Psychology and Psychotherapy-Theory Research and Practice最新文献

The Talking With Voices approach, influenced by the work of the survivor-led Hearing Voices Movement, is a non-pathologising way of relating to the experience of voice hearing which emphasises coping enhancement, formulation and direct dialogue as a way to promote control, cooperation and relationship-building while reducing distress. This article presents insights from specialised mental health practice regarding potential facilitators and obstacles to implementing this approach more widely within statutory settings. Consideration is given to transferable skills for practitioners, guiding principles and values, training requirements and the ongoing challenges of bridging the gap between research and practice in clinical services.

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.

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.

Objective: Adolescent depression is a significant public health concern, with emotional neglect and psychoticism identified as key risk factors. This study investigated their longitudinal effects on adolescent depression within a unified framework.

Method: A total of 1894 Italian adolescents (M = 15.46, SD = 1.10) participated in a three-wave longitudinal study, with assessments conducted at baseline (T1), six months (T2) and twelve months (T3). A cross-lagged panel design was applied to examine the bidirectional relationships and mediation effects among study variables over time.

Results: Emotional neglect was associated with higher levels of psychoticism and depression one year later. Psychoticism, in turn, predicted increases in depression one year later. Mediation analyses showed that emotional neglect indirectly contributed to later depression through its effects on psychoticism. Overall, these findings support cumulative developmental risk models, underscoring the psychological and clinical relevance of these pathways in adolescence.

Conclusions: These results suggested that adolescents experiencing emotional neglect are at heightened risk for depression, with psychoticism compounding this risk. Interventions focusing on emotional support and addressing psychotic tendencies may help mitigate depression and improve adolescent mental health outcomes.

Relational approaches to voice hearing (VH), which emphasize changing a person's attitude towards and relationship with their voices, challenge the medical view of VH as a psychotic symptom that can only be managed, typically through medication. In this paper, we review historical perspectives on VH, exploring factors that led VH to be classified as a core symptom of schizophrenia in the late 20th century. Around the same time, an alternative paradigm emerged through the Hearing Voices Movement, which argued that VH was a variation of normal human consciousness that should be accepted and explored without stigma. Dirk Corstens, a psychiatrist working within that perspective, joined forces with Andrew Moskowitz, a clinical psychologist with experience with dissociative disorders, to publish a paper entitled 'Auditory Hallucinations: Psychotic Symptom or Dissociative Experience'? In that seminal paper, Moskowitz and Corstens (2007) argued-after reviewing research on VH in the general population, similarities in VH between clinical and non-clinical populations, and the relationship between dissociation and voice hearing-that VH was better understood as essentially normal and dissociative in nature, rather than pathological and psychotic. They further argued that voice hearers would benefit from dialogical approaches seeking to understand the purpose of their voices and change the voice hearer's relationship to them. Since then, research and clinical trials have strongly supported all the tenets of the 2007 paper, to the point that relational or dialogical approaches to VH are now rapidly becoming an acceptable complement or even alternative to medical treatment for hearing voices.

Objectives: This study used a network approach to examine gender differences in adolescents regarding unresolved attachment styles, COVID-19 PTSD symptoms, comorbid psychiatric symptoms, and contamination fear. The rationale for the study stems from the suggestion that parents' relationships with adolescents (i.e., attachment) can influence how adolescents cope with distress during COVID-19. Since attachment is linked to gender differences, these differences should also be considered. Furthermore, while much has been documented on secure or insecure attachment, little is known about whether the impact of unresolved attachment can influence psychological distress in adolescents.

Methods: Adolescents (n = 1715; 803 females, 912 males) from five Hong Kong secondary schools completed measures assessing unresolved attachment, contamination-related fears, PTSD symptoms, and general psychological disorders.

Results: No significant gender differences were observed in network density or global strength. However, network structure analysis revealed weaker connections among males compared to females. For males, all unresolved attachment aspects were linked to COVID-19 PTSD and comorbid psychiatric symptoms, while for females, only perceived failed protection correlated with depression. Both genders showed associations between PTSD, comorbid symptoms, and contamination fear.

Conclusions: While trauma and psychological reactions were shared, gender differences emerged in how unresolved attachment influenced distress. Males exhibited broader attachment-related distress links, whereas females showed more specific associations. These findings enhance understanding of adolescent psychotherapy needs during crises.

Objective: This study aimed to evaluate the effectiveness of cognitive behavioural therapy (CBT), parent training programm (PTPs), and their combination as adjunctive interventions to medication in reducing core ADHD symptoms and functional difficulties in children aged 7-11 who had been receiving pharmacological treatment. The goal was to examine whether these psychosocial approaches could enhance treatment outcomes beyond medication alone.

Method: Forty-two mother-child dyads were randomly assigned to one of four groups: (1) medication (M) plus cognitive behavioural therapy (CBT), (2) M plus parent training programme (PTP), (3) M plus both CBT and PTP (combined), and (4) M only (control). Families completed the sociodemographic data form, the Turgay DSM-IV ADHD Assessment Scale, and the Strengths and Difficulties Questionnaire (SDQ) before and after the intervention period. Data were analysed using Kruskal-Wallis H, Mann-Whitney U, Bonferroni correction, Wilcoxon signed-rank, and Chi-square tests, with a significance level set at p < .05.

Results: Significant reductions in attention deficit, hyperactivity, and impulsivity were observed in the M + CBT, M + PTP, and combined groups, as measured by the Turgay DSM-IV ADHD Assessment Scale. According to the SDQ, all three groups also showed significant decreases in SDQ impact scores, suggesting improved functional outcomes. In contrast, the control group showed improvement only in attention deficit, despite a notable increase in SDQ impact scores, indicating worsened overall functioning.

Conclusion: Adjunctive CBT, parent training, and their combination were more effective than medication alone in reducing core ADHD symptoms and improving children's functioning. These findings support the integration of psychosocial interventions into routine ADHD treatment, especially in school and family settings where behavioural support is essential. However, the small sample size limits generalizability, and further research with larger samples, extended follow-up, and placebo-controlled designs is needed to confirm these results and guide evidence-based policy and practice.

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: 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.

Objectives: To evaluate cognitive analytic therapy-guided self-help (CAT-GSH) for depression in terms of outcomes and acceptability.

Design: A parallel mixed methods case series with session-by-session outcome measurement supplemented by patient and staff interviewing.

Methods: Four psychological well-being practitioners (PWPs) delivered CAT-GSH to N = 11 patients in an NHS talking therapies service, and these patients were followed up at 1 month. Acceptability of CAT-GSH was assessed via treatment refusal and dropout rates, sessional attendance and qualitative interviewing of PWPs and patients. Outcomes were assessed by comparing group means at screening, termination and follow-up on sessional measures, calculating the case-by-case recovery rate and benchmarking against relevant research.

Results: All 11 patients offered CAT-GSH accepted; one patient dropped out, all completers attended the full 6 sessions, and 7/10 were in reliable recovery at follow-up. Treatment gains were maintained over the follow-up period, and outcomes appeared equivalent when benchmarked against the evidence base. Patients found CAT-GSH to be a mostly acceptable intervention, and this was due to mood improvements, better recognition skills and implementation of 'exits'. CAT-GSH improved the diversity of the treatment offer for PWPs and provided professional development opportunities.

Conclusions: CAT-GSH holds promise as a low-intensity treatment for depression, but clearly more controlled research is needed.