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Showing papers in "Psychology and Psychotherapy-theory Research and Practice in 2017"


Journal ArticleDOI
TL;DR: Although further research is warranted, the current state of evidence highlights the potential benefits of compassion-based interventions on a range of outcomes that clinicians can use in clinical practice with clients.
Abstract: Purpose Over the last 10–15 years, there has been a substantive increase in compassion-based interventions aiming to improve psychological functioning and well-being. Methods This study provides an overview and synthesis of the currently available compassion-based interventions. What do these programmes looks like, what are their aims, and what is the state of evidence underpinning each of them? Results This overview has found at least eight different compassion-based interventions (e.g., Compassion-Focused Therapy, Mindful Self-Compassion, Cultivating Compassion Training, Cognitively Based Compassion Training), with six having been evaluated in randomized controlled trials, and with a recent meta-analysis finding that compassion-based interventions produce moderate effect sizes for suffering and improved life satisfaction. Conclusions Although further research is warranted, the current state of evidence highlights the potential benefits of compassion-based interventions on a range of outcomes that clinicians can use in clinical practice with clients. Practitioner points There are eight established compassion intervention programmes with six having RCT evidence. The most evaluated intervention to date is compassion-focused therapy. Further RCTs are needed in clinical populations for all compassion interventions. Ten recommendations are provided to improve the evidence-base of compassion interventions.

261 citations


Journal ArticleDOI
TL;DR: Using schema therapy for disorders other than BPD should be based on service user/patient preference and clinical expertise and/or that the theoretical underpinnings of schema therapy justify the use of it therapeutically, because rigorous evidence for other mental health disorders is currently sparse.
Abstract: Purpose Schema therapy was first applied to individuals with borderline personality disorder (BPD) over 20 years ago, and more recent work has suggested efficacy across a range of disorders. The present review aimed to systematically synthesize evidence for the efficacy and effectiveness of schema therapy in reducing early maladaptive schema (EMS) and improving symptoms as applied to a range of mental health disorders in adults including BPD, other personality disorders, eating disorders, anxiety disorders, and post-traumatic stress disorder. Methods Studies were identified through electronic searches (EMBASE, PsycINFO, MEDLINE from 1990 to January 2016). Results The search produced 835 titles, of which 12 studies were found to meet inclusion criteria. A significant number of studies of schema therapy treatment were excluded as they failed to include a measure of schema change. The Clinical Trial Assessment Measure was used to rate the methodological quality of studies. Schema change and disorder-specific symptom change was found in 11 of the 12 studies. Conclusions Schema therapy has demonstrated initial significant results in terms of reducing EMS and improving symptoms for personality disorders, but formal mediation analytical studies are lacking and rigorous evidence for other mental health disorders is currently sparse. Practitioner points First review to investigate whether schema therapy leads to reduced maladaptive schemas and symptoms across mental health disorders. Limited evidence for schema change with schema therapy in borderline personality disorder (BPD), with only three studies conducting correlational analyses. Evidence for schema and symptom change in other mental health disorders is sparse, and so use of schema therapy for disorders other than BPD should be based on service user/patient preference and clinical expertise and/or that the theoretical underpinnings of schema therapy justify the use of it therapeutically. Further work is needed to develop the evidence base for schema therapy for other disorders.

86 citations


Journal ArticleDOI
TL;DR: These findings provide preliminary evidence that systematically fostering self-compassion through specific compassion-focused interventions might facilitate a reduction in depressive symptoms by improving the person's emotion regulation abilities, especially by improving his or her ability to tolerate negative emotions.
Abstract: Objectives To identify the mechanisms involved in the association between self-compassion and depression, we examined whether adaptive emotion regulation would mediate the relationship between self-compassion and depression in individuals with unipolar depression. Furthermore, we explored which specific emotion regulation skills would be most important in this relationship. Design and method Sixty-nine individuals with unipolar depression were assessed with the Self-Compassion Scale and the Emotion Regulation Skills Questionnaire at baseline and with the Beck Depression Inventory-II 1 week later. Results The results showed that successful application of emotion regulation skills mediates the association between self-compassion and depression. Among eight specific emotion regulation skills, only the ability to tolerate negative emotions was identified as a significant mediator in the self-compassion–depression relationship. Conclusions These findings provide preliminary evidence that systematically fostering self-compassion might help depressed individuals cope with their symptoms by enhancing their abilities to tolerate undesired emotions. Practitioner points Systematically fostering self-compassion through specific compassion-focused interventions might facilitate a reduction in depressive symptoms by improving the person's emotion regulation abilities, especially by improving his or her ability to tolerate negative emotions. Hence, compassion-focused interventions might be particularly promising in depressed patients with a tendency to avoid negative emotions and deficits in tolerating them.

60 citations


Journal ArticleDOI
TL;DR: The review showed that BA may be effective in the treatment of depression in young people, but indicated a number of methodological problems in the included studies meaning that the results and conclusions should be treated with caution.
Abstract: Purpose Depression is currently the leading cause of illness and disability in young people. Evidence suggests that behavioural activation (BA) is an effective treatment for depression in adults but less research focuses on its application with young people. This review therefore examined whether BA is effective in the treatment of depression in young people. Methods A systematic review (International Prospective Register of Systematic Reviews reference: CRD42015020453), following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted to examine studies that had explored behavioural interventions for young people with depression. The electronic databases searched included the Cochrane Library, EMBASE, MEDLINE, CINAHL Plus, PsychINFO, and Scopus. A meta-analysis employing a generic inverse variance, random-effects model was conducted on the included randomized controlled trials (RCTs) to examine whether there were overall effects of BA on the Children's Depression Rating Scale – Revised. Results Ten studies met inclusion criteria: three RCTs and seven within-participant designs (total n = 170). The review showed that BA may be effective in the treatment of depression in young people. The Cochrane risk of bias tool and the Moncrieff scale used to assess the quality of the included studies revealed a variety of limitations within each. Conclusions Despite demonstrating that BA may be effective in the treatment of depression in young people, the review indicated a number of methodological problems in the included studies meaning that the results and conclusions should be treated with caution. Furthermore, the paucity of studies in this area highlights the need for further research. Practitioner points Currently BA is included within National Institute for Health and Clinical Excellence (NICE, 2009) guidelines as an evidence-based treatment for depression in adults with extensive research supporting its effectiveness. It is important to investigate whether it may also be effective in treating young people. Included studies reported reductions in depression scores across a range of measures following BA. BA may be an effective treatment of depression in young people.

58 citations


Journal ArticleDOI
TL;DR: Emotion dysregulation appears to be a relevant feature of pathology in many PDs; with replication, it can be considered a treatment target in this population.
Abstract: Emotion dysregulation (ED) is considered a hallmark of borderline personality disorder and is prominent in other personality disorders (PDs). Its presence and contribution to personality pathology need to be explored in the whole range of PDs. In this study, we investigated the association of ED with the whole range of PD traits, symptoms, and interpersonal problems and then investigated whether ED had a unique contribution in predicting the different PDs. A sample of 478 treatment-seeking outpatients was interviewed with the SCID-II. The patients were then tested for symptoms (SCL-90-R), interpersonal problems (IIP-32), and ED (DERS). Results: ED correlated with the large majority of PDs and with symptoms and interpersonal problems. Regression showed how ED explained a unique part of the variance for many PDs. ED appears to be a relevant feature of pathology in many PDs; with replication, it can be considered a treatment target in this population. Practitioner points Emotion dysregulation is present in many personality disorders. Emotion dysregulation is not just explained by heightened symptoms and interpersonal problems in personality disorders. Emotion dysregulation could be considered a treatment target in personality disorders other than borderline.

47 citations


Journal ArticleDOI
TL;DR: A brief CBI of 5 weeks is effective for decreasing mild or moderate depression and anxiety symptoms and improving QoL in ESRD haemodialysis patients.
Abstract: Objectives Psychological treatment of depression in end-stage renal disease (ESRD) has focused on severely depressed patients. We designed and tested a brief (5 weeks) cognitive behavioural intervention (CBI) to reduce mild and moderate depression and anxiety symptoms in patients with ESRD. Design For the purpose of this study, a single-blind, randomized controlled design was used to compare patients with ESRD under haemodialysis treatment with and without the CBI. Methods Depression and anxiety symptoms were screened in 152 subjects (18–60 years old, 84 male). Sixty participants (age 41.8 ± 14.7, 29 males) with mild or moderate scores of depression (Beck Depression Inventory) and anxiety (Beck Anxiety Inventory) were randomly assigned to CBI or the control group. CBI techniques consisted of positive self-reinforcement, deep breathing, muscle relaxation, and cognitive restructuring. Depression, anxiety, quality of life (QoL), and cognitive distortion scores were evaluated at baseline, after 5 weeks (end of treatment) and after 4-week follow-up. All scores were compared by ANOVA for repeated measures with post-hoc tests adjusted by Bonferroni's method (p < .05 was considered significant). Results At follow-up, depression, anxiety, and cognitive distortions had decreased, and QoL had increased in the intervention group, and there were no changes in the control group. Clinical utility was 33% for depression and 43% for anxiety. Conclusions A brief CBI of 5 weeks is effective for decreasing mild or moderate depression and anxiety symptoms and improving QoL in ESRD haemodialysis patients. Practitioner points A brief, systematic and structured cognitive behavioural intervention (CBI) decreases anxiety and depression symptoms and improves quality of life in patients with end-stage renal disease (ESRD) who are being treated with haemodialysis. These benefits are not achieved when anxiety and depression symptoms are identified but not treated psychologically. This CBI consisted of cognitive restructuring of the distorted thoughts (perfectionism, catastrophic thinking, negative self-labelling, and dichotomous thinking) that are correlated with depression and anxiety symptoms and that can be assessed by a validated questionnaire designed for patients with ESRD. The handbooks that were developed for this study are structured and systematic. They could be valuable in supporting the efforts and participation of non-specialized health professionals in CBI such as nurses, physicians, social workers, and psychologists, raising the possibility of further application in a variety of clinical populations. Both the therapy and the client workbooks are available in Spanish upon request.

46 citations


Journal ArticleDOI
TL;DR: A structured assessment of patients' expectation with help of the Depressive Expectations Scale can provide a basis for interventions within cognitive-behavioural treatment of depression and facilitate cognitive restructuring.
Abstract: Objectives Dysfunctional expectations are considered to be core features of various mental disorders. The aim of the study was to develop the Depressive Expectations Scale (DES) as a depression-specific measure for the assessment of dysfunctional expectations. Whereas previous research primarily focused on general cognitions and attitudes, the DES assesses 25 future-directed expectations (originally 75 items) which are situation-specific and falsifiable. Design and methods To evaluate the psychometric properties of the DES, the scale was completed by 175 participants with and without severe depressive symptoms in an online survey. Participants additionally completed the Patient Health Questionnaire modules for depression (PHQ-9) and anxiety (GAD-7). People experiencing depressive symptoms were informed about the study with the help of self-help organizations. Results Reliability analyses indicated excellent internal consistency of the scale. An exploratory factor analyses revealed four factors: social rejection, social support, mood regulation, and ability to perform. The DES sum score strongly correlated with the severity of depressive symptoms. The DES sum score also significantly correlated with symptoms of generalized anxiety. Conclusion The DES was shown to have excellent reliability; validity analyses were promising. As the DES items are situation-specific and falsifiable, they can be tested by the individual using behavioural experiments and may therefore facilitate cognitive restructuring. Thus, a structured assessment of patients’ expectation with help of the DES can provide a basis for interventions within cognitive–behavioural treatment of depression. Practitioner points Assessing situation-specific expectations in patients experiencing depressive symptoms can provide a basis for the conduction of behavioural experiments to test patients’ expectations. For the use of behavioural experiments, therapists should choose those dysfunctional expectations which a patient strongly agrees on. To modify patients’ expectations, they should be exposed to situations where the discrepancy between patients’ expectations and actual situational outcomes can be maximized. The Depressive Expectations Scale can be completed repeatedly to monitor a patient's progress within cognitive–behavioural treatment.

44 citations


Journal ArticleDOI
TL;DR: This result suggests that fear of being devalued in the minds of others has a significant impact on people's psychological well-being, and this effect can be partially explained by self-criticism.
Abstract: Objectives This study explored the relation between external shame, two types of self-criticism, and depressive, anxious and stress symptoms, in a clinical sample. Specifically, we set out to test whether the impact of external shame on such symptoms would be mediated by two forms of self-criticism. Method A total of 279 patients (228 female and 51 male; mean age of 28.58) with axis I and II disorders recruited from several outpatients psychiatric services in Portugal completed the Other as Shamer Scale (OAS), the Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS), and the Depression, Anxiety and Stress Scale (DASS-42). Results Self-criticism mediated in part the shame–psychopathological symptoms link, especially the hated self form. The alternative model where shame mediates the link between self-criticism and psychopathological symptoms was also significant. This result suggests that fear of being devalued in the minds of others has a significant impact on people's psychological well-being, and this effect can be partially explained by self-criticism. Conclusions This study highlights that inadequate self and hated self are separable types of self-criticism, because they show different patterns of association with psychopathology. Shame and self-criticism appear to mutually enhance one another, and both are associated with psychopathological symptoms. External shame and self-criticism should be a target in treatment. Practitioner points External shame and self-criticism are associated with depressive, anxious, and stress symptoms, in a clinical sample. Self-criticism, especially hatred for the self, mediates the shame–psychopathological symptoms link. Shame and self-criticism should be addressed in therapeutic interventions targeting the reduction of depression, anxiety, and stress symptoms.

41 citations


Journal ArticleDOI
TL;DR: Mediation analysis in both the single and one over-arching mediator models revealed that empowerment mediates the relationship between psychological factors and mental health, well-being, and recovery from general life problems in young people.
Abstract: Objectives There is consensus that empowerment is key to recovery from mental health problems, enabling a person to take charge of their life and make informed choices and decisions about their life. However, little is known about the mechanisms through which empowerment affects mental health in young people. The current study involved young people aged 16–29 years and examined empowerment as a potential mediator of the relationship between psychological factors (psychosocial, cognition, coping, and control) and mental health, well-being, and recovery from personal problems. Methods A cross-sectional, Internet-based questionnaire study recruited 423 young people aged between 16 and 29 attending universities in England (n = 336) and Ireland (n = 87). Psychological factors, mental well-being, empowerment, and recovery from personal problems were measured using self-report measures. Results Mediation analysis in both the single and one over-arching mediator models revealed that empowerment mediates the relationship between psychological factors (psychosocial, self-efficacy, thinking style, coping, and control) and mental health, well-being, and recovery from general life problems. Conclusions This study demonstrates the importance of empowerment, showing that it mediates the relationship between psychological processes and mental health, well-being, and recovery in young people. Clinical implications for working with young people within mental health services, and facilitating their empowerment are discussed. Practitioner points Empowerment is currently a poorly defined concept. This study demonstrates how empowerment mediates the relationship between psychological processes and mental health, well-being, and recovery in young people. Clinicians working with young people might benefit from a structured means of understanding and assessing the different ways in which individuals manage their thinking styles. Empowerment in young people is influenced by the manner in which clinicians facilitate them in establishing social networks in support of employment, education, family/social relations and to encourage young people to take an assertive role in their own care.

36 citations


Journal ArticleDOI
TL;DR: Health anxiety in CFS/ME patients is likely to be common and warrants further investigation to provide a better insight into how this may influence treatment and symptom management.
Abstract: Objectives There is a lack of research examining the incidence of health anxiety in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), despite this being an important research area with potentially significant clinical implications. This preliminary study aimed to determine the incidence of anxiety and depression, more specifically health anxiety, in a sample of CFS/ME patients over a 3-month period. Design The research was a cross-sectional questionnaire-based study, using a consecutive sample of patients who were assessed in a CFS/ME service. Method Data were taken from the Short Health Anxiety Inventory and the Hospital Anxiety and Depression Scale to identify incidence of anxiety, depression, and health anxiety. Results Data were collected from 45 CFS/ME patients over the sampling period. Thirty-one patients (68.9%) scored above the normal range but within the subclinical range of health anxiety, and 19 patients (42.2%) scored within the clinically significant health anxiety range. Anxiety and depression were common, with prevalence rates of 42.2% and 33.3% respectively, which is comparable to data found in a recent large-scale trial. Conclusions Health anxiety in CFS/ME patients is likely to be common and warrants further investigation to provide a better insight into how this may influence treatment and symptom management. Practitioner points Anxiety and depression were common in a sample of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) patients, with a high proportion meeting criteria for severe health anxiety. While CFS/ME and health anxiety are distinct and separate conditions, it is unsurprising that patients with CFS/ME, who commonly report feeling ‘delegitimized’, may experience high levels of anxiety relating to their physical symptoms. Clinicians should consider screening for health anxiety due to the possible clinical implications for treatment; mutual maintenance may negatively influence treatment success in a complex condition such as CFS/ME. Health anxiety has been found to be common across other chronic medical conditions but has been shown to be effectively treated with appropriately tailored interventions.

29 citations


Journal ArticleDOI
TL;DR: It is demonstrated how STMBP could be effective in MDD even after 40 sessions, maintaining its effect in a 1-year follow-up, suggesting also an inverse association between RF and alexithymia.
Abstract: Objectives In depressed patients, recent advances have highlighted impairment in mentalizing: identifying and interpreting one's own or other's mental states. Short-Term Psychodynamic Psychotherapy (STPP) has proven to be effective in reducing symptoms and improving relational/functional abilities in these subjects. Therefore, the first aim of our study was to evaluate effectiveness of STPP with Mentalization-Based Techniques (STMBP) on their clinical outcomes and the second, to investigate Reflective Functioning and alexithymia concerning treatment outcomes in depressed subjects. Design A baseline evaluation of reflective functioning, alexithymia and depression was conducted before an STMBP treatment. Patients were re-tested successively after 40 weeks (T1) and in a follow-up after 1 year at the end of the treatment (T2). Methods A total of 24 patients principally diagnosed with Major Depressive Disorder (MDD) underwent a STMBP conducted by two expert therapists. Global Assessment Functioning (GAF), Toronto Alexithymia Scale-20 (TAS-20) and Hamilton Depression Rating Scale (HAM-D) data were collected at the baseline (T0) by two clinical therapists, along with RF scores rated by two trained raters. HAM-D, TAS-20 and GAF follow-ups were conducted at the end of the treatment after 40 weeks (T1) and after 1-year follow-up (T2). Results Results highlighted an improvement of both HAM-D and TAS-20 scores in our sample. Moreover, a negative correlation between RF and TAS-20 was found. Both HAM-D and RF at T0 influenced depressive outcomes at the end of the treatment. Conclusions Results confirmed the effectiveness of STMBP in MDD, suggesting also an inverse association between RF and alexithymia. Practitioner points Our study demonstrates how STMBP could be effective in MDD even after 40 sessions, maintaining its effect in a 1-year follow-up. STMBP improves subjective capability of reflecting on the mental states of oneself and others. Our intervention allows patients to orientate thoughts from inside to outside, reducing negative beliefs also in absence of a pharmacological therapy (during the follow-up).

Journal ArticleDOI
TL;DR: The study illuminated the complex process of making decisions about ones' destiny on a moment-to-moment basis and revealed the torment experienced when occupying this state, while paradoxically, also revealing how indecision about life and death provided a lifeline opportunity for those with RSA.
Abstract: Objective This qualitative study aimed to capture the experience of living in the ambivalent space between life and death for adults with recurrent suicide attempts (RSA). It sought to expand upon an earlier study that explored the processes involved in transitioning away from RSA among adults, which revealed that occupying this ambivalent space is a crucial part of this process. Design Interpretive phenomenological analysis (IPA) was used. This methodology was designed to explore the lived experiences and meaning making and enabled interpretation of the multidimensional subjective experiences of RSA participants. Methods In-depth semi-structured interviews were conducted with eight adult women with a history of RSA who had participated in a therapeutic intervention at the research site (Skills for Safer Living: A Psychosocial/Psychoeducational Intervention for People with Recurrent Suicide Attempts [SfSL/PISA]). The six stages of IPA were followed to analyse the interview data. Results Analysis revealed the superordinate theme, ‘surviving moment to moment’, which refers to a precarious state of making decisions about one's life and destiny on a moment-to-moment basis without clear commitment to either life or death. Two subordinate themes were identified: ‘deciding not to die in the moment’ when the participants were more invested in dying than living and ‘deciding to live in the moment’ when they were more invested in living than dying. Conclusion The study illuminated the complex process of making decisions about ones’ destiny on a moment-to-moment basis. It revealed the torment experienced when occupying this state, while paradoxically, also revealing how indecision about life and death provided a lifeline opportunity for those with RSA. Clinicians who recognize the subtle distinctions associated with this in-between state can tailor their interventions accordingly. Practitioner points Surviving moment to moment is characterized by a state of emotional flux and uncertainty about one's destiny, where the person has not fully committed to either life or death. Within this state, there are two interlinked subprocesses, whereby the person is leaning more towards death or life. A critical feature in working with this client group is to recognize their ambiguity and the fragility and temporality of their decisions about their destiny. The practitioner has an opportunity to be a catalyst in the momentum towards life by demonstrating understanding of this survival struggle and tailoring intervention to fit with the nuanced processes within this state.

Journal ArticleDOI
TL;DR: Examination of alliance processes across time pointed to increasing ruptures, more frequent confrontation ruptures and increasing rupture resolution, suggesting increased volatility, directness and productivity in the therapeutic process across time.
Abstract: Objectives This study aimed to investigate alliance rupture and repair processes in psychotherapy for youth with borderline personality disorder. It sought to examine whether alliance processes differ between treatments, across the phases of therapy, and what associations these processes might have with therapeutic outcomes. Design The study involves repeated measurement of both process and outcome measures. Hypotheses were addressed using within- and between-subjects analyses. Methods Forty-four people, aged 15–24, with a diagnosis of BPD were randomized to receive either 16 sessions of Cognitive Analytic Therapy (CAT) or a supportive treatment known as Befriending. In addition to pre-post outcome assessments, alliance processes were rated using the observer-based Rupture Resolution Rating Scale. Results Results indicated that CAT and Befriending did not differ in terms of number of ruptures, although CAT was associated with more stages of rupture resolution. Examination of alliance processes across time pointed to increasing ruptures, more frequent confrontation ruptures and increasing rupture resolution, suggesting increased volatility, directness and productivity in the therapeutic process across time. Contrary to hypotheses, there was no consistent link between alliance processes and outcome. However, two specific phases were significant. Early treatment ruptures were associated with poor outcome whereas greater late treatment resolution was associated with better outcomes. Conclusions This study suggests that alliance processes can differ across treatments and the phases of therapy in psychotherapy for youth with BPD. Alliance ruptures are more likely to be problematic early in therapy but later in therapy, they appear to be opportunities for therapeutic growth. Practitioner points Alliance ruptures are more likely than not to occur in any given session with a young person with Borderline Personality Disorder. Early in therapy, withdrawal type ruptures are more frequent, whereas late in therapy, confrontation ruptures are more frequent. Late in therapy, alliance ruptures should be viewed as opportunities for therapeutic change, rather than barriers to good outcomes.

Journal ArticleDOI
TL;DR: Art therapy was reported to be an acceptable treatment for the majority of respondents, and may not be a preferred treatment option for a small number of patients, emphasizing the importance of considering patient preference in choice of treatment, and selection of the most suitable patients for art therapy.
Abstract: Purpose This systematic review aimed to synthesize qualitative evidence relating to user and service provider perspective on the acceptability and relative benefits and potential harms of art therapy for people with non-psychotic mental disorders. Methods A comprehensive literature search was conducted in 13 major bibliographic databases from May to July 2013. A qualitative evidence synthesis was conducted using thematic framework synthesis. Results The searches identified 10,270 citations from which 12 studies were included. Ten studies included data from 183 service users, and two studies included data from 16 service providers. The evidence demonstrated that art therapy was an acceptable treatment. The benefits associated with art therapy included the following: the development of relationships with the therapist and other group members; understanding the self/own illness/the future; gaining perspective; distraction; personal achievement; expression; relaxation; and empowerment. Small numbers of patients reported varying reasons for not wanting to take part, and some highlighted potentially negative effects of art therapy which included the evoking of feelings which could not be resolved. Conclusions The findings suggest that for the majority of respondents art therapy was an acceptable intervention, although this was not the case for all respondents. Therefore, attention should be focussed on both identifying those who are most likely to benefit from art therapy and ensuring any potential harms are minimized. The findings provide evidence to commissioners and providers of mental health services about the value of future art therapy services. Practitioner points Art therapy was reported to be an acceptable treatment for the majority of respondents. Art therapy may not be a preferred treatment option for a small number of patients, emphasizing the importance of considering patient preference in choice of treatment, and selection of the most suitable patients for art therapy. Consideration should be made of adjustments to make art therapy inclusive, particularly for those with physical illnesses. Ensuring the competence of the deliverer, providing patients with additional support, such as other therapies if required, and ensuring continuity of care should be key considerations in service provision.

Journal ArticleDOI
TL;DR: It is implied that treatment for self-criticism may be more challenging with people with eating disorders than people with depression, and the importance of exploring people's beliefs about their self-Criticism is highlighted.
Abstract: Objectives To explore the phenomenology of self‐criticism, and the relationship with constructs such as rumination and perfectionism. Design The study followed a three‐group (Depression, n = 26; Eating Disorder, n = 26; Non‐clinical, n = 26) mixed methods design. Method Participants completed a set of questionnaires and were interviewed about the occurrence, impact, and content of self‐critical thinking, along with their beliefs about self‐criticism. Results Both clinical groups reported more frequent, persistent, and less controllable self‐criticism compared to controls, present on average 50–60% of the time. They reported a negative impact on mood, and a moderately severe impact on daily activities. They indicated greater desire to change self‐criticism whilst judging it more difficult to reduce. Habitual self‐criticism was highly correlated with lower self‐esteem, lower self‐compassion, greater rumination, and greater negative perfectionism. Compared to those with depression, the eating disorder group reported harsher self‐criticism, felt it was more part of their personality, and was more beneficial. Conclusions The findings highlight the importance of exploring people's beliefs about their self‐criticism, and imply that treatment for self‐criticism may be more challenging with people with eating disorders than people with depression.

Journal ArticleDOI
TL;DR: This study found that significant events in therapy were characterized by high levels of both emotional and cognitive language, and alliance strengthening, which can be useful in guiding clinicians and improving treatment outcomes.
Abstract: Objective Significant change events are helpful moments within a psychotherapy session that have been shown in previous research to relate strongly to outcome. They are special moments and therefore provide rich data for research into understanding therapeutic process. This study investigated clinical and linguistic features of these helpful moments using and comparing both human ratings and computerized text analysis strategies. Method Significant change events versus non-event passages were studied within 1195 word blocks of transcribed psychotherapy for 20 participants with diagnoses of comorbid depression and personality disorder. Significant events were determined manually by independent raters using the Helpful Aspects of Therapy (HAT) form linked to the Helpful Aspects of Experiential Therapy Content Analysis System (HAETCAS). Mergenthaler's Therapeutic Cycles Model (TCM)-computerized text analysis, identified significant events via linguistic markers. The Linguistic Inquiry and Word Count (LIWC) differentiated emotional and cognitive components. Results Significant events included statements reflecting emotional and cognitive awareness and insight, and moments of alliance strengthening. These events were saturated with both positive and negative emotion words, particularly anger and sadness, and more cognitive insight words. Conclusions Significant moments of psychotherapeutic movement featured high therapeutic alliance. There was evidence of the integration or working through of positive and negative emotional content with cognitive insight - meaning both emotion and cognition were important in these interchanges. Practitioner points This study found that significant events in therapy were characterized by high levels of both emotional and cognitive language, and alliance strengthening. Linguistic analysis methods provide important data on psychotherapeutic processes which can be useful in guiding clinicians and improving treatment outcomes.

Journal ArticleDOI
TL;DR: Qualitative literature exploring inpatient hospital staff experiences of their relationships with people who self-harm found increasing support for staff with a focus on distress tolerance, managing relational issues, and developing self-awareness within the relationship may lead to a more mutually beneficial experience of care.
Abstract: Purpose This review aimed to synthesize qualitative literature exploring inpatient hospital staff experiences of their relationships with people who self-harm. Methods Nine studies were identified from a systematic search of five research databases. Papers included the experiences of physical health and mental health staff working in inpatient settings. The studies employed various qualitative research methods and were appraised using an adapted quality assessment tool (Tong, Sainsbury, & Craig, 2007). A meta-synthesis was conducted using traditional qualitative analysis methods including coding and categorizing data into themes. Results Three main themes derived from the data. ‘The impact of the system’ influenced the extent to which staff were ‘Fearing the harm from self-harm’, or were ‘Working alongside the whole person’. A fear-based relationship occurred across mental health and physical health settings despite differences in training; however, ‘Working alongside the whole person’ primarily emerged from mental health staff experiences. Systemic factors provided either an inhibitory or facilitative influence on the relational process. Conclusions Staff experiences of their relationship with people who self-harm were highlighted to have an important impact on the delivery and outcome of care. Increasing support for staff with a focus on distress tolerance, managing relational issues, and developing self-awareness within the relationship may lead to a more mutually beneficial experience of care. Equally, structure, clarity, and support within inpatient systems may empower staff to feel more confident in utilizing their existing skills. Practitioner points Working with people who self-harm can be emotionally challenging and how staff cope with this can significantly impact on the engagement of staff and patients. Increasing the skills of staff in managing relational issues and tolerating distress, as well as providing support and reflective practice groups may be useful in managing emotional responses to working with people who self-harm. Refining the supportive, procedural, and environmental structures surrounding the caregiving relationship may help enable better integration of physical and mental health care.

Journal ArticleDOI
TL;DR: In this article, the authors investigated the importance of the level of personality organization on the benefits of short-term versus long-term psychotherapies and found that the effect of LPO on psychiatric symptoms and work ability is poorly known.
Abstract: Objectives How level of personality organization (LPO) predicts psychiatric symptoms and work ability in short- versus long-term psychotherapies is poorly known. We investigated the importance of the LPO on the benefits of short-term versus long-term psychotherapies. Design A cohort study based on 326 outpatients with mood or anxiety disorder was allocated to long-term (LPP) and short-term (SPP) psychodynamic psychotherapy, and solution-focused therapy (SFT). Methods The LPO was assessed by interview at baseline and categorized into neuroses and higher level borderline. Outcome was assessed at baseline and 4–9 times during a 5-year follow-up, using self-report and interview-based measures of symptoms and work ability. Results For patients receiving SPP, improvement in work ability, symptom reduction, and the remission rate were more considerable in patients with neuroses than in higher level borderline patients, whereas LPP or SFT showed no notable differences in effectiveness in the two LPO groups. In patients with neuroses, improvement was more considerable in the short-term therapy groups during the first year of follow-up, and in higher level borderline patients LPP was more effective after 3 years of follow-up. The remission rate, defined as both symptom reduction and lack of auxiliary treatment, was higher in LPP than in SPP for both the LPO groups considered. Conclusions In neuroses, short-term psychotherapy was associated with a more rapid reduction of symptoms and increase in work ability, whereas LPP was more effective for longer follow-ups in both LPO groups. Further large-scale studies are needed. Practitioner points Level of personality organization is relevant for selection between short- and long-term psychotherapies. Short-term therapy gives faster benefits for neurotic patients but not for patients with higher level borderline personality organization. Sustained remission from symptoms is more probable after long-term than short-term therapy.

Journal ArticleDOI
TL;DR: This exploratory study represents an important step in examining directly experiences of young children whose parents have BD, and was possible to gather insightful information from children to generate hypotheses and influence service development.
Abstract: Objectives: To explore the experiences of young children of living with a parent with bipolar disorder (BD) and how this impacts on their emotional well‐being. Design: Qualitative study using a computer‐assisted semi‐structured interview, ‘In My Shoes’ (IMS). Methods: Ten children aged between 4 and 10 years with a parent with BD identified via self‐help groups were interviewed about their experience of family life. Thematic analysis was used following transcription. Results: Four main themes emerging from thematic analysis were as follows: perception of parents; knowledge and awareness of BD; managing family life with a ‘bipolar’ parent; and living in a family with BD. Four‐year‐old children could participate in the IMS interviews and discuss their parent's mood, behaviour, and mental health. Children had candid and insightful discussions about their parent's BD including symptoms and parenting, and could reflect on how having a parent with BD affected them emotionally and practically. Older children were better able to articulate their parent's illness and its impact. Conclusions: This exploratory study represents an important step in examining directly experiences of young children whose parents have BD. Using IMS, it was possible to gather insightful information from children to generate hypotheses and influence service development. Children of all ages had some knowledge and understanding of their parent's illness, describing both positive and negative experiences in the family. Further research to build understanding of children's perspectives and the support they feel they and their family would benefit from would enhance the development of appropriate services and interventions.

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TL;DR: Ruminative brooding, defined as a tendency to repeatedly think about emotional aspects of an event, consistently correlates with current low mood across different types of suicidal groups (NS, suicidal ideators, and suicide attempters), and across analyses.
Abstract: Objectives Links between suicidality and depressed mood are well established. There is, however, little information about the emotional regulation processes that underlie the relationship between suicidality and current low mood, and how these processes differ between groups of never-suicidal (NS), suicidal ideators, and suicide attempters. As suicidality and depression are heterogeneous constructs, this study aimed to conduct within- and between-group comparisons of known suicide risk factors that are associated with emotion regulation (neuroticism, trait aggression, brooding, impulsivity, and overgeneral autobiographical memories). Design Correlational design using between- and within-group comparisons from self-report measures. Methods Inter- and intragroup differences were identified using Pearson's correlation coefficients and tests of difference. An analysis of indirect effects was used to investigate whether the relationship between suicidality and current low mood was mediated by neuroticism, trait aggression, brooding, impulsivity, and overgeneral autobiographical memories, and if this relationship varied according to group type. Results Brooding appeared to be a consistent feature of all three groups and was closely related to current low mood. Compared to the NS group, the relationship between suicide attempts and current low mood showed greater associations with brooding, trait aggression, and overgeneral autobiographical memories. Compared to the NS group, the suicidal ideation group showed stronger associations with neuroticism and impulsivity, but these factors did not correlate with low mood. Conclusion These results suggest a need for larger studies to focus on heterogeneity within suicidal populations and consider how different combinations of risk factors may heighten or reduce suicide risk. Practitioner points It is well known that the severity and intensity of suicide and depressed presentations vary because of underlying dispositional and contextual factors (Fried & Nesse, 2015) which, in turn, affect how events are interpreted and responded to. Despite this, there is little research about how these mechanisms operate in different types of suicide groups, and their influence on the relationship between suicidality and current low mood. Understanding interrelationships that affect current low mood is of clinical significance because past suicidal history and deteriorations in already negative mood are linked to repeated suicide attempts and completion. Our findings show that ruminative brooding, defined as a tendency to repeatedly think about emotional aspects of an event, consistently correlates with current low mood across different types of suicidal groups (NS, suicidal ideators, and suicide attempters), and across analyses. Findings also show that suicidal ideation and attempt groups were associated with specific personality characteristics that increased the propensity of emotional responding and interpretation compared to the NS group. The relationship between suicide attempt and current low mood had a higher propensity to be influenced by trait aggression, brooding, and overgenerality compared to the NS group. In contrast, although the suicidal ideation group correlated more strongly with neuroticism and impulsivity, these factors did not influence current low mood. In terms of clinical practice, these findings imply that specific styles of interpretation and thinking may maintain the relationship between suicidality and current low mood. Given the cross-sectional nature of the study, however, it is not possible to imply causality. Nevertheless, the findings obtained provide some support for transdiagnostic models of cognitive-behavioural processes that could be developed further.

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TL;DR: The study adds to the pool of evidence suggesting that SBHC can be tested and that it brings about short-term reductions in psychological and emotional distress in young people, across ethnicities, however, there is no evidence of longer-term effects.
Abstract: OBJECTIVES: The aim of this study was to pilot a test of the effectiveness of school-based humanistic counselling (SBHC) in an ethnically diverse group of young people (aged 11-18 years old), with follow-up assessments at 6 and 9 months. DESIGN: Pilot randomized controlled trial, using linear-mixed effect modelling and intention-to-treat analysis to compare changes in levels of psychological distress for participants in SBHC against usual care (UC). TRIAL REGISTRATION: ISRCTN44253140. METHODS: In total, 64 young people were randomized to either SBHC or UC. Participants were aged between 11 and 18 (M = 14.2, SD = 1.8), with 78.1% of a non-white ethnicity. The primary outcome was psychological distress at 6 weeks (mid-therapy), 12 weeks (end of therapy), 6-month follow-up and 9-month follow-up. Secondary measures included emotional symptoms, self-esteem and attainment of personal goals. RESULTS: Recruitment and retention rates for the study were acceptable. Participants in the SBHC condition, as compared with participants in the UC condition, showed greater reductions in psychological distress and emotional symptoms, and greater improvements in self-esteem, over time. However, at follow-up, only emotional symptoms showed significant differences across groups. CONCLUSIONS: The study adds to the pool of evidence suggesting that SBHC can be tested and that it brings about short-term reductions in psychological and emotional distress in young people, across ethnicities. However, there is no evidence of longer-term effects. PRACTITIONER POINTS: School-based humanistic counselling can be an effective means of reducing the psychological distress experienced by young people with emotional symptoms in the short term. The short-term effectiveness of school-based humanistic counselling is not limited to young people of a White ethnicity. There is no evidence that school-based humanistic counselling has effects beyond the end of therapy.

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TL;DR: In this paper, the authors investigated the role of specific diagnosis of the patient in the formation of the therapeutic alliance and found that the working alliance is of general clinical importance irrespective of the disorder group and should be a central target in all therapies.
Abstract: Objective The therapeutic alliance is intensively investigated in psychotherapy research. However, there is scarce research on the role of the specific diagnosis of the patient in the formation of the therapeutic alliance. Hence, the aim of this study was to address this research gap by comparing the alliance in different mental disorders. Design Our sample comprised 348 patients (mean age = 40 years; 68% female; 133 patients with depression, 122 patients with somatoform disorders, and 93 patients with eating disorders). Methods Patients completed the Working Alliance Inventory and measures of therapeutic outcome in early, middle, and late stages of inpatient psychotherapy. We applied multivariate multilevel models to address the nested data structure. Results All three disorder groups experienced positive alliances that increased across the course of therapy and showed similar alliance–outcome relations that were of comparable strengths as in current meta-analyses. However, we found perspective incongruence of alliance ratings from patient and therapist in the three disorder groups. Conclusions Our results generally indicate that the working alliance is of importance irrespective of the specific mental disorder. Perspective incongruence feedback of working alliance experiences could help to strengthen coordination between patient and therapist and thereby improve the therapeutic process. Further implications of these findings are discussed. Practitioner points We found no differences in the strengths of alliance ratings and alliance–outcome associations in depressive, somatoform, and eating disorder patients. This indicates that the working alliance is of general clinical importance irrespective of the disorder group and should be a central target in all therapies. We found perspective incongruence in alliance ratings between patient and therapist in all three disorder groups. Perspective incongruence feedback of working alliance experiences could help to strengthen coordination between patient and therapist and thereby improve the therapeutic process.

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TL;DR: MAS-A is a reliable expert rating to assess metacognition from patients' free narratives and appears to be a promising tool for the evaluation of metac Cognition in psychotherapy research.
Abstract: Objectives Metacognition, the capacity ‘to think about thinking’ and thus to reflect and to master interpersonal problems on a mentalistic basis, is often impaired among patients with schizophrenia spectrum disorders and has been suggested as a potential treatment target. However, little is known about the reliability of its measurement and links with related phenomena. The aim of this study was to validate a German translation of the Metacognition Assessment Scale (MAS-A) as a measure to assess metacognition from free narratives of patients’ personally relevant episodes and relationships. Design and Methods MAS-A was applied to narratives of 22 individuals with schizophrenia spectrum disorders together with self-ratings and behavioural tests of metacognitive and related functions such as mentalizing and emotional awareness. Multi-level modelling allowed to calculate inter-rater reliability (IRR) and inter-rater agreement (IRA) and to include test results as level-2 predictors of the aggregated scorings on the MAS-A subscales in order to explore convergent validity. After considering neurocognition and symptom scores as further predictors, aggregated scorings were correlated with psychosocial functioning. Results There were high IRRs and IRAs all over the ratings. None of the related measures accounted for variance in MAS-A scorings, indicating the existence of separable, non-overlapping constructs. Verbal memory and positive symptoms were significant predictors for MAS-A subscales. MAS-A, but no other measure, displayed significant associations with psychosocial functioning. Conclusions MAS-A is a reliable expert rating to assess metacognition from patients’ free narratives. Considering the link to psychosocial functioning, MAS-A appears to be a promising tool for the evaluation of metacognition. Practitioner points MAS-A is a reliable tool to evaluate metacognitive function from narratives about emotionally relevant topics and meaningful relationships. Metacognition appears separate from neighbouring constructs such as mentalizing, ToM, or emotional awareness. MAS-A scales are significantly predicted by verbal memory and positive symptoms. Only MAS-A scales display significant associations with psychosocial functioning, and it thus is a promising tool to evaluate metacognition in psychotherapy research.

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TL;DR: A grounded theory study explored experiences of, and reflections on, pride among women with a current or past diagnosis of anorexia nervosa and its evolving nature during treatment, suggesting the evolving nature of pride plays a central role in development, maintenance, and treatment of anoresis.
Abstract: Objective: Theory and clinical literature suggest that pride may play an important role in the maintenance of restrictive eating disorders. A grounded theory study explored experiences of, and reflections on, pride among women with a current or past diagnosis of anorexia nervosa. Design: This is a qualitative study using grounded theory. Method: Semistructured interviews were conducted with 21 women recruited from an eating disorder unit in England, and from a UK self‐help organization. Grounded theory from a constructivist lens was used. Analysis involved coding, constant comparison, and memo‐writing. Results: Pride evolves over the course of anorexia nervosa. Two overarching conceptual categories were identified: ‘pride becoming intertwined with anorexia’ and ‘pride during the journey towards recovery’. These categories encompassed different forms of pride: ‘alluring pride’, ‘toxic pride’, ‘pathological pride’, ‘anorexia pride’, ‘shameful pride’, ‘recovery pride’, and ‘resilient pride’. Initially, pride contributed to self‐enhancement and buffered negative emotions. As the condition progressed, pride became a challenge to health and interfered with motivation to change. During recovery, perceptions of pride altered as a healthy approach to living ensued. Conclusions The evolving nature of pride plays a central role in development, maintenance, and treatment of anorexia nervosa. Understanding of pride and its role in psychotherapeutic work with this client group may increase motivation to change and promote recovery. Future work should investigate whether tackling pride in eating disorders increases treatment efficacy and reduces the risk of relapsing.

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TL;DR: The present qualitative study aimed to identify the barriers to seeking treatment and the factors that encourage or push people to seek help for their OCD (positive and negative enablers).
Abstract: Objectives Obsessive compulsive disorder (OCD) can be hugely disabling. Although very effective psychological treatments exist, many people delay years before seeking help or never seek treatment. There have been clinical observation and short questionnaire studies on why people delay, but little qualitative research exists on this complex subject. The present qualitative study aimed to identify the barriers to seeking treatment and the factors that encourage or push people to seek help for their OCD (positive and negative enablers). Design A qualitative, exploratory study using in-depth, individual, semi-structured interviews was conducted by a researcher with personal experience of OCD. Methods Seventeen people with OCD, contacted through the charity OCD-UK, were interviewed about the factors that impacted on their decision to seek help or not. The interviews were analysed using thematic analysis. Results Barriers identified were stigma, ‘internal / cognitive’ factors, not knowing what their problem was, factors relating to their GP or treatment, and fear of criminalisation. Positive enablers identified were being supported to seek help, information and personal accounts of OCD in the media, and confidence in their GP. Negative enablers were reaching a crisis point and for some participants (whose intrusive thoughts were about harming children) feeling driven to seek treatment because of the nature of the thoughts, that is, seeking help to prevent the ‘harm’ they feared they were capable of doing. Conclusions Participants identified a range of barriers and enablers that impacted on their decision to seek help or not. These give important indicators about the likely causes for delayed help seeking in OCD and ways in which people might be encouraged to seek help earlier. Practitioner points People with OCD may face a wide range of barriers to seeking help, including concern about the reaction of health professionals. The level of awareness, kindness, and understanding shown by first-line practitioners can be very important to those seeking help. Acknowledging a person's journey prior to seeking help is likely to foster trust between therapist and patient. Some barriers to seeking help, for example, fear of criminalisation, may continue to have an important effect afterwards unless sensitively explored and understood.

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TL;DR: It was showed that biomedical views about recovery prevail among multidisciplinary mental health staff, despite recent advancements in patients' broader conceptualization of recovery.
Abstract: Purpose Mental health services remain largely set up to improve patient outcomes through symptom alleviation, but patient views of recovery are broader than symptom remission. Clinicians influence the nature of treatment patients received, but their views about recovery remain poorly understood. The aim of this study was to systematically review the literature examining staff views about psychosocial aspects of recovery in psychosis. Method We systematically searched the PsycInfo, EMBASE, MEDLINE, and CINAHL databases. Of the 6,225 articles identified, 15 met inclusion criteria for review. Results The studies reviewed showed a relatively inconsistent picture. Although there was evidence of staff endorsing psychosocial views of recovery, the majority of studies suggested staff endorsed biomedical models of recovery in psychosis and emphasized the importance of pharmacological, over psychosocial, and interventions. Conclusions The reviewed studies showed that biomedical views about recovery prevail among multidisciplinary mental health staff, despite recent advancements in patients’ broader conceptualization of recovery. Clinical implications are discussed. Practitioner points The psychosocial model of recovery has become widely accepted and now underpins most international recovery policies. Despite a dearth in research, existing studies indicate that mental health staff subscribe to biomedical models of recovery in psychosis, with more emphasis on pharmacological, over psychosocial, and interventions. Robust research targeting staff views about recovery in psychosis is needed.

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TL;DR: Support is added to the suggestion that voice-related distress occurs in the context of an insecure attachment style and negative core beliefs about self and others, as well as to the proposal that attachment anxiety/avoidance drive negative beliefs aboutSelf and others.
Abstract: Objectives Cognitive models propose that levels of distress associated with auditory verbal hallucinations (‘voices’) are influenced by the hearers' beliefs about their voices (perceived malevolence and omnipotence), their negative beliefs about themselves and others and their attachment style. This study aims to test a comprehensive model of the relationship between these variables in order to identify distal and proximal interpersonal and cognitive factors contributing to voice-related distress. This interpersonal–cognitive model of voices proposes that attachment anxiety/avoidance drive negative beliefs about self and others, which in turn lead to persecutory (malevolent/omnipotent) beliefs about voices, which in turn increase levels of voice-related distress. Design/Methods Path analysis was used to test the interpersonal–cognitive model in a sample of 180 people currently hearing voices (57% self-reported schizophrenia-spectrum diagnoses; 90% some form of self-reported mental health diagnosis). Results Path analysis provided support for a model in which there were direct pathways from attachment anxiety and avoidance to negative beliefs about self and others; direct pathways from negative beliefs about self and others to persecutory beliefs about voices; and a direct path from persecutory beliefs about voices, and negative beliefs about self, to voice distress. Conclusions Findings add support to the suggestion that voice-related distress occurs in the context of an insecure attachment style and negative core beliefs about self/others. A therapeutic focus on beliefs about voices, attachment style and core beliefs about self/others may be important to minimize voice-related distress. Further tests of this model that can establish causal relationships between variables are now needed. Practitioner points Distress associated with auditory verbal hallucinations (‘voices’) is highly variable. This study tests a comprehensive interpersonal–cognitive model of voice distress using path analysis with 180 participants. The model tested in the current paper shows that attachment style predicts negative beliefs about self and others, which in turn predicts negative beliefs about voices, which in turn predicts voice-related distress. Findings support the suggestion that voice-related distress occurs in the context of an insecure attachment style and negative core beliefs about self and others. In addition to focusing on beliefs about voices, a therapeutic focus on attachment style and core beliefs about self and others may be important in order to minimize voice-related distress.

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TL;DR: Investigating whether an optimistic disposition differentially predicts patients' ability to benefit from short-term versus long-term psychotherapy found stronger optimism seems to best facilitate engaging in and benefiting from a long- term therapy process, while weaker optimism does not appear to inhibit brief therapy from effecting symptomatic recovery.
Abstract: Objectives Dispositional optimism predicts various beneficial outcomes in somatic health and treatment, but has been little studied in psychotherapy. This study investigated whether an optimistic disposition differentially predicts patients’ ability to benefit from short-term versus long-term psychotherapy. Design A total of 326 adult outpatients with mood and/or anxiety disorder were randomized into short-term (solution-focused or short-term psychodynamic) or long-term psychodynamic therapy and followed up for 3 years. Methods Dispositional optimism was assessed by patients at baseline with the self-rated Life Orientation Test (LOT) questionnaire. Outcome was assessed at baseline and seven times during the follow-up, in terms of depressive (BDI, HDRS), anxiety (SCL-90-ANX, HARS), and general psychiatric symptoms (SCL-90-GSI), all seven follow-up points including patients’ self-reports and three including interview-based measures. Results Lower dispositional optimism predicted faster symptom reduction in short-term than in long-term psychotherapy. Higher optimism predicted equally rapid and eventually greater benefits in long-term, as compared to short-term, psychotherapy. Conclusions Weaker optimism appeared to predict sustenance of problems early in long-term therapy. Stronger optimism seems to best facilitate engaging in and benefiting from a long-term therapy process. Closer research might clarify the psychological processes responsible for these effects and help fine-tune both briefer and longer interventions to optimize treatment effectiveness for particular patients and their psychological qualities. Practitioner points Weaker dispositional optimism does not appear to inhibit brief therapy from effecting symptomatic recovery. Patients with weaker optimism do not seem to gain added benefits from long-term therapy, but instead may be susceptible to prolonged psychiatric symptoms in the early stages of long-term therapy.

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TL;DR: This study established a novel factor structure for the Frost Multidimensional Perfectionism Scale, allowing proof of principle of the role of perfectionism in a relationship with attachment and psychopathology, which after replication, may inform new interventions for perfectionism.
Abstract: Objectives Perfectionism is recognized as a significant risk factor for psychopathology. Emerging research links attachment to perfectionism in adult and college-age samples. The Frost Multidimensional Perfectionism Scale (FMPS) has been used in adults and adolescents with a variety of factor structures found. This study sought to establish the factor structure in a general adolescent sample prior to testing for associations between perfectionism, attachment, and psychopathology in the same sample. Design A cross-sectional survey design was used. Confirmatory factor analysis, and correlational and regression analyses were employed. Methods A total of 290 adolescents, aged 12–18 years, were recruited from a state secondary school. All completed the FMPS along with brief measures of attachment and psychopathology. Result Exploratory and confirmatory factor analyses failed to replicate previously published models, and a new six-item, 1-factor model representing perfectionism was found instead. This new variable was then used to establish a role for perfectionism and attachment anxiety in predicting internalizing problems. Perfectionism also correlated with conduct problems and hyperactivity. Conclusion This study established a novel factor structure for the FMPS, allowing proof of principle of the role of perfectionism in a relationship with attachment and psychopathology, which after replication, may inform new interventions for perfectionism. Caution is noted about the use of extant perfectionism measures that are not properly developmentally informed and which do not capture the dynamic nature of adolescence and adolescent perfectionism. Practitioner points Perfectionism is a feature of adolescent psychopathology, including internalizing and externalizing problems. Perfectionism is associated with attachment anxiety and together contributes to internalizing problems. Current conceptualizations of perfectionism may not capture the specific developmental and dynamic aspects of adolescence and should not be regarded as a stable personality trait.

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TL;DR: The findings suggest that variability in voice-related distress is closely linked to the perceived impact of voices on personal goals, and interventions promoting control over personal goals may be explored as treatment options for clients with distressing voices.
Abstract: Objectives Distressing and pleasant/positive voices (auditory verbal hallucinations) are common in both clinical and non-clinical voice-hearers. Identifying factors that contribute to emotional reactions to voices is essential for developing effective psychological interventions. Several theories propose that facilitation and interference with personal goals are important predictors of distress and well-being. This study examined whether voice-related distress is related to the degree to which voices interfere with personal goals, and whether pleasantness of voices is influenced by the extent to which they facilitate goals. Design Cross-sectional with clinical and non-clinical voice-hearers. Method Twenty-two clinical and 18 non-clinical voice-hearers completed interviews and self-report measures assessing (1) personal goals, (2) content, characteristics, and affective reactions to voices, and (3) ratings of the extent to which voices facilitated and/or interfered with achievement of important personal goals. Results Affective reactions were strongly correlated with measures of goal interference and goal facilitation. Regression analyses revealed that these associations remained significant when controlling for important covariates (e.g., participant grouping; content, frequency and duration of voices). Goal interference was specifically associated with distress, whereas goal facilitation specifically predicted perceived pleasantness of voices. Conclusions This study provides a novel perspective on the factors that might contribute to distress in people who hear voices. The findings suggest that perceived impact of voices on valued personal goals may be an important contributor of voice-related distress. We propose that clinical assessments, formulations, and interventions could benefit from the careful analysis of the perceived impact of voices on goals. Practitioner points These findings suggest that variability in voice-related distress is closely linked to the perceived impact of voices on personal goals. These strong effects observed highlight the importance of considering the role of personal goals in future research on the psychological mechanisms leading to distress associated with voice hearing. Psychological assessments may benefit from the careful exploration of the impact of voice hearing on valued goals, and interventions promoting control over personal goals may be explored as treatment options for clients with distressing voices.