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  Subjects -> PSYCHOLOGY (Total: 871 journals)
Showing 1 - 174 of 174 Journals sorted alphabetically
Acción Psicológica     Open Access   (Followers: 2)
Acta Colombiana de Psicología     Open Access   (Followers: 4)
Acta Comportamentalia     Open Access   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Psychologica     Hybrid Journal   (Followers: 21)
Activités     Open Access   (Followers: 1)
Actualidades en Psicologia     Open Access   (Followers: 1)
Ad verba Liberorum : Journal of Linguistics & Pedagogy & Psychology     Open Access   (Followers: 8)
Addictive Behaviors Reports     Open Access   (Followers: 5)
ADHD Attention Deficit and Hyperactivity Disorders     Hybrid Journal   (Followers: 20)
ADHD Report The     Full-text available via subscription   (Followers: 6)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 38)
Advances in Mental Health     Hybrid Journal   (Followers: 68)
Advances in Physiotherapy     Hybrid Journal   (Followers: 50)
Advances in Psychology     Full-text available via subscription   (Followers: 56)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 28)
African Journal of Cross-Cultural Psychology and Sport Facilitation     Full-text available via subscription   (Followers: 3)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 388)
Aggressive Behavior     Hybrid Journal   (Followers: 17)
Aging, Neuropsychology, and Cognition     Hybrid Journal   (Followers: 33)
Ágora - studies in psychoanalytic theory     Open Access   (Followers: 3)
Aletheia     Open Access   (Followers: 1)
American Behavioral Scientist     Hybrid Journal   (Followers: 15)
American Imago     Full-text available via subscription   (Followers: 3)
American Journal of Applied Psychology     Open Access   (Followers: 33)
American Journal of Community Psychology     Hybrid Journal   (Followers: 24)
American Journal of Health Behavior     Full-text available via subscription   (Followers: 23)
American Journal of Orthopsychiatry     Hybrid Journal   (Followers: 4)
American Journal of Psychoanalysis     Hybrid Journal   (Followers: 21)
American Journal of Psychotherapy     Full-text available via subscription   (Followers: 33)
American Psychologist     Full-text available via subscription   (Followers: 161)
Anales de Psicología     Open Access   (Followers: 2)
Análise Psicológica     Open Access   (Followers: 1)
Análisis y Modificación de Conducta     Open Access   (Followers: 2)
Analysis     Full-text available via subscription   (Followers: 4)
Annual Review of Clinical Psychology     Full-text available via subscription   (Followers: 66)
Annual Review of Organizational Psychology and Organizational Behavior     Full-text available via subscription   (Followers: 25)
Annual Review of Psychology     Full-text available via subscription   (Followers: 195)
Anuario de Psicología / The UB Journal of Psychology     Open Access   (Followers: 1)
Anuario de Psicología Jurídica     Open Access   (Followers: 1)
Anxiety, Stress & Coping: An International Journal     Hybrid Journal   (Followers: 22)
Applied and Preventive Psychology     Hybrid Journal   (Followers: 13)
Applied Cognitive Psychology     Hybrid Journal   (Followers: 65)
Applied Neuropsychology : Adult     Hybrid Journal   (Followers: 32)
Applied Neuropsychology : Child     Hybrid Journal   (Followers: 18)
Applied Psychological Measurement     Hybrid Journal   (Followers: 17)
Applied Psychology     Hybrid Journal   (Followers: 125)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 48)
Applied Psychophysiology and Biofeedback     Hybrid Journal   (Followers: 6)
Archive for the Psychology of Religion / Archiv für Religionspychologie     Hybrid Journal   (Followers: 16)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 26)
Archives of Scientific Psychology     Open Access   (Followers: 3)
Arquivos Brasileiros de Psicologia     Open Access   (Followers: 1)
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia-Pacific Psychiatry     Hybrid Journal   (Followers: 3)
Asian American Journal of Psychology     Full-text available via subscription   (Followers: 5)
Asian Journal of Business Ethics     Hybrid Journal   (Followers: 7)
Assessment     Hybrid Journal   (Followers: 9)
At-Tajdid : Jurnal Ilmu Tarbiyah     Open Access   (Followers: 2)
Attachment: New Directions in Psychotherapy and Relational Psychoanalysis     Full-text available via subscription   (Followers: 16)
Attention, Perception & Psychophysics     Full-text available via subscription   (Followers: 10)
Australian and Aotearoa New Zealand Psychodrama Association Journal     Full-text available via subscription  
Australian Educational and Developmental Psychologist, The     Full-text available via subscription   (Followers: 6)
Australian Journal of Psychology     Hybrid Journal   (Followers: 16)
Australian Psychologist     Hybrid Journal   (Followers: 11)
Autism Research     Hybrid Journal   (Followers: 31)
Autism Research and Treatment     Open Access   (Followers: 29)
Autism's Own     Open Access  
Autism-Open Access     Open Access   (Followers: 5)
Avaliação Psicológica     Open Access  
Avances en Psicologia Latinoamericana     Open Access   (Followers: 1)
Aviation Psychology and Applied Human Factors     Hybrid Journal   (Followers: 17)
Balint Journal     Hybrid Journal   (Followers: 3)
Barbaroi     Open Access  
Basic and Applied Social Psychology     Hybrid Journal   (Followers: 31)
Behavior Analysis in Practice     Full-text available via subscription   (Followers: 6)
Behavior Analysis: Research and Practice     Full-text available via subscription   (Followers: 2)
Behavior Analyst     Hybrid Journal   (Followers: 3)
Behavior Modification     Hybrid Journal   (Followers: 9)
Behavior Research Methods     Hybrid Journal   (Followers: 17)
Behavior Therapy     Hybrid Journal   (Followers: 45)
Behavioral Development Bulletin     Full-text available via subscription  
Behavioral Interventions     Hybrid Journal   (Followers: 7)
Behavioral Neuroscience     Full-text available via subscription   (Followers: 49)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 20)
Behavioral Sleep Medicine     Hybrid Journal   (Followers: 6)
Behaviour     Hybrid Journal   (Followers: 13)
Behaviour Research and Therapy     Hybrid Journal   (Followers: 17)
Behavioural and Cognitive Psychotherapy     Hybrid Journal   (Followers: 110)
Behavioural Processes     Hybrid Journal   (Followers: 6)
Biofeedback     Hybrid Journal   (Followers: 4)
BioPsychoSocial Medicine     Open Access   (Followers: 6)
BMC Psychology     Open Access   (Followers: 15)
Body, Movement and Dance in Psychotherapy: An International Journal for Theory, Research and Practice     Hybrid Journal   (Followers: 9)
Boletim Academia Paulista de Psicologia     Open Access  
Boletim de Psicologia     Open Access  
Brain Informatics     Open Access   (Followers: 1)
British Journal of Clinical Psychology     Full-text available via subscription   (Followers: 122)
British Journal of Developmental Psychology     Full-text available via subscription   (Followers: 35)
British Journal of Educational Psychology     Hybrid Journal   (Followers: 31)
British Journal of Health Psychology     Full-text available via subscription   (Followers: 42)
British Journal of Mathematical and Statistical Psychology     Full-text available via subscription   (Followers: 19)
British Journal of Psychology     Full-text available via subscription   (Followers: 56)
British Journal of Psychotherapy     Hybrid Journal   (Followers: 66)
British Journal of Social Psychology     Full-text available via subscription   (Followers: 31)
Burnout Research     Open Access   (Followers: 7)
Cadernos de psicanálise (Rio de Janeiro)     Open Access  
Cadernos de Psicologia Social do Trabalho     Open Access  
Canadian Art Therapy Association     Hybrid Journal  
Canadian Journal of Behavioural Science     Full-text available via subscription   (Followers: 6)
Canadian Journal of Experimental Psychology     Full-text available via subscription   (Followers: 11)
Canadian Psychology / Psychologie canadienne     Full-text available via subscription   (Followers: 10)
Cendekia : Jurnal Kependidikan dan Kemasyarakatan     Open Access  
Child Development Perspectives     Hybrid Journal   (Followers: 26)
Child Development Research     Open Access   (Followers: 13)
Ciencia Cognitiva     Open Access   (Followers: 2)
Ciencia e Interculturalidad     Open Access  
Ciências & Cognição     Open Access  
Ciencias Psicológicas     Open Access  
Clínica y Salud     Open Access  
Clinical Medicine Insights : Psychiatry     Open Access   (Followers: 9)
Clinical Practice in Pediatric Psychology     Full-text available via subscription   (Followers: 10)
Clinical Psychological Science     Hybrid Journal   (Followers: 11)
Clinical Psychologist     Hybrid Journal   (Followers: 15)
Clinical Psychology & Psychotherapy     Hybrid Journal   (Followers: 67)
Clinical Psychology and Special Education     Open Access   (Followers: 1)
Clinical Psychology Review     Hybrid Journal   (Followers: 33)
Clinical Psychology: Science and Practice     Hybrid Journal   (Followers: 20)
Clinical Schizophrenia & Related Psychoses     Full-text available via subscription   (Followers: 8)
Coaching Psykologi - The Danish Journal of Coaching Psychology     Open Access   (Followers: 1)
Cogent Psychology     Open Access  
Cógito     Open Access  
Cognition & Emotion     Hybrid Journal   (Followers: 36)
Cognitive Behaviour Therapy     Hybrid Journal   (Followers: 14)
Cognitive Neuropsychology     Hybrid Journal   (Followers: 26)
Cognitive Psychology     Hybrid Journal   (Followers: 58)
Consciousness and Cognition     Hybrid Journal   (Followers: 26)
Construção Psicopedagógica     Open Access  
Consulting Psychology Journal : Practice and Research     Full-text available via subscription   (Followers: 3)
Contagion : Journal of Violence, Mimesis, and Culture     Full-text available via subscription   (Followers: 8)
Contemporary Educational Psychology     Hybrid Journal   (Followers: 21)
Contemporary School Psychology     Hybrid Journal   (Followers: 4)
Contextos Clínicos     Open Access  
Counseling Outcome Research and Evaluation     Hybrid Journal   (Followers: 10)
Counseling Psychologist     Hybrid Journal   (Followers: 14)
Counseling Psychology and Psychotherapy     Open Access   (Followers: 7)
Counselling and Psychotherapy Research : Linking research with practice     Hybrid Journal   (Followers: 19)
Counselling and Values     Hybrid Journal   (Followers: 2)
Counselling Psychology Quarterly     Hybrid Journal   (Followers: 10)
Couple and Family Psychoanalysis     Full-text available via subscription   (Followers: 1)
Couple and Family Psychology : Research and Practice     Full-text available via subscription   (Followers: 4)
Creativity Research Journal     Hybrid Journal   (Followers: 20)
Creativity. Theories - Research - Applications     Open Access   (Followers: 1)
Criminal Justice Ethics     Hybrid Journal   (Followers: 6)
Cuadernos de Neuropsicología     Open Access   (Followers: 1)
Cuadernos de Psicologia del Deporte     Open Access  
Cuadernos de Psicopedagogía     Open Access  
Cultural Diversity and Ethnic Minority Psychology     Full-text available via subscription   (Followers: 12)
Cultural-Historical Psychology     Open Access  
Culturas Psi     Open Access  
Culture and Brain     Hybrid Journal   (Followers: 3)
Current Addiction Reports     Hybrid Journal   (Followers: 9)
Current Behavioral Neuroscience Reports     Hybrid Journal   (Followers: 2)
Current Directions In Psychological Science     Hybrid Journal   (Followers: 46)
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 1)
Current Opinion in Psychology     Hybrid Journal   (Followers: 3)
Current Psychological Research     Hybrid Journal   (Followers: 13)
Current Psychology     Hybrid Journal   (Followers: 14)
Current psychology letters     Open Access   (Followers: 2)
Current Research in Psychology     Open Access   (Followers: 20)
Cyberpsychology, Behavior, and Social Networking     Hybrid Journal   (Followers: 14)
Decision     Full-text available via subscription   (Followers: 2)
Depression and Anxiety     Hybrid Journal   (Followers: 14)
Depression Research and Treatment     Open Access   (Followers: 13)
Developmental Cognitive Neuroscience     Open Access   (Followers: 16)
Developmental Neuropsychology     Hybrid Journal   (Followers: 15)
Developmental Psychobiology     Hybrid Journal   (Followers: 9)
Developmental Psychology     Full-text available via subscription   (Followers: 44)
Diagnostica     Hybrid Journal   (Followers: 2)
Dialectica     Hybrid Journal   (Followers: 1)
Discourse     Full-text available via subscription   (Followers: 8)
Diversitas: Perspectivas en Psicologia     Open Access  
Drama Therapy Review     Hybrid Journal   (Followers: 1)
Dreaming     Full-text available via subscription   (Followers: 11)
Drogues, santé et société     Full-text available via subscription  
Dynamics of Asymmetric Conflict: Pathways toward terrorism and genocide     Hybrid Journal   (Followers: 12)
E-Journal of Applied Psychology     Open Access   (Followers: 7)
Ecopsychology     Hybrid Journal   (Followers: 6)
ECOS - Estudos Contemporâneos da Subjetividade     Open Access  
Educational Psychology Review     Hybrid Journal   (Followers: 25)
Educational Psychology: An International Journal of Experimental Educational Psychology     Hybrid Journal   (Followers: 46)
Educazione sentimentale     Full-text available via subscription  
Electronic Journal of Research in Educational Psychology     Open Access   (Followers: 6)
Elpis - Czasopismo Teologiczne Katedry Teologii Prawosławnej Uniwersytetu w Białymstoku     Open Access  
Emotion     Full-text available via subscription   (Followers: 33)
Emotion Review     Hybrid Journal   (Followers: 17)
En-Claves del pensamiento     Open Access   (Followers: 1)
Enseñanza e Investigacion en Psicologia     Open Access  
Epiphany     Open Access   (Followers: 3)
Escritos de Psicología : Psychological Writings     Open Access   (Followers: 2)

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Journal Cover Clinical Psychology & Psychotherapy
  [SJR: 1.171]   [H-I: 51]   [67 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1063-3995 - ISSN (Online) 1099-0879
   Published by John Wiley and Sons Homepage  [1589 journals]
  • How do we know what makes for “best practice” in clinical supervision
           for psychological therapists? A content analysis of supervisory models and
    • Authors: Gillian E. Hardy; Chloe Simpson-Southward, Glenn Waller
      Abstract: Clinical supervision for psychotherapies is widely used in clinical and research contexts. Supervision is often assumed to ensure therapy adherence and positive client outcomes, but there is little empirical research to support this contention. Regardless, there are numerous supervision models, but it is not known how consistent their recommendations are. This review aimed to identify which aspects of supervision are consistent across models, and which are not. A content analysis of 52 models revealed 71 supervisory elements. Models focus more on supervisee learning and/or development (88.46%), but less on emotional aspects of work (61.54%) or managerial or ethical responsibilities (57.69%). Most models focused on the supervisee (94.23%) and supervisor (80.77%), rather than the client (48.08%) or monitoring client outcomes (13.46%). Finally, none of the models were clearly or adequately empirically based. Although we might expect clinical supervision to contribute to positive client outcomes, the existing models have limited client focus and are inconsistent. Therefore, it is not currently recommended that one should assume that the use of such models will ensure consistent clinician practice or positive therapeutic outcomes.Key Practitioner MessagesThere is little evidence for the effectiveness of supervision.There is a lack of consistency in supervision models.Services need to assess whether supervision is effective for practitioners and patients.
      PubDate: 2017-04-19T01:37:25.674055-05:
      DOI: 10.1002/cpp.2084
  • The clinical application of suicide risk assessment: A theory-driven
    • Authors: Sean M. Mitchell; Sarah L. Brown, Jared F. Roush, Angelea D. Bolaños, Andrew K. Littlefield, Andrew J. Marshall, Danielle R. Jahn, Robert D. Morgan, Kelly C. Cukrowicz
      Abstract: The interpersonal theory of suicide posits that thwarted belongingness (TB) and perceived burdensomeness (PB) increase suicide ideation; however, studies have found mixed results regarding this hypothesis among psychiatric inpatients. This study aimed to (a) demonstrate how assessing TB and PB using the Interpersonal Needs Questionnaire (INQ) can provide clinically useful information and (b) investigate how statistical methodology may impact the clinical application of the INQ. Participants were 139 (Sample 1) and 104 (Sample 2) psychiatric inpatients. In both samples, ordinal logistic regression results indicated TB and PB, separately, were significant predictors of suicide ideation-related outcomes; however, when examined as simultaneous predictors, TB was no longer a significant predictor. The interaction between TB and PB was not significant for either sample. Despite this, TB and PB scores provided clinically relevant information about suicide ideation-related outcomes. For example, the highest scores on TB and PB indicated a 93% and 95% chance of having some level of distress due to suicide ideation (Sample 1), a 91% and 92% chance of having some level of desire for death, and a 79% and 84% chance of having some level of desire for suicide, respectively (Sample 2). This study also proposes clinical cutoff scores for the INQ (for TB and PB, respectively, cutoff scores were 22 and 17 for distress due to suicide ideation, 33 and 17 for desire for death, and 31 and 22 for desire for suicide). Although these results indicate that multicollinearity between TB and PB may create interpretational ambiguity for clinicians, TB and PB may each be useful separate predictors of suicide ideation-related outcomes in psychiatric inpatient settings and should be incorporated into suicide risk assessment.Key Practitioner MessageThe 15-item Interpersonal Needs Questionnaire (an assessment of thwarted belongingness and perceived burdensomeness) should be incorporated into suicide risk assessment.Among psychiatric inpatients, greater thwarted belongingness and perceived burdensomeness, as separate predictors, were associated with increased levels of distress due to suicide ideation, desire for death, and desire for suicide.The highest scores on thwarted belongingness and perceived burdensomeness indicated a 79% to 95% chance of experiencing an elevated level of distress due to suicide ideation, desire for death, or desire for suicide.Recommended clinical cutoff scores were provided. For example, thwarted belongingness cutoff score of 31 and perceived burdensomeness cutoff score of 22 maximized the sensitivity and specificity of the INQ to detect some level of desire for suicide.
      PubDate: 2017-04-18T21:25:29.393832-05:
      DOI: 10.1002/cpp.2086
  • Cover Image, Volume 24, Issue 2
    • Authors: Heather D. Hadjistavropoulos; Nicole E. Pugh, Hugo Hesser, Gerhard Andersson
      Abstract: The cover image, by Heather D. Hadjistavropoulos et al., is based on the Research Article Therapeutic Alliance in Internet-Delivered Cognitive Behaviour Therapy for Depression or Generalized Anxiety,
      DOI : 10.1002/cpp.2014. Photo Credit: University of Regina Photography Department.
      PubDate: 2017-04-12T02:12:31.244818-05:
  • Depression, anxiety, and compulsive sexual behaviour among men in
           residential treatment for substance use disorders: The role of
           experiential avoidance
    • Authors: Meagan J. Brem; Ryan C. Shorey, Scott Anderson, Gregory L. Stuart
      Abstract: Nearly one-third of individuals in treatment for substance use disorders endorse at-risk levels of compulsive sexual behaviours (CSBs). Untreated sexual compulsivity may facilitate relapse for treatment-seeking men. Previous research and theory suggest that CSBs are maintained by efforts to escape or alter negative affect (e.g., depression and anxiety). However, this hypothesis has not been examined within a sample of men in treatment for substance use disorders. In an effort to better understand CSBs within a population of men with substance use disorders, the present study is the first to examine experiential avoidance as one potential mechanism underlying the relation between men's symptoms of depression and anxiety and their use of CSBs. The present study reviewed medical records of 150 men in residential treatment for substance use disorders. Structural equation modelling was used to examine pathways from men's depression and anxiety symptoms to CSBs directly and indirectly through experiential avoidance while controlling for alcohol/drug problems and use. Results revealed significant indirect effects of both depression and anxiety symptoms on CSB through experiential avoidance. These results support and extend existing research on CSB in a treatment population. Findings suggest that intervention efforts for CSB may benefit by targeting men's avoidance of painful internal events.Key Practitioner MessageCompulsive sexual behaviour is related to symptoms of depression and anxiety amongst men in residential treatment for substance use disorders.Experiential avoidance is positively related to compulsive sexual behaviour amongst men with substance use disorders.For men in treatment for substance use disorders, the relation between symptoms of depression and anxiety and compulsive sexual behaviour is explained, in part, by experiential avoidance.Helping men with substance use disorders develop more adaptive methods of processing aversive experiences, as opposed to escaping them, may reduce their use of compulsive sexual behaviours when faced with aversive affect.
      PubDate: 2017-04-11T22:10:30.123315-05:
      DOI: 10.1002/cpp.2085
  • The impact of childhood maltreatment on the differential efficacy of CBASP
           versus escitalopram in patients with chronic depression: A secondary
    • Authors: Paul Bausch; Thomas Fangmeier, Ingo Zobel, Dieter Schoepf, Sarah Drost, Knut Schnell, Henrik Walter, Mathias Berger, Claus Normann, Elisabeth Schramm
      Abstract: Childhood maltreatment (CM) has been indicated as a predictor of a differential response to antidepressant treatment with psychotherapy compared to medication. In this secondary analysis, we investigated whether the presence of CM results in a differential indication for the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or escitalopram plus clinical management (ESC). Sixty patients with chronic depression were randomized to either 22 sessions of CBASP or ESC over the course of 8 weeks of acute and 20 weeks of extended treatment at 2 German treatment sites. CM was assessed using the Childhood Trauma Questionnaire and the clinician rated Early Trauma Inventory. Intention-to-treat analyses were used to examine the impact of CM on depression, global functioning, and quality of life. The presence of CM did not result in significant differences in treatment response to CBASP or ESC on any outcome measure after 28 weeks of treatment independent of the type of CM assessment. After 8 weeks, a significant CM × treatment interaction was found for scores on the Montgomery-Asberg Depression Rating Scale. Patients with a history of CM receiving CBASP had a significantly lower response rate compared to patients without CM and to those receiving ESC after 8 weeks. Conclusively, CBASP and ESC are equally effective treatment options for the difficult to treat subgroup of patients with chronic depression and a history of CM. CM may be a predictor of a longer latency of treatment response in the case of psychotherapy.Key Practitioner MessageCBASP and escitalopram are equally effective treatment options for chronic depression.Both treatments are also equally effective for the difficult to treat subgroup of patients with chronic depression and a history of childhood maltreatment.Childhood maltreatment may result in a longer latency of treatment response in the case of psychotherapy.
      PubDate: 2017-03-21T22:32:12.730378-05:
      DOI: 10.1002/cpp.2081
  • Cognitive and metacognitive predictors of symptom improvement following
           treatment for social anxiety disorder: A secondary analysis from a
           randomized controlled trial
    • Authors: Henrik Nordahl; Hans M. Nordahl, Odin Hjemdal, Adrian Wells
      Abstract: Cognitive therapy for social anxiety disorder (SAD) based on the Clark and Wells model emphasizes negative beliefs about the social self and self-consciousness as central causal factors. However, Wells' metacognitive model proposes that metacognitive beliefs are central to pathology universally. The relative importance of cognitive and metacognitive beliefs in the treatment of SAD is therefore an important research question. This study examined change in negative cognitive and negative metacognitive beliefs as independent correlates of symptom improvement in 46 SAD patients undergoing evidence-based treatments. Both types of beliefs decreased during treatment. However, change in metacognitive belief was the only consistent independent predictor across all outcomes and change in cognitive beliefs did not significantly predict outcomes when change in self-consciousness was controlled. The implication of this finding is that metacognitive change might be more important than cognitive belief change in symptom outcome and recovery in SAD.Key Practitioner MessageCognitive and metacognitive beliefs decreased during treatment of SAD.Change in self-consciousness predicted symptom improvement.Change in metacognition predicted symptom improvement over change in cognition.Change in metacognition was a more reliable predictor than change in cognition.
      PubDate: 2017-03-15T00:05:28.264828-05:
      DOI: 10.1002/cpp.2083
  • Information order effects in clinical psychological diagnoses
    • Authors: Jan Christopher Cwik; Jürgen Margraf
      Abstract: Despite the wide application and long history of diagnostic systems, several sources of diagnostic errors remain in the criterion-based diagnosing of mental disorders. The aim of this study was to investigate whether the presentational order of diagnosis-relevant information and pretreatment reports predict diagnostic errors. One hundred twenty psychotherapists participated in the present online study. The study employed a 2 (symptom presentation: core symptoms at vignette's beginning vs. core symptoms at the end of the case vignette) × 2 (pretreatment report: receiving a pretreatment report with an incongruent diagnosis to the case vignette vs. receiving no pretreatment report) between-subjects experimental design, with random assignment. Participants were asked to make diagnoses after reading three case vignettes describing patients with different disorder constellations. Additionally, participants rated their confidence in the diagnoses and their estimation of the severity of each diagnosed condition. Results indicated that order of symptom descriptions predicted the correctness of diagnostic decisions, with a recency effect causing more fully correct diagnostic decisions in cases where diagnostic information was presented last. Receiving incongruent pretreatment reports was predictive for diagnostic errors. In conclusion, the results of this study indicate that diagnoses of mental disorders can depend on the way symptoms are presented or reported.Key Practitioner Message:Therapists' diagnostic decisions are not influenced by pretreatment reports.Diagnostic decisions are affected by information order effects.Diagnostic accuracy of psychotherapists is debatable.High rate of misdiagnoses in case vignette with comorbid disorders.
      PubDate: 2017-03-09T01:00:29.188535-05:
      DOI: 10.1002/cpp.2080
  • Preventing intimate partner violence via the Internet: A randomized
           controlled trial of emotion-regulation and conflict-management training
           for individuals with aggression problems
    • Authors: Hugo Hesser; Sandra Axelsson, Victoria Bäcke, Jonna Engstrand, Tina Gustafsson, Elin Holmgren, Ulrika Jeppsson, Maria Pollack, Kjell Nordén, Dan Rosenqvist, Gerhard Andersson
      Abstract: ObjectiveThe aim of this randomized controlled trial was to investigate the effect of an Internet-delivered cognitive behaviour therapy (iCBT), which incorporated emotion-regulation and conflict-resolution techniques, on intimate partner violence (IPV). Another aim was to test the theoretical underpinnings of the treatment model using mediation analysis.MethodSixty-five participants with aggression problems in intimate adult relationships were recruited from the community and were randomly assigned to iCBT or to a monitored waitlist control. Participants were assessed with standardized self-report measures of IPV or aggression (Multidimensional Measure of Emotional Abuse, Revised Conflict Tactics Scale, and Aggression Questionnaire), relationship quality (Dyadic Adjustment Scale), anxiety or depression symptomatology (Patient Health Questionnaire; Generalized Anxiety Disorder Screener), at pretreatment, posttreatment (8 weeks), and 1-year follow-up. Process variables (subscales of Dysfunctional and Emotional Regulation Scale and Anger Rumination Scale) were assessed weekly over the active treatment phase.ResultsRobust linear regression analysis of all randomized participants showed significant treatment effects on emotional abuse relative to control at postassessment. Mediation analysis using growth curve modeling revealed that the treatment effect was partially mediated by changes in emotion-regulation ability. Controlled effects on secondary outcomes were also observed. Analyses of uncontrolled effects indicted that gains on IPV were maintained at 1-year follow-up.ConclusionsiCBT focusing on enhancing conflict-resolution skills and emotion-regulation ability has the potential to reduce IPV among self-recruited individuals with mild forms of abusive behaviour in intimate relationships. Emotion-regulation ability is potentially a key therapeutic process of change.Key Practitioner MessageInternet-delivered clinician-guided cognitive behaviour therapy is a viable treatment option for reducing intimate partner violence among self-recruited individuals with mild forms of abusive behaviour.For persons who display patterns of frequent and severe violence, other treatments are most likely needed.Emotion-regulation training is potentially a key therapeutic component that ought to be incorporated in interventions targeting IPV.
      PubDate: 2017-03-06T02:20:30.319076-05:
      DOI: 10.1002/cpp.2082
  • Validation of the psychometric properties of cognitive fusion
           questionnaire. A study of the factorial validity and factorial invariance
           of the measure among osteoarticular disease, diabetes mellitus, obesity,
           depressive disorder, and general populations
    • Authors: Joana Alexandra Costa; João Marôco, José Pinto-Gouveia
      Abstract: BackgroundThe cognitive fusion questionnaire (CFQ) is a self-report questionnaire that assesses the extent to which individuals are psychologically entangled with, and dominated by the form–content of their thoughts. The aim of this study was to replicate the factor structure of CFQ in osteoarticular disease, diabetes mellitus, obesity, depressive disorder, and normative population. It further examined the factorial invariance of the CFQ across these 5 groups.MethodData from 299 participants (N General Population = 67, N Osteoarticular Disease = 73, N Diabetes Mellitus = 47, N Depressive Disorder = 45, and N Obesity = 60) were subjected to confirmatory factorial analysis (CFA) to replicate the structural model of CFQ dimensionality.ResultsCFA supported a 1-factor structure with good internal consistency and construct related validity. The 1-factor solution was also supported by a second independent data set, which showed a configural, strict measurement, and structural invariance of the 1-factor solution proposed. Multigroup CFA showed the configural invariance, strict measurement invariance, and structural invariance of CFQ across the 5 groups under study.ConclusionsThe unidimensional model has both similar meanings and the same structure, but the measurement model across the groups was not the same. The study provides the first approach to CFQ to Portuguese population, as a reliable tool of general cognitive fusion. Furthermore, results indicated that CFQ has a coherent structure across multiple samples and clinical utility, as it discriminate individuals with psychological distress from those who do not.
      PubDate: 2017-02-14T22:45:27.025811-05:
      DOI: 10.1002/cpp.2077
  • Mindfulness-based cognitive therapy as an augmentation treatment for
           obsessive–compulsive disorder
    • Authors: Brenda L. Key; Karen Rowa, Peter Bieling, Randi McCabe, Elizabeth J. Pawluk
      Abstract: A significant number of obsessive–compulsive disorder (OCD) patients continue to experience symptoms that interfere with their functioning following cognitive behavioural therapy (CBT). Providing an additional augmentation treatment following CBT could help reduce these residual symptoms. Mindfulness interventions that facilitate less reactivity to thoughts and feelings may be helpful for patients suffering from residual OCD symptoms. The purpose of the current randomized waitlist control trial was to evaluate the feasibility and impact of providing an 8-week mindfulness-based cognitive therapy (MBCT) intervention following completion of a CBT intervention to OCD patients who continued to suffer from significant symptoms. Results indicated that compared to the waitlist control group, MBCT participants reported decreases in OCD symptoms (d = 1.38), depression symptoms (d = 1.25), anxiety symptoms (d = 1.02), and obsessive beliefs (d = 1.20) along with increases in self-compassion (d = 0.77) and mindfulness skills (d = 0.77). Additionally, participants reported high levels of satisfaction with the MBCT intervention. The results suggest that the use of MBCT for OCD as an augmentation therapy is acceptable to patients who continue to suffer from OCD symptoms after completing CBT and provides some additional relief from residual symptoms.Key Practitioner MessageMindfulness interventions teach skills that facilitate disengaging from cognitive routines and accepting internal experience, and these skills may be valuable in treating obsessive–compulsive disorder (OCD), as individuals describe getting “stuck” in repetitive thoughts and consequent rituals.The results of this study suggest that teaching mindfulness skills using an 8-week mindfulness-based cognitive therapy (MBCT) intervention provides an added benefit (decreases in OCD, depression, and anxiety symptoms) for patients with OCD who have completed a cognitive behavioural therapy intervention and continued to suffer from significant symptoms.Participation in MBCT was also associated with increases in mindfulness skills including increased ability to be nonjudgmental and nonreactive. By fostering a nonjudgmental stance towards intrusive thoughts, mindfulness may discourage suppression and avoidance of thoughts and this could lead to increased habituation and a decreased reliance on compulsions.The use of MBCT as an augmentation treatment should be further explored to elucidate whether this treatment is beneficial for preventing relapse of OCD and could be compared against further cognitive behavioural therapy to see if offering participants a different and theoretically compelling intervention, such as MBCT, would outperform “more of the same” for individuals with OCD.
      PubDate: 2017-02-13T21:55:33.98302-05:0
      DOI: 10.1002/cpp.2076
  • Psychometric properties of the Dutch version of the Treatment Support
           Measure (TSM) parent and youth form
    • Authors: Maartje A. M. S. Sonsbeek; Catharina J. M. Holtmaat, Bea G. Tiemens, Giel J. M. Hutschemaekers, Kim Jong
      Abstract: The Treatment Support Measure (TSM) Parent and Youth were created to help clinicians with actionable feedback when youths are not making sufficient progress in treatment. This study examined the psychometric properties of the Dutch TSM Parent and TSM Youth. Parents (n = 172) and youth (n = 122) were recruited at 2 outpatient mental health care institutions. Children of participating parents (50.6% boys) had a mean age of 11.9 years (SD = 3.46; range 4–18). Participating youth (30.3% boys) had a mean age of 15.68 years (SD = 1.75; range 12–18). Participants were asked to complete the TSM and questionnaires measuring related constructs once during treatment. Responses to the TSM Parent items were explained by 9 instead of 5 subscales, and responses to the TSM Youth items were explained by 8 instead of 4 subscales. The internal consistency reliability of both the TSM Parent and the TSM Youth scales was generally good. The convergent validity of the TSM Parent and the TSM Youth was also good, although the divergent validity was less convincing. The criterion validity was inconclusive; the TSM Parent was not able to differentiate between problematic and nonproblematic treatments, but multiple scales of the TSM Youth were able to differentiate between these groups. The TSM Parent and TSM Youth have potential to be helpful tools in clinical practice. They could signal potential barriers to youth progress and direct the conversation between the clinician and youth and parents about adaptation of treatment.Key practitioner messageThis is the first study to investigate the psychometric properties of the Treatment Support Measure (TSM) Parent and Youth versions, which are created to help clinicians with actionable feedback when youths are not making sufficient progress in treatment.The Dutch TSM Parent and TSM Youth have moderate to good psychometric properties.The Dutch TSM Parent and TSM Youth might be helpful tools for use in clinical practice: they contain variables that are related to youth outcome, can signal potential barriers to youth progress, and can direct the conversation between the clinician and the youth and parents about adaptation of treatment.The Dutch TSM Parent and TSM Youth could be added to the regular ROM to facilitate both routine monitoring of outcome and direct and concrete aid to the here-and-now relational processes in treatment.
      PubDate: 2017-02-08T23:55:34.465405-05:
      DOI: 10.1002/cpp.2075
  • Development and validation of a new Italian short measure of disgust
           propensity: The Disgust Propensity Questionnaire (DPQ)
    • Authors: Gabriele Melli; Carlo Chiorri, Eleonora Stopani, Francesco Bulli, Claudia Carraresi
      Abstract: Although a few measures of disgust propensity are available in Italy, most of them take a long time to administer and/or have not shown replicable and sound psychometric properties. In the current study, the authors developed an Italian nine-item self-report measure of disgust propensity (particularly of pathogen disgust)—the Disgust Propensity Questionnaire (DPQ)—to address the limitations of currently available measures. In Study 1, the DPQ was developed through exploratory and confirmatory factor analyses from an initial pool of 33 items that were administered to 784 nonclinical participants. The DPQ showed evidence of an adequate factorial and construct validity as well as internal consistency and temporal stability. In Study 2, additional evidence of the sound psychometric properties of the DPQ was provided by analyzing an independent sample of 315 nonclinical participants and a sample of 208 patients with obsessive–compulsive disorder. This study also showed that the DPQ can discriminate between obsessive–compulsive disorder patients with and without contamination-related concerns, patients with anxiety disorders, and nonclinical participants.Key Practitioner MessageAn Italian nine-item self-report disgust propensity measure was developed to address the limitations of currently available tools.The Disgust Propensity Questionnaire (DPQ) was evaluated using two independent studies in nonclinical and clinical samples.The DPQ showed adequate factorial and construct validity, internal consistency, and temporal stability.It could discriminate between patients with obsessive–compulsive disorder with contamination-related concerns and all other groups.It is a very short and psychometrically sound measure to assess disgust propensity in Italian samples.
      PubDate: 2017-02-08T22:05:30.722721-05:
      DOI: 10.1002/cpp.2073
  • A qualitative investigation in the role of the baby in recovery from
           postpartum psychosis
    • Authors: Charlene Plunkett; Sarah Peters, Angelika Wieck, Anja Wittkowski
      Abstract: Psychosis after childbirth is a rare but severe type of mental health difficulty experienced by perinatal women. Research has explored mothers' experiences of onset and recovery from psychosis after childbirth. This study explored the role of the baby in 12 mothers' experiences of recovery. A thematic analysis of the data identified three core themes that described the role of the baby in the mothers' recovery from psychosis after childbirth. Findings revealed that the baby was central to recovery, experienced by mothers as both helpful and unhelpful. The baby interacted with the mother, increasing self-efficacy, and reducing emotional distress. Findings also showed that the baby could act as a barrier to recovery by increasing the women's emotional distress and hindering access to help and self-care. The findings of the study add to the existing evidence based on recovery from psychosis after childbirth. The research and clinical implications of these findings are discussed with reference to the existing literature.Key Practitioner MessageThe baby has an important role in recovery from psychosis after childbirth.The baby can be perceived by mothers to both hinder and help their recovery.Interacting with the baby can be helpful for the mothers' recovery by improving their self-efficacy and reducing emotional distress.Specialist interventions offered by a mother and baby unit can provide practical support that facilitates mother–baby interactions, which helps move women forward in the recovery process.
      PubDate: 2017-01-31T02:35:46.717274-05:
      DOI: 10.1002/cpp.2074
  • BEfree: A new psychological program for binge eating that integrates
           psychoeducation, mindfulness, and compassion
    • Authors: José Pinto-Gouveia; Sérgio A. Carvalho, Lara Palmeira, Paula Castilho, Cristiana Duarte, Cláudia Ferreira, Joana Duarte, Marina Cunha, Marcela Matos, Joana Costa
      Abstract: Binge eating disorder (BED) is associated with several psychological and medical problems, such as obesity. Approximately 30% of individuals seeking weight loss treatments present binge eating symptomatology. Moreover, current treatments for BED lack efficacy at follow-up assessments. Developing mindfulness and self-compassion seem to be beneficial in treating BED, although there is still room for improvement, which may include integrating these different but complimentary approaches. BEfree is the first program integrating psychoeducation-, mindfulness-, and compassion-based components for treating women with binge eating and obesity.ObjectiveTo test the acceptability and efficacy up to 6-month postintervention of a psychological program based on psychoeducation, mindfulness, and self-compassion for obese or overweight women with BED.DesignA controlled longitudinal design was followed in order to compare results between BEfree (n = 19) and waiting list group (WL; n = 17) from preintervention to postintervention. Results from BEfree were compared from preintervention to 3- and 6-month follow-up.ResultsBEfree was effective in eliminating BED; in diminishing eating psychopathology, depression, shame and self-criticism, body-image psychological inflexibility, and body-image cognitive fusion; and in improving obesity-related quality of life and self-compassion when compared to a WL control group. Results were maintained at 3- and 6-month follow-up. Finally, participants rated BEfree helpful for dealing with impulses and negative internal experiences.ConclusionsThese results seem to suggest the efficacy of BEfree and the benefit of integrating different components such as psychoeducation, mindfulness, and self-compassion when treating BED in obese or overweight women.Key Practitioner MessageThe current study provides evidence of the acceptability of a psychoeducation, mindfulness, and compassion program for binge eating in obesity (BEfree);Developing mindfulness and self-compassionate skills is an effective way of diminishing binge eating, eating psychopathology and depression, and increasing quality of life in women with obesity;Integrating psychoeducation, mindfulness, and compassion seem to be effective in diminishing binge eating, with results maintained up to 6-month postintervention.
      PubDate: 2017-01-25T22:15:27.657302-05:
      DOI: 10.1002/cpp.2072
  • Indirect exposure to client trauma and the impact on trainee clinical
           psychologists: Secondary traumatic stress or vicarious traumatization'
    • Authors: Rakhee Makadia; Rachel Sabin-Farrell, Graham Turpin
      Abstract: ObjectivesThe study investigated the relationship between exposure to trauma work and well-being (general psychological distress, trauma symptoms, and disrupted beliefs) in trainee clinical psychologists. It also assessed the contribution of individual and situational factors to well-being.DesignA Web-based survey was employed.MethodsThe survey comprised the General Health Questionnaire, Secondary Traumatic Stress Scale, Trauma and Attachment Belief Scale, Trauma Screening Questionnaire, and specific questions about exposure to trauma work and other individual and situational factors. The link to the online survey was sent via email to trainee clinical psychologists attending courses throughout the UKResultsFive hundred sixty-four trainee clinical psychologists participated. Most trainees had a caseload of one to two trauma cases in the previous 6 months; the most common trauma being sexual abuse. Exposure to trauma work was not related to general psychological distress or disrupted beliefs but was a significant predictor of trauma symptoms. Situational factors contributed to the variance in trauma symptoms; level of stress of clinical work and quality of trauma training were significant predictors of trauma symptoms. Individual and situational factors were also found to be significant predictors of general psychological distress and disrupted beliefs.ConclusionsThis study provides support for secondary traumatic stress but lacks evidence to support belief changes in vicarious traumatization or a relationship between exposure to trauma work and general psychological distress. The measurement and validity of vicarious traumatization is discussed along with clinical, theoretical implications, and suggestions for future research.Practitioner PointsSecondary traumatic stress is a potential risk for trainee clinical psychologists.Training courses should (a) focus on quality of trauma training as it may be protective; (b) advocate coping strategies to reduce stress of clinical work, as the level of stress of clinical work may contribute to trauma symptoms.Limitations includeExposure to trauma work only uniquely explained a small proportion of variance in trauma symptoms.The study was cross-sectional in nature therefore cannot imply causality.
      PubDate: 2017-01-25T20:16:07.138545-05:
      DOI: 10.1002/cpp.2068
  • A proposed model of psychodynamic psychotherapy linked to Erik Erikson's
           eight stages of psychosocial development
    • Authors: Zelda Gillian Knight
      Abstract: Just as Freud used stages of psychosexual development to ground his model of psychoanalysis, it is possible to do the same with Erik Erikson's stages of development with regards to a model of psychodynamic psychotherapy. This paper proposes an eight-stage model of psychodynamic psychotherapy linked to Erik Erikson's eight stages of psychosocial development. Various suggestions are offered. One such suggestion is that as each of Erikson's developmental stages is triggered by a crisis, in therapy it is triggered by the client's search. The resolution of the search often leads to the development of another search, which implies that the therapy process comprises a series of searches. This idea of a series of searches and resolutions leads to the understanding that identity is developmental and therapy is a space in which a new sense of identity may emerge. The notion of hope is linked to Erikson's stage of Basic Trust and the proposed model of therapy views hope and trust as essential for the therapy process. Two clinical vignettes are offered to illustrate these ideas.Key Practitioner MessagePsychotherapy can be approached as an eight-stage process and linked to Erikson's eight stages model of development.Psychotherapy may be viewed as a series of searches and thus as a developmental stage resolution process, which leads to the understanding that identity is ongoing throughout the life span.
      PubDate: 2017-01-25T20:05:25.305993-05:
      DOI: 10.1002/cpp.2066
  • The Counseling Center Assessment of Psychological Symptoms (CCAPS-62):
           Acceptance, feasibility, and initial psychometric properties in a UK
           student population
    • Authors: Emma Broglia; Abigail Millings, Michael Barkham
      Abstract: BackgroundThe burden and severity of student mental health continue to increase in parallel with increasing financial pressures on students and services alike. There is a need for a student-specific measure of distress that acknowledges their unique context. This study examined the feasibility, acceptance, and initial psychometric properties of a US measure, the Counseling Center Assessment of Psychological Symptoms (CCAPS), in a UK student sample.MethodsA sample of 294 UK help-seeking students from two universities completed the CCAPS-62 and Clinical Outcomes in Routine Evaluation (CORE-10) as a comparator. The factor solution and reliability of the CCAPS-62 were examined. Correlations and clinical boundaries were determined between the CCAPS-62 subscales and CORE-10, and comparisons were made with US published norms.ResultsThe CCAPS-62 demonstrated a strong factor solution that matched the intended subscales. All subscales had good reliability and correlated significantly with the CORE-10. The agreement on caseness between the two measures was 92.8% with 86.3% reaching clinical threshold on both the CCAPS-62 and CORE-10. Severity was most noticeable for academic distress, depression, anxiety, and social anxiety. Compared to US data, UK students showed higher clinical severity for all psychological symptoms.ConclusionsThe CCAPS-62 is a reliable and psychometrically valid assessment measure to use with UK students without revision. The overall distress indicated is similar to that of the CORE-10, but the individual subscales are more informative of specific student concerns including academic distress, social anxiety, and substance abuse. Potential benefits of administering a student-focused assessment measure in student counselling services are discussed.Key Practitioner MessageUniversity students attending counselling in the UK demonstrate clinical severity for academic distress, depression, anxiety, and social anxiety.Compared to university students in the US, UK students present with higher clinical severity on all contextual measures of student psychological distress.It is advantageous for university counselling services to administer a student-specific clinical measure over measures intended for the general clinical population.CCAPS-62 is an acceptable, feasible, and psychometrically valid measure of student psychological distress that can be used in the UK without revision.It is important for university counselling services to continue to provide support from therapists that are trained and experienced in the university context over services intended for the general clinical population.
      PubDate: 2017-01-25T20:00:35.382765-05:
      DOI: 10.1002/cpp.2070
  • The role of guilt sensitivity in OCD symptom dimensions
    • Authors: Gabriele Melli; Claudia Carraresi, Andrea Poli, Donatella Marazziti, Antonio Pinto
      Abstract: Although some studies have found that guilt may precede, motivate, or be a consequence of obsessive–compulsive disorder (OCD), the relationship between guilt and OCD has been under investigated. The studies that explored the role of trait guilt (guilt propensity) in OCD reported inconsistent findings and failed to support its predictive role. Since it has been suggested that OCD patients perceive guilt in a more threatening manner, it might also be relevant to test to what extent they negatively evaluate the experience of guilt (i.e., guilt sensitivity; GS). Study 1 investigated the psychometric properties of a new 10-item Italian measure developed to assess GS—named Guilt Sensitivity Questionnaire—in a nonclinical sample (N = 473). Results from exploratory factor analyses supported the unidimensionality of the scale. It also showed excellent internal consistency and good discriminant validity. Study 2 investigated the role of GS in OCD symptoms, in particular with regard to responsibility for harm obsessions and checking compulsions, using a heterogeneous OCD sample (N = 61) and a control group of patients with anxiety disorders (N = 47). GS was the unique significant predictor of checking related OCD symptoms independent of negative mood states and obsessive beliefs. Guilt Sensitivity Questionnaire scores of patients with responsibility for harm concerns were significantly higher than those of patients with other kinds of obsessive concerns and with anxiety disorders. Findings supported the hypothesis that GS plays a relevant role in OCD symptoms when checking rituals are primarily involved. Implications for current cognitive behavioral models are discussed.Key practitioner message:Guilt sensitivity may play a role in checking-related OCD symptoms.We developed a psychometrically sound unidimensional 10-item scale to assess guilt sensitivity.Guilt sensitivity was a unique predictor of checking-related OCD symptoms.Targeting beliefs about the intolerability/dangerousness of experiencing guilt may be useful.Acceptance-based approaches may be helpful as they promote the acceptance of guilt.
      PubDate: 2017-01-16T23:55:29.60713-05:0
      DOI: 10.1002/cpp.2071
  • Effect of an art brut therapy program called go beyond the schizophrenia
           (GBTS) on prison inmates with schizophrenia in mainland China—A
           randomized, longitudinal, and controlled trial
    • Authors: Hong-Zhong Qiu; Zeng-Jie Ye, Mu-Zi Liang, Yue-Qun Huang, Wei Liu, Zhi-Dong Lu
      Abstract: Creative arts therapies are proven to promote an interconnection between body and mind, but there are major obstacles for providing therapeutic services in prisons due to inmates' inherent mistrust for verbal disclosure and rigid self-defenses, especially among inmates with schizophrenia. Thus, we developed a structured and quantitative art brut therapy program called go beyond the schizophrenia to actually measure the benefits of art therapy on prison inmates in mainland China. Upon completion of the program, the intervention group reported a decrease in anxiety, depression, anger, and negative psychiatric symptoms and showed better compliance with rules, socialization with peers, compliance with medications, and regular sleeping patterns after 16 weekly sessions of go beyond the schizophrenia. This article concludes that the art brut therapy was effective for the inmates with schizophrenia in mainland China and provides encouraging data on how to enhance mental health for inmates with schizophrenia.Key practitioner messageArt brut therapy can reduce emotional distress and negative psychiatric symptoms among Chinese inmates.Arts brut therapy can enhance Chinese inmates' compliance with rules, socialization with peers, compliance with medicines, and regular sleeping patterns.Arts brut therapy in conjunction with medication is highly recommended for recovery of Chinese inmates with schizophrenia, especially for patients with negative symptoms.
      PubDate: 2017-01-12T03:35:39.36157-05:0
      DOI: 10.1002/cpp.2069
  • Change in self-esteem predicts depressive symptoms at follow-up after
           intensive multimodal psychotherapy for major depression
    • Authors: Ulrike Dinger; Johannes C. Ehrenthal, Christoph Nikendei, Henning Schauenburg
      Abstract: Reduced self-esteem is a core symptom of depression, but few studies have investigated within-treatment change of self-esteem as a predictor of long-term outcome in depression. This study investigated change in self-esteem during 8 weeks of multimodal, psychodynamically oriented psychotherapy for 40 depressed patients and tested whether it would predict outcome 6 months after termination. Data was drawn from a randomized clinical pilot trial on day-clinic versus inpatient psychotherapy for depression. Findings supported the association between change in self-esteem and follow-up depression severity, even when controlling for within-treatment symptom change. Change in self-esteem was not related to overall symptoms and interpersonal problems at follow-up. Thus, change in self-esteem may be an important variable in preventing relapse for depression.Key Practitioner MessageSelf-esteem is related to depressive symptoms and interpersonal problems.Improvement of self-esteem during psychotherapy correlates with improvements of symptoms and interpersonal problems.Change of self-esteem during psychotherapy predicts depressive symptoms 6 months after termination of therapy.When treating depressed patients, psychotherapists should work towards an improvement of self-esteem in order to prevent relapse.
      PubDate: 2017-01-08T19:55:23.646969-05:
      DOI: 10.1002/cpp.2067
  • Issue Informatoin
    • Pages: 574 - 574
      Abstract: No abstract is available for this article.
      PubDate: 2017-04-12T02:12:26.021185-05:
      DOI: 10.1002/cpp.2088
  • Contribution of Interpersonal Problems to Eating Disorder Psychopathology
           via Negative Affect in Treatment-seeking Men and Women: Testing the
           Validity of the Interpersonal Model in an Understudied Population
    • Authors: Iryna V. Ivanova; Giorgio A. Tasca, Geneviève Proulx, Hany Bissasda
      Abstract: Research on the psychosocial correlates and theoretical frameworks of men presenting with eating disorders (ED) psychopathology is limited. This study compared treatment-seeking men and women in terms of their levels of interpersonal functioning (affiliation and dominance), regulation of negative emotions (negative affect and instability) and ED psychopathology. The study also investigated the validity of the interpersonal model of ED in men. Results from the cross-sectional data of 388 participants (137 men and 251 women) demonstrated that the structural models fit and that paths were invariant across men and women. There were significant indirect effects of interpersonal functioning on ED psychopathology, mediated through negative affect and instability, for both men and women. Negative affect and instability partially explain the relationship between interpersonal problems and ED psychopathology in treatment-seeking men and women. Current findings highlight the need to evaluate the validity of the model using longitudinal designs to test whether men and women are likely to benefit equally from interpersonal therapies for ED. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageNegative affect and instability mediated the relationship between interpersonal problems and eating disorder psychopathology for treatment-seeking men and women.There were no gender differences between levels of negative affect, emotional instability and interpersonal dysfunction, but women reported slightly higher eating concerns than men.Interpersonal model is a framework that is applicable to understanding and potentially treating men with eating disorders.
      PubDate: 2016-12-28T01:00:26.929286-05:
      DOI: 10.1002/cpp.2060
  • Effects of Functional Analytic Psychotherapy Therapist Training on
           Therapist Factors Among Therapist Trainees in Singapore: A Randomized
           Controlled Trial
    • Authors: Shian-Ling Keng; Emma Waddington, Xiangting Bernice Lin, Michelle Su Qing Tan, Clare Henn-Haase, Jonathan W. Kanter
      Abstract: Functional Analytic Psychotherapy (FAP) is a behavioral psychotherapy intervention that emphasizes the development of an intimate and intense therapeutic relationship as the vehicle of therapeutic change. Recently, research has provided preliminary support for a FAP therapist training (FAPTT) protocol in enhancing FAP competency. The present study aimed to expand on this research by examining the effects of FAPTT on FAP-specific skills and competencies and a set of broadly desirable therapist qualities (labelled awareness, courage and love in FAPTT) in a sample of therapist trainees in Singapore. The study also evaluated the feasibility and acceptability of FAP in the Singaporean context. Twenty-five students enrolled in a master's in clinical psychology program were recruited and randomly assigned to receive either eight weekly sessions of a FAPTT course or to a waitlist condition. All participants completed measures assessing empathy, compassionate love, trait mindfulness, authenticity and FAP-specific skills and competencies pre- and post-training, and at 2-month follow-up. A post-course evaluation was administered to obtain participants' qualitative feedback. Results indicated that compared with the waitlisted group, FAPTT participants reported significant increases in overall empathy, FAP skill and treatment acceptability from pre- to post-training. Improvements were observed on several outcome variables at 2-month follow-up. Participants reported finding the training to be both feasible and acceptable, although several raised issues related to the compatibility of the treatment with the local cultural context. Overall, the findings suggest that FAPTT is effective for improving specific FAP competencies and selected broadly desirable therapist qualities among therapist trainees. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageFunctional Analytic Therapy (FAP) therapist training protocol was effective in improving empathy and FAP skills among Singaporean therapist trainees.These improvements were maintained at 2-month follow-up.The training was found to be acceptable in the Singaporean context, although several adaptations were suggested to increase the compatibility between FAP principles and local cultural norms.
      PubDate: 2016-12-23T03:00:24.259457-05:
      DOI: 10.1002/cpp.2064
  • Psychopathological Differences Between Suicide Ideators and Suicide
           Attempters in Patients with Mental Disorders
    • Authors: Sandra Pérez; Jose H. Marco, Joaquin García-Alandete
      Abstract: BackgroundAlthough suicide is one of the leading causes of death worldwide, there is a need for studies to identify variables that can differentiate patients with suicide ideation at risk of transitioning to an attempt.MethodIn this study, we assessed suicide ideation and attempts, non-suicidal self-injury (NSSI), hopelessness, borderline symptoms and meaning in life in a sample of 348 patients with different diagnoses of mental disorders. We divided the sample into four subgroups: patients without suicide ideation or suicide attempts; patients with current suicide ideation; patients with lifetime suicide attempts and patients with a suicide attempt in the previous year.ResultsThe group with suicide attempts in the previous year showed higher levels of hopelessness, borderline symptoms and NSSI, and lower levels of meaning in life than the other groups.LimitationsGroups were composed of unequal numbers of patients, and in some of them, the sample size was small. The sample was composed mainly of women with eating disorders. The study design was retrospective, and so the results must be considered in terms of correlates.ConclusionsOur results suggest that hopelessness, borderline symptoms—including NSSI—and meaning in life play a key role in suicide attempts. Thus, psychotherapeutic interventions should focus on managing NSSI, searching for meaning and managing emptiness, loss of control and feelings such as self-contempt in patients with suicide ideation. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageRecent suicide attempters show higher levels of hopelessness, borderline symptoms and NSSI than lifetime attempters and suicide ideators.Clinicians should focus attention on assessing hopelessness, borderline symptoms and NSSI in those with suicide ideation.Lower levels of meaning in life are related to recent suicide attempts.Levels of hopelessness differentiate between recent and lifetime suicide attempters.
      PubDate: 2016-12-22T00:50:34.744023-05:
      DOI: 10.1002/cpp.2063
  • Cultural Competence in the Treatment of Addictions: Theory, Practice and
    • Authors: Sally M. Gainsbury
      Abstract: Culturally and linguistically diverse (CALD) populations often have high rates of addictive disorders, but lower rates of treatment seeking and completion than the mainstream population. A significant barrier to treatment is the lack of culturally relevant and appropriate treatment. A literature review was conducted to identify relevant literature related to cultural competence in mental health services delivery and specifically treatment for addictive disorders. Several theoretical models of cultural competence in therapy have been developed, but the lack of rigorous research limits the empirical evidence available. Research indicates that culturally competent treatment practices including providing therapy and materials in the client's language, knowledge, understanding and appreciation for cultural perspectives and nuances, involving the wider family and community and training therapists can enhance client engagement, retention and treatment outcomes for substance use and gambling. Further methodologically rigorous research is needed to isolate the impact of cultural competence for the treatment of addictions and guide research to determine treatment efficacy within specific CALD populations. Training therapists and recruiting therapists and researchers from CALD communities is important to ensure an ongoing focus and improved outcomes for CALD populations due to the importance of engaging these populations with addiction treatment. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner Message:The treatment needs of culturally diverse individuals with addictions are often not met.Theoretical models can guide therapists in incorporating cultural competence.Culturally targeted treatments increase recruitment, retention and treatment outcomes.Cultural competence includes matching clinicians and clients on linguistic and cultural backgrounds as well as being mindful of the impact of culture on client's experience of addiction problems.Few methodologically rigorous trials have been conducted to guide treatment practices and research needs to be incorporated into existing culturally relevant treatment services.
      PubDate: 2016-12-15T00:10:30.111793-05:
      DOI: 10.1002/cpp.2062
  • Assessing Anaclitic and Introjective Characteristics Using the SWAP-200
           Q-Sort: Concurrent Validity with the Inventory of Interpersonal Problems
           Circumplex Scales
    • Authors: Racheli Miller; Mark Hilsenroth
      Abstract: This investigation's goal was to assess the concurrent validity of the four scales of the Anaclitic and Introjective Depression Assessment (AIDA), a newly developed clinician-rated measure, and the Inventory of Interpersonal Problems Circumplex Scales (IIP-64). The AIDA is composed of Shedler–Westen Assessment Procedure items and is comprised of two primitive and two more mature scales of introjective and anaclitic personality types. Specific predictions of relationships were made and are discussed further in this paper. The participants in this study were 106 outpatients engaged in psychodynamic psychotherapy. Patients completed the IIP-64 upon assessment and were rated by their therapist on the Shedler–Westen Assessment Procedure 200 (SWAP-200). The present findings demonstrated several expected relationships between the SWAP-derived AIDA and the IIP-64. Primitive levels of Anaclitic and Introjective characteristics on the AIDA were related to more difficulties involving Affiliation and Dominance on the IIP. The primitive Introjective–Dismissive (Dismissive Depression) scale was related to difficulties involving high Dominance and low Affiliation. The more adaptive Introjective–Self-Critical (Self-Critical Depression) scale was not related to any interpersonal problem. The more adaptive Anaclitic–Needy (Needy Depression) scale was related to difficulties involving high Affiliation, and the primitive Anaclitic–Submissive (Submissive Depression) scale was associated with difficulties related to high Affiliation, as well as problems related to low Dominance in one of two domains. Our results bolster the concurrent validity of the four AIDA scales and add to current knowledge of the differential interpersonal patterns of individuals with more mature and primitive levels of anaclitic and introjective personality types. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageClinicians can utilize the Anaclitic and Introjective Depression Assessment (AIDA; Rost, Fonagy, & Luyten, 2014), derived from Shedler-Westen Assessment Procedure (SWAP) items, to assess if their patients possess Anaclitic or Introjective characteristics.This measure can also be used to assess if the Anaclitic and Introjective characteristics are of a more primitive or mature nature.Clinicians should be aware that individuals with more primitive levels of Anaclitic and Introjective characteristics experience more difficulties involving Affiliation and Dominance than individuals with more mature levels of personality development.Specifically, the more primitive Introjective individual will likely encounter difficulties involving high Dominance and low Affiliation. The more adaptive Introjective individual will likely not demonstrate difficulties in these areas.The more primitive Anaclitic individual will likely encounter more difficulties related to high Affiliation, as well as problems related to low Dominance. The more adaptive Anaclitic individual also likely will encounter difficulties involving high Affiliation Copyright © 2016 John Wiley & Sons, Ltd.
      PubDate: 2016-12-12T02:58:54.264082-05:
      DOI: 10.1002/cpp.2057
  • The Relationship Between Self-Blame for the Onset of a Chronic Physical
           Health Condition and Emotional Distress: A Systematic Literature Review
    • Authors: Leah Callebaut; Philip Molyneux, Tim Alexander
      Abstract: ObjectivePast literature presents contrasting perspectives regarding the potential influence of self-blame on adjustment to illness. This systematic literature review aimed to summarize findings from all investigations to date that have explored the relationship between self-blame for the onset of a chronic physical health condition and emotional distress.MethodBetween November 2014 and February 2015, electronic databases were searched for relevant literature. Only those studies which assessed self-blame directly and related specifically to illness onset were included within the review. The methodological and reporting quality of all eligible articles was assessed, and themes within the findings were discussed using a narrative synthesis approach.ResultsThe majority of studies found self-blame to be associated with increased distress. However, several concerns with the quality of the reviewed articles may undermine the validity of their conclusions.ConclusionsIt is important for professionals supporting people with chronic physical health conditions to have an understanding of how of self-critical causal attributions might relate to emotional distress. Further research is required to understand the concept of self-blame, the factors that may encourage this belief and to develop reliable and valid measures of this experience. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageWhat does this study add'The review presents an exploration of the role of self-blame in emotional adjustment following the diagnosis of a chronic physical health condition.This is the first review to synthesize findings from studies measuring self-blame beliefs directly and specifically for illness onset and their relationship to indicators of distress and wellbeing.Findings suggest that self-blame for illness onset is often associated with emotional distress for people with cancer, HIV/AIDS and cardiovascular disease. This has implications for how healthcare professionals respond to self-blaming beliefs in the context of illness.Research quality concerns are identified for many of the reviewed studies, highlighting a need for further research on this topic.
      PubDate: 2016-12-07T07:36:07.62933-05:0
      DOI: 10.1002/cpp.2061
  • The Early Memories of Warmth and Safeness Scale for adolescents:
           Cross-Sample Validation of the Complete and Brief Versions
    • Authors: Paula Vagos; Diana Ribeiro da Silva, Nélio Brazão, Daniel Rijo, Paul Gilbert
      Abstract: This work presents psychometric analyses on the Early Memories of Warmth and Safeness Scale, which intends to evaluate the subjective perception of ones' early rearing experiences. Factor structure, measurement invariance, latent mean comparisons and validity in relation to external variables (i.e., forms of self-criticism/self-assurance, experiential avoidance and depressive, anxious and stress symptoms) were investigated. A sample of 1464 adolescents (52.3% male adolescents, mean age = 16.16, standard deviation = 1.51) was used, including 1064 participants recruited from schools, 192 participants recruited from foster care facilities and 208 boys recruited from juvenile justice facilities. A shortened version of the scale was also developed and subjected to the same psychometric analyses. A one-factor measurement model was a good fit for the data taken from both the complete and brief versions of the instrument. Such measures showed to be internally consistent with alpha values higher than 0.89. Evidence for their construct validity in relation to external variables was also found, with correlation values ranging from 0.19 to 0.45 for the complete version and from 0.18 to 0.44 for the brief version of the instrument. The brief version was the only one proving to be gender and sample invariant. Boys and girls scored similarly in their account of early memories, whereas community boys presented significantly higher scores when compared with referred and detained boys. Thus, the brief version of the instrument may be an appropriate alternative for use with diverse adolescent samples and may serve to advance knowledge on how early experiences impact on psychopathological outcomes. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioners MessagesThe Early Memories of Warmth and Safeness Scale (EMWSS), assessing early memories of warmth and safeness, was studied across community, referred for behavioural problems and detained Portuguese adolescent samples. A brief version of this instrument was also developed and studied in these same samples.Both versions of the EMWSS revealed a one-factor structure, good internal consistency and construct validity in relation to external variables; the brief version was also found to be invariant across gender and groups.Boys and girls were found to report similar levels of experienced warmth and safeness, whereas community boys reported significantly more of those experiences, followed by detained boys, and, lastly, referred boys.The brief version of the EMWSS represents a quick and valid measure to assess early memories of warmth and safeness in youth, providing for insights into the subjective experience of adolescents with diverse rearing experiences.Early memories of warmth and safeness, as assessed by the brief version of the EMWSS, may serve to advance knowledge on how early experiences impact on psychopathological outcomes in diverse youth samples.
      PubDate: 2016-12-06T00:25:27.975334-05:
      DOI: 10.1002/cpp.2059
  • The Experiences of Fathers When Their Partners are Admitted with Their
           Infants to a Psychiatric Mother and Baby Unit
    • Authors: Holly Reid; Angelika Wieck, Andrew Matrunola, Anja Wittkowski
      Abstract: Mothers with severe post-natal mental illness can be admitted with their infant to a psychiatric mother and baby unit (MBU) in the UK. MBUs provide specialist assessment, management and support. Partners of women admitted to MBUs are integral to their recovery but may show reduced wellbeing themselves, yet their support needs have not been investigated. This study aimed to identify how fathers experience the MBU and how they felt supported. A qualitative design was adopted by using a purposive sample of 17 fathers, recruited from a MBU during their partner's admission. Semi-structured interviews were used, and responses were analysed using an inductive thematic analysis. Four main themes were developed: (1) ‘double whammy’, (2) understanding the admission and illness, (3) support for fathers, and (4) personal stressors and coping. We identified the emotional struggle that fathers experienced when coping simultaneously with the arrival of a baby and their partner's illness. Furthermore, fathers sought support from many sources, but their knowledge of psychiatric services and mental illness was limited. Fathers felt uncertain about their partners' progression and when their partner would return home with their baby. The provision of an information pack and regular one-to-one meetings between fathers and MBU staff are recommended. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessagePartners of mothers admitted to a psychiatric mother and baby unit have shown increased vulnerability to mental illness themselves; however, little is known about the support that these fathers need and receive during this time.Using interviews, this study sought to understand a) how fathers experienced the mental illness of their partner and the unit's services and b) how fathers could be better supported.Fathers face many emotional and practical challenges during their partner's admission and seek support from numerous sources, including the mother and baby unit.Fathers require more information from the mother and baby unit with regard to mental illness and the unit's services. Furthermore, the introduction of regular one-to-one updates between staff and fathers would provide an opportunity for fathers to understand how their partner is progressing and for staff to informally assess the father's wellbeing and outstanding support needs.
      PubDate: 2016-12-02T01:15:32.061377-05:
      DOI: 10.1002/cpp.2056
  • Facilitators and Barriers to Person-centred Care in Child and Young People
           Mental Health Services: A Systematic Review
    • Authors: Dawid Gondek; Julian Edbrooke-Childs, Tjasa Velikonja, Louise Chapman, Felicity Saunders, Daniel Hayes, Miranda Wolpert
      Abstract: Implementation of person-centred care has been widely advocated across various health settings and patient populations, including recent policy for child and family services. Nonetheless, evidence suggests that service users are rarely involved in decision-making, whilst their preferences and goals may be often unheard. The aim of the present research was to systematically review factors influencing person-centred care in mental health services for children, young people and families examining perspectives from professionals, service users and carers. This was conducted according to best practice guidelines, and seven academic databases were searched. Overall, 23 qualitative studies were included. Findings from the narrative synthesis of the facilitators and barriers are discussed in light of a recently published systematic review examining person-centred care in mental health services for adults. Facilitators and barriers were broadly similar across both settings. Training professionals in person-centred care, supporting them to use it flexibly to meet the unique needs of service users whilst also being responsive to times when it may be less appropriate and improving both the quantity and quality of information for service users and carers are key recommendations to facilitate person-centred care in mental health services with children, young people and families. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioners MessagesAs research shows, children and young people are rarely actively involved in their treatment within mental health services. This is despite a strong recent emphasis on providing care within child and young people mental health services according to person-centred principles. Still, there is little known about factors affecting provision of person-centred care with this population.As found by the current study, the most commonly reported factors affecting provision of person-centred care were information sharing (in an appropriate amount and at a right time), listening, respecting and validating, quality of relationship and support, capacity of children and young people to be involved in their care, parental involvement and shortage of resources. These factors were cited as both facilitators and barriers and were found to be universally important by service users, their carers and professional working at the services.The key factors were broadly similar to those reported among adults, particularly regarding information sharing/communication, capacity of service users to be involved and available resources. The main difference was related to a more complex role of a carer in children/young people services.The key recommendations of the review to improve provision of person-centred care are providing professionals with more training in using the approach, supporting them to use it flexibly to meet the unique needs of service users whilst also being responsive to times when it may be less appropriate and improving both the quantity and quality of information for service users.
      PubDate: 2016-12-02T01:06:30.99962-05:0
      DOI: 10.1002/cpp.2052
  • They're NICE and Neat, but Are They Useful' A Grounded Theory of
           Clinical Psychologists' Beliefs About and Use of NICE Guidelines
    • Authors: Alex John Court; Anne Cooke, Amanda Scrivener
      Abstract: Guidelines are ubiquitous but inconsistently used in UK mental health services. Clinical psychologists are often influential in guideline development and implementation, but opinion within the profession is divided. This study utilized grounded theory methodology to examine clinical psychologists' beliefs about and use of NICE guidelines. Eleven clinical psychologists working in the NHS were interviewed. The overall emerging theme was; NICE guidelines are considered to have benefits but to be fraught with dangers. Participants were concerned that guidelines can create an unhelpful illusion of neatness. They managed the tension between the helpful and unhelpful aspects of guidelines by relating to them in a flexible manner. The participants reported drawing on specialist skills such as idiosyncratic formulation and integration. However, due to the pressures and dominant discourses within services they tended to practice in ways that prevent these skills from being recognized. This led to fears that their professional identity was threatened, which impacted upon perceptions of the guidelines. To our knowledge, the theoretical framework presented in this paper is the first that attempts to explain why NICE guidelines are not consistently utilized in UK mental health services. The current need for services to demonstrate ‘NICE compliance’ may be leading to a perverse incentive for clinical psychologists in particular to do one thing but say another and for specialist skills to be obscured. If borne out by future studies, this represents a threat to continued quality improvement and also to the profession. Copyright © 2016 John Wiley & Sons, Ltd.
      PubDate: 2016-11-25T01:05:50.519809-05:
      DOI: 10.1002/cpp.2054
  • From Childhood Trauma to Self-Harm: An Investigation of Theoretical
           Pathways among Female Prisoners
    • Authors: Ruth Howard; Thanos Karatzias, Kevin Power, Adam Mahoney
      Abstract: BackgroundDespite empirical evidence suggesting complex associations between childhood trauma and self-harm, there is a dearth of research investigating this association in the female prison population. The current study explored pathways to self-harm following childhood trauma, by investigating the mediating roles of Post-traumatic Stress Disorder (PTSD) symptoms, emotion regulation and dissociation, in this relationship, within a sample of 89 female prisoners.MethodsCross-sectional, interview-format, questionnaire study within a female prison population. Measures of childhood trauma, self-harm, PTSD, emotion regulation and dissociation were administered.ResultsThe majority of the sample (58.4%) reported history of self-harm. Bootstrapped mediation analyses indicated an indirect effect of emotion regulation on the relationship between childhood trauma and self-harm. An indirect effect was also found for PTSD arousal/reactivity cluster of symptoms. Multiple mediation analyses revealed that interactional effects were present for emotion regulation and arousal/reactivity, and emotion regulation and dissociation, respectively.ConclusionSelf-harm is highly prevalent among female prisoners. Interventions promoting emotion regulation and addressing arousal/reactivity symptoms following traumatization may provide an effective way of addressing this problem.Key Practitioner MessagesSelf-harm is highly prevalent amongst female prisoners, occurring in 58.4% of this sample.Emotion regulation and the arousal/reactivity symptom cluster of PTSD were found to mediate the relationship between childhood trauma and self-harm, both independently and simultaneously. Emotion regulation and dissociation were found to interactionally mediate this relationship.Strategies targeting emotion dysregulation and hyperarousal symptoms, amongst female prisoners who have experienced childhood trauma, may be helpful in reducing self-harming behaviours. Copyright © 2016 John Wiley & Sons, Ltd.
      PubDate: 2016-11-22T21:40:25.182093-05:
      DOI: 10.1002/cpp.2058
  • The Reciprocal Relationship between Bipolar Disorder and Social
           Interaction: A Qualitative Investigation.
    • Authors: Rebecca Owen; Patricia Gooding, Robert Dempsey, Steven Jones
      Abstract: BackgroundEvidence suggests that social support can influence relapse rates, functioning and various clinical outcomes in people with bipolar disorder. Yet ‘social support’ is a poorly defined construct, and the mechanisms by which it affects illness course in bipolar disorder remain largely unknown. Key aims of this study were to ascertain which facets of social interaction affect mood management in bipolar disorder, and how symptoms of bipolar disorder can influence the level of support received.MethodSemi-structured qualitative interviews were conducted with 20 individuals with bipolar disorder. Questions were designed to elicit: the effects of social interaction upon the management and course of bipolar disorder; and the impact of bipolar disorder upon social relationships. An inductive thematic analysis was used to analyse the data.ResultsEmpathy and understanding from another person can make it easier to cope with bipolar disorder. Social interaction can also provide opportunities to challenge negative ruminative thoughts and prevent the onset of a major mood episode. The loss of social support, particularly through bereavement, creates a loss of control and can trigger mania or depression. Hypomanic symptoms can facilitate new social connections, whereas disinhibited and risky behaviour exhibited during mania can cause the breakdown of vital relationships.ConclusionsAn in-depth clinical formulation of an individual's perceptions of how their illness affects and is affected by social interaction is crucial to understanding psychosocial factors which influence mood management. These results have clear application in interventions which aim to promote improved wellbeing and social functioning in bipolar disorder. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioners MessagesThe relationship between bipolar-related experiences and social interaction is complex and multi-faceted.Bipolar disorder can damage social relationships and create a loss of social control via extreme mood states, but it can also offer a social advantage through elevated self-confidence during hypomania and enhanced resilience post-recovery.Positive social experiences can facilitate better personal coping and enhanced mood management, whilst negative social experiences can trigger the onset of acute mood episodes.A comprehensive formulation of the reciprocal links between facets of bipolar disorder and characteristics of interpersonal relationships should be used to guide psychosocial interventions that aim to enhance emotion regulation and improve functioning.
      PubDate: 2016-11-13T20:50:24.813923-05:
      DOI: 10.1002/cpp.2055
  • Narrative Changes Predict a Decrease in Symptoms in CBT for Depression: An
           Exploratory Study
    • Authors: Miguel M. Gonçalves; Joana Ribeiro Silva, Inês Mendes, Catarina Rosa, António P. Ribeiro, João Batista, Inês Sousa, Carlos F. Fernandes
      Abstract: ObjectiveInnovative moments (IMs) are new and more adjusted ways of thinking, acting, feeling and relating that emerge during psychotherapy. Previous research on IMs has provided sustainable evidence that IMs differentiate recovered from unchanged psychotherapy cases. However, studies with cognitive behavioural therapy (CBT) are so far absent. The present study tests whether IMs can be reliably identified in CBT and examines if IMs and symptoms' improvement are associated.MethodsThe following variables were assessed in each session from a sample of six cases of CBT for depression (a total of 111 sessions): (a) symptomatology outcomes (Outcome Questionnaire—OQ-10) and (b) IMs. Two hierarchical linear models were used: one to test whether IMs predicted a symptom decrease in the next session and a second one to test whether symptoms in one session predicted the emergence of IMs in the next session.ResultsInnovative moments were better predictors of symptom decrease than the reverse. A higher proportion of a specific type of IMs—reflection 2—in one session predicted a decrease in symptoms in the next session. Thus, when clients further elaborated this type of IM (in which clients describe positive contrasts or elaborate on changes processes), a reduction in symptoms was observed in the next session.DiscussionA higher expression and elaboration of reflection 2 IMs appear to have a facilitative function in the reduction of depressive symptoms in this sample of CBT. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageElaborating innovative moments (IMs) that are new ways of thinking, feeling, behaving and relating, in the therapeutic dialogue, may facilitate change.IMs that are more predictive of amelioration of symptoms in CBT are the ones focused on contrasts between former problematic patterns and new adjusted ones; and the ones in which the clients elaborate on processes of change.Therapists may integrate these kinds of questions (centred on contrasts and centred on what allowed change from the client's perspective), in the usual CBT techniques.When elaborating these IMs successfully, therapists may expect an improvement in symptoms in the next session of psychotherapy. Copyright © 2016 John Wiley & Sons, Ltd.
      PubDate: 2016-10-20T21:50:22.435546-05:
      DOI: 10.1002/cpp.2048
  • Feasibility and Acceptability of the ‘HABIT’ Group Programme for
           Comorbid Bipolar and Alcohol and Substance use Disorders
    • Authors: Isabelle Biseul; Romain Icick, Perrine Seguin, Frank Bellivier, Jan Scott
      Abstract: ObjectivesWe investigated the feasibility and acceptability of an integrated group therapy (called HABIT) for comorbid bipolar disorder (BD) and alcohol and substance use disorders (ASUD) (BD-ASUD), a disabling clinical presentation for which no specific treatment has been validated. The 14-session HABIT programme employs psychoeducation-oriented cognitive-behaviour therapy (CBT) followed by mindfulness-based relapse prevention (MBRP) therapy.MethodPotential group participants were recruited from adult clients with a DSM-IV diagnosis of BD and an ASUD who were referred by their treating clinician. Observer-rated changes in mood symptoms and ASUD, attendance rates and subjective feedback are reported.ResultsEight of 12 clients referred to the programme initially agreed to join the group, six attended the first group session and five clients completed the programme. Group mean scores for mood symptoms improved over time, with slightly greater reductions in depression during the first module. About 50% of individuals showed clinically significant improvement (≥30% reduction) in alcohol and substance use. Attendance rates showed some variability between individuals and across sessions, but the average attendance rate of the group was marginally higher for the first module (86%) as compared with the second module (77%). Most clients reported high levels of general satisfaction with a group specifically targeted at individuals with BD-ASUD.ConclusionThis small pilot study suggests our intensive group therapy is acceptable and feasible. If findings are replicated, we may have identified a therapy that, for the first time, leads to improvement in both mood and substance use outcomes in clients with difficult-to-treat comorbid BD-ASUD. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageComorbidity between bipolar and alcohol and substance use disorders (BD-ASUD) is frequent and highly disabling;Therapeutic research on approaches that can simultaneously help BD and ASUD is lacking;Previous research highlights the need for integrated treatment of both conditions but showed improvements limited to either element of the comorbid disorder;This pilot study supports the feasibility and acceptability of an intensive, 14-session group therapy programme that integrates CBT and mindfulness approaches.
      PubDate: 2016-10-20T02:36:25.087015-05:
      DOI: 10.1002/cpp.2053
  • Well-being in Chronic Fatigue Syndrome: Relationship to Symptoms and
           Psychological Distress
    • Authors: H. Jackson; A. K. MacLeod
      Abstract: ObjectiveThere is growing recognition in psychology that wellness is more than the absence of disease and distress. Well-being has been defined in numerous ways. Two dominant models include Diener, Eunkook, Suh, Lucas and Smith's (1999) model of subjective well-being (SWB) and Ryff's (1989) model of psychological well-being (PWB). In contrast to the abundance of research investigating negative constructs and psychopathology in chronic fatigue syndrome (CFS), there has been a paucity of positive psychology studies. This study had two aims: to examine PWB and SWB and their relationship to symptoms in CFS and to compare PWB scores in a subgroup of the CFS sample to a matched control group.MethodChronic fatigue syndrome participants (n = 60) completed self-report scales of PWB, SWB, fatigue, anxiety and depression. PWB scores in a subgroup of the CFS sample (n = 42) were compared with those of a matched nonclinical control group (n = 42).ResultsCorrelations between scales of symptoms and well-being were complex. Well-being dimensions were largely independent of physical components of fatigue but strongly related to psychological components of fatigue and psychological distress. Multiple regression indicated that five dimensions of well-being uniquely predicted symptomatology. Compared with the control group, the CFS group scored significantly lower on five of Ryff's six PWB dimensions, with particularly marked deficits in personal growth, environmental mastery and self-acceptance.ConclusionThis multidimensional assessment of well-being advances our understanding of CFS and offers new treatment targets. Future research must investigate whether interventions targeting theses well-being deficits can boost the efficacy of symptom-focused treatments. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessagesPrevious psychological research into CFS has largely focused on the identification of negative constructs and CBT, a treatment that targets evidenced-based negative constructs, has demonstrated efficacy in reducing levels of fatigue and disability. However, the majority of people continue to experience psychiatric symptoms and excessive levels of fatigue post-treatment. Finding ways to enhance the efficacy of existing treatments is a clinical priority.There is evidence to suggest that in clinical populations, standard CBT is effective at reducing negative affect and thinking but fails to enhance low levels of positive affect and thinking, implying treatments may be more effective if they promote positive functioning alongside a reduction of negative functioning.Multidimensional models of well-being suggest that well-being is not a single phenomenon, and different psychological disorders may be characterized by varying well-being deficit profiles.Psychological well-being was found to be diminished in CFS participants compared with controls, with particularly marked deficits in personal growth, environmental mastery and self-acceptance, suggesting that these may be particularly important treatment targets.Well-being dimensions within the CFS group were largely independent of physical symptoms but strongly related to psychological symptoms, suggesting what may be causing low levels of well-being in CFS is largely psychological factors and the general impact of living with a chronic illness rather than symptom levels per se.
      PubDate: 2016-10-13T21:46:12.982242-05:
      DOI: 10.1002/cpp.2051
  • Psychometric Properties and Normative values of Early Maladaptive Schema
           Questionnaires Set for Children and Adolescents (SQS)
    • Authors: Olcay Güner
      Abstract: The Early Maladaptive Schema Questionnaires Set for Children and Adolescents (SQS) was developed to assess early maladaptive schemas in children between the ages of 10 and 16 in Turkey. The SQS consists of five questionnaires that represent five schema domains in Young's schema theory.Psychometric properties (n = 983) and normative values (n = 2250) of SQS were investigated in children and adolescents between the ages of 10 and 16. Both exploratory and confirmatory factor analyses were performed. Results revealed 15 schema factors under five schema domains, with good fit indexes. A total of 14 schema factors were in line with Young's early maladaptive schemas. In addition to these factors, one new schema emerged: self-disapproval. Reliability analyses showed that SQS has high internal consistency and consistency over a 1-month interval. Correlations of SQS with the Adjective Check List (ACL), the Inventory of Parent and Peer Attachment (IPPA), the Symptom Assessment (SA-45) and the Young Schema Questionnaire (YSQ) were investigated to assess criterion validity, and the correlations revealed encouraging results. SQS significantly differentiated between children who have clinical diagnoses (n = 78) and children who have no diagnosis (n = 100). Finally, general normative values (n = 2,250) were determined for age groups, gender and age/gender groups. In conclusion, the early maladaptive schema questionnaires set for children and adolescents turned out to be a reliable and valid questionnaire with standard scores.Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageThe early maladaptive schema questionnaires set for children and adolescents (SQS) is a psychometrically reliable and valid measure of early maladaptive schemas for children between the ages of 10 and 16.SQS consists of five schema domains that represent Young's schema domains including 15 early maladaptive schemas and 97 items.Normative values for each schema were determined for age, gender and age/gender groups.Clinically, SQS presents valuable information about early maladaptive schemas during childhood and adolescence, before such schemas become more pervasive and persistent.
      PubDate: 2016-10-13T21:41:11.349583-05:
      DOI: 10.1002/cpp.2049
  • Four Pathways to Anorexia Nervosa: Patients' Perspective on the Emergence
           of AN
    • Authors: Kjersti S. Gulliksen; Ragnfrid H. S. Nordbø, Ester M. S. Espeset, Finn Skårderud, Arne Holte
      Abstract: IntroductionStudies show that patients' perception of their illness has a direct influence both on their utilization of health services and their adherence to treatment plans. This may be particularly relevant to the treatment of Anorexia Nervosa (AN). Previous studies on AN have typically explored single psycho-social factors that patients with AN relate to the emergence of their illness. There is a need for more coherent systematic descriptions of the complexity of the patients' narratives about how their illness emerged. In this study, we sought to identify common components in the participants' narratives. By identifying different combinations of these components in the narratives, we sought to describe differences in patients' perceived pathways to AN.MethodsParticipants were 36 women aged 18–51 years who had been treated for AN within the past 2 years at five clinical institutions in Norway. Semi-open qualitative interviews were conducted, tape-recorded, transcribed and analysed using grounded theory techniques.ResultsWe identified the following four distinct perceived pathways into AN: ‘The Avoidant’, ‘The Achiever’, ‘The Transformer’ and ‘The Punisher’. The pathways could be regarded as four different projects for mastering life's challenges.DiscussionOur results suggest that there seem to be at least four pathways into AN. This indicates that a common array of symptoms might cover very different psychological dynamics. These might need to be treated therapeutically in different ways and should probably be taken into account during the refinement of diagnostic tools. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageAlthough patients with AN might present similar symptoms, patients' perspectives on the emergence of their problems indicate that a common array of symptoms cover a variety of subjective psychological dynamics.From the experienced patient's stance, there are at least four distinct pathways to the emergence of AN.Attempts to master the challenges of life were found to be a common denominator in the emergence of AN.Recognition and integration of the patient's understanding of her or his problems should be given high priority in treatment of AN.
      PubDate: 2016-10-11T02:35:24.734659-05:
      DOI: 10.1002/cpp.2050
  • Bridging the Gap between Aetiological and Maintaining Factors in Social
           Anxiety Disorder: The Impact of Socially Traumatic Experiences on Beliefs,
           Imagery and Symptomatology
    • Authors: Alice R. Norton; Maree J. Abbott
      Abstract: BackgroundA number of key environmental factors during childhood have been implicated in the aetiology of social anxiety disorder (SAD), including aversive social experiences, traumatic life events and parent–child interaction. However, understanding the nature, interactions and relative contributions of these factors remains unclear. Furthermore, the relation of aversive social experiences to the development of key maintaining factors in SAD requires elucidation.AimsThe current study aimed to extend previous research regarding the aetiology of SAD by investigating the relationship between key environmental factors in childhood, negative beliefs and self-imagery, and the development of SAD.MethodSocial anxiety disorder individuals (n = 40, 87.5% female, Mage = 20.25 years) completed self-report measures of social anxiety symptomatology, traumatic experiences and parenting style. In addition, participants were administered interviews assessing various domains of childhood trauma, as well as negative self-imagery and associated socially traumatic memories.ResultsParticipants reported a high frequency of early traumatic experiences across all domains (physical, emotional, sexual, social and non-relational), as well as a high degree of parental overcontrol. However, social anxiety symptomatology was most strongly correlated with socially traumatic experiences, and mediation analyses suggest that appraisal of aversive social/peer experiences accounts for the relationship of SAD symptomatology with negative self-beliefs and imagery.ConclusionsThese outcomes suggest that social trauma may be a key proximal cause of SAD development, leading to the development of negative beliefs and imagery that subsequently maintain the disorder. These findings have implications for understanding SAD aetiology, and improving treatment outcomes for the disorder. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessagesNegative social experiences have been implicated in the development of social anxiety disorder (SAD), but the role of this predisposing factor remains unclear.Compared with other risk factors for SAD, social anxiety symptomatology was most strongly correlated with socially traumatic experiences.Mediation analyses suggested that appraisal of aversive social experiences accounted for the relationship of SAD symptomatology with negative self-beliefs and imagery.These outcomes suggest that SAD individuals would benefit from interventions targeted at processing socially traumatic memories (e.g., imagery rescripting).
      PubDate: 2016-10-11T01:56:44.631398-05:
      DOI: 10.1002/cpp.2044
  • A Novel Approach to Treating CFS and Co-morbid Health Anxiety: A Case
    • Authors: Jo Daniels; Maria E. Loades
      Abstract: ObjectivesChronic Fatigue Syndrome (CFS) is a debilitating condition that affects 0.2–0.4% of the population. First-line treatments are Cognitive Behaviour Therapy or graded exercise therapy; however, these treatments yield only moderate effect sizes. Emerging research suggests that anxiety about health may be common in CFS. Health anxiety treatment models demonstrate good therapeutic outcomes; however, these models have yet to be applied to CFS. This paper describes the application of a novel cognitive behavioural approach to the treatment of both physical and anxiety related symptoms in a patient with CFS and, furthermore, presents a conceptual hypothesis regarding the mutually maintaining relationship between these two co-occurring conditions.DesignA single-case design was used, with pre-data, post-data and follow-up data. The cognitive behavioural model of health anxiety was adapted and delivered as an eight-session intervention. The intervention was driven by an individualized formulation developed collaboratively with the patient.ResultsThe application of this approach generated reliable and clinically significant reductions in physical and psychological symptoms, which were maintained at 12-month follow-up. The participant no longer fulfilled the criteria for CFS or health anxiety following eight treatment sessions. The treatment approach was found to be agreeable to the patient. All treatment hypotheses were supported.ConclusionsAn adapted cognitive behavioural approach to treating CFS and health anxiety yields positive results and shows promise for application to the broader CFS population. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessagesChronic Fatigue Syndrome (CFS) is a debilitating condition that is difficult to treat successfully; first-line recommended treatments achieve only moderate effect sizes.Anxiety, particularly about health, is reported to be common in CFS. However, anxiety is not specifically targeted within treatment and may negatively influence outcome due to the potentially mutually maintaining nature of these complex conditions.The present study demonstrates that an integrated treatment approach designed to encompass physical and psychological symptoms yields reliable and clinically significant outcomes in 50% of time recommend for first line treatments.Results reflected non-case level status for both CFS and health anxiety at end of treatment, in addition to reductions across all clinical measures.This study demonstrates the fundamental importance of an individualized, rather than generic, treatment approach to complex cases; the ‘meaning’ of experience is a central tenet within a cognitive approach that should be reflected in treatment.
      PubDate: 2016-10-06T20:45:43.418148-05:
      DOI: 10.1002/cpp.2042
  • Change Factors in the Process of Cognitive-Behavioural Therapy for
           Obsessive–Compulsive Disorder
    • Authors: C. Schwartz; S. Hilbert, C. Schubert, S. Schlegl, T. Freyer, B. Löwe, B. Osen, U. Voderholzer
      Abstract: While there is a plethora of evidence for the efficacy of cognitive-behavioural therapy (CBT) in obsessive–compulsive disorder (OCD), studies on change factors of the therapeutic process that account for this success are scarce. In the present study, 155 participants with primary OCD were investigated during CBT inpatient treatment. The Yale–Brown Obsessive–Compulsive Scale-SR served as a measure of symptom severity. In addition, the following process change factors were measured: therapeutic relationship, experience of self-esteem during therapy, experience of mastery, problem actualization and clarification. All variables were assessed on a weekly basis for seven weeks. Linear mixed growth curve analyses were conducted to model the decrease of symptoms over time and to analyse whether the change factors predicted symptom reduction. The analyses revealed a linear decrease of symptoms with high inter-individual variation. Results further showed that increase in self-esteem and mastery experiences as well as the initial score on mastery experience and clarification predicted decrease on the Y-BOCS. We conclude that CBT therapists should focus on clarification in the very first sessions, and try to boost self-esteem and self-efficacy, which is related to mastery, throughout the treatment of OCD. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageIncrease in mastery and self-esteem experiences are associated with symptom decrease in obsessive–compulsive disorder (OCD) during cognitive-behavioural therapy (CBT).Initial score of mastery experiences and problem clarification predict symptom decrease in OCD during CBT.CBT therapists should focus on problem clarification in the very first sessions and try to boost self-esteem and self-efficacy throughout the treatment of OCD.
      PubDate: 2016-10-03T23:27:42.921883-05:
      DOI: 10.1002/cpp.2045
  • Becoming Therapeutic Agents: A Grounded Theory of Mothers' Process When
           Implementing Cognitive Behavioural Therapy at Home with an Anxious Child
    • Authors: Rana Pishva
      Abstract: The premise of parent-centred programmes for parents of anxious children is to educate and train caregivers in the sustainable implementation of cognitive behaviour therapy (CBT) in the home. The existing operationalization of parent involvement, however, does not address the systemic, parent or child factors that could influence this process. The qualitative approach of grounded theory was employed to examine patterns of action and interaction involved in the complex process of carrying out CBT with one's child in one's home. A grounded theory goes beyond the description of a process, offering an explanatory theory that brings taken-for-granted meanings and processes to the surface. The theory that emerged from the analysis suggests that CBT implementation by mothers of anxious children is characterized by the evolution of mothers' perception of their child and mothers' perception of their role as well as a shift from reacting with emotion to responding pragmatically to the child. Changes occur as mothers recognize the crisis, make links between the treatment rationale, child's symptoms and their own parenting strategies, integrate tenets of CBT for anxiety and eventually focus on sustaining therapeutic gains through natural life transitions. The theory widens our understanding of mothers' role, therapeutic engagement, process, and decision-making. The theory also generates new hypotheses regarding parent involvement in the treatment of paediatric anxiety disorders and proposes novel research avenues that aim to maximize the benefits of parental involvement in the treatment of paediatric anxiety disorders. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageMothers of anxious youth who take part in parent-centred programmes experience a shift in their perception of the child and of their role.Parental strategy after CBT implementation shifts from emotional empathy to cognitive empathy.Mothers experience significant challenges and require additional support in prevention of relapse and knowledge translation.
      PubDate: 2016-09-29T23:40:44.406552-05:
      DOI: 10.1002/cpp.2046
  • ‘Many die in the hurricane’: An Interpretative Phenomenological
           Analysis of Adults with Psychosis and a History of Childhood Physical
    • Authors: J. E. Rhodes; L. J. Healey
      Abstract: The study aimed to investigate the experience of adults with a diagnosis of psychosis and who have survived childhood physical abuse. We interviewed eight participants and used interpretative phenomenological analysis to generate themes. The main themes were of perceiving an everyday world of aggression and contempt by others, pervasive mistrust, feeling isolated and for some, attacking oneself with hate. Most participants were also able to reflect on what they saw as ‘paranoia’ or ‘voices’. Paranoia was described as a fluctuating compulsive ‘thread’ of meaning, feeling and sometimes a transformation of the self. The paranoia and voices experienced often involved a dread of murderous obliteration. The discussion considers the relevance of altered consciousness, psychotic states of self and the contribution of mutating narrative and meaning. Our findings point to the importance of therapy for interpersonal difficulties and the long-term effects of trauma. Copyright © 2016 John Wiley & Sons, Ltd.
      PubDate: 2016-09-29T20:05:25.931639-05:
      DOI: 10.1002/cpp.2043
  • What are People's Experiences of a Novel Cognitive Behavioural Therapy for
           Bipolar Disorders' A Qualitative Investigation with Participants on
           the TEAMS Trial
    • Authors: Emmeline Joyce; Sara Tai, Piersanti Gebbia, Warren Mansell
      Abstract: BackgroundPsychological interventions for bipolar disorders typically produce mixed outcomes and modest effects. The need for a more effective intervention prompted the development of a new cognitive behavioural therapy, based on an integrative cognitive model (‘Think Effectively About Mood Swings’ [TEAMS] therapy). Unlike previous interventions, TEAMS addresses current symptoms and comorbidities, and helps clients achieve long-term goals. A pilot randomized controlled trial (the TEAMS trial) of the therapy has recently concluded. This study explored participants' experiences of TEAMS, recommendations for improvement and experiences of useful changes post-therapy.MethodsFourteen TEAMS therapy participants took part in semi-structured interviews. Their accounts were analysed using interpretative thematic analysis. Two researchers coded the dataset independently. Member checks were conducted of the preliminary themes.ResultsTwo overarching themes; ‘useful elements of therapy’ and ‘changes from therapy’ encompassed 12 emerging subthemes. Participants appreciated having opportunities to talk and described the therapy as person-centred and delivered by caring, approachable and skilled therapists. Some recommended more sessions than the 16 provided. Helpful therapeutic techniques were reported to be, normalization about moods, methods to increase understanding of moods, relapse-prevention, reappraisal techniques and metaphors. However, some did not find therapeutic techniques helpful. Post-therapy, many reported changes in managing mood swings more effectively and in their thinking (although some participants reported changes in neither). Many described increased acceptance of themselves and of having bipolar disorder, increased productivity and reduced anxiety in social situations.ConclusionsThe present study evaluates participants' therapy experiences in detail, including aspects of therapy viewed as helpful, and meaningful post-therapy outcomes. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageThis is the first paper to qualitatively explore people's experiences of individual psychotherapy for bipolar disorders. It highlights elements of psychotherapy described as particularly helpful or unhelpful and the clinical changes viewed as most impactful.Participants reported benefitting in a number of ways from TEAMS therapy. They valued learning to reappraise and problem-solve situations and manage moods.Participants identified TEAMS techniques as helpful, such as exploring advantages and disadvantages of moods, and building healthy self-states.
      PubDate: 2016-09-21T20:50:24.43026-05:0
      DOI: 10.1002/cpp.2040
  • Emotional Processing Theory Put to Test: A Meta-Analysis on the
           Association Between Process and Outcome Measures in Exposure Therapy
    • Authors: Christian Rupp; Philipp Doebler, Thomas Ehring, Anna N. Vossbeck-Elsebusch
      Abstract: In order to test the predictions derived from emotional processing theory (EPT), this meta-analysis examined correlations between outcome of exposure therapy and three process variables: initial fear activation (IFA), within-session habituation (WSH) and between-session habituation (BSH). Literature search comprised a keyword-based search in databases, a reverse search and the examination of reference lists. Of the 21 studies included in the analyses, 17 provided data concerning IFA (57 endpoints, total N = 490), five concerning WSH (7 endpoints, total N = 116) and eight concerning BSH (22 endpoints, total N = 304). Owing to this data structure, analyses were performed using robust variance estimation with random-effects models being assumed a priori.Results indicated that WSH and BSH are positively related to treatment outcome. By contrast, the statistical association between IFA and outcome of exposure was not confirmed, whereas our moderator analysis suggested that physiological process measures lead to higher correlations than non-physiological ones. The results for IFA and BSH were affected by selective reporting. In sum, our results do not specifically strengthen EPT while matching other theoretical perspectives such as inhibitory learning and reality testing. Further research is needed to provide recommendations concerning the best way of delivering exposure therapy.Key Practitioner Message:This meta-analysis examined three variables of emotional processing theory (EPT).Initial fear activation was not linearly related to outcomes of exposure therapy.Habituation within and between sessions were shown to correlate with outcome.Outcome reporting bias was shown to play a crucial role in this meta-analysis.Results do not specifically support EPT. Copyright © 2016 John Wiley & Sons, Ltd.
      PubDate: 2016-08-26T02:55:25.710053-05:
      DOI: 10.1002/cpp.2039
  • Psychologists' Perspectives on Therapy Termination and the Use of Therapy
           Engagement/Retention Strategies
    • Authors: Robin Westmacott; John Hunsley
      Abstract: Practicing psychologists (n = 269) were surveyed regarding their perspectives on client reasons for termination at different points in therapy and their use of strategies to engage and retain clients in therapy. Psychologists estimated that one-third of their caseload unilaterally terminated (M = 13% before the third therapy session; M = 20% after the third session). They viewed lack of readiness for change/insufficient motivation as the most important barrier to early treatment engagement, and symptom improvement as the most important reason for clients' unilateral decisions to end therapy after the third session. Most psychologists reported occasional use of the majority of engagement and retention strategies. Although some strategies were used by most psychologists (e.g., building the early working alliance), fewer than 25% of psychologists reported the frequent use of time-limited treatment, appointment reminders or case management procedures. As the implementation of these strategies in clinical practice has the potential to greatly influence client retention rates, future research should examine psychologists' perspectives on and barriers to using these strategies. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageTherapists tend to underestimate the number of clients who make unilateral decisions to end treatment in their own practices. Therapists are unlikely to take steps to engage and retain clients in treatment unless they believe that unilateral termination is a significant problem.Clients who unilaterally end treatment are often experiencing problems with the process of therapy (e.g., dissatisfaction, lack of fit, feeling as though therapy is going nowhere), whereas therapists often attribute failed therapy to clients. It is important to be aware of this tendency and look for other explanations.It is worthwhile to actively solicit clients' barriers in an effort to mitigate them.The empirical literature provides ample evidence that it is helpful for therapists to deliberately employ strategies to engage and retain clients in therapy. All therapists would benefit from considering which strategies fit with their practices.Although almost all therapists emphasize building the early working alliance, and this is essential to good outcome, other evidence-based methods of engaging clients in therapy are largely underutilized, such as systematically monitoring client progress and barriers, placing time limits on treatment, using appointment reminders, and case management.
      PubDate: 2016-08-25T02:45:21.493712-05:
      DOI: 10.1002/cpp.2037
  • The Experimental Manipulation of Desire Thinking in Alcohol use Disorder
    • Authors: Gabriele Caselli; Antonella Gemelli, Marcantonio M. Spada
      Abstract: ObjectiveDesire thinking is a voluntary cognitive process involving verbal and imaginal elaboration of a desired target. Recent research has revealed that desire thinking may play a significant role in the escalation of craving. The goal of this study was to explore the effect of a desire thinking induction on craving in a sample of patients with alcohol use disorder.MethodsTen patients with alcohol use disorder were exposed to a brief exposure to alcohol-related thoughts plus desire thinking induction versus brief exposure to alcohol-related thoughts plus distraction.ResultsThe induction of desire thinking led to a significant increase in distress and urge to use alcohol when compared to a behavioural assessment test and a distraction task. The clinical implications for the treatment of alcohol use disorder are discussed. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessagePsychotherapeutic strategies that target desire thinking, both at the assessment and at the intervention levels, may be relevant in the treatment of craving-related problems.Deriving and illustrating the role of desire thinking in a given episode of craving may support the development of metacognitive awareness about its functions and consequences. Copyright © 2016 John Wiley & Sons, Ltd.
      PubDate: 2016-08-19T00:25:46.523686-05:
      DOI: 10.1002/cpp.2038
  • Evaluation of Life Events in Major Depression: Assessing Negative
           Emotional Bias
    • Authors: Laura Girz; Erin Driver-Linn, Gregory A. Miller, Patricia J. Deldin
      Abstract: BackgroundOverly negative appraisals of negative life events characterize depression but patterns of emotion bias associated with life events in depression are not well understood. The goal of this paper is to determine under which situations emotional responses are stronger than expected given life events and which emotions are biased.MethodsDepressed (n = 16) and non-depressed (n = 14) participants (mean age = 41.4 years) wrote about negative life events involving their own actions and inactions, and rated the current emotion elicited by those events. They also rated emotions elicited by someone else's actions and inactions. These ratings were compared with evaluations provided by a second, ‘benchmark’ group of non-depressed individuals (n = 20) in order to assess the magnitude and direction of possible biased emotional reactions in the two groups.ResultsParticipants with depression reported greater anger and disgust than expected in response to both actions and inactions, whereas they reported greater guilt, shame, sadness, responsibility and fear than expected in response to inactions. Relative to non-depressed and benchmark participants, depressed participants were overly negative in the evaluation of their own life events, but not the life events of others.ConclusionA standardized method for establishing emotional bias reveals a pattern of overly negative emotion only in depressed individuals' self-evaluations, and in particular with respect to anger and disgust, lending support to claims that major depressives' evaluations represent negative emotional bias and to clinical interventions that address this bias. Copyright © 2016 John Wiley & Sons, Ltd.
      PubDate: 2016-08-08T22:19:48.788483-05:
      DOI: 10.1002/cpp.2033
  • Misclassification of Self-Directed Violence
    • Authors: Jan Christopher Cwik; Tobias Teismann
      Abstract: BackgroundInconsistent nomenclature and classification of suicidal behaviour have plagued the field of suicidology for a long time. Recently, the United States Centers for Disease Control (CDC) advocated for the usage of a specific classification system. Aim of the current study was to determine the extent of misdiagnosed acts of self-directed violence—controlling for the level of expertise in psychology/psychotherapy. Additionally, the effect of gender and diagnosis on misclassifications was assessed.MethodA total of 426 participants (laypersons, psychology students, psychotherapists-in-training, licensed psychotherapists) were presented with an array of case vignettes describing different acts of self-directed violence (e.g., non-suicidal self-directed violence, suicide attempt, suicide ideation) and were asked to make a classification. Gender and given diagnosis were varied systematically in two vignettes.ResultsOverall 51.6% of the cases were misclassified (according to the Self-Directed Violence Classification System). The level of expertise was almost unrelated to classification correctness. Yet, psychotherapists were more confident about their judgments. Female gender of the character described in the vignette and an ascribed diagnosis of Borderline Personality Disorder were associated with higher misclassification rates.LimitationsThe validity of case vignettes is discussible.ConclusionsThe results highlight the importance of more methodological and diagnostic training of psychologists regarding suicidal issues. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageMisclassification of non-suicidal and suicidal events is common.Expertise is only weakly associated with classification correctness.Misclassification of suicide attempts occurs more often in women.Misclassification of suicide attempts occurs more often in Borderline Personality Disorder.The use of standardized diagnostic tools in relation to self-directed violence is highly recommended.
      PubDate: 2016-08-02T01:17:07.531042-05:
      DOI: 10.1002/cpp.2036
  • A Semantic Corpus Comparison Analysis of Couple-Focused Interventions for
           Problematic Alcohol Use
    • Authors: Emily C. Soriano; Kelly E. Rentscher, Michael J. Rohrbaugh, Matthias R. Mehl
      Abstract: Incorporating spouses into interventions for problematic alcohol use is associated with increased efficacy; yet, little is known about the therapeutic processes that may explain these effects. In a study of partner language use during couple-focused alcohol interventions, we utilized a linguistic corpus comparison tool, Wmatrix, to identify semantic themes that differentiated couples with successful and unsuccessful treatment outcomes and may therefore also reflect potential change processes. Thirty-three couples participated in a randomized control trial of Family Systems Therapy (FST) or Cognitive Behavioural Therapy (CBT). Linguistic comparisons of partners' speech during the therapy sessions suggested that drinks and alcohol was a significant differentiating semantic theme. Specifically, patients and spouses in FST with successful outcomes used more language related to drinks and alcohol than patients and spouses in FST with unsuccessful outcomes. Post-hoc analyses of context suggested that, in FST, successful spouses spoke less about the patient's drinking and more about alcohol in general (without reference to an individual) than unsuccessful spouses. Conversely, spouses in CBT with successful outcomes used less language related to drinks and alcohol than spouses in CBT with unsuccessful outcomes. In CBT, successful spouses spoke more about the patient's and couple's drinking and less about the spouse's and other people's drinking than unsuccessful spouses. Results emphasize the role of spouse behaviour—in this case indexed via language use—in alcohol treatment outcomes. Findings also suggest potentially distinct therapeutic processes in FST and CBT and highlight the utility of linguistic corpus comparison methods in couple-focused intervention research. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageIncorporating spouses into interventions for problematic alcohol use is associated with increased efficacy; yet, little is known about the specific therapeutic processes that may explain these effects.Findings from this study suggest that semantic themes such as drinks and alcohol in partner speech during therapy sessions differentiate successful and unsuccessful treatment outcomes among couples participating in two couple-focused interventions for problematic alcohol use.In addition, the context in which partners used alcohol-related language differed by intervention type and treatment outcome, which suggests potential therapeutic processes that are unique to the two interventions (Family Systems versus Cognitive Behavioural Therapy).
      PubDate: 2016-08-02T01:01:04.551293-05:
      DOI: 10.1002/cpp.2030
  • Developing a Compassionate Internal Supervisor: Compassion-Focused Therapy
           for Trainee Therapists
    • Authors: Tobyn Bell; Alison Dixon, Russell Kolts
      Abstract: The concept of an ‘internal supervisor’ has been used in psychotherapy to describe the way in which the supervisory relationship is internalized and utilized by the supervisee. This research explores the possibility, and potential benefit, of training therapists to develop a ‘compassionate internal supervisor’. A training programme was developed for trainee cognitive-behavioural therapists using adapted versions of compassion-focused therapy interventions. The training focused on guided imagery exercises and reflective practices undertaken for a 4-week period. Seven trainee cognitive-behavioural therapists were interviewed, utilizing a semi-structured format, regarding their experience of the training programme. The resulting transcriptions were analysed using Interpretative Phenomenological Analysis (IPA). The analysis identified six super-ordinate themes: (1) the varied nature of the supervisor image, (2) blocks and their overcoming, (3) increased compassion and regulation of emotion, (4) impact on cognitive processes, (5) internalization and integration, and (6) professional and personal benefit. The themes describe the varied ways in which participants created and experienced their compassionate supervisor imagery. Working with the personal blocks encountered in the process provided participants with a deeper understanding of the nature of compassion and its potential to support them in their training, practice and personal lives. The process and impact of ‘internalizing’ a compassionate supervisory relationship is described by participants and then discussed for potential implications for psychotherapy training and self-practice. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageCompassion-focused therapy, and related compassionate-mind imagery exercises, can be adapted specifically to develop compassion in trainee psychotherapists.Creating, and engaging with, an ’ideal compassionate supervisor‘ in an imaginal form can support psychotherapy trainees in their clinical practice and development, their supervision and their personal lives.The cultivation of therapist self-compassion can reduce unhelpful cognitive processes such as worry, rumination and self-criticism whilst increasing self-reflection, attentional flexibility and approach behaviour.Identifying, and working with, blocks to compassion is important when cultivating clinician self-compassionTherapist self-practice of compassion-focused exercises can provide important insights into the nature of compassion and its cultivation in clients
      PubDate: 2016-07-25T21:40:24.244814-05:
      DOI: 10.1002/cpp.2031
  • Effectiveness of Short-Term Dynamic Group Psychotherapy in Primary Care
           for Patients with Depressive Symptoms
    • Authors: Ignasi Bros; Pere Notó, Antoni Bulbena
      Abstract: An open prospective controlled study was designed to compare the efficacy of short-term dynamic group psychotherapy with the standard treatment in patients with depressive symptoms attended in the primary care setting. A total of 115 patients with depressive symptoms were assigned to receive psychotherapy (75 min) over 9 months (37 to 39 sessions) (n = 70) or the standard care (n = 45). Outcome measures were the differences between baseline and post-treatment in the 17-item Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HAM-A) and the Short-Form Health Survey (SF-12) questionnaire in the two study groups. At the end of dynamic group psychotherapy, statistically significant improvements in the mean scores of all questionnaires were observed, whereas in control patients, significant improvements were only observed in the HDRS-17 scale and in the Mental Component Summary score of the SF-12. The mean changes after treatment were also higher in the psychotherapy group than in controls in all outcome measures, with statistically significant differences in the mean differences in favour of the psychotherapy group. In summary, implementation of short-term dynamic group psychotherapy run by experienced psychotherapists for patients with depressive symptoms attended in routine primary care centres is feasible and effective.Key Practitioner MessageShort-term dynamic group psychotherapy was delivered as a non-pharmacological intervention to improve depressive symptoms.Statistically significant differences as compared with a control group were observed in 17-item Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HAM-A) and the Short-Form Health Survey (SF-12) questionnaire.Implementation of short-term dynamic group psychotherapy run by experienced psychotherapists for patients with depressive symptoms attended in routine primary care centres is feasible and effective. © 2016 The
      Authors Clinical Psychology & Psychotherapy Published by John Wiley & Sons Ltd
      PubDate: 2016-07-25T21:25:27.124836-05:
      DOI: 10.1002/cpp.2029
  • The Effects of Waiting for Treatment: A Meta-Analysis of Waitlist Control
           Groups in Randomized Controlled Trials for Social Anxiety Disorder
    • Authors: Christiane Steinert; Katja Stadter, Rudolf Stark, Falk Leichsenring
      Abstract: Social anxiety disorder (SAD) is a highly prevalent mental disorder. However, little is known about how SAD changes in subjects who do not receive treatment. Waitlist control groups (WLCGs) are frequently included in randomized controlled trials (RCTs) on the treatment of mental disorders. Data from WLCGs are of value as they provide information on the untreated short-term course of a disorder and may serve as disorder-specific norms of change (benchmarks) against which treatment outcomes of SAD can be compared. Thus, we performed a meta-analysis focusing on the effects occurring in WLCGs of RCTs for SAD.Our study was conducted along the PRISMA guidelines. Thirty RCTs (total n = 2460) comprising 30 WLCGs and 47 treatment groups were included. Mean waiting time was 10.6 weeks. The pooled effect of waiting on SAD measures was g = 0.128 (95% CI: 0.057–0.199). Effects regarding other forms of anxiety, depression and functioning were of similarly small size. In contrast, change in the treatment groups was large, both within (g = 0.887) and between groups (g = 0.860). Our results show that for SAD, changes occurring in WLCGs of RCTs are small. The findings may serve as benchmarks in pilot studies of a new treatment or as an additional comparison in studies comparing two active treatments. For psychotherapy research in general, the small effect sizes found in WLCGs confirm that testing a treatment against a waiting list is not a very strict test. Further research on WLCGs in specific mental disorders is required, for example examining the expectancies of patients randomized to waiting. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageIn clinical practice, patients suffering from a mental disorder often have to wait for treatment. By analyzing data from waitlist control groups we can gain estimates of symptom change that occur during waiting.It could be seen that waiting for treatment only results in a negligible effect. Thus, in the short-term (i.e., 10.6 weeks) time is no healer in social anxiety disorder.Our results are similar to previous meta-analyses on the effects of waiting in other disorders, e.g., depression and posttraumatic stress disorder. Copyright © 2016 John Wiley & Sons, Ltd.
      PubDate: 2016-07-22T02:06:37.656794-05:
      DOI: 10.1002/cpp.2032
  • Understanding the ‘Anorexic Voice’ in Anorexia Nervosa
    • Authors: Matthew Pugh; Glenn Waller
      Abstract: In common with individuals experiencing a number of disorders, people with anorexia nervosa report experiencing an internal ‘voice’. The anorexic voice comments on the individual's eating, weight and shape and instructs the individual to restrict or compensate. However, the core characteristics of the anorexic voice are not known. This study aimed to develop a parsimonious model of the voice characteristics that are related to key features of eating disorder pathology and to determine whether patients with anorexia nervosa fall into groups with different voice experiences. The participants were 49 women with full diagnoses of anorexia nervosa. Each completed validated measures of the power and nature of their voice experience and of their responses to the voice. Different voice characteristics were associated with current body mass index, duration of disorder and eating cognitions. Two subgroups emerged, with ‘weaker’ and ‘stronger’ voice experiences. Those with stronger voices were characterized by having more negative eating attitudes, more severe compensatory behaviours, a longer duration of illness and a greater likelihood of having the binge–purge subtype of anorexia nervosa. The findings indicate that the anorexic voice is an important element of the psychopathology of anorexia nervosa. Addressing the anorexic voice might be helpful in enhancing outcomes of treatments for anorexia nervosa, but that conclusion might apply only to patients with more severe eating psychopathology. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageExperiences of an internal ‘anorexic voice’ are common in anorexia nervosa.Clinicians should consider the role of the voice when formulating eating pathology in anorexia nervosa, including how individuals perceive and relate to that voice.Addressing the voice may be beneficial, particularly in more severe and enduring forms of anorexia nervosa.When working with the voice, clinicians should aim to address both the content of the voice and how individuals relate and respond to it.
      PubDate: 2016-07-20T02:45:29.010738-05:
      DOI: 10.1002/cpp.2034
  • The Contribution of Therapist Effects to Patient Dropout and Deterioration
           in the Psychological Therapies
    • Authors: David Saxon; Michael Barkham, Alexis Foster, Glenys Parry
      Abstract: BackgroundIn the psychological therapies, patient outcomes are not always positive. Some patients leave therapy prematurely (dropout), while others experience deterioration in their psychological well-being.MethodsThe sample for dropout comprised patients (n = 10 521) seen by 85 therapists, who attended at least the initial session of one-to-one therapy and completed a Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at pre-treatment. The subsample for patient deterioration comprised patients (n = 6405) seen by the same 85 therapists but who attended two or more sessions, completed therapy and returned a CORE-OM at pre-treatment and post-treatment. Multilevel modelling was used to estimate the extent of therapist effects for both outcomes after controlling for patient characteristics.ResultsTherapist effects accounted for 12.6% of dropout variance and 10.1% of deterioration variance. Dropout rates for therapists ranged from 1.2% to 73.2%, while rates of deterioration ranged from 0% to 15.4%. There was no significant correlation between therapist dropout rate and deterioration rate (Spearman's rho = 0.07, p = 0.52).ConclusionsThe methods provide a reliable means for identifying therapists who return consistently poorer rates of patient dropout and deterioration compared with their peers. The variability between therapists and the identification of patient risk factors as significant predictors has implications for the delivery of safe psychological therapy services. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageTherapists play an important role in contributing to patient dropout and deterioration, irrespective of case mix.Therapist effects on patient dropout and deterioration appear to act independently.Being unemployed as a patient was the strongest predictor of both dropout and deterioration.Patient risk to self or others was also an important predictor.
      PubDate: 2016-07-17T22:25:57.688875-05:
      DOI: 10.1002/cpp.2028
  • Accommodation of Symptoms in Anorexia Nervosa: A Qualitative Study
    • Authors: John R. E. Fox; Anna Whittlesea
      Abstract: Anorexia nervosa (AN) continues to remain poorly understood within eating disorders. Recent research and theory have moved away from understanding its aetiological causes, addressing instead potential maintaining factors. This study is focused on interpersonal maintenance factors: the response of close others. Relatives of those with AN typically carry the main burden of care, and research has found high levels of carer distress and unmet needs. Recent theories have proposed this emotional impact to contribute to expressed emotion and other unhelpful caregiver interactions which inadvertently maintain AN. One such understudied response is accommodation, described as a ‘process’ whereby caregivers ‘assist or participate’ in symptomatic behaviours of the cared for individual. There is a dearth of research relating to accommodation within eating disorders, particularly qualitative accounts. This study utilized a grounded theory methodology to explore caregivers' responses to managing AN, focusing particularly on carers' experience of accommodation. Eight participants with experience of caring for an individual diagnosed with AN were interviewed. Participants were recruited from a national eating disorder charity and regional eating disorder service. A number of themes emerged, including the importance of caregivers' emotional resources in mediating accommodation responses. Low-perceived efficacy over AN contributed to caregiver burnout. Decreased emotional resources influenced a shift in caregiving aims conducive with accommodation. Nevertheless, carers perceived accommodation as counterproductive to recovery and consequently experienced internal conflict (cognitive dissonance). Dissonance was reduced using a number of cognitive and behavioural strategies. The implications of these findings are discussed with reference to existing literature. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageAnorexia nervosa (AN) can be difficult to manage. Over time, carers can feel powerless, and their emotional resources diminish.Diminished resources led to a shift in caregiving aims and responses. Subsequently, carers accommodated AN-related behaviours.Carers recognized accommodation as counterproductive and experienced internal conflict (dissonance). This was reduced using a number of strategies.Skill-based interventions designed to empower carers to manage difficult AN behaviours are recommended.Motivational interviewing to develop discrepancies between caregiving aims and responses may promote a shift in the caregiving approach.
      PubDate: 2016-06-17T01:05:33.279866-05:
      DOI: 10.1002/cpp.2020
  • Adolescent and Family-focused Cognitive–behavioural Therapy for
           Paediatric Bipolar Disorders: A Case Series
    • Authors: Jens Knutsson; Beata Bäckström, Daiva Daukantaitė, Fredrik Lecerof
      Abstract: Although pharmacological treatments can help alleviate mood symptoms in youth with paediatric bipolar disorder (PBD), residual symptoms still commonly persist. In many cases, these symptoms seriously affect the social and psychological development of children and adolescents suffering from PBD. Complementary interventions, such as psychosocial and psychoeducational treatments, can help children and their families manage mood regulation and other challenges throughout childhood and adolescence. However, most research on such interventions has focused on children, single-family psychoeducation, and individual cognitive behavioural therapy. The present study, conducted in Sweden, used a case-series design to explore whether child- and family-focused cognitive behavioural therapy (CFF-CBT) for PBD, adapted from children (8–12 years) to adolescents (13–18 years) and applied in a multi-family format, could help reduce symptoms, improve psychosocial functioning, increase parents' knowledge of and skills for coping with the disorder, and improve family expressed emotion for adolescents with PBD. Furthermore, we aimed to assess whether the effects of such CFF-CBT are maintained at a one-year follow-up. Seven adolescents and 11 parents in two multi-family groups received twelve sessions of CFF-CBT. Self-rating questionnaires and clinical observations were used to evaluate clinically significant changes for individual cases. The results suggest that CFF-CBT is feasible to deliver in an outpatient psychiatric setting and may be effective for developing parents' skills and knowledge for coping with PBD, increasing adolescents' psychosocial functioning, and improving family climate. The results are in line with previous findings on CFF-CBT for children with PBD, suggesting that CFF-CBT is a valuable adjunctive treatment for adolescents with PBD.Key Practitioner MessagePreliminary evidence indicates that CFF-CBT (RAINBOW) is both acceptable and an important complement to pharmacological treatment for adolescents suffering from paediatric bipolar disorder (PBD).Adolescent PBD populations show a high degree of comorbidity and individual clinical presentations that influence treatment results.Families show a large variation in ability to participate and benefit from RAINBOW treatment. Assessing and addressing pre-treatment environmental stressors and family climate during treatment is important for optimizing treatment effect.Symptoms of PBD fluctuate and new episodes can occur spontaneously. It is therefore important to follow PBD symptoms over time to draw more precise conclusions on treatment effects.When assessing treatment effects on psychiatric symptoms, social functioning, and family climate, it is important to use multiple rating sources, as ratings can vary considerably between adolescents, parents, and clinicians.
      PubDate: 2016-06-16T01:01:04.587228-05:
      DOI: 10.1002/cpp.2027
  • The Inference-Based Approach (IBA) to the Treatment of
           Obsessive–Compulsive Disorder: An Open Trial Across Symptom Subtypes and
           Treatment-Resistant Cases
    • Authors: Frederick Aardema; Kieron P. O`Connor, Marie-Eve Delorme, Jean-Sebastien Audet
      Abstract: The current open trial evaluated an inference-based approach (IBA) to the treatment of obsessive–compulsive disorder (OCD) across symptom subtypes and treatment-resistant cases. Following formal diagnosis through semi-structured interview by an independent evaluator, a total of 125 OCD participants across five major symptom subtypes entered a program of 24 sessions of treatment based on the IBA. An additional group of 22 participants acted as a natural wait-list control group. Participants were administered the Yale–Brown Obsessive–Compulsive Scale before and after treatment as the principal outcome measure, as well as measures of negative mood states, inferential confusion and obsessive beliefs. Level of overvalued ideation was assessed clinically at pre-treatment using the Overvalued Ideation Scale. After 24 weeks of treatment, 102 treatment completers across all major subtypes of OCD showed significant reductions on the Yale–Brown Obsessive–Compulsive Scale with effect sizes ranging from 1.49 to 2.53 with a clinically significant improvement in 59.8% of participants. No improvement was observed in a natural wait-list comparison group. In addition, IBA was effective for those with high levels of overvalued ideation. Change in inferential confusion and beliefs about threat and responsibility were uniquely associated with treatment outcome. The study is the first large-scale open trial showing IBA to be effective across symptom subtypes and treatment-resistant cases. The treatment may be particularly valuable for those who have previously shown an attenuated response to other treatments. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner Message:Psychological treatment based on the inference-based approach is an effective treatment for all major subtypes of obsessive–compulsive disorder.The treatment is equally effective for those with high and low levels of overvalued ideation.Treatment based on the inference-based approach may be particularly valuable for those who have shown an attenuated response to cognitive–behaviour therapy as usual.
      PubDate: 2016-06-09T00:50:42.966926-05:
      DOI: 10.1002/cpp.2024
  • Predictors of Incidence, Remission and Relapse of Axis I Mental Disorders
           in Young Women: A Transdiagnostic Approach
    • Authors: Justina Lukat; Eni S. Becker, Kristen L. Lavallee, William M. Veld, Jürgen Margraf
      Abstract: An understanding of etiological and maintaining factors of mental disorders is essential for the treatment of mental disorders, as well as mental health promotion and protection. The present study examines predictors of the incidence, remission and relapse of a wide range of Axis I mental disorders, using data from the Dresden Predictor Study. A sample of 1394 young German women completed questionnaires evaluating psychological factors (positive mental health, self-efficacy, life satisfaction, neuroticism, psychopathology and dysfunctional attitudes) and global assessment of functioning, as well as structured diagnostic interviews assessing incidence and change (remission, relapse) in mental disorders. Predictors were analysed using a multivariate logistic regression model. Significant factors for incidence of mental disorders included neuroticism and global functioning. A remitting course of mental disorders was predicted by positive mental health, self-efficacy and global assessment of functioning. Relapse was significantly predicted by neuroticism and dysfunctional attitudes. Results imply that mental health promotion is particularly important for women with high neuroticism and low functioning, as they tend to be at risk for incidence. Mental disorder treatment may benefit from strengthening positive mental health and functioning, as these factors promote remission. Relapse-prevention may benefit from attention to neuroticism and dysfunctional attitudes in order to reduce the likelihood of relapse. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner Message:Incidence of mental disorders in young women was predicted by neuroticism and low global functioning. There seems to be a need for preventive interventions addressing high neuroticism and low global functioning.Remission in young women was predicted by positive mental health. It may be helpful to include resource-based interventions, which can strengthen or support general positive mental health.Relapse in young women was predicted by two negative psychological factors: high neuroticism and reporting many dysfunctional attitudes. Psychotherapy addressing the characteristics and behaviour of neurotic patients might be beneficial. Interventions should also focus on addressing and changing dysfunctional attitudes.
      PubDate: 2016-06-03T01:20:31.091913-05:
      DOI: 10.1002/cpp.2026
  • Changes in Object Relations over the Course of Psychodynamic Psychotherapy
    • Authors: A. S. J. Mullin; M. J. Hilsenroth, J. Gold, B. A. Farber
      Abstract: This study explores whether object relations (OR) functioning improves over the course of psychodynamic psychotherapy, and whether this improvement is related to symptom decrease as well as therapist technique. The sample consisted of 75 outpatients engaged in short-term psychodynamic psychotherapy at a university-based psychological service clinic. OR functioning was assessed pre- and post-treatment by independent raters using the Social Cognition and Object Relations Scale from in-session patient relational narratives. The Comparative Psychotherapy Process Scale was used to assess therapist activity and psychotherapy techniques early in treatment. Independent clinical ratings of global OR and psychotherapy techniques were conducted, and rater agreement was found to be in the excellent range. Regarding the results, global OR (overall quality and level of interpersonal functioning) significantly improved with large effect size after psychodynamic therapy. Change in global OR functioning was significantly and positively related to the incidence of psychodynamic techniques in early sessions, as were number of psychotherapy sessions attended. Patient self-reported reliable change in symptomatology and reliable change in global OR were significantly related as well. Multilevel model analyses confirmed pairwise correlations accounting for therapist effects on a variety of process–outcome measures, number of sessions attended, initial levels of psychiatric symptoms, employment of therapeutic techniques as well overall OR functioning at outcome. Limitations of the present study, future research directions and implications for clinical practice are also discussed. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner Message:Psychodynamic psychotherapy seems to be effective in improving object relations functioning.Consider use of psychodynamic techniques early in treatment with patients expressing more pathological object representations.Improvements in object relations functioning during psychodynamic psychotherapy are also related to adaptive changes in patient self-reported symptomatology.Therapist effects were also present for the study. As such therapists should be mindful to assess patient change and their use of technique at several points in treatment and flexibly adjust their approach as necessary.
      PubDate: 2016-05-30T01:25:26.901502-05:
      DOI: 10.1002/cpp.2021
  • Group-Based Compassion-Focused Therapy as an Adjunct to Outpatient
           Treatment for Eating Disorders: A Pilot Randomized Controlled Trial
    • Authors: Allison Catherine Kelly; Lucene Wisniewski, Caitlin Martin-Wagar, Ellen Hoffman
      Abstract: The current study sought to assess the acceptability and feasibility of a compassion-focused therapy (CFT) group as an adjunct to evidence-based outpatient treatment for eating disorders, and to examine its preliminary efficacy relative to treatment as usual (TAU). Twenty-two outpatients with various types of eating disorders were randomly assigned to 12 weeks of TAU (n = 11) or TAU plus weekly CFT groups adapted for an eating disorder population (CFT + TAU; n = 11). Participants in both conditions completed measures of self-compassion, fears of compassion, shame and eating disorder pathology at baseline, week 4, week 8 and week 12. Additionally, participants receiving the CFT group completed measures assessing acceptability and feasibility of the group. Results indicated that the CFT group demonstrated strong acceptability; attendance was high and the group retained over 80% of participants. Participants rated the group positively and indicated they would be very likely to recommend it to peers with similar symptoms. Intention-to-treat analyses revealed that compared to the TAU condition, the CFT + TAU condition yielded greater improvements in self-compassion, fears of self-compassion, fears of receiving compassion, shame and eating disorder pathology over the 12 weeks. Results suggest that group-based CFT, offered in conjunction with evidence-based outpatient TAU for eating disorders, may be an acceptable, feasible and efficacious intervention. Furthermore, eating disorder patients appear to see benefit in, and observe gains from, working on the CFT goals of overcoming fears of compassion, developing more self-compassion and accessing more compassion from others. Copyright © 2016 John Wiley & Sons, Ltd.
      PubDate: 2016-05-30T00:20:40.210442-05:
      DOI: 10.1002/cpp.2018
  • The Relationship between Co-rumination and Internalizing Problems: A
           Systematic Review and Meta-analysis
    • Authors: Jason S. Spendelow; Laura M. Simonds, Rachel E. Avery
      Abstract: Co-rumination refers to the process of engaging in repeated discussion of personal problems in dyadic relationships. The current systematic review and meta-analysis provided an evaluation of the relationship between co-rumination and internalizing problems in children, adolescents and young adults, along with an investigation of potential moderator variables. Studies were eligible for inclusion if they quantitatively assessed the relationship between co-rumination and depression, anxiety and/or internalizing problems using validated measures. An electronic search was conducted in PsycINFO, PsycARTICLES, Medline, Scopus and the Cochrane Library database of systematic reviews for studies published since 2002. In addition, unpublished studies were located by contacting authors in the field and by online searches of dissertation databases. Thirty-eight studies were deemed eligible for inclusion comprising a total of 12 829 community-based participants. A random-effects model was employed in the analysis, and effect sizes were obtained exclusively from cross-sectional data. Small to moderate effect sizes were found across four outcomes representing internalizing problems (mean corrected correlation range 0.14 to 0.26), with no significant variability across these variables. Female participants were found to score significantly higher on measures of co-rumination compared with males (d = −0.55). Moderator analyses revealed mixed findings. No significant effects were found for age, gender or publication status. A significant effect was found for co-rumination questionnaire version used (p = 0.05), and a marginal effect found for co-rumination partner (same-sex best friend versus other confidants; p = 0.08). These findings indicate that co-rumination may have a modest but significant association with internalizing problems. The implications of these findings and directions for further research are discussed. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner Message:Co-rumination has maladaptive (repetitive, unproductive discussion of problems) components, but also shows an association with friendship satisfaction.The current review found that co-rumination has small-moderate association with depression and anxiety.Practitioners should be aware of the way in which people discuss affective distress with others.
      PubDate: 2016-05-23T22:20:44.559898-05:
      DOI: 10.1002/cpp.2023
  • Relational Patterns and the Development of the Alliance: A Systematic
           Comparison of two Cases
    • Authors: Emanuel Schattner; Orya Tishby, Hadas Wiseman
      Abstract: A systematic case study approach was taken to explore the impact of client and therapist relational patterns on the development of the therapeutic alliance and symptom reduction in two cases of psychodynamic psychotherapy treated by the same therapist. The cases were selected from a larger sample and represent two distinct trajectories of alliance development: improvement versus deterioration. The comparison was based on participants' ongoing narratives about each other and about significant others, using the Relationship Anecdote Paradigm (RAP) interview. The qualitative findings were triangulated with process and outcome measures assessed at four time points during the year of treatment. We hypothesized that different therapeutic processes, including different handling by the therapist of interpersonal difficulties as they arose in treatment, could explain the two distinct trajectories of alliance development and symptom change within the caseload of one therapist. Results indicate two linked elements that may explain a steady increase in alliance and decrease in symptoms in one case, compared with the second case that started with an increase in alliance and symptom improvement, but gradually reached an impasse and a setback in symptoms. One element was the extent to which client's and therapist's relational patterns clashed, impacting each other negatively. The second was the extent to which differences and disagreements were stated openly and negotiated so that the therapist could flexibly adapt to meet the client's relational patterns in one case versus inability to do so in the other. Implications for training and other psychotherapy orientations are discussed. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageThe interaction of client and therapist relational patterns may be a key factor in the development of the therapeutic alliance and might potentially impact client outcome.Therapeutic practice will likely be improved if therapists are more aware of their own relational patterns and the ways these interact with their clients' relational patterns.Striving for this awareness should probably be a main focal point for therapists throughout their careers, in their training, supervisions and personal therapies.
      PubDate: 2016-05-17T23:55:26.644887-05:
      DOI: 10.1002/cpp.2019
  • The Role of Gender as a Moderator of the Alliance-Outcome Link in Acute
           Inpatient Treatment of Severely Disturbed Youth
    • Authors: Jeffrey S. Nevid; Jasmine Ghannadpour, Gregory Haggerty
      Abstract: Research is needed to further examine the role of treatment alliance or engagement among child and adolescent patients in inpatient psychiatric settings. In this study, 72 newly admitted patients on an inpatient adolescent psychiatric unit completed measures of symptom severity and treatment alliance. Female patients showed greater symptom severity at both admission and discharge. Residualized gain score analysis showed that male gender predicted greater symptom reduction. Treatment alliance also predicted greater symptom reduction, but only among women. These results suggest that alliance or engagement with acute inpatient psychiatric services may play a more important role among women than men in predicting symptomatic change in severely disturbed adolescents. Copyright © 2016 John Wiley & Sons, Ltd.
      PubDate: 2016-05-13T02:00:32.971599-05:
      DOI: 10.1002/cpp.2025
  • The Role of Coping Change in Borderline Personality Disorder: A
           Process-Outcome Analysis on Dialectical-Behaviour Skills Training
    • Authors: Ueli Kramer
      Pages: 302 - 311
      Abstract: Difficulty in emotion regulation is a hallmark feature of patients with borderline personality disorder (BPD). Skills training concepts based on dialectical-behaviour therapy (DBT) are common and effective treatment options for specifically addressing lacking skills in emotion regulation. However, so far it is unclear which aspects of coping change over the course of DBT skills training and if these coping strategies predict symptom change. The present process-outcome analysis, based on a randomized controlled study, aims at investigating these questions, by referring to a general conception of coping and by using an observer-rated approach to assess coping strategies directly in the therapy sessions. In total, n = 31 patients with BPD underwent two individual clinical interview assessments (pre- and post-study intervention; half of the patients underwent DBT skills training, half were in a wait-list control). All individual assessment sessions were transcribed and analysed using the Coping Action Pattern Rating Scale. Outcome was assessed pre- and post-intervention using the Outcome Questionnaire-45.2 and the Borderline Symptom List 23. The results showed increase in overall coping functioning in patients who underwent the DBT skills training, compared with the controls, and specific increases in relatedness coping where the stress is appraised as challenge, along with specific decreases in autonomy coping where the stress is appraised as threat. These changes predicted changes in general distress and borderline symptomatology. The results are interpreted within a general framework aiming at understanding the psychological effects of treatments for BPD, in particular effects related to coping. Effective emotion regulation strategies may therefore be important candidates as potential change mechanisms in treatments for BPD. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageIt seems important for clinicians to assess the quality of coping strategies as they occur within the session facing a patient with borderline personality disorder.Clinicians may foster the emergence of support-seeking and self-reliance coping strategies in order to increase the effectiveness of therapy.Clinicians may monitor closely the patient's use of ineffective emotion regulation strategies, in particular opposition and submission, with the aim of reducing them early in therapy.
      PubDate: 2016-04-21T00:30:38.563073-05:
      DOI: 10.1002/cpp.2017
  • Therapist Effects on and Predictors of Non-Consensual Dropout in
    • Authors: Dirk Zimmermann; Julian Rubel, Andrew C. Page, Wolfgang Lutz
      Pages: 312 - 321
      Abstract: BackgroundWhereas therapist effects on outcome have been a research topic for several years, the influence of therapists on premature treatment termination (dropout) has hardly been investigated. Since dropout is common during psychological treatment, and its occurrence has important implications for both the individual patient and the healthcare system, it is important to identify the factors associated with it.MethodParticipants included 707 patients in outpatient psychotherapy treated by 66 therapists. Multilevel logistic regression models for dichotomous data were used to estimate the impact of therapists on patient dropout. Additionally, sociodemographic variables, symptoms, personality style and treatment expectations were investigated as potential predictors.ResultsIt was found that 5.7% of variance in dropout could be attributed to therapists. The therapist's effect remained significant after controlling for patient's initial impairment. Furthermore, initial impairment was a predictor of premature termination. Other significant predictors of dropout on a patient level were male sex, lower education status, more histrionic and less compulsive personality style and negative treatment expectations.ConclusionsThe findings indicate that differences between therapists influence the likelihood of dropout in outpatient psychotherapy. Further research should focus on variables, which have the potential to explain these inter-individual differences between therapists (e.g., therapist's experience or self-efficacy). Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessagesThere are substantial differences between therapists concerning their average dropout rates.At the patient level, higher initial impairment, male sex, lower education, less compulsive personality style, more histrionic personality style and low treatment expectations seem to be risk factors of non-consensual treatment termination.Psychometric feedback during the course of treatment should be used to identify patients who are at risk for dropout.
      PubDate: 2016-05-10T03:41:13.434929-05:
      DOI: 10.1002/cpp.2022
  • The Impact of Causal Explanations on Outcome in People Experiencing
           Psychosis: A Systematic Review
    • Authors: Lucy Carter; John Read, Melissa Pyle, Anthony P. Morrison
      Pages: 332 - 347
      Abstract: Findings suggest that the way an individual understands their experiences has important consequences on subsequent health behaviour. One aspect of an individual's understanding is what they believe has caused their experiences. This has been associated with treatment outcome and attitudes towards mental health problems. The aim of this systematic review was to examine the impact of causal beliefs on treatment outcome and stigma in people experiencing psychosis. Three main databases were searched and 21 articles that investigated various aspects of treatment outcome, and stigma in relation to causal beliefs was included in the review. Overall, there were a small number of replicated findings which limits the interpretation of results. There is an indication that causal explanations are associated with various treatment outcomes, including attitudes towards treatment and satisfaction with therapeutic relationships as well as internalized stigma. Spiritual beliefs appeared to be adopted as a coping mechanism and a way to reduce stigma but did not appear to be associated with treatment outcome. Individuals with psychosis do appear to develop causal beliefs that may be associated with engagement with services and treatment, as well as impacting on their attitudes towards themselves and others with mental illness. This may have important implications for clinical practice. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageIndividuals who have experience of psychosis develop their own subjective causal explanations, and these can be complex and contradictory.An individual's causal explanation may influence how they engage with services and treatment, as well as providing a way of coming to terms with their difficulties.Causal explanations may also contribute to the experience of stigma, which is often a significant barrier to recovery for this client group.
      PubDate: 2016-01-25T02:45:08.762876-05:
      DOI: 10.1002/cpp.2002
  • Feasibility and Effects of a Brief Compassion-Focused Imagery Intervention
           in Psychotic Patients with Paranoid Ideation: A Randomized Experimental
           Pilot Study
    • Authors: Leonie Ascone; Johanna Sundag, Björn Schlier, Tania M. Lincoln
      Pages: 348 - 358
      Abstract: Paranoia is characterized by a lack of perceived social safeness and associated negative affect. Low self-esteem, negative self-concepts and negative emotions have been shown to contribute to paranoid symptom formation. Thus, interventions focusing on affiliation and positive affect might be particularly helpful for patients with paranoia. The present study experimentally tested the effect of a one-session, brief compassion-focused imagery derived from Compassion-Focused Therapy (Gilbert, ) versus a control imagery condition in a repeated measures randomized design. A negative affective state was induced via in-sensu exposure to a recent distressful social situation in order to provide a minimum level of threat-related arousal to be down-regulated by the interventions thereafter. The sample consisted of psychotic patients with paranoid ideation (N = 51) who were randomly assigned to one of the experimental conditions. Effects on postulated causal mechanisms, i.e., self-relating (self-reassurance, self-compassion, self-criticism), and affect (self-reported affective states, skin conductance levels) as well as on state paranoia, were tested. Subjective benefit and appraisals of the intervention were explored. There were no specific intervention effects on negative self-relating, negative affect and skin-conductance or on paranoia. However, compassion-focused imagery had significant effects on self-reassurance and happiness. Explorative analyses revealed that the majority of the participants appraised the intervention in a positive manner, indicating good acceptance. The intervention showed an effect on some of the postulated mechanisms but not on others, which might have been because of its brevity. Further investigation of interventions targeting affiliation for people with paranoid experiences appears worthwhile. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageAffiliative imagery work is feasible and appraised positively in psychotic patients.Brief compassion focused imagery increased feelings of happiness and reassurance but did not improve negative self-relating, negative affect or paranoia.Further investigation is warranted to identify which patients benefit most from affiliative imagery.
      PubDate: 2016-02-17T02:05:28.945491-05:
      DOI: 10.1002/cpp.2003
  • How to Train Experienced Therapists in a New Method: A Qualitative Study
           into Therapists' Views
    • Authors: Marieke C. Napel-Schutz; Tineke A. Abma, Lotte L. M. Bamelis, Arnoud Arntz
      Pages: 359 - 372
      Abstract: BackgroundImplementation of new effective treatments involves training, supervision and quality control of therapists, who are used to utilize other methods. Not much is known about therapists' views on how new psychotherapy methods should be taught.ObjectiveThe purpose of this study is to get insight in how experienced therapists experience the training in a new method so that training methods for experienced therapists can be improved.MethodQualitative research using focus groups. For an RCT on the effectiveness of schema therapy (ST) for six personality disorders more than 80 therapists were trained in ST. They applied the ST-protocol after 4-day training, with peer supervision and limited expert supervision. Sixteen of these trained ST therapists from seven health institutions participated in the focus groups. The transcripts and records of the focus groups were analyzed on repeating themes and subthemes and in terms of higher order categories.ResultsTherapists appreciated didactical learning methods but particularly valued experiential learning. Especially, novice ST therapists missed role plays, feedback to learn required skills and attitudes, and attention to their resistance to new techniques (e.g., empathic confrontation and imagery). Peer supervision gave emotional recognition, but therapists lacked regular advice from an ST-expert.ConclusionsIn teaching a new therapeutic method didactic teaching is necessary, but experiential learning is decisive. Experiential learning includes practicing the new therapy and reflecting on one's experiences, including resistance against new methods. Emphatic confrontation, case conceptualization, role play, peer supervision and opportunities to ask an expert supervisor during peer supervision are found to be helpful. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageEspecially by Eperiential learning besides didactic learning.By practicing with many role plays including feedback.By reflecting on one's experiences including resistance against ingredients of the new method.By peer supervision with opportunities to ask an expert supervisor.
      PubDate: 2016-01-21T02:07:23.225217-05:
      DOI: 10.1002/cpp.2004
  • Protection or Vulnerability? A Meta-Analysis of the Relations Between the
           Positive and Negative Components of Self-Compassion and Psychopathology
    • Authors: Peter Muris; Nicola Petrocchi
      Pages: 373 - 383
      Abstract: Self-compassion is increasingly explored as a protective factor in relation to psychopathology. The Self-Compassion Scale (SCS) and its Short Form variant (SCS-SF) are the most widely used instruments for measuring this psychological construct, and previous studies have indeed shown that the total score of this scale is negatively associated with psychopathology. In this article, we point out that half of the items of the SCS and SCS-SF are positive indicators of self-compassion and directly refer to the three key components of self-kindness, common humanity and mindfulness, while the other half of the items are negative indicators of the construct and reflect the precise opposite of the key components, namely self-judgment, isolation and over-identification. A meta-analysis was conducted including 18 studies that reported on the positive and negative indicators of self-compassion as indexed by the SCS/SCS-SF and their relations to various types of psychopathology. Results showed that positive indicators of self-compassion were negatively associated with psychopathology, which confirms their hypothesized protective influence. However, the negative indicators were positively linked to psychopathology, suggesting that these scales tap increased vulnerability to mental health problems. Moreover, tests comparing the strength of the relations between various SCS/SCS-SF counterparts (i.e., self-kindness versus self-judgment, common humanity versus isolation and mindfulness versus over-identification) and psychopathology showed that the negative indicators were significantly stronger linked to mental health problems than the positive indicators. This provides support for the idea that the use of a total self-compassion score of the SCS or SCS-SF, which typically includes the reversely scored negative subscales, will probably result in an inflated relationship with symptoms of psychopathology. Copyright © 2016 John Wiley & Sons, Ltd.
      PubDate: 2016-02-19T03:35:49.535213-05:
      DOI: 10.1002/cpp.2005
  • First-person Pronoun Use in Spoken Language as a Predictor of Future
           Depressive Symptoms: Preliminary Evidence from a Clinical Sample of
           Depressed Patients
    • Authors: Johannes Zimmermann; Timo Brockmeyer, Matthias Hunn, Henning Schauenburg, Markus Wolf
      Pages: 384 - 391
      Abstract: Several theories suggest that self-focused attention plays an important role in the maintenance of depression. However, previous studies have predominantly relied on self-report and laboratory-based measures such as sentence completion tasks to assess individual differences in self-focus. We present a prospective, longitudinal study based on a sample of 29 inpatients with clinical depression, investigating whether an implicit, behavioural measure of self-focused attention, i.e., the relative frequency of first-person singular pronouns in naturally spoken language, predicts depressive symptoms at follow-up over and above initial depression. We did not find a significant cross-sectional association between depressive symptoms and first-person singular pronoun use. However, first-person singular pronoun use significantly predicted depressive symptoms approximately 8 months later, even after controlling for depressive symptoms at baseline or discharge. Exploratory analyses revealed that this effect was mainly driven by the use of objective and possessive self-references such as ‘me’ or ‘my’. Our findings are in line with theories that highlight individual differences in self-focused attention as a predictor of the course of depression. Moreover, our findings extend previous work in this field by adopting an unobtrusive approach of non-reactive assessment, capturing naturally occurring differences in self-focused attention. We discuss possible clinical applications of language-based assessments and interventions with regard to self-focus. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageNaturally occurring individual differences in first-person singular pronoun use provide an unobtrusive way to assess patients' automatic self-focused attention.Frequent use of first-person singular pronouns predicts an unfavourable course of depression.Self-focused language might offer innovative ways of tracking and targeting therapeutic change.
      PubDate: 2016-01-27T21:46:21.545562-05:
      DOI: 10.1002/cpp.2006
  • The Construal of Midwives by Pregnant Women with a Body Mass Index Greater
           Than or Equal to 30 kg/m2 (BMI ≥ 30 kg/m2): A Repertory Grid
    • Authors: Emma L Hodgkinson; Debbie M Smith, Dougal Julian Hare, Anja Wittkowski
      Pages: 392 - 400
      Abstract: ObjectiveTo explore the construal of midwives by pregnant women with a body mass index greater than 30 kg/m2 (BMI ≥ 30 kg/m2).MethodTen pregnant women with a BMI ≥ 30 kg/m2 were recruited from antenatal clinics at a maternity hospital in the North West of England. Each participant completed a repertory grid. The participants chose people to match roles including themselves, pregnant women, midwives of different BMIs and hypothetical elements. They also generated psychological constructs to describe them.ResultsPregnant women with a BMI ≥ 30 kg/m2 construed themselves as vulnerable and self-conscious. Some women endorsed obesity-related stereotypes for themselves and felt responsible for their weight. The midwife with a BMI 18 
      PubDate: 2016-03-03T04:34:29.068927-05:
      DOI: 10.1002/cpp.2009
  • How Veterans Health Administration Suicide Prevention Coordinators Assess
           Suicide Risk
    • Authors: James L. Pease; Jeri E. Forster, Collin L. Davidson, Brooke Dorsey Holliman, Emma Genco, Lisa A. Brenner
      Pages: 401 - 410
      Abstract: This cross-sectional study was designed to examine the suicide risk assessment practices of Suicide Prevention Coordinators (SPCs) within the Veterans Health Administration. Specifically, this study sought to (1) identify factors SPCs consider most important in assessing risk and patient priority; (2) measure the level of consistency and agreement between SPCs in assessing suicide risk and prioritizing cases; and (3) measure individual SPC consistency between cases. SPCs (n = 63) responded to online survey questions about imminent and prolonged risk for suicide in response to 30 fictional vignettes. Combinations of 12 acute and chronic suicide risk factors were systematically distributed throughout the 30 vignettes using the Fedorov () procedure. The SPCs were also asked to identify the level of priority for further assessment both disregarding and assuming current caseloads. Data were analysed using clinical judgement analysis. Suicidal plan, β = 1.64; 95% CI (1.45, 1.82), and preparatory behaviour, β = 1.40; 95% CI (1.23, 1.57), were considered the most important acute or imminent risk factors by the SPCs. There was less variability across clinicians in the assessment of risk when alcohol use (p = 0.02) and hopelessness (p = 0.03) were present. When considering acute or imminent risk factors, there was considerable variability between clinicians on a vignette-by-vignette basis, median SD = 0.86 (range = 0.47, 1.13), and within individual clinicians across vignettes, median R2 = 0.80 (0.49, 0.95). These findings provide insight into how this group of providers think about acute and chronic risk factors contributing to imminent suicide risk in Veterans. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageIdentifies factors that practitioners consider most important in suicide risk assessmentDiscusses how to distinguish between chronic and acute risk for suicideIdentifies factors that lead to more consistent clinical judgments
      PubDate: 2016-04-13T22:20:43.363937-05:
      DOI: 10.1002/cpp.2011
  • The Experience of Postnatal Depression in Immigrant Mothers Living in
           Western Countries: A Meta-Synthesis
    • Authors: Anja Wittkowski; Sonia Patel, John R. Fox
      Pages: 411 - 427
      Abstract: BackgroundPostnatal depression affects women from all cultures and countries. The postnatal period is thought to be a vulnerable time for all mothers. Immigrant women may be at particular risk as they attempt to adhere to childbirth rituals in western societies which might exacerbate stress, while navigating through the multiple stressors they face from migration in the transition to motherhood.MethodsThis study utilized a meta-synthesis approach to synthesize qualitative studies exploring postnatal depression in immigrant mothers living in western countries. Searching six databases identified 16 studies that met criteria.ResultsThe synthesis revealed two overarching themes of migration and cultural influences on immigrant mothers that interact and give rise to psychosocial understandings of postnatal depression, remedies and healthcare barriers. Mothers used self-help coping strategies in line with this.ConclusionsImmigrant mothers living in western countries are subject to multifactorial stressors following childbirth, increasing their susceptibility to postnatal depression. These stressors relate to being an immigrant in a western society and cultural influences, which may be harder to comply with, when removed from their sociocultural context. Social support appears to play a mediating role for these immigrant mothers. There were several similarities between immigrant and non-immigrant mothers including their views of healthcare and medication, their health-seeking behaviours and their fears of having their baby removed. All these findings have implications for healthcare settings in terms of assessments and service delivery. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageIn this meta-synthesis, we explored the experience of postnatal depression in immigrant women living in western countries, including the UK, the USA and Canada.Sixteen qualitative studies were reviewed, and their methodological quality was examined.The findings are based a total sample of 337 women.Two overarching themes were identified that are termed ‘cultural influences’ and ‘migration factors’, which influenced how these mothers coped with their postnatal depression.Social support played a mediating role for these immigrant mothers.
      PubDate: 2016-03-14T07:36:52.260734-05:
      DOI: 10.1002/cpp.2010
  • The Special Challenges of Psychotherapy with Persons with Psychosis:
           Intersubjective Metacognitive Model of Agreement and Shared Meaning
    • Authors: Ilanit Hasson-Ohayon; Shlomo Kravetz, Paul H. Lysaker
      Pages: 428 - 440
      Abstract: Agreement between client and therapist is an essential part of the therapeutic alliance. While there are general challenges to the creation of agreement and shared meaning in all psychotherapies, there are specific challenges while working with persons with psychosis. These challenges include the different narratives of the client and the therapist with regard to their roles and the description of the condition or problem, as well as possible stigmatic views and theoretical bias. Here we present a metacognitive intersubjective model as a framework for the understanding and resolutions of these challenges. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageGoal consensus, agreement and shared meaning are essential for a collaborative process and positive outcome in psychotherapy.Challenges to psychotherapy with persons with psychosis include the different narratives of the client and the therapist with regard to their roles and the description of the condition or problem, as well as possible stigmatic views and theoretical bias.In the intersubjective exchange, the concepts of metacognition and empathy can act as a framework for navigating between the possible challenges and the desired shared meaning and agreement.
      PubDate: 2016-03-14T07:23:29.865541-05:
      DOI: 10.1002/cpp.2012
  • Concepts of Mental Disorders in Trainee Clinical Psychologists
    • Authors: R. Read; N. J. Moberly, D. Salter, M. R. Broome
      Pages: 441 - 450
      Abstract: BackgroundThe models of mental disorders held by all mental health professionals are implicit in their attitudes and inform all aspects of theory and practice. The present study aims to explore the attitudes of trainee clinical psychologists towards mental disorders by building on a study conducted by Harland et al. () with psychiatrists. In so doing, the present study contributes to an evidence base that can inform the development of clinical training programs and multidisciplinary working.MethodsThe Maudsley Attitude Questionnaire was administered in an online survey of trainee clinical psychologists (n = 289).ResultsAnalyses of variance revealed main effects of model, and of diagnostic category, and a significant interaction effect between model and diagnostic category. Principal component analysis revealed a biological–psychosocial continuum and cognitive/behavioural and psychodynamic/spiritual dimensions. Comparisons with Harland et al.'s () psychiatrists revealed large differences, particularly in biological and social constructionist model endorsement.ConclusionResults suggest that the attitudes of psychologists and psychiatrists continue to sit at opposite ends of a biological–psychosocial continuum. However, an area of consensus regarding psychotherapeutic models was indicated. Training courses can be reassured that strong opinions tended to reflect the evidence base. Future research with similarly large representative samples from different disciplines would allow findings of the current study to be better contextualized. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageThe models of mental disorders held by clinical psychologists are implicit in their attitudes and inform all aspects of theory and practice.We found that trainee clinical psychologists continue to favour psychosocial over biological understandings of mental disorders, giving the cognitive, behavioural and psychodynamic models equal value overall, and stronger attitudes were supported by the evidence base.We found that trainee clinical psychologists organized their attitudes around a biological–psychosocial continuum and cognitive/behavioural and psychodynamic/spiritual dimensions.These findings may be useful for those involved in developing clinical training programs and multidisciplinary working because they provide an insight into the attitudes of emerging clinical psychologists.
      PubDate: 2016-03-18T03:30:49.679299-05:
      DOI: 10.1002/cpp.2013
  • Therapeutic Alliance in Internet-Delivered Cognitive Behaviour Therapy for
           Depression or Generalized Anxiety
    • Authors: Heather D. Hadjistavropoulos; Nicole E. Pugh, Hugo Hesser, Gerhard Andersson
      Pages: 451 - 461
      Abstract: There has been limited research on therapeutic alliance in the context of therapist-assisted Internet-delivered cognitive behaviour therapy (ICBT) when delivered in clinical practice. The present study investigated therapeutic alliance in ICBT delivered to patients seeking treatment for symptoms of depression (n = 83) or generalized anxiety (n = 112) as part of an open dissemination trial. ICBT was provided by 27 registered therapists or 28 graduate students working in six geographically dispersed clinics; therapist-assistance was delivered primarily through secure messages and occasionally telephone calls. The Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 were collected pre-, mid- and post-treatment, and the Therapeutic Alliance Questionnaire was assessed mid- and post-treatment. Therapeutic alliance ratings were high both at mid-treatment and post-treatment (above 80%). There was no relationship between therapeutic alliance ratings and improvement on primary outcomes. Among patients treated for depression, lower ratings of mid-treatment alliance were associated with concurrent treatment by a psychiatrist and fewer phone calls and emails from their therapist. Among patients treated for generalized anxiety, ratings of mid-treatment alliance were higher among registered providers as compared to graduate students. Multiple directions for future research on therapeutic alliance in ICBT are offered, including suggestions for developing a new measure of therapeutic alliance specific to ICBT and measuring therapeutic alliance throughout the treatment process. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageThis research demonstrated that therapeutic alliance ratings were very strong at both mid- and post-treatment among patients who received Internet-delivered cognitive behaviour therapy (ICBT) for depression or anxiety in clinical practice.Among patients receiving ICBT for depression, lower ratings of therapeutic alliance were associated with patients reporting concurrent treatment by a psychiatrist and with the receipt of fewer phone calls and emails from the therapist.Among patients receiving ICBT for generalized anxiety, ratings of alliance were higher when patients were treated by registered providers as compared to graduate students.Therapeutic alliance ratings did not predict outcome in ICBT for depression or anxiety.Practitioners have reason to be confident that a therapeutic relationship can be formed in ICBT when delivered in clinical practice.
      PubDate: 2016-04-06T00:31:47.724878-05:
      DOI: 10.1002/cpp.2014
  • Does Therapists' Disengaged Feelings Influence the Effect of Transference
           Work? A Study on Countertransference
    • Authors: Hanne-Sofie Johnsen Dahl; Per Høglend, Randi Ulberg, Svein Amlo, Glen O Gabbard, John Christopher Perry, Paul Crits Christoph
      Pages: 462 - 474
      Abstract: Exploration of the patient–therapist relationship (transference work) is considered a core active ingredient in dynamic psychotherapy. However, there are contradictory findings as for whom and under what circumstances these interventions are beneficial. This study investigates long-term effects of transference work in the context of patients' quality of object relations (QOR) and therapists' self-reported disengaged feelings. Therapists' disengaged feelings may negatively influence the therapeutic process, especially while working explicitly with the transference since discussing feelings that are present in the session is an essential aspect of transference work. One hundred outpatients seeking psychotherapy for depression, anxiety and personality disorders were randomly assigned to one year of dynamic psychotherapy with transference work or to the same type and duration of treatment, but without transference work. Patients' QOR-lifelong pattern was evaluated before treatment and therapists' feelings were assessed using the Feeling Word Checklist-58 after each session. Outcome was measured with self-reports and interviews at pre-treatment, mid-treatment, post-treatment, one year and three years after treatment termination. A significant interaction of treatment group (transference work versus no transference work) by QOR by disengaged therapist feelings was present, indicating that disengaged feelings, even small amounts, were associated with negative long-term effects of transference work, depending on QOR Scale scores. The strengths of the negative association increased significantly with lower levels of QOR. The negative association between even a small increase in disengaged therapist feelings and long-term effects of transference interpretation was substantial for patients with poor QOR, but small among patients with good QOR. Copyright © 2016 John Wiley & Sons, Ltd.Key Practitioner MessageTherapists' emotional reactions to their patients (countertransference) seem to have a significant impact on both the treatment process and outcome of psychotherapy.Therapists' heightened level of disengaged feelings over a treatment period shows an adverse impact on the effect of transference work for all patients, and especially so for patients with a history of poor, non-mutual and complicated relationships.For patients with a history of reciprocal, sound relationships the negative influence of therapists' disengaged countertransference is minimal.Higher therapist disengagement is strongly related to inferior therapists' skill for patients with a history of poor relationships and/or more personality disorder pathology.Training and supervision should provide direct feedback and focus on therapists' internal thought processes and emotional reactions.Therapists need to recognize and understand their feelings and attitudes in order to use the countertransference as a tool to understand the interpersonal process in therapy.
      PubDate: 2016-04-25T01:35:44.933483-05:
      DOI: 10.1002/cpp.2015
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