British Journal of Clinical Psychology最新文献

Background: Bipolar disorder (BD) is associated with reduced psychosocial functioning, partly due to cognitive impairments. Functional remediation (FR), aimed at ameliorating daily functioning, is based on psychoeducation and strategies to cope with cognitive problems. Given the limited number of studies in patients with BD, more studies are needed to evaluate different FR programmes.

Methods: A total of 29 euthymic patients with BD-I followed a 12-session FR programme consisting of both group and individual sessions, offered in two variants: one in-person and one online (video conferencing). Both variants were supported by E-health modules. Feasibility was the primary outcome, as measured with dropout rates and attendance, as well as questionnaires about patients' experiences with the programme. The secondary aim was to explore effects on psychosocial functioning.

Results: Results show an acceptable dropout rate. Attendance was good as 83% visited at least 10 sessions. Analyses of participants' experiences revealed gain of insight and implementation of learned strategies in daily life. Independently working with the E-health modules did not appear feasible. Exploratory analyses showed a significant improvement in psychosocial functioning for both variants.

Limitations: The results of the effect analysis are preliminary, due to a small sample and lack of a control group.

Conclusions: This FR programme showed good feasibility for both the in-person and online variant. Online treatment has advantages as it can reach out to a larger group of participants. Effect analyses indicated reduction in psychosocial impairments in both variants. Larger controlled studies are needed to investigate the treatment effects of the current FR programme.

Objectives: Evidence of the benefits of yoga for patients with major depressive disorder (MDD) is mixed and results mainly from randomized controlled trials (RCTs). Adding qualitative measures to RCTs may give additional insight into the range of outcomes experienced by participants. We therefore used qualitative measures to assess the positive and negative experiences of young women (18-34 years) with depression who received a 9-week mindful yoga intervention added to treatment as usual.

Methods: We conducted qualitative interviews after a 12-month follow-up alongside an RCT in the Netherlands. Questions were open-ended and assessed experiences with mindful yoga reflecting positive or negative experiences. In addition, we explicitly asked about negative effects. Interviews were systematically analysed, and statements were placed in five domains (Affective, Cognitive, Conative, Somatic and Yoga Skills) and diverse subcategories.

Results: We collected qualitative interviews of 58 of the 88 participants randomized to mindful yoga (66%). The majority of participants had no previous experience with yoga (76.8%). Mean age was 24.68 (SD = 4.70). A little over half of the participants were employed (53.6%). All participants were diagnosed with current depression. Level of self-reported symptoms of depression was considered 'severe' and level of clinician-rated symptoms of depression was considered 'moderate'. For most participants, the current episode started 1-2 years ago (35.8%) or more than 2 years ago (34%). Of these 58 participants, 81.0% reported positive effects and 65.5% reported negative effects. Positive experiences consisted mostly of positive affect (56.9%), meta-cognition (44.8%) and general physical relaxation (41.4%). Negative experiences consisted mostly of meta-cognition (37.9%), agitation or irritability (20.7%) and physical inflexibility (12.0%).

Conclusions: Most young women in the mindful yoga intervention experienced both positive and negative effects. In future research, broader measurements of positive effects and structural assessments of negative effects are warranted.

Objectives: Maladaptive beliefs about emotions (e.g., believing emotions are uncontrollable or useless) are theorized to contribute to emotion regulation difficulties and psychological distress. Limited research has examined maladaptive emotion beliefs in clinical populations. This study investigated the psychometric properties and latent profiles of the Emotion Beliefs Questionnaire (EBQ) in a clinical sample.

Methods: A total of 385 adults currently receiving psychotherapy participated in the study. The sample included inpatients (n = 110) from a psychiatric hospital and outpatients (n = 275) recruited through clinics and online in Iran. They completed the Emotion Beliefs Questionnaire alongside measures of emotion regulation difficulties (Perth Emotion Regulation Competency Inventory) and psychological distress (Depression, Anxiety, Stress Scale-21).

Results: Confirmatory factor analyses supported a three-factor model distinguishing beliefs about emotional controllability and the usefulness of positive and negative emotions. The EBQ demonstrated strong internal consistency and convergent and incremental validity. Latent Profile Analysis identified six distinct profiles of emotion beliefs, which were differentially associated with emotion regulation difficulties and psychological distress. Notably, the two profiles characterized by the highest levels of maladaptive emotion beliefs had the highest levels of emotion regulation difficulties and psychological distress.

Conclusions: These findings underscore the heterogeneity of emotion belief patterns in clinical populations and highlight the importance of assessing belief combinations rather than isolated dimensions, which can help with more personalized therapeutic interventions. This study contributes to a more nuanced understanding of emotion beliefs in psychopathology and supports the use of the EBQ as a psychometrically sound tool with clinical samples.

Objectives: Research shows that expecting to enjoy an activity leads to greater enjoyment of that activity. This correspondence between expectations and experience extends to the context of depression, in which both expectations and experience of reward are diminished. However, the mechanisms underlying the relationship between affective expectations of reward and enjoyment of reward remain understudied. One candidate mechanism of such expectancy effects is effort expenditure for reward, which is also found to be diminished in depression. This study examined whether cognitive effort expenditure mediated the relationship between affective expectations of reward and experienced pleasure in response to reward in a sample of dysphoric (n = 85) and non-dysphoric (n = 79) participants.

Methods: Following an unsuccessful expectancy manipulation (reported separately in Horne & Quigley, Cogn. Ther. Res., 2024), participants rated how much pleasure they expected to experience upon earning a monetary reward during a cognitive effort progressive ratio task in which greater reward could be earned by expending greater effort. After completing the task, participants rated how much pleasure they experienced upon earning the reward and how much effort they felt they exerted.

Results and conclusions: We found that subjective, but not objective, effort expenditure mediated the relationship between expected and experienced pleasure, and this was true for both dysphoric and non-dysphoric participants. Anhedonia was a significant moderator, such that the mediated effect was only significant at moderate and high levels of anhedonia. Implications for the treatment of depression are discussed.

Objectives: Early childhood autobiographical memories told by people with Borderline Personality Disorder (BPD) may provide insight into emotional, identity and interpersonal functioning deficits underlying the disorder. We aimed to analyse verbatim transcripts of these memories coded by the Core Conflictual Relationship Theme (CCRT) and Experiencing Scale (EXP).

Design: This study employed a controlled, between-subjects study design.

Methods: Sixty-four individuals (32 with diagnosed BPD and 32 age- and gender-matched controls) were interviewed to generate autobiographical memories using the Adult Attachment Interview. The CCRT method was used to identify themes within relationships and was coded for self (identity) and other (interpersonal) processes, and the EXP scored capacity to communicate internal emotional experiences.

Results: Significant differences were found between BPD and Control participants in their emotional, interpersonal and self-perceptions within autobiographical events. BPD self-descriptions were more psychologically rigid, with significantly lower EXP scores, suggesting poorer capacity to verbalize and emotionally integrate internal experiences and relationships. In addition, BPD participants' CCRTs had significantly less harmonious language, experiencing others as more attacking and less supportive and the self as more withdrawn and determined by others. Impairments were marked by a more helpless external locus of control in relationships.

Conclusions: Studying autobiographical narratives provided specific insight into core underlying deficits of BPD. Specifically, individuals with BPD may have more challenges in developing trust, fostering agency and managing negative expectations. The use of autobiographical memory recall to help inform individuals' relationship themes and internal emotional awareness could help tailor treatment for BPD.

Objectives: Mentalization-Based Treatment (MBT) requires rigorous fidelity assessment to ensure accurate delivery and validate treatment efficacy. This study introduces the Mentalization-Based Treatment Research Adherence and Competence Scale (MBT-RACS), a new instrument developed initially for research purposes to align with contemporary MBT principles and address psychometric and conceptual limitations found in earlier adherence assessment approaches.

Methods: Inter-rater reliability of the MBT-RACS was evaluated using 126 recorded MBT sessions (104 group, 22 individual), rated by 17 trained coders.

Results: The results indicated strong overall reliability, with most domains demonstrating good to excellent inter-rater agreement across both group and individual sessions, irrespective of ratings from two or three raters. Total adherence intraclass correlation coefficients (ICCs) were notably high for both group (.84) and individual (.95) sessions rated by two coders, substantially exceeding the reliability typically reported for comparable adherence instruments.

Conclusions: These findings suggest that the MBT-RACS's format, which emphasizes broader, clinically meaningful domains, may contribute to improved consistency in ratings. The scale's robust reliability supports its applicability in research and clinical supervision, enhancing methodological rigour, quality assurance and targeted feedback for effective MBT training and implementation.

Background and objective: Memory confidence plays a central role in maintaining compulsive checking, as supported by theoretical and empirical evidence. Despite this, no comprehensive intervention targeting all literature-identified factors affecting memory confidence currently exist. Accordingly, this study primarily aimed to develop a novel, evidence-driven intervention to improve memory confidence in compulsive checkers. A secondary aim was to conduct an initial evaluation of its effectiveness.

Methodology: To develop our intervention, we used the Six Steps in Quality Intervention Development Method. Using a preliminary, early-stage RCT involving 20 compulsive checkers (10 in the intervention group and 10 in a waitlist control group), we tested the potential effectiveness of our intervention on memory confidence, memory beliefs, memory performance and checking severity.

Results: A seven-session intervention was developed, with the main purpose of each session outlined was as follows: psychoeducation about compulsive checking and memory confidence, targeting negative memory beliefs, training in how to de-familiarize the checking procedure, training in adaptive checking, targeting high memory standards, targeting inflated responsibility and relapse prevention and termination. Preliminary results from the RCT indicated that our intervention demonstrated significant improvements in memory confidence and memory performance, along with significant reductions in checking severity and negative memory beliefs.

Conclusion: These findings provide promising early support for the feasibility and potential effectiveness of the intervention. They also further support the critical role of memory confidence as a key mechanism underlying this condition.

Background: While the National Health Service (NHS) in the United Kingdom (UK) is increasing provisions for psychological interventions in primary care for patients with long-term conditions (LTCs), there is limited knowledge of effective implementation. This study reports on outcomes of an open pilot trial implementing the Accessible Depression and Anxiety Psychological Therapies for Long Term Conditions (ADAPT-LTC) programme in Scottish primary care services.

Methods: This study entails a pragmatic, real-world implementation evaluation of ADAPT-LTC in primary care using data collected from routine outcome monitoring. Analysis focused on implementation (feasibility, suitability), service (clinical outcomes) and client (care experiences and satisfaction) outcomes. Rates of recovery, reliable improvement, reliable recovery and reliable deterioration were used as indicators of clinical outcomes.

Results: Approximately half of referred patients progressed to treatment. Patient engagement in treatment was split into groups of patients who attended few treatment sessions (approximately <4 sessions) or patients who accessed 6-8 sessions or more. Among patients who participated in treatment, CBT was associated with large pre- to post-treatment effects in reducing depression, anxiety, and functional impairment, with 35%-40% of patients no longer meeting criteria for psychiatric diagnosis and 60% reporting clinically reliable improvements. Patients reported positive care experiences and satisfaction.

Conclusion: Delivering brief psychological intervention in primary care was effective for most patients with LTCs. However, a subgroup of patients did not start treatment or struggled to attend treatment suggesting the programme may not be suitable for all patients. Methods for enhancing engagement and implementation of ADAPT-LTC are discussed.

Objectives: There is evidence that over one quarter of patients return to National Health Service (NHS) talking therapies (TT) services, and the needs of these patients are poorly understood and catered for. This project investigated the acceptability and effectiveness of delivering cognitive analytic therapy (CAT) for patients with depression returning to a TT service with childhood trauma and associated relational difficulties.

Methods: A case-controlled pilot study using TT sessional outcome measures. A 16-session CAT was offered to N = 76 patients who had previously received a high-intensity intervention (mainly cognitive-behavioural therapy; CBT) in the same TT service. Dropout rates, recovery rates and when recovery occurred during the CAT treatment episode were calculated. CAT outcomes were compared against the previous treatment episodes (n = 47) and also benchmarked against the evidence base. Patients were followed up after receiving CAT (n = 16) to assess the durability of change. The number then returning to the TT service after receiving CAT was also tracked.

Results: The dropout rate for CAT was 16.9% and the reliable recovery rate was 40%. Reliable and/or clinically significant reductions in depression tended to occur during early CAT sessions. At a group level, there were significant reductions in depression during CAT. There was no evidence of relapse at follow-up. The return rate to the service following CAT was 28.94%.

Conclusions: CAT appears useful to consider in the offer for patients returning to TT services. Clinical trials now need to focus on the treatment return patient group in TT services across the stepped care model.

Objectives: Studies of unusual sensory experiences, like hallucinations, in people at risk of psychosis usually focus on auditory experiences. This study explored how common experiences across a range of sensory modalities were in people at an ultra-high risk of developing psychosis. Particular attention was paid to the number of modalities reported and their impact. It was hypothesised that people reporting a greater number of modalities of hallucinations would report greater levels of general distress, more delusional ideation, lower emotional well-being and poorer functioning. In addition, the contribution of sleep problems and post traumatic stress disorder (PTSD) symptoms in the reporting of hallucinations in different modalities was explored.

Design: A single-group cross-sectional design was used.

Methods: People at an ultra-high risk of developing psychosis completed measures of hallucinations, delusions, general distress, functioning, emotional well-being, trauma and sleep.

Results: Nearly all participants reported hallucinations in the auditory domain. They also reported a range of other unusual sensory experiences, with visual and somatic/tactile hallucinations being reported by over half. Single sensory experiences or unimodal hallucinations were less common than hallucinations in two or more modalities, which were reported by 88% of the participants. The number of modalities of hallucinations was significantly associated with greater general distress, delusional ideation, reduced emotional well-being and to some extent functioning. PTSD and sleep were identified as potential causal factors for hallucinations across modalities.

Conclusions: Psychological therapies need to account for these experiences and could feasibly target them with treatments that focus on sleep or trauma.