Pub Date : 2025-10-11DOI: 10.1016/j.cpr.2025.102661
Liam Alexander MacKenzie Myles , Matthew Hotton , Francis Madden , Paul M. Salkovskis
Background
This systematic review and meta-analysis evaluated whether people with obsessive-compulsive disorder (OCD) exhibit differences in associative learning.
Methods
CINAHL, Cochrane Library, EMBASE, PsycINFO, PubMed, Scopus and Web of Science were searched for published peer-reviewed studies in English quantitatively examining the relationship between OCD and associative phenomena in humans. 5508 titles, 124 abstracts and 55 full texts were reviewed; citation searching identified 15 records. Sixty-six studies were included. Risk of bias was assessed and random-effects meta-analysis synthesised results.
Results
Obsessive-compulsive disorder was associated with differences in extinction (g = 0.37, p < .001, k = 15) and mediated associative learning (k = 1), but not associative learning (g = −0.12, p = .26, k = 49), avoidance learning (g = 1.5, p = .13, k = 4), blocking (k = 1), generalisation (g = −0.2, p = .16, k = 3), latent inhibition (g = 0.45, p = .39, k = 3), outcome devaluation (g = 0.26, p = .33, k = 7), Pavlovian-to-instrumental transfer (g = −0.24, p = .22, k = 2) or reversal learning (g = 0.16, p = .36, k = 10). The quality of evidence was moderate for reversal learning, low for associative learning, extinction, generalisation, latent inhibition and Pavlovian-to-instrumental transfer, and very low for avoidance learning and outcome devaluation.
Conclusion
Low quality evidence suggests people with OCD learn that stimuli no longer predict negatively valanced outcomes slower than healthy controls. Future research must elucidate the cause of attenuated extinction and its specificity to OCD.
本系统综述和荟萃分析评估了强迫症患者在联想学习方面是否表现出差异。
{"title":"Systematic review and meta-analysis examining the effect of obsessive-compulsive disorder on associative learning","authors":"Liam Alexander MacKenzie Myles , Matthew Hotton , Francis Madden , Paul M. Salkovskis","doi":"10.1016/j.cpr.2025.102661","DOIUrl":"10.1016/j.cpr.2025.102661","url":null,"abstract":"<div><h3>Background</h3><div>This systematic review and meta-analysis evaluated whether people with obsessive-compulsive disorder (OCD) exhibit differences in associative learning.</div></div><div><h3>Methods</h3><div>CINAHL, Cochrane Library, EMBASE, PsycINFO, PubMed, Scopus and Web of Science were searched for published peer-reviewed studies in English quantitatively examining the relationship between OCD and associative phenomena in humans. 5508 titles, 124 abstracts and 55 full texts were reviewed; citation searching identified 15 records. Sixty-six studies were included. Risk of bias was assessed and random-effects meta-analysis synthesised results.</div></div><div><h3>Results</h3><div>Obsessive-compulsive disorder was associated with differences in extinction (g = 0.37, <em>p</em> < .001, k = 15) and mediated associative learning (k = 1), but not associative learning (g = −0.12, <em>p</em> = .26, k = 49), avoidance learning (g = 1.5, <em>p</em> = .13, k = 4), blocking (k = 1), generalisation (g = −0.2, <em>p</em> = .16, k = 3), latent inhibition (g = 0.45, <em>p</em> = .39, k = 3), outcome devaluation (g = 0.26, <em>p</em> = .33, k = 7), Pavlovian-to-instrumental transfer (g = −0.24, <em>p</em> = .22, k = 2) or reversal learning (g = 0.16, <em>p</em> = .36, k = 10). The quality of evidence was moderate for reversal learning, low for associative learning, extinction, generalisation, latent inhibition and Pavlovian-to-instrumental transfer, and very low for avoidance learning and outcome devaluation.</div></div><div><h3>Conclusion</h3><div>Low quality evidence suggests people with OCD learn that stimuli no longer predict negatively valanced outcomes slower than healthy controls. Future research must elucidate the cause of attenuated extinction and its specificity to OCD.</div></div>","PeriodicalId":48458,"journal":{"name":"Clinical Psychology Review","volume":"122 ","pages":"Article 102661"},"PeriodicalIF":12.2,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145412323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-10DOI: 10.1016/j.cpr.2025.102659
Yael I. Nillni , Anna C. Barbano , Jessica N. Coleman , Michelle Fernando , Megan R. Gerber , Nichole Goodsmith , Kristin O. Haeger , Claire A. Hoffmire , Arielle Horenstein , Sabra S. Inslicht , Amanda M. Johnson , Jodie G. Katon , Eydie L. Moses-Kolko , Katherine A. Kosman , Suzanne L. Pineles , Zoe H. Pleasure , Namrata Singh , Laura J. Miller
Compared to their non-Veteran peers, women Veterans have a higher burden of trauma and mental health conditions, which intersect with reproductive health across the lifespan. This scoping review summarizes the outcomes of 83 studies focused on the associations between trauma or mental health and reproductive health among women Veterans in the United States. While research in some areas of reproductive health (i.e., sexual dysfunction, perinatal health) have steadily increased, other areas (e.g., menopausal symptoms) remain largely unstudied. Findings reveal that trauma, particularly sexual trauma, and mental health conditions, especially PTSD and depression, are associated with adverse reproductive health outcomes for women Veterans across the lifespan, including unintended pregnancies, adverse gynecological conditions, sexual dysfunction, adverse perinatal outcomes, and increased distress during routine gynecological care procedures. The review underscores the need for trauma-informed care, integration of reproductive and mental health services, and additional research on underexplored reproductive health outcomes.
{"title":"The intersection of trauma, mental health, and reproductive health among women veterans: A scoping review","authors":"Yael I. Nillni , Anna C. Barbano , Jessica N. Coleman , Michelle Fernando , Megan R. Gerber , Nichole Goodsmith , Kristin O. Haeger , Claire A. Hoffmire , Arielle Horenstein , Sabra S. Inslicht , Amanda M. Johnson , Jodie G. Katon , Eydie L. Moses-Kolko , Katherine A. Kosman , Suzanne L. Pineles , Zoe H. Pleasure , Namrata Singh , Laura J. Miller","doi":"10.1016/j.cpr.2025.102659","DOIUrl":"10.1016/j.cpr.2025.102659","url":null,"abstract":"<div><div>Compared to their non-Veteran peers, women Veterans have a higher burden of trauma and mental health conditions, which intersect with reproductive health across the lifespan. This scoping review summarizes the outcomes of 83 studies focused on the associations between trauma or mental health and reproductive health among women Veterans in the United States. While research in some areas of reproductive health (i.e., sexual dysfunction, perinatal health) have steadily increased, other areas (e.g., menopausal symptoms) remain largely unstudied. Findings reveal that trauma, particularly sexual trauma, and mental health conditions, especially PTSD and depression, are associated with adverse reproductive health outcomes for women Veterans across the lifespan, including unintended pregnancies, adverse gynecological conditions, sexual dysfunction, adverse perinatal outcomes, and increased distress during routine gynecological care procedures. The review underscores the need for trauma-informed care, integration of reproductive and mental health services, and additional research on underexplored reproductive health outcomes.</div></div>","PeriodicalId":48458,"journal":{"name":"Clinical Psychology Review","volume":"122 ","pages":"Article 102659"},"PeriodicalIF":12.2,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-10DOI: 10.1016/j.cpr.2025.102652
David P. Cenkner, Amy L. Dent, Agnes Zhou, Katherine E. Wislocki, Sarah K. Stevens, Sono Lee, Kayvon Amindari, Matt Sereno, Daniel Lu, Megan Chang, Hanniel Uwadia, Ethan G. Smith, Riley Woo, Hana Nip, Bethzaida N. Serrano, Alyson K. Zalta
Posttraumatic stress disorder (PTSD) is an established risk factor for suicidality in service members and veterans (SM/Vs). However, no meta-analysis has examined associations between PTSD symptom severity and suicidality in SM/Vs or moderators of these relationships. Three meta-analyses examined cross-sectional correlations between PTSD symptoms and suicide ideation, attempt, and risk. Seven databases were searched four times, most recently in June 2025. Eligible reports had to include adult SM/Vs, be written in English, be published in or after 1980, assess PTSD symptoms, and include a validated measure of suicidal ideation, attempts, or risk (or single item of attempts). We included 87 ideation effect sizes representing 82,318 SM/Vs, 74 attempt effect sizes representing 104,952 SM/Vs, and 45 risk effect sizes representing 38,927 SM/Vs. Correlated-and-hierarchical effects models with robust variance estimation revealed significant summary correlations for ideation (rz = 0.29; 95 % PI [0.02, 0.57]), attempt (rz = 0.16; 95 % PI [0.003, 0.32]), and risk (rz = 0.40; 95 % PI [0.08, 0.72]), all with statistically significant heterogeneity. Among 19 moderators tested, veteran status (v. active-duty) significantly strengthened the correlation with suicidal ideation (b = 0.12, se = 0.04, t(34.03) = 2.91, p = .006) and suicide attempt (b = 0.08, se = 0.03, t(19.83) = 2.44, p = .024). Partnered status significantly strengthened the correlation with suicide risk (b = 0.01, se = 0.00, t(8.77) = 4.62, p = .001). Findings highlight who might be at greater risk for suicide and underscore the potential benefits of treating PTSD symptoms for suicide prevention in SM/Vs.
创伤后应激障碍（PTSD）是现役军人和退伍军人（SM/Vs）自杀的一个确定的危险因素。然而，没有荟萃分析研究PTSD症状严重程度与SM/ v自杀之间的关系或这些关系的调节因子。三项荟萃分析检验了PTSD症状与自杀意念、企图和风险之间的横断面相关性。七个数据库被搜索了四次，最近一次是在2025年6月。合格的报告必须包括成人SM/ v，用英语书写，在1980年或之后出版，评估PTSD症状，并包括自杀意念、企图或风险（或企图的单项）的有效测量。我们纳入了87个构思效应大小，代表82318个SM/ v， 74个尝试效应大小，代表104952个SM/ v，以及45个风险效应大小，代表38927个SM/ v。具有稳健方差估计的相关和层次效应模型显示，构思（rz = 0.29; 95% PI[0.02, 0.57]）、尝试（rz = 0.16; 95% PI[0.003, 0.32]）和风险（rz = 0.40; 95% PI[0.08, 0.72]）的汇总相关性显著，均具有统计学上显著的异质性。在被测的19个调节因子中，退伍军人身份与自杀意念（b = 0.12, se = 0.04, t(34.03) = 2.91, p = 0.006）和自杀企图（b = 0.08, se = 0.03, t(19.83) = 2.44, p = 0.024）的相关性显著增强。伴侣状态与自杀风险的相关性显著增强（b = 0.01, se = 0.00, t(8.77) = 4.62, p = 0.001）。研究结果强调了哪些人可能有更大的自杀风险，并强调了治疗创伤后应激障碍症状对SM/ v自杀预防的潜在益处。
{"title":"Posttraumatic stress disorder symptoms and suicide ideation, attempt, and risk among active-duty service members and veterans: A systematic review with three meta-analyses of associations and moderators","authors":"David P. Cenkner, Amy L. Dent, Agnes Zhou, Katherine E. Wislocki, Sarah K. Stevens, Sono Lee, Kayvon Amindari, Matt Sereno, Daniel Lu, Megan Chang, Hanniel Uwadia, Ethan G. Smith, Riley Woo, Hana Nip, Bethzaida N. Serrano, Alyson K. Zalta","doi":"10.1016/j.cpr.2025.102652","DOIUrl":"10.1016/j.cpr.2025.102652","url":null,"abstract":"<div><div>Posttraumatic stress disorder (PTSD) is an established risk factor for suicidality in service members and veterans (SM/Vs). However, no meta-analysis has examined associations between PTSD symptom severity and suicidality in SM/Vs or moderators of these relationships. Three meta-analyses examined cross-sectional correlations between PTSD symptoms and suicide ideation, attempt, and risk. Seven databases were searched four times, most recently in June 2025. Eligible reports had to include adult SM/Vs, be written in English, be published in or after 1980, assess PTSD symptoms, and include a validated measure of suicidal ideation, attempts, or risk (or single item of attempts). We included 87 ideation effect sizes representing 82,318 SM/Vs, 74 attempt effect sizes representing 104,952 SM/Vs, and 45 risk effect sizes representing 38,927 SM/Vs. Correlated-and-hierarchical effects models with robust variance estimation revealed significant summary correlations for ideation (<em>r</em><sub><em>z</em></sub> = 0.29; 95 % PI [0.02, 0.57]), attempt (<em>r</em><sub><em>z</em></sub> = 0.16; 95 % PI [0.003, 0.32]), and risk (<em>r</em><sub><em>z</em></sub> = 0.40; 95 % PI [0.08, 0.72]), all with statistically significant heterogeneity. Among 19 moderators tested, veteran status (v. active-duty) significantly strengthened the correlation with suicidal ideation (<em>b</em> = 0.12, <em>se</em> = 0.04, <em>t</em>(34.03) = 2.91, <em>p</em> = .006) and suicide attempt (<em>b</em> = 0.08, <em>se</em> = 0.03, <em>t</em>(19.83) = 2.44, <em>p</em> = .024). Partnered status significantly strengthened the correlation with suicide risk (<em>b</em> = 0.01, <em>se</em> = 0.00, <em>t</em>(8.77) = 4.62, <em>p</em> = .001). Findings highlight who might be at greater risk for suicide and underscore the potential benefits of treating PTSD symptoms for suicide prevention in SM/Vs.</div></div>","PeriodicalId":48458,"journal":{"name":"Clinical Psychology Review","volume":"122 ","pages":"Article 102652"},"PeriodicalIF":12.2,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mentalizing—holding in mind, appraising and reappraising mental states—is evidenced across research disciplines as a key psychological capacity of developmental and clinical importance. Due to this interdisciplinary context, there are a broad range of mentalizing measures available. The primary aim of this review was to systematically review existing mentalizing measures. MEDLINE, PSYCHINFO, HAPI and PSYCHTESTS were searched to identify English-language, text-based, general adult population mentalizing measures.
Mentalizing is established as a multidimensional concept that varies across relational contexts. However, explicit dimensional definition and systematic contextualisation of mentalizing measures is rare. The secondary aim of the review was to develop and pilot a novel framework for classifying the mentalizing dimensions and relational context operationalised by each measure. Following reference to the literature and expert discussion, a dimensional construct framework of mentalizing with 18 components was proposed and applied to existing instruments.
57 text-based measures were identified by the review. Inter-rater agreement using the novel framework was 75%. No measures completely overlapped on dimensions and relational context. Relational contexts of measures were largely mentalizing the self (52) and/or hypothetical unspecified others (33). The review demonstrates that measures of mentalizing can be compared on the basis of dimensions operationalised and relational context, increasing utility in measure selection. Divergent construct validity highlights a need for careful selection of appropriate measures on the basis of mentalizing components of interest. Increased clarity of construct validity could be used to illuminate conflicting findings in the mentalizing literature and to advance the development of new assessment instruments.
{"title":"Measurement of mentalizing: A systematic review and development of a construct validity framework","authors":"Hannah Hawksdale , Beichen Meng , Janet Feigenbaum , Peter Fonagy , Tobias Nolte","doi":"10.1016/j.cpr.2025.102657","DOIUrl":"10.1016/j.cpr.2025.102657","url":null,"abstract":"<div><div>Mentalizing—holding in mind, appraising and reappraising mental states—is evidenced across research disciplines as a key psychological capacity of developmental and clinical importance. Due to this interdisciplinary context, there are a broad range of mentalizing measures available. The primary aim of this review was to systematically review existing mentalizing measures. MEDLINE, PSYCHINFO, HAPI and PSYCHTESTS were searched to identify English-language, text-based, general adult population mentalizing measures.</div><div>Mentalizing is established as a multidimensional concept that varies across relational contexts. However, explicit dimensional definition and systematic contextualisation of mentalizing measures is rare. The secondary aim of the review was to develop and pilot a novel framework for classifying the mentalizing dimensions and relational context operationalised by each measure. Following reference to the literature and expert discussion, a dimensional construct framework of mentalizing with 18 components was proposed and applied to existing instruments.</div><div>57 text-based measures were identified by the review. Inter-rater agreement using the novel framework was 75%. No measures completely overlapped on dimensions and relational context. Relational contexts of measures were largely mentalizing the self (52) and/or hypothetical unspecified others (33). The review demonstrates that measures of mentalizing can be compared on the basis of dimensions operationalised and relational context, increasing utility in measure selection. Divergent construct validity highlights a need for careful selection of appropriate measures on the basis of mentalizing components of interest. Increased clarity of construct validity could be used to illuminate conflicting findings in the mentalizing literature and to advance the development of new assessment instruments.</div></div>","PeriodicalId":48458,"journal":{"name":"Clinical Psychology Review","volume":"122 ","pages":"Article 102657"},"PeriodicalIF":12.2,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-06DOI: 10.1016/j.cpr.2025.102653
C.O. Hawker , S.E. Dias , N.A. Dowling , A.C. Thomas , B.J. Thornley , S.L. Campbell , K.L. Quigley , S.S. Merkouris
Abstract
This scoping review broadly aims to identify recent research on six indices of dropout during face-to-face psychological treatment for harmful gambling, including definitions of dropout, estimates of dropout, reasons for dropout, predictors of dropout, consequences of dropout, and solutions to dropout. A systematic search of electronic databases and grey literature identified 66 studies (from 67 articles/reports) published from 2004, most commonly contributing data to estimates (94 %), followed by predictors (74 %), definitions (73 %), reasons (15 %), consequences (8 %), and solutions (3 %). The findings revealed several definitions of dropout, typically relating to the non-attendance of a pre-defined and usually arbitrary number of treatment sessions, which risks the misclassification of clients with symptom improvement. The median rate of dropout (derived from 76 estimates) was 35.4 % across all treatment types and 34.8 % across Cognitive Behavioural Therapy (CBT) treatments. The most reported reasons for dropout were practical issues (e.g., scheduling conflicts), with few reasons relating to specific therapeutic orientations recorded. A large number of potential predictors have been examined with few consistent results, whereby being married/de-facto appears to consistently lower the risk of dropout. Dropout was consistently associated with higher subsequent gambling symptoms, urges, cognitions, and behaviors, with some additional evidence for worsened psychological symptoms, albeit based on a small number of studies. Only two studies examined the addition of motivational procedures to redress the risk of dropout, which produced favourable results. More research is needed, utilising standardised definitions and bespoke large-scale examinations, to improve retention during gambling treatment.
{"title":"Understanding dropout during psychological treatment for gambling: A scoping review","authors":"C.O. Hawker , S.E. Dias , N.A. Dowling , A.C. Thomas , B.J. Thornley , S.L. Campbell , K.L. Quigley , S.S. Merkouris","doi":"10.1016/j.cpr.2025.102653","DOIUrl":"10.1016/j.cpr.2025.102653","url":null,"abstract":"<div><h3>Abstract</h3><div>This scoping review broadly aims to identify recent research on six indices of dropout during face-to-face psychological treatment for harmful gambling, including definitions of dropout, estimates of dropout, reasons for dropout, predictors of dropout, consequences of dropout, and solutions to dropout. A systematic search of electronic databases and grey literature identified 66 studies (from 67 articles/reports) published from 2004, most commonly contributing data to estimates (94 %), followed by predictors (74 %), definitions (73 %), reasons (15 %), consequences (8 %), and solutions (3 %). The findings revealed several definitions of dropout, typically relating to the non-attendance of a pre-defined and usually arbitrary number of treatment sessions, which risks the misclassification of clients with symptom improvement. The median rate of dropout (derived from 76 estimates) was 35.4 % across all treatment types and 34.8 % across Cognitive Behavioural Therapy (CBT) treatments. The most reported reasons for dropout were practical issues (e.g., scheduling conflicts), with few reasons relating to specific therapeutic orientations recorded. A large number of potential predictors have been examined with few consistent results, whereby being married/de-facto appears to consistently lower the risk of dropout. Dropout was consistently associated with higher subsequent gambling symptoms, urges, cognitions, and behaviors, with some additional evidence for worsened psychological symptoms, albeit based on a small number of studies. Only two studies examined the addition of motivational procedures to redress the risk of dropout, which produced favourable results. More research is needed, utilising standardised definitions and bespoke large-scale examinations, to improve retention during gambling treatment.</div></div>","PeriodicalId":48458,"journal":{"name":"Clinical Psychology Review","volume":"122 ","pages":"Article 102653"},"PeriodicalIF":12.2,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-06DOI: 10.1016/j.cpr.2025.102662
Gabrielle M. Gauthier, Shivani Pandey, Victoria Sanchez, Savanna E. Stromberg, Lori A. Zoellner
Objective
Extreme weather events are increasing in intensity and frequency due to climate change. Better understanding key prospective predictors of chronic posttraumatic stress disorder (PTSD) present in the acute wake of a disaster is essential to allocating limited resources to those at greatest risk. Additionally, identifying prospective predictors of PTSD may help elucidate etiological factors that could be harnessed for psychological interventions to prevent chronic PTSD.
Method
PubMed, PsycInfo and PTSDPubs were systematically searched in February 2025 for longitudinal studies prospectively examining PTSD in adults following extreme weather events (e.g., hurricanes) with at least one pre-disaster or acutely post-disaster (< 18 months) timepoint. Effect sizes of demographic (e.g., gender), pre-event (e.g., pre-disaster psychopathology), and environmental factors (e.g., social support) were extracted and synthesized as correlations using random effects modeling.
Results
Forty-seven unique samples (N = 25,085) were included, with a majority collected in North America (63.83 %). The most frequent disaster type was hurricanes/typhoons (53.19 %). Severity of disaster exposure (r = 0.26), income (r = −0.26), and prior psychopathology (r = 0.26) emerged as the strongest predictors of PTSD.
Conclusions
This is the first meta-analysis to examine prospective predictors of PTSD following extreme weather events collectively. The small- to moderate-sized effects observed suggest that predictors likely operate cumulatively to confer risk. Relative to other trauma types, access to resources, such as higher income, may be an important buffer against mental health problems. Future work should investigate modifiable predictors of PTSD that could potentially be harnessed in early interventions.
{"title":"Posttraumatic stress disorder and climate change: A meta-analysis of prospective, acute predictors of PTSD following extreme weather events","authors":"Gabrielle M. Gauthier, Shivani Pandey, Victoria Sanchez, Savanna E. Stromberg, Lori A. Zoellner","doi":"10.1016/j.cpr.2025.102662","DOIUrl":"10.1016/j.cpr.2025.102662","url":null,"abstract":"<div><h3>Objective</h3><div>Extreme weather events are increasing in intensity and frequency due to climate change. Better understanding key prospective predictors of chronic posttraumatic stress disorder (PTSD) present in the acute wake of a disaster is essential to allocating limited resources to those at greatest risk. Additionally, identifying prospective predictors of PTSD may help elucidate etiological factors that could be harnessed for psychological interventions to prevent chronic PTSD.</div></div><div><h3>Method</h3><div>PubMed, PsycInfo and PTSDPubs were systematically searched in February 2025 for longitudinal studies prospectively examining PTSD in adults following extreme weather events (e.g., hurricanes) with at least one pre-disaster or acutely post-disaster (< 18 months) timepoint. Effect sizes of demographic (e.g., gender), pre-event (e.g., pre-disaster psychopathology), and environmental factors (e.g., social support) were extracted and synthesized as correlations using random effects modeling.</div></div><div><h3>Results</h3><div>Forty-seven unique samples (<em>N</em> = 25,085) were included, with a majority collected in North America (63.83 %). The most frequent disaster type was hurricanes/typhoons (53.19 %). Severity of disaster exposure (<em>r</em> = 0.26), income (<em>r</em> = −0.26), and prior psychopathology (<em>r</em> = 0.26) emerged as the strongest predictors of PTSD.</div></div><div><h3>Conclusions</h3><div>This is the first meta-analysis to examine prospective predictors of PTSD following extreme weather events collectively. The small- to moderate-sized effects observed suggest that predictors likely operate cumulatively to confer risk. Relative to other trauma types, access to resources, such as higher income, may be an important buffer against mental health problems. Future work should investigate modifiable predictors of PTSD that could potentially be harnessed in early interventions.</div></div>","PeriodicalId":48458,"journal":{"name":"Clinical Psychology Review","volume":"122 ","pages":"Article 102662"},"PeriodicalIF":12.2,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite the recognized importance of the therapeutic alliance (TA) in mental health care for people with severe mental illness (SMI), research examining factors associated with the quality of the TA remains limited.
Objectives
This review systematically synthesizes literature on factors associated with TA across six domains: client, mental health professional (MHP), clinical, social, care, and other factors. TA ratings from clients, MHPs, and independent observers are included.
Methods
Parallel literature searches in PsycInfo, Medline, and PubMed between 2000-June 2025 identified 5198 potential articles, of which 48 met inclusion.
Results
Factors associated with better client-rated TA included better illness-insight, client secure attachment style, positive outcome expectancy, less stigma, use of supportive techniques during therapy, early positive connections, and specific MHP characteristics. For MHP-rated, better outcomes were linked to better client insight, MHP attachment style, early positive connections, and less severe client symptomatology.
Discussion
Clinical symptom severity influenced MHP-rated TA, but not client-rated TA. A secure attachment of the client favored TA quality, while other attachment styles appeared to be unrelated to TA. Early positive interactions between client and MHP establish a foundation for later stable TA. Creating a warm, supportive environment helps clients overcome stigma and develop positive outcome expectations. Emphasizing supportive techniques such as providing feedback and shared agenda-setting, rather than focusing solely on the clients' symptomatology, may enhance TA perception. Future TA research may benefit from understanding the interplay between client and MHP-related contributions to the alliance, thereby incorporating the multidisciplinary nature of MHPs involved in SMI treatment.
{"title":"Associated factors of the quality of therapeutic alliance in people with severe mental illnesses: A systematic review","authors":"Melina Tetzlaff , Jojanneke Bruins , Stynke Castelein","doi":"10.1016/j.cpr.2025.102656","DOIUrl":"10.1016/j.cpr.2025.102656","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite the recognized importance of the therapeutic alliance (TA) in mental health care for people with severe mental illness (SMI), research examining factors associated with the quality of the TA remains limited.</div></div><div><h3>Objectives</h3><div>This review systematically synthesizes literature on factors associated with TA across six domains: client, mental health professional (MHP), clinical, social, care, and other factors. TA ratings from clients, MHPs, and independent observers are included.</div></div><div><h3>Methods</h3><div>Parallel literature searches in PsycInfo, Medline, and PubMed between 2000-June 2025 identified 5198 potential articles, of which 48 met inclusion.</div></div><div><h3>Results</h3><div>Factors associated with better client-rated TA included better illness-insight, client secure attachment style, positive outcome expectancy, less stigma, use of supportive techniques during therapy, early positive connections, and specific MHP characteristics. For MHP-rated, better outcomes were linked to better client insight, MHP attachment style, early positive connections, and less severe client symptomatology.</div></div><div><h3>Discussion</h3><div>Clinical symptom severity influenced MHP-rated TA, but not client-rated TA. A secure attachment of the client favored TA quality, while other attachment styles appeared to be unrelated to TA. Early positive interactions between client and MHP establish a foundation for later stable TA. Creating a warm, supportive environment helps clients overcome stigma and develop positive outcome expectations. Emphasizing supportive techniques such as providing feedback and shared agenda-setting, rather than focusing solely on the clients' symptomatology, may enhance TA perception. Future TA research may benefit from understanding the interplay between client and MHP-related contributions to the alliance, thereby incorporating the multidisciplinary nature of MHPs involved in SMI treatment.</div></div>","PeriodicalId":48458,"journal":{"name":"Clinical Psychology Review","volume":"122 ","pages":"Article 102656"},"PeriodicalIF":12.2,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-03DOI: 10.1016/j.cpr.2025.102654
Erlend Pukstad , Joar Øveraas Halvorsen , Magnus Rom Jensen , Solvor Solhaug , Henrik Nordahl
The Self-Regulatory Executive Function (S-REF) model emphasizes biases in metacognition, and particularly negative metacognitive beliefs, as the central mechanism of persistent emotional distress and disorders. Hence, interventions which effectively modify dysfunctional metacognitions are predicted to create improvement regardless of whether metacognitions are directly targeted or not. With an aim to evaluate the empirical support for metacognitions as a mechanism of change in psychopathology, we conducted a systematic review of the literature focusing on metacognitive change and its relationship to change in outcomes across emotional disorders and therapeutic interventions. Systematic searches were conducted and following PRISMA 2020 guidelines, 27 articles were identified. Results were synthesized and evaluated against established criteria for accurately classifying theoretical predictors as mechanisms of change. Our review shows a consistent association between change in metacognitions, particularly negative metacognitive beliefs, and outcome changes across different mental disorders, outcomes, and interventions. This relationship held even when controlling competing mechanisms such as cognitive beliefs and support the criterion of specificity. However, most of the identified studies lacked the methodological rigor needed (e.g., multiple assessment points during the treatment phase) to draw firm conclusions about metacognitions as a causal mechanism of change. Based on the existing literature, we conclude that metacognition is promising as a candidate to be considered a transdiagnostic mechanism of change of emotional disorders. We provide directions for future research necessary to more definitely determine the role of metacognitive change in psychopathology improvement and recovery.
{"title":"Do metacognitive beliefs satisfy criteria as mechanisms of change in treatment? A systematic review and evidence synthesis","authors":"Erlend Pukstad , Joar Øveraas Halvorsen , Magnus Rom Jensen , Solvor Solhaug , Henrik Nordahl","doi":"10.1016/j.cpr.2025.102654","DOIUrl":"10.1016/j.cpr.2025.102654","url":null,"abstract":"<div><div>The Self-Regulatory Executive Function (S-REF) model emphasizes biases in metacognition, and particularly negative metacognitive beliefs, as the central mechanism of persistent emotional distress and disorders. Hence, interventions which effectively modify dysfunctional metacognitions are predicted to create improvement regardless of whether metacognitions are directly targeted or not. With an aim to evaluate the empirical support for metacognitions as a mechanism of change in psychopathology, we conducted a systematic review of the literature focusing on metacognitive change and its relationship to change in outcomes across emotional disorders and therapeutic interventions. Systematic searches were conducted and following PRISMA 2020 guidelines, 27 articles were identified. Results were synthesized and evaluated against established criteria for accurately classifying theoretical predictors as mechanisms of change. Our review shows a consistent association between change in metacognitions, particularly negative metacognitive beliefs, and outcome changes across different mental disorders, outcomes, and interventions. This relationship held even when controlling competing mechanisms such as cognitive beliefs and support the criterion of specificity. However, most of the identified studies lacked the methodological rigor needed (e.g., multiple assessment points during the treatment phase) to draw firm conclusions about metacognitions as a causal mechanism of change. Based on the existing literature, we conclude that metacognition is promising as a candidate to be considered a transdiagnostic mechanism of change of emotional disorders. We provide directions for future research necessary to more definitely determine the role of metacognitive change in psychopathology improvement and recovery.</div></div>","PeriodicalId":48458,"journal":{"name":"Clinical Psychology Review","volume":"122 ","pages":"Article 102654"},"PeriodicalIF":12.2,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-03DOI: 10.1016/j.cpr.2025.102660
Miri Gnainsky , David Roe , Ofir Negri-Schwartz , Yael Cohen-Chazani , Michal Lavidor , Ilanit Hasson-Ohayon
The decision to disclose or conceal a mental illness represents a complex dilemma influenced by various personal, social, and environmental factors. Through a systematic review of 42 quantitative studies published until May 2025, we examined how individuals manage mental illness disclosure and secrecy, and their associations with mental health outcomes, perception-related variables, and functional outcomes. Findings show that secrecy had consistent negative associations with mental health outcomes including depression, well-being, and quality of life, while disclosure's associations with outcomes varied across different contexts. Second, self-perception-related variables, particularly stigma, played a central role – with studies showing different patterns of associations between disclosure and both self-stigma and public stigma. Third, selective disclosure emerged as a strategy for managing disclosure processes across different social contexts. In employment settings, mixed findings emerged regarding disclosure outcomes, with some studies showing associations with job matching and duration, although these varied by workplace context. Several factors that influenced the observed associations were identified, including perceived social support and contextual factors. Notably, disclosure and secrecy operated as distinct rather than opposite processes, with individuals often managing both simultaneously across different contexts. These findings highlight the need for nuanced approaches to supporting disclosure decisions, considering both personal and environmental factors in clinical practice and organizational interventions.
{"title":"To disclose or not to disclose: A systematic review of factors associated with disclosure and concealment of mental illnesses","authors":"Miri Gnainsky , David Roe , Ofir Negri-Schwartz , Yael Cohen-Chazani , Michal Lavidor , Ilanit Hasson-Ohayon","doi":"10.1016/j.cpr.2025.102660","DOIUrl":"10.1016/j.cpr.2025.102660","url":null,"abstract":"<div><div>The decision to disclose or conceal a mental illness represents a complex dilemma influenced by various personal, social, and environmental factors. Through a systematic review of 42 quantitative studies published until May 2025, we examined how individuals manage mental illness disclosure and secrecy, and their associations with mental health outcomes, perception-related variables, and functional outcomes. Findings show that secrecy had consistent negative associations with mental health outcomes including depression, well-being, and quality of life, while disclosure's associations with outcomes varied across different contexts. Second, self-perception-related variables, particularly stigma, played a central role – with studies showing different patterns of associations between disclosure and both self-stigma and public stigma. Third, selective disclosure emerged as a strategy for managing disclosure processes across different social contexts. In employment settings, mixed findings emerged regarding disclosure outcomes, with some studies showing associations with job matching and duration, although these varied by workplace context. Several factors that influenced the observed associations were identified, including perceived social support and contextual factors. Notably, disclosure and secrecy operated as distinct rather than opposite processes, with individuals often managing both simultaneously across different contexts. These findings highlight the need for nuanced approaches to supporting disclosure decisions, considering both personal and environmental factors in clinical practice and organizational interventions.</div></div>","PeriodicalId":48458,"journal":{"name":"Clinical Psychology Review","volume":"122 ","pages":"Article 102660"},"PeriodicalIF":12.2,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-03DOI: 10.1016/j.cpr.2025.102658
Annakarina Mundorf , Hicret Atilgan , Lisa Deneke , Sebastian Ocklenburg
Substance use disorder (SUD) is characterized by compulsive use despite adverse consequences and may be influenced by brain asymmetry affecting cognitive and emotional processes. This systematic review investigates the relationship between brain asymmetry and SUD. PubMed, Web of Science, and PsycInfo were searched for articles published until July 2025, using the search terms: ((Alcoholism) OR (alcohol abuse) OR (substance abuse) OR (addiction)) AND ((handedness) OR (footedness) OR (dichotic listening) OR (line bisection task) OR (visual half field technique) OR (fMRI asymmetry) OR (EEG asymmetry) OR (structural asymmetry)). Inclusion criteria were (i) subjects having a diagnosis of or meeting the criteria for alcoholism, alcohol abuse, substance abuse, or addiction assessed with a validated clinical inventory, (ii) articles must contain information on handedness, footedness, dichotic listening, line bisection task, the visual half-field technique, or hemispheric differences (iii) data must be given for the clinical group separately, (iv) original research article in the English language. For neuroimaging studies, both hemispheres needed to be examined separately. Exclusion criteria included: (i) review articles; (ii) studies without matched groups; (iii) studies on recreational use only; (iv) those involving prenatal substance exposure or comorbid neurological disorders. Risk of bias was assessed with the Newcastle-Ottawa Scale. Forty-nine studies met the criteria. Structural imaging indicates asymmetric white and grey matter alterations: reduced left-hemispheric white matter integrity and lower grey matter volume in frontal and temporal regions. Functional data show compensatory right-hemispheric activation. Behavioral lateralization findings vary by substance type, sex, and age, with potential implications for personalized treatment strategies.
物质使用障碍（SUD）的特征是强迫性使用，尽管有不良后果，可能受到影响认知和情绪过程的大脑不对称的影响。本系统综述探讨了脑不对称与SUD的关系。PubMed， Web of Science和PsycInfo检索到2025年7月之前发表的文章，使用搜索词：（酗酒）或（酒精滥用）或（药物滥用）或（成瘾）)和（（手性）或（脚性）或（二分聆听）或（线对分任务）或（视觉半视野技术）或（fMRI不对称）或（EEG不对称）或（结构不对称））。纳入标准为：(i)受试者被诊断为或符合酒精中毒、酒精滥用、药物滥用或成瘾的标准，通过经过验证的临床清单进行评估；（ii）文章必须包含有关利手性、足性、二分性听力、线对分任务、视觉半视野技术或半球差异的信息；（iii）必须单独提供临床组的数据；（iv）英文原版研究文章。在神经成像研究中，需要分别检查两个大脑半球。排除标准包括：(i)综述文章；（ii）没有匹配组的研究；（iii）只作康乐用途的研究；（iv）涉及产前物质暴露或共病神经系统疾病的。偏倚风险采用纽卡斯尔-渥太华量表进行评估。49项研究符合标准。结构成像显示不对称的白质和灰质改变：左半球白质完整性降低，额叶和颞叶灰质体积降低。功能数据显示右半脑代偿性激活。行为侧化的结果因物质类型、性别和年龄的不同而不同，这可能意味着个性化的治疗策略。
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