Pub Date : 2025-12-01Epub Date: 2025-10-02DOI: 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。
{"title":"Gamified interventions for schizophrenia rehabilitation: A systematic scoping review","authors":"Hongyi Yang , Fangyuan Chang , Dian Zhu , Muroi Fumie , Zhao Liu , Weibo Zhang , Jun Cai","doi":"10.1016/j.cpr.2025.102651","DOIUrl":"10.1016/j.cpr.2025.102651","url":null,"abstract":"<div><div>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 (<em>n</em> = 38), gamified applications (<em>n</em> = 20), and commercial games (<em>n</em> = 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.</div></div>","PeriodicalId":48458,"journal":{"name":"Clinical Psychology Review","volume":"122 ","pages":"Article 102651"},"PeriodicalIF":12.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304032","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 : 2025-12-01Epub 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":"2025-12-01","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 : 2025-12-01Epub 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":"2025-12-01","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 : 2025-12-01Epub 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":"2025-12-01","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}
Pub Date : 2025-12-01Epub 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":"2025-12-01","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":"2025-12-01","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 : 2025-12-01Epub 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":"2025-12-01","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 : 2025-12-01Epub 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。
{"title":"Substance use disorder and altered hemispheric asymmetries: A systematic review","authors":"Annakarina Mundorf , Hicret Atilgan , Lisa Deneke , Sebastian Ocklenburg","doi":"10.1016/j.cpr.2025.102658","DOIUrl":"10.1016/j.cpr.2025.102658","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":48458,"journal":{"name":"Clinical Psychology Review","volume":"122 ","pages":"Article 102658"},"PeriodicalIF":12.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261567","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 : 2025-12-01Epub Date: 2025-11-04DOI: 10.1016/j.cpr.2025.102669
Dorota Ali , Mackenzie Bougoure , Brodie Cooper , Alice M.G. Quinton , Diana Tan , Jack Brett , William Mandy , Murray Maybery , Iliana Magiati , Francesca Happé
‘Autistic burnout’ is described as a debilitating state of exhaustion experienced by autistic people due to living in a world that often lacks accommodations and understanding of their needs. This systematic review thematically synthesised research on how autistic people understand and experience burnout. We reviewed 48 studies (30 qualitative, seven quantitative, and 11 mixed methods), which included approximately 4000 autistic people, predominantly featuring White, female, late-diagnosed autistic adults with at least average intellectual and/or verbal abilities. Our findings suggest that burnout, as experienced by these autistic people, consisted of debilitating exhaustion and increased disability, which could be chronic with intermittent crises. Sensory and social overwhelm, camouflaging, ignorance and stigma, everyday life challenges, and alexithymia contributed to burnout. Burnout held negative consequences for health and well-being, community involvement, and maintaining hope for the future. Having a more accurate framework for self-understanding, meeting the needs for rest, solitude, and sensory relief, and having individual and community support helped with recovery. Addressing burnout effectively will require individual coping strategies, clinical recognition, and broader societal awareness and acceptance of supporting diverse needs and ways of being. Future research should investigate burnout and its associated factors in more representative autistic samples.
{"title":"Burnout as experienced by autistic people: A systematic review","authors":"Dorota Ali , Mackenzie Bougoure , Brodie Cooper , Alice M.G. Quinton , Diana Tan , Jack Brett , William Mandy , Murray Maybery , Iliana Magiati , Francesca Happé","doi":"10.1016/j.cpr.2025.102669","DOIUrl":"10.1016/j.cpr.2025.102669","url":null,"abstract":"<div><div>‘Autistic burnout’ is described as a debilitating state of exhaustion experienced by autistic people due to living in a world that often lacks accommodations and understanding of their needs. This systematic review thematically synthesised research on how autistic people understand and experience burnout. We reviewed 48 studies (30 qualitative, seven quantitative, and 11 mixed methods), which included approximately 4000 autistic people, predominantly featuring White, female, late-diagnosed autistic adults with at least average intellectual and/or verbal abilities. Our findings suggest that burnout, as experienced by these autistic people, consisted of debilitating exhaustion and increased disability, which could be chronic with intermittent crises. Sensory and social overwhelm, camouflaging, ignorance and stigma, everyday life challenges, and alexithymia contributed to burnout. Burnout held negative consequences for health and well-being, community involvement, and maintaining hope for the future. Having a more accurate framework for self-understanding, meeting the needs for rest, solitude, and sensory relief, and having individual and community support helped with recovery. Addressing burnout effectively will require individual coping strategies, clinical recognition, and broader societal awareness and acceptance of supporting diverse needs and ways of being. Future research should investigate burnout and its associated factors in more representative autistic samples.</div></div>","PeriodicalId":48458,"journal":{"name":"Clinical Psychology Review","volume":"122 ","pages":"Article 102669"},"PeriodicalIF":12.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145434588","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}
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.
{"title":"The bidirectional association between peer relationships and internet addiction: A meta-analytic structural equation model based on longitudinal studies","authors":"Xianxin Meng , Lujia Xu , Shuling Gao , Elisa Delvecchio , Claudia Mazzeschi , Carlo Garofalo","doi":"10.1016/j.cpr.2025.102650","DOIUrl":"10.1016/j.cpr.2025.102650","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":48458,"journal":{"name":"Clinical Psychology Review","volume":"122 ","pages":"Article 102650"},"PeriodicalIF":12.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145216183","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}
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