Clinical Psychology Review最新文献

Schizophrenia, a debilitating psychiatric disorder, has a long-term impact on social and occupational functioning. While negative symptoms, notably amotivation, are recognized as poor prognostic factors, the positive force of patient motivation (autonomous motivation) remains underexplored. This systematic review, guided by Self-Determination Theory (SDT), investigated the impact of motivation on clinical presentation, and treatment engagement and response in schizophrenia-spectrum disorders. Fifty-five independent studies (N = 6897), using 23 different motivation scales, met inclusion criteria. Results were categorized into cross-sectional and longitudinal correlates of autonomous motivation, and the effects of motivational interventions. Cross-sectionally, autonomous motivation was positively associated with social/occupational functioning, and negatively associated with negative and positive symptom severity. In longitudinal studies, baseline autonomous motivation predicted engagement in and response to social/occupational treatments, with mixed results in cognitive interventions. In the 16 randomized controlled trials (RCTs), the most common motivational interventions were individualized goal setting and goal attainment support, followed by increasing sense of competence by challenging defeatist beliefs, and enhancing relatedness by increasing contact time. Motivational interventions consistently increased autonomous motivation, treatment engagement and response. More studies are needed, particularly studies that monitor motivation during treatment: proximal assessments could facilitate the identification of treatment elements that impact motivation and engagement and inform treatment modifications to enhance the patient experience and improve treatment efficacy.

Background

Dysfunctional imagery processes characterise a range of emotional disorders. Valid, reliable, and responsive mental imagery measures may support the clinical assessment of imagery and advance research to develop theory and imagery-based interventions. We sought to review the psychometric properties of mental imagery measures relevant to emotional disorders.

Methods

A systematic review registered on the Open Science Framework was conducted using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. Five databases were searched. COSMIN tools were used to assess the quality of study methodologies and psychometric properties of measures.

Results

Twenty-three articles describing twenty-one self-report measures were included. Measures assessed various imagery processes and were organised into four groups based on related emotional disorders. Study methodological quality varied: measure development and reliability studies were generally poor, while internal consistency and hypothesis testing studies were higher quality. Most measurement properties assessed were of indeterminate quality.

Conclusion

Imagery measures were heterogenous and primarily disorder specific. Due to a lack of high-quality psychometric assessment, it is unclear whether most included imagery measures are valid, reliable, or responsive. Measures had limited evidence of content validity suggesting further research could engage clinical populations to ensure their relevance and comprehensiveness.

This review aimed to develop a conceptual model of the therapeutic alliance in the context of psychotherapy and suicidal experiences from therapist and client perspectives. The protocol was pre-registered on PROSPERO (CRD42021268273). MEDLINE, PsycINFO, Web of Science, Embase and CINAHL were systematically searched from database inception to April 2024. Eligible studies were peer-reviewed, qualitative, and included client and/or therapist's perspectives of the therapeutic alliance in the context of psychotherapy and suicidal experiences. Studies were critically appraised and analysed using a meta-ethnography approach involving a reciprocal translation of studies and line of argument synthesis. Thirty-seven papers were included, generating two overarching themes; ‘Working on the edge’ and ‘Being ready, willing, and able to build an alliance in the context of suicidal experiences’. Therapeutic alliance in the context of suicidal experiences is unique, fluid, potentially lifesaving, and influenced by multiple inter-connected internal and external processes and systems. Clinical implications emphasise the need to improve training, supervision, and support for therapists to equip them with the additional skills required in navigating the intricacies of the therapeutic alliance with clients who have suicidal experiences. Flexibly interweaving risk assessment into therapeutic conversation was beneficial to the alliance with suicidal clients and enhanced their safety.

Gaze abnormalities are well documented in infants at elevated risk for autism spectrum disorder (ASD). However, variations in experimental design and stimuli across studies have led to mixed results. The current meta-analysis aimed to identify which type of eye tracking task and stimulus are most effective at differentiating high-risk infants (siblings of children with ASD) who later meet diagnosis criteria from low-risk infants without familial autism. We synthesized 35 studies that used eye tracking to investigate gaze behavior in infants at high genetic risk for autism before 2 years of age. We found that stimulus features, regions of interest (ROIs) and study quality moderated effect sizes across studies. Overall, dynamic stimuli and socially-relevant regions in the social stimuli (i.e. the target and activity of characters' shared focus) reliably detected high-risk infants who later develop ASD. Attention disengagement task and stimuli depicting interactions between human and nonhuman characters could identify high-risk infants who later develop ASD and those who have autism-related symptoms but do not meet the diagnostic criteria as well. These findings provide sensitive and reliable early markers of ASD, which is helpful to develop objective and quantitative early autism screening and intervention tools.

Self-injurious thoughts and behaviours (SITBs) are a leading cause of death, and interpersonal processes (IPs) appear to play a role in SITBs. This systematic review synthesises the literature on IPs and SITBs in daily life and addresses four critical questions: (1) Which IPs have been assessed and how, (2) How are differences in IPs between individuals associated with SITBs?, (3) How are differences in IPs within individuals associated with SITBs? and (4) Do IPs relate differently to self-injurious thoughts than behaviours? Our review followed PRISMA guidelines and eligible literature was screened until 25 April 2024. We identified 58 Experience Sampling studies (32.76% daily-diary studies) of which most focused on IPs from major SITBs theories (e.g., thwarted belongingness) but largely used inconsistent operationalizations. Results from 39 studies investigating within-person associations were mixed. Based on 26 studies, whether differences in IPs between individuals relate to SITBs remains unclear. Three studies have investigated whether IPs relate to the transition from thoughts to behaviours, but temporal models are needed to draw firm conclusions. Studies investigating IPs and SITBs in daily life are largely inconclusive. Psychometrically validated measures are warranted, and future daily-life studies would benefit from drawing on ideation-to-action frameworks.

Adolescence is a time when important decisions about the future are made and vulnerability to mental health problems increases. We reviewed longitudinal studies examining the reciprocal pathways between future-related thinking (hopelessness, hope, optimism/positive future expectations) and adolescent depression and anxiety symptoms. Evidence from 22 studies (N = 10,682) found that negative future-related thinking predicted subsequent depression (r = 0.27, p < .001), an effect still significant after controlling for baseline depression (r = 0.23, p < .001). Higher hopelessness (r = 0.34, p < .001), lower hope (r = 0.16, p < .001), and reduced optimism/positive future expectations (r = 0.18, p < .001) were associated with subsequently increased depressive symptoms. Negative future-related thinking also predicted later increased anxiety symptoms (r = 0.15, p = .021). Concerning the reciprocal pathway, depressive symptoms were associated with later negative future-related thinking (r = 0.32, p < .001), which remained after baseline levels of future-related thinking were controlled (r = 0.07, p = .02). There were insufficient studies to infer reciprocal links between anxiety and future-related thinking. Our analyses provided evidence of a reciprocal developmental relationship between depressive symptoms and future-related thinking, implying a negative cycle. Identifying precursors of this cycle could provide the basis for depression prevention in adolescents and promote better decision-making about the future.

Identifying factors that impact psychological treatment outcomes in older people with common mental health problems (CMHP) has important implications for supporting healthier and longer lives. The aim of the present study was to synthesise the evidence on predictors of psychological treatment outcomes in older people (aged 65+). PubMed, Scopus, Web of Science and PsycINFO were searched and 3929 articles were identified and screened, with 42 studies (N = 7978, M age = 68.9, SD age = 2.85) included: depression: k = 21, anxiety: k = 11, panic disorder: k = 3, mixed anxiety & depression: k = 3, PTSD: k = 2, various CMHP: k = 2, with CBT being the most common treatment (71%). The review identified 28 factors reported as significant predictors of treatment outcome in at least one study, across different domains: psychosocial (n = 9), clinical (n = 6), treatment-related (n = 6), socio-demographic (n = 4), neurobiological (n = 3). Homework completion was the most consistent predictor of positive treatment outcome. Baseline symptom severity was the most frequently studied significant predictor and across all conditions, with higher baseline symptom severity largely linked to worse treatment outcomes. No significant effects on treatment outcome were reported for gender, income and physical comorbidities. For a large majority of factors evidence was mixed or inconclusive. Further studies are required to identify factors affecting psychological treatment outcomes, which will be important for the development of personalised treatment approaches.

The purpose of the current review was to address four questions: 1) Are there differences in family functioning or family environment among patients with different eating disorder (ED) diagnoses? 2) Are there differences in the perception of family functioning or family environment among different family members? 3) Is family functioning or family environment related to ED symptomatology? 4) Does family functioning or family environment change as a result of ED treatment? and 4a) If so, does this impact ED treatment outcome? Although most studies found no differences among ED diagnostic groups, those that did generally found worse family functioning among those with binge/purge symptoms than among those with the restricting subtype of anorexia nervosa. Differences in perceptions of family functioning among family members were found, with patients generally reporting worse functioning than their parents. Worse family functioning was generally found to be related to worse ED symptoms. The variety of treatment approaches and different assessments of outcome made it somewhat unclear whether family functioning consistently improves with ED treatment. More research is needed on family functioning and EDs, particularly in understudied groups such as males, and those with ED diagnoses other than anorexia nervosa or bulimia nervosa.

Objective

The purpose of this systematic review was to evaluate stigma and Functional Neurological Disorder (FND) regarding: 1) prevalence and associated factors, 2) the nature and context of stigma in FND, and 3) stigma-reduction interventions.

Methods

We searched four relevant databases from inception to December 2023, using search terms relevant to FND and stigma themes. We employed the method of synthesis by “aggregation and configuration” to synthesise and analyse the data into emergent themes.

Results

We found 127 studies, spanning 148 countries, involving 18,886 participants. Of these, 4889 were patients, 13,123 were healthcare professionals, and 526 were caregivers. Quantitatively, stigma has been mainly studied in patients with functional seizures, and was higher than patients with epilepsy in three studies. Stigma experienced by patients is associated with poorer quality of life and caregiver burden. We found 10 themes and 29 subthemes revealing stigma as a systemic process, with intrapersonal, interpersonal and structural aspects. Few studies examined the perspective of caregivers, the public or online community. We identified six anti-stigma interventions.

Conclusion

Stigma in FND is a layered process, and affects patient quality of life and provision of care. Stigma needs to be addressed from the top structures, at governmental level, so that appropriate care pathways can be created, giving patients with FND parity of esteem with other medical conditions.

Demographic data from nearly 50 years of treatment research for children and adolescents with attention-deficit/hyperactivity disorder (ADHD) are synthesized. Comprehensive search identified ADHD treatment studies that were between-group designs, included a psychosocial, evidence-based treatment, and were conducted in the United States. One hundred and twenty-six studies that included 10,604 youth were examined. Reporting of demographics varied with 48% of studies (k = 61) reporting ethnicity, 73% (k = 92) reporting race, 80% (k = 101) reporting age (M age = 8.81, SD = 2.82), and 88% (k = 111) reporting gender. Most participants identified as non-Hispanic/Latine (15.99% Hispanic/Latine), White (62.54%), and boys (74.39%; 24.47% girls). Since the 1970s, zero youth in ADHD treatment studies identified as Middle Eastern/North African, 0.1% were American Indian/Alaskan Native or Native Hawaiian Pacific Islander, 1.77% were Asian, 15.10% were Black, and 3.14% were Multiracial. Based on publication year, the proportions of girls, racially minoritized youth, and Hispanic/Latine youth included in ADHD treatment research have increased over time. Girls, non-binary and non-cisgender youth, young children, adolescents, Hispanic/Latine youth, and youth from all racial groups other than White are underrepresented in ADHD treatment research. Research gaps are discussed, and recommendations for comprehensive demographic reporting in child and adolescent psychological research are provided.