Bulletin of the Menninger Clinic最新文献

Multiple studies have demonstrated a relationship between risk factors for sexually transmitted infections (STIs) and mental health needs. This "syndemic" phenomenon suggests that while many patients with mental health conditions are at higher risk for STI acquisition, the relationship also works in the opposite direction: Patients diagnosed with STIs are more likely to have mental health issues. The purposes of this review article are to examine the overlap between mental health and STIs, to provide mental health providers the tools to identify individuals with behavioral health concerns who may be at increased risk for STI acquisition, to discuss how STI diagnosis can affect mental health, and to review interventions to mitigate these risks, such as cognitive-behavioral therapy and motivational interviewing-based behavioral interventions. Integrating primary health care and mental health care for sexual health needs may also help improve delivery of both of these services.

We present a model of disgust-induced avoidant processing of autobiographical memories contributing to the persistence of psychopathology. Following the model, autobiographical memory retrieval is biased toward disgust-related experiences. Critically, disgust promotes the avoidance of specific autobiographical memories by reactively aborting the processing of those memories or by strategically preventing access to them, making disgust appraisals immune to corrective information. In the context of eating disorders/body image, studies provided consistent evidence for a bias toward disgust-related memories of their own body in women with a more negative body image. Although the current research casts doubt on disgust-induced strategic avoidant retrieval of body-related memories, it provided initial evidence for reactive avoidance of such memories. Insight into the role of disgust-induced avoidant memory processing as a transdiagnostic mechanism may help in understanding the refractoriness of disgust-relevant psychopathologies (including depressive and trauma-related disorders) and point to the necessity of therapeutic strategies to address disgust-induced avoidance.

While clinical research on disgust relies on nonclinical research, the framework of disgust as an immune mechanism is not as central in clinical research. The immune framework for disgust may be integrated into clinical research by acknowledging the role of the self as the critical element protected by the immune system. In this review, we offer the premise that at the center of all disgust-related behaviors, thoughts, and cognitions is an attempt to protect the self (i.e., "disgust is self-centered" or DISC). We offer evidence in support of DISC and explore the relevance of DISC to clinical research for several disgust-related psychopathologies (obsessive-compulsive disorder, posttraumatic stress disorder, anorexia nervosa, and self-disgust). We then offer future directions for DISC research into disgust-related psychopathologies.

Disgust is a universal emotion that significantly impacts human behavior and psychological well-being. While clinical psychology researchers made great strides in understanding disgust in the context of psychopathology, nonclinical researchers have contributed valuable insights that can inform clinical perspectives on disgust. This special issue aims to bring together the latest nonclinical research that can shed light on the nature, causes, and consequences of disgust-related psychopathology. The five articles in this issue cover various nonclinical topics, including inhibitory learning, autobiographical memories, food preferences, and the perception of self and others. This issue also covers the role of disgust in specific clinical disorders, including anxiety disorders, obsessive-compulsive disorder, posttraumatic stress disorder, eating disorders, neurodegenerative disorders, and more. By showcasing novel approaches to researching clinical aspects of disgust, this special issue provides a comprehensive and up-to-date understanding of the complex phenomenon of disgust and future directions in research.

Although conditioning approaches have highlighted potential characteristics of disgust in anxiety disorders, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD), these findings have yet to be translated into evidence-based treatments. Examination of the literature suggests various indicators of disgust that predict treatment outcome in these disorders. However, mechanisms remain unclear because studies examining disgust during the course of treatment are limited. Increasingly, the field has moved toward experimental investigation of strategies that reduce disgust. While cognitive reappraisal and imagery techniques appear promising, such techniques have yet to be examined as anxiety disorder treatments in large-scale randomized clinical trials. The literature also points to novel approaches to treating disgust, ranging from an inhibitory-informed approach to exposure therapy to transcranial direct current stimulation. However, the development of novel treatment approaches will require more rigorous experimental psychopathology approaches that can further elucidate processes that contribute to the etiology and/or maintenance of disorders of disgust.

Disliked foods may have important value in the study of the development of disgust. The current review draws from literature across disciplines, including theories of disgust and studies of the development of eating behavior and food preferences, to highlight food as an important category of disgust responses across a wide age range, including children as young as 3 years old and adults. Children's disgust responses to certain types of food are considered to be both innate and culturally constrained behaviors, and their perceptions of other people's food choices indicate potential links between foods and cultural groups. We end by discussing several ongoing and future research areas, including connections between disgust responses and food rejection in infancy and children's food rejection behaviors across cultures.

An estimated 1.8% of U.S. adolescents identify as transgender, and when using expansive language to include diverse identities along the gender continuum (e.g., nonbinary, gender fluid), rates may be notably higher. Gender-diverse youth (GDY) experience significantly elevated rates of depression, anxiety, suicidality, and eating disorders relative to the general population. Youth with autism spectrum disorders also appear to report diverse gender identities at higher rates than neurotypical youth. Gender-minoritized stress, including distal (e.g., transgender related stigma and discrimination) and proximal (e.g., social or familial rejection due to gender-diverse identity) stressors, increase risk for mental health disorders among GDY, and gender affirmation mitigates risk. Gender-affirming medical and behavioral health care is associated with enhanced resilience and positive mental health outcomes for GDY.

This study was developed to examine sexual risk behavior among patients seeking community-based mental health services, including associations with psychological distress, identity dysfunction, and childhood emotional neglect. A mediation model was examined regarding identity dysfunction mediating the link between emotional neglect and sexual risk behavior. A total of 245 outpatients completed questionnaires regarding perceived risky sexual behavior, psychological distress, identity dysfunction, and emotional neglect. Sexual risk behavior was found to be a prevalent issue among individuals seeking outpatient mental health services, with 13% reporting engagement in unsafe sexual practices at least some of the time. Mediation analysis revealed that childhood emotional neglect was indirectly linked with sexual risk behavior through the mediating effect of identity dysfunction. Thus, findings suggest a pathway to sexual risk behaviors through perceived childhood emotional neglect and identity dysfunction. Clinical attention to identity-related vulnerability among this population may be warranted in aiming to mitigate risk-taking associated with sexual practices.

Evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) are efficacious; however, treatment dropout remains high. The delivery of intensive EBPs for PTSD (i.e., sessions three times per week or more) and telemental health may address barriers impacting dropout. Current evidence for intensive EBPs comes primarily from programs specifically designed for this level of care. Therefore, the feasibility of delivering intensive EBPs for PTSD in traditional outpatient clinics remains unclear. The aim of this pilot study was to identify veteran level of interest in intensive treatment and explore the feasibility of delivering intensive treatment via telemental health in an outpatient PTSD clinic at a Veterans Affairs (VA) hospital. One provider offered intensive treatment to 14 veterans. Three of the veterans initiated intensive treatment and completed with benefit. Veteranand system-level barriers, as well as veteran preferences for initiating intensive therapy and suggestions for implementing intensive EBPs in a routine outpatient clinic, are discussed.