British Journal of Clinical Psychology最新文献

Objectives: To document the steps undertaken in a full collaborative co-production design process undertaken between a group of lived experience, clinical and research collaborators to determine the selection and design of three large-scale, multisite, clinically focused studies (including two clinical trials) targeting eating disorders. This work formed part of a grant supporting the development of a National Centre for Research and Translation in Eating Disorders (AEDRTC) funded by the Australian Government. We highlight the phases and activities, principles and values that informed practice - as has been called for recently within the scientific community, in addition to emerging themes and lessons learnt. The paper aimed to contribute to the limited body of published literature on practical approaches to co-production in large-scale research studies and teams.

Methods: We undertook a 1-year full co-production process to collaboratively ideate, choose and design the research studies to be funded and conducted by a nationally-funded centre for research in eating disorders.

Results and conclusion: This manuscript documents all the key stages of the co-production process for the shared agenda setting, choice and design of the three complex research studies, including the establishment of governance and structure, novel IP clauses, processes and principles of shared ideation and collaborative design. We also discuss natural push and pull factors creating tension in a co-production process, reflecting on themes and learnings.

Objectives: Self-beliefs and other-regarding beliefs are related to attachment experiences and may contribute to paranoid beliefs and social functioning difficulties in psychosis. However, their relationships have not been examined jointly from an ecological perspective, while considering different degrees of psychosis risk.

Design: Relationships between avoidant and anxious attachment, self-beliefs and other-regarding beliefs, paranoia, and social functioning in daily-life were examined across the psychosis continuum of familial risk.

Methods: The sample comprised 29 patients with non-affective psychotic disorders (M_age = 39.07, SD = 9.91, 20.68% female), 17 first-degree relatives (M_age = 37.36, SD = 13.86, 64.71% female) and 26 controls (M_age = 36.15, SD = 8.1, 34.6% female). Avoidant and anxious attachment were assessed with the Psychosis Attachment Measure. Self-beliefs, beliefs about others, paranoia, and time spent alone were assessed for one week in participants' daily lives using the Experience Sampling Method. Multilevel models were used to investigate cross-sectional and temporal relationships between the variables.

Results: Less positive self-beliefs and beliefs about others were related to paranoia, but only self-beliefs mediated the association between attachment insecurity and paranoia. People who were alone more frequently held less positive self-beliefs and beliefs about others, and being alone at a specific point in time was related to less positive self-beliefs. Attachment insecurity was unrelated to the amount of time spent alone.

Conclusions: Less positive self-beliefs and beliefs about others were related to higher paranoia levels and fewer social interactions in daily-life. These associations were present in all groups, supporting their utility as cognitive treatment targets in diverse therapeutic contexts.

Objectives: Attention deficit hyperactivity disorder (ADHD), autism, and personality disorder (PD) often present with overlapping symptom profiles, complicating diagnostic assessment and treatment planning. Yet, few studies have examined the extent and nature of these overlaps, or the mechanisms that may underpin them. The current study aimed to address this gap by investigating overlapping symptom profiles of ADHD, autism, and PD, and the potential transdiagnostic mechanisms contributing to such in a community sample.

Design and methods: A total of 512 adults with a history of mental health diagnosis residing in the United States or United Kingdom completed self-report questionnaires assessing ADHD, autism, and PD symptoms, alongside measures of adverse childhood experiences, executive functioning, and mentalization.

Results: We found substantial symptom overlap across ADHD, autism, and PD, with executive functioning emerging as the strongest predictor of shared variance.

Conclusions: Given symptom overlaps in areas related to interpersonal, behavioural, and emotional control, we propose that self-regulation may underlie the common symptoms of ADHD, autism, and PD. Finally, our results support the integration of neurodevelopmental conditions into broader models of psychopathology structure, such as the Hierarchical Taxonomy of Psychopathology (HiTOP), and highlight specific symptom dimensions that can help differentiate between these conditions.

Objectives: There is a crucial need for an evidence-based intervention for young people presenting with moderate complex emotional needs (CEN). UK CEN care has been described as variable and poor quality, with its improvement a UK policy priority. Briefer-versions of full-programme therapy packages utilizing stepped-care models offer a clear and contained pathway for this population, though their current availability in services is scarce. This service evaluation aims to evaluate the efficacy of 'IDEAS' as a piloted brief psychological intervention for young people aged 16-25 presenting with moderate CEN.

Method: A pre-test/post-test design was used to explore clinical outcomes for participants and services via paired sample t-tests, mixed-model ANOVAS and frequency statistics.

Results: Exploratory pre/post-intervention analyses revealed significant reductions in mean scores for the severity of borderline personality disorder symptoms (d = .83), emotion regulation (d = 1.15) and overall wellbeing (reflecting improvement; d = .97) and increases in mean scores for quality of life (d = -.67), including level of satisfaction in one's quality of life and of therapeutic treatment received (d = -.65). These outcomes were maintained at 3-month follow-up, were little influenced by clinician training and supported readiness for discharge post-intervention for more (68.65%) participants.

Conclusions: The current evaluation provides preliminary evidence that IDEAS may offer a feasible, lower-cost alternative to full-programme treatment packages, with benefits for young people, services and Trusts. Given this evaluation of IDEAS being from a small, uncontrolled pilot, the findings are exploratory. Further evaluation is therefore warranted upon its larger-scale implementation.

Background: Parents of autistic children support their children through additional challenges, often experiencing adversity as a result. Such parents report high support needs, yet service provision is often limited. Services often support children through providing various psychological interventions to parents. Quantitative evidence for such interventions is mixed and qualitative evidence is sparse. This review therefore aimed to synthesise the perspectives of UK parents regarding interventions for their autistic child.

Method: The databases Scopus, Embase, Medline, PubMed, PsycInfo, CINAHL, Web of Science and ASSIA were searched in February 2025. Inclusion criteria constituted qualitative articles published in English from 2004 onwards exploring UK parents' perspectives of interventions aimed at supporting autistic children. Articles were evaluated using Standard Quality Assessment Criteria. Thematic meta-synthesis was conducted.

Results: Fourteen papers were identified: eight high-quality, one medium-quality, and four low-quality. Interventions were psychoeducational behavioural, communication-based, sensory-related or mental-health based in nature. Themes included change, relationship with help, parents' need to process and solidarity.

Conclusions: Facilitators of positive change included learning, empowerment, structure and rigour, while barriers included delivery issues and unhelpful information. Parents reported finding solidarity amongst similar parents helpful. Reflective space was deemed useful in facilitating new understanding of autistic lives. Methodological quality varied, with more reflexive and theoretically grounded research encouraged. Future research should also consider implementing embedding processes into qualitative designs.

Objectives: Despite numerous psychotherapy trials, knowledge on service-system efficiency in terms of return to treatment is limited, especially regarding internet-delivered cognitive behavioural therapy (iCBT). We estimated the hazard ratio (HR) of subsequent psychological treatment over several years following the initial psychological intervention.

Methods: This naturalistic register follow-up study in Finland included patients receiving therapist-guided iCBT (2013-2021, n = 30,934) or ≤20-session psychotherapy (2018-2021, n = 3348), and matched population controls (n = 92,846). Their long-term psychotherapy data (≤200 sessions/3 years, requiring prior treatment) were obtained from the Social Insurance Institution. We used Cox proportional hazard regression, adjusting for age, sex, first purchase of psychotropic drugs and onset of the first psychiatric diagnosis.

Results: Given the adjustments, the hazard of subsequent long-term psychotherapy was fourfold after iCBT (HR = 4.08; 95% CI 3.81-4.37) and nearly ninefold after ≤20-session psychotherapy (HR = 8.94; CI 7.79-10.26), compared to those without these prior treatments. Prior ≤20-session psychotherapy was associated with reduced hazard of entering subsequent iCBT (HR .12, CI .09-.16), while prior long-term psychotherapy was not (p = .087). Prior iCBT was associated with a lower hazard of subsequent ≤20-session psychotherapy (HR = .41, CI = .35-.47), while prior long-term psychotherapy was not (p = .332).

Conclusions: Mapping the succession of psychological treatments added knowledge and revealed surprises. For example, patients receiving therapist-guided iCBT were less likely to access subsequent face-to-face psychotherapy than those initially treated face-to-face. While past services are used as a convenience indicator for future services, future research on successive psychological treatments should continue to disentangle clinical need from service systems effects.

Objectives: Team formulation is associated with better working relationships between staff and service users. However, there is a need for greater standardization of practice. We aimed to investigate the inter-rater reliability of the Team Formulation Quality Rating Scale (TFQS) and explore what aspects of team formulation practices were most frequently adhered to.

Method: Staff at nine acute mental health wards participated in team formulation sessions facilitated by Health Care Professions Council registered psychologists. Formulation sessions were audio recorded, and raters used recordings to complete the TFQS. At least two raters rated 19 team formulation sessions.

Results: The TFQS demonstrated excellent inter-reliability for the total scale (ICC = .926, 95% CI = .820 to .971) and moderate inter-rater reliability for subsection A (ICC = .660; 95% CI = .278 to .862) and subsection B (ICC = .733; 95% CI = .361 to .898). Overall, the items for 'collaboration' and 'consideration of life events' were rated better in terms of quality, compared with items relating to 'close of meeting' and 'consideration of goals and values' which tended to receive lower quality ratings.

Conclusion: The TFQS is a reliable tool for measuring quality of team formulation within inpatient settings and should be used in future research and clinical practice. Psychometric properties should be assessed across different clinical settings. Training and supervision should ensure that psychologists' formulations incorporate a focus on the individual's goals and values impacting problem development and resolution.

Objectives: Depressive symptoms are common in females after pregnancy loss. However, research on risk factors for developing a clinical depressive episode remains limited and with inconsistent findings. This study examined the association of demographic variables (like age), pregnancy-related factors (like number of miscarriages or stillbirths), clinical factors (like medical explanation for the pregnancy loss) and neuroticism (as a well-known risk factor for internalizing disorders) with a current major depressive episode and depression severity in 172 women with miscarriage or stillbirth within the previous year.

Design: Case-control study.

Methods: Measures included the semi-structured diagnostic interview DIPS, the State-Trait Anxiety-Depression Inventory (STADI), the Short Version of the Big-Five Inventory (BFI-K). To identify predictors of depression, linear and logistic regression analyses were conducted.

Results: Lower medical support (p = .041), higher stress immediately after the pregnancy loss (p = .027) and higher neuroticism scores (p = .008) were significant predictors of a current major depressive episode in woman with pregnancy loss. Incoherent farewell (p = .043), a history of psychotherapy or psychiatric treatment in the last year (p = .016) and higher neuroticism scores (p < .001) were significantly associated with higher severity of depressive symptoms.

Conclusions: Methodological strengths of our study include a well-validated clinical interview and the investigation of the whole spectrum of gestation age at the time of pregnancy loss. Longitudinal studies should be used to replicate our findings. The knowledge of significant predictors is relevant for the identification of high-risk groups for depression among women with pregnancy loss.

Objective: This review aimed to synthesize and critically examine the methodological characteristics of research on Safety Planning Intervention (SPI) effectiveness for adults experiencing suicidality.

Method: Six databases were systematically searched for studies examining the efficacy/effectiveness of SPIs in adults, following PRISMA guidelines (Cochrane Trials, PubMed, Embase, PsycINFO, Web of Science, Medline). Search terms included terms related to suicidality and self-harm, and safety planning and crisis interventions. Screening was completed independently by two researchers. Study Design, Participants, Study Settings, Types of Safety Planning Interventions, Modalities of Intervention Delivery, Recruitment Methods, Monitoring Periods, Outcomes and Measures used, Results Reported and Guiding Theories were extracted.

Results: Twenty articles were eligible for inclusion. Participants were predominantly veterans (n = 7) and emergency department patients (n = 4). Ten studies used a randomized controlled design, and seven were quasi-experimental. Studies took place in hospital settings (n = 8), mental health crisis care facilities (n = 2), refugee camps (n = 1) and online (n = 4). Interventions included SPI alone, SPI with structured follow-up, or SPI combined with other interventions. Suicide-specific outcomes included suicidal ideation, suicidal behaviour, suicide-related coping and hospitalization/service use. Three studies referenced guiding theories. There was heterogeneity in outcomes studied and measures used. Results reported generally supported the effectiveness of SPI in reducing suicidal ideation and behaviours, reducing hospitalization and increasing outpatient treatment engagement.

Conclusions: Studies varied in intervention setting, intervention procedures and modalities, outcomes assessed and measures used. There was a lack of theory-driven research and research targeting at-risk groups.

Background: Infant negative emotionality (NE) may increase the risk of insecure-resistant attachment, particularly amid postpartum depression, but may also heighten receptivity to intervention. This secondary study tested whether infant NE moderates the effect of Circle of Security Parenting™ (COSP™) on infant-mother attachment.

Method: In a randomized trial (N = 297) involving dyads with maternal depression and/or infant social withdrawal, infant-mother attachment was assessed at 12-16 months; Infant NE was measured at 2-4 months.

Results: Higher infant NE increased the risk of insecure-resistant attachment. NE moderated intervention effects: COSP™ reduced insecure-resistant attachment among high-NE infants.

Discussion: Findings support a diathesis-stress framework: High-NE infants may be more vulnerable to caregiver strain but also more responsive to COSP™.

Trial registration: ClinicalTrials.govID: NCT02497677.