Psychology and Psychotherapy-Theory Research and Practice最新文献

Introduction

Goal-oriented practices involve practitioners working collaboratively with clients to identify, develop and focus on objectives for the therapeutic work. It has been suggested that the key mechanism underpinning goal-oriented practices with young people is the development of epistemic trust via the foundation of open communication, along with shared decision-making: including young people in decisions about their care. However, goal-oriented work in practice is variable in scope and content, with no research consensus on what it entails, the mechanisms of change and reported outcomes.

Method

This research aims to map the extent, range and nature of the evidence-base for goal-oriented practices, including gaps, through a synthesis of the available empirical evidence from the past 20 years. A scoping review of 9783 studies published from 2003 onwards was conducted.

Results

In total, 116 studies were identified for inclusion in the review, focusing on goal-oriented practices specifically related to the mental health and wellbeing of children and young people aged 0–18 (including caregivers as relevant). Alongside presentation of the key elements of the included studies, three themes were developed relating to the features of mental health and wellbeing goal-oriented practice in the contexts of the studies: Conceptual and Empirical Constructs of Goal-Oriented Practices, Quality and Making ‘Good’ Goals, and The Socio-Cultural Contexts of Goal-Oriented Practice.

Conclusion

Several areas for future research are identified that will build on this evidence, and further understanding in this area. Work towards the development of best practice principles will move practice towards transparency in the understanding and delivery of goal-oriented practices.

Background

Parental depression has consistently been shown to impact child's emotion regulation (ER), with limited research on risk and protective factors, especially in preschoolers. Grounded in Morris and colleagues' model of emotion socialization, this study addresses this gap by examining the mediating and moderating roles of parental mentalizing (reflective functioning).

Aims

We aimed to explore whether pre-mentalizing modes mediate the link between parental depressive symptoms and the child's ER tendencies and whether parental interest and curiosity and parental certainty about mental states can buffer this link.

Materials & Methods

The study sample included 732 parents (91% females) of children aged 3–7 years. To assess parental mentalizing, the Parental Reflective Functioning Questionnaire was used. Child ER skills were assessed with the Emotion Regulation Checklist, and depression was assessed with the Patient Health Questionnaire.

Results

Findings demonstrated a negative link between parental depressive symptoms and children's ER skills, mediated by heightened parental pre-mentalizing modes. Contrary to expectations, parental interest and curiosity did not moderate this link, but parental certainty about mental states emerged as a protective factor, weakening the link between depressive symptoms and child ER skills.

Conclusion

The results contribute to the understanding of ER development, particularly in the context of parental depressive symptoms, emphasizing parental mentalizing as a pivotal factor within this intricate dynamic.

Objectives

A rising incidence of eating disorders in the young population and limited effectiveness of available treatment approaches underscore the need for innovative therapies. This study explores therapists' perspectives regarding a promising new manualized psychotherapeutic treatment (MANTRa) for adolescents and young adults with anorexia nervosa (AN).

Methods

Semi-structured qualitative interviews were conducted with 10 therapists (nine female) who provided 24–34 sessions of MANTRa per patient. Interview topics included positive and negative experiences with MANTRa in general, with the workbook and other components. Reflexive thematic analysis was used to interpret the data. Furthermore, written notes taken by the therapists after each sessions were analysed.

Results

The thematic analysis revealed five overarching themes: (1) Variety of therapeutic tools and content elements included in the workbook; (2) Getting the therapeutic process going; (3) Flexibility in use of the workbook; (4) Impact of the scientific and multidisciplinary framework on quality assurance; (5) Formal design of the workbook. Therapists' case formulation letters to the patients were regarded as powerful tools to strengthen therapeutic alliance and promote recovery. In-depth therapists' training, regular supervision and a multi-professional treatment setting were important factors to ensure high treatment quality.

Conclusions

The findings suggest how the MANTRa content (e.g. inclusion of additional therapeutic tools), the therapists' training and the format (e.g. provision of a digital version) can be improved to reach maximum impact. Therapists' formulation letters may be an effective therapeutic tool not only for AN but also across the spectrum of psychiatric disorders in adolescents and young adults.

Background

One in three people with psychosis experience visions. However, little is known about what people see, and current treatments have limited benefits.

Objectives

To improve the understanding and treatment of visions, this study explored the phenomenology of visions in people with psychosis.

Methods

Twelve people with psychosis participated in semi-structured interviews. Reflective thematic analysis was used.

Results

Three main themes were generated covering important aspects of phenomenology: ‘Content’, ‘Coherence’ and ‘Quality’. The first theme ‘Content: People see people’, demonstrated that the most distressing visions were of people. The second theme ‘Coherence: Visions of people who behave like people’, captured how visions were coherent with real human behaviour, often by being multimodal experiences that spoke to and touched the observer. The third theme, ‘Quality: They look too real’ highlighted the compelling sense of authenticity of the visions, making them indistinguishable from reality.

Conclusion

Visions represent what we expect to see in everyday life: people, who act and look real. This powerful combination provides insight into the absorbing and all-encompassing nature of visions and their impact on participant's lives. The framework of ‘Content’, ‘Coherence’ and ‘Quality’ provides guidance to support clinicians and researchers to better explore the phenomenology of visions in psychosis.

Objectives

Sexual minority young adults report higher rates of anxiety and depression, and affective vulnerability factors (i.e. anxiety sensitivity, distress tolerance, emotion dysregulation) may help explain these mental health disparities.

Design

The current cross-sectional study examined differences between sexual minority and heterosexual college students (n = 465; M_age = 19.84, SD = 3.51; 76.3% female) in anxiety, depression and affective vulnerability and whether affective vulnerability served as an explanatory mechanism in these associations.

Methods

Participants completed self-report measures for course credit.

Results

Sexual minority young adults reported greater anxiety, depression, anxiety sensitivity, emotion regulation difficulties and lower distress tolerance. There were also significant indirect effects for all three affective vulnerability variables for anxiety symptoms and for emotion regulation difficulties for depression symptoms.

Conclusions

Affective vulnerability, particularly emotion regulation difficulties, appears to serve as a mechanism through which sexual minority status is associated with anxiety and depression. Improving emotion regulation skills may help to reduce mental health disparities in this population.

Objectives and Design

This qualitative study aimed to explore the treatment experiences of children and young people with Post-traumatic Stress Disorder (PTSD) symptoms, participating in a randomised controlled trial evaluating the effectiveness of Cognitive-Therapy for PTSD (CT-PTSD).

Methods

Thirteen participants aged between 12 and 18 years old, who had all experienced multiple trauma and had undertaken CT-PTSD, were interviewed.

Results

Using thematic analysis, three key themes were identified: ‘Desire for difference’, ‘Journey of becoming able to talk about trauma’ and ‘Positive changes and increased ability to cope’. Prior to the study, participants described experiencing difficult emotions and avoided talking about their traumatic experiences. Participants reported wanting to get the right help and valued the opportunity to help others. Talking about trauma during treatment was perceived as difficult and emotionally draining, however participants reported a sense of relief and that it became easier over time, helping them to make sense of their traumatic experiences. This was facilitated by the therapeutic relationship, their involvement in decision making and the use of written tasks. All participants reported positive changes, both in themselves and in their ability to talk to others about their traumatic experiences.

Conclusion

Engaging in CT-PTSD and talking about traumatic experiences can be empowering for young people and allows them the opportunity to process their trauma leading to increased ability to cope.

Objectives

Whilst cognitive analytic therapy (CAT) is increasingly used as an indirect intervention, there is little evidence of how the approach can be applied to reflective practice. This study sought to develop a process model of cognitive analytic reflective practice (CARP) groups.

Design

Constructivist grounded theory approach supplemented by quantitative measures of helpfulness and group cohesion.

Methods

Twenty-four participants, working within four staff teams in a secure children's home, attended four CARP groups over a 1-year period. Sessions were audio recorded, transcribed and checked for model fidelity and then analysed using grounded theory. Theoretical sampling was achieved via conducting focus groups with teams informed by the emergent categories, and using sessional measures of group cohesion and helpfulness to confirm theoretical saturation.

Results

The model constructed had three interrelated main categories: ‘facilitator processes: establishing a reflective space’, ‘group processes: widening awareness of the self, others, and system’ and ‘outcomes: changing relational dynamics and finding exits.’ The model was validated by evidence from the measures.

Conclusions

The model offers an empirical understanding of how CAT informs reflective practice through a better understanding of reciprocity in the dynamics of care systems.

Trauma and post-traumatic stress are involved in the aetiology and maintenance of voice-hearing. It has been proposed that trauma-focused therapy (TFT) might affect voice-hearing, but previous studies are limited and remain undecided.

Objectives

We aimed to investigate the effect of TFT on voice-hearing in people with PTSD and psychosis using experience sampling method (ESM). A secondary aim was to explore how changes in voice-hearing are related to changes in PTSD.

Design

This is an adjunct longitudinal ESM study of a sub-group of participants (N = 39) from a randomised controlled trial that compared TFT to a waiting-list control group.

Methods

Voice-hearing participants filled in 10 daily voice-hearing-related questionnaires for six consecutive days at baseline and post-treatment at pseudo-random times during the day. PTSD symptom severity was assessed at baseline and post-treatment. Multilevel linear regression was used to test the effect of TFT on voice-hearing and to analyse the relationship between changes in voice-hearing and changes in PTSD.

Results

The intention-to-treat analysis showed a significant interaction effect between time and treatment condition (p < .00001) with a small effect size (dppc2 = −0.27), indicating a larger decrease in voice-hearing in the TFT group than in the waiting-list control group. Also, a significant association was observed between changes in PTSD symptoms and changes in voice-hearing (p < .00001).

Conclusions

Our findings tentatively suggest that, even when voices are not targeted directly, TFT for PTSD can alleviate distressing voices.

Objectives

Disrupted emotion processes are commonly linked to the onset and maintenance of auditory verbal hallucinations. However, a comprehensive approach using an extended emotion model has not previously been applied to voice-hearers to distinguish impairments in emotion processes from non-clinical populations. The present study hypothesised voice-hearers, as compared to controls, would have (1) higher reactivity to negative emotions and lower reactivity to positive emotions, (2) more difficulties regulating negative and positive emotions, (3) more maladaptive strategy use, and (4) higher alexithymia.

Method

T-tests tested these hypotheses, comparing self-report measures of emotional reactivity, emotion regulation and alexithymia in voice-hearers (n = 50) to controls (n = 53).

Results

There were no group differences in emotional reactivity to positive or negative emotions. Compared to controls, voice-hearers showed difficulties in both positive and negative emotion regulation, were more likely to use expressive suppression, and were more likely to be alexithymic.

Conclusions

These findings may help researchers and clinicians identify difficulties in voice-hearers' emotion processing, providing better direction for case formulation and treatment.

Objectives

Lesbian and Gay people (LGP) experience higher rates of mental health difficulties, including self-harm, suicidal behaviours, as well as inequalities in health care, than their heterosexual peers. Dialectical Behaviour Therapy (DBT) is an evidence-based treatment for self-harm and suicidal behaviours, though there is little research on LGP's experiences of DBT. This research aims to explore LGP's experiences of completing a full DBT programme.

Design

A qualitative design with semi-structured individual interviews was utilised. The results were analysed using Interpretative Phenomenological Analysis.

Methods

Six lesbian and two gay adults, aged between 22 and 47 years, living in the United Kingdom took part. All participants had completed a full programme of DBT within the 2 years prior to the interview.

Results

Four superordinate themes emerged from the data: (1) The DBT journey; (2) Connections and Sense of Community during DBT; (3) Sexuality both visible and invisible in DBT and (4) A Gender, Sexuality and Relationship Diverse (GSRD) affirmative future for DBT.

Conclusions

Several clinical implications are suggested to improve DBT for LGP, for example to consider having other LGP within DBT groups, to create a more GSRD-affirming DBT (changes to the DBT manual, DBT therapists, DBT programme and physical DBT space), to adapt DBT techniques to manage sexuality-related difficulties and to adopt a GSRD-centric framework. Overall, DBT appears to be beneficial for LGP.