Journal Of Clinical Psychology[JOURNAL]
Sun
200 papers
Developing a Six-Item Short Form of Ryff's Psychological Well-Being Measure: Demonstration of Short Form Development Using Exhaustive Search.
Joshanloo M
J Clin Psychol · 2026 Mar · PMID 41894641 · Publisher ↗
Using the Midlife in the United States data, this study developed a 6-item short form of Ryff's six-dimensional measure of psychological well-being, with a single item selected to represent each dimension. The study demo...
Using the Midlife in the United States data, this study developed a 6-item short form of Ryff's six-dimensional measure of psychological well-being, with a single item selected to represent each dimension. The study demonstrated the utility of an exhaustive search framework in which all permissible item combinations were systematically evaluated to identify an optimal ultra-short version. Model performance was assessed using global goodness of fit indices (e.g., RMSEA, CFI, SRMR), standardized factor loadings, and coefficient omega to ensure adequate construct representation, unidimensionality, and internal consistency. The resulting short form showed excellent model fit, strong internal consistency, and satisfactory representation of the targeted construct across the development sample and an independent replication sample. Measurement invariance analyses supported full invariance across gender and race, and partial invariance across age and education. Taken together, the findings indicate that the proposed ultra-short scale provides a valid and reliable index of global psychological well-being and is suitable for settings in which domain-level scores are not required and in which time or resource constraints preclude administration of longer measures.
Relative Contributions of Gastrointestinal-Specific Hypervigilance and Anxiety in Explaining Eating Disorder Symptoms.
Pucci G, Hill NG, Schneider Z … +4 more , Brown TA, Burton-Murray H, Guadagnoli L, Forney KJ
J Clin Psychol · 2026 Jul · PMID 41894591 · Full text
OBJECTIVE: Gastrointestinal (GI) disturbances and eating disorder symptoms commonly co-occur. Hypervigilance and anxiety about GI symptoms may motivate eating disorder behaviors to manage and/or avoid GI symptoms. We hyp...
OBJECTIVE: Gastrointestinal (GI) disturbances and eating disorder symptoms commonly co-occur. Hypervigilance and anxiety about GI symptoms may motivate eating disorder behaviors to manage and/or avoid GI symptoms. We hypothesized that GI-specific anxiety would be more strongly associated with dietary restriction and purging than GI-specific hypervigilance. Further, we hypothesized that distinguishing between GI-specific anxiety and hypervigilance would have incremental validity over using an existing measure of GI-anxiety and related constructs initially developed for patients with irritable bowel syndrome, the Visceral Sensitivity Index. METHODS: Three hundred and eighty-two undergraduate students with elevated eating pathology (83.5% female, 87.4% White) completed questionnaires assessing GI-specific hypervigilance and anxiety, the Visceral Sensitivity Index, and eating disorder symptoms. Participants were recruited with elevated shape/weight-oriented eating pathology (N = 309) and elevated avoidant/restrictive food intake disorder-related eating pathology (N = 73). Analyses were pre-registered. RESULTS: Regarding dietary restriction, the relative weight of GI-specific anxiety did not differ from that of GI-specific hypervigilance. Further, neither variable provided incremental validity over the Visceral Sensitivity Index in understanding restriction. Regarding purging, GI-specific anxiety was not more strongly associated with purging than GI-specific hypervigilance. However, GI-specific anxiety, but not GI-specific hypervigilance, demonstrated incremental validity over the Visceral Sensitivity Index in explaining purging. CONCLUSION: Distinguishing between GI-specific hypervigilance and anxiety adds incremental validity in understanding purging but not restriction. Future research should examine whether addressing anxious cognitions about GI symptoms improves purging outcomes.
Losing One's Partner, Losing One's Self: Helping a Patient Process the End of an Early Romantic Relationship Through Psychodynamic Psychotherapy.
Farber BA, Lierle M
J Clin Psychol · 2026 Jul · PMID 41891245 · Publisher ↗
The literature on the psychotherapeutic treatment of individuals suffering from the dissolution of a significant romantic relationship is sparse, especially with regard to those who continue to reflect upon and struggle...
The literature on the psychotherapeutic treatment of individuals suffering from the dissolution of a significant romantic relationship is sparse, especially with regard to those who continue to reflect upon and struggle with a romantic breakup long after the event itself. The present case study explores the psychodynamically-oriented treatment of a young adult patient, with a focus on helping the patient process the ending of a significant romantic relationship from her late adolescence. A twice-weekly, long-term treatment provided a collaborative space to mourn the lost relationship, while facilitating a deepening understanding of the meaning and intensity of this relationship and its enduring effects on the patient's identity, agency, and subsequent romantic relationships. This case highlights the transformative potential of psychodynamic psychotherapy to foster a patient's growth following the dissolution of a romantic relationship.
Psychological Inflexibility's Associations With Lifetime Anxiety Disorders.
Roberts MZ, Boswell JF, Merwin RM … +2 more , Lucksted AA, Forsyth JP
J Clin Psychol · 2026 Jul · PMID 41879463 · Publisher ↗
BACKGROUND: Anxiety has protective functions and could be considered evolutionarily adaptive. Yet, anxiety can also become problematic, and anxiety disorders are common and costly. The present study tested a transdiagnos...
BACKGROUND: Anxiety has protective functions and could be considered evolutionarily adaptive. Yet, anxiety can also become problematic, and anxiety disorders are common and costly. The present study tested a transdiagnostic conceptualization of anxiety disorders that suggests anxiety disorders are associated with inflexible responding to anxiety, even after controlling for anxiety symptom severity. METHODS: A total of 1118 participants across two samples (n = 853 undergraduates; n = 265 community members) completed a battery of self-report measures, including demographics, anxiety (DASS-21), psychological inflexibility (MPFI), and reported lifetime anxiety-related diagnoses. RESULTS: A series of logistic regressions in each sample showed that anxiety was associated with increased odds of endorsing any and each additional lifetime anxiety-related diagnosis, and that psychological inflexibility was incrementally associated above and beyond anxiety severity with greater odds of endorsing any and each additional disorder. CONCLUSIONS: Findings replicated across samples, supporting the conceptualization that one's response to anxiety, beyond how severe that anxiety is, may be an important factor for understanding the degree to which anxiety would interfere in someone's life (i.e., anxiety disorder). Clinically targeting one's response to anxiety may be an important component of mitigating anxiety-related suffering.
Interpersonal Profiles in Social Anxiety Disorder: Different Settings, Different Outcomes?
Babl A, Berger T, Keller A … +8 more , Gómez Penedo JM, Eubanks CF, Baggenstos A, Grosse Holtforth M, Boettcher J, Schulz A, Stolz T, Krieger T
J Clin Psychol · 2026 Jul · PMID 41861352 · Publisher ↗
OBJECTIVE: Social anxiety disorder (SAD) is one of the most common mental disorders, with the majority of those affected not receiving primary care or psychotherapy. Internet-based treatments may be an alternative for in...
OBJECTIVE: Social anxiety disorder (SAD) is one of the most common mental disorders, with the majority of those affected not receiving primary care or psychotherapy. Internet-based treatments may be an alternative for individuals with SAD. We hypothesize that interpersonal characteristics differ between SAD patients in face-to-face (ftf) and online treatments, and that these factors predict treatment outcomes. METHODS: The sample consisted of 539 patients with SAD from four different online treatment studies (N = 376) and one university outpatient clinic in Europe (N = 163) who received integrative CBT. Interpersonal problems were assessed at baseline and symptom severity at baseline and treatment termination. RESULTS: Results showed similar interpersonal patterns of being nonassertive and socially inhibited in both treatment groups at baseline, with patients in online treatment being more severely affected than those in ftf therapy. Interpersonal problems of communion were predictive of outcome in both treatments. Low communion reflects interpersonal coldness, distance, and difficulty forming close bonds, whereas high communion reflects excessive dependence, submissiveness, and overinvolvement with others. Patients with interpersonal problems of low communion benefited more from ftf therapy, while patients with interpersonal problems of high communion benefited more from online therapy. CONCLUSION: These findings underscore the importance of considering interpersonal problems when planning and evaluating treatment for SAD. In the future, it may be possible to predict if a particular SAD patient benefits more from online versus ftf treatment from their baseline interpersonal problems and recommend the suitable treatment.
Depressive Symptoms, Hazardous Alcohol Use, and Suicidality in Bipolar Disorder.
Katz JL, Fiskeaux ML, Lamis DA
J Clin Psychol · 2026 Jul · PMID 41849734 · Publisher ↗
INTRODUCTION: Bipolar disorder is linked to elevated rates of suicidal thoughts, behavior, and death by suicide. The objective of this study was to examine the contribution of depressive symptoms and hazardous alcohol us...
INTRODUCTION: Bipolar disorder is linked to elevated rates of suicidal thoughts, behavior, and death by suicide. The objective of this study was to examine the contribution of depressive symptoms and hazardous alcohol use to suicidality within a predominantly low-income African American sample of individuals with bipolar disorder. METHOD: We recruited 204 patients with bipolar disorder from an urban public hospital's outpatient clinic in the Southeastern U.S. Multiple regression examined associations between depressive symptoms, hazardous alcohol use, and suicidality among past-year drinkers, controlling for gender. RESULTS: The regression model revealed that male gender, depressive symptoms, and hazardous alcohol use accounted for a significant amount of the variance in suicidality. Depressive symptoms exhibited the strongest association (β = 0.367, p < 0.001), followed by hazardous alcohol use (β = 0.171, p = 0.042) and male gender (β = 0.227, p = 0.012). Collectively, these factors accounted for 24.1% of the variance in suicidality (R² = 0.241), underscoring their role in suicide risk among individuals with bipolar disorder. CONCLUSIONS: Findings highlight significant associations between depressive symptoms, hazardous alcohol use, and suicidality in low-income African American individuals with bipolar disorder. Clinical interventions should prioritize comprehensive screening and targeted approaches to address these interconnected risk factors.
The Paradox of Acceptance: A Longitudinal Study on Acceptance, Depression, and the Moderating Role of Anger Suppression Within an ACT Framework.
Kaźmierczak I, Lacko D
J Clin Psychol · 2026 Jul · PMID 41841641 · Publisher ↗
OBJECTIVES: This longitudinal study examined the associations between acceptance of reality and depressive symptoms, in light of inconsistent findings in prior research. Existing studies-mostly cross-sectional-have repor...
OBJECTIVES: This longitudinal study examined the associations between acceptance of reality and depressive symptoms, in light of inconsistent findings in prior research. Existing studies-mostly cross-sectional-have reported negative, positive, or nonsignificant correlations, leaving the role of acceptance in depression unclear. Despite its prominence in third-wave cognitive-behavioral therapies (Hofmann and Asmundson 2008) such as Acceptance and Commitment Therapy (ACT; Hayes et al. 1999), the nature of this association remains debated. To address these gaps, we explored whether levels of acceptance were related to depressive symptoms over time, and whether anger suppression moderated this relationship. METHODS: Self-report data from N = 344 participants who completed the online survey three times, with 2-month intervals between assessments. RESULTS: Higher individual tendency to accept reality was associated with lower depression symptoms. However, elevating acceptance beyond typical thresholds resulted in higher levels of depressive symptoms at subsequent time points, and no relationship between these variables was identified within measurements. Additionally, anger suppression emerged as a moderator of the negative relationship between an individual's tendency to accept reality and depressive symptoms. CONCLUSIONS: These findings help clarify prior inconsistencies by showing that the acceptance-depression link varies with the level of acceptance, temporal perspective, and anger regulation strategies. Interpreted within the ACT framework, the results highlight that elevated acceptance does not always reflect psychological flexibility, and can co-occur with increased depressive symptoms. We highlight the need for further research to explore the mechanisms behind these patterns and examine whether supportive interventions may assist individuals during such phases.
Misophonia in Adolescents: The Interplay of Parental Emotional Expression, Family Functioning, and Childhood Trauma-A Cross-Sectional Control Study.
Ermis DK, Kasar N, Çelebi SB … +1 more , Arslan E
J Clin Psychol · 2026 Jun · PMID 41817313 · Publisher ↗
OBJECTIVE: Misophonia is an underrecognized condition characterized by intense emotional responses to specific auditory stimuli. Beyond its sensory basis, growing evidence suggests that relational experiences and difficu...
OBJECTIVE: Misophonia is an underrecognized condition characterized by intense emotional responses to specific auditory stimuli. Beyond its sensory basis, growing evidence suggests that relational experiences and difficulties in emotional processes may play a critical role in its development and severity. This study aimed to explore the roles of family functioning, adolescent-reported parental emotional expression, and childhood trauma in adolescents with misophonia, using a clinical comparison group with anxiety disorders. METHODS: A total of 128 adolescents aged 12-18 were assessed in a child and adolescent psychiatry outpatient clinic. The misophonia group (n = 78) was identified using the Misophonia Questionnaire (cutoff ≥ 7) and structured clinical interviews. The control group (n = 50) included adolescents with primary anxiety disorders but no clinically significant misophonia symptoms. Validated self-report measures were used to assess family dynamics, perceptions of parental emotional expression, trauma history, and functional impact, along with parent-reported behavioral difficulties that provide indirect information about adolescents' emotion regulation-related challenges. RESULTS: Adolescents with misophonia reported significantly higher levels of emotional and physical neglect and abuse, along with more dysfunctional family dynamics and heightened emotional intrusiveness and irritability. These youth also showed greater difficulties in emotion regulation-related domains, as reflected in parental emotional expression patterns and parent-reported behavioral difficulties, as well as higher levels of functional impairment in home and social settings. Misophonia severity was associated with trauma exposure and maladaptive familial emotional climates. CONCLUSION: Findings suggest that misophonia in adolescence may be shaped by early adverse experiences and relational patterns that contribute to difficulties in emotional functioning. Family-based and trauma-informed approaches should be considered when assessing and treating adolescents presenting with misophonia symptoms.
Preliminary Findings on the Unified Protocol for Transdiagnostic Treatment: A Pilot Trial on Its Effectiveness on Anxiety and Depressive Symptoms for Turkish Adults.
Erarslan-İngeç Ö, Yorulmaz O, Farchione TJ … +1 more , Boschulte M
J Clin Psychol · 2026 Jul · PMID 41815088 · Full text
The present study investigates the feasibility and initial efficacy of the Unified Protocol (UP) as a pilot trial for anxiety and depressive symptoms in Turkish university students with a pretest-posttest control group r...
The present study investigates the feasibility and initial efficacy of the Unified Protocol (UP) as a pilot trial for anxiety and depressive symptoms in Turkish university students with a pretest-posttest control group research design. Thirty-four undergraduate students with high levels of depressive and/or anxiety symptoms were randomly assigned to one of two study conditions: an intervention group based on the UP (n = 17) or a waitlist control group (n = 17). To determine the effectiveness of treatment, a 2 (intervention-control group) x 2 (pre-post test) mixed measures variance analysis was applied for the primary outcome measures: degree of anxiety and depressive symptoms as well as positive and negative affect and psychological well-being. The analyses revealed a significant difference between pre- and post-treatment scores on all outcome measures in the intervention group; these improvements were also significantly greater than those in the control group. These outcomes included participants receiving the Unified Protocol reported lower levels of anxiety and depressive symptoms, decreased negative affect, higher levels of positive affect, and improved psychological well-being compared to the control condition. The findings of this study provide preliminary support for the efficacy of the Unified Protocol in a Turkish sample. The study findings are evaluated in light of the relevant literature and within the scope of the study's limitations, and suggestions for academic and clinical applications are presented.
Italian Validation of the Brief Self-Reported Version of the Spence Children's Anxiety Scale for Children.
De Caro EF, Garofalo C, Delvecchio E … +3 more , Lis A, Ghizzoni G, Mazzeschi C
J Clin Psychol · 2026 Jun · PMID 41793289 · Full text
OBJECTIVES: Clinical assessment of anxiety symptoms in children and adolescents is gaining interest due to the need for brief, valid and reliable instruments that allow early screening through a multiple informant approa...
OBJECTIVES: Clinical assessment of anxiety symptoms in children and adolescents is gaining interest due to the need for brief, valid and reliable instruments that allow early screening through a multiple informant approach. The aim of the present study was to validate the brief self-reported version of the Spence Children's Anxiety Scale for children (SCAS-C-8) by examining its concordances and discrepancies with reports from other informant, for example, parents, as relevant and complementary information for screening. METHODS: Italian children and early adolescents (N = 1019; 50.5% female) aged 8-12 years, their mothers and fathers were included in the study by completing the SCAS-C-8 and its parent-version (SCAS-P-8). The children and early adolescents also self-reported internalizing, that is, anxiety and emotional problems, and externalizing symptoms on the other scales. RESULTS: After confirming the one-factor structure of the SCAS-C-8 and its psychometric properties, that is, reliability, convergent validity with internalizing symptoms and discriminant validity with externalizing symptoms, and complete invariance across sex and age, both concordance and discrepancies between SCAS-C-8 and SCAS-P-8, were examined. Results confirmed the low/moderate agreement between reports of anxiety and that mothers overestimate levels compared to fathers. Sex and age differences emerged in patterns of discrepancy between reports as well. CONCLUSION: Overall, results confirm that the SCAS-C-8 is a valid, reliable, brief, and cross-domain instrument that, together with the parent-reported version, could help to expand the early detection of anxiety symptoms by adopting a systematic approach with multiple informants capable of integrating relevant and complementary information for prevention and intervention programs.
Jealousy: An Emotional Schema Model.
Leahy RL
J Clin Psychol · 2026 Jun · PMID 41792995 · Publisher ↗
Jealousy is a universal emotion related to evolutionary pressures relevant to parental investment. In this article, we examine how jealousy can be treated using an integrative CBT model called Emotional Schema Therapy, w...
Jealousy is a universal emotion related to evolutionary pressures relevant to parental investment. In this article, we examine how jealousy can be treated using an integrative CBT model called Emotional Schema Therapy, which is a social cognitive model emphasizing the patient's theories and strategies about emotion and draws upon evolutionary, attachment, cognitive, and acceptance models. The phenomenology of jealousy is seen as part of this automatic response triggered by perceived threats to attachment relationships. This therapeutic approach fosters a more adaptive approach that would allow for integrating inevitable unpleasant emotions and thoughts into daily life without being overwhelmed by the emotion of jealousy. A case conceptualization is described which focused on how the patient's jealousy was related to early attachment issues, threat detection, intolerance of uncertainty, maladaptive assumptions and biased thinking, and problematic safety behaviors such as interrogating, stalking, and looking for clues. The course of treatment focused on normalizing his experience, relinquishing safety behaviors, placing jealousy in the context of a wide variety of emotions, making room for jealousy, treating intrusive thoughts with mindful detachment, positive collaboration with his spouse, directing compassion toward his spouse, and building mutual acceptance of feelings that did not have to lead to actions such as reassurance seeking. A wide range of techniques drawn from different theoretical approaches is described.
Irregularity in Daily Activities Predicts Depression via Reduced Perceived Control: A Daily Diary Study.
Jang J, Yoon S
J Clin Psychol · 2026 Jun · PMID 41772927 · Full text
OBJECTIVES: Disruptions in social rhythm-referring to irregularities in daily activities such as meals, work, and social interactions-have been associated with increased psychological distress, including depression. Whil...
OBJECTIVES: Disruptions in social rhythm-referring to irregularities in daily activities such as meals, work, and social interactions-have been associated with increased psychological distress, including depression. While circadian rhythm-related factors (e.g., sleep quality) have been proposed as key mechanisms underlying this link, emerging evidence points to additional psychological pathways. This study aimed to examine perceived control as a potential psychological mediator between social rhythm irregularity and depression. METHODS: A 14-day daily diary study was conducted with 124 participants. We investigated the mediating role of perceived control in the relationship between social rhythm irregularity and depression at both the between-person and within-person levels. RESULTS: At the between-person level, lower perceived control significantly mediated the association between greater social rhythm irregularity and higher depressive symptoms, even after controlling for sleep quality as a parallel mediator. At the within-person level, results from a 1-1-1 multilevel mediation model showed that daily perceived control fully mediated the link between daily social rhythm irregularity and end-of-day depressive affect. CONCLUSION: These findings underscore the importance of considering psychological mechanisms, such as perceived control, alongside circadian rhythm-related factors when examining the mental health consequences of irregular daily routines.
The Burden of Disease of Treatment-Seeking Patients With a Cluster-C Personality Disorder in the Netherlands; Quality of Life, Functioning, and Societal Costs.
Groot IZ, Arntz A, Wibbelink CJM … +3 more , Verhoeven B, Bachrach NR, Evers SMAA
J Clin Psychol · 2026 May · PMID 41766302 · Full text
Cluster-C personality disorders (PDs) are common in the general population but often overlooked in scientific research and clinical practice. An important step to increase awareness for timely diagnosis and treatment of...
Cluster-C personality disorders (PDs) are common in the general population but often overlooked in scientific research and clinical practice. An important step to increase awareness for timely diagnosis and treatment of cluster-C PDs is to investigate the burden of disease in terms of quality of life (QoL), daily functioning and the associated costs to society. In addition, a comparison between these patients and a control group can give insight into (1) the actual societal costs that are associated to cluster-C PD problems and (2) potential societal savings to be made from therapeutic interventions. This study included a total of 375 treatment seeking individuals from 10 mental health sites for outpatient treatment in the Netherlands and 104 individuals without severe mental health issues from the general population. Both QoL (EQ-5D-5L and the MHQoL-7D) and general functioning (WHODAS) were assessed as well as a comprehensive cost-interview to measure relevant costs considering a societal perspective. Results indicate that individuals with a cluster-C PD have severely impaired QoL and functioning compared to the control group. The annual costs associated with cluster-C PD were estimated ranging from €27,355 to €60,454 per patient per year depending on the valuation method used. These costs equate 2.8-4.2 times more than those of control group. Looking at the subgroup in cluster-C PD, no differences in QoL, functioning or societal costs were found between individuals with avoidant, dependent and obsessive-compulsive PD. Overall, the findings advocate for more financial resources to study, prevent and treat cluster-C PDs.
Expert Clinician Insights Into the Diagnosis and Treatment of Men With Antisocial and Borderline Personality Disorder: A Qualitative Study.
Broadbear JH, Bhagwandas MG, Crowley S … +2 more , Cheney L, Rao S
J Clin Psychol · 2026 Jun · PMID 41757644 · Full text
OBJECTIVES: Men with presentations consistent with borderline personality disorder (BPD) and antisocial personality disorder (ASPD) are highly visible in community and forensic services. However, mis/underdiagnosis may b...
OBJECTIVES: Men with presentations consistent with borderline personality disorder (BPD) and antisocial personality disorder (ASPD) are highly visible in community and forensic services. However, mis/underdiagnosis may be a consequence of their lower than expected engagement with mental health services, and when they do engage, systematised diagnostic biases may inaccurately differentiate these two subtypes. Given the substantial harms experienced by men who have personality disorder (PD), it is important to understand how personality disorder can be better identified and supported in clinical and forensic settings. METHODS: Ten nationally and internationally recognised clinician participants who have expertise in the diagnosis and treatment of men with PD (80% male; 60% psychologists, 40% psychiatrists) participated in individual, semi-structured qualitative interviews. Participants shared their observations regarding PD presentations in men and recommendations for maximising treatment engagement in community and forensic settings. Transcripts from the 60-90-min interviews were analysed using inductive and deductive thematic analysis. RESULTS: The analysis identified four themes: Getting men through the door, Unmasking Complexity, Holding Steady in the Face of Risk, and Addressing Shame through Connection. Men with BPD tend to under-report their symptoms and distrust mental health services. Clinicians may struggle to differentiate BPD from ASPD, as men's emotional dysregulation often manifests as anger. Participants emphasised appealing to the person's self-interest, building a trusting therapeutic alliance, and carefully addressing shame to facilitate treatment engagement. CONCLUSIONS: Half of the expert clinicians were employed in forensic settings where men with BPD are disproportionately prevalent, rendering their perspectives especially valuable. Assessment of empathetic functioning can help counterbalance clinicians' overemphasis on aggressive behaviours when differentiating BPD from ASPD in men. Incorporation of gendered attributes and targeting associated defensive barriers may improve treatment engagement and effectiveness for men with personality disorder.
Integrating Personality Disorders in the Treatment of Eating Disorders: A Commentary Based on Clinical Cases With Transdiagnostic Approaches.
Sand L, DiMaggio G, Fioravanti G
J Clin Psychol · 2026 Jun · PMID 41755485 · Publisher ↗
Eating disorders (ED) do not fully respond to current empirically supported treatments and treatment attrition is significant. One reason is that the comorbidity between ED and personality disorders (PD) has not been suf...
Eating disorders (ED) do not fully respond to current empirically supported treatments and treatment attrition is significant. One reason is that the comorbidity between ED and personality disorders (PD) has not been sufficiently considered, although it is frequent and poses treatment challenges. The clinical case papers included in this virtual issue of the Journal of Clinical Psychology: In Session dealt with this problem from different theoretical perspectives. All of them tried to address the comorbidity between ED and personality pathology through integrative interventions with positive outcomes on both domains. Patients suffered from different ED and PD diagnoses and each paper showed how the clinician adopted an individually tailored case formulation leading to personalized treatments as early as during the initial assessment. A common thread among the different approaches was a constant attention to ruptures in the therapeutic relationship and efforts at repairing it when necessary. Reasoning on the cases described alongside the introductory literature overview, we suggest that addressing PD is necessary, as focusing only on ED symptoms may partially fail, leave the patient vulnerable to relapse or increase dropout risk. The contribution of individualized case descriptions, as shown in this issue, may lead to adapt ED-focused treatment to deal with comorbid PD traits or full-blown PD when present. This together with addressing common underlying dynamics and skills training could contribute to the much needed improved in treatment attendance and efficacy among ED sufferers.
Impact of the Unified Protocol on Attenuated Psychotic Symptoms, Cognitive Biases and Cognitive Insight in Patients at Ultra High Risk (UHR) for Psychosis: Secondary Results of a Pilot Randomized Controlled Trial.
Peláez T, López-Carrilero R, Espinosa V … +4 more , Balsells S, Fusar-Poli P, Ochoa S, Osma J
J Clin Psychol · 2026 Jun · PMID 41734262 · Full text
BACKGROUND AND HYPOTHESIS: Ultra high risk (UHR) for psychosis can have different clinical trajectories but the remission rates are only 51.9% after 3 years of follow-up. Deficits in metacognition are associated with sev...
BACKGROUND AND HYPOTHESIS: Ultra high risk (UHR) for psychosis can have different clinical trajectories but the remission rates are only 51.9% after 3 years of follow-up. Deficits in metacognition are associated with severity of symptoms and poor response to treatment. We hypothesize that the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) will have a positive effect on attenuated psychotic symptoms, cognitive biases and cognitive insight in UHR individuals. STUDY DESIGN: This article reports the secondary analyses of a pilot randomized controlled trial with 36 UHR participants assigned to either an online group intervention with UP plus Treatment as Usual (UP + TAU) or TAU alone. Assessments were conducted at baseline, post-intervention and 3-month follow-up and included the severity and distress of attenuated psychotic symptoms (CAARMS), cognitive biases (CBQp) and cognitive insight (BCIS). STUDY RESULTS: Significant differences were found in the evolution of the two groups in CAARMS distress scores in favor of the UP condition group. Significant differences in CBQp scores between the two groups were found in the two time assessments in favor of the UP group. No significant differences were found in cognitive insight. CONCLUSIONS: The UP intervention showed promising effects in reducing distress related to attenuated psychotic symptoms and cognitive biases, but not in improving cognitive insight. Given the small sample size, which fell below the initial target, and the pilot nature of the study, these findings should be interpreted with caution and considered preliminary until replicated in adequately powered trials.
Ramadan and the Iftar Meal: A Qualitative Exploration of Signs of Disordered Eating in Muslim Men and Women Living in the United Kingdom.
Zubair A, Hale L, Jeraj S … +1 more , Poole L
J Clin Psychol · 2026 Jun · PMID 41734252 · Full text
OBJECTIVE: To qualitatively explore the lived experiences of fasting during Ramadan and the Iftar meal in Muslim adults with low self-regulation (i.e., low ability to control) eating behavior. METHODS: Semistructured int...
OBJECTIVE: To qualitatively explore the lived experiences of fasting during Ramadan and the Iftar meal in Muslim adults with low self-regulation (i.e., low ability to control) eating behavior. METHODS: Semistructured interviews were conducted with Muslim young adults, scoring below the threshold for low/moderate self-regulation on the Self-Regulation of Eating Behaviour Questionnaire, (SREBQ) (Kliemann et al. 2016). Interviews took place post-Ramadan 2023. Nineteen participants were interviewed (11 females, mean age 24.8 years). Alongside interview questions, vignettes were used to explore participants' experiences of disordered eating. Interviews were audio-recorded and transcribed verbatim. RESULTS: Three themes were developed through reflexive thematic analysis highlighting how experiences of Ramadan and the Iftar meal may lead to the emergence of signs of disordered eating: (1) "refocussing on food provision," which describes the centrality of food and food consumption during Ramadan; (2) "the pressure to consume," which focuses on heightened social expectations that led to overeating during the Iftar meal; (3) "psychological distress and managing unpleasant physical sensations," which refers to the emotional response following overeating and how this could lead to purging. CONCLUSION: This study highlights how the Iftar meal represents a challenging time for adults with low-self regulation of eating and for some is associated with signs of disordered eating. While findings cannot be generalized to the broader Muslim population due to the small sample size, this study suggests a need for further community research regarding the experiences of Muslims vulnerable to disordered eating behavior and how to support them during Ramadan.
Positive Constructs in Schema Therapy: A Scoping Review.
van Donzel L, Claassen AM, Ouwens MA … +4 more , Broersen J, van Alphen SPJ, Louis JP, Videler AC
J Clin Psychol · 2026 May · PMID 41734134 · Full text
Central to the schema therapy model is the development of early maladaptive schemas due to unmet emotional needs in childhood. Recently, focus has shifted towards positive constructs in schema therapy, including early ad...
Central to the schema therapy model is the development of early maladaptive schemas due to unmet emotional needs in childhood. Recently, focus has shifted towards positive constructs in schema therapy, including early adaptive schemas or positive schemas and positive schema modes, such as the "healthy adult" and "happy child." This scoping review explores theoretical perspectives, assessment, and therapeutic use of these positive constructs in schema therapy. The PRISMA-ScR methodology was followed, using predefined search terms and databases (OVID, EBSCO, Mednar). After identifying 345 studies, 144 remained post-deduplication. Articles were screened by two reviewers, and disagreements were settled by consensus among the research team. A total of 47 records were included. A growing interest in positive constructs within schema therapy was found since 2011. The healthy adult and the happy/contented child were the most frequently discussed constructs, followed by early adaptive schemas and positive coping. Key findings include a strong relationship between the healthy adult mode and psychological well-being, while negative correlations exist with psychopathology. Assessment focuses on questionnaires like the Schema Mode Inventory and Young Positive Schema Questionnaire, however empirical evidence for positive schema therapy interventions is lacking. Limitations include diverse publication types and preliminary findings. Recommendations for further research include clarifying the healthy adult mode construct, exploring positive coping, and integrating positive constructs into schema therapy for improved therapeutic outcomes.
The Role of Defense Mechanisms in Self-Injurious Behaviors: A Systematic Review.
Montebarocci O, Sirri L
J Clin Psychol · 2026 Jun · PMID 41722092 · Full text
INTRODUCTION: The identification of psychological risk factors for suicide and self-harm behaviors is necessary for preventive and therapeutic strategies. The aim of this article is to systematically review research arti...
INTRODUCTION: The identification of psychological risk factors for suicide and self-harm behaviors is necessary for preventive and therapeutic strategies. The aim of this article is to systematically review research articles concerning the relationship between defense mechanisms and self-injurious behaviors according to PRISMA criteria. METHODS: PubMed, Web of Science, PsycInfo, and Scopus electronic databases were searched from inception to 01/27/2025 by combining the keywords "defense mechanism*" AND "suicid*" OR "non suicidal" OR "self harm" OR "self injury." Risk of bias was examined with the Study Quality Assessment Tools of the National Heart, Lung, and Blood Institute. RESULTS: A total of 428 records was yielded by electronic search and after removal of duplicates and application of inclusion criteria 24 articles fulfilled the inclusion criteria. Six additional articles were added by means of references search, leading to a total of 30 included articles. About half of the studies were performed in adult samples and the remaining in children and adolescents. Most of the articles included patients recruited in psychiatric settings. Both in adults and adolescents, a significant association between immature defenses, especially displacement, splitting, acting out, and projection, and increased risk for self-injurious behavior was found. Conversely, mature defenses were inversely associated with self-harm ideation and behaviors. CONCLUSIONS: Defenses represent an area where early intervention could be implemented as part of a preventive strategy to reduce self-injurious behaviors. A routine evaluation of defensive functioning should be methodically included in the psychological assessment of patients with self-harming ideation or behaviors.
Helpful Attitude, Associated Behavior, and Communication of Healthcare Professionals Caring for Patients With an Eating Disorder: A Narrative Review.
van Geelkerken LAFE, Klomp MM, van Furth EF … +1 more , Slof-Op't Landt MCT
J Clin Psychol · 2026 Jun · PMID 41722091 · Publisher ↗
OBJECTIVE: Eating disorders (EDs) are life-threatening disorders, in which treatment relationships may largely influence treatment outcomes. This review aimed to identify helpful as well as unhelpful aspects in establish...
OBJECTIVE: Eating disorders (EDs) are life-threatening disorders, in which treatment relationships may largely influence treatment outcomes. This review aimed to identify helpful as well as unhelpful aspects in establishing a beneficial treatment relationship based on patient and healthcare professional perspectives across diverse ED samples, including male patients. METHOD: A literature search yielded 63 relevant original qualitative studies. Thematic analysis and conceptual synthesis, following Evans' method, were employed to analyze these studies. RESULTS: Four overarching themes captured the (un)helpful aspects of healthcare professionals' attitude, behaviors and communication: (1) "Attitude, characteristics and behavior"; (2) "Communication"; (3) "Alliance"; and (4) "Focus of the treatment." Helpful factors included respect, empathy, attunement, trust, collaboration, connection, and individualized care, emphasizing patient autonomy and the whole person rather than focusing solely on the disorder. Unhelpful were punishing, criticizing and blaming patients, and excessive focus on weight gain. Helpful and unhelpful aspects appeared to be similar between male and female patients. CONCLUSIONS: The findings confirm that a respectful attitude, collaborative behavior and supportive communication of healthcare professionals facilitated a treatment relationship, whereas a dismissive attitude undermined this. Further research is needed to establish consensus on involvement of professionals with a personal ED history and on optimal mealtime management to support patients and maintain a strong therapeutic alliance.
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