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Clinical Psychology & Psychotherapy

Impact factor: 2.0 5-Year impact factor: 2.271 Print ISSN: 1063-3995 Online ISSN: 1099-0879 Publisher: Wiley Blackwell (John Wiley & Sons)

Subject: Clinical Psychology

Most recent papers:

  • Cognitive‐behavioral therapy for Internet gaming disorder: A systematic review and meta‐analysis.
    Matthew W.R. Stevens, Daniel L. King, Diana Dorstyn, Paul H. Delfabbro.
    Clinical Psychology & Psychotherapy. October 20, 2018
    --- - |2+ Abstract Objective While there is sufficient research and clinical evidence to support the inclusion of gaming disorder in the latest revision of the International Classification of Diseases (ICD‐11), relatively little is known about the effectiveness of first‐line psychological treatment for gaming disorder or Internet gaming disorder (IGD) as it is listed in the DSM‐5. This systematic review employed meta‐analytic techniques to determine the effectiveness of cognitive‐behavioral therapy (CBT) for IGD on four key outcomes: IGD symptoms, anxiety, depression, and time spent gaming. Method A database search identified 12 independent CBT studies. Effect size estimates (Hedges' g) with associated confidence intervals, prediction intervals and p values, for each pre‐post treatment outcome, were calculated. Study reporting quality was evaluated in accordance with the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Subgroup and moderator analyses were undertaken to investigate potential sources of heterogeneity. Results CBT demonstrated high efficacy in reducing IGD symptoms (g=.92, [0.50,1.34]) and depression (g=.80, [0.21,1.38]) and showed moderate efficacy in reducing anxiety (g=.55, [0.17,0.93]) at post‐test. There was insufficient power to determine whether CBT was capable of reducing time spent gaming. Treatment gains at follow‐up were non‐significant across the four treatment outcomes. Conclusions The pooled findings suggest that CBT for IGD is an effective short‐term intervention for reducing IGD and depressive symptoms. However, the effectiveness of CBT for reducing actual time spent gaming was unclear. Given the limitations of this evidence base, there is a need for more rigorous studies to determine the potential long‐term benefits of CBT for IGD. - Clinical Psychology & Psychotherapy, Volume 0, Issue ja, -Not available-.
    October 20, 2018   doi: 10.1002/cpp.2341   open full text
  • Case conceptualization from a process‐based and modular perspective: rationale and application to mood and anxiety disorders.
    Pierre Philippot, Martine Bouvard, Céline Baeyens, Vincent Dethier.
    Clinical Psychology & Psychotherapy. October 19, 2018
    --- - |2 Abstract This article presents the theoretical, clinical, and practical arguments supporting a process‐based transdiagnostic approach to psychotherapy. A working definition of “psychological process” is provided, as well as a tri‐dimensional categorization of psychological processes potentially involved in psychopathology. Guidelines are proposed to select psychological interventions based on the active psychopathological processes evidenced in a given case. We also provide a rationale to organize treatment as a set of modules, each addressing a specific psychopathological process. Next, we review the main processes that may be active in mood and anxiety disorders, and that are accessible to clinicians in regular practice. For each process, we propose a validated assessment questionnaire. Finally, we offer a free‐access web‐based instrument that allows clients to fill in these questionnaires via an internet survey, and that provides therapists with a tool to easily decode and interpret the questionnaire results, and to present them to the clients. - Clinical Psychology & Psychotherapy, Volume 0, Issue ja, -Not available-.
    October 19, 2018   doi: 10.1002/cpp.2340   open full text
  • What happens when the therapist leaves? The impact of therapy transfer on the therapeutic alliance and symptoms.
    Dirk Zimmermann, Wolfgang Lutz, Michelle Reiser, Kaitlyn Boyle, Brian Schwartz, Viola N.L.S. Schilling, Anne‐Katharina Deisenhofer, Julian A. Rubel.
    Clinical Psychology & Psychotherapy. October 19, 2018
    --- - |2+ Background The therapeutic alliance is an important factor in psychotherapy, affecting both therapy processes and outcome. Therapy transfers may impair the quality of the therapeutic alliance and increase symptom severity. The aim of this study is to investigate the impact of patient transfers in cognitive behavioural therapy on alliance and symptoms in the sessions after the transfer. Method Patient‐ and therapist‐rated therapeutic alliance and patient‐reported symptom severity were measured session‐to‐session. Differences in the levels of alliance and symptom severity before (i.e., with the original therapist) and after (i.e., with the new therapist) the transfer session were analysed. The development of alliance and symptom severity was explored using multilevel growth models. Results A significant drop in the alliance was found after the transfer, whereas no differences were found with regard to symptom severity. After an average of 2.93 sessions, the therapeutic alliance as rated by patients reached pretransfer levels, whereas it took an average of 5.05 sessions for therapist‐rated alliance levels to be at a similar level as before the transfer. Inter‐individual differences were found with regard to the development of the therapeutic alliance over time. Conclusions Therapy transfers have no long lasting negative effects on either symptom impairment or the therapeutic alliance. - Clinical Psychology & Psychotherapy, EarlyView.
    October 19, 2018   doi: 10.1002/cpp.2336   open full text
  • An Adaptive Virtual Reality System for the Treatment of Adjustment Disorder and Complicated Grief: 1‐year Follow‐up Efficacy data.
    Soledad Quero, Mar Molés, Daniel Campos, Sabrina Andreu‐Mateu, Rosa M. Baños, Cristina Botella.
    Clinical Psychology & Psychotherapy. October 17, 2018
    --- - |2 Abstract Adjustment disorders (AD) and complicated grief (CG) are serious mental conditions that have a high prevalence and are associated with significant impairments in social and work functioning. Recently, these categories have been better specified in the new ICD‐11 proposal. Empirical research on the efficacy of treatments for these problems is scarce. This study aims to offer long‐term efficacy data from a between‐groups controlled study that compares two treatment conditions (AD‐protocol applied in a traditional way: N= 18; and the same protocol supported by virtual reality‐VR‐: N =18) and a waiting list (WL) control group (N =18). Both treatment conditions resulted in statistically significant improvements on both primary and secondary outcome measures, with large effect sizes, and this improvement did not occur in the WL. These changes were maintained in both treatment conditions in the medium (6‐month) and long term (12‐month follow‐up). Larger effect sizes were achieved in the VR condition in the long term. Furthermore, clinically significant change estimations on the primary outcome measures showed an advantage for the VR condition This is the first controlled study to compare a traditional face‐to‐face protocol for the treatment of stress‐related disorders to the same protocol supported by VR and a WL control group. - Clinical Psychology & Psychotherapy, Volume 0, Issue ja, -Not available-.
    October 17, 2018   doi: 10.1002/cpp.2342   open full text
  • Suppressor effects in associations between patient attachment to therapist and psychotherapy outcome.
    Katja Petrowski, Hendrik Berth, Susan Schurig, Thomas Probst.
    Clinical Psychology & Psychotherapy. October 17, 2018
    --- - |2+ Abstract Objective Several studies propose that patient attachment to therapist is associated with therapy outcome. However, the magnitude of the effect is diverse, which might be explicable by suppressor effects and the new concept of pseudo‐security. Method Associations between patient attachment to therapist (client‐attachment‐to‐therapist‐scale [CATS]) and psychotherapy outcome (“global severity index” of the Symptom Check List) were evaluated in N = 368 patients. Multilevel models were performed. Results When tested in separate models, secure attachment to therapist was associated with a more favourable outcome (p < 0.05), whereas avoidant and preoccupied attachment to therapist were correlated with a less favourable outcome (both p < 0.05). Avoidant but not preoccupied attachment to therapist suppressed the association between secure attachment to therapist and the outcome. When controlling for the other two CATS scales, avoidant as well as preoccupied attachment to therapist remained associated with a less favourable outcome (p < 0.05). Conclusion Avoidant attachment to therapist suppresses the association between secure attachment to therapist and psychotherapy outcome. Pseudo‐security has to be taken into consideration in self‐report data on patient attachment to therapist. - Clinical Psychology & Psychotherapy, EarlyView.
    October 17, 2018   doi: 10.1002/cpp.2334   open full text
  • Derealization and self‐harm strategies are used to regulate disgust, fear, and sadness in adult survivors of childhood sexual abuse.
    Aoife Bradley, Thanos Karatzias, Eimear Coyle.
    Clinical Psychology & Psychotherapy. October 17, 2018
    --- - |2 Abstract Emotion regulation (ER) difficulties have been identified as an important target for clinical intervention in the treatment of post‐traumatic stress disorder (PTSD) symptoms in survivors of childhood sexual abuse (CSA). However, there is limited research regarding the use of specific strategies to regulate specific emotions following exposure to traumatic events. The aim of the current study was to investigate the indirect effects of four trauma‐related emotions (anger, sadness, disgust, and fear) on PTSD severity via two mediators: derealization and self‐harm. In particular, we tested that if the two hypothetical mediators operate sequentially, derealization precedes self‐harm and/or self‐harm precedes derealization. A predominate female clinical sample (N = 109) of CSA survivors completed measures of experience of emotions, ER, and post‐traumatic stress. Bivariate and serial mediation analyses were conducted to test the direct and indirect effects of trauma‐related emotions on PTSD severity. Serial mediation analyses indicated that there were significant total effects of all trauma‐related emotions on PTSD severity. Three trauma‐related emotions (sadness, disgust, and fear) were indirectly associated to PTSD severity via derealization and self‐harm and via self‐harm and derealization. Results indicate that difficulties in regulating the emotions of sadness, disgust, and fear may result in more severe derealization and self‐harm as coping strategies, which in turn lead to greater PTSD severity. The sequence of mediators does not hold great importance in these pathways. Overall, our findings suggest that therapeutically targeting derealization and self‐harm might enable the reduction of PTSD among CSA survivors. - Clinical Psychology & Psychotherapy, EarlyView.
    October 17, 2018   doi: 10.1002/cpp.2333   open full text
  • Self‐practice/self‐reflection as an alternative to personal training‐therapy in cognitive behavioural therapy training: A qualitative analysis.
    Craig Chigwedere, Richard Thwaites, Brian Fitzmaurice, Gary Donohoe.
    Clinical Psychology & Psychotherapy. October 17, 2018
    --- - |2+ Abstract Introduction The study examined the qualitative impact and credibility of self‐practice/self‐reflection (SP/SR). Methods Nineteen participants reflected on the self‐practice of cognitive behavioural therapy techniques. Written reflections were analysed using inductive thematic analysis. Results Two superordinate themes (a) Personal‐self and (b) Therapist‐self, with themes and subthemes emerged. Conclusion The themes found equivalents in existing goals of traditional therapists' training‐therapy. Though brief, SP/SR may be a credible alternative/adjunctive training‐therapy. - Clinical Psychology & Psychotherapy, EarlyView.
    October 17, 2018   doi: 10.1002/cpp.2331   open full text
  • Clients' experience of change: an exploration of the influence of reformulation tools in Cognitive Analytic Therapy.
    Rebecca Tyrer, Ciara Masterson.
    Clinical Psychology & Psychotherapy. October 10, 2018
    --- - |2 Abstract Case formulation is considered important in both the development of the therapeutic relationship and in starting the process of therapeutic change. Cognitive analytic therapy describes the developmental origins and maintenance of a client's problems in both written (reformulation letter) and diagrammatic form (Sequential diagrammatic reformulation; SDR). This study aimed to investigate the effects of these reformulation tools on insight and symptom change. A small‐N repeated measures design was employed with quantitative and qualitative measures collected from six therapist/client dyads. Participating therapists kept a record of their delivery of CAT reformulation tools. Participating clients completed the insight sub‐scale of the Self‐Reflection and Insight Scale (SRIS‐IN) every fourth session and the Clinical Outcomes in Routine Evaluation‐10 (CORE‐10) every session. Qualitative data from client change interviews regarding their experiences of CAT and attributions of change was explored using template analysis. Participants demonstrated improvements (symptom reduction and insight increases) over the course of the intervention. Administration of reformulation tools did not consistently result in significant changes on insight and symptom measures. However, the tools were identified by participants as leading to insight and emotional change within the context of a good therapeutic relationship. These findings suggest that a genuine therapeutic relationship is an important change mechanism operating through, and strengthened by, CAT‐specific tools. - Clinical Psychology & Psychotherapy, Volume 0, Issue ja, -Not available-.
    October 10, 2018   doi: 10.1002/cpp.2339   open full text
  • Issue Information.

    Clinical Psychology & Psychotherapy. October 09, 2018
    --- - |2 No abstract is available for this article. - Clinical Psychology & Psychotherapy, Volume 25, Issue 5, September/October 2018.
    October 09, 2018   doi: 10.1002/cpp.2140   open full text
  • Intersession improvement and outcome in psychotherapy.
    Andrew Koffmann.
    Clinical Psychology & Psychotherapy. October 05, 2018
    --- - |2+ Abstract Objective Psychotherapy patients who experience large, stable symptomatic improvement between sessions are more likely than those without such sudden gains to benefit from treatment. However, there is limited empirical basis for the definition of sudden gains, and it is unclear how they may affect symptomatic change at other points in treatment. Method In a psychotherapy training clinic, 149 adults completed a distress measure at each session. For each criterion in the definition of sudden gains, we evaluated the prediction of outcome, possible moderating variables, local score instability, and multi‐session change before and after score shifts. Results Large intersession improvement did not lead to increased rate of change later in treatment, but it did predict outcome, regardless of whether nearby session scores were stable. Early improvement during the first five treatment sessions was an independent predictor of outcome. Large intersession improvement generally occurred in the context of local score instability. Conclusion Sudden gains appear to predict outcome because of improvement inherent in the gains themselves. Early overall improvement predicts outcome almost as effectively as do sudden gains. There may be advantages to redefining sudden gains as large intersession improvement, regardless of local score stability. - Clinical Psychology & Psychotherapy, Volume 0, Issue ja, -Not available-.
    October 05, 2018   doi: 10.1002/cpp.2337   open full text
  • Life events, coping styles, and psychological well‐being in children living with parents who harmfully consume alcohol.
    Cinzia Iacopetti, Ilaria Londi, Valentino Patussi, Saulo Sirigatti, Fiammetta Cosci.
    Clinical Psychology & Psychotherapy. October 05, 2018
    --- - |2+ Abstract Introduction Children living with parents who harmfully consume alcohol might experience more life events, in particular negative, than children living with parents who do not harmfully consume alcohol. They also primarily use less adaptive coping styles and often demonstrate lower resilience. No studies evaluated whether coping styles or psychological well‐being might influence the risk of life events occurrence in children living with parents who harmfully consume alcohol. Methods 45 children living with parents who harmfully consume alcohol and 45 children living with parents who do not harmfully consume alcohol, matched for sex and age, were assessed via the Appendix Life Events of the Minnesota Multiphasic Personality Inventory – Adolescent (MMPI‐A), the Coping Inventory for Stressful Situations (CISS), and the Psychological Well‐Being Scales (PWB). Results Children living with parents who harmfully consume alcohol had more life events in the 6‐month period before the assessment, mostly negative and neutral, and lower levels of psychological well‐being than children living with parents who do not harmfully consume alcohol. The risk of having experienced at least one negative or neutral life event was higher in children living with parents who harmfully consume alcohol than in their peers and in those with lower psychological well‐being. The risk of having had a positive life event was not related to parents’ consumption of alcohol but to avoidant coping and low self‐acceptance behaviors. Conclusions Children living with parents who harmfully consume alcohol need interventions aimed at improving psychological well‐being to protect them from life events, especially from negative ones. - Clinical Psychology & Psychotherapy, Volume 0, Issue ja, -Not available-.
    October 05, 2018   doi: 10.1002/cpp.2338   open full text
  • Burnout amongst clinical and counselling psychologist: The role of early maladaptive schemas and coping modes as vulnerability factors.
    Susan Simpson, Gabriella Simionato, Matthew Smout, Michiel F. Vreeswijk, Chris Hayes, Christina Sougleris, Corinne Reid.
    Clinical Psychology & Psychotherapy. October 03, 2018
    --- - |2 Abstract Psychologists are subject to multiple competing emotional demands that increase the risk of burnout. Research has demonstrated that burnout arises from both organizational and personal factors, including psychologists' personal beliefs and coping. Preliminary research indicates that early maladaptive schemas (EMS) are associated with high burnout, yet, to date, the role of EMS and associated coping responses (maladaptive coping modes [MCM]) in predicting high burnout amongst psychologists has not been investigated. Four hundred forty‐three psychologists completed a self‐report online questionnaire comprising the Maslach Burnout Inventory—emotional exhaustion scale (EE), Young Schema Questionnaire, and Schema Mode Inventory. The two most common EMS amongst psychologists were unrelenting standards and self‐sacrifice. There was substantial indication of burnout, with 18.3% in the high range and 29.6% in the moderate range of EE. The most common MCM were detached protector and detached self‐soother. Controlling for demographics and job demands, EMS accounted for an additional 18% variance in EE. MCM accounted for an additional 6% beyond the variance explained by demographics, job demands, and EMS. Practical recommendations are suggested to reduce psychologist burnout. - Clinical Psychology & Psychotherapy, EarlyView.
    October 03, 2018   doi: 10.1002/cpp.2328   open full text
  • Explaining variability in therapist adherence and patient depressive symptom improvement: The role of therapist interpersonal skills and patient engagement.
    Evelien Snippe, Maya J. Schroevers, K. Annika Tovote, Robbert Sanderman, Paul M.G. Emmelkamp, Joke Fleer.
    Clinical Psychology & Psychotherapy. September 28, 2018
    --- - |2 Understanding why therapists deviate from a treatment manual is crucial to interpret the mixed findings on the adherence–outcome association. The current study aims to examine whether therapists' interpersonal behaviours and patients' active engagement predict treatment outcome and therapist adherence in cognitive behaviour therapy (CBT) and mindfulness‐based cognitive therapy (MBCT) for depressive symptoms. In addition, the study explores rater's explanations for therapist nonadherence at sessions in which therapist adherence was low. Study participants were 61 patients with diabetes and depressive symptoms who were randomized to either CBT or MBCT. Depressive symptoms were assessed by the Beck Depression Inventory‐II. Therapist adherence, therapist interpersonal skills (i.e., empathy, warmth, and involvement), patients' active engagement, and reasons for nonadherence were assessed by two independent raters (based on digital video recordings). Therapist adherence, therapists' interpersonal skills, and patients' active engagement did not predict posttreatment depressive symptom reduction. Patients' active engagement was positively associated with therapist adherence in CBT and in MBCT. This indicates that adherence may be hampered when patients are not actively engaged in treatment. Observed reasons for nonadherence mostly covered responses to patient's in‐session behaviour. The variety of reasons for therapist nonadherence might explain why therapist adherence was not associated with outcomes of CBT and MBCT. - Clinical Psychology & Psychotherapy, EarlyView.
    September 28, 2018   doi: 10.1002/cpp.2332   open full text
  • Driving cognitions, rumination, and posttraumatic stress disorder in road traffic accidents survivors.
    Cornelia Măirean.
    Clinical Psychology & Psychotherapy. September 26, 2018
    --- - |2 Abstract This study evaluated the relationships between driving cognitions (i.e., panic‐related cognitions, accident‐related cognitions, and social‐related cognitions), rumination, and posttraumatic stress disorder (PTSD) symptoms in a sample of road traffic accidents (RTAs) survivors. We also investigated the indirect effect of driving cognitions on PTSD symptoms through rumination. The sample included 633 drivers (62% were men; Mage = 36.09; standard deviation [SD] = 11.42 years). The participants completed scales measuring driving cognitions, rumination, and PTSD symptoms, as well as providing their demographic information. The results showed that all three types of driving cognitions assessed in the present study and rumination were significantly positively associated with PTSD symptoms. Furthermore, rumination mediated the relation between social‐related cognitions and PTSD symptoms. The implications for PTSD treatment and future research are discussed. - Clinical Psychology & Psychotherapy, EarlyView.
    September 26, 2018   doi: 10.1002/cpp.2329   open full text
  • Treating anxiety disorders by emotion‐focused psychodynamic psychotherapy (EFPP)—An integrative, transdiagnostic approach.
    Manfred E. Beutel, Leslie Greenberg, Richard D. Lane, Claudia Subic‐Wrana.
    Clinical Psychology & Psychotherapy. September 26, 2018
    --- - |2 Abstract Anxiety disorders are characterized by high levels of anxiety and avoidance of anxiety‐inducing situations and of negative emotions such as anger. Emotion‐focused therapy (EFT) and psychodynamic psychotherapy (PP) have underscored the therapeutic significance of processing and transforming repressed or disowned conflicted or painful emotions. Although PP provides sophisticated means of processing intrapsychic and interpersonal conflict, EFT has empirically tested a set of techniques to access, deepen, symbolize, and transform emotions consistent with current conceptualizations of emotions and memory. Based on our clinical experience, we propose that an integrative emotion‐focused and psychodynamic approach opens new avenues for treating anxiety disorders effectively, and we present a transdiagnostic manual for emotion‐focused psychodynamic psychotherapy. The therapeutic approach takes into account both the activation, processing, and modification of emotion and the underlying intrapsychic and interpersonal conflicts. The short‐term treatment is based on the three phases of initiating treatment, therapeutic work with anxiety, and termination. Emotional poignancy (or liveliness) is an important marker for emotional processing throughout treatment. Instead of exposure to avoided situations, we endorse enacting the internal process of generating anxiety in the session providing a sense of agency and access to warded‐off emotions. Interpretation serves to tie together emotional experience and insight into the patterns and the nature of underlying intrapersonal and interpersonal conflict. Treatment modules are illustrated by brief vignettes from pilot treatments. - Clinical Psychology & Psychotherapy, EarlyView.
    September 26, 2018   doi: 10.1002/cpp.2325   open full text
  • Meaning in life among adolescents: Factorial invariance of the purpose in life test and buffering effect on the relationship between emotional dysregulation and hopelessness.
    Joaquín García‐Alandete, Blanca Gallego Hernández de Tejada, Sandra Pérez Rodríguez, José H. Marco‐Salvador.
    Clinical Psychology & Psychotherapy. September 26, 2018
    --- - |2+ Abstract Objective The purpose of the present study was threefold: first, to analyse the psychometric properties of a 10‐item Spanish version of the Purpose in Life Test, which assesses meaning in life (MiL), in a sample of community adolescents; second, to analyse the differences between the age and gender groups; and third, to analyse whether MiL buffers the relationship between emotional dysregulation and hopelessness. Method Participants were 1,599 adolescents from 12 to 19 years old, M = 15.69, SD = 2.14. The Purpose in Life Test‐10 Items, the Beck Hopelessness Scale, and the Difficulties in Emotional Regulation Scale were used. Results A nine‐item version showed good fit, psychometric properties (internal consistency, construct, and concurrent validity), and factorial invariance across gender and age (12–15 years/16–19 years). Difference in MiL between boys and girls was not significant, whereas between age groups was significant. MiL had a strong buffering effect on the relationship between emotional dysregulation and hopelessness. Discussion It is desirable to promote the sense of MiL in adolescents. MiL plays a significant and strong mediator role in the relationship between emotional dysregulation and hopelessness, reinforcing the positive role of MiL in mental health and as a resource for facing adversity. - Clinical Psychology & Psychotherapy, EarlyView.
    September 26, 2018   doi: 10.1002/cpp.2327   open full text
  • A Systematic Review Of The Clinical Utility Of The Concept Of Self‐Disgust.
    Aoife Clarke, Jane Simpson, Filippo Varese.
    Clinical Psychology & Psychotherapy. September 25, 2018
    --- - |2 Abstract This systematic literature review examined the clinical utility of the construct of self‐disgust in understanding mental distress. Specifically, the review assessed whether there is a shared conceptual definition of self‐disgust, the face and construct validity of the quantitative assessment measures of self‐disgust, and the predictive validity of self‐disgust in formulating the development of a range of psychological difficulties. A systematic database search supplemented by manual searches of references and citations identified thirty‐one relevant papers (27 quantitative, 3 qualitative, 1 mixed). Analysis of qualitative papers indicated a number of shared features in the definition of self‐disgust, including a visceral sense of self‐elicited nausea accompanied by social withdrawal and attempts at cleansing or suppressing aspects of the self. Quantitative assessment measures appeared to capture these dimensionand evidenced good psychometric properties, although some measures may have only partially captured the full self‐disgust construct. Strong relationships were observed between self‐disgust and a range of mental health presentations, in particular depression, body‐image difficulties, and trauma‐related difficulties. However, these relationships are smaller when the effects of other negative self‐referential emotions were controlled, and stronger conclusions about the predictive validity of self‐disgust are limited by the cross‐sectional nature of many of the studies. - Clinical Psychology & Psychotherapy, Volume 0, Issue ja, -Not available-.
    September 25, 2018   doi: 10.1002/cpp.2335   open full text
  • Exploration of the dialogue components in Avatar Therapy for schizophrenia patients with refractory auditory hallucinations: A content analysis.
    Laura Dellazizzo, Olivier Percie du Sert, Kingsada Phraxayavong, Stéphane Potvin, Kieron O'Connor, Alexandre Dumais.
    Clinical Psychology & Psychotherapy. September 17, 2018
    --- - |2 Abstract Auditory verbal hallucinations are hallmark symptoms of schizophrenia and are amongst the most disturbing symptoms of the disorder. Although not entirely understood, the relationship between the voice hearer and their voices has been shown to be an important treatment target. Understanding voice hearers' standpoints through qualitative analysis is central to apprehend a deeper comprehension of their experience and further explore the relevance of interpersonal interventions. Compared with other dialogical intervention, virtual reality‐assisted therapy (Avatar Therapy) enables patients to be in a tangible relation with a representation of their persecutory voice. This novel therapy has shown favourable results, though the therapeutic processes remain equivocal. We consequently sought to begin by characterizing the main themes emerging during the therapy by exploring the hearer's discussion with their avatar. The therapy sessions of 12 of our referrals were transcribed, and the patients' responses were analysed using content analysis methods. Five themes emerged from data saturation: emotional responses to the voices, beliefs about voices and schizophrenia, self‐perceptions, coping mechanisms, and aspirations. All patients had at least one element within each of these themes. Our analyses also enabled us to identify changes that were either verbalized by the patients or noted by the raters throughout therapy sessions. These findings are relevant as they allowed to identify key themes that are hypothesized to be related to therapeutic targets in a novel relational therapy using virtual reality. Future studies to further explore the processes implicated within Avatar Therapy are necessary. - Clinical Psychology & Psychotherapy, EarlyView.
    September 17, 2018   doi: 10.1002/cpp.2322   open full text
  • Disorder‐specific attachment characteristics and experiences of childhood abuse and neglect in adolescents with anorexia nervosa and a major depressive episode.
    Manuela Gander, Kathrin Sevecke, Anna Buchheim.
    Clinical Psychology & Psychotherapy. September 14, 2018
    --- - |2 For the first time, the present study investigates disorder‐specific attachment characteristics and childhood trauma in adolescent inpatients with anorexia nervosa (n = 30, girls/boys: 28/2, age: M = 14.84, SD = 1.20), a major depressive episode (n = 30, girls/boys: 27/3, age: M = 15.14, SD = 1.50), and controls (n = 60, girls/boys: 44/16, age: M = 16.10, SD = 1.20). We used the Structured Clinical Interview to diagnose Axis I disorders, the Adult Attachment Projective Picture System to classify attachment representations, and the Childhood Trauma Questionnaire to assess child maltreatment. Our findings demonstrate an overrepresentation of the unresolved attachment status in the patient samples. A one‐way analysis of variance succeeded by Bonferroni post hoc tests indicated that adolescents with anorexia nervosa show more isolation and dissolution of boundaries between life and death when confronted with situations of solitude. Although they report moderate to severe levels of traumatic childhood experiences, they tend to minimize those. Adolescents with a major depressive episode report higher levels of emotional abuse and neglect in their childhood, leaving them in a state of failed protection and danger during attachment distress. Integrating these attachment‐related characteristics into specific psychotherapeutic interventions might be associated with a better outcome in that age group. - Clinical Psychology & Psychotherapy, EarlyView.
    September 14, 2018   doi: 10.1002/cpp.2324   open full text
  • Chronic illness‐related cognitive fusion explains the impact of body dissatisfaction and shame on depression symptoms in breast cancer patients.
    Inês A. Trindade, Joana Marta‐Simões, Cláudia Ferreira, José Pinto‐Gouveia.
    Clinical Psychology & Psychotherapy. September 13, 2018
    --- - |2 Abstract Breast cancer is linked to psychological distress and mood disorders that are in turn associated with higher psychological dysfunction and decreased breast cancer survival. It is considered that psychological health in breast cancer is considerably affected by body image impairment, which in turn seems to be highly associated with shame. However, the impact of these variables on mental health may not be direct. The current study aimed to explore a comprehensive model regarding the role of chronic illness‐related cognitive fusion in the relationship of body image dissatisfaction and chronic illness‐related shame with depression symptoms. The sample was composed of 75 women with nonmetastatic breast cancer, recruited in a Radiotherapy Service in central Portugal. The conducted path model presented an excellent fit and accounted for 59% of the variance of depressive symptomatology. Further, it demonstrated that body image dissatisfaction's impact on depressed mood is significantly explained by the mechanisms of chronic illness‐related shame and chronic illness‐related cognitive fusion. It was also revealed that chronic illness‐related cognitive fusion additionally mediated the impact of chronic illness‐related shame on depression. These findings are suggestive of the importance of body image and chronic illness shame in the determination of breast cancer patients' depression symptoms and also the central role of chronic illness‐related cognitive fusion in these relationships. Therefore, the implementation of acceptance and defusion‐based psychotherapeutic interventions to improve mental health in cancer patients seems to be of great importance. - Clinical Psychology & Psychotherapy, EarlyView.
    September 13, 2018   doi: 10.1002/cpp.2323   open full text
  • Cognitive behaviour therapy for distress in people with inflammatory bowel disease: A benchmarking study.
    Cheryl Jordan, Bu'Hussain Hayee, Trudie Chalder.
    Clinical Psychology & Psychotherapy. September 12, 2018
    --- - |2+ Abstract Objective Anxiety and depression are common in inflammatory bowel disease (IBD) and have been linked to clinical recurrence. Previous randomized controlled trials (RCT's) have found no evidence that psychological interventions enhance outcomes for people with IBD but have recruited patients without distress. This study investigates the clinical benefits of a nonrandomized uncontrolled study of clinic based cognitive behaviour therapy (CBT) for people with IBD who had moderate–severe levels of anxiety or low mood and compares the results with a previous RCT of CBT in this population. Method Assessments were completed at baseline and end of treatment and included measures of low mood, generalized anxiety, quality of life (QOL), and symptomatic disease activity. The patient health questionnaire and generalized anxiety disorder 7 measures were the primary outcomes. Results in the form of a standardized effect size of treatment were compared with a previous RCT to consider if CBT had greater benefits for those with distress. Results Thirty patients were deemed appropriate for CBT, and 28 accepted treatment. The results from this clinic based CBT intervention suggest statistically significant reductions in symptoms of anxiety (<0.001), low mood (<0.001), and disease activity (p < 0.01) and increases in QOL (p < 0.001). The uncontrolled effect sizes were large and superior to those found in published RCTs. Conclusion This nonrandomized uncontrolled trial of a clinic‐based CBT intervention suggests that CBT may have benefits for those with moderate–severe disturbances to mood and that effect sizes can be improved by targeting those with distress. RCTs are required to establish efficacy. - Clinical Psychology & Psychotherapy, EarlyView.
    September 12, 2018   doi: 10.1002/cpp.2326   open full text
  • Using the Primary Process Emotional‐Behavioural System (PPEB) to Better Meet Patient Needs in Psychotherapy.
    Tien Kuei, Mavis Tsai, Hamish J. McLeod, Ross G. White, Jonathan Kanter.
    Clinical Psychology & Psychotherapy. September 11, 2018
    --- - |2 Abstract In order to increase therapeutic impact by enhancing awareness of clients' nonverbal communications, this article operationalizes the therapeutic alliance as a Needs‐Satisfaction Process. The client's competence as a needs‐seeker and the therapist assisting with the client's expression and satiation of basic social needs are proposed as being key mechanisms of change. Functional model of primary emotions derived from Panksepp's seven primary emotional systems (care seeking, care‐taking, lust, fear and anxiety, anger, play, seeking, plus dominance and disgust) is integrated with Functional Analytic Psychotherapy's emphasis on in‐session contingent natural reinforcement of clients' target behaviors. By identifying in‐the‐moment cues of underlying emotional‐behavioral functions drawn from a categorisation of clients' nonverbal communication, can bridge the gap between client private events and therapist observables, in order to maximize therapist attunement and responsiveness to clients, and to increase the effectiveness of clinical interventions. - Clinical Psychology & Psychotherapy, Volume 0, Issue ja, -Not available-.
    September 11, 2018   doi: 10.1002/cpp.2330   open full text
  • Do clinical experience, formal cognitive behavioural therapy training, adherence, and competence predict outcome in cognitive behavioural therapy for anxiety disorders in youth?
    Jon Fauskanger Bjaastad, Gro Janne Henningsen Wergeland, Bente Storm Mowatt Haugland, Rolf Gjestad, Odd E. Havik, Einar R. Heiervang, Lars‐Göran Öst.
    Clinical Psychology & Psychotherapy. August 30, 2018
    --- - |2+ Abstract Objective The aim was to investigate whether clinical experience, formal cognitive behavioural therapy (CBT) training, adherence, and competence predict outcome in CBT for anxiety disorders in youth. Method Videotapes (N = 181) from the sessions in a randomized controlled effectiveness trial (Wergeland et al., 2014, Behaviour Research and Therapy, 57, 1–12) comprising youth (N = 182, M age = 11.5 years) with mixed anxiety disorders were assessed for treatment adherence and competence using the Competence and Adherence Scale for CBT for anxiety disorders in youth (Bjaastad et al., 2016, Psychological Assessment, 28, 908–916). Therapists' (N = 17) clinical experience and educational background were assessed. Participants completed a diagnostic interview (Anxiety Disorders Interview Schedule, child and parent versions) and an anxiety symptom measure (Spence Children's Anxiety Scale, child and parent versions) at pretreatment, posttreatment, and 1‐year follow‐up. Results Higher therapist adherence was related to better treatment outcomes, whereas number of years of clinical experience and competence was related to worse outcomes. However, these findings were not consistent across informants and the time points for the assessments. Interaction effects suggested that competence among therapists with formal CBT training was related to better patient outcomes. Conclusions Therapist adherence, competence, and clinical experience are associated with outcomes of manualized CBT for youth anxiety disorders, but mixed findings indicate the need for more research in this area. - Clinical Psychology & Psychotherapy, EarlyView.
    August 30, 2018   doi: 10.1002/cpp.2321   open full text
  • Emotion‐focused therapy for binge‐eating disorder: A review of six cases.
    Kevin Glisenti, Esben Strodl, Robert King.
    Clinical Psychology & Psychotherapy. August 17, 2018
    --- - |2+ Abstract Objective This study aimed to provide preliminary evidence of the usefulness of emotion‐focused therapy (EFT) for binge‐eating disorder (BED). Methods We used a single‐subject design in which 12 weeks of individual EFT were applied nonconcurrently to six female adult participants with BED, following three weekly baseline sessions. Participants were assessed for binge‐eating psychopathology and emotion regulation difficulties on a weekly basis during baseline and treatment. They were assessed on a 2‐, 4‐, and 8‐week basis during posttreatment, and they were assessed for binge‐eating episodes, eating disorder attitudes, alexithymia, and psychiatric comorbidity at pretreatment and posttreatment. Results All cases experienced reliable recovery from binge‐eating psychopathology and a significant decrease in binge‐eating frequency. For all cases, there was reliable improvement or recovery on eating and shape concerns, and there was improvement on weight concern for the majority of cases. For all cases, reliable recovery or improvement occurred in overall emotion regulation. Most cases that were in the clinical range pretreatment recovered for anxiety, and reliable improvement in or recovery from depression occurred for all cases. There was reliable recovery or improvement in alexithymia for half of the cases; however, the other half experienced no change or deteriorated. There were no treatment dropouts. Conclusion Individual EFT demonstrates potential as a psychological treatment for BED. The current study provides preliminary evidence to guide the development of a more extensive trial to test the efficacy of individual EFT for BED as well as to identify possible mechanisms of change. - Clinical Psychology & Psychotherapy, EarlyView.
    August 17, 2018   doi: 10.1002/cpp.2319   open full text
  • Dissemination of exposure in the treatment of anxiety disorders and post‐traumatic stress disorder among German cognitive behavioural therapists.
    Sarah Schumacher, Deborah Weiss, Christine Knaevelsrud.
    Clinical Psychology & Psychotherapy. August 17, 2018
    --- - |2 Abstract The efficacy of exposure is beyond doubt, which is reflected in guidelines recommending its application in the treatment of anxiety disorders and post‐traumatic stress disorder (PTSD). Research suggests exposure to be underutilized in clinical practice in the United States and Europe. A systematic investigation of the dissemination of exposure in Germany is lacking. The present study examined the dissemination and application frequency of exposure among German cognitive behavioural therapists working in routine care. In an online‐based survey, 331 psychotherapists provided information on treatment of patients with panic disorder, phobia, and PTSD. By means of multinomial logistic regression analysis, application frequency of exposure (non‐users vs. users vs. frequent users) was predicted by various therapist characteristics. Younger age and less negative beliefs about exposure significantly predicted the affiliation to the frequent users group compared to the non‐users in the treatment of panic disorder or phobia. Concerning treatment of PTSD, only negative beliefs about exposure was identified as significant predictor. Sex, educational level, and number of exposure sessions performed during clinical training were not of predictive value. Current findings suggest that negative beliefs about exposure and age impact the frequent provision of exposure to patients. Modification of negative attitudes might be achieved through specific training strategies. - Clinical Psychology & Psychotherapy, EarlyView.
    August 17, 2018   doi: 10.1002/cpp.2320   open full text
  • The efficacy of narrative exposure therapy in a sample of Iranian women exposed to ongoing intimate partner violence—A randomized controlled trial.
    Tahereh Orang, Sarah Ayoughi, James K. Moran, Hakimeh Ghaffari, Saeedeh Mostafavi, Maryam Rasoulian, Thomas Elbert.
    Clinical Psychology & Psychotherapy. August 06, 2018
    --- - |2+ Abstract Objective The mental health needs of women affected by intimate partner violence (IPV) and living under continuous domestic violence are currently not well understood. The present study investigates the feasibility and efficacy of narrative exposure therapy (NET), compared with commonly used counselling (treatment‐as‐usual, TAU), in a group of currently IPV‐affected women in Tehran, Iran. Method Forty‐five IPV‐affected women with a diagnosis of post‐traumatic stress disorder (PTSD) were randomized to 10 to 12 sessions of either NET (n = 24) or TAU (n = 21). Primary outcome measures, including PTSD, depression, and perceived stress symptoms, were examined at pretreatment and 3‐ and 6‐month follow‐ups. IPV experiences, general lifetime traumatic events, childhood adversities, borderline symptoms, and daily functioning impairment were also inspected. Results NET participants showed a significantly greater symptom reduction in comparison with the TAU group in PTSD, depression, and perceived stress at both follow‐ups. Improvement in daily functioning and reduction of IPV experiences and borderline symptoms at 3‐ and 6‐month follow‐ups were pronounced but not significantly different between the two treatment groups. Conclusion IPV‐affected women living under continuous threat and violence would benefit from trauma‐focused interventions such as NET. - Clinical Psychology & Psychotherapy, EarlyView.
    August 06, 2018   doi: 10.1002/cpp.2318   open full text
  • Issue Information.

    Clinical Psychology & Psychotherapy. August 03, 2018
    --- - |2 No abstract is available for this article. - Clinical Psychology & Psychotherapy, Volume 25, Issue 4, July/August 2018.
    August 03, 2018   doi: 10.1002/cpp.2139   open full text
  • Are family relations connected to the quality of the outcome in adolescent anorexia nervosa? An observational study with the Lausanne Trilogue Play.
    Laura Balottin, Stefania Mannarini, Martina Maria Mensi, Matteo Chiappedi, Umberto Balottin.
    Clinical Psychology & Psychotherapy. July 27, 2018
    --- - |2 The study aims to explore the connection between the family interactive patterns, investigated with a standardized observational tool based on a recorded play session, the Lausanne Trilogue Play, and the outcome of adolescent patients with anorexia nervosa after a 6 months treatment, based on the Morgan–Russel Outcome Assessment Schedule. Seventy‐two parents and adolescent daughters with anorexia nervosa, consecutively referred to an adolescent neuropsychiatric service, participated in the study and underwent an integrated model of treatment, based on constant neuropsychiatric and dietary monitoring, weekly individual psychotherapy for the daughter, and parental counselling and support. A better adolescents' functioning in family relationships, in particular in the triadic ones, at first assessment, was associated with a better outcome. Data on family interactions may help predict the most appropriate intervention for the patient and his family. - Clinical Psychology & Psychotherapy, EarlyView.
    July 27, 2018   doi: 10.1002/cpp.2314   open full text
  • Emotionally aligned: Preliminary results on the effects of a mindfulness‐based intervention for depression on congruence between implicit and explicit mood.
    Carina Remmers, Johannes Zimmermann, Alice Buxton, Hans‐Peter Unger, Sander L. Koole, Christine Knaevelsrud, Johannes Michalak.
    Clinical Psychology & Psychotherapy. July 19, 2018
    --- - |2+ Background Mindfulness‐based interventions (MBIs) are effective in treating major depression. Because mindfulness involves monitoring and accepting current experiences, it may lead people resolve incongruencies between emotional responses that would otherwise remain unnoticed. Mindfulness may thus foster congruence between implicit and explicit emotions. The current randomized controlled trial tested this notion. Methods N = 39 patients with an acute depressive episode were randomly assigned to an 8‐week MBI (n = 24) or a psychopharmacological consultation condition (n = 15). Explicit and implicit mood and depressive symptoms were assessed before treatment and at the end of treatment. Results Compared with the control condition, patients receiving MBI demonstrated higher congruence between implicit and explicit negative mood after treatment. There was no such difference in congruence of implicit and explicit positive mood. Additional analyses showed that only within the MBI group, individual differences in explicit mood became less stable. In contrast, individual differences in implicit mood remained stable in both groups. Limitations There was no control group including an active psychological intervention, the sample was small, and emotional congruence was not assessed within persons. Conclusions These findings correspond with the idea that mindfulness reduces incongruencies between implicit and explicit emotional responses. We found preliminary evidence for this effect for negative emotional responses. There was suggestive evidence that congruence arose from the alignment of explicit responses (which became less stable) to implicit responses (which remained stable). Studying the interplay between implicit and explicit processes may shed light on the working mechanisms of clinical‐psychological interventions. - Clinical Psychology & Psychotherapy, EarlyView.
    July 19, 2018   doi: 10.1002/cpp.2317   open full text
  • Working alliance and outcome effectiveness in videoconferencing psychotherapy: A systematic review and noninferiority meta‐analysis.
    Carl Norwood, Nima G. Moghaddam, Sam Malins, Rachel Sabin‐Farrell.
    Clinical Psychology & Psychotherapy. July 16, 2018
    --- - |2 Abstract Videoconferencing psychotherapy (VCP)—the remote delivery of psychotherapy via secure video link—is an innovative way of delivering psychotherapy, which has the potential to overcome many of the regularly cited barriers to accessing psychological treatment. However, some debate exists as to whether an adequate working alliance can be formed between therapist and client, when therapy is delivered through such a medium. The presented article is a systematic literature review and two meta‐analyses aimed at answering the questions: Is working alliance actually poorer in VCP? And is outcome equivalence possible between VCP and face‐to‐face delivery? Twelve studies were identified which met inclusion/exclusion criteria, all of which demonstrated good working alliance and outcome for VCP. Meta‐analyses showed that working alliance in VCP was inferior to face‐to‐face delivery (standardized mean difference [SMD] = −0.30; 95% confidence interval [CI] [−0.67, 0.07], p = 0.11; with the lower bound of the CI extending beyond the noninferiority margin [−0.50]), but that target symptom reduction was noninferior (SMD = −0.03; 95% CI [−0.45, 0.40], p = 0.90; CI within the noninferiority margin [0.50]). These results are discussed and directions for future research recommended. - Clinical Psychology & Psychotherapy, EarlyView.
    July 16, 2018   doi: 10.1002/cpp.2315   open full text
  • The interplay between experiential states in first generation schema therapy of Cluster C personality problems: A network approach.
    Asle Hoffart.
    Clinical Psychology & Psychotherapy. July 13, 2018
    --- - |2 Abstract We tested a theory‐derived network of within‐person causal relations between experiential states in schema therapy of Cluster C personality problems. The sample consisted of 35 patients with panic disorder and/or agoraphobia and DSM‐IV Cluster C personality traits or disorders who participated in an inpatient programme. In a 6‐week schema therapy phase, the patients had nine or 10 individual sessions and completed measures of experiential states (anger, sadness, depression, anxiety, optimism, and schema belief) before and after each session. The impact of these six states on each other and on themselves over time was examined in mixed models. Schema belief was positively related to subsequent anger and sadness, whereas optimism was negatively related to subsequent schema belief, sadness, and depression. The results suggest that one could maximize the effect of schema therapy on dysphoric feelings in patients with Cluster C personality problems through a therapeutic focus on optimism and schema belief. - Clinical Psychology & Psychotherapy, EarlyView.
    July 13, 2018   doi: 10.1002/cpp.2316   open full text
  • Reconceptualization innovative moments as a predictor of symptomatology improvement in treatment for depression.
    Pablo Fernández‐Navarro, Catarina Rosa, Inês Sousa, Vanessa Moutinho, Ana Antunes, Carina Magalhães, António P. Ribeiro, Miguel M. Gonçalves.
    Clinical Psychology & Psychotherapy. July 10, 2018
    --- - |2+ Abstract Objectives In previous studies, reconceptualization innovative moments were associated with successful psychotherapy. Reconceptualization has two components—(a) a positive temporal contrast between the past self and the present self (contrasting self [CS]) and (b) a description of how and/or why this change has occurred (change process [CP])—from the perspective of the client. The aim of this study is to analyse if CS and CP have the same association with outcomes as reconceptualization. Method Sixteen cases of clients with major depression (305 sessions) were analysed. Longitudinal regression models were used to explore if proportions of CS, CP, and reconceptualization predicted outcome measures and if outcome measures predicted CS, CP, and reconceptualization. Results Reconceptualization is less frequent than CS and CP taken separately, but reconceptualization was a better predictor of treatment outcomes than were its separate components. Moreover, symptom improvement did not predict reconceptualization. Conclusion The construction of new meanings is important in improving depressive symptomatology. Psychotherapists can elicit these new meanings in their regular practice by posing questions that may help clients to conceptualize what is changing in themselves (CS) and questions of how this change is occurring (CP). The construction of an integrative account of these new meanings is associated with psychotherapeutic gains, and thus, reconceptualizing change could improve symptoms of depression. - Clinical Psychology & Psychotherapy, EarlyView.
    July 10, 2018   doi: 10.1002/cpp.2306   open full text
  • Gender role strain, core schemas, and psychotic experiences in ethnically diverse women: A role for sex‐ and gender‐based analysis in psychosis research?
    Maria Haarmans, Kwame McKenzie, Sean A. Kidd, Richard P. Bentall.
    Clinical Psychology & Psychotherapy. July 06, 2018
    --- - |2 Abstract Negative ‐self and ‐others core schemas have been implicated in the development and maintenance of psychotic experiences. One component of the self‐system is gender‐role strain (GRS; perceived discrepancy between actual self and gender‐role norms). Although the role of gender in the formation of core schemas has been underscored in social and developmental psychology literatures, GRS has not been investigated in relation to psychosis. We examined whether it might be associated with negative schemas and psychotic experiences in women consistent with the trend toward sex‐ and gender‐based analysis (SGBA) in health research. Forty‐four women with a schizophrenia spectrum disorder diagnosis and 48 female nonclinical participants completed a series of questionnaires measuring GRS, femininity ideology, core schemas, childhood trauma, and implicit femininity stereotypes (The Gender Stereotype Implicit Association Test). Half the total sample comprised women with minority‐ethnic status. Women in the psychosis group reported higher levels of GRS than comparison participants. Differences in endorsement of femininity ideology between the two groups narrowly missed significance with a trend toward greater femininity ideology in the psychosis group and significantly greater endorsement of the sexual purity domain for minority‐ethnic women. There was no difference in implicit femininity stereotypes. Analyses suggested that the relationship between GRS and symptoms was mediated by negative ‐self and ‐others schemas. Childhood sexual trauma, though higher for women with psychosis, was associated with gender‐role strain in the nonclinical sample only. Findings warrant further investigation with larger samples. SGBA has the potential to fill gaps in our current knowledge with regard to psychosis theory, research, and practice. - Clinical Psychology & Psychotherapy, EarlyView.
    July 06, 2018   doi: 10.1002/cpp.2307   open full text
  • Suicidal ideation in patients with coronary heart disease and hypertension: Baseline results from the DEPSCREEN‐INFO clinical trial.
    Marco Lehmann, Sebastian Kohlmann, Benjamin Gierk, Alexandra M. Murray, Bernd Löwe.
    Clinical Psychology & Psychotherapy. July 04, 2018
    --- - |2+ Abstract Background A high proportion of cardiac patients suffers from depression, which is an antecedent for suicidal ideation. This study identifies clinical vulnerabilities for suicidal ideation in cardiac patients. Methods The primary outcome of the study was severity of suicidal ideation as measured with the Patient Health Questionnaire (PHQ‐9) item No. 9. Covariates were demographics, cardiac characteristics (i.e., Canadian Cardiovascular Society angina rating of chest pain and New York Heart Association rating of shortness of breath), depression (PHQ‐8,i.e., PHQ‐9 minus item No. 9), anxiety (Generalized Anxiety Disorder‐7, GAD‐7), somatic symptoms (PHQ‐15), illness perception (Brief‐Illness Perception Questionnaire), and health‐related quality of life (EuroQol‐5D, EQ 5D). Results Data from 1,976 patients were analysed. At least 14% (95% CI [12%, 16%]) of patients indicated suicidal ideations within the last 2 weeks. Bivariate analyses yielded associations between suicidal ideation and higher levels of depression severity, anxiety severity, somatic symptom burden, chest pain, shortness of breath, negative illness perceptions, reduced health‐related quality of life, and a higher probability of living alone (all p < 0.001). A multivariable ordinal regression revealed depression severity and anxiety severity to show the highest associations with suicidal ideation (ORPHQ‐8 = 1.22, p < 0.001; ORGAD‐7 = 1.09, p < 0.001). Having a defibrillator implant was associated with a lower probability of suicidal ideation (OR = 0.27, p = 0.017). Conclusions This study identified several clinical vulnerabilities of suicidal ideation. The results stress the importance of screening for suicidal ideation in clinical practice. - Clinical Psychology & Psychotherapy, EarlyView.
    July 04, 2018   doi: 10.1002/cpp.2305   open full text
  • Group cognitive–behavioural treatment with long‐term follow‐up and targeting self‐identity for hoarding disorder: An open trial.
    Kieron O'Connor, Yuliya Bodryzlova, Jean‐Sébastien Audet, Natalia Koszegi, Karine Bergeron, Annik Guitard.
    Clinical Psychology & Psychotherapy. July 01, 2018
    --- - |2+ Background Group cognitive–behavioural therapy (G‐CBT) for hoarding disorder (HD) may be an intervention of choice, considering its efficacy, low costs, and impact on comorbid anxiety and depression. But although G‐CBT and modifications of G‐CBT have been applied, none has assessed G‐CBT efficacy at follow‐up. In the current open‐label pilot study, we tested the efficacy of G‐CBT at posttreatment and 6‐month follow‐up and whether the inclusion of targeted reasoning and self‐identity components added to G‐CBT efficacy. Methods Participants (n = 16) with the HD according to the DSM‐5 criteria without major comorbid conditions and not requiring immediate medical intervention were retained. The intervention included a 20‐week G‐CBT with the inclusion of modules on reasoning and self‐identity. Results Very large/large effect sizes, depending on the outcome measure, were observed at posttreatment. Also, HD severity decreased from posttreatment to 6‐month follow‐up. All participants showed reliable change from pretreatment to follow‐up. Conclusions The results emphasize the efficacy of G‐CBT with additional targeted reasoning and self‐components. - Clinical Psychology & Psychotherapy, Volume 25, Issue 5, Page 701-709, September/October 2018.
    July 01, 2018   doi: 10.1002/cpp.2304   open full text
  • Experiences of a transdiagnostic group, the Take Control Course, for clients with common mental health problems: A qualitative study.
    Lydia Morris, Warren Mansell, Rebekah Amos, Dawn Edge.
    Clinical Psychology & Psychotherapy. June 26, 2018
    --- - |2+ Abstract Objectives Despite the promising effectiveness findings for transdiagnostic groups, studies have not explored clients' experiences. There is a risk that clients could perceive that the content of transdiagnostic groups is not sufficiently tailored to their specific problems. Our aims were to examine whether a brief transdiagnostic group, the Take Control Course (TCC), was acceptable to participants and to explore participants' perceptions of psychological change. Methods Qualitative data were collected via 12 semistructured, in‐depth interviews. Data collection and thematic analysis were concurrent and iterative. Results Three superordinate themes were identified: “Style and format,” “Control and flexibility,” and “Change.” The flexible group format was appreciated, as participants felt able to engage at their own pace and adapt relevant aspects. Greater clarity regarding what was within participants' control reduced distress and enabled effective pursuit of valued goals. Participants described significant (predominantly gradual) changes, including substantial improvements within relationships. Conclusions The transdiagnostic format did not prevent participants experiencing the TCC as individually relevant. The flexibility and consistent theoretical framework seemed to contribute to this. The results indicated that greater consideration of control and mindfulness allowed greater cognitive flexibility, an ability to reprioritize and let go of unhelpful habits, which better enabled participants to meet their goals. Implications for group therapy include (a) clearly explaining the format of such groups to clients and (b) providing flexibility in the way the group is delivered where possible. Additional qualitative studies of transdiagnostic groups are required to establish if themes generalize to other transdiagnostic groups. - Clinical Psychology & Psychotherapy, Volume 25, Issue 5, Page 730-744, September/October 2018.
    June 26, 2018   doi: 10.1002/cpp.2303   open full text
  • Dispositional self‐compassion and responses to mood challenge in people at risk for depressive relapse/recurrence.
    Anke Karl, Matthew J. Williams, Jessica Cardy, Willem Kuyken, Catherine Crane.
    Clinical Psychology & Psychotherapy. June 12, 2018
    --- - |2 This paper explores the relationship between dispositional self‐compassion and cognitive emotion regulation capacities in individuals with a history of depression. Study 1 (n = 403) established that self‐compassion was associated with increased use of positive and decreased use of negative strategies, with small to medium sized correlations. Study 2 (n = 68) was an experimental study examining the association between dispositional self‐compassion, use of cognitive emotion regulation strategies, and changes in mood and self‐devaluation in participants exposed to a negative mood induction followed by mood repair (mindfulness, rumination, silence). Individuals with higher levels of dispositional self‐compassion showed greater mood recovery after mood induction, and less self‐devaluation across the experimental procedure, independent of their mood‐repair condition or habitual forms of cognitive emotion regulation. These results suggest that self‐compassion is associated with more adaptive responses to mood challenges in individuals with a history of recurrent depression. - Clinical Psychology & Psychotherapy, Volume 25, Issue 5, Page 621-633, September/October 2018.
    June 12, 2018   doi: 10.1002/cpp.2302   open full text
  • Assessment of metacognitive beliefs in an at risk mental state for psychosis: A validation study of the Metacognitions Questionnaire‐30.
    Measha Bright, Sophie Parker, Paul French, Anthony P. Morrison, Sarah Tully, Suzanne L.K. Stewart, Adrian Wells.
    Clinical Psychology & Psychotherapy. June 07, 2018
    --- - |2+ Aim The Metacognitions Questionnaire‐30 (MCQ‐30) has been used to assess metacognitive beliefs in a range of mental health problems. The aim of this study is to assess the validity of the MCQ‐30 in people at risk for psychosis. Methods One hundred eighty‐five participants meeting criteria for an at risk mental state completed the MCQ‐30 as part of their involvement in a randomized controlled trial. Confirmatory and exploratory factor analyses were conducted to assess factor structure and construct validity. Results Confirmatory factor analyses confirmed the original five‐factor structure of the MCQ‐30. Examination of principal component analysis and parallel analysis outputs also suggested a five‐factor structure. Correlation analyses including measures of depression, social anxiety, and beliefs about paranoia showed evidence of convergent validity. Discriminant validity was supported using the normalizing subscale of the beliefs about paranoia tool. Conclusions The MCQ‐30 demonstrated good fit using the original five‐factor model, acceptable to very good internal consistency of items was evident and clinical usefulness in those at risk for psychosis was demonstrated. - Clinical Psychology & Psychotherapy, Volume 25, Issue 5, Page 710-720, September/October 2018.
    June 07, 2018   doi: 10.1002/cpp.2301   open full text
  • Does experiential avoidance explain the relationships between shame, PTSD symptoms, and compulsive sexual behaviour among women in substance use treatment?
    Meagan J. Brem, Ryan C. Shorey, Scott Anderson, Gregory L. Stuart.
    Clinical Psychology & Psychotherapy. June 05, 2018
    --- - |2+ Objective Untreated compulsive sexual behaviour (CSB) poses a risk to efficacious substance use disorder (SUD) treatment. Yet the ways in which CSB manifests in women with SUDs remains poorly understood. Shame and trauma exposure are well‐documented correlates for women's CSB. Prior theory suggested women with shame and trauma‐related symptoms may engage in CSB in an effort to escape aversive internal experiences. Thus, the present study examined experiential avoidance as a mediator of the relationship between defectiveness/shame beliefs, post‐traumatic stress disorder symptoms, and CSB in a sample of women with SUDs. Method Cross‐sectional, self‐report data were collected from 446 women (M age = 37.40) in residential treatment for SUDs. Results Experiential avoidance partially mediated the relationship between both post‐traumatic stress disorder symptoms and defectiveness/shame beliefs and CSB. Conclusions These results extend theoretical conceptualizations of women's CSB to a treatment population. CSB intervention efforts may benefit from targeting women's avoidance of painful experiences. - Clinical Psychology & Psychotherapy, Volume 25, Issue 5, Page 692-700, September/October 2018.
    June 05, 2018   doi: 10.1002/cpp.2300   open full text
  • Brief coping strategy enhancement for distressing voices: Predictors of engagement and outcome in routine clinical practice.
    Georgie Paulik, Anna‐Marie Jones, Mark Hayward.
    Clinical Psychology & Psychotherapy. May 24, 2018
    --- - |2 Cognitive behaviour therapy is recommended internationally as a treatment for psychosis (targeting symptoms such as auditory hallucinations, or “voices”). Yet mental health services are commonly unable to offer such resource‐intensive psychological interventions. Brief, symptom‐specific and less resource‐intensive therapies are being developed as one initiative to increase access. However, as access increases, so might the risk of offering therapy to clients who are not optimally disposed to engage with and benefit from therapy. Thus, it is important to identify who is most/least likely to engage with and benefit from therapy, and when. In the current study, 225 clients were assessed for suitability for a brief, 4‐session, manualized, cognitive behaviour therapy‐based intervention for voices (named coping strategy enhancement therapy) and 144 commenced therapy, at a transdiagnostic voices clinic based in Sussex, UK. This article reports on the value of depression, anxiety, stress, insight into the origin of voices, length of voice hearing, and demographics in the prediction of engagement and outcomes. The study found that higher levels of baseline depression, anxiety, and stress were significantly associated with poorer outcomes, especially if clients also had high levels of voice‐related distress. The engagement analyses showed that levels of voice‐related distress at baseline predicted dropout. These findings highlight the importance of assessing negative affect and voice‐related distress prior to commencing therapy for distressing voices, to help determine if the client is suitable or ready for brief‐coping strategy enhancement. - Clinical Psychology & Psychotherapy, Volume 25, Issue 5, Page 634-640, September/October 2018.
    May 24, 2018   doi: 10.1002/cpp.2299   open full text
  • Person‐specific validation and testing of functional relations in cognitive‐behavioural case formulation: Guidelines and options.
    Gregory H. Mumma, Andrew J. Marshall, Cortney Mauer.
    Clinical Psychology & Psychotherapy. May 23, 2018
    --- - |2 Although a number of manuals describe how to develop a cognitive‐behavioural case formulation (CBCF) to assist the clinician in developing and implementing tailored CB treatment for complex or comorbid cases, methods to evaluate and test functional hypotheses in the formulation for a particular case are not widely known or used. Thus, formulation‐based, tailored treatments for such cases are likely to be guided by case formulations of uncertain validity. The present article presents guidelines and choices available to the clinical trainee, researcher, or practitioner planning to use a person‐specific (PS) approach to testing CBCF hypotheses about functional relations between triggers, cognitions, and distress or dysfunction. This approach involves repeated assessments completed by the client using an individualized questionnaire that includes both nomothetic and idiographic items of greatest relevance to the client. Guidelines and options for developing this questionnaire and for data collection within the context of a collaborative therapist–client relationship are described. PS data analyses are then used to test case formulation hypotheses that vary in complexity from simple bivariate relations to complex dynamic mediation. A case example using this PS approach is described. Simpler options for the PS evaluation of a CBCF usable by practitioners and trainees as well as more complex options for clinical researchers are included. - Clinical Psychology & Psychotherapy, Volume 25, Issue 5, Page 672-691, September/October 2018.
    May 23, 2018   doi: 10.1002/cpp.2298   open full text
  • Psychosocial roots of paranoid ideation: The role of childhood experiences, social comparison, submission, and shame.
    Célia Barreto Carvalho, Carolina Motta, José Pinto‐Gouveia, Ermelindo Peixoto.
    Clinical Psychology & Psychotherapy. May 09, 2018
    --- - |2+ Background Social experiences have a significant impact on cognitive functioning and appraisals of social interactions. Specifically, recalls of antipathy from parents, submissiveness, and bullying during childhood can have a significant influence on paranoid ideation later in life. Method Multiple hierarchical regression analysis was performed on a sample of 91 patients diagnosed with paranoid schizophrenia in remission and active phase, their first‐degree relatives (n = 32) and unaffected controls (n = 64). Objectives Exploring the impact of distal (events from childhood) and proximal factors (current cognitive, emotional, and behavioural aspects of social functioning) in the frequency, degree of conviction, and distress resulting from paranoid ideation in the participants from 4 samples. Results Proximal and distal factors (shame, submissive behaviour, negative social comparison, antipathy from father) predicted several aspects of paranoid ideation. Those variables had a differential impact in affected patients and healthy controls. Discussion Finding suggests different variables being involved in paranoid ideation, and the specificities of patients with paranoid schizophrenia should be considered in the development of more effective psychotherapeutic interventions. - Clinical Psychology & Psychotherapy, Volume 25, Issue 5, Page 650-661, September/October 2018.
    May 09, 2018   doi: 10.1002/cpp.2195   open full text
  • A therapist version of the Alliance Negotiation Scale.
    Jennifer M. Doran, Juan Martín Gómez‐Penedo, Jeremy D. Safran, Andrés Roussos.
    Clinical Psychology & Psychotherapy. May 03, 2018
    --- - |2 Abstract The aim of the current study was to design and evaluate a therapist version of the Alliance Negotiation Scale (ANS). The ANS was created in order to operationalize the construct of dyadic negotiation in psychotherapy and to augment existing conceptualizations of the working alliance. The ANS has existed only as a client self‐report form since its inception and has demonstrated promise as a psychotherapy process measure. This research intended to develop a complementary therapist self‐report version of the measure. The scale creation process is discussed in detail, and the results of a preliminary psychometric investigation are reported. The ANS‐Therapist version (ANS‐T) was developed using a sample of therapists (n = 114) through a principal components analysis procedure. The ANS‐T contains 9 unidimensional items and was moderately correlated with therapist‐reported working alliance (r = .468). The results of the study support the composition of the ANS‐T and provide initial support for the reliability and validity of the measure. - Clinical Psychology & Psychotherapy, EarlyView.
    May 03, 2018   doi: 10.1002/cpp.2197   open full text
  • Putting the C into CBT: Cognitive challenging with adults with mild to moderate intellectual disabilities and anxiety disorders.
    Lynette Roberts, Sophia Kwan.
    Clinical Psychology & Psychotherapy. April 23, 2018
    --- - |2 Individuals with intellectual disabilities (ID) are more vulnerable to mental health difficulties than the general population, yet there are limited evidence‐based treatments available for this group. There has been a growing interest in adapting cognitive behaviour therapy (CBT) for this population; however, a framework describing how to modify cognitive challenging for a group characterized by cognitive impairment is lacking. The aim of this paper is threefold: (a) to describe how to implement cognitive challenging for adults with ID; (b) to report results from a pilot evaluation of a manualized, modified CBT‐ID programme for anxiety; and (c) to compare participants with mild versus moderate ID on post‐treatment cognitive challenging competencies. Results showed that the broad CBT‐ID programme significantly reduced anxiety in adults with ID as measured by self, informant, and clinician ratings. In addition, adults with mild but not moderate ID demonstrated competence across a range of specific cognitive challenging skills following treatment. These findings contribute to the growing evidence base for the use of CBT with people with ID. In addition, the framework described offers practitioners specific therapeutic methods to effectively challenge maladaptive thoughts that maintain anxiety in this population. - Clinical Psychology & Psychotherapy, Volume 25, Issue 5, Page 662-671, September/October 2018.
    April 23, 2018   doi: 10.1002/cpp.2196   open full text
  • Randomized clinical trial pilot study of prolonged exposure versus present centred affect regulation therapy for PTSD and anger problems with male military combat veterans.
    Julian D. Ford, Damion J. Grasso, Carolyn A. Greene, Michelle Slivinsky, Jason C. DeViva.
    Clinical Psychology & Psychotherapy. April 23, 2018
    --- - |2 A randomized controlled trial pilot study (www.ClinicalTrials.org; NCT01228539) with N = 31 U.S. male military recent combat veterans with PTSD and severe anger problems was conducted comparing 10‐session individual therapy versions of Trauma Affect Regulation: Guide for Education and Therapy (TARGET) versus prolonged exposure (PE). TARGET had fewer drop‐outs than PE (i.e., 29% vs. 64%). At post‐test, improvements were found for both interventions in increased emotion regulation and hope, and reduced PTSD symptoms, hostility, experiential avoidance, and mental health problems. At a four‐month follow‐up, comparable proportions (approximately 40%) of recipients in each therapy maintained clinically significant gains. Self‐rated expectancy of therapeutic outcome and working alliance was comparable for both PE and TARGET early in therapy, at mid‐treatment, and at the end of treatment. While preliminary, these results suggest that TARGET may be a viable therapeutic option for male military veterans with PTSD and anger problems. - Clinical Psychology & Psychotherapy, Volume 25, Issue 5, Page 641-649, September/October 2018.
    April 23, 2018   doi: 10.1002/cpp.2194   open full text
  • Dimensional measure of self and interpersonal functioning: Comparisons with treatment alliance and readiness for inpatient psychotherapy.
    Greg Haggerty, Michelle Stein, Caleb Siefert, Jennifer Zodan, Ashwin Mehra, Kelechi Ogbuji, Jaspreet Sangha, Michael Habib, Samuel J. Sinclair, Mark A. Blais.
    Clinical Psychology & Psychotherapy. April 17, 2018
    --- - |2 The social cognition and object relations scale‐global rating method is a clinical rating system assessing 8 domains of self and interpersonal functioning. It can be applied to score numerous forms of narrative data. In this study, we investigate the SCORS‐G relationship to measures of alliance and readiness for psychotherapy with an adolescent inpatient sample. Seventy‐two psychiatrically hospitalized adolescents were consented and subsequently rated by their individual and group therapist using the SCORS‐G. The unit psychiatrist also completed an assessment of patients' readiness for inpatient psychotherapy. The patients completed a self‐report of their alliance with the inpatient treatment team as a whole. SCORS‐G ratings were positively correlated with assessments of readiness for inpatient psychotherapy and patient‐reported alliance. This study further demonstrates the clinical utility of the SCORS‐G with adolescents. - Clinical Psychology & Psychotherapy, Volume 25, Issue 4, Page 575-582, July/August 2018.
    April 17, 2018   doi: 10.1002/cpp.2193   open full text
  • Mental health disclosure amongst clinical psychologists in training: Perfectionism and pragmatism.
    Tom Grice, Kat Alcock, Katrina Scior.
    Clinical Psychology & Psychotherapy. March 26, 2018
    --- - |2+ Objectives This study investigated the incidence of lived experience of mental health problems amongst UK‐based trainee clinical psychologists and factors associated with anticipated disclosure for trainees both with and without lived experience. Methods A web‐based survey comprising the Multidimensional Perfectionism Scale, an adapted version of the Perceived Devaluation and Discrimination Scale, and questions about lived experience and anticipated likelihood of disclosure. Results The survey was completed by 348 trainees across 19 UK training institutions. Sixty‐seven percent reported lived experience of a mental health problem. For these trainees, there was no difference in anticipated likelihood of disclosing to different recipient types after controlling for maladaptive perfectionism. However, across all participants, anticipated disclosure was associated with maladaptive perfectionism, temporal proximity, anticipated stigma (past), and recipient type. Anticipated stigma (present) was not associated with anticipated disclosure. Conclusions Results support an approach to communicating about mental health disclosure that incorporates responsibility, interdependency, and transparency. Suggestions for further research are discussed. - Clinical Psychology & Psychotherapy, Volume 25, Issue 5, Page 721-729, September/October 2018.
    March 26, 2018   doi: 10.1002/cpp.2192   open full text
  • The influence of psychosocial factors in veteran adjustment to civilian life.
    Margaret A. Bowes, Nuno Ferreira, Mike Henderson.
    Clinical Psychology & Psychotherapy. March 25, 2018
    --- - |2+ Aim Although most veterans have a successful transition to civilian life when they leave the military, some struggle to cope and adjust to the demands and challenges of civilian life. This study explores how a variety of psychosocial factors influence veteran adjustment to civilian life in Scotland, UK, and which of these factors predict a poor adjustment. Methods One hundred and fifty‐four veterans across Scotland completed a set of questionnaires that measured veteran adjustment difficulty, quality of life, mental health, stigma, self‐stigma, attitude towards help‐seeking, likelihood of help‐seeking, experiential avoidance, reappraisal and suppression. Results Veteran adjustment difficulty and quality of life were significantly correlated to a number of psychosocial factors. Mental health, experiential avoidance and cognitive reappraisal were found to be predictors of veteran adjustment difficulty, and experiential avoidance and cognitive reappraisal partially mediated the relationship between mental health and veteran adjustment, with experiential avoidance being the stronger mediator. Discussion Our findings suggest that early assessment of experiential avoidance and cognitive reappraisal and the provision of relevant emotion regulation skills training could potentially reduce the veteran's need for more complex (and costly) psychological interventions in the future. Implications for veterans, as well as the services and professionals involved with veteran transition and health care are discussed. - Clinical Psychology & Psychotherapy, Volume 25, Issue 4, Page 583-600, July/August 2018.
    March 25, 2018   doi: 10.1002/cpp.2182   open full text
  • Psychosis and sexual abuse: An interpretative phenomenological analysis.
    J.E. Rhodes, N.D. O'Neill, P.W. Nel.
    Clinical Psychology & Psychotherapy. March 25, 2018
    --- - |2+ Objectives This study aimed to investigate the first‐person perspective of psychosis sufferers who survived childhood sexual abuse. Methods Interpretative phenomenological analysis was employed to explore the experiences of 7 women with a history of sexual abuse and psychosis. Results Analysis generated six themes: (a) degradation of self, interlinking shame, guilt, and sometimes disgust; (b) body‐self entrapment, experiencing bodily constraint and distortion; (c) a sense of being different to others, involving interpersonal problems; (d) unending struggle and depression, a pervasive sense of defeat; (e) psychotic condemnations and abuse, describing psychotic phenomena related to harm and sexual abuse; and (f) perception of links to the past, the links made from past abuse to current functioning. Conclusion Participants suffered extreme psychological, physical, and interpersonal difficulties past and present. Psychotic experiences reported exhibited themes of condemnation by external entities and reflected the topic of sexual abuse. Participants did not generally link psychosis to their past abusive experiences. - Clinical Psychology & Psychotherapy, Volume 25, Issue 4, Page 540-549, July/August 2018.
    March 25, 2018   doi: 10.1002/cpp.2189   open full text
  • Delivering cognitive behavioural therapy to advanced cancer patients: A qualitative exploration into therapists' experiences within a UK psychological service.
    Suzan Hassan, Kirsty Bennett, Marc Serfaty.
    Clinical Psychology & Psychotherapy. March 25, 2018
    --- - |2+ Background Cognitive behavioural therapy (CBT) is commonly used to treat cancer patients with psychological disorders such as depression. There has been little qualitative research exploring the experience of therapists delivering CBT to patients with advanced cancer and long‐term health conditions generally. Therapists' views may help identify difficulties in delivering therapy and how these may be overcome. The aim of this study was to inform practice by qualitatively exploring the experiences of therapists delivering CBT to patients with advanced cancer. Design Sixteen semi‐structured interviews were conducted with therapists from Increasing Access to Psychological Therapy (IAPT) services in London, UK, who had delivered CBT to patients enrolled on the CanTalk trial. Interviews were recorded, transcribed, and analysed using framework analysis. Results Therapists reported positive experiences when working with the target population. Flexibility, adaptability, and a consideration of individual needs were identified as important when delivering CBT, but the rigidity of IAPT policies and demand for services were perceived as problematic. Although therapists reported adequate training, specialist supervision was desired when delivering therapy to this complex population. Conclusion IAPT therapists can deliver CBT to advanced cancer patients, given therapists positive experiences evident in the present study. However, it was concluded that additional service and modifications of therapy may be needed before positive outcomes for both therapists and patients can be achieved. - Clinical Psychology & Psychotherapy, Volume 25, Issue 4, Page 565-574, July/August 2018.
    March 25, 2018   doi: 10.1002/cpp.2190   open full text
  • Relevance of the Thought–Shape Fusion Trait Questionnaire for healthy women and women presenting symptoms of eating disorders and mixed mental disorders.
    Andrea Wyssen, Luka J. Debbeler, Andrea H. Meyer, Jennifer S. Coelho, Nadine Humbel, Kathrin Schuck, Julia Lennertz, Nadine Messerli‐Bürgy, Stephan N. Trier, Bettina Isenschmid, Gabriella Milos, Hanspeter Flury, Silvia Schneider, Simone Munsch.
    Clinical Psychology & Psychotherapy. March 23, 2018
    --- - |2 Thought–shape fusion (TSF) describes the experience of marked concerns about body weight/shape, feelings of fatness, the perception of weight gain, and the impression of moral wrongdoing after thinking about eating fattening/forbidden foods. This study sets out to evaluate the short version of the TSF trait questionnaire (TSF). The sample consists of 315 healthy control women, 244 women with clinical and subthreshold eating disorders, and 113 women with mixed mental disorders (mixed). The factor structure of the TSF questionnaire was examined using exploratory and subsequent confirmatory factor analyses. The questionnaire distinguishes between a Concept scale and a Clinical Impact scale. However, a lack of measurement invariances refers to significant differences between groups in terms of factor loadings, thresholds, and residuals, which questions cross‐group validity. Results indicate that the concept is understood differently in the 3 groups and refers to the suitability of the questionnaire primarily for individuals presenting with symptoms of eating disorders. - Clinical Psychology & Psychotherapy, Volume 25, Issue 4, Page 601-607, July/August 2018.
    March 23, 2018   doi: 10.1002/cpp.2186   open full text
  • Treatment course and its predictors in patients with somatoform disorders: A routine outcome monitoring study in secondary psychiatric care.
    I.V.E. Carlier, D.H. Andree Wiltens, Y.R. Rood, T. Veen, J. Dekker, A.M. Hemert.
    Clinical Psychology & Psychotherapy. March 23, 2018
    --- - |2+ Aim Somatoform disorders are common and often chronic. It would be helpful to distinguish those patients who are likely to have a positive treatment course from those who are likely to follow a negative course. Such studies of different somatoform disorders are scarce, especially in secondary psychiatric care. This study examined the 6‐month treatment course of psychological, physical symptoms, and functioning, and its predictors in a naturalistic sample of secondary psychiatric care outpatients with somatoform disorders. Method The present study used routine outcome monitoring data of patients with somatoform disorders regarding their 6‐month treatment course of psychological and physical symptoms as well as functioning. The following patient groups were included: total group of somatoform disorders (N = 435), and undifferentiated somatoform disorder (N = 242), pain disorder (N = 102), body dysmorphic disorder (N = 51), and hypochondriasis (N = 40). Measures were Mini‐International Neuropsychiatric Interview plus, Brief Symptom Inventory, Montgomery–Ǻsberg Depression Rating Scale, Brief Anxiety Scale, Short Form Health Survey 36, and Physical Symptom Checklist (PSC). Results The study population generally showed high co‐morbidity, especially with anxiety and mood disorders. The PSC total score, body dysmorphic disorder, and hypochondriasis were significant predictors for the treatment course of symptoms (Brief Symptom Inventory), whereas the PSC total score was the only significant predictor for the course of functioning (Short Form Health Survey 36). Conclusion Secondary psychiatric care outpatients with somatoform disorders showed high co‐morbidity with anxiety and mood disorders, and an unfavourable 6‐month course of both symptoms and functioning. Clinical implications are discussed, such as additional treatment of co‐morbidity in somatoform disorders. - Clinical Psychology & Psychotherapy, Volume 25, Issue 4, Page 550-564, July/August 2018.
    March 23, 2018   doi: 10.1002/cpp.2191   open full text
  • Comparison of early maladaptive schemas between borderline personality disorder and chronic depression.
    Niko Flink, Kirsi Honkalampi, Soili M. Lehto, Virpi Leppänen, Heimo Viinamäki, Sari Lindeman.
    Clinical Psychology & Psychotherapy. March 14, 2018
    --- - |2 Borderline personality disorder (BPD) and chronic depression (CD) are common and challenging mental disorders. Maladaptive cognitive schemas have been proposed to increase vulnerability to both disorders. In order to elucidate the role of maladaptive cognitive schemas in BPD and CD, this study compared psychiatric outpatients with BPD (N = 30) and CD (N = 30) in terms of early maladaptive schemas (EMSs). The groups were compared using the Young Schema Questionnaire short form‐extended (YSQ‐S2‐extended) and the 15D health status questionnaire. BPD patients showed higher endorsement on the majority of EMSs, poorer social functioning, and greater concurrent distress than CD patients. However, after controlling for concurrent effects of psychological distress, the groups did not differ in 14 out of the 18 EMSs. These findings point to significant similarities in maladaptive beliefs between the 2 disorders and do not support broad, specific patterns of EMSs associated with either disorder. The results highlight the need for further study of the role of maladaptive schemas in the development and treatment of chronic mental disorders. - Clinical Psychology & Psychotherapy, Volume 25, Issue 4, Page 532-539, July/August 2018.
    March 14, 2018   doi: 10.1002/cpp.2188   open full text
  • Who stays in addiction treatment groups? Anxiety and avoidant attachment styles predict treatment retention and relapse.
    S. W. Marshall, I. P. Albery, D. Frings.
    Clinical Psychology & Psychotherapy. March 09, 2018
    --- - |2 Attachment styles have been shown to be an important predictor of relationship quality and well‐being. They have also been linked with ability to function well in groups. Insecure attachment styles are thought to be an underlying cause of addiction and represent a target for change in one‐to‐one therapy. How attachment styles themselves affect group therapy for addiction is understudied. The current study addresses this gap by examining the effects of attachment styles on relapse and treatment retention amongst a population of people attending addiction therapy groups. Fifty‐eight individuals in such groups completed measures of attachment anxiety and avoidance. Participants were followed up 4 weeks later, and their continued treatment attendance and relapse status were recorded. In terms of treatment retention, high anxiety/high avoidant participants had the highest retention. In terms of relapse, low anxiety/high avoidant participants had the lowest rates. These results are discussed in terms of the potentially protective effects of avoidant attachment styles during group therapy and the role of anxiety attachment in the continued maintenance of both protective and risky personal relationships. - Clinical Psychology & Psychotherapy, Volume 25, Issue 4, Page 525-531, July/August 2018.
    March 09, 2018   doi: 10.1002/cpp.2187   open full text
  • Treating complicated grief and posttraumatic stress in homicidally bereaved individuals: A randomized controlled trial.
    Mariëtte Denderen, Jos Keijser, Roy Stewart, Paul A. Boelen.
    Clinical Psychology & Psychotherapy. February 26, 2018
    --- - |2 Homicidally bereaved individuals may experience symptoms of Complicated Grief (CG) and Posttraumatic Stress Disorder (PTSD). This Randomized Controlled Trial examined the effectiveness of an 8‐session treatment encompassing Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) to reduce self‐rated CG and PTSD symptoms in 85 Dutch adult homicidally bereaved men and women. We compared changes in symptoms of CG (assessed using the Inventory of Complicated Grief) and PTSD (assessed using the Impact of Event Scale) between an intervention group and a waitlist control group. The treatment was effective in reducing CG and PTSD symptoms, from pretreatment to posttreatment. It can be concluded that EMDR and CBT seem promising treatments for homicidally bereaved individuals for both men and women, and regardless of the time since the loss. Further research is needed to examine whether a combined treatment of EMDR and CBT together is of added value in situations where grief and trauma are intertwined over offering only one of the two treatment modalities. - Clinical Psychology & Psychotherapy, Volume 25, Issue 4, Page 497-508, July/August 2018.
    February 26, 2018   doi: 10.1002/cpp.2183   open full text
  • A proof‐of‐concept pilot randomized comparative trial of brief Internet‐based compassionate mind training and cognitive‐behavioral therapy for perinatal and intending to become pregnant women.
    Alex R. Kelman, Benjamin S. Evare, Alinne Z. Barrera, Ricardo F. Muñoz, Paul Gilbert.
    Clinical Psychology & Psychotherapy. February 23, 2018
    --- - |2+ Objective Depression is a prevalent and costly mental health problem that affects women as well as their larger communities, with substantial impacts on mother and infant during childbearing years. Face‐to‐face care has not adequately addressed this global concern due to difficulties in scaling these resources. Internet interventions, which can provide psychological tools to those lacking adequate access, show promise in filling this void. Method We conducted a 2‐condition proof‐of‐concept pilot randomized trial comparing brief Internet‐based cognitive behavioural therapy (CBT) and brief Internet‐based compassionate mind training (CMT) for women who are currently pregnant, became pregnant within the last year, and intend to become pregnant in the future. Results We found that, although CMT and CBT demonstrated near equivalence in improving affect, self‐reassurance, self‐criticism, and self‐compassion, CMT showed superiority to CBT in reducing depression and anxiety symptoms. Conclusion These findings provide a compelling initial argument for the use of CMT as an avenue for addressing problems associated with negative affect. Implications, limitations, and future directions along this line of research will also be discussed. - Clinical Psychology & Psychotherapy, Volume 25, Issue 4, Page 608-619, July/August 2018.
    February 23, 2018   doi: 10.1002/cpp.2185   open full text
  • Association between intrusive negative autobiographical memories and depression: A meta‐analytic investigation.
    Stella Mihailova, Laura Jobson.
    Clinical Psychology & Psychotherapy. February 23, 2018
    --- - |2 Abstract The study investigated several associations between depression and intrusive negative autobiographical memories. A systematic literature search identified 23 eligible studies (N = 2,582), which provided 59 effect sizes. Separate meta‐analyses indicated that depression was moderately, positively associated with intrusive memory frequency, memory distress, maladaptive memory appraisals, memory avoidance, and memory rumination. Intrusive memory vividness was not significantly associated with depression. There were insufficient data to examine the relationship between depression and memory vantage perspective. Between‐study heterogeneity was high for intrusive memory frequency and memory avoidance, and the percentage of females in studies significantly moderated the relationship between these variables and depression. An additional exploratory meta‐analysis (3 studies; N = 257) indicated that intrusive memories were experienced more frequently by those with posttraumatic stress disorder than those with depression. Overall, the findings suggest that intrusive memories warrant clinical attention as they may contribute to the maintenance of depressive symptomatology. - Clinical Psychology & Psychotherapy, Volume 25, Issue 4, Page 509-524, July/August 2018.
    February 23, 2018   doi: 10.1002/cpp.2184   open full text
  • Impaired emotion processing and a reduction in trust in patients with somatic symptom disorder.
    Maja Erkic, Josef Bailer, Sabrina C. Fenske, Stephanie N. L. Schmidt, Jörg Trojan, Annette Schröder, Peter Kirsch, Daniela Mier.
    Clinical Psychology & Psychotherapy. October 18, 2017
    There is accumulating evidence for deficits in the perception and regulation of one's own emotions, as well as the recognition of others' emotions in somatic symptom disorder (SSD). However, investigations of SSD focusing on specific aspects of emotion processing and how these might interact are missing. We included 35 patients with SSD and 35 healthy controls who completed questionnaires on the perception and regulation of their own emotions, as well as experimental investigations of emotion recognition and trust. In line with previous studies, our results show that SSD patients in comparison to healthy controls have difficulties in the identification and description of own feelings (ηp2 = .381 and ηp2 = .315). Furthermore, we found that patients apply less cognitive reappraisal (ηp2 = .185) but tend to use more expressive suppression (ηp2 = .047). In contrast to previous studies, we found SSD patients to perform superior in emotion recognition, in particular for anger (d = 0.40). In addition, patients with SSD invested less in a trust game (d = 0.73). These results point to a higher sensitivity for negative emotions and less trust in others. Further, these findings suggest a dissociation between the ability to recognize one's own emotions versus others' emotions in SSD. Future interventions targeting emotion processing in SSD might focus on the identification of one's own emotions, prior to the training of emotion regulation.
    October 18, 2017   doi: 10.1002/cpp.2151   open full text
  • Corrective emotional experience in an integrative affect‐focused therapy: Building a preliminary model using task analysis.
    Kaori Nakamura, Shigeru Iwakabe.
    Clinical Psychology & Psychotherapy. October 16, 2017
    Objective The present study constructed a preliminary process model of corrective emotional experience (CEE) in an integrative affect‐focused therapy. Method Task analysis was used to analyse 6 in‐session events taken from 6 Japanese clients who worked with an integrative affect‐focused therapist. The 6 events included 3 successful CEEs and 3 partially successful CEEs for comparison. Results A rational–empirical model of CEE was generated, which consisted of two parallel client change processes, intrapersonal change and interpersonal change, and the therapist interventions corresponding to each process. Therapist experiential interventions and therapist affirmation facilitated both intrapersonal and interpersonal change processes, whereas his relational interventions were associated with the interpersonal change process. The partially successful CEEs were differentiated by the absence of the component of core painful emotions or negative beliefs in intrapersonal change process, which seemed crucial for the interpersonal change process to develop. Conclusions CEE is best represented by a preliminary model that depicts two parallel yet interacting change processes. Intrapersonal change process is similar to the sequence of change described by the emotional processing model (Pascual‐Leone & Greenberg, ), whereas interpersonal change process is a unique contribution of this study. Interpersonal change process was facilitated when the therapist's active stance and use of immediacy responses to make their relational process explicit allowed a shared exploration. Therapist affirmation bridged intrapersonal change to interpersonal change by promoting an adaptive sense of self in clients and forging a deeper emotional connection between the two. Key Practitioner Message In‐session corrective emotional experience consists of intrapersonal and interpersonal change processes. The intrapersonal change process involved experiencing adaptive emotions such as grief. The interpersonal change process involved the processing of the relational experience in which the therapist and the client explicitly discussed the immediate feelings towards each other and the meaning of a new relational experience in the here and now. Therapist active stance as well as therapist affirmation responses that validate and support client resilience and strength facilitated both intrapersonal and interpersonal change.
    October 16, 2017   doi: 10.1002/cpp.2150   open full text
  • Continuity between DSM‐5 Section II and Section III personality traits for obsessive–compulsive personality disorder.
    Jacqueline Liggett, Martin Sellbom, Bo Bach.
    Clinical Psychology & Psychotherapy. October 11, 2017
    Objective Obsessive–compulsive personality disorder (OCPD) is formally operationalized in Section II of the DSM‐5 by a heterogeneous collection of 8 categorical criteria. Section III contains an alternative model operationalizing personality disorders via dimensional personality traits and associated impairment. The extent to which the personality traits used to define OCPD in Section III correspond with the Section II operationalization of the disorder is contested. The current study aims to contribute to the evidence base necessary to solidify the optimal trait profile for this disorder via a more fine‐tuned examination of OCPD. Method The research questions were examined using a clinical sample of 142 Danish adults who completed the Structured Clinical Interview for DSM‐IV Axis II Disorders and the Personality Inventory for DSM‐5 to index both the Sections II and III (personality traits) operationalizations of OCPD, respectively. Results Bivariate correlations supported Rigid Perfectionism and Perseveration as traits relevant to OCPD; however, hierarchical regression analyses indicated that of the 4 traits used in the Section III operationalization of OCPD, only Rigid Perfectionism uniquely predicted OCPD (p < .05). In addition to Rigid Perfectionism, the conceptually relevant traits of Submissiveness, Suspiciousness, and (low) Impulsivity were also found to uniquely predict OCPD and its specific symptoms in a regression model. Conclusions These findings indicate that the traits proposed in Section III are only partially aligned with the traditional, Section II conceptualization of OCPD, and may be augmented by incorporating Submissiveness, Suspiciousness, and (low) Impulsivity. In light of the current findings and existing literature, a modified constellation of traits to operationalize OCPD is likely justified. Key Practitioner Message Rigid Perfectionism, Perseveration, and Restricted Affectivity emerged as Section III OCPD traits that were substantially associated with the Section II categorical criteria of OCPD. Rigid Perfectionism is strongly associated, and Perseveration is moderately associated with Section II OCPD. Rigid Perfectionism should be considered the core personality trait underpinning OCPD. The trait facets of Submissiveness, Suspiciousness, and Impulsivity also predicted individual Section II OCPD criteria. OCPD may be best conceptualized as a disorder characterized by Rigid Perfectionism and Perseveration, with other traits influencing how the disorder manifests.
    October 11, 2017   doi: 10.1002/cpp.2147   open full text
  • Fluctuations in alliance and use of techniques over time: A bidirectional relation between use of “common factors” techniques and the development of the working alliance.
    Nili Solomonov, Kevin S. McCarthy, John R. Keefe, Bernard S. Gorman, Mark Blanchard, Jacques P. Barber.
    Clinical Psychology & Psychotherapy. September 29, 2017
    Objective The aim of this study was twofold: (a) Investigate whether therapists are consistent in their use of therapeutic techniques throughout supportive–expressive therapy (SET) and (b) Examine the bi‐directional relation between therapists' use of therapeutic techniques and the working alliance over the course of SET. Method Thirty‐seven depressed patients were assigned to 16 weeks of SET as part of a larger randomized clinical trial (Barber, Barrett, Gallop, Rynn, & Rickels, ). Working Alliance Inventory‐Short Form (WAI‐SF) was collected at Weeks 2, 4, and 8. Use of therapeutic interventions was rated by independent observers using the Multitheoretical List of Therapeutic Interventions (MULTI). Intraclass correlation coefficients assessed therapists' consistency in use of techniques. A cross‐lagged path analysis estimated the working alliance inventory‐ Multitheoretical List of Therapeutic Interventions bidirectional relation across time. Results Therapists were moderately consistent in their use of prescribed techniques (psychodynamic, process‐experiential, and person‐centred). However, they were inconsistent, or more flexible, in their use of “common factors” techniques (e.g., empathy, active listening, hope, and encouragements). A positive bidirectional relation was found between use of common factors techniques and the working alliance, such that initial high levels of common factors (but not prescribed) techniques predicted higher alliance later on and vice versa. Conclusion Therapists tend to modulate their use of common factors techniques across treatment. Additionally, when a strong working alliance is developed early in treatment, therapists tend to use more common factors later on. Moreover, high use of common factors techniques is predictive of later improvement in the alliance.
    September 29, 2017   doi: 10.1002/cpp.2143   open full text
  • Therapeutic alliance in psychological therapy for people with schizophrenia and related psychoses: A systematic review.
    Lucy Shattock, Katherine Berry, Amy Degnan, Dawn Edge.
    Clinical Psychology & Psychotherapy. September 29, 2017
    Therapeutic alliance is a key predictor of therapy outcomes. Alliance may be particularly pertinent for people with schizophrenia as this group often have a history of interpersonal trauma and relationship difficulties including difficult relationships with mental health staff. This review aimed to determine (a) the quality of therapeutic alliance between people with schizophrenia and their therapists; (b) whether alliance predicts therapeutic outcomes; and (c) variables associated with alliance. Databases were searched from inception up to April 2015. The search yielded 4,586 articles, resulting in 26 eligible studies, involving 18 independent samples. Weighted average client and therapist Working Alliance Inventory‐Short Form total scores were 64.51 and 61.26, respectively. There was evidence that alliance predicts overall psychotic symptomatic outcomes and preliminary evidence for alliance predicting rehospitalization, medication use, and self‐esteem outcomes. There was evidence for specific client‐related factors being linked to different perspectives of alliance. For example, poorer insight and previous sexual abuse were associated with worse client‐rated alliance, whereas baseline negative symptoms were associated with worse therapist‐rated alliance. Therapist and therapy‐related factors, including therapists' genuineness, trustworthiness, and empathy were associated with better client‐rated alliance, whereas suitability for therapy, homework compliance, and attendance were associated with better therapist‐rated alliance. Key clinical implications include the need to consider alliance from both client and therapist perspectives during therapy and training and supervision to enhance therapist qualities that foster good alliance. Future research requires longitudinal studies with larger samples that include pan‐theoretical, well‐validated alliance measures to determine causal predictor variables.
    September 29, 2017   doi: 10.1002/cpp.2135   open full text
  • Developments on committed action: Validity of the CAQ‐8 and analysis of committed action's role in depressive symptomatology in breast cancer patients and healthy individuals.
    Inês A. Trindade, Joana Marta‐Simões, Cláudia Ferreira, José Pinto‐Gouveia.
    Clinical Psychology & Psychotherapy. September 27, 2017
    Committed action, a process of acceptance and commitment therapy's psychological flexibility model, is considered an understudied construct that currently can only be measured by one instrument, the Committed Action Questionnaire (CAQ‐8). This study aims at analysing the psychometric properties of the CAQ‐8 in healthy individuals and breast cancer patients. This study also aims to explore the specific meditational role of committed action in the well‐established relationship between experiential avoidance and depression symptoms. The healthy sample comprised 294 adults from the general population, and the breast cancer samples comprised 82 participants. Both groups completed the validated self‐report measures. CAQ‐8's robustness was examined through validity analyses, confirmatory factor analyses, and multigroup analysis. The meditational model was conducted using structural equation modelling. The CAQ‐8 presented good internal consistency and construct, convergent, concurrent, and divergent validity in both samples. Further, the CAQ‐8 showed incremental validity over a measure of engaged living. Findings also demonstrated measurement invariance between healthy individuals and breast cancer patients. Regarding the conducted meditational model that was also invariant between the two analysed groups, it was demonstrated that part of the effect that experiential avoidance holds on depressive symptomatology is explained by committed action. This study suggests that the CAQ‐8 is adequate for use in healthy and cancer populations. Moreover, it provides novel, empirical support regarding the links between committed action, experiential avoidance, and depressed mood, being also the first investigation to particularly study committed action in a cancer population. Implications for theory and practice are discussed.
    September 27, 2017   doi: 10.1002/cpp.2125   open full text
  • Does an emotion‐focused two‐chair dialogue add to the therapeutic effect of the empathic attunement to affect?
    Jan Reidar Stiegler, Helge Molde, Elisabeth Schanche.
    Clinical Psychology & Psychotherapy. September 27, 2017
    An increasing amount of research suggests that it is beneficial to work explicitly with emotions in psychotherapy. Emotion‐focused therapy (EFT) utilizes interventions that are thought to enhance the evocativeness of emotional processing and facilitate explorations of new meaning. The purpose of this study was to examine the effect of such an intervention on therapeutic outcome. The intervention, a two‐chair dialogue drawn from emotion‐focused therapy, was added to the treatment conditions that consisted of empathically following the clients' emotional processes. The treatment comprised 2 phases. Using a multiple baseline design, 21 self‐critical clients (15 women and 6 men) with clinically significant symptoms of depression and/or anxiety first received 5, 7, or 9 sessions of a baseline treatment focused on alliance building, empathic attunement to affect, and therapeutic presence and genuineness. A two‐chair dialogue intervention was then added for 5 sessions. The symptoms were measured before each session using Beck's Depression Inventory, Beck's Anxiety Index, and Forms of Self‐Criticizing/Attacking and Self‐Reassuring Scale. An analysis using Hierarchical Linear Modelling revealed that the phase with the two‐chair dialogue had a larger impact on symptoms of anxiety and depression when compared to the baseline phase. On BDI‐II, there was a greater impact on somatic‐affective components than cognitive components. Self‐criticism was reduced when we used time as a predictor for both phases but not significantly more after introducing the intervention. The results corroborate that the two‐chair dialogue intervention is associated with change beyond what is shown when relationship conditions alone are being provided. Implications and limitations are discussed.
    September 27, 2017   doi: 10.1002/cpp.2144   open full text
  • Exploring the paths between dysfunctional attitudes towards motherhood and postpartum depressive symptoms: The moderating role of self‐compassion.
    Ana Fonseca, Maria Cristina Canavarro.
    Clinical Psychology & Psychotherapy. September 27, 2017
    Better understanding how cognitive processes operate to influence women's depressive symptoms during the postpartum period is crucial for informing preventive and treatment approaches. The present study aimed to examine the relationship between women's dysfunctional attitudes towards motherhood and depressive symptoms, considering the mediating role of negative automatic thoughts and the moderating role of self‐compassion. A sample of 387 women in the postpartum period cross‐sectionally answered a set of questionnaires to assess dysfunctional attitudes towards motherhood, negative automatic thoughts (general and postpartum‐specific), depressive symptoms, and self‐compassion. Women with clinically significant depressive symptoms presented more dysfunctional attitudes towards motherhood, more frequent negative thoughts, and lower self‐compassion. More dysfunctional beliefs about others' judgments and about maternal responsibility were associated with higher depressive symptoms, and this effect occurred through both general and postpartum‐specific thoughts related to the metacognitive appraisal of the thought content. Moreover, these relationships occurred only when women presented low or moderate levels of self‐compassion. These results highlight the need to comprehensively assess women's cognitive variables during the postpartum period with appropriate measures, for the early identification of women with more dysfunctional beliefs about motherhood, who may be at higher risk of depression. Moreover, preventive/treatment approaches should aim not only to challenge women's preexisting dysfunctional beliefs but also to promote a more self‐compassionate attitude towards themselves.
    September 27, 2017   doi: 10.1002/cpp.2145   open full text
  • Children's psychosocial functioning and parents' quality of life in paediatric short stature: The mediating role of caregiving stress.
    Neuza Silva, Monika Bullinger, Rachel Sommer, Anja Rohenkohl, Stefanie Witt, Julia Quitmann.
    Clinical Psychology & Psychotherapy. September 27, 2017
    Objectives On the basis of the multidimensional model of the caregiving process, this study aimed (a) to compare the levels of quality of life (QoL) and psychological problems of children with short stature and the levels of caregiving stress and QoL of their parents, between diagnostic, treatment, and current height deviation groups, and (b) to examine the direct and indirect links, via caregiving stress, between children's psychosocial functioning and their parents' QoL. Method The sample was collected in 5 European countries and comprised 238 dyads of 8‐ to 18‐year‐old children and adolescents with a clinical diagnosis of growth hormone deficiency or idiopathic short stature and one of their parents. The children completed self‐report measures of height‐related QoL (Quality of Life in Short Stature Youth Core Module) and psychological problems (Strengths and Difficulties Questionnaire); the parents reported on their own QoL (EUROHIS‐QOL‐8 Index) and caregiving stress (Quality of Life in Short Stature Youth Effects on Parents subscale). Results Children who were treated and who achieved normal height reported better QoL compared to those untreated and with current short stature. Parents of children with idiopathic short stature and current short stature presented greater caregiving stress than parents of children with growth hormone deficiency and achieved normal height. Children's better psychosocial functioning was indirectly associated with parents' better QoL, via less caregiving stress, and these links were invariant across diagnoses, treatment status, and current height deviation. Conclusions These results suggest that, along with growth hormone treatments, multidisciplinary interventions in paediatric endocrinology should be family‐centred, by targeting both the children's psychosocial functioning and the parents' stress, in order to improve individual and family adaptation. Key Practitioner Message Height‐related quality of life impairments and more internalizing problems in children and adolescents with short stature increase caregiving stress, which in turn has a negative impact on parents' quality of life, independently of patients' diagnosis, treatment status, and current height deviation. In addition to growth hormone treatment, multidisciplinary interventions in the context of paediatric short stature should target the children's and adolescents' psychosocial functioning, as well as provide the parents with cognitive and behavioural strategies to manage their child's physical, emotional, social, and behavioural problems. Caregiving stress should be routinely assessed and selected as a strategic intervention target for family‐centred psychosocial interventions aimed at promoting parents' adaptation outcomes (e.g., quality of life). Psychosocial interventions should prioritize the children and adolescents who had never been treated with growth hormone and who have current short stature, as well as the parents of children with idiopathic short stature and current short stature.
    September 27, 2017   doi: 10.1002/cpp.2146   open full text
  • Does assimilation of problematic experiences predict a decrease in symptom intensity?
    Isabel Morais Basto, William B. Stiles, Daniel Rijo, João Salgado.
    Clinical Psychology & Psychotherapy. September 10, 2017
    The assimilation model describes therapeutic change as an integration of experiences that had previously been problematic, distressing, avoided, or warded off. This study assessed whether assimilation was associated with treatment outcome in a sample of psychotherapeutic treatments for depression. Further, it assessed the direction of the association—whether increasing assimilation predicted decreases in symptom intensity or decreasing symptom intensity predicted increases in assimilation. Method Participants were 22 clients with mild to moderate depression drawn from a clinical trial comparing cognitive behavioral therapy with emotion‐focused therapy. The direction of prediction between assimilation progress and changes in self‐reported symptom intensity was assessed. Results The assimilation progress was shown to be a better predictor of decreases in symptom intensity than the reverse. Conclusion The results supported the assimilation model's suggestion that assimilation progress promotes decreases in symptom intensity in the treatment of clients with major depressive disorder.
    September 10, 2017   doi: 10.1002/cpp.2130   open full text
  • Do therapists' subjective variables impact on psychodynamic psychotherapy outcomes? A systematic literature review.
    Vittorio Lingiardi, Laura Muzi, Annalisa Tanzilli, Nicola Carone.
    Clinical Psychology & Psychotherapy. September 05, 2017
    Background Despite growing attention to the general therapist effects in a wide range of clinical settings, little is known about the individual, cross‐situational, and therapy–nonspecific variables that impact on the differential effectiveness of clinicians. The current study is a systematic review of the evidence relating to the influence of therapist's subjective characteristics on outcomes of psychodynamic psychotherapies. Method A multistage and systematic search of articles published between 1987 and 2017 identified 30 relevant studies, which were organized into 6 areas according to the specific therapist's variable considered. Results Therapists' interpersonal functioning and skills showed the strongest evidence of a direct effect on treatment outcomes. Furthermore, there were preliminary evidence that therapists' attachment styles, their interpersonal history with caregivers, and their self‐concept might affect outcomes through interaction effects with other constructs, such as technical interventions, patient's pathology, and therapeutic alliance. The high variability between studies on therapists' overall reflective or introspective abilities and personality characteristics suggested the need for more systematic research in these areas, whereas therapists' values and attitudes showed small effects on therapeutic outcome. Conclusions The present review clarifies how a deep examination of the contribution of therapists' subjective characteristics can help elucidate the complex association between relational and technical factors related to the outcome of psychodynamic treatments.
    September 05, 2017   doi: 10.1002/cpp.2131   open full text
  • Analysing phase progression in Susan's case.
    Joana F. Ferreira, António B. Vasco, Michael Basseches, Andreia Santos, João M. Ferreira.
    Clinical Psychology & Psychotherapy. August 31, 2017
    This study adds a phase‐by‐phase perspective to the case of Susan, with the aim of better understanding the processes of change in this therapeutic case. A team of 3 raters integrated the sequential phases of the Paradigmatic Complementarity Metamodel with a moment‐by‐moment tracking method—the Developmental Analysis of Psychotherapy Process method—to analyse this therapeutic process and clarify what happened throughout that may explain phase gains and how the therapist facilitated them. The results suggest that Susan evolved in accordance with the sequence of phases proposed by the Paradigmatic Complementarity Metamodel. We illustrate and explain this with therapeutic interactions representative of Susan's development within the evolving therapeutic process. This case study is the third of a series intended to contribute towards the optimization of clinical decisions in therapeutic processes by identifying markers of phase progression and assessing the value of the therapeutic interventions offered.
    August 31, 2017   doi: 10.1002/cpp.2110   open full text
  • Tracking and understanding phase progression in Lisa's case.
    Joana F. Ferreira, António B. Vasco, Michael Basseches, Nuno Conceição, Catarina Vaz‐Velho, Rhonda Goldman.
    Clinical Psychology & Psychotherapy. August 30, 2017
    This study adds a phase‐by‐phase perspective to the well‐known, and thoroughly analysed on a moment‐by‐moment basis, case of Lisa. The aim is to see whether this phase‐by‐phase analysis adds anything valuable to the understanding of the processes of change in this case and the therapeutic processes in general. In this good‐outcome case study, a team of raters integrated the temporal sequencing phase component of the Paradigmatic Complementarity Metamodel (PCM) with a moment‐by‐moment tracking method—the Developmental Analysis of Psychotherapy Process Method (DAPP)—to analyse what occurred along the process that could explain the phase transitions and consolidations observed and how the therapist facilitated them. We illustrate and explain the therapeutic progression with therapeutic interactions from the dyad. The results suggest that Lisa evolved in accordance with the sequence of phases proposed by the PCM until phase 4 (out of 7). However, only phase 2 gains show evidence of structural consolidation. The sequence of phases proposed by the PCM seems to represent a natural progression for patients throughout the therapeutic process, and the consideration of a phase‐by‐phase map in analysing and thinking of therapeutic cases may be a valuable tool regarding clinical decision making.
    August 30, 2017   doi: 10.1002/cpp.2111   open full text
  • Improving functional outcome in bipolar disorder: A pilot study on metacognitive training.
    Paula Haffner, Esther Quinlivan, Jana Fiebig, Lene‐Marie Sondergeld, Elisa Sophie Strasser, Mazda Adli, Steffen Moritz, Thomas Josef Stamm.
    Clinical Psychology & Psychotherapy. August 30, 2017
    Background Effective group psychological interventions in bipolar disorder are rare. In this study, we present “metacognitive training (MCT) for bipolar disorder”—an adaption of a group intervention that has proven effective in other severe psychiatric disorders. MCT is a structured, interactive approach that addresses cognitive biases, social cognition, and self‐esteem. In this pilot study, we investigated psychosocial functioning as primary outcome measure, as well as the feasibility of MCT and its acceptance among bipolar patients. Methods Thirty‐four outpatients with bipolar disorder were recruited. Inclusion criteria were euthymia and psychosocial functioning with a score >11 assessed by the Functional Assessment Short Test. The subjects received eight weekly MCT sessions. Before and after the intervention, psychosocial functioning, quality of life (QoL), and patient views were assessed. Results Patients improved significantly in global psychosocial functioning, with a large effect size from baseline to post‐treatment. Over the intervention period, patient QoL improved significantly in terms of their physical health, however not for other QoL subdomains. Treatment adherence was 80%, and patients' appraisal of the training was positive. Limitations As this study lacks a control group, it is not possible to ascertain whether the positive treatment effects are attributable to MCT. Additionally, it is unclear whether gains in psychosocial functioning would have been maintained long term. Conclusions This pilot trial conclusively shows that MCT is feasible and provides preliminary evidence for both the acceptance and efficacy of MCT. Further studies with larger samples and control condition will be necessary to build on these findings.
    August 30, 2017   doi: 10.1002/cpp.2124   open full text
  • How do women's partners view perinatal mental health services? A qualitative meta‐synthesis.
    Billie Lever Taylor, Jo Billings, Nicola Morant, Sonia Johnson.
    Clinical Psychology & Psychotherapy. August 30, 2017
    Objectives Perinatal mental health difficulties are prevalent among women and can adversely affect their partners too. There is also increasing recognition that a woman's partner can play a vital role in relation to her perinatal mental health and should be supported and involved in decisions about her care. Yet it is unclear how services are experienced by the partners of women with perinatal mental health difficulties. This study aimed to synthesize qualitative evidence of partners' views of perinatal mental health care. Methods A systematic search of 5 electronic databases identified 20 studies that met the inclusion criteria. The findings of these studies were synthesized using an approach based on meta‐ethnography. Results Six themes were identified, namely, the marginalization and neglect of women's partners, an unmet need for information, partners' ambivalence about involvement and support, practical barriers to involvement, views about support for women's partners, and the impact on partners of the care women received. Conclusions Given the importance of women's partners in relation to perinatal mental health as well as to women's engagement with support and treatment outcomes, greater consideration should be given to their needs to ensure they feel well informed and involved in perinatal mental health care, rather than marginalized. However, professionals also need to challenge the barriers to involvement and support that women's partners face and consider the ways in which services may reinforce these barriers. KEY PRACTITIONER MESSAGE Partners of women with perinatal mental health difficulties play a vital role. However, they often feel uninformed and marginalized by services and professionals. They also face significant barriers to accessing support themselves or being more involved. Services and professionals may reinforce these barriers and need to challenge them. Further consideration must be given to the needs of women's partners.
    August 30, 2017   doi: 10.1002/cpp.2133   open full text
  • Different aspects of emotional intelligence of borderline personality disorder.
    Mathell Peter, Arnoud R. Arntz, Theo Klimstra, Ad J.J.M. Vingerhoets.
    Clinical Psychology & Psychotherapy. August 30, 2017
    Objectives The present study investigated deficiencies in different components of emotional intelligence in borderline personality disorder (BPD). Method The Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT) and the Emotional Quotient Inventory (EQ‐i) were used to assess EI dimensions. BPD patients (N = 85; 69 women; M = 33.6 years) were compared with Cluster C personality disorder (PD) patients (N = 39; 23 women; M = 36.6 years) and nonpatients (N = 69; 44 women; M = 35.6 years). Results Compared to the Cluster C PD patients and the nonpatient group, BPD patients displayed only deficits in their ability to understand emotions as measured with the Mayer–Salovey–Caruso Emotional Intelligence Test. The Emotional Quotient Inventory only revealed deficits in stress management in BPD patients compared to Cluster C PD patients. Conclusions Our findings suggest that BPD patients have the ability to regulate emotions effectively, but they subjectively experience deficits in emotion regulation and therefore may not use this ability when they need it.
    August 30, 2017   doi: 10.1002/cpp.2126   open full text
  • Comparing the acceptability of a positive psychology intervention versus a cognitive behavioural therapy for clinical depression.
    Irene Lopez‐Gomez, Covadonga Chaves, Gonzalo Hervas, Carmelo Vazquez.
    Clinical Psychology & Psychotherapy. August 30, 2017
    There is growing evidence on the efficacy of positive psychology interventions (PPI) to treat clinical disorders. However, very few studies have addressed their acceptability. The present study aimed to analyse 2 key components of acceptability (i.e., client satisfaction and adherence to treatment) of a new PPI programme, the Integrative Positive Psychological Intervention for Depression (IPPI‐D), in comparison to a standard cognitive behavioural therapy (CBT) programme in the treatment of clinical depression. One hundred twenty‐eight women with a DSM‐IV diagnosis of major depression or dysthymia were allocated to a 10‐session IPPI‐D or CBT group intervention condition. Results showed that both interventions were highly acceptable for participants. Attendance rates were high, and there were no significant differences between conditions. However, the IPPI‐D condition showed significantly higher client satisfaction than the CBT condition. Moreover, acceptability did not differ based on participants' severity of symptoms, regardless of condition. These findings encourage further investigations of the applicability of PPI in clinical settings in order to broaden the range of acceptable and suitable therapies for depressed patients. Key Practitioner Message This study sheds light on the client satisfaction and adherence to a positive intervention. For participants, positive psychology interventions (PPI) may be more satisfactory than CBT as PPI are framed within a positive mental health model and, consequently, may reduce the risk of stigmatization Because acceptability of treatments and preferences may affect the efficacy of treatments, this study provides an excellent opportunity to offer professionals more therapeutic options to tailor treatments to clients' needs and expectations
    August 30, 2017   doi: 10.1002/cpp.2129   open full text
  • Preschool children's response to behavioural parent training and parental predictors of outcome in routine clinical care.
    Lianne Veen‐Mulders, Pieter J. Hoekstra, Maaike H. Nauta, Barbara J. Hoofdakker.
    Clinical Psychology & Psychotherapy. August 30, 2017
    Objective To investigate the effectiveness of behavioral parent training (BPT) for preschool children with disruptive behaviours and to explore parental predictors of response. Methods Parents of 68 preschool children, aged between 2.7 and 5.9 years, participated in BPT. We evaluated the changes in children's behaviour after BPT with a one group pretest–posttest design, using a waiting period for a double pretest. Outcome was based on parents' reports of the intensity and number of behaviour problems on the Eyberg Child Behavior Inventory. Predictor variables included parents' attention‐deficit/hyperactivity disorder symptoms, antisocial behaviours, and alcohol use, and maternal parenting self‐efficacy and disciplining. Results Mother‐reported child behaviour problems did not change in the waiting period but improved significantly after BPT (d = 0.63). High levels of alcohol use by fathers and low levels of maternal ineffective disciplining were each associated with somewhat worse outcome. Conclusions BPT under routine care conditions clearly improves disruptive behaviours in preschool children. Mothers who consider themselves as inadequate in disciplining and mothers whose partners do not consume high levels of alcohol report the largest improvements. Key practitioner Disruptive behaviours in referred preschool children improve when parents follow behavioural parent training under routine care conditions. Behavioural parent training is useful to help parents experience fewer behaviours as troublesome. About one third of the parents for whom behavioural parent training was indicated never started the treatment. Clinicians are recommended to put additional effort in motivating and facilitating parents to actually participate in behavioural parent training. It may be useful to assess and treat problematic alcohol use in fathers before behavioural parent training. Behavioural parent training may be particularly effective when mothers perceive themselves as inadequate in disciplining.
    August 30, 2017   doi: 10.1002/cpp.2117   open full text
  • Effectiveness of bereavement counselling through a community‐based organization: A naturalistic, controlled trial.
    Catherine Newsom, Henk Schut, Margaret S. Stroebe, Stewart Wilson, John Birrell, Mirjam Moerbeek, Maarten C. Eisma.
    Clinical Psychology & Psychotherapy. August 29, 2017
    This controlled, longitudinal investigation tested the effectiveness of a bereavement counselling model for adults on reducing complicated grief (CG) symptoms. Participants (N = 344; 79% female; mean age: 49.3 years) were adult residents of Scotland who were bereaved of a close relation or partner, experiencing elevated levels of CG, and/or risks of developing CG. It was hypothesized that participants who received intervention would experience a greater decline in CG levels immediately following the intervention compared to the control participants, but the difference would diminish at follow‐up (due to relapse). Data were collected via postal questionnaire at 3 time points: baseline (T), post‐intervention (T + 12 months), and follow‐up (T + 18 months). CG, post‐traumatic stress, and general psychological distress were assessed at all time points. Multilevel analyses controlling for relevant covariates were conducted to examine group differences in symptom levels over time. A stepwise, serial gatekeeping procedure was used to correct for multiple hypothesis testing. A main finding was that, contrary to expectations, counselling intervention and control group participants experienced a similar reduction in CG symptoms at postmeasure. However, intervention participants demonstrated a greater reduction in symptom levels at follow‐up (M = 53.64; d = .33) compared to the control group (M = 62.00). Results suggest community‐based bereavement counselling may have long‐term beneficial effects. Further longitudinal treatment effect investigations with extensive study intervals are needed. Key Practitioner Messages Bereavement counselling for elevated‐ and high‐risk bereaved persons has a beneficial effect on grief symptoms over 18 months. Preliminary indications suggest no marked difference in the effectiveness of bereavement counselling for elevated versus high levels of complicated grief. Professionally trained volunteer counselling by a non‐profit organization complements professional services.
    August 29, 2017   doi: 10.1002/cpp.2113   open full text
  • Resilience to suicide ideation: A cross‐cultural test of the buffering hypothesis.
    Paula Siegmann, Tobias Teismann, Nathalie Fritsch, Thomas Forkmann, Heide Glaesmer, Xiao Chi Zhang, Julia Brailovskaia, Jürgen Margraf.
    Clinical Psychology & Psychotherapy. August 29, 2017
    Depression and suicide ideation are common in student populations across the world. The present study investigated factors buffering the association between depression and suicide ideation. A total of 2,687 Chinese students and 601 German students took part in the investigation. Social support, satisfaction with life, self‐efficacy, psychosocial stress resistance, and positive mental health were considered as resilience factors moderating the association between depressive symptoms and suicide ideation within both samples. Positive mental health moderated the impact of depressive symptoms on suicide ideation in German and Chinese students. Life satisfaction moderated the impact of depressive symptoms on suicide ideation in German students. Social support moderated the impact of depressive symptoms on suicide ideation in Chinese students. No interaction effects were found for self‐efficacy and psychosocial stress resistance. Positive mental health, satisfaction with life, and perceived social support seem to confer resilience and should be taken into account, when assessing individuals for suicide risk.
    August 29, 2017   doi: 10.1002/cpp.2118   open full text
  • The predictive value of early maladaptive schemas in paranoid responses to social stress.
    Johanna Sundag, Leonie Ascone, Tania M. Lincoln.
    Clinical Psychology & Psychotherapy. August 25, 2017
    Background Social stress and negatively valenced cognitive representations of the self (self‐schemas) play an important role in the formation of delusions. However, it has not been investigated whether and which self‐schemas explain paranoid responses to social stress. Building on the framework of schema theory, the aim of this study was thus to investigate whether more pronounced early maladaptive schemas (EMSs) were associated with increased paranoid ideation after a social stress induction in patients with persecutory delusions (PD). Method Patients with PD (n = 20) and healthy controls (n = 40) were assessed for EMSs with the Young Schema Questionnaire. They were then exposed to a social stress situation in which they were socially excluded in a Cyberball paradigm. Prior to and after the social stress induction, paranoid symptoms were assessed. Results Patients with PD responded with a stronger increase in paranoia and revealed a significantly higher EMS total score compared to the healthy controls. As expected, higher increases in paranoia following the social stress were accounted for by higher EMS total scores. Exploratory analyses showed that particularly the specific EMSs Defectiveness/Shame and Enmeshment/Undeveloped Self were associated with the increase in paranoia. Conclusions EMSs are associated with stress‐related symptom increases in patients with PD. It thus seems worthwhile to further investigate the relevance of specific schemas for paranoia. The findings also suggest that addressing EMSs in psychological treatment of patients with PD holds potential.
    August 25, 2017   doi: 10.1002/cpp.2128   open full text
  • Social cognition and metacognition in social anxiety: A systematic review.
    Styliani Gkika, Anja Wittkowski, Adrian Wells.
    Clinical Psychology & Psychotherapy. August 24, 2017
    Cognitive–behavioural and metacognitive approaches to emotional disorder implicate beliefs in social anxiety, but the types of beliefs differ across these perspectives. Cognitive models suggest that social beliefs about the self (i.e., high standards and conditional and unconditional beliefs) are central. In contrast, the metacognitive model gives centre stage to metacognitive beliefs (i.e., positive and negative beliefs about thinking) as main contributors to the maintenance of the disorder. Despite an expanding research interest in this area, the evidence for such contributions has not yet been reviewed. This study set out to systematically review relevant cross‐sectional, longitudinal, and experimental investigations of the direct and indirect (through cognitive processes, such as anticipatory processing, self‐focused attention, the post‐mortem, and avoidance) relationships of social and metacognitive beliefs with social anxiety. Clinical and nonclinical samples were included, and correlation and regression coefficients as well as results from group comparisons (e.g., t tests and analyses of variance) were extracted. Overall, 23 papers were located, through PsycINFO, PubMed, and Web of Science, and reviewed using narrative synthesis. The results showed a robust positive relationship between social beliefs and social anxiety that appeared to be mediated by cognitive processes. Specific metacognitive beliefs were found to positively contribute to social anxiety both directly and indirectly, through cognitive processes. The study's findings are limited to 2 models of social anxiety and other minor limitations (e.g., grey literature was excluded). With these accounted for, the results are discussed in terms of the conceptualization and treatment of social anxiety and suggestions for future research are made. KEY PRACTITIONERS MESSAGES High standards and conditional and unconditional beliefs positively and significantly correlated with social anxiety. These relationships appeared to be affected by cognitive processes, such as anticipatory processing, self‐focused attention, and post‐mortem processing. Positive and negative metacognitive beliefs and beliefs about the need to control thoughts positively and significantly correlated with social anxiety. Metacognitive beliefs showed both direct and indirect (via cognitive processes) effects on social anxiety. The general methodological quality of the papers was moderate to very good.
    August 24, 2017   doi: 10.1002/cpp.2127   open full text
  • Reducing the time until psychotherapy initiation reduces sick leave duration in participants diagnosed with anxiety and mood disorders.
    Sandra Alonso, José H. Marco, Joaquín Andani.
    Clinical Psychology & Psychotherapy. August 23, 2017
    Background Sick leave in patients with a mental disorder is characterized by having a long duration. Studies suggest that the time until a patient on sick leave for a common mental health disorder initiates evaluation and treatment by a healthcare professional is an important factor in the duration of the sick leave. However, in these studies, the intervention was not performed by a mental health specialist. The aim of this study was to find out whether the length of sick leave was associated with the time before initiating psychotherapy, age, time until returning to work after psychotherapy ends, and duration of psychotherapy. In a further analysis, we examined whether the model composed of age, duration of psychotherapy, and time before initiating psychotherapy predicted the length of sick leave. Method The sample consisted of 2,423 participants, 64.1% (n = 1,554) women and 35.9% (n = 869) men, who were on sick leave for anxiety disorders or depressive disorder. Results The total duration of the sick leave of participants diagnosed with depression and anxiety was positively associated with the time before beginning psychotherapy. Time before beginning psychotherapy predicted the length of sick leave when the variables age and duration of psychotherapy were controlled. Conclusion It is necessary to reduce the time until beginning psychotherapy in people on sick leave for common mental disorders.
    August 23, 2017   doi: 10.1002/cpp.2134   open full text
  • Are experiences of psychosis associated with unhelpful metacognitive coping strategies? A systematic review of the evidence.
    Rachel Sellers, Adrian Wells, Anthony P. Morrison.
    Clinical Psychology & Psychotherapy. August 23, 2017
    This review investigated whether unhelpful metacognitive coping strategies, such as attentional biases, worry, rumination, and thought control, are associated with experiences of psychosis. These processes, known collectively as the Cognitive Attentional Syndrome (CAS), form a central tenet of the Self‐Regulatory Executive Function model. Three research questions based on assumptions underlying the CAS were addressed. It was predicted that processes of (a) self‐focused processing, (b) negative perseverative thinking (worry and rumination), and (c) counterproductive thought control would be associated with experiences of psychosis. A comprehensive search of the literature identified 51 eligible studies: 17 investigated self‐focused attention, 25 investigated perseverative processing (worry: n = 18; rumination: n = 10), and 9 investigated thought control strategies. Findings indicated that unhelpful metacognitive coping strategies associated with the CAS are related to experiences of psychosis and appear to share important relationships with distress. Implications for future research and clinical practice are discussed. Key Practitioner Message The unhelpful coping strategies postulated by the Self‐Regulatory Executive Function model, may have an important role in distressing experiences of psychosis.
    August 23, 2017   doi: 10.1002/cpp.2132   open full text
  • Early maladaptive schemas associated with dimensional and categorical psychopathology in patients with borderline personality disorder.
    Álvaro Frías, Sara Navarro, Carol Palma, Núria Farriols, Ferrán Aliaga, Ana Salvador, Elena Aluco, Bárbara Martínez, Laia Solves.
    Clinical Psychology & Psychotherapy. August 17, 2017
    Objective To ascertain the foundations for a schema‐focused therapy model for the treatment of borderline personality disorder. Methods The sample consisted of 102 borderline personality disorder outpatients. Dimensional psychopathology was assessed using the Scale for Suicidal Ideation, the Aggression Questionnaire, and the Symptom CheckList Revised. Categorical psychopathology was measured using the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders, Patient Edition. Stepwise linear/logistic multiple regression analyses were used to determine the predictive role of the schema domains tested by the Young Schema Questionnaire on both types of psychopathology. Receiver operating characteristic curves were calculated for those binary outcomes. Results Regarding dimensional psychopathology, disconnection/rejection predicted greater suicidal ideation (β = .39, p = .002), physical/overt aggressiveness (β = .27, p = .05), and psychotic‐like symptoms, such as paranoid ideation (β = .35, p = .003). Other‐directedness predicted greater anger/inner aggressiveness (β = .22, p = .05) and internalizing symptoms, such as phobic anxiety (β = .39, p = .001). Regarding categorical psychopathology, disconnection/rejection significantly predicted the presence of lifetime comorbidities with eating disorders (adjusted odds ratio [AOR] = 1.12, 95% CI = 0.99–1.24) and posttraumatic stress disorder (AOR = 1.2, 95% CI = 1.04–1.3), resulting in a good balance of sensitivity/specificity, respectively (.97/.96 and .88/.89). Other‐directedness significantly predicted the absence of lifetime comorbidity with substance‐use disorders (AOR = .74, 95% CI = 0.57–0.95). These relationships remained significant after controlling for confounders (e.g., comorbidity with other personality disorders, clinical global severity). Conclusions Two schema domains, disconnection/rejection and other‐directedness, were directly associated with dimensional and categorical psychopathology among borderline personality disorder patients. These findings provide further information about the foundations and target interventions when implementing schema‐focused therapy on this population.
    August 17, 2017   doi: 10.1002/cpp.2123   open full text
  • Confirming the mechanisms behind cognitive‐behavioural therapy effectiveness in chronic pain using structural equation modeling in a sample of patients with temporomandibular disorders.
    Estrella Durá‐Ferrandis, Maite Ferrando‐García, Mª José Galdón‐Garrido, Yolanda Andreu‐Vaillo.
    Clinical Psychology & Psychotherapy. August 14, 2017
    Objective To evaluate whether therapeutic mechanisms assumed to explain the effect of cognitive behavioural therapy (CBT) concerning temporomandibular symptoms are confirmed by structural equation modelling. Method Patients were randomly assigned to either an experimental group receiving CBT (N = 41) or a standard therapy control group (N = 31). Subjects were assessed before and after intervention using mediator variables hypothesized according to the CBT model, as well as outcome variables and other socio‐demographic and clinical measures. Results The results confirm that the effect of treatment on pain intensity was partially mediated by distress, catastrophizing, perceived control, distraction, and mental self‐control. The self‐medication frequency was partially mediated by distraction. Pain interference was partially mediated by distress, distraction, and mental self‐control. Reduction in the number of painful points on palpation was partially explained by distress, although in this case, there was a significant direct effect of treatment not mediated by other variables. Conclusions The results could set the principles for the development of more efficient and effective cognitive behavioural interventions for chronic pain. Key Practitioner Message Cognitive‐behavioural models fundamentals for chronic pain interventions (and concretely in TMD patients) are tested and partially confirmed, providing experts and professionals with specific knowledge to be transferred to clinical practice. The article provide key messages for the psychologists (and other professionals) working on pain management, identifying those strategies directly linked with the improvement of outcome measures. The results provide evidence‐based orientations for the future application of the CBT to chronic pain, thereby making interventions more efficient as they would only be focused on the most effective technique.
    August 14, 2017   doi: 10.1002/cpp.2114   open full text
  • Ambivalence and guilt feelings: Two relevant variables for understanding caregivers' depressive symptomatology.
    Andrés Losada, María Márquez‐González, Carlos Vara‐García, Laura Gallego‐Alberto, Rosa Romero‐Moreno, Karl Pillemer.
    Clinical Psychology & Psychotherapy. August 14, 2017
    Providing care for a relative with dementia is considered to be a chronic stressor that has been linked to negative mental health consequences for caregivers. A theoretical model was developed and tested to assess the degree to which ambivalence and guilt feelings contribute to caregivers' depressive symptomatology. Participants included 212 dementia family caregivers. In addition to ambivalence and guilt feelings, sociodemographic characteristics, behavioural and psychological symptoms of dementia, and depressive symptomatology were assessed. Hypotheses derived from the stress and coping model were tested using path analysis. The analysed model showed an excellent fit to the data. In total, 35% of the variance in depressive symptomatology was explained by the assessed variables. Although significant correlations were obtained between frequency and appraisal of behavioural and psychological symptoms of dementia and depression, the obtained model suggests that this effect was mediated through ambivalence. In addition, ambivalence had an indirect effect on depression. The association of ambivalence with depression was explained through feelings of guilt; that is, respondents who reported ambivalent feelings were more likely to experience guilt, leading in turn to greater depressive symptomatology. The findings suggest that dementia caregivers' ambivalence and guilt feelings are relevant for understanding their depressive symptomatology. These factors should be addressed in psychological interventions with caregivers.
    August 14, 2017   doi: 10.1002/cpp.2116   open full text
  • The role of feared possible selves in obsessive–compulsive and related disorders: A comparative analysis of a core cognitive self‐construct in clinical samples.
    Frederick Aardema, Richard Moulding, Gabriele Melli, Adam S. Radomsky, Guy Doron, Jean‐Sebastien Audet, Magali Purcell‐Lalonde.
    Clinical Psychology & Psychotherapy. August 09, 2017
    Increasingly, cognitive‐behavioural models have been considering the role of beliefs about the self in the development and maintenance of obsessive–compulsive disorder (OCD), including sensitive domains of self‐concept and feared self‐perceptions. This has led to the development of the Fear of Self Questionnaire (FSQ; Aardema et al., ), which has shown strong internal consistency, divergent and convergent validity, and found to be a major predictor of unwanted thoughts and impulses (i.e., repugnant obsessions). The current study aimed to investigate fear of self‐perceptions using the FSQ in an OCD sample (n = 144) and related psychological disorders (eating disorders, n = 57; body dysmorphic disorder, n = 33) in comparison to a non‐clinical (n = 141) and clinical comparison group (anxiety/depressive disorders, n = 27). Following an exploratory factor analysis of the scale in the OCD sample, the results showed that participants with OCD in general did not score significantly higher on fear of self‐perceptions than did the clinical comparison participants. However, consistent with previous findings, fear of self was highly characteristic among OCD patients with unwanted repugnant thoughts and impulses. In addition, fear of self‐perceptions were significantly more elevated in those with eating or body dysmorphic disorders relative to the other non‐clinical and clinical groups. The construct of a “feared possible self” may be particularly relevant in disorders where negative self‐perception is a dominant theme, either involving concerns about one's inner self or concerns related to perceived bodily faults.
    August 09, 2017   doi: 10.1002/cpp.2121   open full text
  • A collaborative care skills workshop for carers: Can it be delivered in 1 day?
    Paul E. Jenkins, Sonia Bues, Julie Cottrell, Joel Hawkins, Laura Pinder, Susan Price, Anne Stewart.
    Clinical Psychology & Psychotherapy. August 07, 2017
    Carers of individuals with eating disorders (EDs) report high levels of burden and distress and describe a number of unmet needs. As a result, a number of interventions have been designed to support carers, including the “Maudsley eating disorder collaborative care skills workshops,” which comprise six 2‐hr workshops delivered over 3 months for parents and carers of people with EDs. The current study aimed to test a proof‐of‐concept that this workshop could be effectively delivered in 1 day. An additional aim was to assess whether the workshop had direct effects on carer skills. A nonexperimental repeated measures research design was employed, giving measures before and after a 1‐day workshop. Results suggested significant increases in carer self‐efficacy and carer skills, with moderate to large effect sizes. Qualitative analyses supported these results whilst also generating ideas to improve the 1‐day workshop.
    August 07, 2017   doi: 10.1002/cpp.2119   open full text
  • What approaches for promoting shared decision‐making are used in child mental health? A scoping review.
    Helen Cheng, Daniel Hayes, Julian Edbrooke‐Childs, Kate Martin, Louise Chapman, Miranda Wolpert.
    Clinical Psychology & Psychotherapy. July 28, 2017
    Objective Whilst the benefits of shared decision‐making (SDM) have been promoted across different health settings, its implementation is complex, particularly for children and young people with mental health difficulties. The aim of this scoping review was to identify and describe SDM approaches (tools, techniques, and technologies) used in child and youth mental health. Method Electronic databases and grey literature were searched. Papers were included if they satisfied these criteria: English language; described an SDM approach (tool, technique, or technology); included sufficient detail on the SDM approach for quality assessment; did not use only a questionnaire to provide feedback on SDM or related concepts (e.g., therapeutic alliance) without another SDM approach; child or adolescent population (up to 18 years); carers of children or adolescents; and mental health setting. Screening and data extraction were performed by two co‐authors, and each included record was quality assessed against a set of essential ingredients of SDM identified by previous studies. Results Of the 8,153 initial results, 22 were eligible for final inclusion. These could be grouped into six approaches: therapeutic techniques, psychoeducational information, decision aids, action planning or goal setting, discussion prompts, and mobilizing patients to engage. The quality of approaches identified ranged from one to seven of the nine essential elements of SDM. Conclusion Evidence suggests that a range of approaches are being developed to support SDM in child and youth mental health. Rigorous research evaluating the effectiveness of these approaches is urgently needed, particularly from the perspective of children and young people. Key practitioner message This scoping review is the first to categorise and outline different shared decision‐making (SDM) approaches (tools, techniques, and technologies) as suggested by The Health Foundation and has identified six distinct approaches used in child and youth mental health Each of the six extant SDM approaches has been qualitatively assessed using a most comprehensive list of essential elements of SDM available so far in the area Whilst evidence suggests that a range of approaches is being developed to support SDM in child and youth mental health, rigorous research evaluating the effectiveness of these approaches is largely lacking The current review may serve as a useful guideline for those institutions and health service organisations that are keen to implement an SDM approach for children and young people in their care Further research is urgently needed to establish the effect of SDM on clinical outcomes, as well as whether such approaches are cost effective
    July 28, 2017   doi: 10.1002/cpp.2106   open full text
  • A randomized controlled trial comparing EMDR and CBT for obsessive–compulsive disorder.
    Zoe Marsden, Karina Lovell, David Blore, Shehzad Ali, Jaime Delgadillo.
    Clinical Psychology & Psychotherapy. July 28, 2017
    Background This study aimed to evaluate eye movement desensitization and reprocessing (EMDR) as a treatment for obsessive–compulsive disorder (OCD), by comparison to cognitive behavioural therapy (CBT) based on exposure and response prevention. Method This was a pragmatic, feasibility randomized controlled trial in which 55 participants with OCD were randomized to EMDR (n = 29) or CBT (n = 26). The Yale‐Brown obsessive–compulsive scale was completed at baseline, after treatment and at 6 months follow‐up. Treatment completion and response rates were compared using chi‐square tests. Effect size was examined using Cohen's d and multilevel modelling. Results Overall, 61.8% completed treatment and 30.2% attained reliable and clinically significant improvement in OCD symptoms, with no significant differences between groups (p > .05). There were no significant differences between groups in Yale‐Brown obsessive–compulsive scale severity post‐treatment (d = −0.24, p = .38) or at 6 months follow‐up (d = −0.03, p = .90). Conclusions EMDR and CBT had comparable completion rates and clinical outcomes.
    July 28, 2017   doi: 10.1002/cpp.2120   open full text
  • Differences in clinical intrusive thoughts between obsessive–compulsive disorder, generalized anxiety disorder, and hypochondria.
    Pablo Romero‐Sanchiz, Raquel Nogueira‐Arjona, Antonio Godoy‐Ávila, Aurora Gavino‐Lázaro, Mark H. Freeston.
    Clinical Psychology & Psychotherapy. July 26, 2017
    Differences and similarities between intrusive thoughts typical of obsessive–compulsive disorder, generalized anxiety disorder, and hypochondriasis are relevant for their differential diagnosis, formulation, and psychological treatment. Previous research in non‐clinical samples pointed out the relevance of some process variables, such as responsibility, guilt, or neutralization strategies. This research is aimed to investigate the differences and similarities between clinical obsessions, worries, and illness intrusions in some of these process variables. A second aim is to identify models based on these variables that could reliably differentiate between them. Three groups of patients with obsessive–compulsive disorder (n = 35; 60% women, mean age 38.57), generalized anxiety disorder (n = 36; 61.1% women, mean age 41.50), and hypochondriasis (n = 34; 70.6% women, mean age 31.59) were evaluated using the Cognitive Intrusions Questionnaire—Transdiagnostic Version (Romero‐Sanchiz, Nogueira‐Arjona, Godoy‐Ávila, Gavino‐Lázaro, & Freeston, ). The results showed that some appraisals (e.g., responsibility or egodystonicity), emotions (e.g., guilt or insecurity), neutralization strategies, and other variables (e.g., verbal content or trigger from body sensation) are relevant for the discrimination between obsessions, worries, and illness intrusions. The results also showed 3 stable models based on these variables for the discrimination between these thoughts. The implication of these results in the diagnosis, formulation, and psychological treatment of obsessive–compulsive disorder, generalized anxiety disorder, and hypochondriasis is discussed. Key Pratictioner Message The current study provides evidence about the discrimination between clinical obsessions, worries, and illness intrusions from a transdiagnostic perspective. The differentiation between them is crucial for the diagnosis, formulation, and psychological treatment of obsessive–compulsive disorder, generalized anxiety disorder, and hypochondriasis. Appraisals such as responsibility or egodystonicity, emotions such as guilt or insecurity, and other variables such as frequency, neutralization strategies or verbal form were found relevant for the discrimination between these types of thoughts. Three stable binary logistic models including these variables were developed for the discrimination between these thoughts.
    July 26, 2017   doi: 10.1002/cpp.2107   open full text
  • Four years comparative follow‐up evaluation of community‐based, step‐down, and residential specialist psychodynamic programmes for personality disorders.
    Marco Chiesa, Antonella Cirasola, Peter Fonagy.
    Clinical Psychology & Psychotherapy. July 26, 2017
    Although the fulcrum of service provision for personality disorder (PD) has shifted from hospital‐based to psychodynamically‐ and cognitively‐oriented outpatient programmes, very few studies have attempted to compare specialist moderate intensity outpatient programmes with specialist high‐intensity residential models, or to explore whether a period of inpatient treatment may be necessary to improve outcome and prognosis. In this article, we prospectively compare changes over a 4‐year period in 3 groups of patients with personality disorders (N = 162) treated in a specialist community‐based (CBP, N = 30), a step‐down (RT‐CBP, N = 87), and a specialist residential programme (RT, N = 45) in psychiatric distress, deliberate self‐injury, and suicide attempt using multilevel modelling and multivariate logistic regression analyses. The results showed that percentages of early‐dropout were significantly different (p = .0001) for the 3 programmes (CBP = 13.4%, RT‐CBP = 10.2%, and RT = 41.4%). A significant interaction between treatment model and time was found for psychiatric distress (p = .001), with CBP and RT‐CBP achieving more marked changes (g = 1.20 and g = 0.68, respectively) compared to RT (g = 0.30) at 48‐month follow‐up. CBP and RT‐CBP were found to significantly reduce impulsive behaviour (deliberate self‐injury and suicide attempt) compared to RT. Severity of presentation was not found to be a significant predictor of outcome. Long‐term RT showed no advantage over long‐term CBP, either as stand‐alone or as step‐down treatment. Replication may be needed to confirm generalizability of results, and a number of limitations in the study design may moderate the inferences that can be drawn from the results.
    July 26, 2017   doi: 10.1002/cpp.2109   open full text
  • An evaluation of the effectiveness of psychological therapy in reducing general psychological distress for adults with autism spectrum conditions and comorbid mental health problems.
    Sarah H. Blainey, Freya Rumball, Louise Mercer, Lauren Jayne Evans, Alison Beck.
    Clinical Psychology & Psychotherapy. July 26, 2017
    Objective To investigate the effectiveness of psychological therapy in reducing psychological distress for adults with autism spectrum conditions (ASC) and co‐morbid mental health conditions in routine clinical practice. To explore the effect of individual characteristics and service factors on change in general distress. Method In a specialist psychological therapies service for adults with ASC, the Clinical Outcomes in Routine Evaluation‐Outcome Measure (CORE‐OM) self‐report questionnaire of psychological distress is completed by clients at start and end of therapy. Change over time and reliable and clinical change was assessed for 81 of a total of 122 clients (66.4%). Factors which may influence change over time were explored using available clinical information. Results Overall, there was a significant reduction in CORE‐OM score during therapy with a small effect size. Most clients showed an improvement in psychological distress over therapy (75.4% improved, with 36.9% of these showing reliable changes). Significant and comparable reductions from pre‐therapy to post‐therapy were seen across the sample, showing that individual differences did not mediate therapy effectiveness. CORE‐OM scores mediate the association between age of ASD diagnosis and hours of therapeutic input required, with greater age at diagnosis and higher distress associated with longer therapy duration. Conclusions Our preliminary findings suggest that psychological therapy may be effective in reducing general distress for clients with ASC and co‐morbid mental health conditions and should be routinely offered. Individuals who are diagnosed with ASD in adulthood are likely to require a longer course of therapy when their general distress scores are high. Key Practitioner Message Co‐morbid mental health conditions are common in adults on the autism spectrum, but there is little evidence for what might be helpful in reducing rates of mental health conditions in this population. This study demonstrates that adapted psychological therapy offered in a specialist adult ASC service was somewhat effective in reducing distress for adults with autism. Individual characteristics and service factors did not influence the extent of change in general distress over the course of therapy; significant and comparable reductions in general distress from pre‐therapy to post‐therapy were seen across the sample. Individuals who are diagnosed with ASD in adulthood are likely to require a longer course of therapy when their pre‐therapy general distress scores are high. Adaptations that may need to be made to services and to therapy delivery are discussed.
    July 26, 2017   doi: 10.1002/cpp.2108   open full text
  • Animal‐assisted psychotherapy for young people with behavioural problems in residential care.
    Alexander Muela, Nekane Balluerka, Nora Amiano, Miguel Angel Caldentey, Jone Aliri.
    Clinical Psychology & Psychotherapy. July 20, 2017
    The aim of this study was to evaluate the impact of an animal‐assisted psychotherapy (AAP) programme on clinical symptoms, personal adjustment, and adaptive skills in a group of adolescents in residential care who had experienced childhood trauma and who presented mental health problems and difficulties adapting to the care home environment. The 87 participants (Mage = 15.17, SD = 1.53) were divided into two groups: a treatment group (25 girls and 27 boys; Mage = 15.00, SD = 1.55) and a control group (9 girls and 26 boys; Mage = 15.42, SD = 1.50). The programme consisted of 34 sessions involving both group (23 sessions) and individual (11 sessions) AAP. The Behaviour Assessment System for Children was used to evaluate clinical and adaptive dimensions of behaviour and personality. The results indicated that, in comparison with controls, the young people who took part in the AAP programme reported a significant improvement on two measures of internalizing symptoms, namely, depression and sense of inadequacy. Although no significant differences were observed in relation to externalizing symptoms, the adolescents who received the AAP programme showed improved social skills in terms of their ability to interact satisfactorily with peers and adults in the care home environment, as well as a more positive attitude towards teachers at school. These results suggest that AAP may be a promising treatment for young people who have experienced childhood trauma and who subsequently find it difficult to adapt to the residential care setting.
    July 20, 2017   doi: 10.1002/cpp.2112   open full text
  • Intensive Short‐Term Dynamic Psychotherapy for generalized anxiety disorder: A pilot effectiveness and process‐outcome study.
    Peter Lilliengren, Robert Johansson, Joel M. Town, Steve Kisely, Allan Abbass.
    Clinical Psychology & Psychotherapy. July 04, 2017
    The objective of this study was to evaluate the clinical‐ and cost‐effectiveness of Intensive Short‐Term Dynamic Psychotherapy (ISTDP) for generalized anxiety disorder (GAD). We further aimed to examine if a key clinical process within the ISTDP framework, termed the level of mobilization of unprocessed complex emotions (MUCE), was related to outcome. The sample consisted of 215 adult patients (60.9% female) with GAD and comorbid conditions treated in a tertiary mental health outpatient setting. The patients were provided an average of 8.3 sessions of ISTDP delivered by 38 therapists. The level of MUCE in treatment was assessed from videotaped sessions by a rater blind to treatment outcome. Year‐by‐year healthcare costs were derived independently from government databases. Multilevel growth models indicated significant decreases in psychiatric symptoms and interpersonal problems during treatment. These gains were corroborated by reductions in healthcare costs that continued for 4 years post‐treatment reaching normal population means. Further, we found that the in‐treatment level of MUCE was associated with larger treatment effects, underlining the significance of emotional experiencing and processing in the treatment of GAD. We conclude that ISTDP appears to reduce symptoms and costs associated with GAD and that the ISTDP framework may be useful for understanding key therapeutic processes in this challenging clinical population. Controlled studies of ISTDP for GAD are warranted.
    July 04, 2017   doi: 10.1002/cpp.2101   open full text
  • Experiencing health‐related quality of life in paediatric short stature – a cross‐cultural analysis of statements from patients and parents.
    Rachel Sommer, Monika Bullinger, John Chaplin, Ju‐ky Do, Mick Power, Andreas Pleil, Julia Quitmann.
    Clinical Psychology & Psychotherapy. July 04, 2017
    Objectives Direct assessment of the patient perspective is necessary to thoroughly understand patients' experiences of disease. We aimed to examine information from children with short stature on their perceived HrQoL within 5 European countries. Methods Patients, identified through clinical databases, were approached by their clinicians according to the inclusion criteria regarding a diagnosis of growth hormone deficiency or idiopathic short stature and age requirements. A focus group methodology was applied in 84 children and 112 parents. Based on a category system, individual statements were allocated to domains. To evaluate the emerging topics, qualitative content analysis was conducted. Domains and respective coding frequencies per category were compared across countries and respondents. Results The highest number of statements produced by the children and parents were related to social (29%) and emotional needs and concerns (28%). In particular, children stressed their experience of social exclusion but also their perception of social support. Regarding emotional needs, they stated mainly the desire to be taller in order to be less teased by peers. National differences were identified, for example, Swedish (22%) and British (16%) children and their parents (Sweden 26%; Britain 23%) stressed physical HrQoL aspects, whereas German children (21%) strongly focused on treatment aspects, mainly the benefit of treatment. Conclusion Comprehensive knowledge of the impact of a chronic condition such as short stature on wellbeing is an important precondition of effective treatment. Because socioemotional topics were rated in all the countries to be most important, interventions aimed at improving HrQoL should target social and emotional responses to short stature. Key Practitioner Messages Focus group discussions have been shown to be a useful method for children with short stature and their parents to describe, communicate, prioritize and present aspects of health‐related quality of life to health care professionals. Social and emotional aspects of living with short stature are the most frequently discussed topics by children as well as by parents across countries; these topics provide important objectives for tailoring appropriate psychosocial interventions. Clinicians should consider both child and parent concerns, include psychosocial screening tools and propose appropriate referral options for patients and family members.
    July 04, 2017   doi: 10.1002/cpp.2105   open full text
  • Attachment and dissociation as mediators of the link between childhood trauma and psychotic experiences.
    Josie Pearce, Jane Simpson, Katherine Berry, Sandra Bucci, Andrew Moskowitz, Filippo Varese.
    Clinical Psychology & Psychotherapy. June 27, 2017
    Exposure to childhood trauma has been implicated in the development of paranoia and hearing voices, but the mechanisms responsible for these associations remain unclear. Understanding these mechanisms is essential for ensuring that targeted interventions can be developed to better support people experiencing distress associated with paranoia and voices. Recent models have proposed that dissociation may be a mechanism specifically involved in the development of voices and insecure attachment in the development of paranoia. Recent theoretical proposals have added to this and argued that fearful attachment could also lead to increased vulnerability for voices. This study was the first to examine whether dissociation and insecure attachment styles mediated the relationship between childhood trauma and these psychotic experiences. One hundred and twelve participants experiencing clinical levels of psychosis completed measures of dissociation, childhood trauma, attachment, voices, and paranoia. Results revealed positive associations between fearful (but not dismissive and anxious) attachment, dissociation, trauma, and psychotic experiences. Mediation analyses indicated that dissociation, but not fearful attachment, significantly mediated the relationship between trauma and voices. Conversely, both dissociation and fearful attachment significantly mediated the relationship between trauma and paranoia. The findings suggest that insecure attachment might be more strongly related to paranoia than hallucinations and suggest that fearful attachment may be a more promising mechanism to explain this relationship. Furthermore, the findings suggest that the impact of dissociation on psychotic experiences may extend to paranoia. Future research is required to replicate these findings using interview‐based attachment measures. Key practitioner messages Dissociation is a robust mediator of the link between childhood trauma and experiences of psychosis, and as such, clinicians should routinely enquire about the presence of dissociation. Clinicians should consider dissociation when formulating clients' difficulties and include dissociation as a possible therapeutic target for psychological interventions in psychosis. Fearful attachment is robustly associated with paranoia and should be taken into account throughout assessment, formulation, and intervention.
    June 27, 2017   doi: 10.1002/cpp.2100   open full text
  • In‐session behaviours and adolescents' self‐concept and loneliness: A psychodrama process–outcome study.
    Hod Orkibi, Bracha Azoulay, Sharon Snir, Dafna Regev.
    Clinical Psychology & Psychotherapy. June 27, 2017
    As adolescents spend many hours a day in school, it is crucial to examine the ways in which therapeutic practices in schools promote their well‐being. This longitudinal pilot study examined the contribution of school‐based psychodrama group therapy to the self‐concept dimensions and perceived loneliness of 40 Israeli adolescents (aged 13–16, 60% boys) in public middle schools. From a process–outcome perspective, we also examined the understudied trajectory of adolescents' in‐session behaviours (process variables) and its associations with changes in their self‐concepts and loneliness (outcome variables). Psychodrama participants reported increases in global, social, and behavioural self‐concepts and a decrease in loneliness compared to the control group. In‐session productive behaviours increased and resistance decreased throughout the therapy, but varied process–outcome relationships were found. The study suggests that conducting further research into the process–outcome relationships in psychodrama group therapy is warranted to pinpoint specific mechanisms of change. Suggestions for future studies are provided.
    June 27, 2017   doi: 10.1002/cpp.2103   open full text
  • An exploration of the relationship between use of safety‐seeking behaviours and psychosis: A systematic review and meta‐analysis.
    Sarah Tully, Adrian Wells, Anthony P. Morrison.
    Clinical Psychology & Psychotherapy. June 21, 2017
    Safety‐seeking behaviours are responses employed to protect against perceived threat. In relation to anxiety disorders, safety‐seeking behaviours have been implicated in both the formation and maintenance of distress. Several studies have highlighted similar findings in relation to psychosis; however, this literature has not yet been synthesized. This review is, therefore, being conducted in order to synthesize the literature on safety seeking in people with psychosis to increase the understanding of this relationship. A systematic search identified and included 43 studies comprising 2,592 participants, published between 1995 and 2015. The results indicated that people experiencing psychosis commonly respond to their experiences with behavioural and cognitive strategies intended to manage their difficulties. In relation to safety seeking, avoidance, and resistance, there was a pattern that these responses are associated with increased distress and appraisals of threat. The results relating to engagement response styles showed the opposite pattern. These results provide support for cognitive models of safety seeking and psychosis with many of the meta‐analyses reported here showing a clear pattern of association between behavioural responses and distress. However, the results reported within individual studies are mixed. This appears to be particularly true with the response style of distraction, with our analyses unable to clarify this relationship. It is possible that the mixed results could reflect the complexities in defining safety seeking and distinguishing it from coping in this population. The clinical implications of this are discussed. Key practitioner message People experiencing psychosis commonly respond to their unusual experiences with behavioural and cognitive strategies intended to manage their difficulties. In general, reducing safety seeking behaviours, including avoidance and resistance, seems likely to be helpful in the longer term reduction of distress associated with psychosis. However, it should not be assumed that certain responses are always unhelpful. The clinician should work with each individual to find out what each response style means to them and help them to assess its function and purpose. Formal evaluation of current and historical advantages and disadvantages of specific strategies could also be helpful.
    June 21, 2017   doi: 10.1002/cpp.2099   open full text
  • Change in attachment states of mind of women with binge‐eating disorder.
    Hilary Maxwell, Giorgio A. Tasca, Renee Grenon, Kerri Ritchie, Hany Bissada, Louise Balfour.
    Clinical Psychology & Psychotherapy. June 21, 2017
    Insecure and unresolved/disorganized attachment states of mind may impact affect regulation and interpersonal functioning that contribute to binge eating in women with binge‐eating disorder (BED). Group psychological treatment may facilitate changes from insecure to secure and from unresolved–disorganized to non‐unresolved/disorganized attachment states of mind. This study used attachment theory to understand better the psychopathology of BED and co‐morbid overweight status and to understand better the treatment response of patients with BED who receive group psychotherapy. Women with BED attended group psychodynamic interpersonal psychotherapy and completed the Adult Attachment Interview pretreatment and 6 months posttreatment. Matched samples of overweight women without BED and normal‐weight women without BED completed the Adult Attachment Interview at 1 time point. Women with BED had significantly higher rates of preoccupied and unresolved/disorganized attachment states of mind compared to normal‐weight women without BED and had similar rates of insecure and unresolved/disorganized attachment states of mind compared to overweight women without BED. Of the women with BED who had an insecure and/or unresolved/disorganized attachment states of mind at pretreatment, about 60% demonstrated clinically relevant changes to secure and to non‐unresolved/disorganized states of mind at 6 months post group psychodynamic interpersonal psychotherapy. Results indicated that some women with BED may benefit from interventions that help them regulate hyperactivated affect and create coherent narratives. Both women with BED and overweight women without BED may benefit from treatments that help them develop more adaptive affect regulation strategies related to unresolved/disorganized attachment states of mind. Key Practitioner Messages A preoccupied attachment state of mind may be an underlying and maintaining factor for women with binge‐eating disorder Time‐limited psychodynamic and interpersonal group psychotherapies, like Group Psychodynamic Interpersonal Psychotherapy, may help those with binge‐eating disorder to process and organize their attachment memories which may lead to improved affect regulation and interpersonal functioning Psychological theories and treatment for binge‐eating disorder and overweight may benefit from considering the current impact of insecure and unresolved/disorganized attachment states of mind
    June 21, 2017   doi: 10.1002/cpp.2095   open full text
  • Cyberchondria: Examining relations with problematic Internet use and metacognitive beliefs.
    Thomas A. Fergus, Marcantonio M. Spada.
    Clinical Psychology & Psychotherapy. June 16, 2017
    Cyberchondria refers to the repeated use of the Internet to search for health‐related information, which leads to negative consequences. This two‐part study provides the first known examination of how cyberchondria relates to (a) problematic Internet use and (b) metacognitive beliefs. Participants were U.S. community adults who reported using the Internet to search for health‐related information (Study 1: N = 337, Study 2: N = 260). In Study 1, cyberchondria shared a strong association with problematic Internet use, and that association was unaccounted for by age, gender, current reported medical status, negative affect, or health anxiety. In Study 2, cyberchondria was found to share moderate to strong associations with metacognitive beliefs. The association between cyberchondria and metacognitive beliefs about the uncontrollability of thoughts remained intact after accounting for the Study 1 covariates, as well as anxiety sensitivity and intolerance of uncertainty. Neither anxiety sensitivity nor intolerance of uncertainty shared unique associations with cyberchondria. These results provide a preliminary indication that a metacognitive conceptualization of problematic Internet use may be applicable to cyberchondria. Key practitioner message A metacognitive conceptualization of cyberchondria appears tenable. Metacognitive beliefs, particularly about the uncontrollability of thoughts, appear more relevant to cyberchondria than either anxiety sensitivity or intolerance of uncertainty. Metacognitive treatment strategies could be useful in the treatment of cyberchondria.
    June 16, 2017   doi: 10.1002/cpp.2102   open full text
  • Does the severity of psychopathology of Italian students receiving counselling services increase over time? A 5‐year analysis and a comparison with a clinical and non‐clinical sample.
    Maria Grazia Strepparava, Marco Bani, Federico Zorzi, Umberto Mazza, Francesca Barile, Giorgio Rezzonico.
    Clinical Psychology & Psychotherapy. June 13, 2017
    Psychological problems—from the most minor such as exams anxiety to the more severe such as personality disorders—are not rare in young adults. University Counselling Services often present the only opportunity for undergraduates to meet health professionals and to be confronted with their difficulties in a non‐clinical setting or—in cases of more severe psychopathology—to be referred to mental health services. Recent research attests to the increasing severity of psychological problems among undergraduate and graduate university students. The question necessarily arises as to whether this trend is replicated in the general population being referred to mental health services and, if such is the case, whether there are differences between the two populations. This paper analyses the change in the severity of self‐reported symptoms in a sample of 194 students attending a University Counselling Service over a course of 5 years (2010–2014). Clinical severity was assessed in both groups by Symptoms Check List 90‐Revised, Clinical Outcome in Routine Evaluation‐Outcome Measure, and Emotion Regulation Questionnaire scores. Results show a substantial stability in severity level across time, and a comparison with an age‐matched sample of patients referred to a public hospital clinical psychology service shows overlapping data with respect to disease severity level. As the mental health of university students is an important public health issue, the implications for the organization and structure of university counselling services and the connection with public mental health hospital centres are discussed. Key Practitioner Message The severity of distress and symptoms in Italian students who access psychological counselling service remained stable across a 5‐year period. The level of severity of distress and symptoms in students who access psychological counselling service was higher and similar to that of a mental health service. The results suggest to develop multilevel interventions to address the broader well‐being needs of university students providing both low‐ and high‐intensity interventions and develop a network with mental health services.
    June 13, 2017   doi: 10.1002/cpp.2096   open full text
  • Compassionate Attention and Regulation of Eating Behaviour: A pilot study of a brief low‐intensity intervention for binge eating.
    Cristiana Duarte, José Pinto‐Gouveia, R. James Stubbs.
    Clinical Psychology & Psychotherapy. June 13, 2017
    A low‐intensity 4‐week intervention that included components of compassion, mindfulness, and acceptance was delivered to women diagnosed with binge eating disorder. Participants were randomly assigned to 1 of 2 conditions: intervention (n = 11) or waiting list control (n = 9). Participants in the intervention condition were invited to practise mindfulness, soothing rhythm breathing, and compassionate imagery practices with a focus on awareness and acceptance of emotional states and triggers to binge eating and engagement in helpful actions. Results revealed that, in the intervention group, there were significant reductions in eating psychopathology symptoms, binge eating symptoms, self‐criticism, and indicators of psychological distress; there were significant increases in compassionate actions and body image‐related psychological flexibility. Data suggest that developing compassion and acceptance competencies may improve eating behaviour and psychological well‐being in individuals with binge eating disorder. Key practitioner message A low‐intensity 4‐week intervention for BED was tested. The intervention included components of compassion, mindfulness, and acceptance. Results showed efficacy in reduced binge eating and eating psychopathology. Participants showed reductions in self‐criticism and psychological distress. Participants increased in self‐compassion and body image psychological flexibility.
    June 13, 2017   doi: 10.1002/cpp.2094   open full text
  • Sudden gains in exposure‐focused cognitive‐behavioral group therapy for panic disorder.
    Raquel Nogueira‐Arjona, Martí Santacana, María Montoro, Silvia Rosado, Roser Guillamat, Vicenç Vallès, Miquel A. Fullana.
    Clinical Psychology & Psychotherapy. May 11, 2017
    In the context of psychological treatment, a sudden gain is a large and enduring improvement in symptom severity that occurs between two single therapy sessions. The influence of sudden gains on long‐term outcomes and functional impairment in anxiety disorders is not well understood, and little is known with regard to panic disorder in particular. In addition, previous research on patients with anxiety disorders has produced inconsistent results regarding the relationship between sudden gains and cognitive change. We examined the incidence of sudden gains in a large sample (n = 116) of panic disorder patients undergoing exposure‐focused cognitive‐behavioral group therapy, and compared panic severity, functional impairment, and cognitive change in patients with and without sudden gains at posttreatment and 6‐month follow‐up. Participants who experienced sudden gains displayed lower levels of panic severity and functional impairment at posttreatment and 6‐month follow‐up than those who did not experience sudden gains. However, we observed no difference in cognitive changes between groups, either at posttreatment or at follow‐up. Our results demonstrate that the beneficial effects of sudden gains on therapeutic outcomes not only extend to long‐term and functional outcome measures but are also evident in less cognitive (i.e., exposure‐focused) forms of psychological treatment. Key Practitioner Message Sudden gains are common in panic disorder patients undergoing exposure‐based cognitive‐behavioral group therapy. Sudden gains during exposure‐focused therapy are linked to greater improvement in panic disorder severity and functional impairment. The positive impact of sudden gains on panic disorder severity and functional impairment is maintained in the long term.
    May 11, 2017   doi: 10.1002/cpp.2093   open full text
  • Insecure attachment and maladaptive schema in disordered eating: The mediating role of rejection sensitivity.
    Tara De Paoli, Matthew Fuller‐Tyszkiewicz, Isabel Krug.
    Clinical Psychology & Psychotherapy. May 09, 2017
    Aim The current study aimed to assess insecure attachment and the disconnection and rejection domain of maladaptive schema in the context of disordered eating. Rejection sensitivity (RS) was proposed as a mediator between maladaptive schema and disordered eating. Method The sample consisted of 108 female participants with a lifetime eating disorder diagnosis and 508 female control participants. Participants were asked to complete a number of self‐report measures related to insecure attachment (anxious and avoidant), maladaptive schema (emotional deprivation, abandonment, mistrust, social isolation, and defectiveness), RS (interpersonal and appearance‐based), and disordered eating. Results Path analysis indicated that anxious attachment was associated with disordered eating through multiple pathways involving emotional deprivation, abandonment, interpersonal RS, and appearance‐based RS. Avoidant attachment was not related to disordered eating behaviours. Conclusion The results indicate that both interpersonal and appearance‐based RS are important mediators for the relationships between insecure attachment, maladaptive schema, and disordered eating. Key Practitioner Message The results from the current study suggest that insecure attachment leads to maladaptive schema, which in turn leads to sensitivity to rejection and subsequent disordered eating behaviour. Attachment anxiety, but not attachment avoidance, was related to greater endorsement of all five schemas in the disconnection and rejection domain. Path analysis revealed that, of the schema in the disconnection and rejection domain, only emotional deprivation and abandonment were related to disordered eating. Interpersonal and appearance‐based rejection sensitivity were significant mediators of the relationship between emotional deprivation and disordered eating as well as the relationship between abandonment and disordered eating. Differentiating between schemas within schema domains has clinical value in further understanding the pathway to disordered eating. The schemas of emotional deprivation and abandonment are implicated in disordered eating, suggesting the need to target these schemas in schema therapy.
    May 09, 2017   doi: 10.1002/cpp.2092   open full text
  • The development of a change model of “exits” during cognitive analytic therapy for the treatment of depression.
    Sundeep Kaur Sandhu, Stephen Kellett, Gillian Hardy.
    Clinical Psychology & Psychotherapy. May 03, 2017
    Objectives “Exits” in cognitive analytic therapy (CAT) are methods that change unhelpful patterns or roles during the final “revision” phase of the therapy. How exits are conceived and achieved is currently poorly understood. This study focussed on the revision stage to explore and define how change is accomplished in CAT. Methods Qualitative content analysis studied transcripts of sessions 6 and 7 of a protocol delivered 8‐session CAT treatment for depression. Eight participants met the study inclusion criteria, and therefore, 16 sessions were analysed. Results The exit model developed contained 3 distinct (but interacting) phases: (a) developing an observing self via therapist input or client self‐reflection, (b) breaking out of old patterns by creating new roles and procedures, and (c) utilisation of a range of methods to support and maintain change. Levels of interrater reliability for the exit categories that formed the model were good. Conclusions The revision stage of CAT emerged as a complex and dynamic process involving 3 interacting stages. Further research is recommended to understand how exits relate to durability of change and whether change processes differ according to presenting problem. Key Practitioner Messages Exit work in cognitive analytic therapy is a dynamic process that requires progression through stages of insight, active change, and consolidation. Development of an “observing self” is an important foundation stone for change, and cognitive analytic therapists need to work within the client's zone of proximal development. A number of aspects appear important in facilitating change, such as attending to the process and feelings generated by change talk.
    May 03, 2017   doi: 10.1002/cpp.2090   open full text
  • Emotion dysregulation in hypochondriasis and depression.
    Josef Bailer, Michael Witthöft, Maja Erkic, Daniela Mier.
    Clinical Psychology & Psychotherapy. April 26, 2017
    Background The aim of this study was to explore whether certain aspects of emotion dysregulation (i.e., facets of alexithymia and rumination) are more closely linked to hypochondriasis than to depression and vice versa. Methods Nineteen patients with hypochondriasis (HYP), 33 patients with depression, and 52 healthy control participants completed the Toronto Alexithymia Scale, the Response Styles Questionnaire, and additional symptom and illness behaviour scales. A clinical interview was used to establish DSM‐IV diagnoses and to exclude all cases with more than one axis I diagnosis. Results Depression patients reported more difficulties describing feelings and more symptom‐ and self‐focused rumination than both HYP patients and healthy individuals, whereas HYP patients differed only from healthy individuals in regard to more difficulties in identifying feelings and more symptom‐focused rumination. Multiple regression analyses, including all assessed facets of emotion dysregulation, showed that the degree of somatoform features (somatic symptoms, health anxiety, and illness behaviour) was specifically predicted by higher difficulties in identifying feelings scores, whereas depressive symptom levels were specifically predicted by higher rumination scores. Conclusions Specific associations were found between difficulties in identifying feelings and key features of HYP, whereas depression was linked to a more generalized pattern of emotion regulation deficits. Key Practitioner Message Emotion dysregulation can be found in hypochondriasis and depression Difficulties in identifying own feelings are specifically linked to somatic symptoms, health anxiety, and illness behaviour, whereas a more generalized pattern of emotion dysregulation is found in relation to depression Further research is needed to investigate whether the effectiveness of current treatments for depression, hypochondriasis, health anxiety, and related disorders could be improved by additional emotion regulation interventions
    April 26, 2017   doi: 10.1002/cpp.2089   open full text
  • How do we know what makes for “best practice” in clinical supervision for psychological therapists? A content analysis of supervisory models and approaches.
    Chloe Simpson‐Southward, Glenn Waller, Gillian E. Hardy.
    Clinical Psychology & Psychotherapy. April 19, 2017
    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 Messages There 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.
    April 19, 2017   doi: 10.1002/cpp.2084   open full text
  • Depression, anxiety, and compulsive sexual behaviour among men in residential treatment for substance use disorders: The role of experiential avoidance.
    Meagan J. Brem, Ryan C. Shorey, Scott Anderson, Gregory L. Stuart.
    Clinical Psychology & Psychotherapy. April 11, 2017
    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 Message Compulsive 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.
    April 11, 2017   doi: 10.1002/cpp.2085   open full text
  • The impact of childhood maltreatment on the differential efficacy of CBASP versus escitalopram in patients with chronic depression: A secondary analysis.
    Paul Bausch, Thomas Fangmeier, Ingo Zobel, Dieter Schoepf, Sarah Drost, Knut Schnell, Henrik Walter, Mathias Berger, Claus Normann, Elisabeth Schramm.
    Clinical Psychology & Psychotherapy. March 21, 2017
    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 Message CBASP 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.
    March 21, 2017   doi: 10.1002/cpp.2081   open full text
  • Cognitive and metacognitive predictors of symptom improvement following treatment for social anxiety disorder: A secondary analysis from a randomized controlled trial.
    Henrik Nordahl, Hans M. Nordahl, Odin Hjemdal, Adrian Wells.
    Clinical Psychology & Psychotherapy. March 15, 2017
    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 Message Cognitive 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.
    March 15, 2017   doi: 10.1002/cpp.2083   open full text
  • Information order effects in clinical psychological diagnoses.
    Jan Christopher Cwik, Jürgen Margraf.
    Clinical Psychology & Psychotherapy. March 09, 2017
    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.
    March 09, 2017   doi: 10.1002/cpp.2080   open full text
  • Preventing intimate partner violence via the Internet: A randomized controlled trial of emotion‐regulation and conflict‐management training for individuals with aggression problems.
    Hugo Hesser, Sandra Axelsson, Victoria Bäcke, Jonna Engstrand, Tina Gustafsson, Elin Holmgren, Ulrika Jeppsson, Maria Pollack, Kjell Nordén, Dan Rosenqvist, Gerhard Andersson.
    Clinical Psychology & Psychotherapy. March 06, 2017
    Objective The 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. Method Sixty‐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. Results Robust 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. Conclusions iCBT 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 Message Internet‐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.
    March 06, 2017   doi: 10.1002/cpp.2082   open full text
  • Pathways into psychopathology: Modeling the effects of trait emotional intelligence, mindfulness, and irrational beliefs in a clinical sample.
    K. V. Petrides, María G. Gómez, Juan‐Carlos Pérez‐González.
    Clinical Psychology & Psychotherapy. February 21, 2017
    We investigated possible pathways into mental illness via the combined effects of trait emotional intelligence (trait EI), mindfulness, and irrational beliefs. The sample comprised 121 psychiatric outpatients (64.5% males, mean age = 38.8 years) with a variety of formal clinical diagnoses. Psychopathology was operationalized by means of 3 distinct indicators from the Millon Clinical Multi‐Axial Inventory (mild pathology, severe pathology, and clinical symptomatology). A structural equation model confirmed significant direct trait EI and mindfulness effects on irrational beliefs and psychopathology. Trait EI also had a significant indirect effect on psychopathology via mindfulness. Together, the 3 constructs accounted for 44% of the variance in psychopathology. A series of hierarchical regressions demonstrated that trait EI is a stronger predictor of psychopathology than mindfulness and irrational beliefs combined. We conclude that the identified pathways can provide the basis for the development of safe and effective responses to the ongoing mental health and overmedication crises. Key Practitioners Messages Self‐perception constructs concerning one's beliefs about oneself have a major impact on the likelihood of developing psychopathological symptoms. Emotional perceptions captured by trait emotional intelligence were stronger predictors of psychopathology than either or both mindfulness and irrational beliefs in a clinical sample of adults. If the seed factors of psychopathology are mainly psychological, rather than mainly biological, and given that psychological constructs, like trait emotional intelligence, mindfulness, and irrational beliefs, are amenable to training and optimization, the findings herein provide the impetus for a much needed shift of emphasis from pharmacological to psychological treatments.
    February 21, 2017   doi: 10.1002/cpp.2079   open full text
  • 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.
    Joana Alexandra Costa, João Marôco, José Pinto‐Gouveia.
    Clinical Psychology & Psychotherapy. February 14, 2017
    Background The 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. Method Data 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. Results CFA 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. Conclusions The 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.
    February 14, 2017   doi: 10.1002/cpp.2077   open full text
  • Mindfulness‐based cognitive therapy as an augmentation treatment for obsessive–compulsive disorder.
    Brenda L. Key, Karen Rowa, Peter Bieling, Randi McCabe, Elizabeth J. Pawluk.
    Clinical Psychology & Psychotherapy. February 13, 2017
    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 Message Mindfulness 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.
    February 13, 2017   doi: 10.1002/cpp.2076   open full text
  • A qualitative investigation in the role of the baby in recovery from postpartum psychosis.
    Charlene Plunkett, Sarah Peters, Angelika Wieck, Anja Wittkowski.
    Clinical Psychology & Psychotherapy. January 31, 2017
    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 Message The 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.
    January 31, 2017   doi: 10.1002/cpp.2074   open full text
  • A proposed model of psychodynamic psychotherapy linked to Erik Erikson's eight stages of psychosocial development.
    Zelda Gillian Knight.
    Clinical Psychology & Psychotherapy. January 25, 2017
    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 Message Psychotherapy 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.
    January 25, 2017   doi: 10.1002/cpp.2066   open full text
  • Indirect exposure to client trauma and the impact on trainee clinical psychologists: Secondary traumatic stress or vicarious traumatization?
    Rakhee Makadia, Rachel Sabin‐Farrell, Graham Turpin.
    Clinical Psychology & Psychotherapy. January 25, 2017
    Objectives The 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. Design A Web‐based survey was employed. Methods The 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 UK Results Five 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. Conclusions This 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 Points Secondary 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 include Exposure 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.
    January 25, 2017   doi: 10.1002/cpp.2068   open full text
  • The role of guilt sensitivity in OCD symptom dimensions.
    Gabriele Melli, Claudia Carraresi, Andrea Poli, Donatella Marazziti, Antonio Pinto.
    Clinical Psychology & Psychotherapy. January 16, 2017
    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.
    January 16, 2017   doi: 10.1002/cpp.2071   open full text
  • 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.
    Hong‐Zhong Qiu, Zeng‐Jie Ye, Mu‐Zi Liang, Yue‐Qun Huang, Wei Liu, Zhi‐Dong Lu.
    Clinical Psychology & Psychotherapy. January 12, 2017
    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 message Art 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.
    January 12, 2017   doi: 10.1002/cpp.2069   open full text
  • Change in self‐esteem predicts depressive symptoms at follow‐up after intensive multimodal psychotherapy for major depression.
    Ulrike Dinger, Johannes C. Ehrenthal, Christoph Nikendei, Henning Schauenburg.
    Clinical Psychology & Psychotherapy. January 08, 2017
    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 Message Self‐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.
    January 08, 2017   doi: 10.1002/cpp.2067   open full text
  • 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.
    Iryna V. Ivanova, Giorgio A. Tasca, Geneviève Proulx, Hany Bissasda.
    Clinical Psychology & Psychotherapy. December 28, 2016
    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 Message Negative 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.
    December 28, 2016   doi: 10.1002/cpp.2060   open full text
  • Effects of Functional Analytic Psychotherapy Therapist Training on Therapist Factors Among Therapist Trainees in Singapore: A Randomized Controlled Trial.
    Shian‐Ling Keng, Emma Waddington, Xiangting Bernice Lin, Michelle Su Qing Tan, Clare Henn‐Haase, Jonathan W. Kanter.
    Clinical Psychology & Psychotherapy. December 23, 2016
    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 Message Functional 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.
    December 23, 2016   doi: 10.1002/cpp.2064   open full text
  • Psychopathological Differences Between Suicide Ideators and Suicide Attempters in Patients with Mental Disorders.
    Sandra Pérez, Jose H. Marco, Joaquin García‐Alandete.
    Clinical Psychology & Psychotherapy. December 22, 2016
    Background Although 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. Method In 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. Results The 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. Limitations Groups 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. Conclusions Our 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 Message Recent 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.
    December 22, 2016   doi: 10.1002/cpp.2063   open full text
  • Cognitive Analytic Therapy for Bipolar Disorder: A Pilot Randomized Controlled Trial.
    Mark Evans, Stephen Kellett, Simon Heyland, Jo Hall, Shazmin Majid.
    Clinical Psychology & Psychotherapy. December 20, 2016
    The evidence base for treatment of bipolar affective disorder (BD) demands the evaluation of new psychotherapies in order to broaden patient choice. This study reports on the feasibility, safety, helpfulness and effectiveness of cognitive analytic therapy (CAT). In a pilot randomized controlled trial, BD patients in remission were randomized to either receiving 24 sessions of CAT (n = 9) or treatment as usual (n = 9) and were assessed in terms of symptoms, functioning and service usage over time. In the CAT arm no adverse events occurred, 8/9 completed treatment, 5/8 attended all 24 sessions and 2/8 were categorized as recovered. The most common helpful event during CAT was recognition of patterns in mood variability, with helpfulness themes changing according to phase of therapy. No major differences were found when comparing the arms over time in terms of service usage or psychometric outcomes. The study suggests that conducting further research into the effectiveness of CAT in treating BD is warranted and guidance regarding future trials is provided. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Treating BD with CAT appears feasible and safe. Retaining fidelity to the reformulation, recognition and revision structure of CAT appears useful. Participants stated that across the phases of CAT, focussing on patterns of mood variability was consistently helpful.
    December 20, 2016   doi: 10.1002/cpp.2065   open full text
  • Cultural Competence in the Treatment of Addictions: Theory, Practice and Evidence.
    Sally M. Gainsbury.
    Clinical Psychology & Psychotherapy. December 15, 2016
    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.
    December 15, 2016   doi: 10.1002/cpp.2062   open full text
  • Assessing Anaclitic and Introjective Characteristics Using the SWAP‐200 Q‐Sort: Concurrent Validity with the Inventory of Interpersonal Problems Circumplex Scales.
    Racheli Miller, Mark Hilsenroth.
    Clinical Psychology & Psychotherapy. December 12, 2016
    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 Message Clinicians 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
    December 12, 2016   doi: 10.1002/cpp.2057   open full text
  • The Relationship Between Self‐Blame for the Onset of a Chronic Physical Health Condition and Emotional Distress: A Systematic Literature Review.
    Leah Callebaut, Philip Molyneux, Tim Alexander.
    Clinical Psychology & Psychotherapy. December 07, 2016
    Objective Past 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. Method Between 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. Results The 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. Conclusions It 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 Message What 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.
    December 07, 2016   doi: 10.1002/cpp.2061   open full text
  • Facilitators and Barriers to Person‐centred Care in Child and Young People Mental Health Services: A Systematic Review.
    Dawid Gondek, Julian Edbrooke‐Childs, Tjasa Velikonja, Louise Chapman, Felicity Saunders, Daniel Hayes, Miranda Wolpert.
    Clinical Psychology & Psychotherapy. December 02, 2016
    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 Messages As 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.
    December 02, 2016   doi: 10.1002/cpp.2052   open full text
  • The Experiences of Fathers When Their Partners are Admitted with Their Infants to a Psychiatric Mother and Baby Unit.
    Holly Reid, Angelika Wieck, Andrew Matrunola, Anja Wittkowski.
    Clinical Psychology & Psychotherapy. December 02, 2016
    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 Message Partners 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.
    December 02, 2016   doi: 10.1002/cpp.2056   open full text
  • They're NICE and Neat, but Are They Useful? A Grounded Theory of Clinical Psychologists' Beliefs About and Use of NICE Guidelines.
    Alex John Court, Anne Cooke, Amanda Scrivener.
    Clinical Psychology & Psychotherapy. November 25, 2016
    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. Key Practitioner Message Guidelines have many benefits, but the current pressure for services to be ‘NICE compliant’ may be having unintended negative as well as positive effects. Lack of implementation may be partly the result of active choice by clinicians concerned to use the full range of professional skills and to offer flexibility and choice to service users. The current context is creating a perverse incentive for clinicians to say one thing but do another. This is problematic for services and a potential threat to the profession of clinical psychology.
    November 25, 2016   doi: 10.1002/cpp.2054   open full text
  • From Childhood Trauma to Self‐Harm: An Investigation of Theoretical Pathways among Female Prisoners.
    Ruth Howard, Thanos Karatzias, Kevin Power, Adam Mahoney.
    Clinical Psychology & Psychotherapy. November 22, 2016
    Background Despite 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. Methods Cross‐sectional, interview‐format, questionnaire study within a female prison population. Measures of childhood trauma, self‐harm, PTSD, emotion regulation and dissociation were administered. Results The 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. Conclusion Self‐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. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Messages Self‐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.
    November 22, 2016   doi: 10.1002/cpp.2058   open full text
  • The Reciprocal Relationship between Bipolar Disorder and Social Interaction: A Qualitative Investigation.
    Rebecca Owen, Patricia Gooding, Robert Dempsey, Steven Jones.
    Clinical Psychology & Psychotherapy. November 13, 2016
    Background Evidence 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. Method Semi‐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. Results Empathy 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. Conclusions An 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 Messages The 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.
    November 13, 2016   doi: 10.1002/cpp.2055   open full text
  • Feasibility and Acceptability of the ‘HABIT’ Group Programme for Comorbid Bipolar and Alcohol and Substance use Disorders.
    Isabelle Biseul, Romain Icick, Perrine Seguin, Frank Bellivier, Jan Scott.
    Clinical Psychology & Psychotherapy. October 20, 2016
    Objectives We 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. Method Potential 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. Results Eight 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. Conclusion This 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 Message Comorbidity 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.
    October 20, 2016   doi: 10.1002/cpp.2053   open full text
  • Narrative Changes Predict a Decrease in Symptoms in CBT for Depression: An Exploratory Study.
    Miguel M. Gonçalves, Joana Ribeiro Silva, Inês Mendes, Catarina Rosa, António P. Ribeiro, João Batista, Inês Sousa, Carlos F. Fernandes.
    Clinical Psychology & Psychotherapy. October 20, 2016
    Objective Innovative 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. Methods The 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. Results Innovative 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. Discussion A 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 Message Elaborating 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.
    October 20, 2016   doi: 10.1002/cpp.2048   open full text
  • Well‐being in Chronic Fatigue Syndrome: Relationship to Symptoms and Psychological Distress.
    H. Jackson, A. K. MacLeod.
    Clinical Psychology & Psychotherapy. October 13, 2016
    Objective There 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. Method Chronic 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). Results Correlations 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. Conclusion This 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 Messages Previous 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.
    October 13, 2016   doi: 10.1002/cpp.2051   open full text
  • An Integrative Bio‐Psycho‐Social Theory of Anorexia Nervosa.
    Calum Munro, Louise Randell, Stephen M Lawrie.
    Clinical Psychology & Psychotherapy. October 13, 2016
    The need for novel approaches to understanding and treating anorexia nervosa (AN) is well recognized. The aim of this paper is to describe an integrative bio‐psycho‐social theory of maintaining factors in AN. We took a triangulation approach to develop a clinically relevant theory with face validity and internal consistency. We developed theoretical ideas from our clinical practice and reviewed theoretical ideas within the eating disorders and wider bio‐psycho‐social literature. The synthesis of these ideas and concepts into a clinically meaningful framework is described here. We suggest eight key factors central to understanding the maintenance and treatment resistance of anorexia nervosa: genetic or experiential predisposing factors; dysfunctional feelings processing and regulation systems; excessive vulnerable feelings; ‘feared self’ beliefs; starvation as a maladaptive physiological feelings regulation mechanism; maladaptive psychological coping modes; maladaptive social behaviour; and unmet physical and psychological core needs. Each of these factors serves to maintain the disorder. The concept of universal physical and psychological core needs can provide an underpinning integrative framework for working with this distinctly physical and psychological disorder. This framework could be used within any treatment model. We suggest that treatments which help address the profound lack of trust, emotional security and self‐acceptance in this patient group will in turn address unmet needs and improve well‐being. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message The concept of unmet physical and psychological needs can be used as an underlying integrative framework for understanding and working with this patient group, alongside any treatment model. A functional understanding of the neuro‐biological, physiological and psychological mechanisms involved in anorexia nervosa can help patients reduce self‐criticism and shame. Fears about being or becoming fat, greedy, needy, selfish and unacceptable (‘Feared Self’) drive over‐compensatory self‐depriving behaviour (‘Anorexic Self’). Psychological treatment for anorexia nervosa should emphasize a focus on feelings and fostering experiences of acceptance and trust. Treatment for patients with anorexia nervosa needs to be longer than current clinical practice.
    October 13, 2016   doi: 10.1002/cpp.2047   open full text
  • Bridging the Gap between Aetiological and Maintaining Factors in Social Anxiety Disorder: The Impact of Socially Traumatic Experiences on Beliefs, Imagery and Symptomatology.
    Alice R. Norton, Maree J. Abbott.
    Clinical Psychology & Psychotherapy. October 11, 2016
    Background A 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. Aims The 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. Method Social 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. Results Participants 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. Conclusions These 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 Messages Negative 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).
    October 11, 2016   doi: 10.1002/cpp.2044   open full text
  • Four Pathways to Anorexia Nervosa: Patients' Perspective on the Emergence of AN.
    Kjersti S. Gulliksen, Ragnfrid H. S. Nordbø, Ester M. S. Espeset, Finn Skårderud, Arne Holte.
    Clinical Psychology & Psychotherapy. October 11, 2016
    Introduction Studies 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. Methods Participants 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. Results We 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. Discussion Our 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 Message Although 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.
    October 11, 2016   doi: 10.1002/cpp.2050   open full text
  • A Novel Approach to Treating CFS and Co‐morbid Health Anxiety: A Case Study.
    Jo Daniels, Maria E. Loades.
    Clinical Psychology & Psychotherapy. October 06, 2016
    Objectives Chronic 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. Design A 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. Results The 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. Conclusions An 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 Messages Chronic 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.
    October 06, 2016   doi: 10.1002/cpp.2042   open full text
  • Change Factors in the Process of Cognitive‐Behavioural Therapy for Obsessive–Compulsive Disorder.
    C. Schwartz, S. Hilbert, C. Schubert, S. Schlegl, T. Freyer, B. Löwe, B. Osen, U. Voderholzer.
    Clinical Psychology & Psychotherapy. October 03, 2016
    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 Message Increase 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.
    October 03, 2016   doi: 10.1002/cpp.2045   open full text
  • ‘Many die in the hurricane’: An Interpretative Phenomenological Analysis of Adults with Psychosis and a History of Childhood Physical Abuse.
    J. E. Rhodes, L. J. Healey.
    Clinical Psychology & Psychotherapy. September 29, 2016
    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.
    September 29, 2016   doi: 10.1002/cpp.2043   open full text
  • Becoming Therapeutic Agents: A Grounded Theory of Mothers' Process When Implementing Cognitive Behavioural Therapy at Home with an Anxious Child.
    Rana Pishva.
    Clinical Psychology & Psychotherapy. September 29, 2016
    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 Message Mothers 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.
    September 29, 2016   doi: 10.1002/cpp.2046   open full text
  • What are People's Experiences of a Novel Cognitive Behavioural Therapy for Bipolar Disorders? A Qualitative Investigation with Participants on the TEAMS Trial.
    Emmeline Joyce, Sara Tai, Piersanti Gebbia, Warren Mansell.
    Clinical Psychology & Psychotherapy. September 21, 2016
    Background Psychological 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. Methods Fourteen 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. Results Two 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. Conclusions The 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 Message This 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.
    September 21, 2016   doi: 10.1002/cpp.2040   open full text
  • Emotional Processing Theory Put to Test: A Meta‐Analysis on the Association Between Process and Outcome Measures in Exposure Therapy.
    Christian Rupp, Philipp Doebler, Thomas Ehring, Anna N. Vossbeck‐Elsebusch.
    Clinical Psychology & Psychotherapy. August 26, 2016
    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. Copyright © 2016 John Wiley & Sons, Ltd. 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.
    August 26, 2016   doi: 10.1002/cpp.2039   open full text
  • Psychologists' Perspectives on Therapy Termination and the Use of Therapy Engagement/Retention Strategies.
    Robin Westmacott, John Hunsley.
    Clinical Psychology & Psychotherapy. August 25, 2016
    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 Message Therapists 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.
    August 25, 2016   doi: 10.1002/cpp.2037   open full text
  • Evaluation of Life Events in Major Depression: Assessing Negative Emotional Bias.
    Laura Girz, Erin Driver‐Linn, Gregory A. Miller, Patricia J. Deldin.
    Clinical Psychology & Psychotherapy. August 08, 2016
    Background Overly 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. Methods Depressed (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. Results Participants 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. Conclusion A 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.
    August 08, 2016   doi: 10.1002/cpp.2033   open full text
  • A Semantic Corpus Comparison Analysis of Couple‐Focused Interventions for Problematic Alcohol Use.
    Emily C. Soriano, Kelly E. Rentscher, Michael J. Rohrbaugh, Matthias R. Mehl.
    Clinical Psychology & Psychotherapy. August 02, 2016
    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 Message Incorporating 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).
    August 02, 2016   doi: 10.1002/cpp.2030   open full text
  • Misclassification of Self‐Directed Violence.
    Jan Christopher Cwik, Tobias Teismann.
    Clinical Psychology & Psychotherapy. August 02, 2016
    Background Inconsistent 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. Method A 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. Results Overall 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. Limitations The validity of case vignettes is discussible. Conclusions The results highlight the importance of more methodological and diagnostic training of psychologists regarding suicidal issues. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Misclassification 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.
    August 02, 2016   doi: 10.1002/cpp.2036   open full text
  • Effectiveness of Short‐Term Dynamic Group Psychotherapy in Primary Care for Patients with Depressive Symptoms.
    Ignasi Bros, Pere Notó, Antoni Bulbena.
    Clinical Psychology & Psychotherapy. July 25, 2016
    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. © 2016 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd. Key Practitioner Message Short‐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.
    July 25, 2016   doi: 10.1002/cpp.2029   open full text
  • Developing a Compassionate Internal Supervisor: Compassion‐Focused Therapy for Trainee Therapists.
    Tobyn Bell, Alison Dixon, Russell Kolts.
    Clinical Psychology & Psychotherapy. July 25, 2016
    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 Message Compassion‐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‐compassion Therapist self‐practice of compassion‐focused exercises can provide important insights into the nature of compassion and its cultivation in clients
    July 25, 2016   doi: 10.1002/cpp.2031   open full text
  • The Effects of Waiting for Treatment: A Meta‐Analysis of Waitlist Control Groups in Randomized Controlled Trials for Social Anxiety Disorder.
    Christiane Steinert, Katja Stadter, Rudolf Stark, Falk Leichsenring.
    Clinical Psychology & Psychotherapy. July 22, 2016
    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 Message In 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.
    July 22, 2016   doi: 10.1002/cpp.2032   open full text
  • Understanding the ‘Anorexic Voice’ in Anorexia Nervosa.
    Matthew Pugh, Glenn Waller.
    Clinical Psychology & Psychotherapy. July 20, 2016
    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 Message Experiences 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.
    July 20, 2016   doi: 10.1002/cpp.2034   open full text
  • The Contribution of Therapist Effects to Patient Dropout and Deterioration in the Psychological Therapies.
    David Saxon, Michael Barkham, Alexis Foster, Glenys Parry.
    Clinical Psychology & Psychotherapy. July 17, 2016
    Background In the psychological therapies, patient outcomes are not always positive. Some patients leave therapy prematurely (dropout), while others experience deterioration in their psychological well‐being. Methods The 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. Results Therapist 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). Conclusions The 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 Message Therapists 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.
    July 17, 2016   doi: 10.1002/cpp.2028   open full text
  • Accommodation of Symptoms in Anorexia Nervosa: A Qualitative Study.
    John R. E. Fox, Anna Whittlesea.
    Clinical Psychology & Psychotherapy. June 17, 2016
    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 Message Anorexia 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.
    June 17, 2016   doi: 10.1002/cpp.2020   open full text
  • Adolescent and Family‐focused Cognitive–behavioural Therapy for Paediatric Bipolar Disorders: A Case Series.
    Jens Knutsson, Beata Bäckström, Daiva Daukantaitė, Fredrik Lecerof.
    Clinical Psychology & Psychotherapy. June 16, 2016
    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. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Preliminary 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.
    June 16, 2016   doi: 10.1002/cpp.2027   open full text
  • The Inference‐Based Approach (IBA) to the Treatment of Obsessive–Compulsive Disorder: An Open Trial Across Symptom Subtypes and Treatment‐Resistant Cases.
    Frederick Aardema, Kieron P. O`Connor, Marie‐Eve Delorme, Jean‐Sebastien Audet.
    Clinical Psychology & Psychotherapy. June 09, 2016
    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.
    June 09, 2016   doi: 10.1002/cpp.2024   open full text
  • Predictors of Incidence, Remission and Relapse of Axis I Mental Disorders in Young Women: A Transdiagnostic Approach.
    Justina Lukat, Eni S. Becker, Kristen L. Lavallee, William M. Veld, Jürgen Margraf.
    Clinical Psychology & Psychotherapy. June 03, 2016
    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.
    June 03, 2016   doi: 10.1002/cpp.2026   open full text
  • Group‐Based Compassion‐Focused Therapy as an Adjunct to Outpatient Treatment for Eating Disorders: A Pilot Randomized Controlled Trial.
    Allison Catherine Kelly, Lucene Wisniewski, Caitlin Martin‐Wagar, Ellen Hoffman.
    Clinical Psychology & Psychotherapy. May 30, 2016
    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.
    May 30, 2016   doi: 10.1002/cpp.2018   open full text
  • Changes in Object Relations over the Course of Psychodynamic Psychotherapy.
    A. S. J. Mullin, M. J. Hilsenroth, J. Gold, B. A. Farber.
    Clinical Psychology & Psychotherapy. May 30, 2016
    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.
    May 30, 2016   doi: 10.1002/cpp.2021   open full text
  • The Relationship between Co‐rumination and Internalizing Problems: A Systematic Review and Meta‐analysis.
    Jason S. Spendelow, Laura M. Simonds, Rachel E. Avery.
    Clinical Psychology & Psychotherapy. May 23, 2016
    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.
    May 23, 2016   doi: 10.1002/cpp.2023   open full text
  • The Role of Gender as a Moderator of the Alliance‐Outcome Link in Acute Inpatient Treatment of Severely Disturbed Youth.
    Jeffrey S. Nevid, Jasmine Ghannadpour, Gregory Haggerty.
    Clinical Psychology & Psychotherapy. May 13, 2016
    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.
    May 13, 2016   doi: 10.1002/cpp.2025   open full text
  • Therapist Effects on and Predictors of Non‐Consensual Dropout in Psychotherapy.
    Dirk Zimmermann, Julian Rubel, Andrew C. Page, Wolfgang Lutz.
    Clinical Psychology & Psychotherapy. May 10, 2016
    Background Whereas 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. Method Participants 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. Results It 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. Conclusions The 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 Messages There 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.
    May 10, 2016   doi: 10.1002/cpp.2022   open full text
  • Does Therapists' Disengaged Feelings Influence the Effect of Transference Work? A Study on Countertransference.
    Hanne‐Sofie Johnsen Dahl, Per Høglend, Randi Ulberg, Svein Amlo, Glen O Gabbard, John Christopher Perry, Paul Crits Christoph.
    Clinical Psychology & Psychotherapy. April 25, 2016
    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 Message Therapists' 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.
    April 25, 2016   doi: 10.1002/cpp.2015   open full text
  • The Role of Coping Change in Borderline Personality Disorder: A Process‐Outcome Analysis on Dialectical‐Behaviour Skills Training.
    Ueli Kramer.
    Clinical Psychology & Psychotherapy. April 21, 2016
    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 Message It 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.
    April 21, 2016   doi: 10.1002/cpp.2017   open full text
  • How Veterans Health Administration Suicide Prevention Coordinators Assess Suicide Risk.
    James L. Pease, Jeri E. Forster, Collin L. Davidson, Brooke Dorsey Holliman, Emma Genco, Lisa A. Brenner.
    Clinical Psychology & Psychotherapy. April 13, 2016
    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 Message Identifies factors that practitioners consider most important in suicide risk assessment Discusses how to distinguish between chronic and acute risk for suicide Identifies factors that lead to more consistent clinical judgments
    April 13, 2016   doi: 10.1002/cpp.2011   open full text
  • Therapeutic Alliance in Internet‐Delivered Cognitive Behaviour Therapy for Depression or Generalized Anxiety.
    Heather D. Hadjistavropoulos, Nicole E. Pugh, Hugo Hesser, Gerhard Andersson.
    Clinical Psychology & Psychotherapy. April 06, 2016
    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 Message This 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.
    April 06, 2016   doi: 10.1002/cpp.2014   open full text
  • Concepts of Mental Disorders in Trainee Clinical Psychologists.
    R. Read, N. J. Moberly, D. Salter, M. R. Broome.
    Clinical Psychology & Psychotherapy. March 18, 2016
    Background The 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. Methods The Maudsley Attitude Questionnaire was administered in an online survey of trainee clinical psychologists (n = 289). Results Analyses 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. Conclusion Results 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 Message The 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.
    March 18, 2016   doi: 10.1002/cpp.2013   open full text
  • The Special Challenges of Psychotherapy with Persons with Psychosis: Intersubjective Metacognitive Model of Agreement and Shared Meaning.
    Ilanit Hasson‐Ohayon, Shlomo Kravetz, Paul H. Lysaker.
    Clinical Psychology & Psychotherapy. March 14, 2016
    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 Message Goal 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.
    March 14, 2016   doi: 10.1002/cpp.2012   open full text
  • The Experience of Postnatal Depression in Immigrant Mothers Living in Western Countries: A Meta‐Synthesis.
    Anja Wittkowski, Sonia Patel, John R. Fox.
    Clinical Psychology & Psychotherapy. March 14, 2016
    Background Postnatal 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. Methods This 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. Results The 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. Conclusions Immigrant 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 Message In 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.
    March 14, 2016   doi: 10.1002/cpp.2010   open full text
  • 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 Study.
    Emma L Hodgkinson, Debbie M Smith, Dougal Julian Hare, Anja Wittkowski.
    Clinical Psychology & Psychotherapy. March 03, 2016
    Objective To explore the construal of midwives by pregnant women with a body mass index greater than 30 kg/m2 (BMI ≥ 30 kg/m2). Method Ten 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. Results Pregnant 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 < 30 kg/m2 was considered to be most similar to the ideal midwife, while the midwife with a BMI ≤ 18 kg/m2 was construed as having an undesirable interpersonal style. The midwife with a BMI ≥ 40 kg/m2 was often construed as sharing similar experiences to the pregnant women with a BMI ≥ 30 kg/m2, such as struggling with the psychological consequences of a raised BMI. Some women construed the midwife with a BMI 30 < 40 kg/m2 in a positive way, whereas others viewed it as sharing similar feelings about weight as the midwife with a BMI ≥ 40 kg/m2. Conclusions The pregnant women with a BMI ≥ 30 kg/m2 in this study described perceptions of themselves and the midwives responsible for their care, which may affect their engagement and satisfaction with services. Pregnant women with a BMI ≥ 30 kg/m2 should be involved in service development activities to ensure the structure of services and the language used by midwives are acceptable and do not confirm weight‐related stereotypes. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Pregnant women with a BMI ≥ 30 kg/m2 construe themselves as vulnerable and self‐conscious and perceive themselves responsible for their weight. Pregnant women with a BMI ≥ 30 kg/m2 construe midwives with a low BMI as having an undesirable, cold, interpersonal style. Midwives with a raised BMI are construed as similar to the women, because they share the uncomfortable psychological consequences of a raised BMI. The nature of pregnant women's construal may affect their engagement and satisfaction with maternity services and midwifery care.
    March 03, 2016   doi: 10.1002/cpp.2009   open full text
  • Protection or Vulnerability? A Meta‐Analysis of the Relations Between the Positive and Negative Components of Self‐Compassion and Psychopathology.
    Peter Muris, Nicola Petrocchi.
    Clinical Psychology & Psychotherapy. February 19, 2016
    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.
    February 19, 2016   doi: 10.1002/cpp.2005   open full text
  • Feasibility and Effects of a Brief Compassion‐Focused Imagery Intervention in Psychotic Patients with Paranoid Ideation: A Randomized Experimental Pilot Study.
    Leonie Ascone, Johanna Sundag, Björn Schlier, Tania M. Lincoln.
    Clinical Psychology & Psychotherapy. February 17, 2016
    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 Message Affiliative 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.
    February 17, 2016   doi: 10.1002/cpp.2003   open full text
  • First‐person Pronoun Use in Spoken Language as a Predictor of Future Depressive Symptoms: Preliminary Evidence from a Clinical Sample of Depressed Patients.
    Johannes Zimmermann, Timo Brockmeyer, Matthias Hunn, Henning Schauenburg, Markus Wolf.
    Clinical Psychology & Psychotherapy. January 27, 2016
    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 Message Naturally 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.
    January 27, 2016   doi: 10.1002/cpp.2006   open full text
  • The Impact of Causal Explanations on Outcome in People Experiencing Psychosis: A Systematic Review.
    Lucy Carter, John Read, Melissa Pyle, Anthony P. Morrison.
    Clinical Psychology & Psychotherapy. January 25, 2016
    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 Message Individuals 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.
    January 25, 2016   doi: 10.1002/cpp.2002   open full text
  • How to Train Experienced Therapists in a New Method: A Qualitative Study into Therapists' Views.
    Marieke C. Napel‐Schutz, Tineke A. Abma, Lotte L. M. Bamelis, Arnoud Arntz.
    Clinical Psychology & Psychotherapy. January 21, 2016
    Background Implementation 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. Objective The 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. Method Qualitative 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. Results Therapists 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. Conclusions In 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 Message Especially 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.
    January 21, 2016   doi: 10.1002/cpp.2004   open full text
  • Short‐Term Cognitive–Behavioural Group Treatment for Hoarding Disorder: A Naturalistic Treatment Outcome Study.
    Richard Moulding, Maja Nedeljkovic, Michael Kyrios, Debra Osborne, Christopher Mogan.
    Clinical Psychology & Psychotherapy. January 11, 2016
    The study aim was to test whether a 12‐week publically rebated group programme, based upon Steketee and Frost's Cognitive Behavioural Therapy‐based hoarding treatment, would be efficacious in a community‐based setting. Over a 3‐year period, 77 participants with clinically significant hoarding were recruited into 12 group programmes. All completed treatment; however, as this was a community‐based naturalistic study, only 41 completed the post‐treatment assessment. Treatment included psychoeducation about hoarding, skills training for organization and decision making, direct in‐session exposure to sorting and discarding, and cognitive and behavioural techniques to support out‐of‐session sorting and discarding, and nonacquiring. Self‐report measures used to assess treatment effect were the Savings Inventory—Revised (SI‐R), Savings Cognition Inventory, and the Depression, Anxiety and Stress Scales. Pre‐post analyses indicated that after 12 weeks of treatment, hoarding symptoms as measured on the SI‐R had reduced significantly, with large effect sizes reported in total and across all subscales. Moderate effect sizes were also reported for hoarding‐related beliefs (emotional attachment and responsibility) and depressive symptoms. Of the 41 participants who completed post‐treatment questionnaires, 14 (34%) were conservatively calculated to have clinically significant change, which is considerable given the brevity of the programme judged against the typical length of the disorder. The main limitation of the study was the moderate assessment completion rate, given its naturalistic setting. This study demonstrated that a 12‐week group treatment for hoarding disorders was effective in reducing hoarding and depressive symptoms in an Australian clinical cohort and provides evidence for use of this treatment approach in a community setting. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message A 12‐week group programme delivered in a community setting was effective for helping with hoarding symptoms with a large effect size. Hoarding beliefs (emotional attachment and responsibility) and depression were reduced, with moderate effect sizes. A third of all participants who completed post‐treatment questionnaires experienced clinically significant change. Suggests that hoarding CBT treatment can be effectively translated into real‐world settings and into a brief 12‐session format, albeit the study had a moderate assessment completion rate.
    January 11, 2016   doi: 10.1002/cpp.2001   open full text
  • Developing Emotion‐Based Case Formulations: A Research‐Informed Method.
    Antonio Pascual‐Leone, Ueli Kramer.
    Clinical Psychology & Psychotherapy. January 11, 2016
    Objectives New research‐informed methods for case conceptualization that cut across traditional therapy approaches are increasingly popular. This paper presents a trans‐theoretical approach to case formulation based on the research observations of emotion. Methods The sequential model of emotional processing (Pascual‐Leone & Greenberg, 2007) is a process research model that provides concrete markers for therapists to observe the emerging emotional development of their clients. We illustrate how this model can be used by clinicians to track change and provides a ‘clinical map,’ by which therapist may orient themselves in‐session and plan treatment interventions. Results Emotional processing offers as a trans‐theoretical framework for therapists who wish to conduct emotion‐based case formulations. First, we present criteria for why this research model translates well into practice. Second, two contrasting case studies are presented to demonstrate the method. Conclusions The model bridges research with practice by using client emotion as an axis of integration. Key Practitioner Message Process research on emotion can offer a template for therapists to make case formulations while using a range of treatment approaches. The sequential model of emotional processing provides a ‘process map’ of concrete markers for therapists to (1) observe the emerging emotional development of their clients, and (2) help therapists develop a treatment plan. Copyright © 2016 John Wiley & Sons, Ltd.
    January 11, 2016   doi: 10.1002/cpp.1998   open full text
  • Sexual and Non‐Sexual Trauma, Depression and Self‐Esteem in a Sample of Polish Women. A Cross‐Sectional Study.
    Justyna Kucharska.
    Clinical Psychology & Psychotherapy. January 05, 2016
    The purpose of this research was to explore the issue of the psychological aftermaths of traumatic events in women. According to the existing body of evidence, women suffer more often than men from mental health problems as a result of a traumatic event—one of the explanations for this is that women experience sexual trauma more frequently and this type of trauma causes more severe negative consequences. Therefore, the main aim of this research was to compare the aftermaths of sexual and non‐sexual traumatic events in women. Only traumatic events in adulthood were taken into consideration and were divided into two categories: recent events (previous two years) and those of an earlier occurrence. Depression and low level of self‐esteem were included in the research model as possible consequences of traumatic events. A total of 273 women from Poland took part in a questionnaire survey. As hypothesized, in the case of recent events, participants who experienced a sexual trauma showed a higher level of depression and lower level of self‐esteem compared with those subjects, who experienced a non‐sexual trauma or did not experience a traumatic event at all. However, this effect was not observed in the case of events of earlier occurrence. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Relations between traumatic experiences and the level of depression and self‐esteem in women were demonstrated. Women who experienced sexual trauma showed higher levels of depression and lower levels of self‐esteem than women who experienced other types of trauma. Time of the occurrence of the traumatic events matters: the relations between traumatic events, depression and self‐esteem were demonstrated in the case of the events that occurred within the last two years.
    January 05, 2016   doi: 10.1002/cpp.1994   open full text
  • The Association among Childhood Trauma, Pathological Dissociation and Gambling Severity in Casino Gamblers.
    Claudio Imperatori, Marco Innamorati, Francesco Saverio Bersani, Francesca Imbimbo, Maurizio Pompili, Anna Contardi, Benedetto Farina.
    Clinical Psychology & Psychotherapy. December 21, 2015
    The aim of the present study was to explore the role of pathological dissociation in mediating the association between childhood trauma (CT) and gambling severity. One hundred seventy‐one (134 men and 37 women) gamblers recruited in gambling environments (i.e., two Italian casinos) have been enrolled in the study. Psychopathological assessments included the Childhood Trauma Questionnaire (CTQ), the Dissociative Experiences Scale‐Taxon (DES‐T), the South Oaks Gambling Screen (SOGS), the CAGE and the Hospital Anxiety and Depression Scale. A mediational model, analyzing the direct and indirect effects of CTQ on SOGS through the mediating role of DES‐T, showed that the relation between CTQ and SOGS was fully mediated by DES‐T scores (b = 0.07; se = 0.15; p < 0.001). This finding raises the possibility that CT explains gambling severity through the presence of pathological dissociative symptoms and dissociative pathogenetic processes. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Gambling severity is associated with both childhood trauma and pathological dissociation in casino gamblers. A mediational model shows that the effect of childhood trauma on gambling severity is entirely mediated by pathological dissociation. From a clinical point of view, our results highlight the importance of assessing, and possibly treating, dissociative symptoms in individuals with gambling disorder.
    December 21, 2015   doi: 10.1002/cpp.1997   open full text
  • ‘Do You Practice What You Preach?’ A Qualitative Exploration of Therapists' Personal Practice of Compassion Focused Therapy.
    Corinne Gale, Thomas Schröder, Paul Gilbert.
    Clinical Psychology & Psychotherapy. December 21, 2015
    Background Therapists' personal practice of therapy techniques can impact on a range of areas, including: empathy for the client, therapeutic understanding, therapist skills and self‐awareness. Compassion Focused Therapy (CFT) draws extensively on personal practice during training, and on‐going personal practice is encouraged. However, the impact of this has not been examined. Objectives To explore therapists' experiences of personal practice in relation to CFT, and the impact this has upon them and their therapeutic work. Design A qualitative approach was adopted, using inductive thematic analysis. Methods Ten therapists, who had trained in CFT, took part in a semi‐structured interview to explore their experiences of personal practice. Results Five main themes were identified. These highlighted that: (1) experiences of personal practice often felt strange to start with but were surprisingly powerful; (2) with practice, the exercises became more automatic and could be adopted as a ‘way of life’; (3) personal practice was felt to increase both self‐compassion and compassion for others; (4) personal practice often helped participants to feel more present for their clients; and (5) participants were more aware of what they were bringing to therapy. Conclusions This exploratory study demonstrated that personal practice is an important part of CFT training and can have a positive impact upon therapists both personally and professionally. It is concluded that the results justify further research in order to establish the applicability of these findings with a larger sample. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages Personal practice facilitates experiential learning and is an important element of CFT training, which impacts on both personal and professional development. CFT trainers need to ensure that sufficient time is provided for both personal practice and reflection. CFT trainees should be aware that initial reactions to personal practice can be powerful and sometimes unsettling. As for therapy itself, working through fears, blocks and resistances is important. Personal practice is a valuable self‐care strategy, and therapists are encouraged to engage in personal practice after training.
    December 21, 2015   doi: 10.1002/cpp.1993   open full text
  • Ashamed and Fused with Body Image and Eating: Binge Eating as an Avoidance Strategy.
    Cristiana Duarte, José Pinto‐Gouveia, Cláudia Ferreira.
    Clinical Psychology & Psychotherapy. December 21, 2015
    Binge Eating Disorder (BED) is currently recognized as a severe disorder associated with relevant psychiatric and physical comorbidity, and marked emotional distress. Shame is a specific negative emotion that has been highlighted as central in eating disorders. However, the effect of shame and underlying mechanisms on binge eating symptomatology severity remained unclear. This study examines the role of shame, depressive symptoms, weight and shape concerns and eating concerns, and body image‐related cognitive fusion, on binge eating symptomatology severity. Participated in this study 73 patients with the diagnosis of BED, established through a clinical interview—Eating Disorder Examination 17.0D—who completed measures of external shame, body‐image related cognitive fusion, depressive symptoms and binge eating symptomatology. Results revealed positive associations between binge eating severity and depressive symptoms, shame, weight and shape concerns, eating concerns and body image‐related cognitive fusion. A path analysis showed that, when controlling for the effect of depressive symptoms, external shame has a direct effect on binge eating severity, and an indirect effect mediated by increased eating concern and higher levels of body image‐related cognitive fusion. Results confirmed the plausibility of the model, which explained 43% of the severity of binge eating symptoms. The proposed model suggests that, in BED patients, perceiving that others see the self negatively may be associated with an entanglement with body image‐related thoughts and concerns about eating, which may, in turn, fuel binge eating symptoms. Findings have important clinical implications supporting the relevance of addressing shame and associated processes in binge eating. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Shame is a significant predictor of symptomatology severity of BED patients. Shame significantly impacts binge eating, even controlling for depressive symptoms. Shame significantly predicts body image‐related cognitive fusion and eating concern. Body image‐fusion and eating concern mediate the link between shame and binge eating. Binge eating may be seen as an avoidance strategy from negative self‐evaluations.
    December 21, 2015   doi: 10.1002/cpp.1996   open full text
  • Psychotherapeutic Intervention in the Demobilization Process: Addressing Combat‐related Mental Injuries with Narrative Exposure in a First and Second Dissemination Stage.
    Anke Köbach, Susanne Schaal, Tobias Hecker, Thomas Elbert.
    Clinical Psychology & Psychotherapy. December 16, 2015
    Background Depending on the exposure to traumatic stressors and combat, 20% to 50% of ex‐combatants present with trauma‐related disorders, and more than half of the members of armed groups have a proclivity to violence. Therefore, psychotherapeutic assistance should address both, trauma‐related suffering and the lowered threshold for aggressive behaviour. Objective Supporting the demobilization process of ex‐combatants in the eastern DR‐Congo, we implemented a version of Narrative Exposure Therapy adapted for Forensic Offender Rehabilitation (FORNET). Method In two successive dissemination stages (DS), local counsellors conducted FORNET. In DS1, they were trained by clinical experts, and in DS2, the by then experienced counsellors trained and supervised a second group of local counsellors (DS2). The training consisted of a 3‐week workshop covering theoretical concepts and practical therapeutic skills. In DS1 and DS2, a total of 98 demobilizing combatants received an intervention; treatment‐as‐usual served as the control condition. Posttraumatic stress disorder, appetitive aggression, depression severity and drug dependence were assessed prior to the intervention and 6 and 12 months later; additionally, we assessed reintegration success. Results Six months post‐intervention, FORNET significantly reduced Posttraumatic stress disorder symptoms but had less effect on the trait of appetitive aggression; moreover, beneficial effects were found for depression severity and drug dependence as well as for reintegration indices. Treatment gains were retained at 12 months. Conclusions Individuals without previous training in psychotherapy can learn to effectively apply the brief intervention FORNET and support the demobilization process in ongoing conflicts. The study suggests that it is possible to pass down psychotherapeutic techniques over generations of counsellors. © 2015 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd. Key Practitioner Message Posttraumatic stress symptoms, depression and clinically relevant levels of drug dependence can effectively be reduced with a version of Narrative Exposure Therapy (NET) adapted for Forensic Offender Rehabilitation (FORNET). The intervention is effective in the context of ongoing conflict. Individuals without previous training in psychotherapy can learn to effectively apply the brief intervention FORNET. It is possible to pass down psychotherapeutic techniques like FORNET over generations of counsellors. Psychotherapeutic interventions like FORNET may facilitate the transition to peace in war‐torn regions.
    December 16, 2015   doi: 10.1002/cpp.1986   open full text
  • Rumination, Entrapment and Suicide Ideation: A Mediational Model.
    Tobias Teismann, Thomas Forkmann.
    Clinical Psychology & Psychotherapy. December 11, 2015
    Rumination has been shown to be positively associated with suicide ideation. Yet, only few studies have attempted to explain potential mediators of this association. Perceptions of entrapment are a core component of recent psychological models of suicidality and might mediate the relationship between rumination and suicide ideation. Possible mediator effects were investigated in an online sample (n = 142) and a clinical sample (n = 226) of adults receiving outpatient psychotherapy. Results demonstrated that perceptions of entrapment fully mediated the association between ruminative thinking and suicide ideation. However, the reverse relationship, where the association between entrapment and suicide ideation is mediated by ruminative thinking, was not supported. These findings suggest that the relationship between rumination and suicide ideation is explained by perceptions of entrapment. Theoretical and clinical implications are discussed. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Ruminative thinking and perceptions of entrapment are associated with suicidal ideation and suicidal behavior. Perceptions of entrapment fully mediate the association between ruminative thinking and suicide ideation. Clinically, it could be useful to incorporate perceptions of entrapment into the psychosocial risk assessment of persons contemplating suicide.
    December 11, 2015   doi: 10.1002/cpp.1999   open full text
  • Meaning in Life in People with Borderline Personality Disorder.
    Jose H. Marco, Sandra Pérez, Joaquin García‐Alandete, Reyes Moliner.
    Clinical Psychology & Psychotherapy. December 07, 2015
    Low feelings of meaning in life are associated with depression, hopelessness and suicide, substance abuse and emotional dysregulation. The aim of this study is to offer results about the importance of the construct meaning in life in the psychopathology of BPD. In study 1, the sample was made up of 223 participants, 141 participants with BPD and 82 participants with another mental disorder but without BPD. In study 2, the sample was made up of 80 participants with BPD. Study 1 indicated that the participants with BPD had a lower feeling of meaning in life than the participants with mental disorders but without a BPD. Study 2 indicated that meaning in life was highly negatively correlated with the symptoms of BPD. The model composed of emotional dysregulation, and meaning in life was significantly associated with BPD psychopathology. The present study supports the association between meaning in life with the psychopathology of BPD. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message The results of this study suggest that meaning in life is a relevant variable in the psychopathology of BPD The results of this study suggest that meaning in life is associated with non‐suicide self injuries This study suggests that current therapies for BPD should focus on increasing the meaning in life in these patients
    December 07, 2015   doi: 10.1002/cpp.1991   open full text
  • Assessing Attachment in Psychotherapy: Validation of the Patient Attachment Coding System (PACS).
    Alessandro Talia, Madeleine Miller‐Bottome, Sarah I.F. Daniel.
    Clinical Psychology & Psychotherapy. November 24, 2015
    The authors present and validate the Patient Attachment Coding System (PACS), a transcript‐based instrument that assesses clients' in‐session attachment based on any session of psychotherapy, in multiple treatment modalities. One‐hundred and sixty clients in different types of psychotherapy (cognitive–behavioural, cognitive–behavioural‐enhanced, psychodynamic, relational, supportive) and from three different countries were administered the Adult Attachment Interview (AAI) prior to treatment, and one session for each client was rated with the PACS by independent coders. Results indicate strong inter‐rater reliability, and high convergent validity of the PACS scales and classifications with the AAI. These results present the PACS as a practical alternative to the AAI in psychotherapy research and suggest that clinicians using the PACS can assess clients' attachment status on an ongoing basis by monitoring clients' verbal activity. These results also provide information regarding the ways in which differences in attachment status play out in therapy sessions and further the study of attachment in psychotherapy from a pre‐treatment client factor to a process variable. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message The Patient Attachment Coding System is a valid measure of attachment that can classify clients' attachment based on any single psychotherapy transcript, in many therapeutic modalities Client differences in attachment manifest in part independently of the therapist's contributions Client adult attachment patterns are likely to affect psychotherapeutic processes
    November 24, 2015   doi: 10.1002/cpp.1990   open full text
  • The Phenomenology and Generation of Positive Mental Imagery in Early Psychosis.
    Jennifer Laing, Tristan Morland, Miriam Fornells‐Ambrojo.
    Clinical Psychology & Psychotherapy. November 11, 2015
    Background Theoretical models of depression and bipolar disorder emphasise the importance of positive mental imagery in mood and behaviour. Distressing, intrusive images are common in psychosis; however, little is known about positive imagery experiences or their association with clinical symptoms. The aim of the current study was to examine the phenomenology of positive imagery in early psychosis and the relationship between the characteristics of positive, future‐oriented imagery and symptom severity. Method Characteristics, thematic content and appraisals of recent self‐reported images were examined in 31 people with early psychosis. The vividness and perceived likelihood of deliberately generated, future‐oriented images were investigated in relation to clinical symptoms. Results Eighty‐four percent of participants reported experiencing a recent positive image. Themes included the achievement of personal goals, spending enjoyable time with peers and family, loving, intimate relationships and escape from current circumstances. The vividness and perceived likelihood of generated prospective imagery were negatively correlated with levels of depression and social anxiety. Conclusions The relationship between emotional problems and the ability to imagine positive, future events may have implications for motivation, mood and goal‐directed behaviour in psychosis. Everyday experiences of positive imagery may represent the simulation of future goals, attempts to cope or avoid aversive experiences or idealised fantasy. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message The majority of participants experienced a recent positive image with themes related to goal attainment and social relationships. Depression and social anxiety levels were correlated with the vividness of intentionally generated positive future‐oriented images and their perceived likelihood. The assessment of positive imagery in early psychosis appears warranted and may provide insights regarding individual coping strategies, values and goals.
    November 11, 2015   doi: 10.1002/cpp.1976   open full text
  • Development and Validation of the Morphing Fear Questionnaire (MFQ).
    Eva Zysk, Roz Shafran, Tim I. Williams, Gabriele Melli.
    Clinical Psychology & Psychotherapy. November 05, 2015
    Morphing fears (also called transformation obsessions) involve concerns that a person may become contaminated by and acquire undesirable characteristics of others. These symptoms are found in patients with obsessive–compulsive disorder (OCD) and are thought to be related to mental contamination. Given the high levels of distress and interference morphing fears can cause, a reliable and valid assessment measure is needed. This article describes the development and evaluation of the Morphing Fear Questionnaire (MFQ), a 13‐item measure designed to assess for the presence and severity of morphing fears. A sample of 900 participants took part in the research. Of these, 140 reported having a current diagnosis of OCD (SR‐OCD) and 760 reported never having had OCD (N‐OCD; of whom 24 reported a diagnosis of an anxiety disorder and 23 reported a diagnosis of depression). Factor structure, reliability and construct and criterion‐related validity were investigated. Exploratory and confirmatory factor analyses supported a one‐factor structure replicable across the N‐OCD and SR‐OCD group. The MFQ was found to have high internal consistency and good temporal stability and showed significantly greater associations with convergent measures (assessing obsessive–compulsive symptoms, mental contamination, thought–action fusion and magical thinking) than with divergent measures (assessing depression and anxiety). Moreover, the MFQ successfully discriminated between the SR‐OCD sample and the N‐OCD group, anxiety disorder sample and depression sample. These findings suggest that the MFQ has sound psychometric properties and that it can be used to assess morphing fear. Clinical implications are discussed. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Little remains known about morphing fears, but it is an important area of investigation due to symptoms being highly distressing and often debilitating Because morphing fears commonly present as obscure symptoms, they may not be recognized as a type of OCD The MFQ is a robust measure with clinical utility; it can facilitate recognition and assessment of morphing fears The MFQ will allow for further investigations of the prevalence, correlates and treatment outcomes of morphing fears.
    November 05, 2015   doi: 10.1002/cpp.1987   open full text
  • Common Factors and Depressive Symptom Relief Trajectories in Group Teletherapy for Persons Ageing with HIV.
    Timothy G. Heckman, Bernadette Davantes Heckman, Timothy Anderson, Joseph A. Bianco, Mark Sutton, Travis I. Lovejoy.
    Clinical Psychology & Psychotherapy. November 04, 2015
    Telepsychology research has focused primarily on treatment efficacy, with far less attention devoted to how common factors relate to teletherapy outcomes. This research identified trajectories of depressive symptom relief in 105 older people living with HIV with elevated depressive symptoms enrolled in a randomized clinical trial testing two 12‐session group teletherapies and compared common factors (e.g., therapeutic alliance and group cohesion) across depressive symptom trajectory groups. Growth mixture modelling of weekly depression scores identified three depressive symptom change groups: (1) ‘early improvers’ (31%) who reported reductions in depressive symptoms by Session 4; (2) ‘delayed improvers’ (16%) whose symptoms improved after Session 5 and (3) ‘non‐improvers’ (53%). Therapeutic alliance was unrelated to treatment outcome group. Group cohesion was greater in early improvers than non‐improvers. Group cohesion was unexpectedly lower, and group member similarity was greater in delayed improvers than non‐improvers. Early improvers had been living with HIV/AIDS for fewer years than non‐improvers. In group teletherapy, group cohesion and group member similarity are more important than client–therapist alliance. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message In group teletherapy with older people living with HIV (OPLWHIV), three latent outcome trajectory groups emerged over the 12‐week treatment period: (1) non‐improvers (53%); (2) early improvers (31%) and (3) delayed improvers (16%). In group teletherapy with OPLWHIV, group cohesion is a stronger predictor of depressive symptom relief than is client–therapist alliance. OPLWHIV in group teletherapy who do not respond to treatment until the latter therapy sessions can still experience depressive symptom relief comparable with early responders.
    November 04, 2015   doi: 10.1002/cpp.1989   open full text
  • Posttraumatic Growth in Populations with Posttraumatic Stress Disorder—A Systematic Review on Growth‐Related Psychological Constructs and Biological Variables.
    Christine F. Schubert, Ulrike Schmidt, Rita Rosner.
    Clinical Psychology & Psychotherapy. October 30, 2015
    Posttraumatic growth (PTG) and Posttraumatic Stress Disorder (PTSD) are possible consequences of trauma. PTG is supposed to emerge from cognitive processes and can have functional and dysfunctional aspects. This systematic review aims to identify and evaluate publications assessing PTG in adults diagnosed with PTSD in order to analyse the relationship between both constructs, how PTG is related to specific psychological variables and if there are biological variables linked to PTG. This extended review evaluates the quality of measures applied and is the first to study PTG only in populations meeting full PTSD criteria. In addition, the relationship between PTG and other relevant constructs, such as openness, optimism and social support, is explored. Our systematic literature search identified 140 studies of which 19 fulfilled our inclusion criteria; most of them used the Post‐Traumatic Growth Inventory. Results indicate that trauma survivors with PTSD exhibit more PTG than those without PTSD and that PTG can be intensified during the therapeutic process whereat it is unclear whether PTG is a desirable outcome of PTSD therapy. Positive correlations between PTG and PTSD are reported. For diagnosed populations, we could not find strong evidence of a quadratic relationship between PTG and PTSD, although some studies support this hypothesis. Findings regarding the association of PTG with psychological variables are heterogeneous. Only one study focused on PTG as well as on biological variables (salivary cortisol) but did not discuss possible links between these two so far unconnected research fields in PTSD. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Trauma survivors with PTSD develop more PTG than those without PTSD, it remains unclear whether PTSD and PTG are curvilinearly related. PTG can be enhanced through PTSD therapy, nevertheless one must not assume that PTG is a favorable treatment outcome since we do not know if the development of PTG during therapy promotes the reduction of PTSD symptoms. It is unclear whether PTG in PTSD sufferers is a constructive outcome of cognitive processes or a positive illusion in favor of avoidance and denial. Results regarding the association of personality factors, social support and PTG are inconsistent, studies on biological aspects of PTG are lacking.
    October 30, 2015   doi: 10.1002/cpp.1985   open full text
  • Anxious Children and Adolescents Non‐responding to CBT: Clinical Predictors and Families' Experiences of Therapy.
    Irene Lundkvist‐Houndoumadi, Mikael Thastum.
    Clinical Psychology & Psychotherapy. October 30, 2015
    The purpose of the study was to examine clinical predictors of non‐response to manualized cognitive behaviour therapy (CBT) among youths (children and adolescents) with anxiety disorders, and to explore families' perspective on therapy, using a mixed methods approach. Non‐response to manualized group CBT was determined among 106 youths of Danish ethnicity (7–17 years old) with a primary anxiety disorder, identified with the Clinical Global Impression of Improvement Scale at the 3‐month follow‐up. Twenty‐four youths (22.6 %) had not responded to treatment, and a logistic regression analysis revealed that youths with a primary diagnosis of social phobia were seven times more likely not to respond, whereas youths with a comorbid mood disorder were almost four times more likely. Families of non‐responding youths with primary social phobia and/or a comorbid mood disorder (n = 15) were interviewed, and data were analysed through interpretative phenomenological analysis. Two superordinate themes emerged: youths were not involved in therapy work, and manualized group format posed challenges to families. The mixed methods approach provided new perspectives on the difficulties that may be encountered by families of non‐responding youths with a primary social phobia diagnosis and youths with a comorbid mood disorder during manualized group CBT. Clinical implications related to youths' clinical characteristics, and families' experience and suggestions are drawn. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages Youths with an anxiety disorder, who had a primary social phobia diagnosis and those, who had a comorbid mood disorder, were more likely not to respond to manualized group CBT. Parents of those non‐responding youths often considered them as motivated to overcome their difficulties, but due to their symptomatology, they were unreceptive, reluctant and ambivalent and therefore not actively involved in therapy. The non‐responding youths with social phobia felt evaluated and nervous of what others thought of them in the group. The parents of the non‐responding youths with a comorbid mood disorder felt the group format placed restraints on therapists' ability to focus on their individual needs.
    October 30, 2015   doi: 10.1002/cpp.1982   open full text
  • Development and Validation of the Pride in Eating Pathology Scale (PEP‐S).
    Cintia L. Faija, John R. E. Fox, Stephanie Tierney, Sarah Peters, Patricia A. Gooding.
    Clinical Psychology & Psychotherapy. October 27, 2015
    There is a growing body of theoretical and clinical literature highlighting the role of pride in maintaining eating disordered behaviours. Despite its clinical importance, there are no measures to assess feelings of pride associated with eating psychopathology. This study describes the development and validation of the Pride in Eating Pathology Scale (PEP‐S), a self‐report questionnaire that examines feelings of pride towards eating disordered symptoms (e.g., pride in food restriction, thinness and weight loss). Participants were 390 females, recruited from university and community populations, whose mean age was 26.99 years. Respondents rated pride in eating pathology on a 7‐point Likert‐scale. Principal Component Analysis indicated that the 60‐item scale comprised a four component structure: (1) pride in weight loss, food control and thinness, (2) pride in healthy weight and healthy eating, (3) pride in outperforming others and social recognition and (4) pride in capturing other people's attention due to extreme thinness. These four components explained a total of 65.31% of the variance. The PEP‐S demonstrated very good internal reliability (α ranging from 0.88 to 0.98) and very good test–retest reliability over a 3‐week time‐span (r ranging from 0.81 to 0.93). The PEP‐S also showed excellent convergent and discriminant validity. Furthermore, the scale discriminated between women with high and low levels of eating psychopathology. The PEP‐S is a psychometrically robust measure of pride in eating pathology. It has the potential to advance theoretical understanding and may also be clinically useful. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message The PEP‐S is a valid, reliable, quick and easy to administer self‐report questionnaire that measures pride related to eating pathology. The PEP‐S assesses four clinically relevant dimensions: (1) pride in weight loss, food control and thinness, (2) pride in healthy weight and healthy eating, (3) pride in outperforming others and social recognition and (4) pride in capturing other people's attention due to extreme thinness. The PEP‐S has very good internal and test–retest reliability, and very good convergent and discriminant validity. The PEP‐S distinguishes between women with higher and lower levels of eating psychopathology. The PEP‐S makes an important contribution to understanding pride in eating psychopathology, which is essential from both clinical and theoretical perspectives.
    October 27, 2015   doi: 10.1002/cpp.1988   open full text
  • Cut‐off Scores and Clinical Change Indices for the Dutch Outcome Questionnaire (OQ‐45) in a Large Sample of Normal and Several Psychotherapeutic Populations.
    Reinier Timman, Kim Jong, Nita Neve‐Enthoven.
    Clinical Psychology & Psychotherapy. October 26, 2015
    The Outcome Questionnaire‐45 (OQ‐45; Lambert et al., ) has been designed for frequent assessment of a patient's functioning during the course of psychotherapy and has become one of the most frequently used outcome measures in the Netherlands. The OQ‐45 was originally normed on outpatients in secondary care only, but is applied in a wide variety of patient populations. As such, it has become increasingly important to provide cut‐off scores with the normal population, as well as between different patient populations. The present large‐scale Dutch study aims to provide cut‐off scores between several populations. Data were collected from the normal population (n = 1810) and patients in five different treatment settings: outpatient primary care (n = 1581), outpatient secondary care (n = 9433), private practice (n = 457), day patient (n = 481) and inpatient therapies (n = 485), a total of more than 14.000 administrations. Reliable change indices and cut‐off scores were calculated using the method of Jacobson and Truax (). The reliable change index for the patient population was calculated as 18 and the cut‐off between the normal and patient population as 56. Sensitivity, specificity and area under the curves of cut‐off scores between the normal population and the treatment settings were satisfactory and generally higher than 0.80. Between the patient populations, these measures were generally too low for strict use. The OQ‐45 total score can satisfactorily discriminate between the normal and patient populations. For assignment to specific treatment types, the OQ‐45 may help, but its use is somewhat limited in practice. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message The Dutch OQ‐45 has satisfactory levels of reliability, sensitivity, specificity and area under the curve. The new overall cut‐off score for normal function for the Dutch OQ‐45 is 56 and the new reliable change index is 18. Cut‐off scores for several therapeutic treatments are provided.
    October 26, 2015   doi: 10.1002/cpp.1979   open full text
  • Enhancing CBT for Chronic Insomnia: A Randomised Clinical Trial of Additive Components of Mindfulness or Cognitive Therapy.
    Mei Yin Wong, Melissa J. Ree, Christopher W. Lee.
    Clinical Psychology & Psychotherapy. October 26, 2015
    Although cognitive behavioural therapy (CBT) for insomnia has resulted in significant reductions in symptoms, most patients are not classified as good sleepers after treatment. The present study investigated whether additional sessions of cognitive therapy (CT) or mindfulness‐based therapy (MBT) could enhance CBT in 64 participants with primary insomnia. All participants were given four sessions of standard CBT as previous research had identified this number of sessions as an optimal balance between therapist guidance and patient independence. Participants were then allocated to further active treatment (four sessions of CT or MBT) or a no further treatment control. The additional treatments resulted in significant improvements beyond CBT on self‐report and objective measures of sleep and were well tolerated as evidenced by no dropouts from either treatment. The effect sizes for each of these additional treatments were large and clinically significant. The mean scores on the primary outcome measure, the Insomnia Severity Index, were 5.74 for CT and 6.69 for MBT, which are within the good‐sleeper range. Treatment effects were maintained at follow‐up. There were no significant differences between CT and MBT on any outcome measure. These results provide encouraging data on how to enhance CBT for treatment of insomnia. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message CBT treatments for insomnia can be enhanced using recent developments in cognitive therapy. CBT treatments for insomnia can be enhanced using mindfulness‐based treatments. Both cognitive therapy and mindfulness produce additional clinically significant change.
    October 26, 2015   doi: 10.1002/cpp.1980   open full text
  • The Experience of Caring For or Living with an Individual with an Eating Disorder: A Meta‐Synthesis of Qualitative Studies.
    John RE Fox, Madeleine Dean, Anna Whittlesea.
    Clinical Psychology & Psychotherapy. October 16, 2015
    Eating disorders (ED) has the highest mortality rate of psychiatric disorders and a high incidence of comorbidity. Because of the average age of onset, care typically befalls family members. However, despite the severity of the disorder and the burden placed on the family, research into the caregiving experience is still developing. Studies have shown caregivers of individuals with ED to experience high levels of distress, burden and expressed emotion. Recent theoretical models have underscored the importance of caregivers' responses as a maintenance factor for the ED, and family therapy has proved efficacious. However, the literature pertaining to the experience of family members living with or caring for an individual with an ED has not been systematically reviewed. This review aimed to synthesize qualitative studies relating to the caring experience and its impact, thereby gaining an understanding from the perspective of the individuals themselves. Relevant search terms were utilized to systematically search key databases. Twenty studies, with a total sample of 239 participants, met the inclusion criteria. Nine core themes emerged from the synthesis, forming the basis of an explanatory theory. The ED was found to have a pervasive impact upon family members, mediated by a number of factors. Cognitive appraisals affected the caregiving experience and responses to the individual. The experience of caregiving was continually reappraised leading to a process of adaptation. The majority of studies identified unmet carer needs. The implications of the findings are discussed with reference to existing theoretical models and in terms of clinical practice. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages Carers experience a significant amount of guilt and distress once they have found out about their loved one's eating disorder. Across the studies, there were many themes of unmet need for carers. Siblings have often been overlooked by both clinicians and researchers. Interventions for people with eating disorders should also acknowledge carers and close family members.
    October 16, 2015   doi: 10.1002/cpp.1984   open full text
  • Cognitive Therapy and Task Concentration Training Applied as Intensified Group Therapies for Social Anxiety Disorder with Fear of Blushing—A Randomized Controlled Trial.
    Samia Härtling, Jens Klotsche, Anke Heinrich, Jürgen Hoyer.
    Clinical Psychology & Psychotherapy. October 09, 2015
    The current study examines the efficacy of intensified group therapy for social anxiety disorder with fear of blushing. Task concentration training (TCT) and cognitive therapy (CT) were applied during one weekend and compared with a waiting list condition in a randomized controlled trial including 82 patients. On a second weekend, another intervention was added (resulting in TCT–CT and CT–TCT sequences) to examine order effects. Task concentration training and CT were both superior to the waiting list and equally effective after the first therapy weekend. Also, no differences were found between the sequences TCT–CT and CT–TCT at post‐assessment. At 6‐ and 12‐month follow‐up, effects remained stable or further improved. At the 6‐month follow‐up, remission rates in completers, established by diagnostic status, were between 69% and 73%. Intensified group therapy is highly effective in treating social anxiety disorder with fear of blushing. Group formats for patients sharing a common primary concern may contribute to the dissemination of cognitive–behavioural therapy. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message: This study focuses on blushing from fearful individuals within the SAD spectrum to improve evidence for treatment efficacy in those whose social fears are centred around observable bodily sensations. This study integrates task concentration training into the SAD model of Clark and Wells to combine two evidence‐based treatments for SAD under one treatment model. This study uses an innovative format of brief, intensified group therapy, conducted on two full‐day weekend group sessions delivered over two weekends, with strong observed effect sizes.
    October 09, 2015   doi: 10.1002/cpp.1975   open full text
  • Metacognitions and Mindful Attention Awareness in Depression: A Comparison Of Currently Depressed, Previously Depressed and Never Depressed Individuals.
    Stian Solem, Roger Hagen, Catharina E. A. Wang, Odin Hjemdal, Knut Waterloo, Martin Eisemann, Marianne Halvorsen.
    Clinical Psychology & Psychotherapy. October 09, 2015
    Abstract The primary aim of the study was to test (1) how metacognition relates to the concept of mindful attention awareness, and (2) whether metacognitions or mindful attention awareness best predicted symptoms of depression. Data was collected from three samples: currently depressed (n = 37), previously depressed (n = 81) and never depressed controls (n = 50). There was a moderate correlation between mindful attention awareness and three of five metacognitive subscales. Both mindful attention awareness and metacognition were significantly correlated with depression severity scores after controlling for anxiety. The depressed group had significantly more dysfunctional metacognitions and less mindful attention awareness than the never depressed group. Negative beliefs about worry and mindful attention awareness were also significantly different in the previously depressed group compared with the never depressed. This suggests that metacognitions and mindful attention awareness can be vulnerability factors for depression. The results also indicated that anxiety symptoms and negative beliefs about worry were the most important factors in predicting depression. In conclusion, the study shows that metacognitions and mindful attention awareness are two related but separate constructs and that metacognitions emerged as the best predictor of depression. These results provide support for the metacognitive model of emotional disorders. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Metacognitions and mindful attention awareness are related but separate constructs Both mindful attention awareness and metacognition are associated with depression Anxiety and negative beliefs about worry (metacognitions) are most important in predicting depression Addressing metacognitions in therapy should be considered in treatment of depression
    October 09, 2015   doi: 10.1002/cpp.1983   open full text
  • Evaluating the Responsiveness to Therapeutic Change with Routine Outcome Monitoring: A Comparison of the Symptom Questionnaire‐48 (SQ‐48) with the Brief Symptom Inventory (BSI) and the Outcome Questionnaire‐45 (OQ‐45).
    Ingrid V. E. Carlier, Viktória Kovács, Martijn S. Noorden, Christina Feltz‐Cornelis, Nanda Mooij, Yvonne W. M. Schulte‐van Maaren, Albert M. Hemert, Frans G. Zitman, Erik J. Giltay.
    Clinical Psychology & Psychotherapy. October 09, 2015
    Assessment of psychological distress is important, because it may help to monitor treatment effects and predict treatment outcomes. We previously developed the 48‐item Symptom Questionnaire (SQ‐48) as a public domain self‐report psychological distress instrument and showed good internal consistency as well as good convergent and divergent validity among clinical and non‐clinical samples. The present study, conducted among psychiatric outpatients in a routine clinical setting, describes additional psychometric properties of the SQ‐48. The primary focus is on responsiveness to therapeutic change, which to date has been rarely examined within psychiatry or clinical psychology. Since a questionnaire should also be stable when no clinically important change occurs, we also examined test–retest reliability within a test–retest design before treatment (n = 43). A pre‐treatment/post‐treatment design was used for responsiveness to therapeutic change, comparing the SQ‐48 with two internationally widely used instruments: the Brief Symptom Inventory (n = 97) and the Outcome Questionnaire‐45 (n = 109). The results showed that the SQ‐48 has excellent test–retest reliability and good responsiveness to therapeutic change, without significant differences between the questionnaires in terms of responsiveness. In sum, the SQ‐48 is a psychometrically sound public domain self‐report instrument that can be used for routine outcome monitoring, as a benchmark tool or for research purposes. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message The SQ‐48 is developed as a public domain self‐report questionnaire, in line with growing efforts to develop clinical instruments that are free of charge. The SQ‐48 has excellent test–retest reliability and good responsiveness to therapeutic change or patient progress. There were no significant differences in terms of responsiveness between the SQ‐48 and BSI or OQ‐45. The SQ‐48 can be used as a routine evaluation outcome measure for quality assurance in clinical practice. Providing feedback on patient progress via outcome measures could contribute to the enhancement of treatment outcomes.
    October 09, 2015   doi: 10.1002/cpp.1978   open full text
  • Love Yourself as a Person, Doubt Yourself as a Therapist?
    Helene A. Nissen‐Lie, Michael Helge Rønnestad, Per A. Høglend, Odd E. Havik, Ole Andrè Solbakken, Tore C. Stiles, Jon T. Monsen.
    Clinical Psychology & Psychotherapy. October 09, 2015
    Objective There are reasons to suggest that the therapist effect lies at the intersection between psychotherapists' professional and personal functioning. The current study investigated if and how the interplay between therapists' (n = 70) professional self‐reports (e.g., of their difficulties in practice in the form of ‘professional self‐doubt’ and coping strategies when faced with difficulties) and presumably more global, personal self‐concepts, not restricted to the professional treatment setting (i.e., the level of self‐affiliation measured by the Structural Analysis of Social Behaviour (SASB) Intrex, Benjamin, ), relate to patient (n = 255) outcome in public outpatient care. Method Multilevel growth curve analyses were performed on patient interpersonal and symptomatic distress rated at pre‐, post‐ and three times during follow‐up to examine whether change in patient outcome was influenced by the interaction between their therapists' level of ‘professional self‐doubt’ and self‐affiliation as well as between their therapists' use of coping when faced with difficulties, and the interaction between type of coping strategies and self‐affiliation. Results A significant interaction between therapist ‘professional self‐doubt’ (PSD) and self‐affiliation on change in interpersonal distress was observed. Therapists who reported higher PSD seemed to evoke more change if they also had a self‐affiliative introject. Therapists' use of coping strategies also affected therapeutic outcome, but therapists' self‐affiliation was not a moderator in the interplay between therapist coping and patient outcome. Conclusion A tentative take‐home message from this study could be: ‘Love yourself as a person, doubt yourself as a therapist’. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages The findings of this study suggest that the nature of therapists' self‐concepts as a person and as a therapist influences their patients' change in psychotherapy. These self‐concept states are presumably communicated through the therapists' in‐session behaviour. The study noted that a combination of self‐doubt as a therapist with a high degree of self‐affiliation as a person is particularly fruitful, while the combination of little professional self‐doubt and much positive self‐affiliation is not. This finding, reflected in the study title, ‘Love yourself as a person, doubt yourself as a therapist’, indicates that exaggerated self‐confidence does not create a healthy therapeutic attitude. Therapist way of coping with difficulties in practice seems to influence patient outcome. Constructive coping characterized by dealing actively with a clinical problem, in terms of exercising reflexive control, seeking consultation and problem‐solving together with the patient seems to help patients while coping by avoiding the problem, withdrawing from therapeutic engagement or acting out one's frustrations in the therapeutic relationship is associated with less patient change.
    October 09, 2015   doi: 10.1002/cpp.1977   open full text
  • A Cross‐Sectional Study of Psychological Comparison Processes That May Underlie the Acceptance of Chronic Pain.
    Harald Orfgen, Arie Dijkstra.
    Clinical Psychology & Psychotherapy. August 04, 2015
    Acceptance of chronic pain varies between patients but may also be expected to develop and change within patients. In this latter framework, the present study explored three psychological processes that may contribute to changes in acceptance: social comparisons, temporal comparisons and counterfactual comparisons. In general, these comparisons are used to cope with negative life events, and they may also play a role in acceptance of pain. In this study, the two subscales of the Chronic Pain Acceptance Questionnaire (Activity Engagement and Pain Willingness) were complemented with a scale of Affective Acceptance. Using linear regression analyses, data from these three acceptance scales were regressed on three scales of temporal comparison processes, four scales of social comparison processes and one scale of counterfactual comparisons. The results showed that the comparison processes explained up to 37% of the variance in acceptance, especially a higher frequency of thinking of one's present condition in relation to a condition in the past, and feeling bad when comparing with others who are doing better, were consistently related to lower acceptance. These explorative results may inspire experimental studies to influence comparison processes and, eventually, to address those comparison processes in interventions for patients with chronic pain to improve acceptance. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message In addition to beliefs indicating Activity Engagement and Pain Willingness, Affective acceptance of pain may also be a relevant dimension and manifestation of acceptance Social comparisons, temporal comparisons and counterfactual comparisons are related to acceptance of pain In patients with pain psychological comparison processes can be relevant in diagnosing possible causes of non‐optimal acceptance of chronic pain Practitioners may try to influence each of the three types of psychological comparison processes in individuals and observe the effects
    August 04, 2015   doi: 10.1002/cpp.1973   open full text
  • The Perception of Threat from Emotions in Predicting Binge Eating Behaviours in People Who Are Obese and Seeking Treatment for Their Weight.
    J. R. E. Fox, R. M. Msetfi, R. S. Johnson, E. Haigh.
    Clinical Psychology & Psychotherapy. August 03, 2015
    Objective The affect regulation theory suggests that people binge eat to regulate negative emotional states. In this study, we used a basic emotions perspective to consider the role of perceived threat of emotions, emotional suppression and reduced emotional expressiveness in predicting binge eating behaviours in people who are obese. Method Treatment‐seeking participants with obesity (N = 51, body mass index range from 30.8 to 60.2 kg m−2) completed measures of ‘perception of threat from emotion’ as well as ‘emotional expressiveness’ and binge eating. Results The results demonstrated that perceived threat of sadness predicted binge eating (β = .55, p < .05). Additionally, a mediation analysis revealed that reduced emotional expressiveness mediated the relationship between perceived threat of fear and binge eating (β = .25, 95%). Discussion These findings are contextualized within a theoretical perspective that suggests that individuals who binge eat are threatened by certain emotional states and they use binge eating to suppress certain, but not all, emotional states. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Considering basic emotions within binge eating should be a part of a psychological assessment and treatment. This should consider how emotions could often be perceived as being threatening and their expression is limited. It is possible that the emotions of fear and sadness appear to be particularly threatening within binge eating/obese populations.
    August 03, 2015   doi: 10.1002/cpp.1972   open full text
  • Different Perspectives of Clinicians and Patients with Severe Mental Illness on Motivation for Treatment.
    Eline C. Jochems, Arno Dam, Hugo J. Duivenvoorden, Sylvia C. M. Scheffer, Christina M. Feltz‐Cornelis, Niels L. Mulder.
    Clinical Psychology & Psychotherapy. July 22, 2015
    The present study assessed motivation for engaging in treatment as rated by clinicians (n = 57) and patients with severe mental illness (SMI, n = 294) using measures based on three different motivation theories. Questionnaires were derived from self‐determination theory, the transtheoretical model and the integral model of treatment motivation. It was investigated to which extent clinicians of patients with SMI were able to estimate their patient's perspective on motivation for engaging in treatment, to which extent they agreed on the patient's motivation and which factors were associated with estimation and agreement on treatment motivation. It was found that clinicians were poorly to moderately capable of estimating their patient's type of motivation and readiness for change. Further, agreement on the level of motivation between patients and clinicians was moderate. These findings were consistent across diagnostic groups (psychotic and personality disorders). A higher quality therapeutic relationship was generally associated with higher clinician‐rated motivation. The patient's ethnicity and socially desirable responding were factors that differentiated between scales of different motivation theories. It is concluded that patients with SMI and their clinicians have different perceptions on the patient's motivation for engaging in psychiatric treatment, regardless of the theoretical framework that is used to measure motivation. The findings imply that a negotiated approach is needed where both perceptions of clinicians and patients on motivation for treatment are considered to ensure effective mental health interventions. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Clinicians show poor to moderate capability in estimating how patients perceive their motivation for engaging in treatment, especially so when the patient's motives revolve around feelings of shame and guilt. Clinicians generally give higher motivation ratings for patients where they experience a higher quality therapeutic relationships with, whereas—depending on the scale that is used to measure motivation—they give lower ratings to patients who respond in socially desirable ways and to ethnic minority patients. As patients with SMI and their clinicians have different perceptions on the patient's motivation for engaging in psychiatric treatment (regardless of the theoretical framework that is used to assess motivation), this implies that a negotiated approach is needed where both perceptions of clinicians and patients on motivation for treatment are considered to ensure effective mental health interventions.
    July 22, 2015   doi: 10.1002/cpp.1971   open full text
  • Cognitive–Behavioural Therapy and Psychodynamic Psychotherapy in the Treatment of Combat‐Related Post‐Traumatic Stress Disorder: A Comparative Effectiveness Study.
    Ofir Levi, Yair Bar‐Haim, Yitshak Kreiss, Eyal Fruchter.
    Clinical Psychology & Psychotherapy. July 20, 2015
    This study compared the effectiveness of two psychotherapy approaches for treating combat veterans with chronic post‐traumatic stress disorder (PTSD): cognitive–behavioural therapy (CBT) and psychodynamic psychotherapy (PDT). These treatments are routinely used by the Unit for Treatment of Combat‐Related PTSD of the Israel Defense Forces (IDF). IDF veterans with chronic PTSD were assigned to either CBT (n = 148) or PDT (n = 95) based on the nature of their complaint and symptoms. Psychiatric status was assessed at baseline, post‐treatment and 8–12 months follow‐up using the Clinician‐Administered PTSD Scale, the PTSD Questionnaire, the Montgomery and Asberg Depression Rating Scale and the Psychotherapy Outcome Assessment and Monitoring System‐Trauma Version assessment questionnaire. Both treatment types resulted in significant reduction in symptoms and with improved functioning from pre‐treatment to post‐treatment, which were maintained at follow‐up. No differences between the two treatments were found in any the effectiveness measures. At post‐treatment, 35% of the CBT patients and 45% of the PDT patients remitted, with no difference between the groups. At follow‐up, remission rates were 33% and 36% for the CBT and PDT groups, respectively. The study recommends further randomized controlled trials to determine treatment efficacy. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Both cognitive‐behavioural therapy and psychodynamic psychotherapy have to be treatments offered in clinics for treating PTSD. Therapists who treat PTSD should be familiar with cognitive‐behavioural and dynamic methods. The type of treatment chosen should be based on thorough psychosocial assessment.
    July 20, 2015   doi: 10.1002/cpp.1969   open full text
  • The Effects of Bug‐in‐the‐Eye Supervision on Therapeutic Alliance and Therapist Competence in Cognitive‐Behavioural Therapy: A Randomized Controlled Trial.
    Florian Weck, Marion Jakob, Julia M. B. Neng, Volkmar Höfling, Florian Grikscheit, Martin Bohus.
    Clinical Psychology & Psychotherapy. July 14, 2015
    Live supervision enables a supervisor to have direct insight into the psychotherapeutic process and allows him or her to provide immediate feedback to the trainee. Therefore, live supervision might be superior to traditional supervisory formats that only allow for the provision of delayed feedback. When considering the different live supervision formats, bug‐in‐the‐eye (BITE) supervision is particularly promising because of its improved and less invasive procedure. The current study compared the efficacy of BITE supervision with that of delayed video‐based (DVB) supervision. In the present study, 23 therapists were randomly assigned to either the BITE supervision or DVB supervision groups. The participants were psychotherapy trainees who treated 42 patients (19 under BITE supervision and 23 under DVB supervision) over 25 sessions of cognitive‐behavioural therapy. Two independent raters blind to the treatment conditions evaluated therapeutic alliance and therapist competence based on 195 videotapes. Therapeutic alliance was significantly stronger among the treatments conducted under BITE supervision than those conducted under DVB supervision. Moreover, a higher level of therapeutic competence was found in the BITE condition than in the DVB condition. However, no differences between supervision conditions were found when the results were controlled for the level of therapeutic alliance and therapist competence demonstrated in the first session. No differences were observed between the supervision conditions with respect to patient outcomes. There is evidence that BITE supervision is able to improve therapeutic alliance and therapist competence. However, these findings should be interpreted with caution because possible pre‐treatment differences between therapists might explain the superiority of BITE supervision. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message BITE supervision positively influences the therapeutic alliance and therapeutic competencies during cognitive‐behavioural therapy. A supervision format that more directly addresses therapeutic processes is more effective in improving those processes than an indirect supervision format. Pre‐treatment differences between therapists might explain the superiority of BITE supervision. BITE supervision can be considered a safe intervention.
    July 14, 2015   doi: 10.1002/cpp.1968   open full text
  • Exploring Phase Progression Throughout the Therapeutic Process: The Case of Eva.
    Joana F. Ferreira, António B. Vasco, Michael Basseches, Andreia Santos, João M. Ferreira.
    Clinical Psychology & Psychotherapy. July 14, 2015
    This study intends to clarify how Eva [a good‐outcome case] developed a more differentiated and integrated sense of herself and her experience, and how the therapist facilitated this developmental process. It aims to deepen our understanding of the processes of change throughout the therapeutic process by analysing a longitudinal case study integrating a phase‐by‐phase map—the sequential phases of the Paradigmatic Complementarity Metamodel [PCM]—with a moment‐by‐moment tracking method—the Developmental Analysis of Psychotherapy Process [DAPP] Method. A team of three researchers analysed the sessions from the first year of therapy, identified phase transitions and consolidations, and discussed what in the process appears to have fostered them. The results suggest that Eva evolved in accordance with the sequence of phases proposed by the PCM, which we illustrate and explain with therapeutic interactions representative of Eva's development within the evolving therapeutic process. This case study is one of a series intended to contribute to the optimization of clinical decision making by identifying markers of phase progression and assessing the usefulness of the therapeutic interventions offered. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Integrating moment‐by‐moment and phase‐by‐phase guiding maps facilitates the understanding of therapeutic processes. Therapists' attunement and responsiveness to patients' assimilation capacities supports therapeutic progress. Being aware of both phase‐by‐phase and moment‐by‐moment movements in psychotherapy helps lead to better clinical decisions.
    July 14, 2015   doi: 10.1002/cpp.1970   open full text
  • Experiences of Detention under the Mental Health Act for Adults with Anorexia Nervosa.
    Tara Seed, John Fox, Katherine Berry.
    Clinical Psychology & Psychotherapy. June 29, 2015
    People with Anorexia Nervosa are often resistant to treatment and can be detained under the Mental Health Act. Detention can be distressing for some client groups; however, there is little research to explore how people with Anorexia Nervosa experience detention and how these experiences impact on recovery. This study utilized a qualitative methodology to develop a model for understanding how people perceive, experience and process detention under the Mental Health Act. Data from 12 participants was analysed using constructivist grounded theory. Four overarching categories conceptualize their experience over time: ‘the battle’, ‘the bubble’, ‘stepping out of the bubble’ and ‘the anorexic self’. Within each overarching category are further subordinate categories that represent the nuances of the data. The resultant model is discussed in relation to the literature, whilst recommendations have been made to embed person‐centred, recovery practice into inpatient services. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message People detained under the mental health act with anorexia nervosa often respond by engaging in a battle with clinicians. This follows by the person withdrawing into a ‘bubble’ where the individual starts to feel some relief that they are no longer in control of their eating, but this competes with the lack of self and the emerging anorexic self. Clinicians need to be aware that individuals detained may have mixed feelings about their hospital admission.
    June 29, 2015   doi: 10.1002/cpp.1963   open full text
  • Influence of Family and Childhood Memories in the Development and Manifestation of Paranoid Ideation.
    Célia Barreto Carvalho, Carolina Motta, José Pinto‐Gouveia, Ermelindo Peixoto.
    Clinical Psychology & Psychotherapy. June 22, 2015
    Several studies point out to the influence of social experiences on perceptions of the environment and others in cognitive functioning and different aspects of psychopathology. The current study aimed at studying the influence of the psychosocial risk factors in a mixed sample of participants from the general population and affected by paranoid schizophrenia. The extent to which the existence of negative life events and events that are threatening to the inner models of the self (i.e., history of maltreatment, physical, social or psychological abuse) or the memories of these traumatic events occurring during childhood are related to the existence of paranoid beliefs in adulthood was explored. Results suggested that memories of parental behaviours characterized by antipathy from both parental figures, submissiveness and bullying victimization were important predictors of paranoid ideation in adult life. This further emphasizes the need for understanding the family and social dynamics of people presenting paranoid ideations to the development of therapeutic interventions that can effectively reduce the invalidation caused by severe psychopathology, as is the case of schizophrenia. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Memories of family dynamics characterized by behaviours of antipathy from both parental figures, submissiveness and bullying victimization are important predictors of paranoid ideation in adult life. The study highlights the importance of exploring subjective recalls of feelings and behaviours associated with early rearing experiences, peer relationships and themes related to social rank theory in the roots of internal models of relationship with the self and others in the general sample, patients diagnosed with schizophrenia and their first‐degree relatives. Our findings indicate that schizophrenic patients in active phase differ regarding memories of threat and submission and are more likely to remember childhood experiences perceived as threatening during an active phase than when in remission. It is possible that by changing these internal models and social interaction styles, patients may be able to get involved in more cooperating and affiliative interactions, disconfirming these early beliefs about others being rejecting, critical or hostile towards the self, and more effectively reducing the invalidation caused by positive and negative symptomatology of schizophrenia on social functioning.
    June 22, 2015   doi: 10.1002/cpp.1965   open full text
  • Living with Mental Illness: A Cognitive Behavioural Group Psycho‐education Programme with Women in Secure Settings.
    C. G. Long, E. Banyard, O. Dolley.
    Clinical Psychology & Psychotherapy. June 19, 2015
    The provision of psycho‐educational groups for people diagnosed with schizophrenia is an important part of successful treatment. The value of such interventions is less clearly established in secure settings with no reports on women. Gender differences in the manifestation of schizophrenia highlight the importance of a gender‐specific intervention. A ‘Living with Mental Illness’ group programme for women in a secure psychiatric setting is described and evaluated. Those who completed group treatments (n = 20; 63%) showed improved knowledge of schizophrenia, decreased fear of schizophrenia, greater insight and increased optimism and perceived control of the illness. They also showed increased hope and greater self‐compassion. Pre–post group findings reflected improved ratings of compliance with drug treatments, appropriate behaviour and insight into risk. This was reflected in a decrease in risk behaviours, improved attendance at treatment sessions and a reduction in symptomatology. Group members also reported a positive group therapeutic alliance. Findings are discussed in the context of gender‐specific treatment, research, methodological issues characteristic of a real‐world evaluations and the need to assess the long‐term benefits of such treatment. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Psycho‐educational groups for secure inpatients with schizophrenia need to address gender‐specific differences in the manifestation of the condition. Such interventions as part of a broader treatment initiative can be associated with clinical improvement that is both illness specific and leads to improved engagement with care initiatives. The needs of patients who do not complete treatments needs to be regularly reassessed.
    June 19, 2015   doi: 10.1002/cpp.1967   open full text
  • Mindfulness‐Based Cognitive Therapy for Psychosis: Measuring Psychological Change Using Repertory Grids.
    Chloe Randal, Sandra Bucci, Tirma Morera, Moya Barrett, Daniel Pratt.
    Clinical Psychology & Psychotherapy. June 15, 2015
    There are an increasing, but limited, number of studies investigating the benefits of mindfulness interventions for people experiencing psychosis. To our knowledge, changes following mindfulness for psychosis have not yet been explored from a personal construct perspective. This study had two main aims: (i) to explore changes in the way a person construes their self, others and their experience of psychosis following a Mindfulness‐Based Cognitive Therapy (MBCT) group; and (ii) to replicate the findings of other studies exploring the feasibility and potential benefits of MBCT for psychosis. Sixteen participants, with experience of psychosis, completed an 8‐week MBCT group. Participants completed pre‐group and post‐group assessments including a repertory grid, in addition to a range of outcome measures. There was some evidence of changes in construing following MBCT, with changes in the way participants viewed their ideal self and recovered self, and an indication of increased self‐understanding. Improvements were found in participants' self‐reported ability to act with awareness and in recovery. This study demonstrates the feasibility and potential benefits of MBCT groups for people experiencing psychosis. Furthermore, it provides some evidence of changes in construal following MBCT that warrant further exploration. Large‐scale controlled trials of MBCT for psychosis are needed, as well as studies investigating the mechanisms of change. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message MBCT may contribute to change in individuals' perceptions and increase self‐understanding. The study highlights the importance of measuring change in recovery following MBCT. Findings support the need for person‐centred approaches to assessment and monitoring of personal change following therapy. Similar studies using a control group are needed in order to identify whether the changes found are attributable to participation in an MBCT group. Copyright © 2015 John Wiley & Sons, Ltd.
    June 15, 2015   doi: 10.1002/cpp.1966   open full text
  • Is Seeing Believing? The Process of Change During Cognitive–behavioural Therapy for Distressing Visual Hallucinations.
    Rea Wilson, Daniel Collerton, Mark Freeston, Thomas Christodoulides, Robert Dudley.
    Clinical Psychology & Psychotherapy. June 03, 2015
    People with psychosis often report distressing visual hallucinations (VH). In contrast to auditory hallucinations, there is little empirical evidence on effective interventions. The effectiveness of a novel‐focused cognitive–behavioural therapy (CBT) intervention for VH was explored using a multiple baseline single case design with four participants. Change to individual appraisals, emotional and behavioural responses to VH were measured with daily diaries kept throughout the baseline and intervention phase lasting up to 16 sessions. Maintenance of change was tracked during a follow‐up period of one month. Changes in appraisals, distress and response in accordance with the theory was evident in two out of four of the cases. However, change occurred within the baseline phase that limited the conclusions that change could be attributed to CBT alone. There was some evidence of clinically significant change and reliable change for two out of four of the cases at follow‐up on one of the standardized psychiatric assessments. The research reported here has theoretical and clinical implications for refinement of the model and interventions for distressing VH. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Distressing visual hallucinations (VH) are a relatively common symptom of psychosis. Visual hallucinations seem to be associated with greater impairment and disability. We have no specific treatment for VH. The appraisal of the visual experience and the behavioural response is important in maintaining the distress. Cognitive–behavioural therapy for VH at present has limited value.
    June 03, 2015   doi: 10.1002/cpp.1962   open full text
  • Comorbidity in Emetophobia (Specific Phobia of Vomiting).
    Mark Sykes, Mark J. Boschen, Elizabeth G. Conlon.
    Clinical Psychology & Psychotherapy. May 28, 2015
    Background Emetophobia (fear of vomiting) is an anxiety disorder in which individuals report clinical levels of fear that they may vomit or be exposed to the vomit of others. The prevalence of comorbidity of emetophobia with other conditions has previously only been investigated using self‐report instruments. Method Sixty‐four adults with emetophobia participated in an online structured clinical diagnostic interview assessing the presence of emetophobia and other conditions. Results Higher comorbidity for depression, generalized anxiety disorder, panic disorder, social anxiety disorder and obsessive–compulsive disorder were found in participants compared with general population norms. Conclusions Emetophobia is commonly comorbid with other anxiety and depressive disorders. Comorbidity rates, when assessed using a structured clinical interview, were lower than previously reported using self‐report alone. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Emetophobia (specific phobia of vomiting) is a clinical fear of vomiting. Individuals with emetophobia show high comorbidity with other anxiety and mood disorders. The most common comorbid conditions were generalized anxiety disorder, panic disorder, hypochondriasis and obsessive–compulsive disorder. Clinicians should ensure that they assess for the presence of comorbid conditions when treating emetophobia.
    May 28, 2015   doi: 10.1002/cpp.1964   open full text
  • Judgmental Biases of Individuals with a Fear of Blushing: The Role of Relatively Strict Social Norms.
    Corine Dijk, Peter J. Jong, Madelon L. Peters.
    Clinical Psychology & Psychotherapy. May 20, 2015
    Blushing‐fearful individuals often expect that others will judge them negatively. In two studies, we tested if this could be explained by having relatively strict beliefs about what is appropriate social behaviour. Study 1 used a student sample (n = 74), whereas study 2 compared a clinical treatment‐seeking sample of blushing‐fearful individuals (n = 33) with a non‐anxious control group (n = 31). In both studies, participants were asked to read descriptions of common behaviours that could be considered as breaching the prevailing social norms but not necessarily so. Participants indicated (i) to what extent they considered these behaviours as violating the prevailing norm and (ii) their expectation of observers' judgments. Study 1 showed that strict norms were indeed related to fear of blushing and that the tendency of fearful participants to expect negative judgments could at least partly explain this relationship. Study 2 showed that high‐fearful and low‐fearful individuals do indeed differ in the strictness of their norms and that especially the norms that individuals apply to themselves might be relevant. These findings may provide fresh clues for improving available treatment options. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages Blushing‐fearful individuals attribute relatively strict social norms to other people about which behaviours are appropriate and which are not and have stricter personal norms as well. Blushing‐fearful individuals' tendency to expect overly negative judgments in ambivalent social situations can partly be explained by their relatively strict social norms. Having relatively strict social norms may (also) explain why blushing-fearful individuals report to blush often and intensely. It may be worthwhile to address strict social norms in therapy for fear of blushing.
    May 20, 2015   doi: 10.1002/cpp.1958   open full text
  • Metacognition in First Episode Psychosis: Item Level Analysis of Associations with Symptoms and Engagement.
    Angus MacBeth, Andrew Gumley, Matthias Schwannauer, Antonino Carcione, Hamish J. McLeod, Giancarlo Dimaggio.
    Clinical Psychology & Psychotherapy. May 12, 2015
    Significant metacognitive impairments are observed in first episode psychosis (FEP) and chronic psychosis samples. There is evidence of associations between metacognition and presentation in FEP, but the relative contribution of metacognitive understanding of the self and the other is as yet unclear. The current study is a secondary analysis of date on metacognition, symptoms and engagement with treatment (help‐seeking) in an FEP sample. In a cross‐sectional cohort study, individuals in the first 12 months of treatment metacognition were assessed with the Metacognition Assessment Scale‐Revised version (MAS‐R). Psychotic symptomatology and help‐seeking within treatment (clinician‐rated service engagement) were also measured. An item level analysis of the MAS‐R was conducted exploring associations between symptoms and cognitive, emotional, differentiation, integration and decentration aspects of metacognition. We report that associations between negative symptoms and deficits in the understanding of other's mental states extend across cognitive, emotional, integrative and decentration aspects of metacognition. We also report associations between negative symptoms and understanding one's own mind. We also note that cognitive and decentration aspects of metacognition were significantly associated with help‐seeking once in treatment. Our findings suggest that an appreciation of metacognitive processes may inform treatment frameworks for FEP. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages Individual components of metacognition including the capacity to relate cognitive and emotional variables are important in first episode phychosis. Impaired metacognitive understanding of both one's own and others' mental states is associated with increased negative symptoms. Metacognitive variables may be important in understanding how different individuals seek help or engage with services after the initiation of treatment.
    May 12, 2015   doi: 10.1002/cpp.1959   open full text
  • Using the Repertory Grid Technique to Examine Trainee Clinical Psychologists' Construal of Their Personal and Professional Development.
    Katy Hill, Anja Wittkowski, Emma Hodgkinson, Richard Bell, Dougal J. Hare.
    Clinical Psychology & Psychotherapy. May 12, 2015
    The repertory grid technique was used to explore how 26 third‐year trainee clinical psychologists construed their personal and professional selves over the course of training and into the future. Each trainee completed a demographic questionnaire and a repertory grid with 10 elements: four ‘personal self’ elements, four ‘professional self’ elements and two ‘qualified clinical psychologist’ elements. They then rated the 10 elements on 10 bipolar constructs of their choosing. Trainees' personal and professional selves were construed to be similar to each other. Trainees had low self‐esteem and reported currently feeling anxious, stressed, unsettled and lacking an appropriate work–life balance. These difficulties were attributed to the demands of training and were expected to resolve once training was completed with future selves being construed as similar to ideal selves. Suggestions for future research with improved methodology are made, and the implications of the findings for trainees, training providers and employers of newly qualified clinical psychologists are given. The overall implication being that stress in training is normative and the profession has a duty to normalize this and ensure that self‐care and personal development are recognized as core competencies of the clinical psychologist for the benefit of its members and their clients. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Clinical psychology trainees experience training as demanding and stressful, which negatively impacts on their personal and professional self‐image and self‐esteem. However, they are optimistic that they will become more like their ideal self in the future. Stress in clinical training (and beyond) is normative, and thus, personal development and self‐care should be recognized as clinical psychologist's core competencies.
    May 12, 2015   doi: 10.1002/cpp.1961   open full text
  • Trainee Therapists' Experiences of Supervision During Training: A Meta‐synthesis.
    Hannah M. N. Wilson, Jenny S. Davies, Stephen Weatherhead.
    Clinical Psychology & Psychotherapy. April 28, 2015
    Purpose Supervision is typically mandatory for therapists in training and plays an important role in their professional development. A number of qualitative studies have considered specific aspects of supervision. This systematic review aimed to synthesize these studies' findings and explore the experience and impact of supervision for trainee therapists. Methods A systematic search of the literature was conducted, and inclusion/exclusion criteria were applied. This led to a sample of 15 qualitative studies, with which a meta‐synthesis was conducted. Results The meta‐synthesis led to four key concepts: supervision as a learning opportunity, the supervisory relationship, power in supervision and the impact of supervision. These themes explored helpful and unhelpful aspects of supervision, including some concerns regarding the evaluation of supervision. Conclusions Supervision can effectively support trainee therapists in their personal and professional development. However, it can also lead to feelings of distress and self‐doubt. Supervisors need to consider the power differential within supervision and attend to different factors within the supervisory relationship. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Supervision can encourage personal and professional development, but it can also have a detrimental impact on trainee therapists' well‐being, and consequently their clinical work and clients' experiences. Supervisees may not disclose unhelpful events or impacts from supervision, for fear of negative evaluation. Evaluation of supervisors should be facilitated and encouraged, to maintain good practice.
    April 28, 2015   doi: 10.1002/cpp.1957   open full text
  • Redefining Outcome Measurement: A Model for Brief Psychotherapy.
    Everett McGuinty, John Nelson, Alain Carlson, Eric Crowther, Dina Bednar, Mirisse Foroughe.
    Clinical Psychology & Psychotherapy. April 27, 2015
    Context The zeitgeist for short‐term psychotherapy efficacy has fundamentally shifted away from evidence‐based practices to include evidence‐informed practices, resulting in an equally important paradigm shift in outcome measurement designed to reflect change in this short‐term modality. Objective The present article delineates a short‐term psychotherapy structure which defines four fundamental stages that all brief therapies may have in common, and are represented through Cognitive Behavioral Therapy, Solution‐Focused Brief Therapy, Narrative Therapy, and Emotion‐Focused Therapy. Method These four theoretical approaches were analyzed via a selected literature review through comparing and contrasting specific and common tasks as they relate to the process of psychotherapy and change. Once commonalities were identified within session, they were categorized or grouped into themes or general stages of change within the parameters of a four to six session model of short‐term therapy. Commonalities in therapeutic stages of change may more accurately and uniformly measure outcome in short‐term work, unlike the symptom‐specific psychometric instruments of longer‐term psychotherapy. Results A systematic framework for evaluating the client and clinician adherence to 20 specific tasks for these four short‐term therapies is presented through the newly proposed, Brief Task Acquisition Scale (BTAS). It is further proposed that the client–clinicians' adherence to these tasks will track and ultimately increase treatment integrity. Conclusion Thus, when the client–clinician relationship tracks and evaluates the three pillars of (1) stage/process change, (2) task acquisition, and (3) treatment integrity, the culmination of these efforts presents a new way of more sensitively measuring outcome in short‐term psychotherapy. Data collection is suggested as a first step to empirically evaluate the testable hypotheses suggested within this current model. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message The clinician practitioner will note that the proposed Brief Services model removes the subjectivity of client satisfaction as a reliable outcome measure, and relies upon client and therapist adherence to specific tasks and stages of change within and across short‐term psychotherapy. The clinical significance of the BTAS for the practitioner is three fold. The psychometric instrument (1) tracks stage or process change, (2) guides task acquisition, and (3) incorporates greater treatment integrity unlike other outcome measures. The BTAS present a new way of conceptualizing change in short‐term psychotherapy regardless of modality or presenting issue, making it a more flexible and usable instrument for the clinician. The BTAS may measure outcome more sensitively and accurately, thus offering the client, therapist and client‐therapist more information regarding change at each stage and at the end of short‐term psychotherapy.
    April 27, 2015   doi: 10.1002/cpp.1953   open full text
  • Interpersonal Factors Are Associated with Lower Therapist Adherence in Cognitive–Behavioural Therapy for Panic Disorder.
    Hana F. Zickgraf, Dianne L. Chambless, Kevin S. McCarthy, Robert Gallop, Brian A. Sharpless, Barbara L. Milrod, Jacques P. Barber.
    Clinical Psychology & Psychotherapy. April 17, 2015
    Objective The contributions of disorder severity, comorbidity and interpersonal variables to therapists' adherence to a cognitive–behavioural treatment (CBT) manual were tested. Method Thirty‐eight patients received panic control therapy (PCT) for panic disorder. Trained observers watching videotapes of the sixth session of a 24‐session protocol rated therapists' adherence to PCT and their use of interventions from outside the CBT model. Different observers rated patients' behavioural resistance to therapy in the same session using the client resistance code. Interview measures obtained before treatment included the Panic Disorder Severity Scale, the anxiety disorders interview schedule for Diagnostic and Statistical Manual of Mental Disorders (DSM)‐IV and the structured clinical interview for DSM‐IV, Axis II. Questionnaire measures were the anxiety sensitivity index at intake, and, at session 2, the therapist and client versions of the working alliance inventory—short form. Results The higher the patients' resistance and the more Axis II traits a patient had, the less adherent the therapist. Moreover, the more resistant the client, the more therapists resorted to interventions from outside the CBT model. Stronger therapist and patient alliance was also generally related to better adherence, but these results were somewhat inconsistent across therapists. Pretreatment disorder severity and comorbidity were not related to adherence. Conclusions Interpersonal variables, particularly behavioural resistance to therapy, are related to therapists' ability to adhere to a treatment manual and to their use of interventions from outside of the CBT model. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner message Patients' behavioural resistance to therapy may make it more difficult for cognitive–behavioural clinicians to adhere to a structured treatment protocol and more likely for them to borrow interventions from outside the CBT model. Patients' Axis II traits may make adherence to treatment CBT protocol more difficult, although whether this is true varies across therapists. Therapists' adherence to a structured protocol and borrowing from outside of the CBT model do not appear to be affected by disorder severity or Axis I comorbidity.
    April 17, 2015   doi: 10.1002/cpp.1955   open full text
  • Expert Insight into the Assessment of Competence in Cognitive–Behavioural Therapy: A Qualitative Exploration of Experts' Experiences, Opinions and Recommendations.
    Kate Muse, Freda McManus.
    Clinical Psychology & Psychotherapy. April 10, 2015
    To offer insight into how cognitive–behavioural therapy (CBT) competence is defined, measured and evaluated and to highlight ways in which the assessment of CBT competence could be further improved, the current study utilizes a qualitative methodology to examine CBT experts' (N = 19) experiences of conceptualizing and assessing the competence of CBT therapists. Semi‐structured interviews were used to explore participants' experiences of assessing the competence of CBT therapists. Interview transcripts were then analysed using interpretative phenomenological analysis in order to identify commonalities and differences in the way CBT competence is evaluated. Four superordinate themes were identified: (i) what to assess, the complex and fuzzy concept of CBT competence; (ii) how to assess CBT competence, selecting from the toolbox of assessment methods; (iii) who is best placed to assess CBT competence, expertise and independence; and (iv) pitfalls, identifying and overcoming assessment biases. Priorities for future research and ways in which the assessment of CBT competence could be further improved are discussed in light of these findings. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message: A qualitative exploration of experts' experiences, opinions and recommendations for assessing the competence of CBT therapists. Semi‐structured interviews were conducted and analysed using interpretive phenomenological analysis. Themes identified shed light on (i) what to assess; (ii) how to assess; (iii) who is best placed to assess; and (iv) common pitfalls. Priorities for future research and ways in which the assessment of CBT competence could be further improved are discussed in light of these findings.
    April 10, 2015   doi: 10.1002/cpp.1952   open full text
  • Assertive Anger Mediates Effects of Dialectical Behaviour‐informed Skills Training for Borderline Personality Disorder: A Randomized Controlled Trial.
    Ueli Kramer, Antonio Pascual‐Leone, Laurent Berthoud, Yves Roten, Pierre Marquet, Stéphane Kolly, Jean‐Nicolas Despland, Dominique Page.
    Clinical Psychology & Psychotherapy. April 10, 2015
    Dialectical behaviour therapy (DBT)‐informed skills training for borderline personality disorder (BPD) aims at the development of specific emotion regulation skills in patients, particularly with regard to the regulation of problematic anger. While the effects of dialectical behaviour skills training have been shown, their processes of change are rarely examined. Neacsiu, Rizvi and Linehan (2010) found that patient's self‐reported use of emotion regulation skills was a mediator of therapeutic change in these treatments; however, they found no effect for problematic anger. From an integrative perspective on anger (Pascual‐Leone & Greenberg, 2007; Pascual‐Leone & Paivio, 2013), there are several forms of anger, varying in their degree of therapeutic productivity. The present add‐on randomized controlled trial included n = 41 patients with BPD (n = 21 DBT‐informed skills training versus n = 20 treatment as usual). The first study examined the outcome of the DBT‐informed skills training encompassing basic components of training in mindfulness, distress tolerance, interpersonal effectiveness and emotion regulation. Results showed that symptom reduction was significantly greater in the DBT‐informed skills training, compared with the treatment as usual. The second study used process assessment, for which all patient completers underwent a 50‐min‐long psychological interview both early and late in treatment, which was rated using the Classification of Affective Meaning States. DBT‐informed skills training produced increased levels of primary ‘assertive’ anger, as compared with the treatment as usual, whereas no effect was found for ‘rejecting’ secondary anger. Most importantly, we showed that changes in assertive anger mediated the reported symptom reduction, in particular in patient's social roles. We discuss these results in the context of underlying mechanisms of change in DBT skills group treatments, in particular towards developing more productive forms of anger in this patient population. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message A 20‐session dialectical behaviour therapy (DBT)‐informed skills training is a promising adjunct intervention for patients with borderline personality disorder, in particular for reducing problems related to social role. Increases in assertive anger mediate the effects of DBT‐informed skills training, whereas rejecting anger remains unchanged over the course of treatment. Short‐term objectives for intervention might involve the specific increase of assertive anger in BPD, by using DBT‐informed skills training; long‐term objectives for intervention might involve a specific decrease of rejecting anger in BPD.
    April 10, 2015   doi: 10.1002/cpp.1956   open full text
  • Comparing Methods to Denote Treatment Outcome in Clinical Research and Benchmarking Mental Health Care.
    Edwin Beurs, Marko Barendregt, Arco Heer, Erik Duijn, Bob Goeree, Margot Kloos, Kees Kooiman, Helen Lionarons, Andre Merks.
    Clinical Psychology & Psychotherapy. April 07, 2015
    Approaches based on continuous indicators (the size of the pre‐to‐post‐test change; effect size or ΔT) and on categorical indicators (Percentage Improvement and the Jacobson–Truax approach to Clinical Significance) are evaluated to determine which has the best methodological and statistical characteristics, and optimal performance, in comparing outcomes of treatment providers. Performance is compared in two datasets from providers using the Brief Symptom Inventory or the Outcome Questionnaire. Concordance of methods and their suitability to rank providers is assessed. Outcome indicators tend to converge and lead to a similar ranking of institutes within each dataset. Statistically and conceptually, continuous outcome indicators are superior to categorical outcomes as change scores have more statistical power and allow for a ranking of providers at first glance. However, the Jacobson–Truax approach can complement the change score approach as it presents outcome information in a clinically meaningful manner. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioners Messages When comparing various indicators or treatment outcome, statistical considerations designate continuous outcomes, such as the effect size of the pre–post change (effect size or ΔT) as the optimal choice. Expressing outcome in proportions of recovered, changed, unchanged or deteriorated patients has supplementary value, as it is more easily interpreted and appreciated by clinicians, managerial staff and, last but not the least, by patients. If categorical outcomes are used with small datasets, true differences in institutional performance may get obscured due to diminished power to detect differences. With sufficient data, outcome according to continuous and categorical indicators converge and lead to similar rankings of institutes' performance.
    April 07, 2015   doi: 10.1002/cpp.1954   open full text
  • The Relationship between Theoretical Orientation and Countertransference Expectations: Implications for Ethical Dilemmas and Risk Management.
    Robert M. Gordon, Francesco Gazzillo, Andrea Blake, Robert F. Bornstein, Janet Etzi, Vittorio Lingiardi, Nancy McWilliams, Cheryll Rothery, Anthony F. Tasso.
    Clinical Psychology & Psychotherapy. March 27, 2015
    Countertransference (CT) awareness is widely considered valuable for differential diagnosis and the proactive management of ethical dilemmas. We predicted that the more practitioners' theoretical orientation (TO) emphasizes insight into the dynamics of subjective mental life, the better they will be at using their CT expectations in differential diagnosis with high‐risk patients. To test this hypothesis, we compared psychodynamic therapy (PDT) practitioners who emphasize insight into subjective mental life with practitioners who do not emphasize this epistemology. Results indicated that PDT practitioners expected significantly more CT than practitioners of cognitive–behavioural therapy (CBT) and other practitioners (e.g., family systems, humanistic/existential and eclectic) to patients with borderline personality organization overall. PDT practitioners had significantly more CT expectations to patients with borderline‐level pathologies as compared with neurotic‐level patients than both CBT and other practitioners. PDT practitioners were significantly more expectant of CT issues than CBT practitioners with respect to the personality disorders most associated with acting out and risk management problems (e.g., paranoid, psychopathic, narcissistic, sadistic, sadomasochistic, masochistic, hypomanic, passive–aggressive, counterdependent and counterphobic). The other practitioners generally had CT expectations between PDT and CBT. These findings suggest that clinical training into CT may be useful in differential diagnoses and in helping to avoid ethical dilemmas regardless of one's theoretical preference. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Insight into countertransference can be used to help with differential diagnoses and to help prevent possible management problems with acting out patients. The Psychodynamic Diagnostic Manual is a useful taxonomy in that it includes countertransference as a diagnostic aid.
    March 27, 2015   doi: 10.1002/cpp.1951   open full text
  • Ambivalence in Narrative Therapy: A Comparison Between Recovered and Unchanged Cases.
    António P. Ribeiro, Miguel M. Gonçalves, Joana R. Silva, Andreia Brás, Ines Sousa.
    Clinical Psychology & Psychotherapy. March 25, 2015
    Research on the identification of poor outcome predictors is crucial for the prevention of therapeutic failure. Previous research suggests that clients' persistent ambivalence is one possible path to unsuccessful psychotherapy. The present study analyses ambivalence—here operationalized as return‐to‐the‐problem markers (RPMs)—in five recovered and five unchanged cases of narrative psychotherapy for major depression. The results suggest that both recovered and unchanged cases presented a similar proportion of RPMs at baseline and a decreasing pattern of these ambivalence markers throughout therapy. However, the decreasing was more accentuated in recovered than in unchanged cases, and at the end of the treatment, the proportion of RPMs of the unchanged cases was significantly higher. The results are discussed in light of previous research on ambivalence in psychotherapy, focusing on the meaning of ambivalence and its clinical implications. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Ambivalence towards change, here operationalized as RPMs, seems to be a common process in both recovered and unchanged cases, perhaps signalling the uncertainty and anxiety that change may elicit. Although the number of RPMs decreased in both the recovered and unchanged cases, this reduction was significantly higher in the recovered group. Moreover, at the end of therapy, the recovered group revealed a significantly lower proportion of RPMs than the unchanged group, suggesting that ambivalence resolution (or lack thereof) may play a determining role in the therapy's evolution and outcome. RPMs in later stages of therapy may be operationalized as ‘red flags’ for the therapist to acknowledge the client's stuckness and adapt his or her intervention efforts, turning these instances into developmental opportunities.
    March 25, 2015   doi: 10.1002/cpp.1945   open full text
  • Fear of Self and Unacceptable Thoughts in Obsessive–Compulsive Disorder.
    Gabriele Melli, Frederick Aardema, Richard Moulding.
    Clinical Psychology & Psychotherapy. March 16, 2015
    Cognitive‐behavioural models have linked unacceptable or repugnant thoughts in obsessive–compulsive disorder (OCD) with vulnerable self‐themes and fear‐of‐self concerns. To investigate this notion, Aardema and coworkers recently developed and validated the Fear of Self‐Questionnaire (FSQ) in non‐clinical samples, finding it had strong internal inconsistency, and good divergent and convergent validity, including strong relationships to obsessional symptoms and with other processes implicated in cognitive models of OCD (e.g., obsessive beliefs and inferential confusion). The current article describes two studies that aim to replicate and extend these findings in clinical OCD and non‐clinical samples. Study 1 investigated the psychometric properties of an Italian translation of the FSQ in a non‐clinical sample (n = 405). Results of confirmatory factor analysis supported the unidimensionality of the scale; the FSQ also showed very good internal consistency and temporal stability. Study 2 investigated the role of fear of self in OCD symptoms, and unacceptable thoughts and repugnant obsessions in particular, using a clinical OCD sample (n = 76). As expected, fear of self was a unique, major predictor of unacceptable thoughts independent of negative mood states and obsessive beliefs. Moreover, even when considered with obsessive beliefs, anxiety and depression, the feared self was the only unique predictor of obsessionality, providing support for the notion that self‐themes could explain why some intrusions convert into obsessions, whereas others do not. Implications for current cognitive‐behavioural models are discussed. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Unacceptable thoughts in OCD have been linked with vulnerable self‐themes and a fear of self. Aardema and coworkers recently developed and validated the Fear of Self‐Questionnaire (FSQ). Study 1 investigated the Psychometric properties of an Italian translation of the FSQ in a non‐clinical sample. Study 2 investigated the role of fear of self in unacceptable thoughts, using a clinical OCD sample. Fear of self was a unique, major predictor of unacceptable thoughts in OCD over and beyond obsessive beliefs.
    March 16, 2015   doi: 10.1002/cpp.1950   open full text
  • The German Version of the Behavioral Activation for Depression Scale (BADS): A Psychometric and Clinical Investigation.
    Tobias Teismann, Andrea Ertle, Nadine Furka, Ulrike Willutzki, Juergen Hoyer.
    Clinical Psychology & Psychotherapy. March 15, 2015
    The Behavioral Activation for Depression Scale (BADS) was developed to measure core concepts of behavioural activation for depression. A number of studies, mostly based on analogue samples, have provided initial support for the BADS. In the present study, we examined the psychometric properties of the German version of the scale more broadly, including change sensitivity and clinical treatment data. A mixed sample of students (N = 312) and depressed outpatients in partial remission undergoing cognitive‐behavioural group treatment for depressive rumination (N = 59) was examined. To analyze construct validity, a set of theoretically relevant constructs such as perseverative thinking, distraction and mindfulness was also assessed. Results indicated good psychometric properties, additional evidence for construct validity of the total scale and subscales, and adequate fit of the data to the original factor structure. Furthermore, the BADS proved to be sensitive to changes in participants undergoing treatment for depression. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Behavioural activation (BA) is an effective treatment for patients suffering from unipolar depression. The Behavioral Activation for Depression Scale (BADS) can be used to measure core elements of the BA treatment rationale. It is useful to track changes in activation within treatment. The BADS is available in different languages and has shown to possess good psychometric properties.
    March 15, 2015   doi: 10.1002/cpp.1948   open full text
  • Interpersonal Subtypes and Therapy Response in Patients Treated for Posttraumatic Stress Disorder.
    Julia König, Margarete Onnen, Regina Karl, Rita Rosner, Willi Butollo.
    Clinical Psychology & Psychotherapy. February 26, 2015
    Interpersonal traits may influence psychotherapy success. One way of conceptualizing such traits is the interpersonal circumplex model. In this study, we analyse interpersonal circumplex data, assessed with the Inventory of Interpersonal Problems (Horowitz, Strauß, & Kordy, 1994) from a randomized study with 138 patients suffering from posttraumatic stress disorder after trauma in adulthood. The study compared cognitive processing therapy and dialogical exposure therapy, a Gestalt‐based intervention. We divided the interpersonally heterogeneous sample according to the quadrants of the interpersonal circumplex. The division into quadrants yielded subgroups that did not differ in their general psychological distress, but the cold‐submissive quadrant tended to exhibit higher posttraumatic stress disorder symptom severity and interpersonal distress than the other three. There was also a trend for patients in different quadrants to be affected differently by the treatments. Correlation analyses supported these results: in cognitive processing therapy, more dominant patients had more successful therapies, while in dialogical exposure therapy, success was not correlated with interpersonal style. Results indicate that especially patients with cold interpersonal styles profited differentially from the two treatments offered. Dividing samples according to the interpersonal circumplex quadrants seems promising. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message: Interpersonal traits may contribute to psychotherapy outcome. Dividing the sample according to the quadrants of the interpersonal circumplex, as opposed to cluster analysis, yielded promising results. Patients higher in dominance fared better with cognitive processing therapy, while interpersonal style had no correlations with therapy success in dialogical exposure therapy.
    February 26, 2015   doi: 10.1002/cpp.1946   open full text
  • Measuring Subtypes of Emotion Regulation: From Broad Behavioural Skills to Idiosyncratic Meaning‐making.
    Antonio Pascual‐Leone, Nicole M. Gillespie, Emily S. Orr, Shawn J. Harrington.
    Clinical Psychology & Psychotherapy. February 20, 2015
    The current paper introduces the notion of clinically relevant subtypes of emotion regulation behaviours. A new measure of emotion regulation, the Complexity of Emotional Regulation Scale (CERS), was established as psychometrically sound. It was positively correlated with a measure of emotional awareness (r = 0.28, p < 0.001) and negatively correlated with measures of self‐criticism (r = −0.28, p < 0.001) and depression (r = −0.35, p = 0.025), among others. Participants were drawn from two samples: clients from a university counselling centre and a non‐clinical student sample. Comparisons were conducted between non‐clinical and clinical samples to determine the effects of depression and other symptoms of psychopathology on participant's generation of strategies for emotion regulation. Participants in the clinical sample more often identified an intention to soothe but did not follow through as compared with the non‐clinical group, F(1, 198) = 4.662, p < 0.04. Furthermore, individuals in the non‐clinical sample were more likely to engage in specific, meaning‐making strategies when compared with the clinical group, F(1, 198) = 5.875, p < 0.02. Implications from the current studies suggest the possible applicability of the CERS to clinical settings using an interview rather than questionnaire format. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message: Emotion regulation should be thought of as being on a continuum of complexity, where strategies range from general (‘one size fits all’) action to specific (‘personal and idiosyncratic’) meaning. The best emotion regulation strategy depends on a client's presenting difficulty and level of distress.
    February 20, 2015   doi: 10.1002/cpp.1947   open full text
  • Understanding Clinicians' Use of Cues When Assessing the Future Risk of Violence: A Clinical Judgement Analysis in the Psychiatric Setting.
    Barbara Brown, Tim Rakow.
    Clinical Psychology & Psychotherapy. February 04, 2015
    Research is sparse on how clinicians' judgement informs their violence risk assessments. Yet, determining preferences for which risk factors are used, and how they are weighted and combined, is important to understanding such assessments. This study investigated clinicians' use of static and dynamic cues when assessing risk in individual patients and for dynamic cues considered in the recent and distant past. Clinicians provided three violence risk assessments for 41 separate hypothetical cases of hospitalized patients, each defined by eight cues (e.g., psychopathy and past violence severity/frequency). A clinical judgement analysis, using regression analysis of judgements for multiple cases, created linear models reflecting the major influences on each individual clinician's judgement. Risk assessments could be successfully predicted by between one and four cues, and there was close agreement between different clinicians' models regarding which cues were relevant for a given assessment. However, which cues were used varied between assessments: history of recent violence predicted assessments of in‐hospital risk, whereas violence in the distant past predicted the assessed risk in the community. Crucially, several factors included in actuarial/structured risk assessment tools had little influence on clinicians' assessments. Our findings point to the adaptivity in clinicians' violence risk assessments, with a preference for relying on information consistent with the setting for which the assessment applies. The implication is that clinicians are open to using different structured assessment tools for different kinds of risk assessment, although they may seek greater flexibility in their assessments than some structured risk assessment tools afford (e.g., discounting static risk factors). Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Across three separate violence risk assessments, clinicians' risk assessments were more strongly influenced by dynamic cues that can vary over time (e.g., level of violence) than by static cues that are fixed for a given individual (e.g., a diagnosis of psychopathy). The variation in the factors affecting risk assessments for different settings (i.e., in hospital versus in the community) was greater than the variability between clinicians for such judgements. The findings imply a preference for risk assessment strategies that offer flexibility: either using different risk assessment tools for different purposes and settings or employing a single tool that allows for different inputs into the risk assessment depending upon the nature of the assessment. The appropriateness of these clinical intuitions about violence risk that are implied by our findings warrants further investigation.
    February 04, 2015   doi: 10.1002/cpp.1941   open full text
  • Client and Therapist Attachment Styles and Working Alliance.
    Sandra Bucci, Annily Seymour‐Hyde, Alison Harris, Katherine Berry.
    Clinical Psychology & Psychotherapy. February 02, 2015
    Working alliance has been shown to be important in influencing the outcome of therapy. Research evidence suggests that characteristics of both clients and therapists impact on the development of the working alliance. Although attachment theory is well researched, there is relatively limited research on the relationship between both therapist and client attachment style and the working alliance; traditionally, research has placed greater emphasis on client characteristics. The current study examines the extent to which both client and therapist self‐reported attachment styles are related to the working alliance. Thirty clients and 42 therapists were recruited from primary care psychology services. Thirty client–therapist dyads were examined. Participants completed self‐report measures of anxiety and depression, attachment style and working alliance at a single time point. Client and therapist attachment security were not independently related to working alliance. However, there was a significant association between therapist insecure attachment and alliance in more symptomatic clients. There was also some evidence that therapists and clients with oppositional attachment styles reported more favourable alliances. The study suggests that the relationship between therapist attachment style and alliance is not straightforward. It is likely that the complexity of clients' presenting problems, coupled with interaction between client–therapist attachment styles, influences the therapeutic alliance. Key Practitioner Message Therapist insecure attachment may negatively affect the therapeutic alliance in more symptomatic clients. It is important to consider the interaction between client and therapist attachment and how these interactions influence the therapeutic alliance. Therapists should be aware of their own personal attachment style and reflect on how this might manifest during the therapeutic process.
    February 02, 2015   doi: 10.1002/cpp.1944   open full text
  • A Qualitative Exploration of the Use of Attachment Theory in Adult Psychological Therapy.
    Eilish Burke, Adam Danquah, Katherine Berry.
    Clinical Psychology & Psychotherapy. January 19, 2015
    There is a growing interest into how attachment theory can inform psychotherapeutic practice with adults. This study aimed to explore how a group of therapists with an interest in attachment theory use it in their work with adult clients. A cross‐sectional qualitative design was adopted. Sampling, data collection and analysis procedures were guided by grounded theory principles. Semi‐structured telephone interviews were conducted with 12 therapists from a variety of training backgrounds. Data were coded and developed into thematic categories. Six primary themes were identified to describe how attachment theory influenced the clinical practice of the sample through the following: (i) complementing other therapeutic models; (ii) providing a framework to understand the development of clients' mental health problems; (iii) working with different attachment styles; (iv) thinking about the therapeutic relationship as an attachment relationship; (iv) influencing the different stages of the therapeutic process; and (vi) influencing clinical service design and delivery. It is concluded that attachment theory can play a significant role in influencing the practice of therapists and can be usefully adopted to complement therapeutic processes irrespective of the therapist's dominant clinical orientation. Further research is needed to explore the views of clinicians from different theoretical orientations and to investigate the security of the client–therapist attachment within the context of therapeutic change processes. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Attachment theory may have implications for practice across a range of different types of therapy and may help therapists to bridge apparent differences between modality‐specific formulation and techniques. Attachment theory can be used to understand the development of mental health problems. Therapists should assess and formulate clients' attachment styles, and these formulations should guide therapeutic approaches. Attachment theory provides a comprehensive framework for facilitating the therapist's attentiveness to relational issues and use of the therapeutic relationship as a fulcrum for change. The principles of attachment theory can be used to inform all stages of the therapeutic process, as well as the design and delivery of mental health services.
    January 19, 2015   doi: 10.1002/cpp.1943   open full text
  • Exploring Outcomes Related to Anxiety and Depression in Completers of a Randomized Controlled Trial of Complicated Grief Treatment.
    Kim Glickman, M. Katherine Shear, Melanie Wall.
    Clinical Psychology & Psychotherapy. December 22, 2014
    The present study examines a more fine‐grained analysis of anxiety‐related and depression‐related outcomes amongst a sample of treatment completers who were assigned to complicated grief treatment (CGT) (n = 35) or interpersonal psychotherapy (IPT) (n = 34) in a previously reported randomized controlled trial. We examined effects of antidepressant use and measures of anxiety and depression, focusing especially on guilt related to the death or deceased and grief‐related avoidance in order to further understand the differential effectiveness of CGT and IPT amongst participants who received the full course of treatment. Analyses showed that CGT produced greater reductions in anxiety and depressive symptoms including negative thoughts about the future and grief‐related avoidance. CGT's advantage over IPT in lowering depression was most pronounced amongst those not taking antidepressants. Our results further elucidate CGT effects and support the idea that CG and major depressive disorder are distinct conditions. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Targeted treatment for complicated grief (CG) produces benefits in associated mood and anxiety symptoms and CG symptoms. Amongst patients with CG, interpersonal psychotherapy seems relatively ineffective in ameliorating depressive symptoms. Grief‐related depressive symptoms may not respond to standard treatments unless CG symptoms are also addressed. Reducing grief‐related symptoms, such as anxieties about the future, guilt related to the death or deceased and avoidance of reminders of the loss may be important aspects in reducing CG.
    December 22, 2014   doi: 10.1002/cpp.1940   open full text
  • Effects of Mood Induction on the Pain Responses in Patients with Migraine and the Role of Pain Catastrophizing.
    Zahra Goli, Ali Asghari, Alireza Moradi.
    Clinical Psychology & Psychotherapy. December 19, 2014
    Migraine has close associations with depression and anxiety. Catastrophizing, an alarmist reaction to pain, has been proposed as one of the mediators in the relationship between headache and emotional distress. However, much experimental evidence is needed to make such a view more validated. The aims of this study are to examine the effects of mood induction on the pain responses and to investigate the role of pain catastrophizing in the relationship between pain and mood amongst a sample of patients with migraine. For this purpose, 60 patients with migraine were recruited from a headache clinic in Tehran‐Iran and were randomly assigned into one of three groups: negative mood induced group, positive mood induced group and control group. The following instruments and measures were used in this study: mood induction by presenting different types of films (positive, negative), a computerized cognitive task to elicit pain, Beck Depression Inventory and Pain Catastrophizing Scale. The results showed that while the induction of depressed mood increased the pain intensity, the induction of positive mood reduced it significantly (p < 0.05). Further analyses revealed that catastrophizing is as a confounding factor in the relationship between pain and mood. Once catastrophizing scores were entered into the analyses as a covariate, the significant effect of mood on the pain intensity reduced. In conclusion, both mood and catastrophizing are important factors in understanding the migraine pain. Clinical implications of these findings are discussed in the paper. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Pain‐related catastrophizing and mood induction are important factors in understanding pain intensity amongst patients with migraine pain.Catastrophizing as a confounding factor in the relationship between pain and mood may partially mediate the relationship between mood and pain.Therapeutic interventions should focus on the reduction of depression and catastrophizing.
    December 19, 2014   doi: 10.1002/cpp.1939   open full text
  • Baseline Patient Characteristics Predicting Outcome and Attrition in Cognitive Therapy for Social Phobia: Results from a Large Multicentre Trial.
    Juergen Hoyer, Joerg Wiltink, Wolfgang Hiller, Robert Miller, Simone Salzer, Stephan Sarnowsky, Ulrich Stangier, Bernhard Strauss, Ulrike Willutzki, Eric Leibing.
    Clinical Psychology & Psychotherapy. December 11, 2014
    We examined the role of baseline patient characteristics as predictors of outcome (end‐state functioning, response and remission) and attrition for cognitive therapy (CT) in social anxiety disorder (SAD). Beyond socio‐demographic and clinical variables such as symptom severity and comorbidity status, previously neglected patient characteristics (e.g., personality, self‐esteem, shame, interpersonal problems and attachment style) were analysed. Method Data came from the CT arm of a multicentre RCT with n = 244 patients having DSM‐IV SAD. CT was conducted according to the manual by Clark and Wells. Severity of SAD was assessed at baseline and end of treatment with the Liebowitz Social Anxiety Scale (LSAS). Multiple linear regression analyses and logistic regression analyses were applied. Results Up to 37% of the post‐treatment variance (LSAS) could be explained by all pre‐treatment variables combined. Symptom severity (baseline LSAS) was consistently negatively associated with end‐state functioning and remission, but not with response. Number of comorbid diagnoses was negatively associated with end‐state functioning and response, but not with remission. Self‐esteem was positively associated with higher end‐state functioning and more shame with better response. Attrition could not be significantly predicted. Conclusions The results indicate that the initial probability for treatment success mainly depends on severity of disorder and comorbid conditions while other psychological variables are of minor importance, at least on a nomothetic level. This stands in contrast with efforts to arrive at an empirical‐based foundation for differential indication and argues to search for more potent moderators of therapeutic change rather on the process level. Key Practitioner Message Personality, self‐esteem, shame, attachment style and interpersonal problems do not or only marginally moderate the effects of interventions in CT of social phobia.Symptom severity and comorbid diagnoses might affect treatment outcome negatively.Beyond these two factors, most patients share a similar likelihood of treatment success when treated according to the manual by Clark and Wells. Copyright © 2014 John Wiley & Sons, Ltd.
    December 11, 2014   doi: 10.1002/cpp.1936   open full text
  • Development and Validation of a Short Version of the Supervisory Relationship Questionnaire.
    Tom Cliffe, Helen Beinart, Myra Cooper.
    Clinical Psychology & Psychotherapy. December 11, 2014
    The Supervisory Relationship Questionnaire (SRQ) is one of the few theoretically sound and psychometrically valid questionnaires for measuring the SR within clinical supervision. However, its length can make it difficult to use in clinical practice and research. This study aimed to produce a shorter version of the SRQ (the Short Supervisory Relationship Questionnaire: S‐SRQ) that retained its reliability and psychometric validity. The SRQ's 67 items were initially reduced using the criteria of external, internal and face validity. Two hundred and three UK trainee clinical psychologists then completed a series of online questionnaires including the S‐SRQ and other clinical supervision measures. A Principal Component Analysis identified three components of the S‐SRQ: ‘safe base’, ‘reflective education’ and ‘structure’, and an 18‐item version was produced. Analyses revealed that the S‐SRQ has high internal reliability, adequate test–retest reliability and good convergent, divergent and predictive validity. Participants also rated the S‐SRQ as easy to use and potentially helpful for providing feedback on the SR in supervision. The S‐SRQ (three subscales, 18 items) is a valid and reliable measure of the SR from the supervisee perspective. The current findings also support aspects of existing models of the SR. The S‐SRQ is a promising measure for use in clinical, training and research settings. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message The Short Supervisory Relationship Questionnaire (S‐SRQ) is a psychometrically reliable and valid 18‐item measure of the supervisory relationship based on the SRQ.Clinically, the measure represents a quick and accessible means for supervisees to assess the quality of their supervisory relationship and discuss this with their supervisors.It can also be used in conjunction with the supervisor‐completed Supervisory Relationship Measure to support a dyadic discussion about clinical supervision and the supervisory relationship.
    December 11, 2014   doi: 10.1002/cpp.1935   open full text
  • The Role of Therapist Attachment in Alliance and Outcome: A Systematic Literature Review.
    Amy Degnan, Annily Seymour‐Hyde, Alison Harris, Katherine Berry.
    Clinical Psychology & Psychotherapy. December 02, 2014
    Objectives This review examined the impact of therapist attachment style on therapeutic alliance and outcomes. Methods Systematic search procedures yielded 11 studies for inclusion that measured associations between therapist attachment style and alliance and/or outcome. Results There is some preliminary evidence that therapist attachment style and interactions between therapist and client attachment style contribute to alliance and therapy outcomes. However, methodological weaknesses and heterogeneity across studies highlight the need for more rigorously designed research in this area. Conclusions There is sufficient evidence to suggest that therapists need to pay attention to the influence of their own attachment style in therapeutic processes and that there is merit in pursing this area of research further. The review is important in highlighting key design issues to consider in future studies. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Therapist attachment style has the potential to influence therapeutic alliance and client outcome.Improvements in therapeutic practice might be achieved if therapists have greater knowledge of their own attachment styles and how these interact with their clients' attachment styles to influence the psychotherapy relationship and outcomes.From the outset of their careers, therapists should receive training and supervision to enhance the awareness of their individual attachment experiences and how these play out during the therapeutic process.
    December 02, 2014   doi: 10.1002/cpp.1937   open full text
  • Cognitive and Guided Mastery Therapies for Panic Disorder with Agoraphobia: 18‐Year Long‐Term Outcome and Predictors of Long‐Term Change.
    Asle Hoffart, Liv M. Hedley, Karol Svanøe, Harold Sexton.
    Clinical Psychology & Psychotherapy. December 01, 2014
    In this study, we wished to compare the long‐term outcome of (medication‐free) panic disorder with agoraphobia patients randomized to cognitive or guided mastery therapy. Thirty‐one (67.4%) of 46 patients who had completed treatment were followed up about 18 years after end of treatment. In the combined sample and using intent‐to‐follow‐up analyses, there were large within‐group effect sizes of −1.79 and −1.63 on the primary interview‐based and self‐report outcome measures of avoidance of situations when alone, and 56.5% no longer had a panic disorder and/or agoraphobia diagnosis. No outcome differences between the two treatments emerged. Guided mastery was associated with greater beneficial changes in catastrophic beliefs and self‐efficacy. For two of five outcome measures, more reduction in panic‐related beliefs about physical and mental catastrophes from pre‐ to post‐treatment predicted lower level of anxiety from post‐treatment to 18‐year follow‐up when the effect of treatment changes in (a) self‐efficacy and (b) anxiety was controlled. However, for one of the outcome measures, this effect attenuated with time. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message The results suggest that the very‐long‐term outcome of both cognitive therapy and guided mastery therapy for agoraphobia is positive.The results support the role of catastrophic beliefs as mediator of change.The pattern of results suggests that learning processes other than catastrophic beliefs may be important for long‐term outcome as well.
    December 01, 2014   doi: 10.1002/cpp.1934   open full text
  • Perceived Parental Bonding, Early Maladaptive Schemas and Outcome in Schema Therapy of Cluster C Personality Problems.
    Synve Hoffart Lunding, Asle Hoffart.
    Clinical Psychology & Psychotherapy. November 25, 2014
    Objective The objective of this paper was to examine the relationships between perceived parental bonding, Early Maladaptive Schemas (Young et al., 2003), and outcome of schema therapy of Cluster C personality problems and whether the perceptions of parental bonding could be influenced by schema therapy. Method The sample consisted of 45 patients with panic disorder and/or agoraphobia and Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Cluster C personality traits who participated in an 11‐week inpatient programme consisting of two phases; the first was a 5‐week panic/agoraphobia‐focused cognitive therapy, whereas the second phase was a personality‐focused schema therapy. The patients were assessed at pre‐treatment, mid‐treatment and post‐treatment and at 1‐year follow‐up. Results Opposite to our hypothesis, lower paternal care at pre‐treatment was related to more reduction in Cluster C personality traits from pre‐treatment to 1‐year follow‐up. Maternal protection was related to the schema domains of impaired autonomy and exaggerated standards. Overall schema severity and the schema emotional inhibition at pre‐treatment were associated with less change in Cluster C traits. Perceived maternal care was reduced from pre‐treatment to 1‐year follow‐up, and more reduction in maternal care was related to less reduction in Cluster C traits. Discussion Parental bonding failed to predict treatment outcome in the expected direction, but maternal protection was related to two of the schema domains. Overall schema severity and the particular schema emotional inhibition predicted outcome. Furthermore, perceived maternal care was reduced from before to after treatment. Future studies should examine these questions in larger samples of Cluster C patients receiving schema therapy of a longer duration. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Most schemas within the impaired autonomy domain and the schema self‐sacrifice seem to be related to low perceived maternal protection. Overall schema severity and the schema emotional inhibition predict a poorer outcome of schema therapy of Cluster C personality problems, and therapy should give priority to emotional inhibition when this schema is endorsed. Therapists should be aware that schema therapy carries the risk to lead to a more negative view of mother's care during upbringing and this risk is accentuated with less benefit of therapy.
    November 25, 2014   doi: 10.1002/cpp.1938   open full text
  • Emotion‐Focused Family Therapy for Eating Disorders Across the Lifespan: A Pilot Study of a 2‐Day Transdiagnostic Intervention for Parents.
    Adèle Lafrance Robinson, Joanne Dolhanty, Amanda Stillar, Katherine Henderson, Shari Mayman.
    Clinical Psychology & Psychotherapy. November 23, 2014
    Emotion‐focused family therapy is a transdiagnostic approach that affords parents and caregivers a significant role in their loved one's recovery from an eating disorder. A 2‐day intervention was developed on the basis of emotion‐focused family therapy principles and delivered to 33 parents of adolescent and adult children. Data were collected pre‐ and post‐intervention. Through education and skills practice, parents were taught strategies with respect to meal support and symptom interruption as well as emotion coaching. Parents were also supported to identify and work through their own emotional blocks that could interfere with their supportive efforts. Analyses revealed a significant increase in parental self‐efficacy, a positive shift in parents' attitudes regarding their role as emotion coach and a reduction in the fears associated with their involvement in treatment, including a decrease in self‐blame. Overall, this broad‐based, low‐cost intervention shows promise, and future research is warranted. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message A low‐cost, intensive emotion‐focused family therapy intervention shows promise for parents of individuals with an eating disorder, regardless of their loved one's age, symptom profile or involvement in treatment.Working with parents' emotions and emotional reactions to their child's struggles has the potential to improve supportive efforts.An emotion‐focused family therapy intervention for parents yields high satisfaction rates, improves parental self‐efficacy and reduces fears regarding their involvement, including self‐blame.
    November 23, 2014   doi: 10.1002/cpp.1933   open full text
  • Testing the Mediating Effects of Obsessive Beliefs in Internet‐Based Cognitive Behaviour Therapy for Obsessive‐Compulsive Disorder: Results from a Randomized Controlled Trial.
    Erik Andersson, Brjánn Ljótsson, Erik Hedman, Hugo Hesser, Jesper Enander, Viktor Kaldo, Gerhard Andersson, Nils Lindefors, Christian Rück.
    Clinical Psychology & Psychotherapy. November 23, 2014
    Although cognitive interventions for obsessive–compulsive disorder (OCD) have been tested in randomized trials, there are few trials that have tested the specific mechanisms of cognitive interventions, i.e. how they achieve their effects. In this study, we aimed to investigate the mediating effects of a short cognitive intervention in the treatment of OCD and used data from a recently conducted randomized controlled trial where 101 participants were allocated to either Internet‐based CBT (ICBT) or to a control condition. Obsessive beliefs were measured at pre‐treatment, at the time they had received the cognitive intervention, and also at post‐treatment. Weekly OCD symptoms were measured throughout the 10 weeks of treatment. We hypothesized that (1) the ICBT group would have greater reductions in obsessive beliefs (controlling for change in OCD symptoms) after completing the cognitive intervention, and that (2) this reduction would, in turn, predict greater OCD symptom reduction throughout the rest of the treatment period. Contrary to our expectations, the longitudinal mediation analysis indicated that (1) being randomized to ICBT actually increased the degree of obsessive beliefs after receiving the cognitive intervention at weeks 1–3, and (2) increase in obsessive beliefs predicted better outcome later in treatment. However, when repeating the analysis using cross‐sectional data at post‐treatment, the results were in line with the initial hypotheses. Results were replicated when the control condition received ICBT. We conclude that, although obsessive beliefs were significantly reduced at post‐treatment for the ICBT group, early increase rather than decrease in obsessive beliefs predicted favourable outcome. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message This study investigated the impact of cognitive interventions on obsessive beliefs for patients with obsessive–compulsive disorder.Results showed that a sudden increase in obsessive beliefs is not an indicator of worse treatment response. On the contrary, it is more likely that the patient is better off when having this sudden increase.Clinicians should not be alarmed if the patient has a sudden increase in obsessive beliefs, but we do recommend the clinician to investigate the reasons for this further.
    November 23, 2014   doi: 10.1002/cpp.1931   open full text
  • The Rate and Shape of Change in Binge Eating Episodes and Weight: An Effectiveness Trial of Emotionally Focused Group Therapy for Binge‐Eating Disorder.
    Angelo Compare, Giorgio A. Tasca.
    Clinical Psychology & Psychotherapy. November 21, 2014
    Objective This study investigated the phases of change and the relationship between binge eating (BE) episodes and weight across 20 weeks of emotionally focused group therapy (EFGT) and combined therapy (CT) of EFGT plus dietary counselling for BE disorder. Methods We used a non‐randomized observational study design that included 118 obese adult patients with BE disorder who were treated by manualized therapy protocols. Participants were assigned to treatment condition (EFGT or CT) based on consensus among clinicians. Participants were assessed weekly during the 20 weeks of therapy for weight and BE episodes and at pre‐treatment and 6 months post‐treatment. Results Binge eating episodes and weight significantly declined during EFGT and CT. Compared with EFGT, CT resulted in more rapid weight loss across weeks of therapy. BE episodes and weight significantly covaried, and their positive association increased as sessions progressed. Change in BE episodes and weight during treatment was best modelled by a cubic growth curve showing a slow rate of change in early sessions, a faster rate of change in middle sessions and a slower rate of change in late sessions. This cubic modelling of change was associated with better outcomes 6 months post‐treatment. Conclusion Cubic modelling of change supported a three‐stage model of EFGT and CT, and the cubic trajectory was associated with better outcomes at follow‐up. The addition of dietary counselling to EFGT resulted in earlier response to treatment in terms of BE episodes and weight among those in the CT condition. Key Practitioner Message Decline in binge eating (BE) episodes is related to decline in weight, and this relationship was greater towards the end of treatment.Emotionally focused group therapy plus dietary counselling that targets both affect regulation and nutritional problems resulted in faster rate of response early in treatment both in terms of BE episodes and weight.Combined emotionally focused group therapy and dietary counselling may provide clinicians with an additional approach to treating BE disorder. Copyright © 2014 John Wiley & Sons, Ltd.
    November 21, 2014   doi: 10.1002/cpp.1932   open full text
  • Crossing the Boundaries of Privacy in Accidental Encounters: Interpretative Phenomenological Analysis of Therapists' Experiences.
    Igor J. Pietkiewicz, Monika Włodarczyk.
    Clinical Psychology & Psychotherapy. October 30, 2014
    This qualitative study explores psychodynamic therapists' experiences associated with unexpected encounters with their patients outside the clinical setting. Information was collected using a semi‐structured interview protocol from 10 experienced practitioners in Poland and examined according to the interpretative phenomenological analysis principles. Four overarching themes are discussed in the paper. Results show that accidental encounters often challenged practitioners' privacy, led to involuntary self‐disclosure (causing discomfort and distress) and required re‐negotiating roles and boundaries in the new context. Various coping strategies were also identified and analysed, including withdrawal, anticipation and avoidance, as well as using community support. Findings are discussed in terms of their implications for mental health professionals and psychotherapy training. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message All people manage their boundaries of privacy. Therapists should thoroughly consider circumstances, and personal or situational risk factors, which lead to crossing or violating these boundaries. They need to reflect upon the social and personal limitations associated with their occupation and the price they have to pay for the high status role.
    October 30, 2014   doi: 10.1002/cpp.1930   open full text
  • Effectiveness of Day Hospital Mentalization‐Based Treatment for Patients with Severe Borderline Personality Disorder: A Matched Control Study.
    Dawn L. Bales, Reinier Timman, Helene Andrea, Jan J. V. Busschbach, Roel Verheul, Jan H. Kamphuis.
    Clinical Psychology & Psychotherapy. July 24, 2014
    The present study extends the body of evidence regarding the effectiveness of day hospital Mentalization‐Based Treatment (MBT) by documenting the treatment outcome of a highly inclusive group of severe borderline personality disorder (BPD) patients, benchmarked by a carefully matched group who received other specialized psychotherapeutic treatments (OPT). Structured diagnostic interviews were conducted to assess diagnostic status at baseline. Baseline, 18‐month treatment outcome and 36‐month treatment outcome (after the maintenance phase) on psychiatric symptoms (Brief Symptom Inventory) and personality functioning (118‐item Severity Indices of Personality Problems) were available for 29 BPD patients assigned to MBT, and an initial set of 175 BPD patients assigned to OPT. Propensity scores were used to determine the best matches for the MBT patients within the larger OPT group, yielding 29 MBT and 29 OPT patients for direct comparison. Treatment outcome was analysed using multilevel modelling. Pre to post effect sizes were consistently (very) large for MBT, with a Cohen's d of −1.06 and −1.42 for 18 and 36 months, respectively, for the reduction in psychiatric symptoms, and ds ranging from 0.81 to 2.08 for improvement in domains of personality functioning. OPT also yielded improvement across domains but generally of moderate magnitude. In conclusion, the present matched control study, executed by an independent research institute outside the UK, demonstrated the effectiveness of day hospital MBT in a highly inclusive and severe group of BPD patients, beyond the benchmark provided by a mix of specialized psychotherapy programmes. Interpretation of the (large) between condition effects warrants cautionary caveats given the non‐randomized design, as well as variation in treatment dosages. Copyright © 2014 John Wiley & Sons, Ltd.
    July 24, 2014   doi: 10.1002/cpp.1914   open full text
  • Psychological Well‐Being and Anticipated Positive Personal Events: Their Relationship to Depression.
    Olivia. J. H. Edmondson, Andrew K. MacLeod.
    Clinical Psychology & Psychotherapy. July 07, 2014
    Well‐being is now defined in a number of multicomponent ways. One approach to defining well‐being—psychological well‐being (PWB; Ryff, )—encompasses six dimensions of positive functioning. This study's first aim was to compare PWB self‐report scores from a group of depressed participants (N = 26) with a non‐depressed group (N = 26). The second aim was to examine anticipated well‐being, specifically, how the positive events people anticipate in the future are seen as being related to various aspects of their well‐being. Participants completed the self‐report scales of PWB and a task which elicited events participants were looking forward to in the future and their thoughts about what was good about those events. Responses about the value of the events were independently coded for the presence of the six PWB dimensions. The depressed group scored significantly lower on all dimensions of self‐reported PWB than the control group, with particularly marked deficits on environmental mastery and self‐acceptance. For anticipated events, positive relations with others was the most commonly present aspect of PWB in participants' responses about what was good about the events. The frequency of PWB dimensions present in participants' responses was similar between the two groups with the exception of the depressed group having more self‐acceptance related responses and fewer positive relationship responses. The well‐established lack of positive anticipation found in depressed individuals is likely to mean a diminished resource for a wide range of aspects of well‐being but especially positive relationships with others. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message The treatment of depression is thought to be more effective when it enhances psychological well‐being as well as reducing dysfunction. In the present study, all dimensions of psychological well‐being were lower in depressed participants with particularly marked deficits in environmental mastery and self‐acceptance, suggesting that these may be particularly important treatment targets. People with depression show specific deficits in being able to anticipate future positive events. The present study suggests that anticipated well‐being linked to positive relationships with other people may be particularly impacted by the lack of anticipated future events found in depression.
    July 07, 2014   doi: 10.1002/cpp.1911   open full text
  • The Role of Metacognitions in Expressed Emotion and Distress: A Study on Caregivers of Persons with First‐Episode Psychosis.
    Jens Einar Jansen, Susanne Harder, Ulrik Helt Haahr, Hanne‐Grethe Lyse, Marlene Buch Pedersen, Anne Marie Trauelsen, Erik Simonsen.
    Clinical Psychology & Psychotherapy. June 01, 2014
    BackgroundIn first‐episode psychosis, the family is considered an important part in the recovery process. This is often accompanied by significant distress, which is acknowledged in numerous studies. However, little is known about the psychological factors involved. MethodOne hundred and twenty‐seven caregivers of persons with first‐episode psychosis completed a series of questionnaires aimed at investigating the contribution of expressed emotion and metacognitions to caregiver distress. ResultsLinear mixed model analysis found that emotional over‐involvement and metacognitions independently predicted caregiver distress. Mediation analysis using bootstrapping showed that emotional over‐involvement could be seen as mediating the effect of metacognitions on distress. ConclusionThe current study is a first step towards understanding the role of metacognitions in caregiver distress, thus opening up for the possibility of using interventions from ‘contextual behaviour therapies’. Implications and future studies are discussed. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message This study is the first attempt to address caregiver concerns from the perspective of contextual cognitive behavioural therapy. The metacognitive framework for caregiver distress in first‐episode psychosis may help develop new therapeutic interventions to better support families. The study proposes a psychological understanding of emotional over-involvement and caregiver distress.
    June 01, 2014   doi: 10.1002/cpp.1907   open full text
  • Effectiveness of Psychotherapy in Personality Disorders Not Otherwise Specified: A Comparison of Different Treatment Modalities.
    Eva K. Horn, Anna Bartak, Anke M. M. A. Meerman, Bert V. Rossum, Uli M. Ziegler, Moniek Thunnissen, Mirjam Soons, Helene Andrea, Elisabeth F. M. Hamers, Paul M. G. Emmelkamp, Theo Stijnen, Jan J. V. Busschbach, Roel Verheul.
    Clinical Psychology & Psychotherapy. May 29, 2014
    Objective Although personality disorder not otherwise specified (PDNOS) is highly prevalent and associated with a high burden of disease, only a few treatment studies in this patient group exist. This study is the first to investigate the effectiveness of different modalities of psychotherapy in patients with PDNOS, i.e., short‐term (up to 6 months) and long‐term (more than 6 months) outpatient, day hospital, and inpatient psychotherapy. Method A total of 205 patients with PDNOS were assigned to one of six treatment modalities. Effectiveness was assessed over 60 months after baseline. The primary outcome measure was symptom severity, and the secondary outcome measures included psychosocial functioning and quality of life. The study design was quasi‐experimental, and the multiple propensity score was used to control for initial differences between treatment groups. Results All treatment modalities showed positive outcomes, especially in terms of improvements of symptom severity and social role functioning. At 12‐month follow‐up, after adjustment for initial differences between the treatment groups, short‐term outpatient psychotherapy and short‐term inpatient psychotherapy showed most improvement and generally outperformed the other modalities concerning symptom severity. At 60 months after baseline, effectiveness remained but observed differences between modalities mostly diminished. Conclusion Patients with PDNOS benefit from psychotherapy both at short‐term and long‐term follow‐up. Short‐term outpatient psychotherapy and short‐term inpatient psychotherapy seem to be superior to the other treatment modalities at 12‐month follow‐up. At 60‐month follow‐up, treatments showed mostly comparable effectiveness. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Messages The effectiveness of different modalities of psychotherapy in patients with PDNOS (i.e., short‐term vs long‐term; outpatient versus day hospital versus inpatient psychotherapy) has not yet been compared. Different modalities of psychotherapy are effective for patients with PDNOS, and positive effects remain after 5 years. In patients with PDNOS short‐term (less than 6 months) outpatient psychotherapy and short‐term inpatient psychotherapy seem to be superior to the four other treatment modalities at 12‐month follow‐up. At 60‐month follow‐up, treatments showed mostly comparable effectiveness.
    May 29, 2014   doi: 10.1002/cpp.1904   open full text
  • Internal Representations of the Therapeutic Relationship Among Adolescents in Psychodynamic Psychotherapy.
    Dana Atzil‐Slonim, Orya Tishby, Gaby Shefler.
    Clinical Psychology & Psychotherapy. May 15, 2014
    This study examined changes in adolescents' internal representations of their relationship with their therapist and the extent to which these changes were related to changes in their representations of their relationship with their parents and to treatment outcomes. MethodThirty adolescents (aged 15–18 years, 70% women) undergoing psychodynamic psychotherapy participated in relationship anecdote paradigms interviews based on the core conflictual relationship theme method and completed outcome measures at the beginning of treatment and a year later. ResultsAdolescents' positive representations of their therapists increased throughout the year of treatment, whereas their negative representations did not change. There was an association between the development of the therapeutic relationship and improvement in the perception of the relationship with parents over the course of therapy. Increases in the level of positive representations and decreases in the level of negative representations of the therapist were associated with greater satisfaction with treatment but not with the other outcome measures. These results support the centrality of the therapeutic relationship in the process of change during adolescents' psychodynamic psychotherapy. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message The finding that positive representations of the therapist increased throughout treatment but that negative representations remained steady suggests that therapists who treat adolescents should expect and be able to hear adolescent clients' positive and negative internal representations of themselves. Therapists need to realize that although adolescents often experience negative emotions and perceptions in therapy as in other significant relationships, this does not necessarily block the development of positive emotions. The finding that changes in the representations of the therapist are associated with changes in the representations of parents is in line with psychodynamic theory, which posits that psychotherapy facilitates new interpersonal experiences and new insights through the exploration of the therapeutic relationship. Working in the ‘here and now’ may eventually impact the nature of other significant relationships, particularly with parents in the case of adolescents.
    May 15, 2014   doi: 10.1002/cpp.1903   open full text
  • Yoga‐Enhanced Cognitive Behavioural Therapy (Y‐CBT) for Anxiety Management: A Pilot Study.
    Manjit K. Khalsa, Julie M. Greiner‐Ferris, Stefan G. Hofmann, Sat Bir S. Khalsa.
    Clinical Psychology & Psychotherapy. May 07, 2014
    Cognitive behavioural therapy (CBT) is an effective treatment for generalized anxiety disorder, but there is still room for improvement. The aim of the present study was to examine the potential benefit of enriching CBT with kundalini yoga (Y‐CBT). Participants consisted of treatment resistant clients at a community mental health clinic. A total of 32 participants enrolled in the study and 22 completed the programme. After the Y‐CBT intervention, pre‐post comparisons showed statistically significant improvements in state and trait anxiety, depression, panic, sleep and quality of life. Results from this preliminary study suggest that Y‐CBT may have potential as a promising treatment for those suffering from generalized anxiety disorder. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Messages Yoga‐enhanced cognitive behavioural therapy (Y‐CBT) may be a promising new treatment for those suffering from generalized anxiety disorder. Y‐CBT may also reduce depression in those suffering from generalized anxiety. Y‐CBT may reduce depression and anxiety in a clinic population where clients suffer from multiple diagnoses including generalized anxiety disorder.
    May 07, 2014   doi: 10.1002/cpp.1902   open full text
  • The Development of a Measure of Confidence in Delivering Therapy to People with Intellectual Disabilities.
    Dave Dagnan, John Masson, Amy Cavagin, Richard Thwaites, Chris Hatton.
    Clinical Psychology & Psychotherapy. May 06, 2014
    Current policy in UK health services emphasizes that, where possible, people with intellectual disabilities should access the same services as people without intellectual disabilities. One of the barriers to this is the confidence of clinicians and therapists. In this paper, we report on the development of a scale to describe the confidence of therapists in working with people with intellectual disabilities (the Therapy Confidence Scale–Intellectual Disabilities [TCS‐ID]). One‐hundred and eighty‐one therapists who provided talking therapies but who did not work primarily with people with intellectual disabilities completed the scale; 43 people completed the scale twice for test–retest reliability purposes. One‐hundred and seven people also completed a scale of general therapy self‐efficacy. The TCS‐ID has a single factor structure accounting for 62% of the variance, Cronbach's alpha for the scale is 0.93 and test–retest reliability is 0.83. There are significant differences in confidence based upon participants experience in working with people with intellectual disabilities and their therapeutic orientation, and there is a significant association between the TCS‐ID and the General Therapy Self‐efficacy Scale. Sixty clinicians working in mainstream mental health services received training on adapting their therapeutic approaches to meet the needs of people with intellectual disabilities. The TCS‐ID was used pre‐training and post‐training and demonstrated a significant increase in confidence for all group. We suggest that the scale has good psychometric properties and can be used to develop an understanding of the impact of training for mainstream therapist in working with people with intellectual disabilities. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message There is increasing emphasis on people with intellectual disabilities receiving services from mainstream mental health services. There is no research describing the experiences and outcomes of people with intellectual disabilities receiving mainstream talking therapy services. The confidence that clinicians have in working with people with intellectual disabilities may be a barrier to them receiving mainstream services. The Therapy Confidence Scale–Intellectual Disabilities is a psychometrically sound scale for measuring the confidence of therapists in working with people with intellectual disabilities and is a useful outcome measure for training clinicians to work with people with intellectual disabilities.
    May 06, 2014   doi: 10.1002/cpp.1898   open full text
  • Predicting Psychotherapy Dropouts: A Multilevel Approach.
    Alexander F. Kegel, Christoph Flückiger.
    Clinical Psychology & Psychotherapy. April 29, 2014
    The role of therapeutic processes in predicting premature termination of psychotherapy has been a particular focus of recent research. The purpose of this study was to contrast outpatients who completed therapy and those who dropped out with respect to their self‐reported in‐session experiences of self‐esteem, mastery, clarification and the therapeutic alliance. The 296 patients with mixed disorders were treated with an integrative form of cognitive–behavioural therapy without pre‐determined time limit (M = 20.2 sessions). Multilevel analyses indicated that patients who did not completetreatment reported, on average, lower levels of self‐esteem, mastery and clarification and lower ratings of their therapeutic alliance in treatment in contrast to patients who completed therapy. Patient‐reported change in self‐esteem experiences over the course of treatment turned out to be the strongest predictor of dropout from psychotherapy or successful completion. When dropout occurred before the average treatment length was reached, patients reported fewer clarifying experiences as early as the first session and their ratings of the therapeutic alliance were characterized by an absence of positive development. Both of these aspects seem to be involved in patients' decisions to leave treatment early. The findings underscore the importance of the therapeutic process in understanding the mechanisms behind treatment dropout. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Analyses data from 296 patients at a private outpatient clinic in a routine practice setting (CBT). Completer/dropout definition: presence or absence of measurement battery at post-assessment. Focuses on change in therapy processes by investigating post‐session reports. Finds that positive changes in self‐esteem experiences is the most robust predictor of dropout, followed by ratings of clarification experiences and the global alliance. In line with recent dropout research, these process indicators might help to detect therapeutic situations that are connected with psychotherapy dropouts.
    April 29, 2014   doi: 10.1002/cpp.1899   open full text
  • Validation of a Measure of Alliance for an Adolescent Inpatient Setting.
    Greg Haggerty, Caleb J. Siefert, Samuel J. Sinclair, Jennifer Zodan, Ronke Babalola, Mark A. Blais.
    Clinical Psychology & Psychotherapy. April 27, 2014
    The link between alliance and treatment outcome is robust. Nevertheless, few, if any, self‐report measures exist to assess the alliance between hospitalized adolescents and their treatment team as a whole. The present study looks to extend the use of a brief self‐report measure of inpatient treatment alliance designed for adult inpatients to be used with adolescents. The scale is designed incorporating items that tap the three factors of alliance (bond, goals and collaboration) to assess the alliance that the patient has with his or her treatment team. Our results show that the Inpatient‐Treatment Alliance Scale is unifactoral, shows good psychometrics and is linked in theoretically meaningful ways to global clinician ratings of engagement in individual psychotherapy. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Inpatient treatment of adolescents requires the assessment of alliance to be between the patient and his or her treatment team rather than an individual clinician. Assessment of the alliance can benefit clinicians treating hospitalized adolescents especially because these patients are difficult to engage with in treatment. This study shows that the Inpatient‐Treatment Alliance Scale is a promising measure for assessing treatment alliance on an adolescent inpatient setting.
    April 27, 2014   doi: 10.1002/cpp.1901   open full text
  • The Process of Seeking Psychotherapy and Its Impact on Therapy Expectations and Experiences.
    Katherine P. Elliott, Robin Westmacott, John Hunsley, Orly Rumstein‐McKean, Marlene Best.
    Clinical Psychology & Psychotherapy. April 24, 2014
    Seeking psychotherapy can be conceptualized as having three stages: deciding that therapy might help, deciding to seek therapy and contacting a therapist. The present study examined the duration and difficulty of clients' decisions to seek psychotherapy and whether these experiences were predictive of expected difficulty and commitment to the therapy process. One‐hundred and fifty‐five adults seeking individual psychological services from a university training clinic were assessed before intake; 107 of these participants also completed measures between the third and fourth therapy sessions and at post‐therapy. Deciding that therapy might help was reported to be the most difficult step and took the longest, with each subsequent step becoming easier and briefer. At each step, the more difficult the decision, the more time participants took to make it. Higher distress was associated with more difficulty in deciding that therapy might help and deciding to seek therapy. Duration and difficulty of decisions to seek therapy were positively correlated with expectations of difficulty in therapy as measured prior to treatment and following the third session but were not associated with participants' commitment to therapy. The implications of these results for clinicians and mental health services are discussed. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message The most difficult and time‐consuming step for those who seek mental health services is recognizing that their distressing experiences are connected to mental health; clinicians may aid this challenge by providing information on the nature of mental disorders and common symptoms of emotional distress on websites or through other means (e.g., physicians' waiting rooms and advertising campaigns). The next most difficult and time‐consuming step for those who seek mental health services is deciding that psychotherapy may help; by providing easily accessible information (e.g., on websites) about what psychotherapy entails, including clinicians' expectations of clients and the benefits/challenges of therapy, potential clients may be able to progress through this step more rapidly and with less difficulty. Clients' expectations of the value of psychotherapy and their commitment to engage in therapy do not appear to be affected by how long it took, or how difficult it was, to obtain psychotherapy. Factors such as forming a strong therapeutic alliance and providing support and guidance during the initial sessions of therapy may be more important in helping potential clients commit to therapy than what they experienced in their efforts to receive psychotherapy.
    April 24, 2014   doi: 10.1002/cpp.1900   open full text
  • A New Therapeutic Community: Development of a Compassion‐Focussed and Contextual Behavioural Environment.
    David Veale, Paul Gilbert, Jon Wheatley, Iona Naismith.
    Clinical Psychology & Psychotherapy. April 14, 2014
    Social relationships and communities provide the context and impetus for a range of psychological developments, from genetic expression to the development of core self‐identities. This suggests a need to think about the therapeutic changes and processes that occur within a community context and how communities can enable therapeutic change. However, the ‘therapeutic communities’ that have developed since the Second World War have been under‐researched. We suggest that the concept of community, as a change process, should be revisited within mainstream scientific research. This paper briefly reviews the historical development of therapeutic communities and critically evaluates their current theory, practice and outcomes in a systematic review. Attention is drawn to recent research on the nature of evolved emotion regulation systems, the way these are entrained by social relationships, the importance of affiliative emotions in the regulation of threat and the role of fear of affiliative emotions in psychopathology. We draw on concepts from compassion‐focussed therapy, social learning theory and functional analytical psychotherapy to consider how members of a therapeutic community can be aware of each other's acts of courage and respond using compassion. Living in structured and affiliative‐orientated communities that are guided by scientific models of affect and self‐regulation offers potential therapeutic advantages over individual outpatient therapy for certain client groups. This conclusion should be investigated further. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Current therapeutic community practice is not sufficiently evidence based and may not be maximizing the potential therapeutic value of a community. Compassion‐focussed therapy and social learning theory offer new approaches for a therapeutic environment, involving an understanding of the role, nature and complexities of compassionate and affiliative relationships from staff and members, behavioural change guided by learning theory, a clear formulation based on threat‐derived safety strategies, goal setting and positive reinforcement.
    April 14, 2014   doi: 10.1002/cpp.1897   open full text
  • Early Maladaptive Schemas: A Comparison Between Bipolar Disorder and Major Depressive Disorder.
    Kristine Kahr Nilsson, Krista Nielsen Straarup, Marianne Halvorsen.
    Clinical Psychology & Psychotherapy. March 18, 2014
    Background It is still unclear how bipolar disorder (BD) differentiates from major depressive disorder (MDD) outside major mood episodes. To further elucidate this area, the present study compared the two mood disorders in terms of early maladaptive schemas (EMSs) during remission. Method The sample consisted of 49 participants with BD and 30 participants with MDD who were currently in remission. The participants completed the Young Schema Questionnaire. Results The BD group scored significantly higher than the MDD group on seven EMSs: abandonment, failure to achieve, insufficient self‐control, subjugation, unrelenting standards, enmeshment and entitlement. Conclusion By suggesting that EMSs are more severe in BD compared with MDD, the findings highlight potential vulnerabilities in BD, which merit further examination in terms of their underlying causes and potential treatment implications. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Early maladaptive schemas are relevant psychological dimensions to consider in remitted phases of major mood disorders. Findings from the current study suggest that early maladaptive schemas are more prevalent in adults with bipolar disorder compared to adults with major depressive disorder when measured during remission. Interventions targeting early maladaptive schemas may be valuable in treatment of bipolar disorder.
    March 18, 2014   doi: 10.1002/cpp.1896   open full text
  • Common Factor Mechanisms in Clinical Practice and Their Relationship with Outcome.
    Carolina Gaitan‐Sierra, Michael E. Hyland.
    Clinical Psychology & Psychotherapy. March 16, 2014
    This study investigates three common factor mechanisms that could affect outcome in clinical practice: response expectancy, the affective expectation model and motivational concordance. Clients attending a gestalt therapy clinic (30 clients), a sophrology (therapeutic technique) clinic (33 clients) and a homeopathy clinic (31 clients) completed measures of expectancy and the Positive Affect and Negative Affect Schedule (PANAS) before their first session. After 1 month, they completed PANAS and measures of intrinsic motivation, perceived effort and empowerment. Expectancy was not associated with better outcome and was no different between treatments. Although some of the 54 clients who endorsed highest expectations showed substantial improvement, others did not: 19 had no change or deteriorated in positive affect, and 18 had the same result for negative affect. Intrinsic motivation independently predicted changes in negative affect (β = −0.23). Intrinsic motivation (β = 0.24), effort (β = 0.23) and empowerment (β = 0.20) independently predicted positive affect change. Expectancy (β = −0.17) negatively affected changes in positive affect. Clients found gestalt and sophrology to be more intrinsically motivating, empowering and effortful compared with homeopathy. Greater improvement in mood was found for sophrology and gestalt than for homeopathy clients. These findings are inconsistent with response expectancy as a common factor mechanism in clinical practice. The results support motivational concordance (outcome influenced by the intrinsic enjoyment of the therapy) and the affective expectation model (high expectations can lead for some clients to worse outcome). When expectancy correlates with outcome in some other studies, this may be due to confound between expectancy and intrinsic enjoyment. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message: Common factors play an important role in outcome. Intrinsic enjoyment of a therapeutic treatment is associated with better outcome. Active engagement with a therapeutic treatment improves outcome. Unrealistic expectations about a therapeutic treatment can have a negative impact on outcome.
    March 16, 2014   doi: 10.1002/cpp.1894   open full text
  • A Wait‐List Randomized Controlled Trial of Loving‐Kindness Meditation Programme for Self‐Criticism.
    Ben Shahar, Ohad Szsepsenwol, Sigal Zilcha‐Mano, Netalee Haim, Orly Zamir, Simi Levi‐Yeshuvi, Nava Levit‐Binnun.
    Clinical Psychology & Psychotherapy. March 16, 2014
    Self‐criticism is a vulnerability risk factor for a number of psychological disorders, and it predicts poor response to psychological and pharmacological treatments. In the current study, we evaluated the efficacy of a loving‐kindness meditation (LKM) programme designed to increase self‐compassion in a sample of self‐critical individuals. Thirty‐eight individuals with high scores on the self‐critical perfectionism subscale of the Dysfunctional Attitude Scale were randomized to an LKM condition (n = 19) or a wait‐list (WL) condition (n = 19). Measures of self‐criticism, self‐compassion and psychological distress were administered before and immediately following the intervention (LKM or WL). WL participants received the intervention immediately after the waiting period. Both groups were assessed 3 months post‐intervention. Intent‐to‐treat (n = 38) and per‐protocol analyses (n = 32) showed significant reductions in self‐criticism and depressive symptoms as well as significant increases in self‐compassion and positive emotions in the LKM condition compared with the WL condition. A follow‐up per‐protocol analysis in both groups together (n = 20) showed that these gains were maintained 3 months after the intervention. These preliminary results suggest that LKM may be efficacious in alleviating self‐criticism, increasing self‐compassion and improving depressive symptoms among self‐critical individuals. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Self‐criticism plays a major role in many psychological disorders and predicts poor response to brief psychological and pharmacological treatments for depression. The current study shows that loving‐kindness meditation, designed to foster self‐compassion, is efficacious in helping self‐critical individuals become less self‐critical and more self‐compassionate. The study also suggests that practising loving‐kindness may reduce depressive symptoms and increase positive emotions.
    March 16, 2014   doi: 10.1002/cpp.1893   open full text
  • The Individual Therapy Process Questionnaire: Development and Validation of a Revised Measure to Evaluate General Change Mechanisms in Psychotherapy.
    Johannes Mander, Angelika Schlarb, Martin Teufel, Ferdinand Keller, Martin Hautzinger, Stephan Zipfel, Andreas Wittorf, Isa Sammet.
    Clinical Psychology & Psychotherapy. March 06, 2014
    There is a dearth of measures specifically designed to assess empirically validated mechanisms of therapeutic change. To fill in this research gap, the aim of the current study was to develop a measure that covers a large variety of empirically validated mechanisms of change with corresponding versions for the patient and therapist. To develop an instrument that is based on several important change process frameworks, we combined two established change mechanisms instruments: the Scale for the Multiperspective Assessment of General Change Mechanisms in Psychotherapy (SACiP) and the Scale of the Therapeutic Alliance—Revised (STA‐R). In our study, 457 psychosomatic inpatients completed the SACiP and the STA‐R and diverse outcome measures in early, middle and late stages of psychotherapy. Data analyses were conducted using factor analyses and multilevel modelling. The psychometric properties of the resulting Individual Therapy Process Questionnaire were generally good to excellent, as demonstrated by (a) exploratory factor analyses on both patient and therapist ratings, (b) CFA on later measuring times, (c) high internal consistencies and (d) significant outcome predictive effects. The parallel forms of the ITPQ deliver opportunities to compare the patient and therapist perspectives for a broader range of facets of change mechanisms than was hitherto possible. Consequently, the measure can be applied in future research to more specifically analyse different change mechanism profiles in session‐to‐session development and outcome prediction. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message This article describes the development of an instrument that measures general mechanisms of change in psychotherapy from both the patient and therapist perspectives. Post‐session item ratings from both the patient and therapist can be used as feedback to optimize therapeutic processes. We provide a detailed discussion of measures developed to evaluate therapeutic change mechanisms.
    March 06, 2014   doi: 10.1002/cpp.1892   open full text
  • Sitting Posture Makes a Difference—Embodiment Effects on Depressive Memory Bias.
    Johannes Michalak, Judith Mischnat, Tobias Teismann.
    Clinical Psychology & Psychotherapy. February 27, 2014
    Basic research has shown that the motoric system (i.e., motor actions or stable postures) can strongly affect emotional processes. The present study sought to investigate the effects of sitting posture on the tendency of depressed individuals to recall a higher proportion of negative self‐referent material. Thirty currently depressed inpatients either sat in a slumped (depressed) or in an upright (non‐depressed) posture while imagining a visual scene of themselves in connection with positive or depression related words presented to them on a computer screen. An incidental recall test of these words was conducted after a distraction task. Results of a mixed ANOVA showed a significant posture x word type interaction, with upright‐sitting patients showing unbiased recall of positive and negative words but slumped patients showing recall biased towards more negative words. The findings indicate that relatively minor changes in the motoric system can affect one of the best‐documented cognitive biases in depression. Practical implications of the findings are discussed. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Features of patients' motoric system (i.e., habitual movement patterns or body postures) might be relevant for individual case conceptualization. Training patients to change habitual motoric patterns (e.g., dysfunctional posture or movement patterns) might attenuate negatively biased information processing in depressed patients. Training patients in mindful body awareness might be useful because it fosters an intuitive understanding of the interplay of bodily and emotional processes.
    February 27, 2014   doi: 10.1002/cpp.1890   open full text
  • Patient and Therapist Perspectives on Alliance Development: Therapists' Practice Experiences as Predictors.
    Helene A. Nissen‐Lie, Odd E. Havik, Per A. Høglend, Michael Helge Rønnestad, Jon T. Monsen.
    Clinical Psychology & Psychotherapy. February 26, 2014
    Research has shown that the therapist's contribution to the alliance is more important for the outcome than the patient's contribution (e.g., Baldwin, Wampold, & Imel, 2007); however, knowledge is lacking about which therapist characteristics are relevant for alliance building and development. The objective of this study was to explore the development of the working alliance (using the Working Alliance Inventory), rated by both patients and therapists as a function of therapist in‐session experiences. The therapist experiences were gathered by means of the Development of Psychotherapists Common Core Questionnaire (Orlinsky & Rønnestad, 2005). Data from the Norwegian Multisite Study of the Process and Outcome of Psychotherapy (Havik et al., 1995) were used. Multilevel growth curve analyses of alliance scores from Sessions 3, 12, 20 and 40 showed that the therapist factors predicted working alliance levels or growths differently, depending on whether the alliance was rated by patients or by therapists. For example, it emerged that therapists' negative reactions to patients and their in‐session anxiety affected patient‐rated alliance but not therapist‐rated alliance, whereas therapist experiences of flow (Csikszentmihalyi, 1990) during sessions impacted only the therapist‐rated alliance. The patterns observed in this study imply that therapists should be particularly aware that their negative experiences of therapy are noticed by, and seem to influence, their clients when they evaluate the working alliance through the course of treatment. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message The findings of this study suggest that the working alliance is influenced by therapists' self‐reported practice experiences, which presumably are communicated through the therapists' in‐session behaviours. The study found a notable divergence between practice experiences that influenced the therapists and those that influenced the patients when evaluating the working alliance. Specifically, practitioners' self‐reported difficulties in practice, such as their negative reactions to patients and their in‐session anxiety, affected patient‐rated alliance but not therapist‐rated alliance, whereas therapist experiences of ‘flow’ during sessions impacted only the therapist‐rated alliance. Practitioners should note that patient alliance ratings were more likely to be influenced by therapists' negative practice experiences than by positive ones. The divergence in the patient and therapist viewpoints has potential implications for therapist training and supervision and everyday self‐reflection.
    February 26, 2014   doi: 10.1002/cpp.1891   open full text
  • Therapeutic Alliance in the Personal Therapy of Graduate Clinicians: Relationship to the Alliance and Outcomes of Their Patients.
    Stephanie H. Gold, Mark J. Hilsenroth, Klara Kuutmann, Jesse J. Owen.
    Clinical Psychology & Psychotherapy. February 18, 2014
    This is the first study to explore the relationship between aspects of a therapists' personal therapy and the subsequent psychotherapy process and outcome they perform. The participants were 14 graduate clinicians with various experiences in personal therapy, who treated 54 outpatients engaged in short‐term psychodynamic psychotherapy at a university‐based community clinic. Results demonstrated non‐significant relationships between the duration of personal therapy as well as a graduate clinician's overall alliance in their personal therapy with alliance ratings made by themselves as therapists and their patients, as well as the number of psychotherapy sessions attended by patients. However, the clinician's personal therapy alliance was significant and positively related to their patients' rating of outcome. Additionally, a significant negative correlation was observed between the degree of perceived helpfulness in their personal therapy and how these clinicians rated alliances, as the therapist, with their patients. The current findings suggest a relationship between a clinician's personal therapy alliance and the outcome of treatments they conduct. Implications for clinical training and practice as well as future research are discussed. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message While graduate clinician's personal therapy alliance was not significantly related to their patients' ratings of alliance, it was related to their patients' ratings of outcome. Trainee satisfaction with or quality of their personal therapy may be a more relevant than the amount or duration of their treatment in regard to the process and outcomes of their patients. The findings from retrospective clinician surveys on the helpfulness of their personal therapy may not be entirely consistent with empirical examination of these issues. The relation of personal therapy and outcome may work through improving the therapist's level of adaptive functioning (i.e., psychological‐relational‐emotional health) and future research should examine this simpler, more parsimonious, explanation for our findings.
    February 18, 2014   doi: 10.1002/cpp.1888   open full text
  • Revisiting Chronic Pain Patient Profiling: An Acceptance‐based Approach in an Online Sample.
    Jessica C. Payne‐Murphy, Abbie O. Beacham.
    Clinical Psychology & Psychotherapy. February 05, 2014
    Over 116 million Americans experience chronic pain, incurring an annual cost of $635bn in healthcare and lost work. Acceptance‐based therapies have gained increasing recognition for improving functional outcomes. In our online chronic pain sample, we predicted that (1) patients would cluster into low, medium and high groups of chronic pain acceptance and (2) positive affect, negative affect and perceived disability scores would differ overall by cluster, with the most positive outcomes found in the high cluster and the least found in the low cluster. Participants completed the Chronic Pain Acceptance Questionnaire, Positive and Negative Affect Scales and the Pain Disability Index. A k‐means cluster analysis was conducted using activity engagement (AE) and pain willingness (PW) totals from the Chronic Pain Acceptance Questionnaire. As predicted, cluster analysis specified three groups: low AE/low PW, high AE/high PW and medium AE/medium PW. Significant multivariate analysis of covariance results were obtained according to Wilks' λ (0.55), F(6,266) = 15.39, p < 0.01, and indicated differences in positive affect, negative affect and perceived disability within each cluster. Follow‐up analyses of covariance revealed mean differences in the predicted directions: the high‐high group showed the most positive affect and the least negative affect and perceived disability. Conversely, the low‐low group displayed the least positive affect (M = 20.28, SD = 7.86), the most negative affect (M = 28.05, SD = 9.33) and perceived disability (M = 49.57, SD = 9.46). The presence of these clusters introduces key questions about the possibility of creating tailored interventions based on cluster profiles. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Higher levels of Acceptance are associated with better functional and affective outcomes for chronic pain patients. Lower Acceptance is associated with poorer functional and affective outcomes. Tailoring interventions using Acceptance‐based profiling may improve chronic pain therapies.
    February 05, 2014   doi: 10.1002/cpp.1886   open full text
  • Conditioned Subjective Responses to Socially Relevant Stimuli in Social Anxiety Disorder and Subclinical Social Anxiety.
    Daniella Tinoco‐González, Miquel Angel Fullana, David Torrents‐Rodas, Albert Bonillo, Bram Vervliet, Guillem Pailhez, Magí Farré, Oscar Andión, Víctor Perez, Rafael Torrubia.
    Clinical Psychology & Psychotherapy. January 26, 2014
    Although enhanced fear conditioning has been implicated in the origins of social anxiety disorder (SAD), laboratory evidence in support of this association is limited. Using a paradigm employing socially relevant unconditioned stimuli, we conducted two separate studies to asses fear conditioning in individuals with SAD and non‐clinical individuals with high social anxiety (subclinical social anxiety [SSA]). They were compared with age‐matched and gender‐matched individuals with another anxiety disorder (panic disorder with agoraphobia) and healthy controls (Study 1) and with individuals with low social anxiety (Study 2). Contrary to our expectations, in both studies, self‐report measures (ratings of anxiety, unpleasantness and arousal to the conditioned stimuli) of fear conditioning failed to discriminate between SAD or SSA and the other participant groups. Our results suggest that enhanced fear conditioning does not play a major role in pathological social anxiety. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message We used a social conditioning paradigm to study fear conditioning in clinical and subclinical social anxiety. We found no evidence of enhanced fear conditioning in social anxiety individuals. Enhanced fear conditioning may not be a hallmark of pathological social anxiety.
    January 26, 2014   doi: 10.1002/cpp.1883   open full text
  • A Measurable Impact of a Self‐Practice/Self‐Reflection Programme on the Therapeutic Skills of Experienced Cognitive‐Behavioural Therapists.
    Melanie L. Davis, Richard Thwaites, Mark H. Freeston, James Bennett‐Levy.
    Clinical Psychology & Psychotherapy. January 26, 2014
    The need for effective training methods for enhancing cognitive‐behavioural therapist competency is not only relevant to new therapists but also to experienced therapists looking to retain and further enhance their skills. Self‐practice/self‐reflection (SP/SR) is a self‐experiential cognitive‐behavioural therapy (CBT) training programme, which combines the experience of practicing CBT methods on oneself with structured reflection on the implications of the experience for clinical practice. In order to build on previous qualitative studies of SP/SR, which have mainly focused on trainee CBT therapists, the aim of the current study was to quantify the impact of SP/SR on the therapeutic skills of an experienced cohort of CBT therapists. Fourteen CBT therapists were recruited to participate in an SP/SR programme specifically adapted for experienced therapists. In the context of a quasi‐experimental design including multiple baselines within a single‐case methodology, therapists provided self‐ratings of technical cognitive therapy skill and interpersonal empathic skill at four critical time points: baseline, pre‐SP/SR and post‐SP/SR and follow‐up. Analysis of programme completers (n = 7) indicated that SP/SR enhances both technical skill and interpersonal therapeutic skill. Further intention‐to‐treat group (n = 14) analyses including both those who left the programme early (n = 3) and those who partially completed the programme (n = 4) added to the robustness of findings with respect to technical cognitive therapy skills but not interpersonal empathic skills. It was concluded that SP/SR, as a training and development programme, could offer an avenue to further therapeutic skill enhancement in already experienced CBT therapists. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message It was possible to quantify the positive impact of a self‐practice/self‐reflection (SP/SR) training and development programme within a cohort of experienced cognitive‐behavioural (CBT) therapists. Through SP/SR, experienced CBT therapists can further enhance their self‐perceived therapeutic skills in two key domains; technical cognitive therapy skills and interpersonal empathic skill. Further SP/SR studies should aim to incorporate objective measurement of therapeutic skill, ideally from more than one rating source.
    January 26, 2014   doi: 10.1002/cpp.1884   open full text
  • Preliminary Evidence for a Nexus between Rumination, Behavioural Avoidance, Motive Satisfaction and Depression.
    Timo Brockmeyer, Martin Grosse Holtforth, Tobias Krieger, David Altenstein, Nadja Doerig, Johannes Zimmermann, Matthias Backenstrass, Hans‐Christoph Friederich, Hinrich Bents.
    Clinical Psychology & Psychotherapy. January 26, 2014
    The present study tested a theoretically derived link between rumination and depressive symptoms through behavioural avoidance and reduced motive satisfaction as a key aspect of positive reinforcement. Rumination, behavioural avoidance, motive satisfaction and levels of depression were assessed via self‐report measures in a clinical sample of 160 patients with major depressive disorder. Path analysis‐based mediation analysis was used to estimate the direct and indirect effects as proposed by the theoretical model. Operating in serial, behavioural avoidance and motive satisfaction partially mediated the association between rumination and depressive symptoms, irrespective of gender, medication and co‐morbid anxiety disorders. This is the first study investigating the associations between behavioural avoidance, rumination and depression in a clinical sample of depressed patients. The findings are in line with an understanding of rumination in depression as also serving an avoidance function. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message: Rumination, avoidance, motive satisfaction and levels of depressive symptoms were examined in a clinical sample of 160 outpatients with major depressive disorder. Path analysis‐based mediation analysis revealed that, operating in serial, avoidance and motive satisfaction partially mediated the link between rumination and levels of depressive symptoms. Findings support an understanding of rumination in depression as serving an avoidance function.
    January 26, 2014   doi: 10.1002/cpp.1885   open full text
  • Correcting Psychotherapists' Blindsidedness: Formal Feedback as a Means of Overcoming the Natural Limitations of Therapists.
    James Macdonald, John Mellor‐Clark.
    Clinical Psychology & Psychotherapy. January 22, 2014
    Purpose Monitoring of client progress in psychological therapy using formal outcome measures at each session has been shown to increase the effectiveness of treatment. It seems likely that this ‘feedback’ effect is achieved by enabling therapists to identify clients at risk of treatment failure so that therapists can pay greater attention to client difficulties, which may be hindering therapeutic work. To date, little attention has been given to understanding relevant mechanisms of formal feedback in psychological therapy. In order to understand and maximize the benefits of feedback, it is essential to explore potential mechanisms contributing to this effect. Research in social psychology may help to explain how feedback works. Methods Findings on cognitive biases in the field of social psychology are explored and linked to preliminary findings in the field of psychotherapy research. Results Research on cognitive biases and expertise is congruent with indications that clinical prediction in psychotherapy is unreliable and that it may be difficult for clinicians to detect errors in their judgement as a result of a lack of clear corrective feedback. This problem is linked to the fact that clinical outcomes occur in a complex ‘noisy’ environment where prediction is inherently difficult. Conclusion Formal feedback may derive its benefits from its ability to help correct naturally occurring biases in therapists' assessment of their work. If these biases are seen as normal, but often avoidable if feedback is used, this may pave the way to greater acceptance of formal feedback by clinicians and enhanced outcomes for clients. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message The use of formal feedback tools can help therapists overcome inevitable limitations in their ability to predict poor response to treatment, enhancing the likelihood of detecting and resolving client difficulties in therapy.
    January 22, 2014   doi: 10.1002/cpp.1887   open full text
  • Attachment Representation in Institutionalized Children: A Preliminary Study Using the Child Attachment Interview.
    Maria Zaccagnino, Martina Cussino, Alessandra Preziosa, Fabio Veglia, Antonella Carassa.
    Clinical Psychology & Psychotherapy. January 07, 2014
    The experience of being removed from one's home and the transition to a residential care system pose enormous challenges for a child. Substantial evidence has been found regarding severe developmental effects due to early exposition to extreme psychosocial and affective deprivation. The research on Bowlby's theoretical proposals has highlighted the link between insecure, disorganized and atypical attachment patterns and children both living in foster care facilities and adopted out of those institutions. The goal of this pilot study is to investigate the attachment representation in an Italian sample of children in middle childhood (9–13 years old) who have been removed from their homes. Method Two compared groups of children participated in this study. The first group was composed of 24 Italian children who had been removed from their homes. The second group, considered as the control group, was composed of 35 Italian children who had never been in foster care placement. The quality of children's attachment to their primary caregivers was assessed by the Child Attachment Interview, an innovative semi‐structured interview that seeks to bridge the measurement gap identified in middle childhood Results The children in foster care placement show a higher percentage of insecure and disorganized attachment representations and lower scores on the Child Reflective Functioning Scale. Conclusions The clinical implications and enhancements to effective intervention for foster children's caretaking are discussed. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Attachment theory. Clinical implications of Attachment experiences. Assessment tools of Attachment in middle childhood.
    January 07, 2014   doi: 10.1002/cpp.1882   open full text
  • Patient Crying in Psychotherapy: Who Cries and Why?
    Kristen L. Capps, Katherine Fiori, Anthony S. J. Mullin, Mark J. Hilsenroth.
    Clinical Psychology & Psychotherapy. December 12, 2013
    Aim The aim of the present study is to further the understanding of who cries in therapy and the relation of technique with crying behaviour in therapy. Method Psychological assessment feedback sessions, prior to the initiation of formal therapy for 52 patients beginning psychotherapy at a university‐based clinic were coded for discrete crying segments. Data about patient characteristics and the process of the session were collected at the time of the session. Therapist's interventions were recorded verbatim and independently rated. Results The number of times a patient cried during their session correlated negatively with global assessment of functioning scores and positively with measures of borderline personality disorder pathology as well as a measure of severity of childhood sexual abuse. Patients' crying behaviour demonstrated significant negative correlations with the overall experience of the session (bad/good), smoothness and positivity. Group differences between criers and non‐criers reflected these trends as well. No significant correlations or group differences were found with regard to patient‐rated or therapist‐rated alliance as it relates to crying behaviour. Analysis indicates that therapist intervention prior to patient crying most often encouraged the exploration and expression of difficult affect, new perspectives on key issues or the patient's fantasies and wishes. Discussion Our study addresses a significant gap in the clinical literature on crying. Crying behaviour seems to be related to certain clinical variables and has a negative impact on patient experience of the session in which they cry, although the alliance remained unaffected. Limitations Small sample, outpatients with mild/moderate psychopathology and graduate trainees provided therapy. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Patients with greater problems in emotional dysregulation, borderline personality disorder symptoms and greater severity of childhood sexual abuse are more likely to display greater affective intensity during the beginning of treatment. Results suggest that the alliance may remain strong despite patients experiencing a session in which they cried as difficult. Therapeutic interventions that focus on affect, new understanding of old patterns and patient fantasies with outpatient clinical populations appeared to be associated with crying in session.
    December 12, 2013   doi: 10.1002/cpp.1879   open full text
  • Exploring Self‐criticism: Confirmatory Factor Analysis of the FSCRS in Clinical and Nonclinical Samples.
    Paula Castilho, José Pinto‐Gouveia, Joana Duarte.
    Clinical Psychology & Psychotherapy. December 04, 2013
    The Forms of Self‐criticizing/Attacking and Self‐reassuring Scale (FSCRS) is a self‐report questionnaire that assesses the forms of self‐criticism and self‐reassurance. The aim of this study was to explore the latent structure of the FSCRS in nonclinical and clinical samples. Data from 381 participants from the general population and from 304 participants from clinical settings were subjected to confirmatory factor analyses to explore several structural models reflecting alternative representations of the FSCRS dimensionality. Overall, the model with the best fit to the data, in both samples, was the three‐factor model (inadequate self, hated self and reassured self subscales) replicating the FSCRS original structure. The scale showed good psychometric characteristics, and the three factors discriminated between the clinical and nonclinical samples. To our knowledge, this is the first study to confirm the factor structure of the FSCRS in a purely clinical sample, and to test alternative models. This study adds to the existent literature that has been supporting the conceptualization of self‐criticism as a multidimensional construct. Given the good psychometric properties of the Portuguese version of the FSCRS, its use is encouraged and recommended for the assessment of self‐criticism in both clinical and research settings. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Our results suggest that self‐criticism is associated with psychopathology indicators and, for this reason, should be addressed in clinical settings. Also, self‐criticism is not a single process, and thus therapists may need to explore in more detail its different forms (i.e., feeling inadequate and hateful feelings for the self). The FSCRS questionnaire may be an important tool in aiding therapists in assessing their patients, given its ability to discriminate individuals from the normal population and individuals from clinical settings. Thus, self‐criticism is s not only theoretically but also clinically meaningful. Given the idea that self‐reassuring operates through a different affect system, helping people develop inner warmth and compassion for the self may be important to counteract feelings of self‐hatred and self‐attack.
    December 04, 2013   doi: 10.1002/cpp.1881   open full text
  • The Experience of Cognitive Impairment in People with Psychosis.
    Helen Wood, Caroline Cupitt, Tony Lavender.
    Clinical Psychology & Psychotherapy. November 27, 2013
    Cognitive impairment has been widely studied in people with psychosis. However, research is lacking into the subjective experience of cognitive impairment, its impact and ways in which individuals cope. This study aimed to provide an account of the experience of cognitive impairment in people with a diagnosis of schizophrenia, including what difficulties people experience, how these difficulties are understood, how people respond to these difficulties and how they perceive others' views of these difficulties. A semi‐structured interview was carried out with eight participants with a diagnosis of schizophrenia focusing on participants' experiences of difficulties with cognitive functioning. Interpretative phenomenological analysis was used to analyse interview transcripts. Experience of cognitive impairment was understood in terms of six master themes: impaired controlled thinking, physical sensations and impaired movement, explanations for the impairment and comparisons to the past, managing the impairment, how others see the impairment and anticipating the future. This study is the first rigorous qualitative study of the subjective experience of cognitive impairment in people with psychosis, and it provides greater context for empirical findings. The results have significant implications for clinical psychology, including education about cognitive difficulties and the importance of cognitive functioning to formulation. New areas for research include coping strategies in relation to functioning and future perspectives, ascertaining staff understanding of cognitive impairment, and reflective conversation style as an intervention for metacognitive difficulties. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Difficulties with cognitive functioning should be considered in clinical practitioners' formulations of clients' difficulties in the context of psychosis. Services should consider providing service user and carer education about cognitive impairment in psychosis. Staff may need further training in order to support people with psychosis who have difficulties with cognitive functioning.
    November 27, 2013   doi: 10.1002/cpp.1878   open full text
  • A Randomized Controlled Trial of a Correspondence‐Based Intervention for Carers of Relatives with Psychosis.
    Frank P. Deane, Sarah Marshall, Trevor Crowe, Angela White, David Kavanagh.
    Clinical Psychology & Psychotherapy. November 27, 2013
    Background Family members play a crucial role in supporting the recovery of loved ones with psychosis. The journey of recovery is not only traversed by the person experiencing the mental illness but also by their family. Interventions to support these families have traditionally either focused on psychoeducation or addressed problematic interactions or expressed emotion. Family programmes have far less frequently emphasized supporting family members' adjustment to the challenges posed by their relative's disorder or their recovery from associated distress. The study compared a control condition that received only a psychoeducational booklet (Information) and a condition also receiving a correspondence‐based interactive recovery‐oriented intervention (Connections). The Connections group was expected to show greater improvements in recovery knowledge, well‐being, experiences of caregiving, hopefulness and distress. Method A randomized controlled trial was conducted to evaluate the effectiveness of two correspondence‐based family interventions delivered to 81 carers of relatives with psychosis. Results Intent‐to‐treat analyses showed no differential outcomes between conditions, but an analysis of participants who substantially completed their allocated treatment showed that carers receiving Connections had significantly more improvements in well‐being, positive experiences of caregiving and distress. Conclusions Correspondence interventions that support carer's recovery may result in more positive mental health for those who complete key elements of the programme compared with information alone. However, many carers do not complete a correspondence programme and this may limit its impact. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message A focus on recovery‐oriented interventions holds relevance for carers as well as their loved ones with mental illness. To our knowledge, this is the first randomized controlled trial of a recovery‐focused intervention for carers. Carers may receive positive mental health benefits from recovery‐focused correspondence programmes to the extent that they can be encouraged to remain engaged with such programmes.
    November 27, 2013   doi: 10.1002/cpp.1880   open full text
  • Time to Improve and Recover from Depressive Symptoms and Interpersonal Problems in a Clinical Trial.
    Rodrigo T. Lopes, Miguel M. Gonçalves, Daniel Fassnacht, Paulo P. P. Machado, Inês Sousa.
    Clinical Psychology & Psychotherapy. October 28, 2013
    Results from an earlier clinical trial comparing narrative therapy with cognitive–behavioural therapy (Lopes et al., 2013) suggested that narrative therapy is efficacious for depression. However, there were significant differences in symptom reduction on the Beck Depression Inventory‐II, favouring cognitive–behavioural therapy, if dropouts were included in the analysis, suggesting that time to recovery or improvement would differ in both treatments. Contrarily, results showed that treatment assignment was not a predictor for differential effect. Using a survival analytic approach, it was found that four sessions were necessary for 50% improvement and 16 sessions for 50% recovery. Additionally, depressive symptoms changes occurred significantly faster than interpersonal changes, again regardless of treatment assignment. These results support previous findings of the dose–response literature and of the phase model of change, with the advantage of being specific to psychotherapy with depressive clients. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message For 50% of clients with major depressive disorder, it takes four sessions to improve and 16 sessions to recover, regardless of whether they were treated with narrative therapy or cognitive–behavioural therapy. For those clients who recover, they do so by session 11.Clients change depressive symptoms more consistently and much faster than they change interpersonal problems. For clients who will not recover during brief interventions and especially for clients who present strong interpersonal problems at onset, long‐term treatment plans should be considered.More emphasis should be laid on symptomatic relief in the early stages of treatment and on interpersonal issues at later stages.
    October 28, 2013   doi: 10.1002/cpp.1873   open full text
  • Attribution of Somatic Symptoms in Hypochondriasis.
    Julia M. B. Neng, Florian Weck.
    Clinical Psychology & Psychotherapy. October 09, 2013
    The misinterpretation of bodily symptoms as an indicator of a serious illness is a key feature of the criteria and the cognitive–behavioural models of hypochondriasis. Previous research suggests that individuals suffering from health anxiety endorse attributions of physical disease, whereas persons with elevated general anxiety have the tendency to attribute psychological causes to their symptoms. However, whether a somatic attribution style is specific to patients with hypochondriasis, as opposed to those with anxiety disorders, has not yet been investigated and is therefore part of the present study. Fifty patients with hypochondriasis, 50 patients with a primary anxiety disorder and 50 healthy participants were presented with nine common bodily sensations and had to spontaneously attribute possible causes to the symptoms. Patients with hypochondriasis differed from patients with anxiety disorders and healthy controls in giving significantly fewer normalizing explanations, but attributing more often in terms of moderate or serious diseases. Patients with anxiety disorders also made significantly fewer normalizing attributions and more somatic attributions to a severe illness than healthy controls. There were no differences between the groups in the frequency of psychological attributions and somatic attributions concerning mild diseases. The present study demonstrates that hypochondriasis is associated with a disorder‐specific attribution style connecting somatic symptoms primarily with moderate and serious diseases. By contrast, normalizing attributions are largely omitted from consideration by patients with hypochondriasis. The findings conform with the cognitive conception of hypochondriasis and support the strategy of modifying symptom attributions, as practiced in cognitive–behavioural therapy. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Patients with hypochondriasis show a disorder‐specific attribution style, which is biased towards moderate and serious diseases.This finding stresses the importance of therapeutic interventions challenging dysfunctional symptom attributions.In addition to attributions in terms of moderate and serious diseases, patients with hypochondriasis also produce constructive attributions (normalizing, psychological or in terms of mild illnesses).Therefore, particular emphasis should be placed on a comprehensive exploration of all existing symptom attributions. By identifying beneficial attributions already in existence, the patient's resources are brought into focus and form the basis for reattribution training.
    October 09, 2013   doi: 10.1002/cpp.1871   open full text
  • ‘I Divide Life into Different Dimensions, one Mental and one Physical, to be Able to Handle Life, you Know?’ Subjective Accounts of the Content of Psychotic Symptoms.
    Jennifer Strand, Elisabeth Olin, Inga Tidefors.
    Clinical Psychology & Psychotherapy. October 04, 2013
    Background Previous research indicates that the content of psychotic symptoms is of significant importance for the individual who experiences them. However, there are limitations concerning the use of self‐report instruments for capturing experiences that are of highly personal nature. The aim of this study was to provide a deeper understanding of how individuals with psychosis make sense of the content of their psychotic symptoms. Method Semi‐structured interviews were conducted with 12 individuals, some of whom were experiencing active symptoms and some of whom had experienced symptoms within the last 12 months. The interviews explored the individuals' understanding of psychotic symptoms in terms of the content and the possible meaning of the content. All participants were patients at a unit specializing in psychosis. The study applied interpretive phenomenological analyses to highlight the subjective understanding of the content of psychotic symptoms. Results Interpersonal experiences were a consistent theme in participants' understanding of the content of their psychotic symptoms. Grandiose content was understood as being related to lack of relationships and helplessness, whereas harassing content was related to experiences of being abused. Commanding content was linked to emotional consequences of intrusive relationships and to distressing life events. Supportive content was viewed as a substitute for real‐life persons. Conclusions These results support previous findings suggesting that the content of psychotic symptoms is related to interpersonal experiences. The study highlights the importance of validating the patient's own knowledge and interpretations of symptoms. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message All participants related a meaning to the content of their psychotic symptoms. The participants generally linked the content of their symptoms to an absence of relationships or to relationships that were described as abusive or intrusive. Participants who described the symptom content as helpful did not express a wish to be rid of these symptoms. The interpersonal references for explaining symptoms support the use of therapeutic interventions that understand psychotic symptoms as reflections of real‐life experiences and relationships.
    October 04, 2013   doi: 10.1002/cpp.1872   open full text
  • Patterns of Change in Different Phases of Outpatient Psychotherapy: A Stage‐Sequential Pattern Analysis of Change in Session Reports.
    Julian Rubel, Wolfgang Lutz, Dietmar Schulte.
    Clinical Psychology & Psychotherapy. October 02, 2013
    Knowledge about typical change patterns of psychotherapy patients can help to improve treatment guidelines for psychological disorders. Recent studies showed that it is possible to identify several patient subgroups with regard to their early change pattern. However, although focusing on the early phase of treatment, change patterns in later stages have hardly been investigated yet. In this study, Growth Mixture Modelling was used to identify latent change classes in different phases of therapy in a naturalistic sample of 1229 psychotherapy outpatients. Furthermore, this paper inquired into the relation between the change patterns in different phases as well as their predictive power for therapy length and outcome. Results revealed different change patterns for the three investigated phases. While in an early treatment phase, (sessions one–six) five different change patterns could be identified: the number of change classes decreased considerably over time, resulting in three patterns in the second (sessions 7–12) and two in the third phase (sessions 13–18). In each phase, by far, the biggest class showed a pattern of good progress with small/no further improvements. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Messages Most change in patients' progress estimates took place in an early phase of the treatment and levelled out on a relatively high level in later phases of the treatment. Substantial improvements were still present in later phases of the treatment but occurred less frequent than in early stages. Continuous outcome monitoring and feedback systems should integrate progress measures to monitor patients progress especially in the early phase of the treatment and feed the so gained information back to therapists.
    October 02, 2013   doi: 10.1002/cpp.1868   open full text
  • Emotion and Self‐Cutting: Narratives of Service Users Referred to a Personality Disorder Service.
    Charlotte Morris, Jane Simpson, Mark Sampson, Frank Beesley.
    Clinical Psychology & Psychotherapy. October 01, 2013
    Theory and existing research suggest that emotion regulation capabilities develop during the formative years. Emotion dysregulation is associated with psychological distress and may contribute towards difficulties such as personality disorder and self‐harm. This study aimed to explore the contexts in which individuals' narratives of emotional experience and self‐harm developed. Eight participants who cut themselves and were seen by a personality disorder service were recruited. Semi‐structured interviews were carried out, and interview transcripts were analysed using a narrative approach. Five temporal themes were generated: ‘Seen and not heard’, ‘A big release … to get rid of all the pain and hurt’, ‘A vicious circle’, ‘A different world’ and ‘Trying to turn my life around’. The findings highlight how early experiences may have led participants to perceive emotions as unacceptable and subsequently suppress emotion in adulthood. Suppression of emotions appeared to be related to appraisals of emotions and to secondary emotional distress. Furthermore, cutting was linked to suppression of emotions as well as negative self‐beliefs formed during childhood and reinforced through subsequent experiences. The study emphasizes the need for therapeutic approaches to focus on emotions when working with individuals who self‐cut. Furthermore, the findings indicate the need for compassionate and validating health services that may help service users develop more optimistic future narratives. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Focusing on emotions in therapy rather than self‐harming behaviour per se may be beneficial for individuals who self‐cut. Encouraging abstinence from cutting, without first helping clients learn emotion regulation skills, may lead to more serious self‐cutting.
    October 01, 2013   doi: 10.1002/cpp.1870   open full text
  • Level and Appraisal of Fatigue are Not Specific in Burnout.
    Arno Van Dam, Ger Keijsers, Marc Verbraak, Paul Eling, Eni Becker.
    Clinical Psychology & Psychotherapy. September 10, 2013
    Fatigue is a main feature of the burnout syndrome but also very common in other psychiatric disorders such as major depression and anxiety disorders. This raises the question of whether the level and appraisal of fatigue is experienced differently by individuals suffering from burnout than by those exhibiting anxiety disorders and major depression. If fatigue is experienced differently in burnout compared with other disorders, this may clarify why fatigue is the main feature of the burnout syndrome. This knowledge may lead to the application of specific therapeutic interventions aimed at the experience of fatigue in burnout. In the present study, we investigated whether fatigue is experienced differently in burnout patients than in patients suffering from anxiety disorders or major depression. We presented 73 burnout patients, 67 depressed patients, 57 patients with an anxiety disorder and 127 healthy participants with a rating scale containing statements about the fatigue–performance relationship, and we assessed the level of fatigue, depression and anxiety. The level of fatigue reported by burnout patients was high but did not differ from that of the other patient groups. The appraisal of fatigue also did not differ among the patient groups. The burnout patients did not appraise their fatigue as a result of unrewarding activities nor did they catastrophize fatigue in an exceptional way. Thus, the level of fatigue and the appraisal of fatigue may be less relevant to the understanding of the specific pathological processes associated with burnout than is often presumed. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message The level of fatigue and the appraisal of fatigue in burnout patients do not differ from those reported in patients with major depression or anxiety disorders ,and may therefore, not be relevant to the understanding of the specific pathological processes associated with burnout. General level of fatigue appeared to predict worrying about fatigue and fear of social rejection, regardless of diagnosis. Fatigue is a feature of several psychiatric disorders. Understanding fatigue may help to gain insight into pathological processes underlying a range of disorders.
    September 10, 2013   doi: 10.1002/cpp.1869   open full text
  • Reading Group Rehabilitation for Patients with Psychosis: A Randomized Controlled Study.
    Umberto Volpe, Fabiana Torre, Valeria De Santis, Francesco Perris, Francesco Catapano.
    Clinical Psychology & Psychotherapy. September 09, 2013
    Objective Group reading activities are often reported to be helpful in a variety of psychiatric conditions. However, data on the effects of structured reading rehabilitation activities, in both hospital and community settings for patients with psychosis, are still scarce. Our aim was to investigate the effects on clinical status, disability, psychosocial functioning and cognitive functioning of a structured group reading activity, in a sample of hospitalized patients with psychosis. Methods We enrolled 41 consecutive patients with psychosis and randomly assigned them to a structured group reading programme. For all included patients, we psychometrically evaluated clinical symptomatology, psychosocial functioning and disability, as well as cognitive functioning. All evaluations were repeated at a 6‐month follow‐up. Repeated‐measure multiple analyses of variance were used to test the effect of the group reading activities on the clinical, psychosocial and cognitive measures. Results We found that, after 6 months from discharge, structured group reading activities induced a statistically significant improvement of cognitive (p < 0.007) and psychosocial (p < 0.008) functioning in patients with psychosis and reduced their disability (p < 0.005), with respect to the control group. Furthermore, such programmes are easy to implement and were perceived as extremely ‘interesting’ and ‘useful’ by patients with psychosis. Conclusions Rehabilitation programmes focusing on group reading activities should be regarded as a valid psychosocial rehabilitation tool for psychotic patients with severe mental disability. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message A structured group reading programme induced a significant symptomatological cognitive and psychosocial amelioration in hospitalized patients with psychosis. The improvement was sustained also at the 6‐month follow‐up, with respect to the control group. Structured group reading activities are perceived, by severely ill psychiatric patients, as highly useful, interesting and pleasant, while they are relatively easy to implement.
    September 09, 2013   doi: 10.1002/cpp.1867   open full text
  • Length of Stay of Inpatients with Eating Disorders.
    Jane Morris, Ashley V. Simpson, Steven James Voy.
    Clinical Psychology & Psychotherapy. September 03, 2013
    Introduction Inpatient treatment for eating disorders is a scarce, expensive resource. We aimed to examine length of stay (LOS) in specialist Scottish inpatient units and to identify relationships between LOS, outcome measures and other factors. Method Audit of 206 admissions (89 adolescents and 117 adults) between 2009 and 2011 to all seven inpatient units in Scotland that specialize in the treatment of eating disorders. Data was collected retrospectively from electronic database and patient case files. Results Physical and psychological eating disorder symptoms improved significantly during specialist inpatient admissions. Mean LOS for adolescents was 141.4 days and for adults 113.0 days. Patients gained weight during admission and increased LOS correlated with increased weight gain. Treatment under the Mental Health Act or with nasogastric feeding increased LOS in adolescents. Conclusion Future efforts should be invested in prospective studies, including several years' post‐discharge follow‐up, to explore correlations with LOS and guide treatment decisions. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Inpatient treatment in specialist eating disorder units is associated with nutritional and psychological benefits in adults and adolescents. Treatment requiring legal detention or nasogastric feeding involves longer admission. Further research is needed to see whether benefits are lasting.
    September 03, 2013   doi: 10.1002/cpp.1865   open full text
  • Are Young People Hospitalised with Psychosis Interested in Psychological Therapy?
    Deborah Mitchison, Simon Jakes, Siobhan Kelly, John Rhodes.
    Clinical Psychology & Psychotherapy. August 27, 2013
    Objectives Psychotic clients may be difficult to engage in psychological therapy, and many potential participants decline to participate in controlled trials of cognitive behavioural therapy. The aim of this study was to investigate psychotic patients' perspectives regarding therapy. Design The design was qualitative and used thematic analysis to investigate emerging themes. Methods A total of 46 inpatients with psychosis were interviewed about their views on therapy. Interview summaries were submitted to thematic analysis. Results A total of 41% of participants were rated as interested, 36% were rated as not interested and 23% appeared ambivalent, or their interest in therapy was unable to be assessed. Themes related to interest in therapy included the desire to build skills, to address (usually non‐psychotic) symptoms and for a therapeutic relationship. Themes related to not wanting therapy included a denial of psychological problems, distrust in the healthcare system and psychologists and low perceived efficacy in therapy. Conclusions A large minority of psychotic patients may be interested in therapy, although mostly not to address psychotic symptoms. Future research on pre‐treatment approaches to disconfirm negative perceptions and increase interest in therapy is warranted. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message The reasons why some patients with psychosis are not interested in receiving psychological therapy may relate to past negative experiences with psychologists, negative perceptions of psychologists as a group and low perceived efficacy of therapy. These barriers may be addressed through interactions with psychotic patients during an admission to a hospital that disconfirms these perceptions and provides a positive alternative experience with a psychologist. Patients who are hospitalized with psychosis may be interested in receiving psychological therapy; however, the reason for this likely will not be to address psychotic symptoms. Rather, the therapist should be willing to work with the patient on a range of other presenting problems. If a patient has a lack of insight into their psychotic symptoms, this does not always negate them from perceiving other psychological problems for which they may desire support in addressing. Thus, therapists should be encouraged to approach all psychotic patients on a ward, even when there is an apparent lack of awareness of their psychotic symptoms. The themes related to patients' perspectives were generated from psychologists' summaries of interviews with patients and not directly from verbatim transcripts. Although this meant that the reasons given for participants being interested or not interested in therapy were interpreted by the psychologist, efforts were made to relate the exact reasons provided by the participants. Eighteen (29%) of the potential participants were not interviewed, usually as a result of their being discharged or transferred prior to arrangement of an interview. This meant we were unable to capture the views of these patients. Discharge prior to being seen by a psychologist is a barrier to engaging a patient in therapy and preventing them falling through the gaps of service provision.
    August 27, 2013   doi: 10.1002/cpp.1864   open full text
  • mHealth: A Mechanism to Deliver More Accessible, More Effective Mental Health Care.
    Matthew Price, Erica K. Yuen, Elizabeth M. Goetter, James D. Herbert, Evan M. Forman, Ron Acierno, Kenneth J. Ruggiero.
    Clinical Psychology & Psychotherapy. August 05, 2013
    The increased popularity and functionality of mobile devices has a number of implications for the delivery of mental health services. Effective use of mobile applications has the potential to (a) increase access to evidence‐based care; (b) better inform consumers of care and more actively engage them in treatment; (c) increase the use of evidence‐based practices; and (d) enhance care after formal treatment has concluded. The current paper presents an overview of the many potential uses of mobile applications as a means to facilitate ongoing care at various stages of treatment. Examples of current mobile applications in behavioural treatment and research are described, and the implications of such uses are discussed. Finally, we provide recommendations for methods to include mobile applications into current treatment and outline future directions for evaluation. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Mobile devices are becoming increasingly common among the adult population and have tremendous potential to advance clinical care. Mobile applications have the potential to enhance clinical care at stages of treatment—from engaging patients in clinical care to facilitating adherence to practices and in maintaining treatment gains. Research is needed to validate the efficacy and effectiveness of mobile applications in clinical practice. Research on such devices must incorporate assessments of usability and adherence in addition to their incremental benefit to treatment.
    August 05, 2013   doi: 10.1002/cpp.1855   open full text
  • Determinants of Health and Disability in Ageing Population: The COURAGE in Europe Project (Collaborative Research on Ageing in Europe).
    Matilde Leonardi, Somnath Chatterji, Seppo Koskinen, Jose Luis Ayuso‐Mateos, Josep Maria Haro, Giovanni Frisoni, Lucilla Frattura, Andrea Martinuzzi, Beata Tobiasz‐Adamczyk, Michal Gmurek, Ramon Serrano, Carla Finocchiaro,.
    Clinical Psychology & Psychotherapy. July 24, 2013
    COURAGE in Europe was a 3‐year project involving 12 partners from four European countries and the World Health Organization. It was inspired by the pressing need to integrate international studies on disability and ageing in light of an innovative perspective based on a validated data‐collection protocol. COURAGE in Europe Project collected data on the determinants of health and disability in an ageing population, with specific tools for the evaluation of the role of the built environment and social networks on health, disability, quality of life and well‐being. The main survey was conducted by partners in Finland, Poland and Spain where the survey has been administered to a sample of 10 800 persons, which was completed in March 2012. The newly developed and validated COURAGE Protocol for Ageing Studies has proven to be a valid tool for collecting comparable data in ageing population, and the COURAGE in Europe Project has created valid and reliable scientific evidence, demonstrating cross‐country comparability, for disability and ageing research and policy development. It is therefore recommended that future studies exploring determinants of health and disability in ageing use the COURAGE‐derived methodology. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message COURAGE in Europe Project collected data on the determinants of health and disability in an ageing population, with specific tools for the evaluation of the role of built environment and social networks on health, disability quality of life and well‐being. The COURAGE Protocol for Ageing Studies has proven to be a valid tool for collecting comparable data in the ageing population. The COURAGE in Europe Consortium recommends that future studies exploring determinants of health and disability in ageing use COURAGE‐derived methodology.
    July 24, 2013   doi: 10.1002/cpp.1856   open full text
  • Memories of Shame Experiences with Others and Depression Symptoms: The Mediating Role of Experiential Avoidance.
    Sérgio Carvalho, Alexandra Dinis, José Pinto‐Gouveia, Cátia Estanqueiro.
    Clinical Psychology & Psychotherapy. July 23, 2013
    Background Shame experiences have been suggested to be related with psychopathological symptoms and with self‐relevant beliefs. Recent studies also suggest that avoidant‐focused strategies (e.g., rumination, thought suppression and dissociation) mediate the impact of shame memories and depression symptoms. However, experiential avoidance has been found to mediate the relation between early experience of abuse and psychopathological symptoms. Our goal was to test the mediating effect of experiential avoidance in the relation between both the nature of shame experiences at the hands of caregivers and the centrality of shame memories with others, and depression symptoms. Method Using structural equation modelling, we assessed the frequency and nature of recalled shame experiences at the hands of caregivers, the centrality of shame experiences with others throughout childhood and adolescence, experiential avoidance and depression symptomatology in 161 participants from general population. Results Experiential avoidance mediates the impact of shame experiences with caregivers and depression symptoms. Experiential avoidance also mediated the association between the centrality of shame experiences with others and depression symptoms. Conclusion Our results suggest that shame memories with others do not per se impact on depression symptoms, but rather the unwillingness to experience them and the attempts to control them. Hence, our results emphasize the importance of addressing affect regulation processes such as avoidance when dealing with shame memories, particularly with patients who experience depression symptoms. Key Practitioner Message The recall of shame experiences with caregivers is associated with the experience of depression symptoms, even when these experiences are not perceived as central points to one's life identity and story. This seems to suggest a necessity to explore these experiences in a therapeutic setting. Our findings suggest that experiential avoidance is a key process through which these memories of shame experiences impact on depression symptomatology. Hence, it seems to be of great importance to reduce experiential avoidance and help people change the way they relate with these memories.Copyright © 2013 John Wiley & Sons, Ltd.
    July 23, 2013   doi: 10.1002/cpp.1862   open full text
  • Mapping SAGE questionnaire to the International Classification of Functioning, Disability and Health (ICF).
    Alberto Raggi, Rui Quintas, Emanuela Russo, Andrea Martinuzzi, Daniela Costardi, Giovanni Battista Frisoni, Maria Grazia Franco, Alessandra Andreotti, Matti Ojala, Sebastián Peña, Jaime Perales, Somnath Chatterji, Marta Miret, Beata Tobiasz‐Adamczyk, Seppo Koskinen, Lucilla Frattura, Matilde Leonardi.
    Clinical Psychology & Psychotherapy. July 17, 2013
    The collaborative research on ageing in Europe protocol was based on that of the World Health Organization Study on global AGEing and adult health (SAGE) project that investigated the relationship between health and well‐being and provided a set of instruments that can be used across countries to monitor health and health‐related outcomes of older populations as well as the strategies for addressing issues concerning the ageing process. To evaluate the degree to which SAGE protocol covered the spectrum of disability given the scope of the World Health Organization International Classification of Functioning, Disability and Health (ICF), a mapping exercise was performed with SAGE protocol. Results show that the SAGE protocol covers ICF domains in a non‐uniform way, with environmental factors categories being underrepresented, whereas mental, cardiovascular, sensory functions and mobility were overrepresented. To overcome this partial coverage of ICF functioning categories, new assessment instruments have been developed. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Mapping exercises are valid procedures to understand the extent to which a survey protocol covers the spectrum of functioning. The mapping exercise with SAGE protocol shows that it provides only a partial representation of body functions and activities and participation domains, and the coverage of environmental factors is poor. New instruments are therefore needed for researchers to properly understand the health and disability of ageing populations.
    July 17, 2013   doi: 10.1002/cpp.1857   open full text
  • Therapists' Professional and Personal Characteristics as Predictors of Working Alliance in Short‐Term and Long‐Term Psychotherapies.
    Erkki Heinonen, Olavi Lindfors, Tommi Härkänen, Esa Virtala, Tuija Jääskeläinen, Paul Knekt.
    Clinical Psychology & Psychotherapy. June 28, 2013
    To investigate the determinants of the therapeutic working relationship and better understand its intrapersonal and interpersonal nature, this study investigated therapist characteristics as predictors of the formation and development of patient‐rated and therapist‐rated working alliances within a clinical trial of short‐term versus long‐term therapies. Short‐term (solution‐focused and short‐term psychodynamic) and long‐term (long‐term psychodynamic therapy and psychoanalysis) therapies were provided by 70 volunteering, experienced therapists to 333 patients suffering from depressive and/or anxiety disorders. Therapists' professional and personal characteristics, measured prior to the start of the treatments, were assessed with the comprehensive self‐report instrument, Development of Psychotherapists Common Core Questionnaire. The Working Alliance Inventory was rated by both therapists and patients at the third session and at the 7 months' follow‐up point from the initiation of therapy. Therapists' self‐rated basic interpersonal skills were found to predict the formation of better patient‐rated alliances in both short‐term and long‐term therapies. Engaging, encouraging relational style fostered improvement of patients' working alliances especially in the course of short‐term therapies. However, it led to patient alliance deterioration in long‐term therapies, where constructive coping techniques proved more beneficial. Therapists' professional self‐confidence and work enjoyment, along with their self‐experiences in personal life, consistently predicted their alliances, but were less salient for patient ratings of alliance. The divergence of therapist and patient viewpoints has implications for therapist training and supervision, as characteristics found detrimental or helpful for the working relationship rated from the perspective of one party may not be predictive of the other therapy participant's experience. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message In both short‐term and long‐term therapies, patients form more positively evaluated working alliances with those therapists who experience their overall basic relational skills as better. However, as patients' experience of alliance also develops during the course of therapy, it seems that briefer treatments may benefit more from a therapist's engaging and affirming relational style than long‐term therapy.Practitioners' professional lack of confidence and enjoyment in therapy work predict poorer working alliances as rated by themselves, but therapists generally seem to be able to contain these difficult experiences, so that they do not predict worse patient‐rated alliances.Therapists' self‐experiences in their close personal relationships, such as how open, forceful or private they experience themselves, predict how they will experience the working relationships with their patients.Practitioners should be aware that how they evaluate their working relationships with specific patients may be notably influenced by their overall experiences of their professional and private selves and also that many of these self‐experienced qualities have less strong or direct bearing on their patients' experiences.
    June 28, 2013   doi: 10.1002/cpp.1852   open full text
  • The Applicability of a Seminal Professional Development Theory to Creative Arts Therapies Students.
    Hod Orkibi.
    Clinical Psychology & Psychotherapy. June 03, 2013
    The purpose of this mixed‐methods study was to test the extent to which a seminal theory of the professional development of counsellors and therapists is applicable to the particular experiences of creative arts therapies graduate students who learn how to use the arts in psychotherapy. Nevertheless, readers may consider the results of the present study transferable to other healthcare disciplines. Questionnaires for each developmental phase were used for data collection, and analysis included data quantification, assessment of inter‐rater agreement and theory derivation procedure. Results indicate that creative arts therapies students were concerned about translating theory into practice, learning how experienced therapists concretely function in practice, and reducing cognitive dissonance upon realization that their pre‐training lay conceptions of helping were no longer valid. Stress and anxiety drove students to adopt easily mastered techniques that were implemented creatively in practicum. The results confirm that students who were older and had undergraduate human‐service education and/or considerable life experience were less concerned about their suitability to the profession, were more acquainted with a professional working style and searched for their individual way of becoming therapists. Finally, recommendations for future research are suggested, and implications for practice are offered. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message The study tested the applicability of a seminal theory of the professional development of counsellors and therapists to creative arts therapies students.Students were concerned about reducing cognitive dissonance upon realization that their pre‐training lay conceptions of helping were no longer valid.Stress and anxiety drove students to adopt easily mastered techniques that were implemented creatively in practicum.Older students, with previous human‐service education or considerable life experience, were more certain about their suitability to the profession.
    June 03, 2013   doi: 10.1002/cpp.1851   open full text
  • Mindfulness‐based Narrative Therapy for Depression in Cancer Patients.
    B. Rodríguez Vega, C. Bayón Pérez, A. PalaoTarrero, A. Fernández Liria.
    Clinical Psychology & Psychotherapy. May 28, 2013
    Mindfulness‐based narrative therapy (MBNT) is a therapeutic intervention for the treatment of depression in cancer patients. In a previous randomized controlled trial, MBNT was found to ameliorate anxiety and depression, improve functional dimensions of quality of life, and enhance treatment adherence. In this review, we describe MBNT and its technical characteristics in the context of other psychotherapeutic interventions for depression in cancer patients. We highlight needed adjustments to other narrative approaches and recommend clinical modifications tailored to the needs of cancer patients that are intended to encompass the client's initial depressive narrative. The narrative construction is supported by emotional regulation and attachment relationships on the one hand and by individual and social linguistic capabilities on the other. Through destabilization of the depressive narrative, MBNT facilitates the emergence of new meanings using both verbal and non‐verbal techniques based on mindfulness. The attitude and practice of mindfulness are integrated throughout the therapeutic process. In summary, MBNT makes use of linguistic interventions, promotes mindfulness and emotional regulation, and can be adapted specifically for use with cancer patients. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message In this review, we describe mindfulness‐based narrative therapy (MBNT) for the treatment of depression in cancer patients.In a previous controlled trial, we found significant benefits of MBNT in terms of reducing depressive symptoms and improving treatment adherence and quality of life in depressed, non‐metastatic cancer patients.Narrative construction is socially and neurobiologically derived.MBNT makes use of linguistic interventions, promotes mindfulness and emotional regulation, and can be adapted specifically for use with cancer patients.MBNT is proposed as an interesting and promising intervention, particularly for patients with somatic pathologies.
    May 28, 2013   doi: 10.1002/cpp.1847   open full text
  • Physical and Mental Health, Anxiety and Depressive Symptoms in Caregivers of Patients in Vegetative State and Minimally Conscious State.
    M. Pagani, A. M. Giovannetti, V. Covelli, D. Sattin, A. Raggi, M. Leonardi.
    Clinical Psychology & Psychotherapy. May 26, 2013
    Caregivers of patients in vegetative state and minimally conscious state play a crucial role in the process of taking care and, as previous studies reported, they can suffer of high burden and negative health outcomes. The aim of this national cross‐sectional study was to assess whether physical and mental health of caregivers, considering gender differences, is related to the presence of depressive symptoms, anxiety, age and patient's disease duration. Four‐hundred and eighteen caregivers, 294 women and 124 men, completed the State Trait Anxiety Inventory‐Y, Beck Depression Inventory, second version and Short Form‐12. Hierarchical multiple regression analyses were performed to evaluate to which extent depressive and anxiety symptoms predict physical and mental health. Men reported higher levels of mental health state, whereas physical health was not different across gender. High levels of anxiety symptoms were associated to negative mental health outcomes in both genders, whereas depressive symptoms were found to impact on female's mental and physical health only. A comprehensive and cost‐effective screening of anxiety and depressive symptoms may help to identify determinants of health worsening in order to plan, when necessary, caregivers' support. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Messages Female caregivers of patients in vegetative state and minimally conscious state have poorer levels of mental health, whereas physical health is similar to men's.Anxiety symptoms are related to negative mental health outcomes in both male and female caregivers, whereas depressive symptoms are found to impact on female mental and physical health only.It is essential to consider and assess depressive and anxiety symptoms as they may contribute to caregivers' health worsening. This knowledge can lead to plan more comprehensive and tailored caregivers' supports and a better care for patients.
    May 26, 2013   doi: 10.1002/cpp.1848   open full text
  • A Clinical Treatment Intervention for Dysphoria: Externalizing Metaphors Therapy.
    Everett McGuinty, David Armstrong, Anne‐Marie Carrière.
    Clinical Psychology & Psychotherapy. May 20, 2013
    The purpose of this article is to explore a novel, short‐term treatment intervention for internalizing behaviours. This intervention is primarily based upon an externalizing process, transforming of metaphoric imagery, and shifting of underlying maladaptive emotional schemas. This article addresses the clinical population of children and youth, specifically through outlining the protocol, externalizing metaphors therapy. A selective review of significant works regarding the efficacy of short‐term therapy was conducted, including the process of change within narrative therapy. It is proposed that two specific processes account for the mental health change experienced by clients who receive this new treatment intervention: (1) externalization of problems and (2) purposeful client‐generated metaphor manipulation, impacting upon underlying schemas. From these theoretical constructs, the present article outlines a three‐session treatment protocol that manualizes these key clinical processes. A case study is presented to illustrate this intervention for anxiety and depression. Further clinical research is underway to address the testable hypotheses resulting from the current theoretical model. Clinical trials in brief psychotherapy are suggested to empirically evaluate the efficacy of this new treatment intervention for dysphoria. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message This article outlines a short‐term treatment intervention for anxiety and depression (dysphoira) through a novel 3‐session model, where the clinician‐practitioner can obtain competency through a one‐day workshop. Its relevance for the clinical researcher and the mental health community is in its versatility in addressing internalizing behavior for four clinical populations: (1) children and adolescents; (2) children and adolescents on the autism spectrum; (3) adults in general; and, (4) adults with a dual‐diagnosis. The treatment protocol described within is based upon the externalizing and deconstructive properties of Narrative Therapy, and the transformation of metaphoric imagery of Metaphor Therapy; both of which have little empirical support with narrative practices gaining international attention and widespread usage ‐ through brief therapy, long‐term therapy, and walk‐in clinics in North America. For the first time, the theoretical constructs of the 3‐session model are described and a case example illustrates the interlinking concepts.
    May 20, 2013   doi: 10.1002/cpp.1844   open full text
  • Clinical Psychologists' Views of Intensive Interaction as an Intervention in Learning Disability Services.
    Ruth Berry, Graham Firth, Catherine Leeming, Vishal Sharma.
    Clinical Psychology & Psychotherapy. May 20, 2013
    Intensive Interaction was initially developed in the 1980s as an educational approach for developing social communication and engagement with people with severe or profound intellectual disabilities and/or autism. Intensive Interaction has subsequently been adopted by a range of practitioners and professionals working in learning disability services and has a broad multi‐disciplinary acceptance, being recommended in a number of UK governmental guidance documents. Despite this, there has been limited work on developing a deeper psychological understanding of the approach. This study utilises a qualitative description/thematic analysis approach to explore how clinical psychologists conceptualise the approach with regard to currently accepted psychological theories, as well as looking at other factors that influence their adoption and advocacy. The sample deliberately consisted of eight NHS (National Health Service) clinical psychologists known to be using or advocating the use of Intensive Interaction with people with a learning disability. The results of this study indicate that although the participants referred to some theories that might explain the beneficial outcomes of Intensive Interaction, these theories were rarely explicitly or clearly referenced, resulting in the authors having to attribute specific theoretical positions on the basis of inductive analysis of the participants' responses. Moreover, the participants provided varying views on how Intensive Interaction might be conceptualised, highlighting the lack of a generally accepted, psychologically framed definition of the approach. In conclusion, it was felt that further research is required to develop a specifically psychological understanding of Intensive Interaction alongside the formation of a Special Interest Group, which might have this task as one of its aims. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Messages There appeared to be a limited recognition amongst the participants of the specific psychological theories that can be seen to explain the beneficial outcomes of Intensive Interaction. The participants were found to differ in how they explained the approach and typically used everyday ‘non‐psychological’ language or individual concepts/terms rather than clearly or extensively referencing particular theoretical models. The participants appeared to differ in the range of clients who they thought might benefit from Intensive Interaction. An Intensive Interaction Special Interest Group, which includes clinical psychologists, should be set up to instigate psychologically informed theory development and research with the broader aims of fostering greater understanding and adoption of Intensive Interaction within services for people with severe or profound intellectual disabilities and/or autism.
    May 20, 2013   doi: 10.1002/cpp.1846   open full text
  • Psychodynamic Therapy from the Perspective of Self‐organization. A Concept of Change and a Methodological Approach for Empirical Examination.
    Antje Gumz, Michael Geyer, Elmar Brähler.
    Clinical Psychology & Psychotherapy. May 06, 2013
    Observations from therapeutic practice and a series of empirical findings, for example, those on discontinuous change in psychotherapeutic processes, suggest modelling the therapeutic process as a self‐organizing system with stable and critical instable phases and abrupt transitions. Here, a concept of psychotherapeutic change is presented that applies self‐organization theory to psychodynamic principles. The authors explain the observations and considerations that form the basis of the concept and present some connections with existing findings and concepts. On the basis of this model, they generated two hypotheses regarding the co‐occurrence of instability and discontinuous change and the degree of synchrony between the therapist and patient. A study design to test these hypotheses was developed and applied to a single case (psychodynamic therapy). After each session, patient and therapist rated their interaction. A measure of instability was calculated across the resulting time series. Sequences of destabilization were observed. On the basis of points of extreme instability, the process was divided into phases. Local instability maxima were accompanied by significant discontinuous change. Destabilization was highly synchronous in therapist and patient ratings. The authors discussed the concept and the methodological procedure. The approach enables the operationalization of crises and to empirically assess the significance of critical phases and developments within the therapeutic relationship. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message We present a concept of change that applies self‐organization theory to psychodynamic therapy. We empirically tested the hypotheses formulated in the concept based on an extract of 125 long‐term psychodynamic therapy sessions. We continuously monitored the therapeutic interaction and calculated a measure of the instability of the assessments. We identified several sequences of stable and unstable episodes. Episodes of high instability were accompanied by discontinuous change. On the basis of these episodes of high instability, we divided the process into four phases. Mean values of variables differed across these phases. Destabilization proved to be highly synchronous in therapist and patient ratings. The approach allows to empirically assess critical phases and developments within the therapeutic relationship.
    May 06, 2013   doi: 10.1002/cpp.1840   open full text
  • Incompleteness as a Link between Obsessive–Compulsive Personality Traits and Specific Symptom Dimensions of Obsessive–Compulsive Disorder.
    Willi Ecker, Jochen Kupfer, Sascha Gönner.
    Clinical Psychology & Psychotherapy. May 06, 2013
    This paper examines the contribution of incompleteness/‘not just right experiences’ (NJREs) to an understanding of the relationship between obsessive–compulsive disorder (OCD) and obsessive–compulsive personality traits (OCPTs). It investigates the association of specific OCD symptom dimensions with OCPTs, conceptualized as continuous phenomena that are also observable below the diagnostic threshold. As empirical findings and clinical observation suggest that incompleteness feelings/NJREs may play a significant affective and motivational role for certain OCD subtypes, but also for patients with accentuated OCPTs, we hypothesized that OCPTs are selectively linked with incompleteness‐associated OCD symptom dimensions (ordering, checking, hoarding and counting). Moreover, we assumed that this selective relationship cannot be demonstrated any more after statistical control of incompleteness, whereas it is preserved after statistical control of anxiety, depression, pathological worry and harm avoidance. Results from a study with a large clinical sample (n = 185) partially support these hypotheses and suggest that NJREs may be an important connecting link between specific OCD symptom dimensions, in particular ordering and checking, and accentuated OCPTs. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Obsessive–compulsive personality traits (OCPTs) are positively related to obsessive–compulsive disorder symptom dimensions (ordering, checking, hoarding and counting) hypothesized or found to be associated with incompleteness/‘not just right experiences’ (NJREs), but not to washing and obsessions. This positive relationship, which is strongest for ordering and checking, is eliminated when NJREs are statistically controlled. Ordering, checking and accentuated OCPTs may share NJREs as a common affective‐motivational underpinning. Dysfunctional behaviour patterns of people with accentuated OCPTs or obsessive–compulsive personality disorder (OCPD) may be viewed as efforts to avoid or reduce subjectively intolerable NJREs. On the basis of such a conceptualization of OCPD as an emotional disorder, a novel treatment approach for OCPD focusing on habituation to NJREs could be developed.
    May 06, 2013   doi: 10.1002/cpp.1842   open full text
  • The Relation Between Antisocial and Borderline Personality Symptoms and Early Maladaptive Schemas in a Treatment Seeking Sample of Male Substance Users.
    Ryan C. Shorey, Scott Anderson, Gregory L. Stuart.
    Clinical Psychology & Psychotherapy. May 06, 2013
    Individuals with substance use disorders are more likely to have antisocial and borderline personality disorder than non‐substance abusers. Recently, research has examined the relations between early maladaptive schemas and personality disorders, as early maladaptive schemas are believed to underlie personality disorders. However, there is a dearth of research on the relations between early maladaptive schemas and personality disorders among individuals seeking treatment for substance abuse. The current study examined the relations among early maladaptive schemas and antisocial and borderline personality within in a sample of men seeking substance abuse treatment (n = 98). Results demonstrated that early maladaptive schema domains were associated with antisocial and borderline personality symptoms. Implications of these findings for substance use treatment and research are discussed. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Antisocial (ASPD) and Borderline (BPD) personality disorder symptoms are prevalence among individuals seeking substance abuse treatment. Early maladaptive schemas are believed to underlie the development of ASPD and BPD symptoms, and are also prevalence among individuals seeking substance use treatment. Findings from the current study suggest that specific early maladaptive schema domains predict ASPD and BPD symptoms in a substance abuse treatment seeking sample of adult males. The treatment of ASPD and BPD among men seeking substance use treatment may want to focus on early maladaptive schemas.
    May 06, 2013   doi: 10.1002/cpp.1843   open full text
  • Adolescents with Anxiety and Depression: Is Social Recovery Relevant?
    Laura M. Simonds, Rebecca A. Pons, Nicola J. Stone, Fiona Warren, Mary John.
    Clinical Psychology & Psychotherapy. May 01, 2013
    Social recovery has become a prominent aspect of mental health service design and delivery in the past decade. Much of the literature on social recovery is derived from first‐person accounts or primary research with adult service users experiencing severe mental illness. There is a lack of both theoretical and empirical work that could inform consideration of how the concept of social recovery might apply to adolescents experiencing common (non‐psychotic) mental health problems such as anxiety and depression. The current study was conducted to understand the process of experiencing anxiety and depression in young people. Semi‐structured interviews were conducted with nine adolescents with anxiety and depression (seven girls and two boys aged 14–16 years) and 12 mothers who were recruited from a specialist Child and Adolescent Mental Health Service in the South of England. Thematic analysis indicated that young people do experience a process of ‘recovery’; the processes participants described have some congruence with the earlier stages of adult recovery models involving biographical disruption and the development of new meanings, in this case of anxiety or depression, and changes in sense of identity. The accounts diverge with regard to later stages of adult models involving the development of hope and responsibility. The findings suggest that services should attend to social isolation and emphasise support for positive aspirations for future selves whilst also attending to young people's and parents' expectations about change. Methodological challenges face enquiry about ‘recovery’ given its connotations with cure in everyday language. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Theoretical and empirical work on social recovery in young people and families is lacking. Using interviews, this study sought to understand the relevance of social recovery for adolescents with anxiety and depression and their mothers. Findings suggest some congruence with the earlier stages of adult recovery models involving meaning and identity. Findings diverge with regard to later stages of adult recovery models involving hope and responsibility. Social recovery in mental health services for young people needs significant empirical attention and critical debate.
    May 01, 2013   doi: 10.1002/cpp.1841   open full text
  • The Protective Role of Self‐compassion in Relation to Psychopathology Symptoms and Quality of Life in Chronic and in Cancer Patients.
    José Pinto‐Gouveia, Cristiana Duarte, Marcela Matos, Sofia Fráguas.
    Clinical Psychology & Psychotherapy. March 25, 2013
    The importance of self‐compassion in the context of medical problems has been highlighted in previous research. Its role in the psychological adjustment of cancer patients, however, has remained unexplored. The current study aimed at examining whether self‐compassion and self‐critical judgement would distinctively predict general psychopathological symptoms and quality of life in three distinct groups: a mixed sample of cancer patients (n = 63), patients with chronic illnesses (n = 68) and healthy subjects (n = 71). Correlation analyses revealed significant associations between lower self‐compassion and increased depressive and stress symptoms, and lower scores in quality of life dimensions in the patients' samples. The opposite correlational pattern was found regarding self‐critical judgement. In the case of healthy subjects, these correlations were weaker or nonsignificant. Regression analyses revealed that in patients with chronic illnesses, self‐critical judgement emerged as the best predictor of depressive and stress symptoms, and quality of life dimensions. In patients with cancer, however, it was the affiliate dimension of self‐compassion that was found to significantly predict lower levels of depressive and stress symptoms, and increased quality of life. These findings have important clinical implications by suggesting the relevance of nurturing a caring and kind relation with oneself in the face of challenging medical conditions, particularly in patients with cancer. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message The link between self‐compassion and psychopathology and quality of life was examined in a mixed sample of cancer patients, in chronic patients, and in healthy subjects. Self‐compassion is associated with decreased psychopathological symptoms of stress and depression, and better quality of life in patients with chronic illnesses, and especially in patients with cancer. Psychological supportive interventions targeting the development of self‐compassionate attributes and skills may have beneficial effects in the psychological adjustment of medically ill patients, namely patients with cancer.
    March 25, 2013   doi: 10.1002/cpp.1838   open full text
  • Clinical Psychologists' Experiences of Reflective Staff Groups in Inpatient Psychiatric Settings: A Mixed Methods Study.
    Cara Heneghan, John Wright, Gilli Watson.
    Clinical Psychology & Psychotherapy. January 28, 2013
    Background Reflective practice groups have been recommended for improving staff wellbeing and team functioning in inpatient psychiatric services, and clinical psychologists have been identified as potential leaders in this type of work. Research is limited with little information about reflective practice group guidelines, prevalence and effectiveness. Aims The aims of this study were to describe clinical psychologists' practice in reflective groups for staff in inpatient psychiatric services and to explore how such groups are conceptualized and implemented. Methods Online questionnaires and follow‐up interviews were used to gain broad descriptions of practice and in‐depth information about participants' experiences. The sample consisted of 73 clinical psychologists working in the UK, six of whom were interviewed. Data were analysed using descriptive statistics, content analysis and thematic analysis. Results Clinical psychologists regularly facilitate reflective staff groups in inpatient psychiatric settings in the UK. Common outcomes related to staff wellbeing, service culture and teamwork. Engagement, group dynamics and lack of management support were common challenges. Group experiences were influenced by the organizational context. Conclusions Clinical psychologists' practices regarding reflective staff groups were in line with recent professional developments. Several difficulties were described, which may be indicative of both a difficulty inherent to the task and a training gap in reflective staff group process. The study had methodological limitations but offers a useful contribution to the literature, and enables practice and training implications to be drawn. The need for further research exploring facilitator characteristics, views of group participants and the impact of reflective staff groups on patients is indicated. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message The term ‘reflective practice group’ encompasses a range of practices, but a typical group structure was found with common aims, outcomes and challenges. Reflective staff groups are regularly facilitated by clinical psychologists in inpatient psychiatric settings in the UK and are influenced by practitioner experience as well as psychodynamic, systemic and group process theories. The safety required for reflective groups to function is influenced by the organizational context, and groups can contribute to shifts in culture toward including psychosocial perspectives. Reflective staff groups represent one type of contribution to an inpatient psychiatric service and team relationships; other processes to encourage alternative professional perspectives and values might also support change. More research is recommended to explore facilitator characteristics, the views of staff teams on reflective staff groups and the impact of these groups on patients.
    January 28, 2013   doi: 10.1002/cpp.1834   open full text
  • From New Vistas to Life Lines: Psychologists' Satisfaction with Supervision and Confidence in Supervising.
    Aisling McMahon, Darina Errity.
    Clinical Psychology & Psychotherapy. January 28, 2013
    This study aimed to provide the first detailed survey of Irish psychologists' supervision practices as well as to identify what is related to satisfaction with supervisory support and to confidence in providing supervision. An online survey was distributed nationwide to Irish psychologists. Participants were mostly clinical and counselling psychologists. Three‐quarters of the participants constituted 51% of the total population of Irish health service psychologists, the remainder working in various non‐health service settings. The results showed that most Irish psychologists attend supervision but at a low frequency, typically once monthly. One‐third were dissatisfied with their supervision, greater satisfaction being related to having more frequent clinical supervision and having external individual clinical supervision. Having a safe and trustworthy relationship with supervisors was a dominant issue, and two‐thirds of psychologists wanted separation of their clinical and line management supervision. Although 70% were supervisors, only 40% were confident in their supervisory skills and just 16% had formal supervisor training. Independent predictors of supervisory confidence were experience as a psychologist, having formal supervisor training, experience as a supervisor and confidence as a therapist. A novel finding was that longer experience of personal therapy was related to greater confidence as a supervisor. This study indicates the need for access to more frequent clinical supervision to be facilitated for psychologists and for there to be clear separation of line management and clinical supervision. It is also essential that more resources are put into training supervisors. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message While most psychologists are engaged in supervision, frequency of attendance is low, with more satisfied psychologists having more frequent supervision. Most psychologists want separation of their clinical and line management supervision and have a preference for external supervision, safe and trustworthy relationships with supervisors being their primary concern. Only 16% of psychologists had formal training in supervision but having such training significantly contributed to greater confidence as a supervisor, indicating an urgent need to provide more supervisor training for psychologists.
    January 28, 2013   doi: 10.1002/cpp.1835   open full text
  • Cognition, Imagery and Coping among Adolescents with Social Anxiety and Phobia: Testing the Clark and Wells Model in the Population.
    Klaus Ranta, Martti T. Tuomisto, Riittakerttu Kaltiala‐Heino, Päivi Rantanen, Mauri Marttunen.
    Clinical Psychology & Psychotherapy. January 24, 2013
    The Clark and Wells' cognitive model of social phobia suggests that self‐focused attention, negative observer‐perspective images of oneself and safety behaviours maintain anxiety in subjects with SP. Empirical research among adults supports the model, but limited evidence for it has been obtained in other age groups or in the general population. We examined automatic thoughts, imagery, safety behaviours and general coping of adolescents with social anxiety and phobia. These were elicited by a thought listing procedure in a recalled, distressing social situation. The target variables were compared between adolescents with high versus normal self‐reported social anxiety (HSA/NSA) and between adolescents with clinical/subclinical SP (SP/SSP) versus no diagnosis. Adolescents with HSA reported overall negative thoughts, negative observer‐perspective images and safety behaviours more frequently than adolescents with NSA. The SP/SSP group displayed the same difference, and clearer, relative to the no diagnosis group, but additionally reported negative thoughts focused more often on self. Minor differences in coping were found between the groups. The study suggests that adolescents with SP already display the negative self‐focused cognitions, observer‐perspective imagery and behavioural pattern found among adults with SP. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Social anxiety associates with observer‐perspective imagery and safety behaviours in adolescence. Adolescents with clinical social phobia report frequent negative self‐focused thoughts. However, such negative cognitions focused on self do not associate to self‐reported social anxiety. The cognitive model of social phobia (Clark & Wells, 1995) is applicable to adolescents.
    January 24, 2013   doi: 10.1002/cpp.1833   open full text
  • Social Rank and Symptom Change in Eating Disorders: A 6‐month Longitudinal Study.
    Nicholas A. Troop, Leanne Andrews, Syd Hiskey, Janet L. Treasure.
    Clinical Psychology & Psychotherapy. January 08, 2013
    Background Following previous cross‐sectional research adopting an evolutionary approach to social rank and eating disorders, the present study explored the predictive value of social rank for changes in eating disorder symptoms in a 6‐month longitudinal study. Methods Seventy‐three women and men with a history of eating disorders were followed up over 6 months. A broad range of measures of social rank were used to determine whether social rank at baseline predicted residual changes in eating disorder symptoms. Results Low social rank (in terms of perceived external entrapment and submissive behaviour) predicted an increase in symptoms of anorexia but not symptoms of bulimia. The predictive value of low social rank was not mediated by changes in depressive symptoms. Conclusion Perceived low rank predicts an increase in anorexic symptoms. However, further research is required to determine the precise nature of how social rank exerts its influence on the development of eating disorder symptoms. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message: Self‐perceived low social rank predicts an increase in anorexic symptoms but not bulimic symptoms. The effect of low social rank on changes in anorexic symptoms was not mediated by changes in depressive symptoms. Interventions for anorexia nervosa may need to incorporate techniques for increasing status and/or self‐compassion.
    January 08, 2013   doi: 10.1002/cpp.1830   open full text
  • Forecasting Success: Patients' Expectations for Improvement and Their Relations to Baseline, Process and Outcome Variables in Group Cognitive–Behavioural Therapy for Depression.
    Michelle Tsai, John S. Ogrodniczuk, Ingrid Sochting, Jamal Mirmiran.
    Clinical Psychology & Psychotherapy. December 19, 2012
    There is growing evidence for the important role of patients' outcome expectations to the process and outcome of psychotherapy, yet its relevance to group cognitive–behavioural therapy (CBT) for depression has not been examined. In an effort to fill this void, the present study investigated expectations for improvement among 80 psychiatric outpatients attending a group CBT program for depression. The study addressed the following four questions: (1) Which baseline patient characteristics might be associated with patients' expectations for improvement? (2) Does providing a rationale and outline for treatment affect patients' expectations? (3) Are patients' expectations related to the quality of therapeutic alliance? and (4) Are patients' expectations associated with the outcome of treatment? The main findings of the study are as follows: (a) baseline symptoms of depression, quality of life and current suicidal ideations were consistently associated with outcome expectancies; (b) outcome expectancies were unrelated to treatment completion status; (c) although expectancy ratings did not change significantly for the group as a whole, there was some variability in how individual patient's expectancy ratings changed; (d) baseline expectancies were related to early‐treatment alliance quality, but not to mid‐treatment alliance, whereas early‐treatment expectancies were significantly associated with mid‐treatment alliance; and (e) baseline expectations of favourable outcome had a negative association with improvement in anxiety symptoms, yet expectancy ratings from session 3 had a positive association with improvement in quality of life and interpersonal problems. Increases in expectancy ratings were significantly related to improvement in anxiety, quality of life and interpersonal problems. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Patients who present in a particularly hopeless and demoralized state are likely to have low expectations for a positive outcome of treatment. Efforts should be made in the first few sessions of therapy to mobilize patients' hope and expectation of success, for increases in one's expectations may facilitate a favourable treatment outcome. An optimistic outlook on the probability of success in treatment may contribute to the development of a strong working relationship between the patient and the therapist.
    December 19, 2012   doi: 10.1002/cpp.1831   open full text
  • Observer‐rated Coping Associated with Borderline Personality Disorder: An Exploratory Study.
    Ueli Kramer.
    Clinical Psychology & Psychotherapy. December 19, 2012
    BackgroundLittle is known about coping specificities, as operationalization of the concept of affect regulation, in borderline personality disorder (BPD). It is most important to take into account methodological criticisms addressed to the self‐report questionnaire approach and to compare BPD coping specificities to the ones of neighbouring diagnostic categories, such as bipolar disorder (BD). Sampling and MethodsThe present exploratory study compared the coping profiles of N = 25 patients presenting BPD to those of N = 25 patients presenting BD and to those of N = 25 healthy controls. All participants underwent a clinical interview that was transcribed and rated using the Coping Patterns observer‐rater system. ResultsResults partially confirmed study hypotheses and showed differences between BPD patients and healthy controls in all coping domains (competence, resources and autonomy), whereas the only coping domain presenting a BPD‐specific lack of skills, compared with the BD patients, was autonomy, a set of coping strategies facing stress appraised as challenge. These coping processes were linked to general and BPD symptomatology. ConclusionsThese results extend conclusions of earlier studies on affect regulation processes in BPD and bear important clinical implications, in the context of dialectical behavior therapy and other therapeutic approaches. Limitations of this exploratory study, such as the small sample size, are acknowledged. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Coping can be reliably assessed in the narrative process in an non-structured interview frame. Patients with borderline personality disorder present with a specific lack of skills in affect regulation related to autonomy issues, compared to patients with bipolar disorder and healthy controls. Lack of skills in accommodation to distressing emotions in borderline personality disorder is related to symptom gravity and may be treated using radical acceptance strategies.
    December 19, 2012   doi: 10.1002/cpp.1832   open full text
  • Alternative Caregiving Figures and their Role on Adult Attachment Representations.
    Maria Zaccagnino, Martina Cussino, Rachel Saunders, Deborah Jacobvitz, Fabio Veglia.
    Clinical Psychology & Psychotherapy. December 13, 2012
    BackgroundThe present work represents the first Italian study investigating whether and how mothers who describe unloving experiences with both parents during childhood could become more secure as adults (termed earned‐secures). MethodThe sample consisted of 94 women from northern Italy. All the subjects were administered the Adult Attachment Interview (AAI) and fill in a screening test evaluating depressive symptoms. ResultsNo significative differences were found regarding depressive symptomatology across the different attachment classifications. The majority of the samples (84%) remember an important alternative support figure during childhood (before 12 years old). Earned‐secures significantly differ from continuous‐secure and insecure groups (F = 27.202; p ≤ 0.01) on the amount of the emotional support from the main alternative support figure and on the average amount of emotional support across alternative support figures (F = 10.44; p ≤ 0.01). The majority of alternative support figures (80%) were grandparents. ConclusionsA corrective emotional experience allows the subject to work through his negative childhood experiences and acquire modalities of interaction that enable him/her to function more effectively in the world. The clinical implications of this study will be discussed. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Attachment theory. Clinical implications of attachment experiences. Corrective emotional experience.
    December 13, 2012   doi: 10.1002/cpp.1828   open full text
  • Implementing Evidence‐Based Practice for Patients with Chronic Fatigue Syndrome.
    Jan F. Wiborg, Michel Wensing, Marcia Tummers, Hans Knoop, Gijs Bleijenberg.
    Clinical Psychology & Psychotherapy. December 11, 2012
    The aim of our study was to explore whether community‐based mental health care centres (MHCs) are able to implement and sustain cognitive behaviour therapy (CBT) for chronic fatigue syndrome (CFS) with the help of an implementation manual. We monitored the implementation process and treatment outcome data of three Dutch MHCs that implemented or sustained CBT for CFS, one in the context of a stepped care programme. We compared these data with findings of other treatment studies conducted in the context of CBT for CFS. All three MHCs included at least 40 patients with dropout rates between 15% and 35% from intention‐to‐treat to second assessment. Effect sizes ranged between 0.88 and 1.76 for changes in fatigue severity and 0.43 and 1.23 for changes in physical functioning. With one exception, these outcomes were within the range of our benchmark. Contrary to original expectations, we provided additional implementation support to the two MHCs new with CBT for CFS. We concluded that our implementation manual does not seem to substitute external support for team leaders and associated professions during initial implementation of CBT for CFS but may have the potential to make this assistance more efficient. Particular attention should be paid to challenges of implementing stepped care for CFS. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioners Message: Implementation of CBT for CFS in community‐based MHCs was monitored. External support was provided in addition to an implementation manual during initial implementation of CBT for CFS. Participating MHCs were generally capable of successfully implementing and delivering CBT for CFS. Implementation of low‐intensity interventions for CFS might better be postponed until therapists have sufficient experience with conventional CBT for CFS.
    December 11, 2012   doi: 10.1002/cpp.1827   open full text
  • Supervisee Self‐disclosure: A Clinical Psychology Perspective.
    Nicola Spence, John R. E. Fox, Laura Golding, Anna Daiches.
    Clinical Psychology & Psychotherapy. December 11, 2012
    Clinical supervision is a multi‐functional intervention within numerous psychotherapeutic professions, including clinical psychology. It often relies on supervisees' verbal disclosures of pertinent information. There is limited research on supervisee self‐disclosure in the UK, and none using clinical psychology populations. This study aimed to address the limitations in the evidence base. It used a constructivist grounded theory methodology to investigate qualified UK clinical psychologists' use of self‐disclosure in supervision in order to develop a theoretical understanding of their self‐disclosure processes. Ten clinical psychologists from various time points across the career span were recruited to the study. Four core conceptual categories were identified in the analysis as being integral to participants' decision‐making processes: ‘Setting the Scene’, ‘Supervisory Relationship’, ‘Using Self‐disclosure’ and ‘Reviewing Outcome of Self‐disclosure’. These four categories are comprised of a number of subcategories. The study's findings are compared with the current literature base, and it is argued that there are tensions with the scientist–practitioner model as it could be interpreted to encourage an expert stance, which may limit the self‐disclosure of qualified supervisees. The implications of this perspective are discussed. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message: Supervision is a key process in supporting qualified clinical psychologists and the use of disclosure appears to be important in facilitating useful supervision. It appears that clinical psychologists go through a number of complex processes in deciding whether to self disclose.
    December 11, 2012   doi: 10.1002/cpp.1829   open full text
  • Relationship Between Patient Pre‐treatment Object Relations Functioning and Psychodynamic Techniques Early in Treatment.
    Anthony S. J. Mullin, Mark J. Hilsenroth.
    Clinical Psychology & Psychotherapy. December 06, 2012
    This study explored the relationship between patient pre‐treatment object relations (OR) functioning and psychodynamic techniques employed during two early sessions (third and ninth). The sample consisted of 76 outpatients engaged in short‐term psychodynamic psychotherapy. Results showed that lower levels of patient pre‐treatment OR functioning, particularly in the identity and affective domains, were related to a greater use of psychodynamic–interpersonal techniques in sessions. Patients who had more adaptive management of aggressive impulses were related to a greater use of cognitive–behavioural techniques by therapists. In addition, exploratory analyses between OR functioning and specific psychodynamic–interpersonal and cognitive–behavioural techniques showed that lower OR functioning in terms of affect, self‐esteem, identity coherence, social causality, emotional investment in relationships as well as Global OR were significantly related to therapist focus on avoidance of important topics and affective changes during the session. Implications for clinical practice and Q1 future research are discussed. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message: Consider more frequent use of psychodynamic techniques early in treatment with patients expressing more pathological object representations, particularly when these deficits are in the affective and identity domains. Lower patient object relations functioning may necessitate an in session focus on issues that are avoided or uncomfortable early in treatment. Lower patient object relations functioning may necessitate the need to address and explore labile affective expressions in session as they occur early in treatment. When patients are able to more adaptively express or manage aggressive impulses early within psychodynamic psychotherapy consider the integration of problem solving, goal oriented, future focused (i.e., CB) techniques.
    December 06, 2012   doi: 10.1002/cpp.1826   open full text
  • Personality Disorder Traits and Self‐Reported Target Problems in a Treatment‐Seeking Sample.
    Nick Huband, Chris Evans, Conor Duggan, Omer Khan.
    Clinical Psychology & Psychotherapy. December 06, 2012
    Background Assessments of personality disorder (PD) by clinicians or researchers are not always congruent with the problems that clients view as most salient. This can result in disagreement over areas for change, leading to dissatisfaction and the risk of treatment attrition. Method The sample comprised 141 treatment‐seeking adults with PD. Each described the five things they most wanted to change about themselves. These target problems were compared with PD diagnoses obtained from the International Personality Disorder Examination. Results The congruence between the clients' target problems and PD traits identified by the professionals was generally weak. Disagreement arose where a client's target problem was not a PD trait and, less frequently, where the client and the professional agreed on the presence of a trait but not on its importance. Surprisingly, doubting the trustworthiness of others was the most commonly reported target problem in this treatment‐seeking sample even though many such participants did not qualify for that particular paranoid trait. Conclusion Personality disorder diagnoses were generally poor indicators of the problems these clients cited as most important. This lack of correspondence may explain some of the lack of effectiveness of interventions for PD. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message: The problem that a client with personality disorder (PD) views as most important may only be weakly identified in a formal diagnostic assessment. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, PD traits are insufficient to describe fully the things clients most want to change about themselves. Many clients with PD consider difficulty trusting others to be their most important problem, despite not qualifying for that particular paranoid trait. Risk of disagreement between the clinician and the client might be reduced if both parties can engage in a discussion about the results of any formal diagnostic assessment.
    December 06, 2012   doi: 10.1002/cpp.1825   open full text
  • Emotion Coupling and Regulation in Anorexia Nervosa.
    John R. E. Fox, Emily Smithson, Sarah Baillie, Nuno Ferreira, Ingrid Mayr, Michael J. Power.
    Clinical Psychology & Psychotherapy. November 20, 2012
    Objective The present study sought to investigate emotion regulation strategies in people with anorexia nervosa (AN) and whether the theoretical concept of ‘emotion coupling’ between anger and disgust could help to explain some of the specific eating disorder symptomatology in people with AN. Method This ‘emotion coupling’ hypothesis was tested using a mood induction procedure within laboratory conditions, where individuals with AN (n = 22) were matched with control participants (n = 19). Participants completed a bank of different measures prior to the study, and these included measures of eating pathology, core beliefs about the self and others, and emotion regulation strategies. Within the experimental part of this study, anger, disgust and body size estimation were measured prior to and after an anger induction procedure (i.e., a repeated measures design). Results People with AN demonstrated a significantly more internal‐dysfunctional way to regulate their emotional states, when compared with matched controls. Within the ‘emotional coupling’ part of the study, participants showed a significant increase in levels of disgust and body size estimation following an anger induction when compared with matched controls. Discussion The significance of these results was considered in the light of the new Schematic, Propositional, Analogical and Associative Representation Systems in eating disorders model. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Emotions and emotion processing are problematic for people with anorexia nervosa.Overestimation in body size for people with anorexia nervosa may be due to the coupling of anger and disgust.Clinicians need to consider the importance of automatic cognitive routes of emotion elicitation that may maintain certain eating disorder symptoms, such as poor body image.
    November 20, 2012   doi: 10.1002/cpp.1823   open full text
  • Towards a Taxonomy of Common Factors in Psychotherapy—Results of an Expert Survey.
    Wolfgang Tschacher, Ulrich Martin Junghan, Mario Pfammatter.
    Clinical Psychology & Psychotherapy. November 06, 2012
    Background How change comes about is hotly debated in psychotherapy research. One camp considers 'non‐specific' or 'common factors', shared by different therapy approaches, as essential, whereas researchers of the other camp consider specific techniques as the essential ingredients of change. This controversy, however, suffers from unclear terminology and logical inconsistencies. The Taxonomy Project therefore aims at contributing to the definition and conceptualization of common factors of psychotherapy by analyzing their differential associations to standard techniques. Methods A review identified 22 common factors discussed in psychotherapy research literature. We conducted a survey, in which 68 psychotherapy experts assessed how common factors are implemented by specific techniques. Using hierarchical linear models, we predicted each common factor by techniques and by experts' age, gender and allegiance to a therapy orientation. Results Common factors differed largely in their relevance for technique implementation. Patient engagement, Affective experiencing and Therapeutic alliance were judged most relevant. Common factors also differed with respect to how well they could be explained by the set of techniques. We present detailed profiles of all common factors by the (positively or negatively) associated techniques. There were indications of a biased taxonomy not covering the embodiment of psychotherapy (expressed by body‐centred techniques such as progressive muscle relaxation, biofeedback training and hypnosis). Likewise, common factors did not adequately represent effective psychodynamic and systemic techniques. Conclusion This taxonomic endeavour is a step towards a clarification of important core constructs of psychotherapy. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message This article relates standard techniques of psychotherapy (well known to practising therapists) to the change factors/change mechanisms discussed in psychotherapy theory. It gives a short review of the current debate on the mechanisms by which psychotherapy works. We provide detailed profiles of change mechanisms and how they may be generated by practice techniques.
    November 06, 2012   doi: 10.1002/cpp.1822   open full text
  • Exploring the Psychological Processes Underlying Touch: Lessons from the Alexander Technique.
    T. Jones, L. Glover.
    Clinical Psychology & Psychotherapy. November 06, 2012
    The experience of touch is significant; both in its positive implications and in how it attracts caution and controversy. Accordingly, physical contact within psychological therapy has been shown to improve well‐being and the therapeutic relationship, yet the majority of therapists never or rarely use touch. This research aimed to explore psychological processes underlying touch through the Alexander Technique, a psycho‐physical technique taught one to one using touch. Six individuals who had received the Alexander Technique were interviewed, and 111 completed surveys. Interview data suggested an incompatibility between touch and the spoken word, which was understood through the way touch lacks verbal discourses in our society. The largely simplistic and dichotomous verbal understanding we have (either only very positive or very negative) could help understand some of the societal‐level caution surrounding touch. Touch was seen also as a nurturing experience by interviewees, which influenced inter‐personal and intra‐personal relational processes. Developmental models were used to frame the way touch strengthened the pupil–teacher relationship and the way pupils' intra‐personal psychological change seemed linked to this relational experience. The surveys largely supported these findings, and discussion is made around the notable way pupils negatively interpreted the intention of the survey. Implications for the use of touch in psychological therapies are discussed, as are limitations and ideas for future research. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Touch is a powerful experience, and physical contact within psychological therapy has been shown to improve well‐being and the therapeutic relationship, yet the majority of therapists never or rarely use touch. The AT is an alternative therapeutic approach to psycho‐physical well‐being that offers an interesting model to study the impact of touch. Findings from those that have used the technique reaffirmed that touch can improve well‐being and can be a powerful force in the ‘therapeutic relationship’. Accounts drew strong parallels with developmental experiences, which may be of particular interest to those working psychodynamically. Findings also highlighted the lack of discourses our culture has for touch and how the ones we share can be super‐imposed onto experiences. This should be kept in mind when discussing all types of physical contact with clients. Outcomes from AT pupils cannot be generalized to those seeking psychological support; however, the findings accentuated the power of holistic working. This is important as we begin to understand more around how emotions are held in the body.
    November 06, 2012   doi: 10.1002/cpp.1824   open full text
  • The Interpersonal Circle and the Interpersonal Octagon: A Confluence of Ideas.
    John Birtchnell.
    Clinical Psychology & Psychotherapy. October 17, 2012
    This paper compares and contrasts the underlying principles of two conceptual systems—the interpersonal circle and the interpersonal octagon—for classifying and measuring a person's interpersonal tendencies. Both systems have been represented by two intersecting axes: a horizontal one extending from close/warm involvement to distant/cold separation and a vertical one extending from upper/control to lower/submission. In both systems, intermediate axes have been inserted between these two main ones. Where the circle would appear to be concerned with traits, the octagon is concerned with what have been termed states of relatedness. The two systems differ in their explanation and definition of adaptive and maladaptive relating behaviour. Whereas the circle has been closely aligned with the establishment of a bipolar relationship between the poles of the axes and with the mathematical model that is called the circumplex, the octagon has not. The most widely used circle‐based measure is the circumplex version of the Inventory of Interpersonal Problems. It generates high positive correlations between scales and a large, first general factor, but these imperfections have been corrected by the statistical procedure called ipsatization. The principal octagon‐based measure is the Person's Relating to Others Questionnaire. A number of high positive correlations have been demonstrated between the scales of the Inventory of Interpersonal Problems and the corresponding scales of the Person's Relating to Others Questionnaire. Therefore, despite there being differences in the underlying theories, the two questionnaires would appear to be measuring similar constructs. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message: The interpersonal circle and the interpersonal octagon are two separate theoretical systems for representing a person's relating tendencies. Both systems are constructed around a horizontal, close‐distant axis and a vertical, upper‐lower axis. Both systems acknowledge that relating can be either adaptive or maladaptive, but where the circle incorporates both adaptive and maladaptive forms of relating within the same theoretical structure, there is a separate, adaptive (positive) octagon and and a separate, maladaptive (negative) octagon. Both systems have a questionnaire for the measurement of a person's general relating tendencies, but the octagon-based questionnaire is designed specifically to measure maladaptive (negative) relating. Interrelating concerns the relating that occurs between two specified individuals. Questionnaires have been developed by which each individual can record how, within the framework of the octagon, s/he relates (negatively) to the other and how s/he considers that the other relates (negatively) to her/him. There is no interrelating measure that is based upon the circle.
    October 17, 2012   doi: 10.1002/cpp.1819   open full text
  • Recall of Threat and Submissiveness in Childhood and Psychopathology: The Mediator Effect of Self‐Criticism.
    Paula Castilho, José Pinto‐Gouveia, Vânia Amaral, Joana Duarte.
    Clinical Psychology & Psychotherapy. October 14, 2012
    Research has robustly shown that early negative parenting experiences are associated with psychopathology and self‐criticism in adulthood. This study investigates recall of personal feelings of perceived threat and subordination in childhood and its relation to psychopathology. In addition, we explore the mediator role of self‐criticism in this association. A sample of 193 subjects from the general population completed self‐report questionnaires measuring the study variables. The mediator analyses suggested that the impact of submissiveness experiences in childhood on depression and anxiety is mediated by self‐criticism. Our findings highlight the route through which the recall of personal feelings of perceived involuntary subordination to parents contributes to depression and anxiety in adulthood. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Although the relation between early experiences of abuse and later psychological problems is now well established, there has been less study on subtler forms of threat and subordinate behaviour in childhood. Given ours and previous findings, therapists should be aware of, and prone to explore, these early experiences. Most studies exploring early negative experiences mainly refer to attachment theory‐related constructs (e.g., attachment style). We also highlight the importance of noting rank structure and rank style in the family. Self‐criticism seems to be a key process in the relation between early aversive experiences of subordination and psychopathology. Given the idea that self‐reassuring operates through a different affect system, helping people develop inner warmth and compassion for the self may be important to counteract feelings of self‐hatred and self‐attack.
    October 14, 2012   doi: 10.1002/cpp.1821   open full text
  • Thinness in the Pursuit for Social Safeness: An Integrative Model of Social Rank Mentality to Explain Eating Psychopathology.
    José Pinto‐Gouveia, Cláudia Ferreira, Cristiana Duarte.
    Clinical Psychology & Psychotherapy. October 01, 2012
    The current study tests a model based on social rank mentality investigating whether women who feel inferior and believe others see them negatively, and feel under pressure to compete to avoid social inferiority, present increased body dissatisfaction and drive for thinness and whether these associations are mediated by distinct emotional regulation processes. The predictions from the model proposed were examined through path analyses, in a sample of 125 women from the general population and 102 patients with eating disorders. Results showed that the path model explained 51% of body dissatisfaction variance and 61% of drive for thinness and allowed us to confirm that social ranking variables increased drive for thinness through higher levels of self‐criticism and lower levels of self‐compassion. The findings suggest that the nuclear eating disorders' features arise as a result of a more self‐critical and less compassionate attitude with the self, in the context of a mentality focused on social ranking and competition. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message The current study explores an innovative comprehensive model based on social rank theory to understand eating disorders' symptoms in women. A mentality focused on ranking, shame and competition predicts body image dissatisfaction. This ranking‐focused mentality, along with body image dissatisfaction, leads to drive for thinness through increased self‐criticism and decreased self‐compassion. These findings support the emergent psychotherapeutic approaches for eating disorders that target self‐criticism and self‐compassion.
    October 01, 2012   doi: 10.1002/cpp.1820   open full text
  • Differences between Depression and Paranoia: The Role of Emotional Memories, Shame and Subordination.
    José Pinto‐Gouveia, Marcela Matos, Paula Castilho, Ana Xavier.
    Clinical Psychology & Psychotherapy. September 20, 2012
    The present study explores how emotional memories, shame and submissive behaviour in adulthood are differently related to depression and paranoia, in a sample of 255 subjects from the general community population. Results show that emotional memories (especially, shame traumatic memory) are significantly correlated with external and internal shame. Emotional memories are significantly associated with submissive behaviour. Both types of shame are correlated with submissive behaviour, particularly internal shame. Emotional memories, external and internal shame are linked to depressive symptoms. Emotional memories, external and internal shame, and submissive behaviour are significantly related to paranoia. Path analysis results suggested that (1) shame traumatic memory and recall of threat and submissiveness in childhood predicted depressive symptoms through external and internal shame; (2) early emotional memories of shame, threat and submissiveness predicted paranoid ideation both directly and indirectly, through external shame; and (3) emotional memories impact on paranoid ideation both through their effect upon external shame and also through their indirect effect upon submission, which in turn fully mediates the effect of internal shame upon paranoid ideation. These findings highlight the differences between depression and paranoia. In depression, it is the internalization of early experiences of shame, threat and submissiveness that heighten the vulnerability to depressive states. In paranoia, not only shame traumas and recollections of threat and submissiveness directly influence paranoid beliefs but also these memories promote external and internal shame thoughts and feelings and submissive defenses, which in turn increase paranoid ideation. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Individuals with shame traumas, threat and submissiveness experiences in childhood and high levels of external and internal shame report more depressive symptoms. High levels of paranoid beliefs are associated with high negative emotional memories, external and internal shame thoughts and feelings, and submissive behaviour defenses. Therapy for depression needs to incorporate strategies that help individuals develop skills to deal with shame experiences and its outputs. Treatment for paranoid ideation must address external and internal shame, as well as emotional memories of shame, threat and submissiveness in childhood and development of assertive skills.
    September 20, 2012   doi: 10.1002/cpp.1818   open full text
  • Treatment Response in Type 2 Diabetes Patients with Major Depression.
    C. Gois, V. V Dias, I. Carmo, R. Duarte, A. Ferro, A. L. Santos, F. Sousa, A. Barbosa.
    Clinical Psychology & Psychotherapy. September 10, 2012
    Aims Major depression is more prevalent in patients with type 2 diabetes mellitus (T2DM) than in general population. Comparing psychotherapeutic and pharmacological treatment responses could help to inform the choice between available treatment options. Method Thirty‐four patients with T2DM and major depression detected by using the Hospital Anxiety‐Depression Scale (HADS), the Montgomery‐Äsberg Depression Rating Scale (MADRS) and a structured interview (Mini‐International Neuropsychiatric Interview) were randomized to undergo Interpersonal Psychotherapy (IPT) or treatment with sertraline in a 3‐month acute intervention course in addition to a 3‐month continuation format. Provided that the initial MADRS score was not reduced ≥25% at week 6, these early non‐responding patients continued treatment in a sequential add‐on combined format. Psychological adjustment to diabetes, attachment style, diabetes self‐efficacy, quality of life and HbA1c were also evaluated along intervention. Results Out of 22 early‐responding patients (11 for each treatment type), 16 had clinically significant improvements (<50% initial MADRS score) at endpoint with 11 reaching remission (MADRS scores ≤8), and with no significant differences between IPT and sertraline. Within sequential add‐on treatment, out of eight patients, only three of them achieved a clinically significant improvement and only one reached remission. Conclusions These preliminary results suggested that IPT may be an option to treat major depression in T2DM against medical care with sertraline. Early non‐responding patients likely need alternative or longer treatment interventions. Limitations of this study relate to small sample and absence of a control group, which was difficult to implement due to ethical restrictions. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Findings suggest that Interpersonal Psychotherapy is a useful tool to treat major depression in type 2 diabetes patients. A significant number of type 2 diabetes patients with major depression do not achieve depression remission irrespective of the type of treatment. Further clinical research should focus on addictive effects of psychotherapy and psychopharmacology in the treatment of depressed patients with chronic somatic diseases.
    September 10, 2012   doi: 10.1002/cpp.1817   open full text
  • Scientific Communication in Clinical Psychology: Examining Patterns of Citations and References.
    Andrew M. Kiselica, John Ruscio.
    Clinical Psychology & Psychotherapy. September 02, 2012
    Previous studies of scientific communication used citation mapping, establishing psychology as a ‘hub science’ from which many other fields draw information. Within psychology, the clinical and counselling discipline is a major ‘knowledge broker’. This study analyzed scientific communication among three major subdisciplines of clinical psychology—the cognitive–behavioural, psychodynamic and humanistic schools of thought—by examining patterns of references within and citations to 305 target articles published in leading journals of these subdisciplines. The results suggest that clinical researchers of each theoretical orientation engage in more insular scientific communication than an integrationist would find desirable and that cognitive–behavioural articles are more closely connected to mainstream psychology and related fields. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioners Message Eclectic practitioners draw on several different theoretical orientations to inform their practice; as such, they should be interested in understanding the patterns of scientific communication within and across theoretical orientations. Practitioners work in a variety of different mental health settings, with a variety of other professionals in psychology‐related fields, and should be interested in how much influence their particular theoretical orientation has on the work of colleagues. Many practitioners rely on new, evidence‐based research to inform their work. The results of this study provide these individuals with an objective measure of the influence of empirical work in different areas of clinical psychology.
    September 02, 2012   doi: 10.1002/cpp.1815   open full text
  • Cognitive Bibliotherapy for Mild Depressive Symptomatology: Randomized Clinical Trial of Efficacy and Mechanisms of Change.
    Ramona Moldovan, Oana Cobeanu, Daniel David.
    Clinical Psychology & Psychotherapy. September 02, 2012
    Background It has been increasingly recognized that subthreshold depression is associated with considerable personal, social and economic costs. However, there is no accepted definition or clear‐cut treatment for subthreshold depression. Cognitive bibliotherapy is a promising approach, but further research is necessary in order to assess its clinical efficacy and key mechanisms of change. Aim This study aimed to investigate the efficacy of bibliotherapy for subthreshold depression and test whether maladaptive cognitions mediate the effects of bibliotherapy on depressive symptoms. Method A total of 96 young adults with subthreshold depression were randomized in one of the following treatment conditions: immediate treatment, delayed treatment, placebo and no treatment. The main outcome was represented by depressive symptoms assessed before, during and immediately after the treatment, as well as at 3‐month follow‐up. Automatic thoughts, dysfunctional attitudes and irrational beliefs were also assessed throughout the study, and we investigated their involvement as mediators of bibliotherapy effects on depressive symptoms. Results The results indicated that cognitive bibliotherapy resulted in statistically and clinically significant changes both in depressive symptoms and cognitions, which were maintained at follow‐up. In contrast, placebo was only associated with a temporary decrease in depressive symptoms, without significant cognitive changes. No changes in symptoms or cognitions were found in the delayed treatment and no treatment groups. We also found that automatic thoughts significantly mediated the effect of bibliotherapy on depressive symptoms. Conclusion This study provided compelling evidence for the efficacy of cognitive bibliotherapy in subthreshold depression and showed that changes in automatic thoughts mediated the effect of bibliotherapy on depressive symptoms. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Cognitive bibliotherapy is an effective treatment of subthreshold depression. Changing automatic thoughts is important, as they mediate the bibliotherapy effect on depressive symptoms. Cognitive bibliotherapy is a potential alternative or adjunct to psychotherapy for mildly depressed adults.
    September 02, 2012   doi: 10.1002/cpp.1814   open full text
  • Changes in Symptom Severity, Schemas and Modes in Heterogeneous Psychiatric Patient Groups Following Short‐term Schema Cognitive–Behavioural Group Therapy: A Naturalistic Pre‐treatment and Post‐treatment Design in an Outpatient Clinic.
    M. F. Vreeswijk, P. Spinhoven, E. H. M. Eurelings‐Bontekoe, J. Broersen.
    Clinical Psychology & Psychotherapy. August 30, 2012
    Schema therapy has proven to be an effective treatment for patients with borderline personality disorder. However, little is known of its merits in other psychiatric (personality) disorders. Objective This study investigated whether schema therapy in a group setting (group schema cognitive–behavioural therapy [SCBT‐g]) was associated with changes in symptom and schema and mode severity. Furthermore, the aim was to search for baseline predictors and possible mediators of treatment outcome. Design and method Sixty‐three heterogeneous psychiatric outpatients who attended the SCBT‐g were included as participants. In this naturalistic pre‐treatment and post‐treatment design, data were available on the Symptom Checklist 90, the Schema Questionnaire and the Young–Atkinson Mode Inventory. Results All outcome measurements showed changes with moderate to high effect sizes, with 53.2% of the patients showing a significant reduction in severity of psychiatric symptoms and schemas and modes. Higher pre‐treatment levels of the schema domain Other Directedness predicted greater symptom reduction. Pre‐treatment to mid‐treatment changes in schema severity predicted subsequent symptom improvement, but change in symptoms and schemas proved to be strongly correlated. Conclusions In this naturalistic study, SCBT‐g was associated with reduced symptom and schema and mode severity in more than half of the psychiatric outpatients. Furthermore, the results suggest that changes in schemas and symptomatology mutually reinforce each other. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Over 50% of ambulatory patients show clinical improvement after treatment in a short‐term schema therapy group. Other Directedness seems to be a predictor of schema group therapy success. More randomized controlled trial studies and prediction and mediation studies on (short‐term) schema group therapy are sorely needed.
    August 30, 2012   doi: 10.1002/cpp.1813   open full text
  • Psychological Woundedness and its Evaluation in Applications for Clinical Psychology Training.
    Gavin Ivey, Theresa Partington.
    Clinical Psychology & Psychotherapy. August 22, 2012
    This paper reports on a qualitative study investigating clinical psychology programme selectors' perceptions of psychological ‘woundedness’ in the autobiographical narratives of applicants for clinical psychology training. Woundedness was here defined in terms of the ongoing or residual psychological impact of adverse experiences and psychic conflicts. Ten selectors were presented with a sample of applicants' written autobiographical narratives, differentiated by the conspicuous presence or absence of psychological woundedness. The selectors, who were not informed of the specific aims of the study, ranked applicant protocols and were interviewed individually about their impressions of the protocols and the criteria that they used to rank them. Most selectors were positively biased toward ‘wounded’ narratives and suspicious of those in which woundedness was manifestly absent. Although generally disposed to favour wounded applicants, how woundedness was presented, rather than the mere presence of it, was a discriminating feature in selectors' appraisal of wounded narratives. Selectors were concerned that unresolved woundedness may compromise applicants' professional boundaries, impair self‐reflective capacity and lead to damaging countertransference enactments. The relative extent to which applicant woundedness appeared to be resolved was significant in selectors' assessment of applicants' clinical training potential. A distinction is thus proposed between obstructive and facilitative woundedness in clinical psychology applicants. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message A sample of clinical psychology programme selectors identified psychological woundedness as a significant feature in applicant autobiographies. Selectors favoured applicant autobiographies showing evidence of woundedness. The distinction between obstructive and facilitative woundedness is important in how the selector sample evaluated woundedness.
    August 22, 2012   doi: 10.1002/cpp.1816   open full text
  • An Evaluation of the Impact of Introducing Compassion Focused Therapy to a Standard Treatment Programme for People with Eating Disorders.
    Corinne Gale, Paul Gilbert, Natalie Read, Ken Goss.
    Clinical Psychology & Psychotherapy. June 28, 2012
    Objective This study explored the outcome of introducing Compassion Focused Therapy (CFT) into a standard treatment programme for people with eating disorders. In particular, the aim was to evaluate the principle that CFT can be used with people with eating disorders and improve eating disorder symptomatology. Method Routinely collected questionnaire data were used to assess cognitive and behavioural aspects of eating disorders and social functioning/well being (n = 99). Results There were significant improvements on all questionnaire measures during the programme. An analysis by diagnosis found that people with bulimia nervosa improved significantly more than people with anorexia nervosa on most of the subscales. Also, in terms of clinical significance, 73% of those with bulimia nervosa were considered to have made clinically reliable and significant improvements at the end of treatment (compared with 21% of people with anorexia nervosa and 30% of people with atypical eating disorders). Conclusion This study demonstrates the potential benefits of using CFT with people with eating disorders and highlights the need for further research on this new approach. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message CFT offers new ways to conceptualize and formulate some of the self‐critical and shame‐based difficulties associated with eating disorders. CFT offers a framework that can enable people with eating disorders to conceptualize their difficulties in different ways. CFT can be combined with standard therapies especially cognitive behavioural therapy. CFT can be especially useful in a group context where the relationships between members can become increasingly compassionate, validating, supportive and encouraging.
    June 28, 2012   doi: 10.1002/cpp.1806   open full text
  • A Socio‐interpersonal Perspective on PTSD: The Case for Environments and Interpersonal Processes.
    Andreas Maercker, Andrea B. Horn.
    Clinical Psychology & Psychotherapy. June 22, 2012
    Post‐traumatic stress disorder (PTSD) is a common reaction to traumatic experiences. We propose a socio‐interpersonal model of PTSD that complements existing models of post‐traumatic memory processes or neurobiological changes. The model adds an interpersonal perspective to explain responses to traumatic stress. The framework draws from lifespan psychology, cultural psychology and research into close relationships and groups. Additionally, clinical knowledge about PTSD is incorporated. This involves knowledge about shame, guilt, estrangement feelings and protective factors, such as social support and forgiveness. Three levels are proposed at which relevant interpersonal processes can be situated and should be adequately researched. First, the individual level comprises social affective states, such as shame, guilt, anger and feelings of revenge. Second, at the close relationship level, social support, negative exchange (ostracism and blaming the victim), disclosure and empathy are proposed as dyadic processes relevant to PTSD research and treatment. Third, the distant social level represents culture and society, in which the collectivistic nature of trauma, perceived injustice, and social acknowledgement are concepts that predict the response trajectories to traumatic stress. Research by the current authors and others is cited in an effort to promote future investigation based on the current model. Methodological implications, such as multi‐level data analyses, and clinical implications, such as the need for couple, community or larger‐level societal interventions, are both outlined. Copyright © 2012 John Wiley & Sons, Ltd.Key Practitioner Message The socio‐interpersonal model proposes an interpersonal view of the processes that occur in the aftermath of a traumatic experience.At the individual level, the model integrates the social affective phenomena that clinical research identifies in PTSD patients, including shame, guilt, anger, revenge and the urges or reluctance to disclose.At the level of close relationships, there is an emphasis on the role of the individuals' partner, family or social support in the development or maintenance of PTSD and its recovery.At the distant social level, societal and cultural factors, e.g., individualistic versus collectivistic or other human value orientations, are acknowledged as contributing to the severity and course of PTSD.Increasing attention should be given to new approaches of PTSD treatment that refer to an interpersonal view of PTSD, e.g., communication training, PTSD‐specific couples' therapy or community programs.
    June 22, 2012   doi: 10.1002/cpp.1805   open full text
  • What Do Service Users with Bipolar Disorder Want from a Web‐Based Self‐Management Intervention? A Qualitative Focus Group Study.
    Nicholas J. Todd, Steven H. Jones, Fiona A. Lobban.
    Clinical Psychology & Psychotherapy. June 19, 2012
    BackgroundBipolar disorder (BD) is a chronic and recurrent severe mental health problem. A web‐based self‐management intervention provides the opportunity to widen access to psychological interventions. This qualitative study aims to identify what an ideal web‐based intervention would look like for service users with BD.MethodsTwelve service users with BD were recruited in the UK and took part in a series of focus groups to inform and refine the development of a web‐based self‐management intervention. Reported here is a subset analysis of data gathered with the primary aim of identifying the needs and desires of service users for such an intervention for BD. We analysed service users' responses to questions about content, outcomes, format, barriers and support. Focus groups were transcribed verbatim, and thematic analysis was employed.ResultsThe data were ordered into four key themes: (1) gaining an awareness of and managing mood swings; (2) not just about managing mood swings: the importance of practical and interpersonal issues; (3) managing living within mood swings without losing the experience; (4) internet is the only format: freely accessible, instant and interactive; (5) professional and peer support to overcome low motivation and procrastination difficulties.LimitationsThe small group of participants are not representative of those living with BD.ConclusionsThese findings have significantly enhanced our understanding of what service users with BD want from a web‐based self‐management intervention and have clear implications for the future development of such approaches. Copyright © 2012 John Wiley & Sons, Ltd.Key Practitioner Message Service users desire a web‐based self‐management approach that gives them the techniques they need to not only manage their moods but also manage their lives alongside the disorder, including interpersonal and practical issues.Service users describe their primary outcome, not as a cure or reduction in their symptoms, but instead being able to live a fulfilling life alongside their condition.Service users see the internet as their preferred format because of the increased accessibility to evidence‐based intervention.Service users discussed the potential barriers to web‐based interventions including motivation and procrastination. Effective and acceptable content and low‐level support provide potential solutions to these issues.
    June 19, 2012   doi: 10.1002/cpp.1804   open full text
  • Differences in Early Maladaptive Schemas between a Sample of Young Adult Female Substance Abusers and a Non‐clinical Comparison Group.
    Ryan C. Shorey, Gregory L. Stuart, Scott Anderson.
    Clinical Psychology & Psychotherapy. May 22, 2012
    Early maladaptive schemas, defined as cognitive and behavioural patterns of viewing oneself and the world that cause considerable distress, are increasingly being recognized as an important underlying correlate of mental health problems. Recent research has begun to examine early maladaptive schemas among individuals seeking treatment for substance abuse. Unfortunately, there is limited research on whether substance abusers score higher on early maladaptive schemas than non‐clinical controls. Thus, the current study examined whether a sample of young adult female substance abuse treatment seekers (n = 180) scored higher than a non‐clinical group of female college students (n = 284) on early maladaptive schemas. Results demonstrated that the substance abuse group scored higher than the non‐clinical group on 16 of the 18 early maladaptive schemas. In addition, a number of differences in early maladaptive schemas were large in effect size. Implications of these findings for future research and substance abuse treatment programmes are discussed. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Young adult female substance users have a number of early maladaptive schemas that may be contributing to the onset and maintenance of substance use. Findings from the current study suggest that early maladaptive schemas are more prevalent among young adult female substance abusers than a non‐clinical control group, even after controlling for demographic differences between groups. The treatment of substance abuse among young adults should consider targeting early maladaptive schemas.
    May 22, 2012   doi: 10.1002/cpp.1803   open full text
  • A Triphasic Metacognitive Formulation of Problem Drinking.
    Marcantonio M. Spada, Gabriele Caselli, Adrian Wells.
    Clinical Psychology & Psychotherapy. May 16, 2012
    AbstractIn this paper, a triphasic metacognitive formulation of problem drinking and its implications for treatment are presented together with a summary of the evidence consistent with this approach. In the triphasic formulation during the pre‐alcohol use phase, alcohol‐related triggers, in the form of cravings, images, memories or thoughts, activate positive metacognitive beliefs about extended thinking, which lead to desire thinking, rumination and worry or their combination. The activation of the latter brings to an escalation of cravings and negative affect, strengthening negative metacognitive beliefs about the need to control thoughts and enhancing the likelihood of alcohol use. In the alcohol use phase, positive metacognitive beliefs about alcohol use and a reduction in metacognitive monitoring contribute to dysregulation in alcohol use. Over the course of time and as the drinking problem escalates in severity, negative metacognitive beliefs about the uncontrollability of alcohol use and alcohol‐related thoughts emerge, contributing to the perseveration of dysregulated alcohol use. In the post‐alcohol use phase following the activation of positive metacognitive beliefs about post‐event rumination, the affective, cognitive and physiological consequences of dysregulated alcohol use become the subject of rumination. This, in turn, leads to a paradoxical increase in negative affect and alcohol‐related thoughts, together with the strengthening of negative metacognitive beliefs about such thoughts. Intermittent attempts to suppress alcohol‐related thoughts increase the likelihood of returning to use alcohol as a means of achieving self‐regulation. Copyright © 2012 John Wiley & Sons, Ltd.Key Practitioner MessageA metacognitive formulation of problem drinking that may aid assessment, conceptualization and treatment across the problem drinking spectrum.
    May 16, 2012   doi: 10.1002/cpp.1791   open full text
  • The Role of the Therapeutic Alliance in the Regulation of Emotion in Psychosis: An Attachment Perspective.
    Karen Annette Owens, Gillian Haddock, Katherine Berry.
    Clinical Psychology & Psychotherapy. May 09, 2012
    Objectives: This article aims to explore the value of attachment theory as a framework for understanding the ways in which the staff–patient relationship is associated with different methods of regulating emotion in individuals with a diagnosis of psychosis. Method: Patient participants with a diagnosis of schizophrenia, schizoaffective disorder or psychosis not otherwise specified and mental health workers were recruited from 24‐hour rehabilitation teams. Patient participants completed questionnaires assessing emotion regulation, attachment, therapeutic alliance and symptomatology. The therapeutic alliance was also assessed from mental workers' perspective. Results: Insecure attachment was significantly associated with greater difficulties in regulating emotions. A strong therapeutic alliance was associated with fewer difficulties in regulating emotions. Conclusions: Attachment is a useful theoretical construct for understanding psychosis, with evidence for a link between a positive staff–patient relationship and enhanced emotion regulation. Clinical implications of these findings are discussed. Copyright © 2012 John Wiley & Sons, Ltd.Key Practitioner MessageThe study supports a link between attachment organisation and psychosis, characterised by difficulties in emotion regulation.A positive patient‐key worker relationship may facilitate the development of emotion regulation in this client group.A key implication of these findings is the training of MDT staff in the implementation of attachment‐informed interventions.
    May 09, 2012   doi: 10.1002/cpp.1793   open full text
  • Interaction among Alliance, Psychodynamic–Interpersonal and Cognitive–Behavioural Techniques in the Prediction of Post‐session Change.
    Jesse Owen, Mark J. Hilsenroth, Emil Rodolfa.
    Clinical Psychology & Psychotherapy. April 24, 2012
    The current study examined the interaction of clients' perceptions of the psychodynamic–interpersonal (PI) and cognitive–behavioural (CB) techniques that their therapist utilized in their most recent therapy session and working alliance in the prediction of post‐session changes. Seventy‐five clients were treated by 25 therapists at a counselling centre in the USA. We posited that alliance would interact with clients' perceptions of their therapists' use of PI and CB techniques in the prediction of post‐session changes. The results revealed a three‐way interaction between clients' perceptions of the alliance, PI techniques and CB techniques in the prediction of post‐session changes. More PI and more CB techniques and more PI but fewer CB techniques were associated with better post‐sessions changes in the context of higher alliances. More CB techniques but fewer PI techniques and fewer PI and fewer CB techniques were not significantly associated with post‐session changes in the context of higher (or lower) alliances. Copyright © 2012 John Wiley & Sons, Ltd.Key Practitioner MessageClients' perceptions of PI techniques in the context of stronger alliances were most beneficial for post‐session outcomes. Thus, a high alliance will likely maximize the impact of PI techniques.Clients who rated their therapist as being relatively inactive reported fewer positive post‐session outcomes, suggesting that an idle therapeutic approach is not advantageous.Therapist differences explained two to three times more variation in session outcomes than client ratings of alliance or techniques. Some therapists are better at facilitating positive session outcomes as compared with others, suggesting that a potential key barometer of therapists' effectiveness may be captured by session outcomes.
    April 24, 2012   doi: 10.1002/cpp.1792   open full text
  • Psychiatric Comorbidity is Associated with Increased Skill Deficits.
    Nikola Stenzel, Stefan Krumm, Jens Hartwich‐Tersek, Sylvia Beisel, Winfried Rief.
    Clinical Psychology & Psychotherapy. April 04, 2012
    Recent research on psychotherapy has focused on the development and evaluation of disorder‐specific treatments. Even though much progress has been made, treatments have not yet reached an ideal level of effectiveness. One reason for this could be the systematic overlap and high comorbidity between mental disorders. Consequently, a new trend has been the examination of transdiagnostic factors in order to conceptualize psychopathology and develop treatment tools. One approach is to strengthen skills (e.g., emotion regulation) that are relevant in different mental disorders. The unique feature of this study is the simultaneous examination of several skills and their relation to psychopathology. Therefore, the current study investigated the skill levels of different groups of inpatients (tinnitus, tinnitus/unipolar mood disorder and anxiety/unipolar mood disorder) and normal controls (n = 124). Participants were evaluated with the ‘operationalized assessment of skills interview’. This interview allows the simultaneous assessment of seven skills (problem solving, social competence, stress management, emotion regulation, relaxation ability, self‐efficacy and self‐esteem) that are relevant for treatment planning. The results confirm negative correlations between skills and the number of comorbid diagnoses. Multivariate analyses identified significant differences in skill levels between clinical sample and normal controls. Furthermore, within the clinical sample, there were significant differences in skill levels and skill profiles between the different clinical subsamples. To conclude, the improvement of skills that can support recovery from mental disorders is especially relevant for patients with multiple diagnoses. The authors suggest assessing the different skills prior to treatment and considering the skill profiles when planning interventions. Copyright © 2012 John Wiley & Sons, Ltd.Key Practitioner MessageLower skill levels are associated with higher comorbidity and higher level of psychopathology of patients.There is evidence for specific skill profiles within different clinical subsamples.The improvement of skills that can impact recovery from mental disorders is especially relevant for patients with multiple diagnoses.It makes sense to assess the different skills independently and consider them separately when planning interventions.
    April 04, 2012   doi: 10.1002/cpp.1790   open full text
  • Depression in Early, Middle and Late Adolescence: Differential Evidence for the Cognitive Diathesis–Stress Model.
    Caroline Braet, Leen Van Vlierberghe, Eva Vandevivere, Lotte Theuwis, Guy Bosmans.
    Clinical Psychology & Psychotherapy. April 04, 2012
    Cognitive theory is a prominent framework to study depression in both adults and adolescents. This theory stated that dysfunctional schemas are moderators (known as diathesis) in the association of current stress and psychopathology. However, in adolescents, less evidence has been found so far to corroborate the importance of these schemas. This study aimed to investigate in a cross‐sectional design the moderating role of adolescents' early maladaptive schemas (EMS) on depressive symptoms. This will be studied in relation to both important daily stressors (i.e., maternal, paternal and peer rejection) and stressful life events. METHOD Adolescents (N = 228, age 12–18 years), selected from inpatient and outpatient clinical settings and a non‐referred sample, completed questionnaires and interviews measuring psychopathology, cognitive schemas, peer rejection, maternal and paternal rejection, and stressful life events. Parents completed questionnaires about their adolescent measuring psychopathology, stressful life events and peer rejection, as well as their own parental behaviour. RESULTS Correlational analyses revealed significant associations between the study variables. Evidence was found for an interaction effect between the adolescents' EMS and peer rejection in explaining depressive symptoms, but only in late adolescents. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Stress induced by maternal and, in lesser extent, paternal rejection is contributing to depressive symptoms primarily in younger and to lesser extent in older age groups. The quality of peer relationships becomes an increasingly salient source of distress as adolescence unfolds and is certainly an important mechanism affecting depression in adolescence. Maladaptive schemas only start functioning as a cognitive diathesis in late adolescence, increasing depression in response to peer‐related distress. Since maladaptive schemas are not yet operating as cognitive vulnerability factors in early and middle adolescence, early interventions for depressive disorders may be more effective compared with treatment in later adolescence.
    April 04, 2012   doi: 10.1002/cpp.1789   open full text
  • Validation of the Swedish Version of the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE‐OM).
    M. L. Elfström, C. Evans, J. Lundgren, B. Johansson, M. Hakeberg, S. G. Carlsson.
    Clinical Psychology & Psychotherapy. March 22, 2012
    The purpose of this study was to perform an initial validation of a Swedish translation of the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE‐OM). The CORE‐OM is a broad self‐report instrument of psychological problems, designed as an outcome measure for evaluating the effects of psychological therapy. Participants included a non‐clinical group of 229 university students and a clinical group of 619 persons from four primary care sites. The Swedish CORE‐OM showed excellent acceptability, high internal consistency and test–retest reliability, as well as acceptable convergent validity. There was strong differentiation of the clinical and non‐clinical samples, with the clinical group scoring significantly more psychological problems than the non‐clinical group. Sensitivity to change was demonstrated in psychological treatments in primary care. Overall, the psychometric characteristics of the Swedish CORE‐OM were very similar to the original UK data. Nevertheless, the validity of the Swedish version needs to be examined more in detail, in larger and more diverse samples. Our results so far, however, provide support for using the Swedish CORE‐OM as a psychological problems measure. To our knowledge, there are few other relatively short measures in Swedish that are free to reprint that meet the demands for psychometric properties and utility in primary care settings in which patients typically present a broad range of psychological problems. Copyright © 2012 John Wiley & Sons, Ltd.Key Practitioner MessageThe Swedish version of the CORE‐OM is a valid questionnaire for assessing the severity of a broad range of psychological problems.
    March 22, 2012   doi: 10.1002/cpp.1788   open full text
  • Attachment and Socio‐Emotional Skills: A Comparison of Depressed Inpatients, Institutionalized Delinquents and Control Adolescents.
    Marie Delhaye, Chantal Kempenaers, Rob Stroobants, Luc Goossens, Paul Linkowski.
    Clinical Psychology & Psychotherapy. February 28, 2012
    This study compared 50 depressed inpatients, 51 institutionalized delinquents and 51 control adolescents (total n = 152) regarding attachment and associated socio‐emotional skills. All of the participants took an individual interview (i.e., anamnesis, diagnostic interview and intelligence test) and completed the attachment measure and self‐report measures of socio‐emotional skills (i.e., emotional intelligence, empathy and resilience). Results showed that controls scored higher on secure attachment, whereas both of the other groups scored higher on preoccupied attachment. Depressed adolescents had lower scores on emotional intelligence than did controls. Finally, depressed adolescents had lower scores than the other two groups on resilience. The anxious or preoccupied attachment in both clinical groups, the overall frailty of depressive adolescents and the apparent resilience of delinquent adolescents despite their cognitive limitations should inform the respective treatment plans for these groups of adolescents. Suggestions for future research into differences between depressed and delinquent adolescents are outlined. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Both depressed and delinquent adolescents show more anxious attachment. Depressed adolescents are less resilient than delinquent adolescents. Delinquent adolescents are less intelligent than the other two groups but well‐adjusted overall. These differences should inform treatment plans for these two clinical groups.
    February 28, 2012   doi: 10.1002/cpp.1787   open full text
  • Cross‐Cultural Opening in German Outpatient Mental Healthcare Service: An Exploratory Study of Structural and Procedural Aspects.
    Mike‐Oliver Mösko, Fernanda Gil‐Martinez, Holger Schulz.
    Clinical Psychology & Psychotherapy. February 28, 2012
    Mental healthcare services need to be sensitive towards the cultural needs of patients. Cross‐cultural opening is an organizational process to fulfil these needs. This study aims to provide representative structural and procedural data regarding the use of German outpatient mental healthcare services by allochthonous patients, the diversity of psychotherapists in outpatient mental healthcare service, the cross‐cultural encounters of therapists and the cross‐cultural sensitivity of psychotherapists working in this healthcare area. Of all public outpatient psychotherapists in Hamburg, 81% (n = 485) participated in this survey. Regarding the distribution of the population in this metropolis, allochthonous therapists were underrepresented. Unlike the overall distribution of foreign inhabitants, the largest groups of immigrant therapists came from England, German‐speaking countries and other countries within the European Union. The proportion of allochthonous patients in outpatient mental healthcare service was almost half of the proportion of the allochthonous in the general population. Psychotherapists with a migration background regarded themselves as having a higher level of cross‐cultural sensitivity than their native colleagues, especially those who have had fewer cross‐cultural encounters. Overall, psychotherapists named different challenges in providing cross‐cultural treatment. For the German outpatient mental healthcare service to be more accessible to immigrants and their descendants, a greater number of bilingual psychotherapists must gain access to the mental healthcare service, and more advanced cross‐cultural sensitivity training and supervision should be provided. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message German outpatient psychotherapists are culturally and linguistically diverse. Nevertheless, psychotherapists with a migration background are underrepresented in outpatient mental healthcare services. Patients with a migration background are also underrepresented in the German outpatient mental healthcare system. Because mental healthcare services must be sensitive and respectful towards patients' cultural and linguistic needs, the mental healthcare outpatient service must be more accessible to therapists who speak languages other than German and English. Psychotherapeutic treatment of patients with a migration background can be tremendously challenging because of other cultures' differing value systems. Prospective, advanced training in cross‐cultural sensitivity and cross‐cultural supervision should be provided.
    February 28, 2012   doi: 10.1002/cpp.1785   open full text
  • Feedback‐Based Alcohol Interventions for Mandated Students: An Effectiveness Study of Three Modalities.
    Jacqueline Alfonso, Thomas V. Hall, Michael E. Dunn.
    Clinical Psychology & Psychotherapy. February 24, 2012
    The present study used a randomized clinical trial design to examine the effectiveness of personalized alcohol feedback delivered individually, in a group and via computer on alcohol use and related negative consequences in a sample of 173 college students referred for alcohol‐related violations. Findings revealed statistically significant reductions in alcohol use and related harms for the individually delivered intervention, with significant reductions in alcohol‐related harms for the electronically delivered intervention. No statistically significant results were found for the group‐delivered intervention or between groups, and a main effect of time was noted for all outcome variables. This study adds to the literature by being the first randomized clinical trial to include analyses of an empirically supported individually delivered personalized alcohol feedback intervention with more cost‐effective group‐delivered and electronically delivered feedback formats within a single research design, by expanding the range of participant drinking habits reported at baseline to include all drinking levels and not solely those classified as ‘heavy drinking’ and by providing anonymity pre‐intervention and post‐intervention given the potential demand characteristics to underreport illegal and/or illicit behaviours in this vulnerable population. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Personalized alcohol feedback delivered in a one‐on‐one, face‐to‐face format serves to decrease both alcohol use and harms in mandated college students. The use of web‐delivered personalized alcohol feedback may be clinically useful when working with a mandated student population to reduce alcohol‐related harms. Personalized alcohol feedback delivered in a group setting may not be indicated for use with a mandated student population as it does not demonstrate decreases in either alcohol use or harms, possibly because of the normalization of deviant behaviour.
    February 24, 2012   doi: 10.1002/cpp.1786   open full text
  • Any Indication for Bias due to Participation? Comparison of the Effects of a Parent Management Training Rated by Participating and Non‐Participating Parents.
    Christopher Hautmann, Herbert Hoijtink, Ilka Eichelberger, Anja Görtz‐Dorten, Charlotte Hanisch, Julia Plück, Daniel Walter, Manfred Döpfner.
    Clinical Psychology & Psychotherapy. February 24, 2012
    Ratings of parents that have participated in a parent training for child externalizing behaviour problems might be biased (e.g., they may report symptom reduction to reward their own endeavours for attending the training). The potential for bias in parent ratings was investigated in a secondary analysis of an effectiveness study of a parent management training for children (aged 3–10 years) with externalizing behaviour problems under routine care conditions. For the 56 families included in the current analysis, we compared the ratings of training participants (predominately mothers) and training non‐participants (predominately fathers). A 3‐month waiting period prior to treatment served as the control condition. Outcome measures were attention problems and conduct problems of the children and perceived parental self‐efficacy rated by both the mothers and fathers. Child attention problems and conduct problems both decreased significantly during the treatment period for participating and non‐participating parents, and the changes in ratings during treatment were of a similar magnitude for participants compared with non‐participants. Taking into account the methodological limitations of the current analysis, no indication was found that treatment effects are strongly biased due to participation in the training. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Messages Previous positive findings of mothers' and fathers' ratings on parent management training for children with externalizing problem behaviour have mostly come from parents who also attended the training. For child behavioural problems, the results of the current analysis demonstrate similar perceived changes by parents who did and did not participate in the training. Our findings underscore the relevance and importance of parent ratings for treatment evaluation.
    February 24, 2012   doi: 10.1002/cpp.1784   open full text
  • Do Gender Differences in Depression Remain after Controlling for Early Maladaptive Schemas? An Examination in a Sample of Opioid Dependent Treatment Seeking Adults.
    Ryan C. Shorey, Gregory L. Stuart, Scott Anderson.
    Clinical Psychology & Psychotherapy. February 14, 2012
    The abuse of opioids is a serious and prevalent problem and research is needed on factors that may place individuals at risk for misusing opioids. Depression is a common co‐morbid mental health problem among opioid users. Theory and research suggest that early maladaptive schemas may underlie mental health problems including depression and substance abuse. The current study sought to determine whether early maladaptive schemas were associated with depression among a treatment seeking sample of male and female opioid users (n = 194). We also examined whether depression, as assessed by the Minnesota Multiphasic Personality Inventory, Second Edition, varied by gender and whether gender differences in depression remained after controlling for early maladaptive schemas. Results showed that women scored significantly higher than men on three of the five early maladaptive schema domains and that gender did not predict depression after controlling for schema domains. Early maladaptive schemas were also more strongly associated with depression for men than women. Implications of these findings for interventions and future research are discussed. Copyright © 2012 John Wiley & Sons, Ltd. Key Practicioner Message Individuals with opioid dependence have a number of early maladaptive schemas that may be contributing to the onset and maintenance of substance use. Although there are generally broad gender differences in major depression, findings from the current study suggest that early maladaptive schemas are a better predictor of depressive symptoms than gender among opioid dependent adults. The treatment of opioid dependence, with or without co‐morbid depressive symptoms, should target early maladaptive schemas.
    February 14, 2012   doi: 10.1002/cpp.1772   open full text
  • The Thinner the Better: Self‐Esteem and Low Body Weight in Anorexia Nervosa.
    Timo Brockmeyer, Martin Grosse Holtforth, Hinrich Bents, Annette Kämmerer, Wolfgang Herzog, Hans‐Christoph Friederich.
    Clinical Psychology & Psychotherapy. February 07, 2012
    The aim of the present study was to examine the associations between self‐esteem, motive satisfaction, and body weight in acute (acAN) and recovered (recAN) inpatients with anorexia nervosa (AN) and in healthy controls. Both acAN and recAN showed lower levels of self‐esteem as compared with healthy controls but did not differ from each other. In acAN, decreased body weight was associated with increased self‐esteem. Satisfaction of an achievement motive but not satisfaction of a superiority motive mediated this association. No such correlations could be observed in the other groups. This is the first study to show an often assumed association between decreased body weight and increased self‐esteem in AN patients. These preliminary results strengthen the assumption that low body weight may foster self‐esteem in patients with acAN, mainly through the satisfaction of an achievement motive. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Self‐esteem should be focused very early in the treatment of AN since weight gain may deprive the patient of an important source of self‐esteem. Treatment interventions should be attuned to underlying motives of threatened self‐esteem; in AN patients, the enhancement of self‐esteem via weight loss seems to be rather fuelled by the satisfaction of an achievement motive than by the satisfaction of a superiority motive. Specific trainings to improve self‐esteem in AN patients seem to be promising as an add‐on to regular treatment.
    February 07, 2012   doi: 10.1002/cpp.1771   open full text
  • Online Cognitive–Behavioural Treatment of Bulimic Symptoms: A Randomized Controlled Trial.
    Jeroen Ruwaard, Alfred Lange, Janneke Broeksteeg, Aitziber Renteria‐Agirre, Bart Schrieken, Conor V. Dolan, Paul Emmelkamp.
    Clinical Psychology & Psychotherapy. February 01, 2012
    Background Manualized cognitive–behavioural treatment (CBT) is underutilized in the treatment of bulimic symptoms. Internet‐delivered treatment may reduce current barriers. Objective This study aimed to assess the efficacy of a new online CBT of bulimic symptoms. Method Participants with bulimic symptoms (n = 105) were randomly allocated to online CBT, bibliotherapy or waiting list/delayed treatment condition. Data were gathered at pre‐treatment, post‐treatment and 1‐year follow‐up. Outcome Measures The primary outcome measures were the Eating Disorder Examination Questionnaire (EDE‐Q) and the frequency of binge eating and purging episodes. The secondary outcome measure was the Body Attitude Test. Results Dropout from Internet treatment was 26%. Intention‐to‐treat ANCOVAs of post‐test data revealed that the EDE‐Q scores and the frequency of binging and purging reduced more in the online CBT group compared with the bibliotherapy and waiting list groups (pooled between‐group effect size: d = 0.9). At 1‐year follow‐up, improvements in the online CBT group had sustained. Conclusion This study identifies online CBT as a viable alternative in the treatment of bulimic symptoms. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message In comparison with no treatment and unsupported bibliotherapy, online CBT induces strong reductions in bulimic symptoms.Internet‐delivered treatment may provide an acceptable treatment alternative for bulimic patients who are reticent about face‐to‐face contact.Therapist support appears to be a critical determinant of treatment adherence and effectiveness.Unsupported bibliotherapy may have only small immediate effects but may increase the probability of recovery in the long term by promoting positive attitudes towards treatment.
    February 01, 2012   doi: 10.1002/cpp.1767   open full text
  • The combined predictive effect of patient characteristics and alliance on long‐term dynamic and interpersonal functioning after dynamic psychotherapy.
    Anne Grete Hersoug, Per Høglend, Glen O. Gabbard, Steinar Lorentzen.
    Clinical Psychology & Psychotherapy. February 01, 2012
    On the basis of the well‐established association between early alliance and outcome, this exploratory study investigated the associations between the therapeutic alliance and long‐term outcome, 3 years after treatment termination. In addition to the early alliance, pre‐treatment patient characteristics and expectancies that were significantly related to early alliance were included in the statistical analyses. The data are from the First Experimental Study of Transference, a dismantling randomized clinical trial with long‐term follow‐up. One hundred out‐patients who sought psychotherapy due to depression, anxiety and personality disorders were treated. Alliance was measured with Working Alliance Inventory after session 7. Change was determined using linear mixed model analyses. The alliance alone had a significant impact on long‐term outcome of the predetermined primary outcome variables of the study: Psychodynamic Functioning Scales and Inventory of Interpersonal Problems. Contrary to common clinical wisdom, when the pre‐treatment patient variables were included, more personality disorder pathology was the strongest predictor of favourable outcome, over and above the effect of the alliance, which was no longer significant. Clinical implications are discussed. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Patients with more personality pathology responded more favourably to long‐term relational dynamic psychotherapy than patients with less personality pathology.Patient characteristic had stronger effect on long‐term outcome, over and above the effect of alliance.In relational dynamic psychotherapy, it is important to focus on dysfunctional interpersonal problems, as they appear both in the transference and in the patients' day to day life outside therapy.The therapeutic task is to balance a forthright discussion of recurrent patterns of interpersonal difficulty with an empathic appreciation that these patterns are hard to change because of their longstanding entrenched nature.
    February 01, 2012   doi: 10.1002/cpp.1770   open full text
  • The Effect of Shame and Shame Memories on Paranoid Ideation and Social Anxiety.
    Marcela Matos, José Pinto‐Gouveia, Paul Gilbert.
    Clinical Psychology & Psychotherapy. January 30, 2012
    Background Social wariness and anxiety can take different forms. Paranoid anxiety focuses on the malevolence of others, whereas social anxiety focuses on the inadequacies in the self in competing for social position and social acceptance. This study investigates whether shame and shame memories are differently associated with paranoid and social anxieties. Method Shame, traumatic impact of shame memory, centrality of shame memory, paranoia and social anxiety were assessed using self‐report questionnaires in 328 participants recruited from the general population. Results Results from path analyses show that external shame is specifically associated with paranoid anxiety. In contrast, internal shame is specifically associated with social anxiety. In addition, shame memories, which function like traumatic memories, or that are a central reference point to the individual's self‐identity and life story, are significantly associated with paranoid anxiety, even when current external and internal shame are considered at the same time. Thus, traumatic impact of shame memory and centrality of shame memory predict paranoia (but not social anxiety) even when considering for current feelings of shame. Conclusion Our study supports the evolutionary model suggesting there are two different types of ‘conspecific’ anxiety, with different evolutionary histories, functions and psychological processes. Paranoia, but less so social anxiety, is associated with traumatic impact and the centrality of shame memories. Researchers and clinicians should distinguish between types of shame memory, particularly those where the self might have felt vulnerable and subordinate and perceived others as threatening and hostile, holding malevolent intentions towards the self. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Shame and shame memories are distinctively related to paranoia and social anxiety.External shame is especially associated with paranoid ideation, whereas internal shame is specifically linked to social anxiety.The historical route of shame memories, especially those structured as traumatic and central memories to personal identity and life story, may play a significant role in paranoia, perhaps more so than in social anxiety.Therapy for paranoia or social anxiety should integrate strategies to work with shame.Therapeutic interventions with patients experiencing paranoid anxiety should evaluate and address their shame memories, particularly those that function as traumatic and central memories to their self‐identity and life narrative.
    January 30, 2012   doi: 10.1002/cpp.1766   open full text
  • How to Define, Find and Classify Side Effects in Psychotherapy: From Unwanted Events to Adverse Treatment Reactions.
    Michael Linden.
    Clinical Psychology & Psychotherapy. January 18, 2012
    Objective Empirical research on the negative effects of psychotherapy is insufficient, partly because there is a lack of theoretical concept on how to define, classify and assess psychotherapy side effects. This paper proposes a model for the definition, classification and assessment of psychotherapy side effects. Method Definitions are provided for ‘unwanted events’, ‘treatment‐emergent reactions’, ‘adverse treatment reactions’, ‘malpractice reactions’, ‘treatment non‐response’, ‘deterioration of illness’, ‘therapeutic risks’ and ‘contraindications’. We describe processes analysing the causality of negative events and the correctness of treatment. Result A procedural model on how to find, classify and evaluate negative events is described, the unwanted event to adverse treatment reaction (UE–ATR) checklist. Conclusion Recognition of adverse treatment effects is a characteristic of good therapists and treatments. Psychotherapists should be sensitive for negative effects. This can help improve the quality of treatment. The UE–ATR checklist can be used in psychotherapy trials, quality assurance, clinical practice and training of psychotherapists.Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message If you do not find adverse treatment effects, then ask yourself why and do not assume that there are no side effects.The detection and management of adverse treatment effects is not a sign of bad but of good clinical practice.
    January 18, 2012   doi: 10.1002/cpp.1765   open full text
  • Combat Experiences, Pre‐Deployment Training, and Outcome of Exposure Therapy for Post‐Traumatic Stress Disorder in Operation Enduring Freedom/Operation Iraqi Freedom Veterans.
    Matthew Price, Daniel F. Gros, Martha Strachan, Kenneth J. Ruggiero, Ron Acierno.
    Clinical Psychology & Psychotherapy. January 18, 2012
    The association between exposure to multiple potentially traumatic events (PTEs) and subsequent increased risk of post‐traumatic stress disorder (PTSD) is well established. However, less is known about the relation between exposure to numerous PTEs, as is typical with military service, and treatment outcome. Furthermore, there has been little research examining military specific protective factors, such as pre‐deployment preparedness, on PTSD treatment response. The current study investigated combat exposure and potential moderators of treatment outcome for exposure therapy in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with PTSD. One hundred and eleven OEF/OIF veterans diagnosed with PTSD participated in 8 weeks of exposure therapy. Results indicated that increased combat exposure was associated with a reduced rate of change in PTSD symptoms but not depression symptoms. These findings were consistent across two measures of combat exposure. There was preliminary support for the moderating effect of pre‐deployment preparedness on the association between combat exposure and treatment response. Together, these findings suggest that increased combat exposure is associated with poor treatment response in veterans with PTSD; however, this can be reduced by elevated pre‐deployment preparedness. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message Increased combat exposure is associated with poorer treatment response.Pre‐deployment training is associated with improved treatment response.PTSD interventions should account for the frequency of combat in military personnel.
    January 18, 2012   doi: 10.1002/cpp.1768   open full text