、中度和高度/临床显著边缘型人格障碍（BPD）症状者在 SI-IAT 中的群体差异：参与者（N = 111；58% 女性；89% 白人；年龄 = 30.25）在两个时间点完成 SI-IAT 和自我报告测量：结果：较高的 BPD 症状得分与 NSSI 的内隐认同呈显著正相关，并且在控制抑郁指数、NSSI 史和其他协变量的情况下，预测 NSSI 认同。将第一阶段的 SI-IAT 分数作为协变量输入后，BPD 分数不再显著预测第二阶段的 SI-IAT 分数。与无BPD症状/BPD症状轻微的人相比，BPD症状中度和高度/临床症状明显的人与NSSI身份的内隐关联更高/更强：有 BPD 症状的个体可能比其他临床群体更隐性地认同 NSSI；在未来的研究中需要对 BPD 的隐性评估进行检查，以进一步探索该患者群体对 NSSI 的隐性认同，从而进一步了解横断面和前瞻性关系。

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引用次数: 0

Development of the Flexibility in Daily Life scale to measure multidimensional cognitive and behavioural flexibility in health and disease 开发 "日常生活灵活性量表"，用于测量健康和疾病中的多维认知和行为灵活性。

IF 3.1 3区心理学 Q1 PSYCHOLOGY, CLINICAL

British Journal of Clinical Psychology

Pub Date : 2024-09-22 DOI: 10.1111/bjc.12505

Kristina Horne, Tao Chen, Muireann Irish

Objectives

Inflexibility of thought and behaviour is a transdiagnostic feature of many neuropsychiatric disorders and presents several empirical measurement challenges. Here, we developed and validated the Flexibility in Daily Life scale (FIDL); a novel, self-report questionnaire, which captures expressions of cognitive and behavioural flexibility in daily life and is sensitive to natural shifts in these processes across the adult lifespan.

Methods

The FIDL was developed using a deductive scale development approach, which aimed to capture common themes within the flexibility literature and across diagnoses (e.g. insistence on sameness, preference for routines). Following multidisciplinary consensus, an initial 37-item questionnaire was submitted for validation in an online sample of 295 healthy adult participants (19–78 years).

Results

Exploratory factor analysis produced a revised 21-item version comprising five factors, labelled: Repetition, Switching, Predictability/Control, Routine, and Thoughts/Beliefs. Internal consistency reliability was good-to-strong for the total FIDL score and moderate-to-strong for individual subscales. Convergent validity was established between the FIDL and an existing measure of cognitive flexibility. Critically, the FIDL total score evinced a U-shaped relationship with age, whereby flexibility was lower at the younger and older tails of the lifespan and greater in middle age. The same U-shaped trajectory emerged for the Repetition, Routine, and Thoughts/Beliefs factors.

Conclusions

Overall, the FIDL is a valid and reliable multidimensional measure of flexibility, which upholds a clearly defined factor structure and good psychometric properties. It promises to be a valuable clinical and research tool to assess the natural fluctuations in flexibility across the lifespan and departures thereof.

目的：思维和行为的不灵活性是许多神经精神疾病的一个跨诊断特征，同时也给实证测量带来了一些挑战。在此，我们开发并验证了日常生活灵活性量表（FIDL）；这是一种新颖的自我报告式问卷，可捕捉日常生活中认知和行为灵活性的表现形式，并对这些过程在成人生命周期中的自然变化非常敏感：FIDL 采用演绎量表开发方法，旨在捕捉灵活性文献和不同诊断中的共同主题（如坚持同一性、偏好常规）。在达成多学科共识后，最初的 37 个项目的问卷被提交给 295 名健康成年参与者（19-78 岁）的在线样本进行验证：结果：探索性因素分析得出了 21 个项目的修订版，包括五个因素，分别为重复、转换、可预测性/控制、常规和想法/信念。FIDL 总分的内部一致性信度为良好至强，各分量表的内部一致性信度为中等至强。FIDL 与现有的认知灵活性测量方法之间具有一致性。重要的是，FIDL 总分与年龄呈 U 型关系，即在生命周期的青年期和老年期，灵活性较低，而在中年期则较高。重复、常规和思维/信念因子也呈现出同样的U型轨迹：总之，FIDL 是一种有效、可靠的多维灵活性测量方法，具有明确的因子结构和良好的心理测量特性。它有望成为一种有价值的临床和研究工具，用于评估人一生中灵活性的自然波动及其偏离情况。

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引用次数: 0

Broadening accessibillity and scalability of interventions for trauma-related conditions 扩大创伤相关疾病干预措施的可及性和可扩展性。

IF 3.1 3区心理学 Q1 PSYCHOLOGY, CLINICAL

British Journal of Clinical Psychology

Pub Date : 2024-09-18 DOI: 10.1111/bjc.12500

Caitlin Hitchcock, Skye Fitzpatrick

Objectives

Trauma-related conditions, such as post-traumatic stress disorder, are associated with high rates of impairment and distress. Evidence-based interventions for many trauma-related conditions exert robust effects on their primary outcomes. However, logistical, financial, geographic and stigma-related barriers to accessing these interventions exist.

Methods

Innovations that overcome barriers to access and engagement and increase the scalability of interventions for trauma-related conditions are sorely needed.

Results and Conclusions

Here, we explore the following two potential avenues towards meeting this need: changes to the delivery model, including embedding interventions in settings which are already accessed by trauma-exposed individuals (e.g. schools, social care systems) and harnessing advancements in technology to provide truly accessible trauma-focussed interventions.

目标：创伤相关疾病，如创伤后应激障碍，与高比例的损伤和痛苦相关。针对许多创伤相关疾病的循证干预措施对其主要结果产生了强有力的影响。然而，在使用这些干预措施时，存在着后勤、经济、地理和与耻辱相关的障碍：方法：亟需创新措施来克服获得和参与干预的障碍，并提高创伤相关状况干预措施的可扩展性：在此，我们探讨了满足这一需求的以下两个潜在途径：改变提供模式，包括将干预措施嵌入到受创伤者已经接触到的环境中（如学校、社会医疗系统）；利用先进技术提供真正可获得的以创伤为重点的干预措施。

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引用次数: 0

A narrative review of factors affecting memory confidence in the context of compulsive checking: A search for evidence-based potential therapeutic targets to improve memory confidence 对强迫性检查中影响记忆信心因素的叙述性回顾：寻找基于证据的潜在治疗目标，提高记忆信心。

IF 3.1 3区心理学 Q1 PSYCHOLOGY, CLINICAL

British Journal of Clinical Psychology

Pub Date : 2024-09-17 DOI: 10.1111/bjc.12501

Javad Abbasi Jondani, Fariba Yazdkhasti

Background and Objectives

According to current models of compulsive checking, memory confidence greatly contributes to the development and maintenance of checking behaviours. However, how to intervene in memory confidence in an evidence-based manner has not yet been fully understood. Thus, the purpose of the current paper was to identify the factors influencing memory confidence through the review of experimental evidence.

Methods

PubMed, Google Scholar, OpenGrey and ProQuest databases were searched by combining two sets of keywords related to memory confidence and checking. Our search yielded 24 experiments. Due to the considerable heterogeneity of the studies regarding questionnaires, tasks and paradigms used, data were synthesized using a narrative review approach.

Results

Six factors emerged from a thorough review of the literature, including negative memory belief, higher memory standard, inflated sense of responsibility, familiarization with the checked stimuli, number of checks and anxious valence of the checked stimuli.

Conclusion

The findings have important implications for the treatment of compulsive checking. We suggested general guidelines to translate these factors into a novel intervention to increase memory confidence in compulsive checkers.

背景和目的：根据目前的强迫性检查模型，记忆自信在很大程度上导致了检查行为的发展和维持。然而，如何以证据为基础对记忆信心进行干预，目前还没有完全搞清楚。因此，本文旨在通过回顾实验证据，找出影响记忆信心的因素：结合与记忆信心和检查相关的两组关键词，对 PubMed、Google Scholar、OpenGrey 和 ProQuest 数据库进行了检索。我们共搜索到 24 项实验。由于这些研究在问卷、任务和所用范式方面存在相当大的异质性，因此我们采用叙述性综述的方法对数据进行了综合：通过对文献的深入研究，我们发现了六个因素，包括消极记忆信念、较高的记忆标准、膨胀的责任感、对被检查刺激的熟悉程度、检查次数和被检查刺激的焦虑情绪：结论：这些发现对强迫性检查的治疗具有重要意义。我们提出了将这些因素转化为新型干预措施的一般指导原则，以增强强迫性检查者的记忆信心。

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引用次数: 0

Emotion regulation and psychopathology: Investigating differential associations between emotion regulation skills and psychological symptoms using a network approach 情绪调节与精神病理学：利用网络方法调查情绪调节技能与心理症状之间的不同关联。

IF 3.1 3区心理学 Q1 PSYCHOLOGY, CLINICAL

British Journal of Clinical Psychology

Pub Date : 2024-09-16 DOI: 10.1111/bjc.12493

Sebastian Trautmann, Markus Muehlhan, Matthias Berking, Sandra Miethe, Janna Wigger, Małgorzata Dragan

Objectives

Emotion regulation plays an important role in the development and maintenance of psychopathology. However, the question whether specific ER skills are related to specific psychological symptoms has rarely been studied, but has important implications for targeted interventions. This analysis aims to explore potential differential associations between various ER skills and psychological symptoms using a network analysis approach.

Methods

Routine data from a transdiagnostic clinical sample of 716 patients (460 females, 256 males) from an outpatient clinic for psychotherapy were analysed. Nine ER skills were assessed with the Emotion Regulation Skills Questionnaire, and nine symptom dimension scores were obtained using the Brief Symptom Inventory. A regularized partial correlation network models including ER skills and individual symptom domains were calculated. Bridge expected influence was calculated to estimate the strength of association of each ER skill with psychological symptoms.

Results

Only the following ER skills were most strongly related to psychological symptoms (bridge expected influence): Tolerance, Confrontation and Modification. All other ER skills were indirectly connected to symptom severity through these four skills. The strongest direct edges between ER skills and symptoms were Modification—Depression, Confrontation—Obsession-Compulsion and Tolerance—Interpersonal Sensitivity, which were significantly stronger than the vast majority of other associations between ER skills and psychological symptoms.

Conclusions

These exploratory findings provide valuable targets for future studies to investigate specific associations between ER skills and psychological symptoms which could help to improve outcome monitoring and efficacy of interventions targeting ER.

目的：情绪调节在心理病理学的发展和维持中起着重要作用。然而，特定的情绪调节技能是否与特定的心理症状相关这一问题却鲜有研究，但却对有针对性的干预措施具有重要意义。本分析旨在利用网络分析方法探讨各种ER技能与心理症状之间的潜在差异关联：方法：分析了来自心理治疗门诊的 716 名患者（460 名女性，256 名男性）的跨诊断临床样本的常规数据。通过情绪调节技能问卷评估了九种情绪调节技能，并通过症状简明量表获得了九种症状维度得分。计算了包括 ER 技能和单个症状领域的正则化偏相关网络模型。通过计算桥接预期影响来估算每种ER技能与心理症状的关联强度：结果：只有以下应急反应技能与心理症状的关系最为密切（桥式预期影响）：结果：只有以下几项急诊室技能与心理症状的关系最为密切（桥接预期影响）：容忍、对抗和修正。所有其他急诊室技能都通过这四种技能与症状严重程度间接相关。急诊室技能与症状之间最紧密的直接联系是 "调节-抑郁"、"对抗-强迫 "和 "容忍-人际敏感性"，它们明显强于急诊室技能与心理症状之间的绝大多数其他联系：这些探索性发现为今后的研究提供了有价值的目标，即研究急诊室技能与心理症状之间的具体关联，这有助于改善针对急诊室干预的结果监测和疗效。

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引用次数: 0

Effects of social anxiety and self-schemas on the impact and meaningfulness of positive versus negative social autobiographical memories 社交焦虑和自我暗示对积极与消极社交自传体记忆的影响和意义的影响。

IF 3.1 3区心理学 Q1 PSYCHOLOGY, CLINICAL

British Journal of Clinical Psychology

Pub Date : 2024-09-16 DOI: 10.1111/bjc.12504

Katie E. Martin, Sophie M. Kudryk, David A. Moscovitch

Objective

Social anxiety is characterized by maladaptive self-schemas about being socially undesirable. Self-schemas are deeply held beliefs which are derived from negative autobiographical memories of painful social experiences. In contrast to the plethora of past research on negative memories in social anxiety, almost no research has investigated objectively positive social autobiographical memories. In this preregistered study, we examined the effects of social anxiety and self-schemas on the appraised impact and meaningfulness of retrieved positive versus negative social autobiographical memories.

Method

Participants recruited via Prolific (final n = 343) were randomized to one of two conditions in which they were instructed to retrieve, orally narrate, and appraise a positive or negative social autobiographical memory of a specific experience from their personal past where they felt either valued or unvalued, respectively.

Results

Results demonstrated that participants rated their positive memories as more impactful and meaningful than negative memories overall, but this effect was reversed for participants who endorsed having either stronger negative self-schemas or greater social anxiety symptoms, for whom negative memories were more impactful. Additionally, participants who endorsed having stronger positive self-schemas rated their negative memories as significantly less impactful and their positive memories as nearly more impactful.

Conclusion

Together, these results elucidate how self-schemas and social anxiety are related to autobiographical memory appraisals, paving the way for future research on memory-based therapeutic interventions for social anxiety disorder.

目的社交焦虑的特点是对自己不受欢迎的不适应性自我模式。自我暗示是一种根深蒂固的信念，来自于对痛苦社交经历的负面自传记忆。与以往关于社交焦虑中负面记忆的大量研究形成鲜明对比的是，几乎没有研究对客观的正面社交自传记忆进行过调查。在这项预先登记的研究中，我们考察了社交焦虑和自我暗示对检索到的积极与消极社交自传记忆的评估影响和意义的影响：方法：通过 Prolific（最终人数 = 343）招募的参与者被随机分配到两个条件中的一个，在这两个条件中，他们被要求检索、口头叙述和评价其个人过去特定经历中的积极或消极的社会自传体记忆，在这段记忆中，他们分别感到自己被重视或不被重视：结果表明，总体而言，参与者对其积极记忆的评价比对消极记忆的评价更有影响力和意义，但这一效应在那些自认有较强消极自我暗示或较严重社交焦虑症状的参与者身上发生了逆转，对他们来说，消极记忆更有影响力。此外，自我定型较强的参与者认为负面记忆的影响明显较小，而认为正面记忆的影响几乎更大：总之，这些结果阐明了自我模式和社交焦虑与自传体记忆评价之间的关系，为今后研究基于记忆的社交焦虑症治疗干预铺平了道路。

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引用次数: 0

Gender bias in assessing narcissistic personality: Exploring the utility of the ICD-11 dimensional model 自恋型人格评估中的性别偏见：探索 ICD-11 维度模型的实用性

IF 3.1 3区心理学 Q1 PSYCHOLOGY, CLINICAL

British Journal of Clinical Psychology

Pub Date : 2024-09-11 DOI: 10.1111/bjc.12503

A. Green, N. J. S. Day, C. M. Hart, B. F. S. Grenyer, B. Bach

Objectives

Narcissistic personality disorder as captured in categorical diagnostic systems (e.g., DSM-5) emphasizes grandiose features more associated with masculine norms and under-emphasizes vulnerable features more associated with femininity. This poses significant implications in diagnostic outcome and clinical treatment in women with narcissistic preoccupations. Research finds that clinicians using the DSM-5 categorical system tend to diagnose vulnerable narcissism in women as other ‘feminized’ personality disorders (e.g., borderline), but no research has explored gender differences in narcissism using the new ICD-11 dimensional framework for personality disorders. This study investigated the clinical utility of the ICD-11 approach in capturing gender differences in narcissistic presentations.

Methods

Adopting an online vignette-based study, mental health clinicians (N = 157; 71.3% female) completed ratings of ICD-11 personality disorder severity and trait domains for two cases reflecting ‘grandiose’ and ‘vulnerable’ narcissism in hypothetical male or female patients.

Results

The results showed that ratings of core impairments in personality functioning and overall severity were consistent irrespective of patient or clinician gender, contrasting prior research using categorical models.

Conclusion

While some differences were observed in trait domain (e.g., negative affectivity) between patient gender, these results suggest the clinical utility of the ICD-11 model as emphasizing elements of personality functioning in the process of assessment and diagnosis, therefore potentially being less susceptible to influences of gender stereotype in aiding clinical conceptualization.

目的分类诊断系统（如 DSM-5）中的自恋型人格障碍更强调与男性规范相关的自大特征，而不太强调与女性气质相关的脆弱特征。这对有自恋倾向的女性的诊断结果和临床治疗产生了重大影响。研究发现，使用 DSM-5 分类系统的临床医生倾向于将女性的脆弱自恋诊断为其他 "女性化 "人格障碍（如边缘型人格障碍），但还没有研究使用新的 ICD-11 人格障碍维度框架来探讨自恋的性别差异。本研究调查了ICD-11方法在捕捉自恋表现中的性别差异方面的临床实用性。方法采用基于小故事的在线研究，心理健康临床医生（N = 157；71.3%为女性）对两个病例完成了ICD-11人格障碍严重程度和特质领域的评分，这两个病例反映了假设男性或女性患者的 "自大 "和 "脆弱 "自恋。结果结果显示，无论患者或临床医生的性别如何，对人格功能核心损伤和总体严重程度的评分都是一致的，这与之前使用分类模型的研究形成了对比、这些结果表明，ICD-11 模型在评估和诊断过程中强调了人格功能的要素，因此在帮助临床概念化时不易受到性别刻板印象的影响。

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引用次数: 0

Momentary displays of compassion and the relationship between psychosis, mood and risk incidents on inpatient wards: An experience sampling study 住院病人病房中瞬间表现出的同情心与精神病、情绪和风险事件之间的关系：经验取样研究。

IF 3.1 3区心理学 Q1 PSYCHOLOGY, CLINICAL

British Journal of Clinical Psychology

Pub Date : 2024-09-04 DOI: 10.1111/bjc.12496

Leanne Irwin, Katherine Berry, Tobyn Bell, Lesley-Anne Carter, Alisa Udachina

Objectives

Psychosis can be thought of as a threat-based experience. Compassion has been shown to be effective in reducing threat, although highly distressed individuals may struggle to be self-compassionate. This study explored the effects of compassionate interactions with staff on inpatients with psychosis.

Method

Experience Sampling Method (ESM) was used to investigate the relationships between compassion from staff and paranoia, voice hearing, distress related to psychosis experiences, affect and risk incidents in daily life. Twenty-two service users residing on inpatient mental health wards took part. Baseline measures of compassion, fears of compassion and affect were taken. Participants completed ESM assessments 10 times per day, over 6 days.

Results

Compassion from staff was associated with a small increase in voice hearing, but was not associated with paranoia, paranoia-related distress, voice-related distress, negative affect, positive affect, or risk incidents in daily life. Baseline fears of compassion moderated the relationships between compassion from staff and some of the service user outcomes. For inpatients scoring low on fears of compassion, compassionate interactions were associated with increased positive affect and lower paranoia. However, for those scoring high on fears of compassion, this relationship was reversed, and compassionate interactions were associated with higher paranoia and lower positive affect.

Conclusion

People with psychosis who have fears of compassion may benefit from receiving support to address these fears in order to experience the benefit from the compassion of staff. The results should be interpreted with caution due to the low number of observations and limited statistical power.

目的：精神病可被视为一种基于威胁的体验。尽管高度痛苦的人可能难以自我同情，但同情已被证明能有效降低威胁。本研究探讨了与员工的同情互动对精神病住院患者的影响：方法：采用经验取样法（ESM）调查工作人员的同情与偏执狂、幻听、与精神病经历相关的痛苦、情感和日常生活中的风险事件之间的关系。22 名住在精神健康住院病房的服务使用者参加了调查。对同情、对同情的恐惧和情感进行了基线测量。参与者在6天内每天完成10次ESM评估：结果：工作人员的同情与嗓音听力的小幅增加有关，但与妄想症、妄想症相关困扰、嗓音相关困扰、消极情绪、积极情绪或日常生活中的风险事件无关。对同情的基线恐惧调节了工作人员的同情与某些服务使用者结果之间的关系。对于同情恐惧得分较低的住院患者来说，同情互动与积极情绪的增加和偏执的降低有关。然而，对于那些同情恐惧得分较高的患者来说，这种关系则相反，同情互动与较高的偏执狂和较低的积极情绪相关：结论：对同情有恐惧的精神病患者可以通过接受支持来消除这些恐惧，从而从工作人员的同情中获益。由于观察人数较少，统计能力有限，因此在解释结果时应谨慎。

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