Clinical Psychology Review最新文献_第4页

Measurement of mentalizing: A systematic review and development of a construct validity framework 心理化的测量：建构效度框架的系统回顾与发展

IF 12.2 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical Psychology Review

Pub Date : 2025-10-10 DOI: 10.1016/j.cpr.2025.102657

Hannah Hawksdale , Beichen Meng , Janet Feigenbaum , Peter Fonagy , Tobias Nolte

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.

心理化——牢记、评估和重新评估心理状态——在各个研究学科中都被证明是一种具有发展和临床重要性的关键心理能力。由于这种跨学科的背景，有广泛的心理测量可用。本次审查的主要目的是系统地审查现有的心理措施。检索MEDLINE， PSYCHINFO， HAPI和PSYCHTESTS以确定英语，基于文本的一般成人人群心理化措施。

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引用次数: 0

Understanding dropout during psychological treatment for gambling: A scoping review 了解赌博心理治疗期间的辍学：范围审查

IF 12.2 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical Psychology Review

Pub Date : 2025-10-06 DOI: 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.

这一范围审查的广泛目的是确定在面对面的有害赌博心理治疗中辍学的六个指标的最新研究，包括辍学的定义、辍学的估计、辍学的原因、辍学的预测因素、辍学的后果和辍学的解决方案。对电子数据库和灰色文献进行系统搜索，确定了2004年以来发表的66项研究（来自67篇文章/报告），其中最常见的是为估计（94%）提供数据，其次是预测（74%）、定义（73%）、原因（15%）、结果（8%）和解决方案（3%）。研究结果揭示了辍学的几种定义，通常与不参加预先定义的、通常是任意数量的治疗有关，这有可能对症状改善的客户进行错误分类。所有治疗类型的中位辍学率（来自76项估计）为35.4%，认知行为疗法（CBT）治疗的中位辍学率为34.8%。据报道，大多数辍学的原因是实际问题（例如，日程冲突），很少有与具体治疗取向有关的原因记录。对大量潜在的预测因素进行了研究，但几乎没有一致的结果，即结婚/同居似乎始终能降低辍学的风险。辍学与随后更高的赌博症状、冲动、认知和行为一致相关，尽管基于少量研究，但还有一些额外的证据表明心理症状会恶化。只有两项研究考察了增加激励程序以纠正辍学风险，并产生了有利的结果。需要更多的研究，利用标准化的定义和定制的大规模检查，以提高赌博治疗期间的记忆力。

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引用次数: 0

Posttraumatic stress disorder and climate change: A meta-analysis of prospective, acute predictors of PTSD following extreme weather events 创伤后应激障碍和气候变化：极端天气事件后创伤后应激障碍的前瞻性、急性预测因素的荟萃分析。

IF 12.2 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical Psychology Review

Pub Date : 2025-10-06 DOI: 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.

目的：由于气候变化，极端天气事件的强度和频率正在增加。更好地了解灾后急性期慢性创伤后应激障碍（PTSD）的主要预测因素，对于将有限的资源分配给风险最大的人群至关重要。此外，确定PTSD的前瞻性预测因素可能有助于阐明病因，可以利用心理干预来预防慢性PTSD。方法：系统检索PubMed、PsycInfo和PTSDPubs于2025年2月进行的纵向研究，前瞻性研究极端天气事件（如飓风）后至少有一个灾前或灾后急性（< 18个月）时间点的成人PTSD。使用随机效应模型提取人口统计学（如性别）、事件前（如灾前精神病理学）和环境因素（如社会支持）的效应大小，并将其合成为相关性。结果：纳入47份独特样本（N = 25,085），其中大部分来自北美（63.83%）。最常见的灾害类型是飓风/台风（53.19%）。灾难暴露的严重程度（r = 0.26）、收入（r = -0.26）和既往精神病理（r = 0.26）是PTSD的最强预测因子。结论：这是首次对极端天气事件后PTSD的前瞻性预测因素进行meta分析。观察到的小到中等大小的效应表明，预测因子可能会累积起作用，从而赋予风险。相对于其他类型的创伤，获得资源，如较高的收入，可能是对抗心理健康问题的重要缓冲。未来的工作应该研究创伤后应激障碍的可修改的预测因素，这些因素可能在早期干预中被利用。

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引用次数: 0

Associated factors of the quality of therapeutic alliance in people with severe mental illnesses: A systematic review 影响严重精神疾病患者联合治疗质量的相关因素：一项系统综述

IF 12.2 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical Psychology Review

Pub Date : 2025-10-04 DOI: 10.1016/j.cpr.2025.102656

Melina Tetzlaff , Jojanneke Bruins , Stynke Castelein

Introduction

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.

尽管治疗联盟（TA）在严重精神疾病（SMI）患者的精神卫生保健中的重要性得到公认，但研究与TA质量相关的因素仍然有限。

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引用次数: 0

Do metacognitive beliefs satisfy criteria as mechanisms of change in treatment? A systematic review and evidence synthesis 元认知信念是否满足治疗改变机制的标准？系统回顾和证据综合。

IF 12.2 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical Psychology Review

Pub Date : 2025-10-03 DOI: 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.

自我调节执行功能（Self-Regulatory Executive Function, S-REF）模型强调元认知中的偏见，特别是消极的元认知信念，是持续情绪困扰和障碍的核心机制。因此，无论元认知是否直接针对，预测有效改变功能失调元认知的干预措施都能产生改善。为了评估元认知作为一种精神病理变化机制的实证支持，我们系统地回顾了有关元认知变化及其与情绪障碍结局变化和治疗干预之间关系的文献。按照PRISMA 2020指南进行了系统检索，确定了27篇文章。对结果进行了综合和评估，以准确地将理论预测因子分类为变化机制。我们的综述显示，元认知的变化，特别是消极的元认知信念，与不同精神障碍、结果和干预措施的结果变化之间存在一致的关联。这种关系甚至在控制竞争机制（如认知信念和支持特异性标准）时也成立。然而，大多数已确定的研究缺乏所需的方法严谨性（例如，在治疗阶段的多个评估点），以得出关于元认知作为变化的因果机制的确切结论。基于已有的文献，我们认为元认知有望成为情绪障碍改变的一种跨诊断机制。为进一步明确元认知改变在精神病理改善和康复中的作用提供了必要的研究方向。

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引用次数: 0

To disclose or not to disclose: A systematic review of factors associated with disclosure and concealment of mental illnesses 袒露或不袒露：对袒露和隐瞒精神疾病相关因素的系统回顾

IF 12.2 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical Psychology Review

Pub Date : 2025-10-03 DOI: 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.

公开或隐瞒精神疾病的决定是一个复杂的困境，受到各种个人、社会和环境因素的影响。通过对截至2025年5月发表的42项定量研究的系统回顾，我们研究了个体如何管理精神疾病的披露和保密，以及它们与心理健康结果、感知相关变量和功能结果的关系。研究结果表明，保密与心理健康结果（包括抑郁、幸福感和生活质量）存在一致的负相关，而披露与结果的关联在不同的背景下有所不同。其次，自我感知相关的变量，特别是耻辱，发挥了核心作用——研究显示，披露与自我耻辱和公众耻辱之间存在不同的关联模式。第三，选择性披露是一种管理不同社会背景下披露过程的策略。在就业环境中，关于信息披露的结果出现了不同的结果，一些研究显示与工作匹配和持续时间有关，尽管这些结果因工作环境而异。确定了影响观察到的关联的几个因素，包括感知到的社会支持和背景因素。值得注意的是，披露和保密作为不同的过程而不是相反的过程运作，个人经常在不同的背景下同时管理这两个过程。这些发现强调了在考虑临床实践和组织干预中的个人和环境因素的情况下，需要采取细致入微的方法来支持披露决策。

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引用次数: 0

Substance use disorder and altered hemispheric asymmetries: A systematic review 物质使用障碍和半球不对称改变：系统综述

IF 12.2 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical Psychology Review

Pub Date : 2025-10-03 DOI: 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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引用次数: 0

The motivational anatomy of fear: A closer look at core threats 恐惧的动机剖析：对核心威胁的更近距离观察。

IF 12.2 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical Psychology Review

Pub Date : 2025-10-03 DOI: 10.1016/j.cpr.2025.102655

Elad Zlotnick, Jonathan D. Huppert

“Core threats” are the ultimate feared consequences motivating avoidance behaviors and underpinning surface-level fears. For example, the surface fear of contamination may stem from core threats such as death, suffering, or harming loved ones. Whereas traditional models of anxiety recognize the role of motivation, they have not emphasized how global motivations shape threat appraisal and avoidance. We distinguish core threats from core beliefs: while core beliefs describe how individuals view themselves, others, and the world (which typically influence the likelihood of core threats), core threats specify why outcomes matter emotionally—what makes them motivating (i.e., why are they individually costly). Core threats provide the motivational structure that organizes diverse fears across anxiety disorders and beyond. They help explain generalization, persistence, and relapse. Phenomenologically, core threats are highly individualized, reflecting personal values over diagnostic categories. Contemporary models of treatment of anxiety often emphasize metacognitive regulation processes while treating fear content as interchangeable or secondary. We propose a complementary perspective: motivationally guided appraisals determine what becomes threatening and why. We formalize this perspective in a computational framework that distinguishes motivational drivers of avoidance, including core threats, distress intolerance, and exaggerated duration. Just as categories are organized around central exemplars, fear structures are organized around motivationally central threats. Conditioning research mirrors this principle: fear generalizes more strongly from central exemplars and remains sensitive to the value of the underlying outcome. Targeting core threats—the motivational focus of fear—offers a pathway to engage broader fear networks, improve generalization, reduce relapse, and guide personalized interventions.

“核心威胁”是最终恐惧的结果，激发了逃避行为，并支撑了表面的恐惧。例如，表面上对污染的恐惧可能源于死亡、痛苦或伤害亲人等核心威胁。尽管传统的焦虑模型承认动机的作用，但它们并没有强调全局动机如何影响威胁评估和回避。我们将核心威胁与核心信念区分开来：核心信念描述了个人如何看待自己、他人和世界（这通常会影响核心威胁的可能性），而核心威胁则说明了为什么结果在情感上很重要——是什么让它们具有激励作用（即，为什么它们对个人来说代价高昂）。核心威胁提供了一种动机结构，将焦虑障碍和其他障碍之间的各种恐惧组织起来。它们有助于解释普遍化、持续性和复发。在现象学上，核心威胁是高度个性化的，反映了个人价值观而不是诊断类别。当代焦虑治疗模式往往强调元认知调节过程，而将恐惧内容视为可互换或次要的。我们提出了一个补充的观点：动机导向的评估决定了什么会成为威胁，以及为什么会成为威胁。我们在一个计算框架中将这一观点形式化，该框架区分了回避的动机驱动因素，包括核心威胁、痛苦不容忍和夸大的持续时间。正如类别是围绕中心范例组织的，恐惧结构是围绕动机中心威胁组织的。条件反射研究反映了这一原则：恐惧更强烈地从中心范例中概括出来，并对潜在结果的价值保持敏感。针对核心威胁——恐惧的动机焦点——提供了一条参与更广泛的恐惧网络、提高普遍性、减少复发和指导个性化干预的途径。

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引用次数: 0

Gamified interventions for schizophrenia rehabilitation: A systematic scoping review 精神分裂症康复的游戏化干预：一个系统的范围审查。

IF 12.2 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical Psychology Review

Pub Date : 2025-10-02 DOI: 10.1016/j.cpr.2025.102651

Hongyi Yang , Fangyuan Chang , Dian Zhu , Muroi Fumie , Zhao Liu , Weibo Zhang , Jun Cai

Schizophrenia affects 24 million people worldwide, yet standard rehabilitation remains resource-intensive and its effectiveness inconsistent. To clarify whether game-based approaches can close these gaps, we reviewed studies published between January 2014–June 2025 in PubMed, Web of Science, PsycINFO and the ACM Digital Library. Eighty-two studies comprising about 5800 unique participants met the predefined eligibility criteria and were qualitatively synthesized. Interventions fell into three partially overlapping groups: serious games (n = 38), gamified applications (n = 20), and commercial games (n = 29). Outcomes were clustered into six domains—cognitive function, social function, symptom management, motor function, lifestyle management, and self-efficacy—and benefits proved to be domain- and modality-specific. Virtual reality-based serious games yielded the largest gains in social cognition (Cohen's d = 0.26–1.66). Gamified applications produced moderate-to-large improvements in negative symptoms (d ≈ 0.75–0.90) and achieved the highest engagement indices. Commercial games delivered small-to-moderate enhancements in motor fitness and social functioning (d ≈ 0.22–0.80). Evidence quality remains limited, as only 45 controlled trials were randomized; 12 enrolled at least 100 participants; 10 tracked outcomes beyond three months; only one achieved a low risk-of-bias rating, more than 90 % originated in high-income countries, and fewer than one-third articulated a theoretical framework. The data generally support gamified interventions as promising adjunctive tools rather than standalone replacements for conventional care. Multi-site randomized trials with ≥12-month follow-ups and harmonized core outcome sets, mechanism-driven optimizations that isolate active game mechanics, and cost-effectiveness plus equity analyses are necessary.

全世界有2400万人患有精神分裂症，但标准康复仍然是资源密集型的，其效果也不一致。为了弄清基于游戏的方法是否能够缩小这些差距，我们回顾了2014年1月至2025年6月期间发表在PubMed、Web of Science、PsycINFO和ACM数字图书馆上的研究。包含约5800名独特参与者的82项研究符合预定义的资格标准，并进行了定性合成。干预分为三个部分重叠的组：严肃游戏（38个）、游戏化应用（20个）和商业游戏（29个）。结果被集中到六个领域——认知功能、社会功能、症状管理、运动功能、生活方式管理和自我效能——并且益处被证明是特定领域和模式的。基于虚拟现实的严肃游戏在社交认知方面的收益最大（Cohen’s d = 0.26-1.66）。游戏化应用对负面症状产生了中等到较大的改善（d≈0.75-0.90），并实现了最高的参与指数。商业游戏在运动健康和社交功能方面表现出小到中等程度的增强（d≈0.22-0.80）。证据质量仍然有限，因为只有45个对照试验是随机的；12个项目招募了至少100名参与者；10个追踪了超过三个月的结果；只有一项研究获得了低偏倚风险评级，90%以上来自高收入国家，不到三分之一的研究阐述了理论框架。数据普遍支持游戏化干预作为有希望的辅助工具，而不是传统护理的独立替代品。多地点随机试验，随访≥12个月，协调核心结果集，机制驱动优化，隔离主动游戏机制，成本效益和公平分析是必要的。

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引用次数: 0

The bidirectional association between peer relationships and internet addiction: A meta-analytic structural equation model based on longitudinal studies 同伴关系与网络成瘾的双向关系：基于纵向研究的元分析结构方程模型

IF 12.2 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical Psychology Review

Pub Date : 2025-10-02 DOI: 10.1016/j.cpr.2025.102650

Xianxin Meng , Lujia Xu , Shuling Gao , Elisa Delvecchio , Claudia Mazzeschi , Carlo Garofalo

Decades of research implicates peer relationships in internet addiction. Yet, inconsistent findings, underpowered studies, and the tendency for researchers to assume one direction of influence have clouded understanding of whether peer relationships is a vulnerability factor for internet addiction, a consequence of internet addiction, or both. Our primary aim was to address this by using meta-analytic structural equation modeling to test cross-lagged reciprocal relations between peer relationships and internet addiction. Our secondary aim was to examine possible moderators that might explain heterogeneity across studies by conducting a multivariate random-effects meta-analysis. A total of 37 articles were identified for inclusion, including 45,212 subjects. The results show that peer relationships significantly negatively predict internet addiction over time and vice versa. Moderating analyses showed that cultural background had moderating effects on the prediction of peer relationships on internet addiction. Time lag and cultural background had moderating effects on the prediction of internet addiction on peer relationships. The results reveal a complex bidirectional dynamic relationship between peer relationships and internet addiction, providing empirical basis and practical guidance for formulating targeted prevention and intervention strategies.

几十年的研究表明网络成瘾与同伴关系有关。然而，不一致的发现、缺乏说服力的研究，以及研究人员倾向于假设一个方向的影响，使人们无法理解同伴关系是网络成瘾的一个脆弱因素，还是网络成瘾的一个后果，或者两者兼而有之。我们的主要目的是通过使用元分析结构方程模型来测试同伴关系和网络成瘾之间的交叉滞后互惠关系来解决这个问题。我们的第二个目的是通过进行多变量随机效应荟萃分析来检查可能解释研究异质性的调节因子。共确定纳入37篇文章，包括45,212名受试者。结果表明，同伴关系对网络成瘾具有显著的负向预测作用，反之亦然。调节分析表明，文化背景对同伴关系对网络成瘾的预测有调节作用。时差和文化背景对网络成瘾对同伴关系的预测有调节作用。研究结果揭示了同伴关系与网络成瘾之间存在复杂的双向动态关系，为制定针对性的预防和干预策略提供了实证依据和实践指导。

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