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Metacognitive and Related Approaches in the Treatment of Schizophrenia-Spectrum Disorders 精神分裂症谱系障碍治疗中的元认知及相关方法
IF 18.4 1区 心理学 Q1 PSYCHOLOGY Pub Date : 2025-11-15 DOI: 10.1146/annurev-clinpsy-061724-085601
Joanna M. Fiszdon, Ashley M. Schnakenberg Martin, Matthew M. Kurtz
Schizophrenia-spectrum disorders (SSD) are characterized by interruptions in one's sense of self, cognitive dysfunction, disorganized thinking, belief inflexibility, and unusual experiences such as hallucinations and delusions. Disruptions in metacognition—skill in reflecting upon one's own and other's thought processes—have increasingly been viewed as a core foundation of these features of SSD. We focus this review on Metacognitive Reflection and Insight Therapy (MERIT) and Metacognitive Training (MCT), two metacognitive therapies for SSD designed to improve integration in perceptions of self and others, and to gain greater awareness of biases and the fallibility of cognitions, respectively. We explicate their theoretical underpinnings, treatment targets, and commonly used techniques and summarize their evidence base. We also provide a brief overview of two related therapies, cognitive remediation and cognitive behavioral therapy, with a focus on identifying their metacognitive components, and we compare mechanisms of action, efficacy, and evidence base across these different approaches.
精神分裂症谱系障碍(SSD)的特征是自我意识中断、认知功能障碍、思维混乱、信仰僵化以及幻觉和妄想等不寻常的经历。元认知的中断——反思自己和他人思维过程的技能——越来越被视为SSD这些特征的核心基础。我们将重点回顾元认知反思和洞察力疗法(MERIT)和元认知训练(MCT),这两种用于SSD的元认知疗法,旨在改善自我和他人感知的整合,并提高对偏见和认知错误的认识。我们阐述了它们的理论基础、治疗目标和常用技术,总结了它们的证据基础。我们还简要概述了两种相关疗法,认知补救和认知行为疗法,重点介绍了它们的元认知成分,并比较了这些不同方法的作用机制、疗效和证据基础。
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引用次数: 0
Economic Inequality and Mental Health: Causality, Mechanisms, and Interventions 经济不平等与心理健康:因果关系、机制和干预
IF 18.4 1区 心理学 Q1 PSYCHOLOGY Pub Date : 2025-05-07 DOI: 10.1146/annurev-clinpsy-081423-025710
Divyangana Rakesh, Koichiro Shiba, Michèle Lamont, Crick Lund, Kate E. Pickett, Tyler J. VanderWeele, Vikram Patel
Almost all countries in the world have witnessed a rapid increase in levels of economic inequality, a measure of the distribution of income and wealth across the population, since the advent of neoliberal economic policies in the 1970s. In this review, we conceptualize inequality as an ecological construct and discuss why it matters for the mental health of populations and for individual clinical outcomes. We then discuss some of the key mechanisms through which economic inequality influences mental health beyond poverty itself: social comparison and social capital. We also consider how the effect might vary across specific vulnerable groups in the population, such as young people and minoritized communities. Finally, we discuss methodological challenges in studying the relationship between inequality and mental health and conclude by outlining future research directions and possible interventions at the governmental, community, and individual levels to mitigate the negative mental health consequences of economic inequality.
自20世纪70年代新自由主义经济政策出现以来,世界上几乎所有国家都见证了经济不平等水平的迅速上升。经济不平等是衡量收入和财富在人口中分配的一种指标。在这篇综述中,我们将不平等概念化为一种生态结构,并讨论了为什么它对人群的心理健康和个人临床结果很重要。然后,我们讨论了经济不平等在贫困本身之外影响心理健康的一些关键机制:社会比较和社会资本。我们还考虑了人口中特定弱势群体(如年轻人和少数族裔社区)的影响如何变化。最后,我们讨论了研究不平等与心理健康之间关系的方法挑战,并概述了未来的研究方向和政府、社区和个人层面可能的干预措施,以减轻经济不平等对心理健康的负面影响。
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引用次数: 0
Clinical Staging for Psychiatry and Psychology. 精神病学和心理学的临床分期。
IF 16.5 1区 心理学 Q1 PSYCHOLOGY Pub Date : 2025-05-01 Epub Date: 2025-03-19 DOI: 10.1146/annurev-clinpsy-081423-025310
Dominic Dwyer, Rochelle Ruby Ye, Barnaby Nelson, Patrick McGorry

A global mental health crisis is threatening a generation of young people with a lifetime of symptoms that do not fit neatly into diagnostic systems. Optimal decisions regarding treatments, services, research, and policies are critically needed, yet such decisions are based on idiosyncratic categorization of clinical courses. This review suggests clinical staging approaches may unite mental health stakeholders around shared targets to reduce mental illness. It first presents key approaches to clinical staging and then outlines how clinical knowledge has been translated into a unified transdiagnostic staging heuristic and clinical service structure over the past 30 years. Directions for short-, medium-, and long-term action are recommended with global community engagement. With investment from the mental health community, staging could reduce suffering through the use of an ethical, organized, and targeted system of communication.

一场全球性的心理健康危机正威胁着一代年轻人,他们一生的症状都无法完全纳入诊断体系。关于治疗、服务、研究和政策的最佳决策是迫切需要的,然而这些决策是基于临床病程的特殊分类。这篇综述表明,临床分期方法可以团结精神卫生利益相关者围绕共同的目标,以减少精神疾病。它首先介绍了临床分期的关键方法,然后概述了过去30年来临床知识如何转化为统一的跨诊断分期启发式和临床服务结构。在全球社区参与的情况下,建议了短期、中期和长期行动的方向。有了精神卫生界的投资,分期治疗可以通过使用合乎道德的、有组织的和有针对性的交流系统来减少痛苦。
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引用次数: 0
Reward Processing in Mood Disorders and Schizophrenia: A Neurodevelopmental Framework 情绪障碍和精神分裂症的奖赏加工:一个神经发育框架
IF 18.4 1区 心理学 Q1 PSYCHOLOGY Pub Date : 2025-03-11 DOI: 10.1146/annurev-clinpsy-080822-041621
Robin Nusslock, Vijay A. Mittal, Lauren B. Alloy
Major depressive disorder (MDD), bipolar disorder, and schizophrenia involve disruptions in processing rewarding stimuli. In this review, we propose that distinct mechanistic pathways underlie these disruptions in mood disorders versus schizophrenia, and we highlight the importance of understanding these differences for developing personalized treatments. We summarize evidence suggesting that reward processing abnormalities in mood disorders are driven by dysregulated motivational systems; MDD is characterized by blunted responses to reward cues, and bipolar disorder is characterized by heightened responses. In contrast, we argue that reward processing disruptions in schizophrenia do not reflect abnormalities in motivation or hedonic experience; rather, they reflect impairments in the cognitive representation of past and future rewards as well as misdirected attention to irrelevant stimuli. To integrate these findings, we present a neurodevelopmental framework for the onset of mood and psychotic disorders and explore how disruptions in normative brain development contribute to their pathophysiology, timing, and onset. Additionally, we move beyond viewing these conditions as homogeneous disorders and discuss how reward processing profiles may align with specific symptom dimensions.
重度抑郁症(MDD)、双相情感障碍和精神分裂症都涉及对奖励刺激的处理中断。在这篇综述中,我们提出在情绪障碍与精神分裂症之间存在不同的机制途径,并强调了解这些差异对于开发个性化治疗的重要性。我们总结的证据表明,情绪障碍的奖励处理异常是由失调的动机系统驱动的;重度抑郁症的特点是对奖励线索的反应迟钝,而双相情感障碍的特点是反应增强。相反,我们认为精神分裂症的奖励处理中断并不反映动机或享乐体验的异常;相反,它们反映了对过去和未来奖励的认知表征的损伤,以及对无关刺激的错误注意力。为了整合这些发现,我们提出了情绪和精神障碍发病的神经发育框架,并探讨了正常大脑发育的中断如何影响其病理生理学、时间和发病。此外,我们超越了将这些条件视为同质障碍,并讨论了奖励处理概况如何与特定症状维度相一致。
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引用次数: 0
Harnessing Implementation Science in Clinical Psychology: Past, Present, and Future 在临床心理学中运用实施科学:过去、现在和未来
IF 18.4 1区 心理学 Q1 PSYCHOLOGY Pub Date : 2025-02-20 DOI: 10.1146/annurev-clinpsy-081423-021727
Rinad S. Beidas, Meredith Boyd, Elizabeth Casline, Kelli Scott, Zabin Patel-Syed, Chynna Mills, Brian Mustanski, Simone Schriger, Faith Summersett Williams, Claire Waller, Sarah A. Helseth, Sara J. Becker
Implementation science aspires to equitably accelerate the uptake of clinical research into practice to improve population health. The focus of implementation science includes individual behavior change mechanisms that are similar to those that drive the field of clinical psychology. For this reason, clinical psychologists are well-suited to take up implementation science methods in pursuit of improving the quality of behavioral health care. To do so, clinical psychologists must expand beyond individual behavior change to include a focus on organizations and systems. In this review, we reflect on ways that clinical psychologists can lead in the integration of implementation science principles and approaches into clinical psychology research and practice. We discuss the role clinical psychologists play in closing know–do gaps in behavioral health and describe how clinical psychologists can build implementation science competencies. We end with current controversies and opportunities for innovation to further improve the quality of behavioral health care.
实施科学渴望公平地加速临床研究进入实践,以改善人口健康。实施科学的重点包括个人行为改变机制,类似于那些推动临床心理学领域的机制。因此,临床心理学家非常适合采取实施科学的方法来追求提高行为保健的质量。要做到这一点,临床心理学家必须超越个人的行为改变,把重点放在组织和系统上。在这篇综述中,我们反思了临床心理学家如何将实施科学的原理和方法融入临床心理学的研究和实践。我们讨论了临床心理学家在缩小行为健康知识差距方面的作用,并描述了临床心理学家如何建立实施科学能力。我们以当前的争议和创新机会结束,以进一步提高行为卫生保健的质量。
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引用次数: 0
Anxiety and Related Disorders During the Perinatal Period 围产期焦虑及相关障碍
IF 18.4 1区 心理学 Q1 PSYCHOLOGY Pub Date : 2025-02-15 DOI: 10.1146/annurev-clinpsy-081423-020126
Nichole Fairbrother, Fiona L. Challacombe, Sheryl M. Green, Heather A. O'Mahen
Anxiety and anxiety-related disorders are, as a group, the most common mental health conditions and are more common among women compared with among men. It is now evident that these disorders affect one in five pregnant and postpartum people and are more common than depression. For some disorders (e.g., obsessive–compulsive disorder), there is also evidence of an elevated risk for their development and exacerbation during perinatal periods. In this article, we review the literature pertaining to anxiety and anxiety-related disorders during the perinatal period. We also provide information related to pregnancy-specific anxiety and fear of childbirth constructs that exist outside of diagnostic classification but are particularly important in the perinatal context. We review the scope, prevalence, and etiology of these disorders as well as comorbidity, screening, assessment, and treatment. We conclude with an overview of some of the key gaps in knowledge and recommendations for future research.
作为一个群体,焦虑和与焦虑相关的疾病是最常见的精神健康状况,在女性中比在男性中更常见。现在很明显,这些疾病影响了五分之一的孕妇和产后妇女,比抑郁症更常见。对于某些疾病(如强迫症),也有证据表明其在围产期发展和恶化的风险增加。在这篇文章中,我们回顾了有关焦虑和焦虑相关障碍在围产期的文献。我们还提供了与妊娠特异性焦虑和分娩恐惧相关的信息,这些信息存在于诊断分类之外,但在围产期环境中尤为重要。我们回顾了这些疾病的范围、患病率和病因,以及合并症、筛查、评估和治疗。最后,我们概述了一些关键的知识差距和对未来研究的建议。
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引用次数: 0
Movement Toward Dimensional Symptom Models of Comorbid Obsessive–Compulsive Disorder and Eating Disorders 向共病性强迫症和饮食失调的维度症状模型发展
IF 18.4 1区 心理学 Q1 PSYCHOLOGY Pub Date : 2025-02-11 DOI: 10.1146/annurev-clinpsy-081423-020831
Cheri A. Levinson, Avantika Kapadia, Luis E. Sandoval-Araujo, Irina A. Vanzhula, Karyne Machry
Obsessive–compulsive disorder (OCD) and eating disorders (EDs) are highly comorbid. Despite the high comorbidity, there is little understanding of why these disorders coexist and even less research on how to best treat this co-occurrence. In this article, we review the literature on comorbid OCD-ED and discuss potential underlying shared mechanisms, including anxiety/avoidance, perfectionism, intolerance of uncertainty, habit formation, disgust, shame and guilt, rumination, metacognitive beliefs, and shared biological characteristics. We then discuss prior models of OCD-ED comorbidity and shift the perspective from latent or categorical models to dimensional symptom models (e.g., network models). We describe how dimensional symptom models could advance the conceptualization, treatment, and prevention of comorbid OCD-ED. Next, we discuss how idiographic (one-person) symptom models could advance personalized treatment and provide a treatment example. Finally, we discuss future research needed to advance the field and improve treatment outcomes.
强迫症(OCD)和饮食失调(EDs)是高度共病的。尽管有很高的合并症,但人们对这些疾病共存的原因知之甚少,对如何最好地治疗这种合并症的研究就更少了。在本文中,我们回顾了有关共病强迫症的文献,并讨论了潜在的共同机制,包括焦虑/回避、完美主义、对不确定性的不容忍、习惯形成、厌恶、羞耻和内疚、反刍、元认知信念和共同的生物学特征。然后,我们讨论了强迫症-强迫症共病的先前模型,并将观点从潜在或分类模型转移到维度症状模型(例如,网络模型)。我们描述如何维度症状模型可以推进概念化,治疗和预防共病强迫症。接下来,我们将讨论具体(一人)症状模型如何推进个性化治疗,并提供一个治疗实例。最后,我们讨论了推进该领域和改善治疗结果所需的未来研究。
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引用次数: 0
Youth with Behavioral Health Symptoms in the Juvenile Legal System: From Assessment of Needs to Interventions to Scalability 少年法律制度中有行为健康症状的青少年:从需求评估到干预再到可扩展性
IF 18.4 1区 心理学 Q1 PSYCHOLOGY Pub Date : 2025-02-11 DOI: 10.1146/annurev-clinpsy-081423-021503
Kathleen Kemp, Kaitlin Sheerin, Casey Pederson, Miyah Grant, Crosby Modrowski, Anthony Spirito
This article provides an overview of the current state of assessment and clinical intervention approaches for youth with juvenile legal system (JLS) involvement. The review includes (a) a brief overview of characteristics of youth with JLS involvement; (b) current screening and assessment frameworks within the JLS that identify treatment needs; (c) an overview of effective clinical interventions for common behavioral health concerns among youth with JLS involvement, including information about tailoring interventions to address the multiple intersecting identities (e.g., race, ethnicity, gender identity, sexual orientation) of youth within the JLS; and (d) an overview of implementation models and scalability of interventions.
本文概述了青少年与少年法律系统(JLS)参与的评估和临床干预方法的现状。检讨的内容包括:(a)扼要概述青少年参与智障活动的特点;(b)联合诊疗系统内确定治疗需要的现行筛选和评估框架;(c)对参与联合服务青年常见行为健康问题的有效临床干预措施的概述,包括关于针对联合服务青年多重交叉身份(如种族、族裔、性别认同、性取向)量身定制干预措施的信息;(d)干预措施的实施模式和可扩展性概述。
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引用次数: 0
Pathways to Crime and Antisocial Behavior: A Critical Analysis of Psychological Research and a Call for Broader Ecological Perspectives 犯罪和反社会行为的途径:心理学研究的批判性分析和对更广泛的生态学观点的呼吁
IF 18.4 1区 心理学 Q1 PSYCHOLOGY Pub Date : 2025-02-11 DOI: 10.1146/annurev-clinpsy-081423-024754
Edelyn Verona, Bryanna Fox
The United States has one of the highest rates of correctional supervision among all nations in the world, reflecting the disproportionate incarceration of racial minorities and economically disadvantaged groups. Scholars have emphasized the role of structural factors and governmental policies in long-term shifts in crime and incarceration. However, much of the psychological research on crime and antisocial behaviors has not deeply considered this broader context, focusing mostly on individual and proximal environmental risk factors. This article presents a novel synthesis of large cross-disciplinary literatures that have not been previously integrated. After a brief summary of dominant themes in psychological research on the topic, we review the strong evidence, primarily from fields outside of psychology, for structural forces that explain pathways into criminal justice involvement, independent of individual-level explanations. A broader ecological framework is outlined to help unconfound individual and structural influences, with the hope of motivating policy change that is evidence-based and equitable.
美国是世界上惩教监督率最高的国家之一,这反映了少数民族和经济弱势群体被监禁的比例过高。学者们强调了结构性因素和政府政策在犯罪和监禁的长期变化中的作用。然而,许多关于犯罪和反社会行为的心理学研究并没有深入考虑这一更广泛的背景,主要集中在个人和近端环境风险因素上。这篇文章提出了一个新的综合大型跨学科的文献,以前没有整合。在简要总结了关于该主题的心理学研究的主要主题之后,我们回顾了主要来自心理学以外领域的有力证据,这些证据表明,结构力量可以解释刑事司法参与的途径,独立于个人层面的解释。本文概述了一个更广泛的生态框架,以帮助理清个人和结构的影响,希望推动循证和公平的政策变革。
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引用次数: 0
Analysis of Intensive Longitudinal Data: Putting Psychological Processes in Perspective 密集的纵向数据分析:透视心理过程
IF 18.4 1区 心理学 Q1 PSYCHOLOGY Pub Date : 2025-02-07 DOI: 10.1146/annurev-clinpsy-081423-022947
E.L. Hamaker
Research based on intensive longitudinal data (ILD)—consisting of many repeated measures from one or multiple individuals—is rapidly gaining popularity in psychological science. To appreciate the unique potential of ILD research for clinical psychology, this review begins by examining how our three traditional research approaches fall short when the goal is to investigate processes. It then explores how the analysis of ILD can be used to study a process as it unfolds within a specific person over time but also to study average process features or individual differences therein. By emphasizing the alignment between research questions, data collection, and analytical strategies, the potential of ILD research is further highlighted. It is argued that for future progress it is essential to integrate machine learning and causal inference methods with statistical techniques for ILD and to become more explicit about timescales, time frames, and dynamics in psychological theories.
基于密集纵向数据(ILD)的研究-由一个或多个个体的许多重复测量组成-在心理科学中迅速流行起来。为了了解ILD研究在临床心理学中的独特潜力,本综述首先检查了我们的三种传统研究方法在研究过程时是如何不足的。然后,它探讨了ILD的分析如何用于研究一个特定的人随着时间的推移而展开的过程,以及研究其中的平均过程特征或个体差异。通过强调研究问题、数据收集和分析策略之间的一致性,进一步突出了ILD研究的潜力。作者认为,为了未来的发展,必须将机器学习和因果推理方法与ILD的统计技术相结合,并在心理学理论中更加明确地了解时间尺度、时间框架和动态。
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引用次数: 0
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Annual Review of Clinical Psychology
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