British Journal of Clinical Psychology最新文献

Introduction: Compared to their exclusively gay/lesbian or heterosexual identifying peers, young people identifying as bisexual+ (e.g. bisexual, pansexual, asexual, queer or questioning) are at elevated risk for suicidal ideation (SI) and attempts (SA). The present study aimed to establish whether the prevalence of, and psychosocial risk factors for, SI and SA vary as a function of sexual identity.

Methods: Young adults (N = 274; 18-29 years old) were recruited via online crowdsourcing. They completed questionnaires assessing adverse childhood experiences (ACEs), emotion dysregulation, impulsivity, depression symptoms and lifetime history of SI and SA. Spearman correlations, Kruskal-Wallis H-tests and binomial logistic regression models were used.

Results: No variable was associated with SI. Bisexual+ individuals reported greater SA than the heterosexual group, though statistically similar to the gay/lesbian group. A similar pattern emerged for ACEs. The bisexual+ group reported greater depression symptoms than the gay/lesbian group. Impulsivity and emotion dysregulation did not vary by sexual identity. Controlling for these psychosocial and sociodemographic variables did not alter results: bisexual+ individuals were almost three times more likely to report SA than heterosexual individuals, OR = 2.93 95% CI [1.16, 7.44]; gay/lesbian and heterosexual individuals had a statistically similar likelihood of reporting SA, OR = 1.09, 95% CI [0.27, 4.37].

Conclusion: This is the first study to establish that young adults identifying as bisexual+ are at greater risk for SA after controlling for well-established psychosocial correlates; this was not the case for SI. Further work is needed to establish the aetiology of this risk.

Background: Although psychological interventions can be effective for the treatment of major depressive disorder, some patients' symptoms persist or rapidly recur after therapy. This study aimed to synthesize research findings on predictors and moderators of treatment response for persisting forms of depression, such as chronic, recurrent, and treatment-resistant depression.

Methods: A systematic review of studies investigating predictors and moderators of response to outpatient psychological treatment for adults with persisting forms of depression was conducted by searching Web of Science, Scopus, and PsycInfo. A total of 23 eligible studies were included, assessed for risk of bias, and summarized using a narrative synthesis.

Results: Sixty-five predictor and moderator variables were examined across studies, categorized into sociodemographic, clinical, interpersonal/personality, psychological, and treatment variables. Most variables were only examined in single studies, which were rarely adequately powered for predictor and moderator analyses. Among variables studied more frequently (age, gender, baseline depression severity, childhood trauma), only baseline depression severity was found to be a replicated and consistent predictor of poorer treatment response. Risk of bias was low to medium for the majority of studies.

Limitations: Meta-analysis could not be done due to methodological heterogeneity among studies.

Conclusion: Our current understanding of significant predictors and moderators for persisting forms of depression is limited. A high level of baseline severity of depressive symptoms is so far the only variable consistently associated with poorer treatment response in this clinical population.

Objectives: Prior research indicates that jury duty can be distressing for some jurors. This study examined: (1) the influence of prior trauma characteristics (type, exposure, time since trauma), medical fear and mental health difficulties on stress and emotional responses during a mock trial and 1 week later; and (2) associations between early stress reactions during a trial on subsequent stress and emotional reactivity after exposure to skeletal evidence and 1 week later.

Methods: Mock jurors (n = 180) completed baseline self-report mental health measures, read a summary of a murder case and were then exposed to graphic skeletal evidence. Stress and/or emotional responses were collected at baseline, after reading the case summary, before and after viewing the skeletal evidence and 7 days post-trial.

Results: Participants reported a wide range of prior traumatic experiences, with nearly half reporting pre-existing mental health difficulties. Average traumatic stress symptoms tripled from baseline to follow-up, with 44% of participants meeting PTSD-type criteria 7 days later. Medical fear and mental health difficulties were positively associated with some stress and/or emotional responses throughout the trial, with mixed findings concerning trauma characteristics, stress and emotional reactivity. Initial stress and emotional responses to case evidence were linked to later stress and emotional reactions, after accounting for pre-existing trauma and mental health characteristics.

Conclusions: Past trauma experiences, mental health difficulties and immediate stress responses during a trial can exacerbate emotional and stress reactions. Addressing the psychological impacts of pre-existing trauma symptoms could improve juror well-being during this important civic duty.

Background: Recent studies have shown that individuals with obsessive-compulsive disorder (OCD) tend to endorse a feared self that they perceive to be immoral, insane and/or dangerous. The current study investigated the relationship between morality-related feared self, self-relevance and OC-related cognitions and behaviours such as moral deliberation, threat interpretation bias, discomfort, urge to act and likelihood of acting in OC-relevant situations in a non-clinical sample.

Method: A total of 78 participants (27 female, M_age = 29.85, SD = 9.8) underwent a priming study. Participants had their feared-self primed firstly via an unscrambling task in either a feared self or neutral condition and secondly via a writing task about moral transgressions. The response time for these tasks was recorded as a measurement of moral deliberation. Further, self-relevance was primed by having half of the participants' complete tasks that referenced their actions, whereas half of the participants completed tasks that referenced others' actions.

Results: It was found that participants' pre-existing level of feared self was linked to threat interpretation bias, discomfort and urge to act in OC-relevant situations. A primed sense of feared self and self-relevance also demonstrated significant links to changes in OC-relevant symptoms.

Conclusion: These results indicate that environmental cues related to morality may lead to OC-related symptoms.

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.