Psychology and Psychotherapy-Theory Research and Practice最新文献

Objectives: This qualitative study, which provides practical insights for the field, described the transition process of psychological service providers towards online care provision. We aimed to describe the process of professionals' adaptation to new methods of distant psychological care, including its main facilitating and complicating elements.

Methods: We used a qualitative approach, specifically evaluation design, employing reflexive thematic analyses conducted by the software ATLAS.ti. Semi-structured interviews were conducted with 51 professionals, and 14 focus groups with 44 experts. We worked with 95 experienced professionals specializing in clinical psychology, psychological counseling, and counseling those affected by domestic violence. All of them have had practical exposure to delivering care online.

Results: The results show that after first-hand involvement, most of the providers have moved from being cautious experimenters to being regular practitioners of online remote psychological care in cases where it is appropriate. Technical difficulties and negative stereotypes receded, with many respondents striving to provide online services for their clients' benefit. However, some negative aspects persist, including the lack of timely support from key institutions.

Conclusions: Logistical barriers stem from poor management and insufficient political, legislative and financial support. Ethical and legal challenges require serious attention from key system players. The question of embodiment, involving new therapeutic cues and compensating for absent ones, warrants thorough follow-up research. Bias and stereotype-related barriers, often shaped by providers' attitudes, can be addressed through targeted training and shared professional experiences.

Background: Exposure-based CBT is highly effective in treating patients with panic disorder and agoraphobia; however, access to such treatments is often limited. Smartphone-based self-management apps offer a promising low-threshold treatment alternative to face-to-face therapy. Although such health apps have shown to be effective in reducing anxiety symptoms, comparisons to active treatments are still scarce. Therefore, this study compared the effectiveness of a self-help app to an established face-to-face CBT intervention for panic and agoraphobia.

Method: The present study conducts a post hoc comparison of two independent RCTs examining participants with panic disorder and/or agoraphobia. Interventions in both studies were based on the same CBT manual. Study 1 (n = 138) included face-to-face CBT; Study 2 addressed the effects of a digital self-help intervention (n = 57). Main outcomes comprised symptoms of both panic disorder and agoraphobia, depressive symptoms and agoraphobic avoidance. Data were analysed using linear mixed models in intent-to-treat and completer data sets.

Results: Linear mixed models showed that face-to-face treatment was superior to app treatment in reducing panic and agoraphobic symptoms (R² = 0.32), depressive symptoms (R² = 0.24) and agoraphobic avoidance (R² = 0.12 and 0.15). Dropout rates did not differ significantly, and both interventions demonstrated high levels of adherence.

Discussion: Although a smartphone-based CBT intervention was effective in reducing symptoms of panic and agoraphobia, its efficacy was significantly below the effects of the same intervention delivered in face-to-face format. Thus, digital interventions might be most suitable within a stepped-care approach or to bridge waiting times for psychotherapy.

Objectives: In recent decades, research has increasingly highlighted the devastating effects of childhood trauma and relational processes that violate human development. However, the unique dynamics of such early-life deprivations in adults who practice meditation, a context where the complexity of such wounding (and healing) may become apparent, remains underexplored. The objectives of this study were to explore how individuals with a history of inconsistent evolved developmental niche (EDN) care experience their meditation journeys, and to understand the emotional and relational processes that emerge in this context.

Design: A qualitative design using interpretative phenomenological analysis (IPA) was adopted to capture participants' lived experiences.

Methods: Six adults with a history of inconsistent EDN care and at least 3 months of regular meditation practice participated in semi-structured interviews. Transcripts were analysed using IPA to identify key experiential themes.

Results: Three themes emerged from the data: (1) 'An inconsistent EDN in childhood left lasting emotional and relational wounds into adulthood', (2) 'Meditation eased inner turmoil but revealed different ways of dealing with emotions and the body', and (3) 'Meditation offered a space to explore relating to the self and others, areas complicated by their inconsistent EDN'. Findings illustrated the inheritance and development of immature defence mechanisms alongside emotional and relational challenges. Participants described feelings of increased calmness and closeness with others as benefits of meditation, though for some, pre-existing difficulties persisted or were amplified.

Conclusion: These results raise awareness of the long-term effects surrounding unresolved traumatic dynamics and the importance of delivering trauma-informed care. They also highlight the potential of meditation to uncover psychological dynamics and experiences rooted in early life which have the emotional potency to pose risks to individuals coming into contact with them.

Objectives: Despite studies showing that persons with hearing impairments (HI) or vision impairments (VI) have an increased risk of developing mental health disorders, mental health services frequently are not accessible and suited to the specific needs of both populations. However, there is limited research addressing how mental health services can be improved to meet these needs.

Design: This qualitative interview study explores barriers and strategies to improve accessibility in mental health services for persons with HI or VI in Germany, as viewed with a multi-perspective approach.

Methods: Using problem-centred interviews, which combine a flexible interview guide with a focus on specific issues, we applied a participatory research approach to gather insights from 58 participants, including mental health professionals specialised in treating persons with HI or VI and persons with HI or VI with lived experience as clients in mental health services.

Results: The qualitative content analysis yielded 44 inductive subcategories within a category system of seven deductive main categories. Key barriers included communication, limited visual accessibility and environmental challenges, while improvement strategies focused on tailored therapeutic adaptations as well as proactive and collaborative practices between therapists and clients.

Conclusions: Our findings highlight the need for structural changes and expanded mental health services that cater to the specific needs of persons with sensory impairments. These insights should contribute to improving mental health services, training programs for professionals and emphasise the importance of including persons with HI or VI, both professionals and clients, in the participatory development of accessible care.

Objectives: Accessing psychological therapy presents unique challenges for Muslims, who are underrepresented in primary care mental health services in the United Kingdom. This qualitative study sought the narratives of British Muslims to gain insight into the perceived barriers and facilitators to engagement with therapy.

Methods: Eighty participants responded to an online free-text survey question enquiring about their views on therapy with a non-Muslim therapist after completing a short experimental study. A structured tabular approach grounded in reflexive thematic analysis was used to analyse data.

Results: Three main themes were identified in our analysis: 'Fundamental differences', 'It's not worth the risk' and 'Overcoming barriers'. Within these themes we explore perceived interpersonal and systemic tensions, as well as facilitators to engagement with psychological therapy.

Conclusions: These findings are discussed in terms of implications for clinicians working with Muslim clients, with a focus on the importance of understanding and attending to faith and relational concerns.

Purpose: Body image is a transdiagnostic construct that seems poorly understood in psychosis. Poor body image is associated with paranoia, which makes it a theoretically meaningful treatment target in psychosis. We systematically reviewed associations between body image and psychosis symptoms in both the 'general' population and people living with psychotic disorders, synthesised known correlates of negative body image in people living with psychotic disorders and performed a meta-synthesis to understand the lived experience of body image in people with psychosis.

Methods: Ovid MEDLINE, OVID Embase, OVID APA PsycINFO, EBSCOhost Cinahl and the Cochrane Central Register of Controlled Trials were searched in January 2024. The methodological quality and risk of bias were assessed using the mixed-methods appraisal tool.

Results: 20,565 participants were included from 31 studies, of which 2127 (10.3%) were living with psychotic conditions, 18,294 from the general population, 129 people with other conditions being compared to psychosis (such as bipolar disorder) and 15 carers. There were 25 quantitative studies (24 cross-sectional, 1 prospective), 5 qualitative studies and 1 mixed-methods study. Cross-sectional evidence suggests associations between negative body image and psychotic symptoms, especially paranoia, as well as wider mental and physical health outcomes. Potential factors contributing to the persistence of poor body image include psychotic symptoms, worries about appearance-related judgements, negative self-concept, body ambivalence, appearance-related safety-seeking behaviours and traumatic memories.

Conclusions: Negative body image is relevant to the lives of people with psychosis spectrum conditions. Recommendations to guide and improve future research are reported.

Objective: The integration of religious beliefs is considered an essential component of evidence-based practice; however, clients from faith-based communities frequently report that their beliefs are overlooked in therapy. While existing research primarily centres on therapists' perspectives, there is limited understanding of how Muslim clients themselves make sense of therapy when their religious identity is not acknowledged, particularly within mental health systems often grounded in Western psychological models. This study, therefore, aimed to explore the mental healthcare experiences of Muslim therapy users in the UK who received therapy where their religion was perceived as minimised or excluded, despite its personal significance.

Design: A qualitative approach was adopted, underpinned by a critical realist epistemology. Semi-structured interviews were conducted with 25 Muslim participants, aged 18-56 years. These interviews were conducted remotely via Teams and subsequently transcribed for analysis. Data analysis was performed using reflexive thematic analysis.

Results: Three overarching themes were generated through the analysis: feeling powerless and unseen when attempting to bring Islam, shaking my foundation and feeling compelled to choose between my faith or therapy. Participants described a significant emotional impact when Islam was excluded or minimised.

Conclusion: These findings highlight the need for therapists to actively explore and integrate clients' religious worldviews, and for services to consider culturally responsive practices. The findings also suggest a need for enhanced cultural competence training and systemic changes to improve the therapeutic experience for Muslim clients. This study offers insight for developing more inclusive and effective mental health practices as well as implications for clinical practice.

Background: The current Mental Health Practitioner (MHP) workforce within NHS primary care is without a competency framework to guide job planning, interviews and service provision.

Aims: This paper aims to present an inclusive level-based framework for MHPs in primary care.

Materials and methods: The competency framework is based on previous frameworks and the results of service evaluation projects. Research into other existing competency frameworks allowed for the expansion of the identified competencies to ensure a thorough and complete framework was produced. The document was circulated to stakeholders and sense checked with colleagues working in primary care mental health service delivery.

Results: The framework provided has an explicit focus on seven key features: (1) knowledge for primary care-based MHPs, (2) core relational skills, (3) core clinical skills, (4) personal characteristics and values, (5) leadership and working with teams, (6) self-care and support and (7) competencies for primary care services supporting MHPs.

Discussion: Consideration of the competencies presented can help develop job descriptions, interview content and service provision requirements for MHPs across a variety of primary care settings.

Conclusion: Following this paper further evaluation as to acceptability and implementation of this framework within primary care settings may be a beneficial undertaking.

Objectives: To understand the impact of and subsequent reactions to exposure to extreme violence in young adults in South Africa exposed during school years. In particular, to get an in-depth understanding of its immediate consequences and factors that ameliorate or exacerbate it.

Design: An exploratory qualitative research design was used, using purposive sampling.

Methods: Semi-structured interviews with 21 young South African adults aged 19-31 were conducted online. Transcripts were analysed using thematic analysis.

Results: Violence exposure was found to result in trauma reactions with themes of a continued sense of being unsafe, feeling damaged and defective because of having these reactions, and mistrust towards others. In terms of coping reactions, a theme of avoidance and/or reacting with aggressive behaviour was identified, which likely exacerbated the challenges they experienced. By contrast, a more positive theme was identified in some, focused on having a sense of community and connectedness, which was experienced as ameliorating these challenges.

Conclusions: Exposure to community and school violence in childhood has a lasting impact on mental health and adjustment in later life. The impact is likely worsened by mistrust of others, a continued sense of feeling unsafe and counterproductive coping mechanisms, while connectedness and community seem to lessen the impact. Further research can refine these findings to build an understanding of these mechanisms to inform secondary prevention and treatment interventions in low- and middle-income countries.

Objectives: Early emerging emotional and behavioural problems can have a significant adverse impact on children's wellbeing, mental health and educational outcomes that can persist through adolescence and adulthood. A growing body of research highlights children's ability to recognise and understand emotions as a transdiagnostic intervention target. Interventions aimed at helping parents support this ability in their child could lead to benefits. Therefore, the current study aimed to systematically develop a brief parenting intervention to support children's emotional understanding.

Design: We followed Medical Research Council (MRC) guidance for developing complex interventions and used the Delphi method to gather consensus on the content and delivery of the intervention.

Methods: In Round 1, interviews were conducted with academics, clinicians, parents and child and family practitioners with relevant experience. Thematic analysis of interviews generated themes and subthemes which were used to create a survey. In Round 2, this survey was shared with participants and they rated how important different potential elements of the intervention were to include in the manual.

Results: Round 1 interviews generated themes including practicalities, creating a safe group space and intervention content. In Round 2, all participants (response rate: 86.4%) were asked to complete the survey and results indicated all items achieved at least moderate consensus for inclusion.

Conclusions: How results were used to inform the intervention is discussed and implications for clinical practice addressed. This research has informed the development of a new parenting intervention which will be further researched in a feasibility trial.