Journal Of Clinical Psychology[JOURNAL]
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200 papers
Characterizing Moment-to-Moment Variability in Readiness to Live: An Ecological Momentary Assessment Investigation of Readiness to Live, Wish to Live, and Suicidal Desire.
Gerner JL, Albury EA, Stivers M … +3 more , Moscardini EH, Britton PC, Tucker RP
J Clin Psychol · 2025 Oct · PMID 40638245 · Publisher ↗
INTRODUCTION: Readiness to live (RTL) is a protective factor against suicidal thoughts and behaviors. It encompasses one's motivation to live and take steps towards staying alive. It is relatively stable, predicting lowe...
INTRODUCTION: Readiness to live (RTL) is a protective factor against suicidal thoughts and behaviors. It encompasses one's motivation to live and take steps towards staying alive. It is relatively stable, predicting lower odds of suicidal ideation at one- to 6-month follow-ups. However, little is known about its short-term stability. Research is needed to describe the construct and compare it to similar protective factors, like wish to live (WTL). METHODS: College undergraduates (N = 51), selectively recruited for endorsing past 2-week suicidal desire, completed surveys (5/day for 10 days) on their smart phones. Descriptive and variability statistics of RTL, WTL, and suicidal desire were conducted. Multi-level models were used to determine if RTL is associated with suicidal desire concurrently and prospectively. RESULTS: 78.4% (n = 40) of participants indicated a change in RTL over the study period and RTL demonstrated greater stability than WTL and suicidal desire. RTL was associated with suicidal desire concurrently, but not prospectively, while WTL remained associated both concurrently and prospectively. LIMITATIONS: The sample included only undergraduate college students, limiting generalizability to more diverse samples. CONCLUSIONS: Results demonstrate that RTL remains relatively stable over short time scales. While RTL and WTL are similar, the constructs are not redundant, with each providing unique information that may aid in treatment planning. Future research should replicate these findings in samples with more severe suicidal desire and extend them to suicidal behavior.
Practicing Clinical Telesupervision During COVID-19: Chaos Into Competency.
Soheilian SS, O'Shaughnessy T, Lehmann JS … +1 more , Rivero M
J Clin Psychol · 2025 Oct · PMID 40637349 · Publisher ↗
The global pandemic, COVID-19, changed how clinical supervisors conducted supervision with their supervisees. Clinical supervisors, most with limited to no training in telesupervision, shifted from providing primarily in...
The global pandemic, COVID-19, changed how clinical supervisors conducted supervision with their supervisees. Clinical supervisors, most with limited to no training in telesupervision, shifted from providing primarily in person clinical supervision, to telesupervision. The purpose of our study was to better understand supervisor experiences of telesupervision, as well as provide a historical record of the influence of the pandemic on clinical training in mental health focused professions. We used qualitative and quantitative research methods to evaluate clinical supervisors' experiences with telesupervision precipitated by the global pandemic. We also evaluated the relationship between the working alliance and attitudes towards telesupervision. Overall, supervisors reported both benefits and challenges of engaging in telesupervision. Data revealed categories of technology, organization & productivity, and communication & connection, as the top three challenges experienced by clinical supervisors. Supervisors reported flexibility & organization, and productivity & growth, as the top two benefits of engaging in telesupervision during the pandemic. Quantitative data suggested a small to moderate, positive, relationship between supervisor perception of the working alliance and attitudes towards telesupervision. Data suggested that supervisors with more positive attitudes about telesupervision also had more positive perceptions of the working alliance. Implications for research, practice, and theory are discussed.
Burden of Disease of Borderline Personality Disorder: A Comprehensive Evaluation of Quality of Life and Societal Cost of Illness.
Wibbelink CJM, Arntz A, Kamphuis JH … +3 more , Groot IZ, Sinnaeve R, Evers SMAA
J Clin Psychol · 2025 Sep · PMID 40637289 · Full text
Information on the burden of disease, including quality of life (QoL) and societal costs, of borderline personality disorder (BPD) is crucial, as healthcare policymakers consider the burden of disease when setting priori...
Information on the burden of disease, including quality of life (QoL) and societal costs, of borderline personality disorder (BPD) is crucial, as healthcare policymakers consider the burden of disease when setting priorities for treatment reimbursement. We conducted a comprehensive evaluation of the burden of disease of BPD by estimating annual costs from a societal perspective using a bottom-up approach and distinguishing between costs primarily related to psychological and somatic problems. QoL was determined using a generic QoL measure (EQ-5D five-level version [EQ-5D-5L]) as well as a measure specifically designed for individuals with psychological problems (Mental Health Quality of Life seven-dimensional questionnaire [MHQoL-7D]). Additionally, societal costs and QoL were compared with a comparison group. Data from 204 Dutch treatment-seeking outpatients diagnosed with BPD and 86 individuals without severe psychological problems were analyzed. The results indicated a severely impaired QoL (EQ-5D-5L: 0.51, MHQoL-7D: 0.24) combined with substantial societal costs (average total €35,038 per year) for BPD outpatients, markedly different from the comparison group. Societal costs of BPD were primarily attributable to psychological problems, with costs in other sectors as the main cost driver. The BPD group incurred higher costs for most patient and family cost items and cost items in other sectors, whereas differences in healthcare costs were limited to outpatient psychiatric treatment, consultations with general practitioners, emergency care, and social work. The high economic burden, along with the low QoL, suggests that increased treatment reimbursement for BPD would benefit both patients and society at large. Trial Registration: The BOOTS study was registered in the Overview of Medical Research in the Netherlands (NL-OMON21337), formerly known as the Netherlands Trial Register.
Evaluation of a 20-Item Version of the Trauma-Related Drinking to Cope Questionnaire.
Hawn SE, Smith L, Armitage K … +4 more , Ball S, Lau-Barraco C, Powers A, Amstadter AB
J Clin Psychol · 2025 Oct · PMID 40568775 · Full text
OBJECTIVES: This study sought to develop and psychometrically evaluate an expanded version of the Trauma-Related Drinking to Cope (TRD) scale, a four-item self-report tool, which was developed to address a crucial gap in...
OBJECTIVES: This study sought to develop and psychometrically evaluate an expanded version of the Trauma-Related Drinking to Cope (TRD) scale, a four-item self-report tool, which was developed to address a crucial gap in self-medication research. Before the development of the TRD, no measures existed which assessed alcohol use for coping with symptoms of posttraumatic stress disorder (PTSD) specifically. Previous work showed that the TRD has strong psychometric properties and clinical utility in its ability to identify individuals with PTSD who may be at risk for developing comorbid alcohol use disorder (AUD). The aim of the present study was to develop and test a comprehensive, 20-item version of the TRD ("TRD-20"), which assesses drinking to cope with each of the 20 DSM-5 symptoms of PTSD. METHODS: We piloted the 20-item TRD measure among a diverse sample of 555 trauma-exposed undergraduates who use alcohol (M = 23.29, SD = 7.29; 49.5% white; 79.3% woman-identifying). RESULTS: A four factor model indexing drinking to cope with symptoms aligning with the four PTSD symptom clusters fit the data well (χ(164) = 355.67, p < 0.001; CFI = 0.950; TLI = 0.942; RMSEA = 0.046), with all standardized factor loadings exceeding 0.8. We also found strong evidence supporting the construct and criterion validity of the TRD-20, specifically in relation to existing measures of drinking coping motives, PTSD symptoms, alcohol consumption, and alcohol-related problems. CONCLUSION: These findings highlight the TRD-20 as a useful measure for determining an individual's PTSD-specific drinking motives, which carries implications for improving understanding and treatment of PTSD-AUD comorbidity.
Social Support and Suicide Ideation in Clinical and Community Adolescents.
Kalgren T, Brausch AM
J Clin Psychol · 2025 Sep · PMID 40552530 · Publisher ↗
BACKGROUND: In the United States, over 3 million adolescents report suicide ideation, and ~800,000 attempt suicide each year (CDC 2021). Social support has repeatedly been identified as a protective factor for suicide id...
BACKGROUND: In the United States, over 3 million adolescents report suicide ideation, and ~800,000 attempt suicide each year (CDC 2021). Social support has repeatedly been identified as a protective factor for suicide ideation in adolescent community samples. However, findings are mixed for adolescents in clinical samples. The current study examined associations between social support and suicide ideation in clinical and community adolescents with the intent to gain a comprehensive understanding of the potential buffering effects of social support. METHOD: Sample 1 included 456 students from public middle and high schools, and Sample 2 included 100 adolescents from a children's crisis stabilization unit. A total of 47 (11%) participants in Sample 1 and 76 (78%) participants in Sample 2 reported lifetime suicide ideation. RESULTS: Both peer and parent support were significantly associated with lower lifetime suicide ideation severity in the community sample. However, no significant associations were found in the clinical sample. CONCLUSIONS: Our findings highlight the importance of social support as a buffer for suicide ideation in adolescents in community settings. Results highlighted the need for additional interventions for adolescents in clinical settings.
Understanding Adolescents' Perceived Barriers to Engagement in Online Cognitive Behaviour Therapy Programs for Anxiety and Their Ideas for Enhancing User Experience.
Senyard EL, Rowe A, Krishnamoorthy G … +1 more , March S
J Clin Psychol · 2025 Oct · PMID 40531591 · Full text
BACKGROUND: Self-Help Internet Cognitive Behavioural Therapy (iCBT) interventions are highly efficacious and overcome numerous barriers adolescents experience when accessing face-to-face interventions, including stigma,...
BACKGROUND: Self-Help Internet Cognitive Behavioural Therapy (iCBT) interventions are highly efficacious and overcome numerous barriers adolescents experience when accessing face-to-face interventions, including stigma, privacy, lengthy wait lists and cost. Despite this, adolescents struggle to engage in Self-Help iCBT, which is problematic given that there is a relationship between higher engagement and better treatment outcomes. The reasons for poor engagement among adolescents are unclear. Using the iCBT program, BRAVE Self-Help as an example, this study explored (1) the barriers to engagement directly from the adolescent's perspective and, (2) their viewpoints on enhancing engagement in iCBT. METHODS: Semi-structured interviews were conducted with 14 adolescents aged 12-17 years (M = 14.36, SD = 2.12) who had participated in BRAVE Self-Help in the previous 12 months. Reflexive thematic analysis was utilised to analyse data. RESULTS: Stigma, program factors (program design, content and length) and environmental factors (competing priorities and distractions), were identified as adolescent barriers to engagement. With respect to strategies to enhance engagement, adolescents identified (1) specific program factors (positive reinforcement and personalisation), and (2) support factors (reminders and optional support). CONCLUSIONS: Codesign methods with adolescents at both the design and implementation stages of iCBT programs is imperative for engagement.
Non-Randomized Clinical Trial of a Short-Term Therapy Group for Adults Diagnosed With Borderline Personality Disorder: An Intermediate Step in Care.
Bartsch DR, Cooke-O'connor L, Connerty T … +2 more , Dahlenburg SC, Cammell P
J Clin Psychol · 2025 Sep · PMID 40530492 · Full text
OBJECTIVE: The aim of this study was to evaluate the effectiveness of Road Maps, a short-term therapy group program (i.e., 12 weeks) as part of an intermediate step in care for adults with a diagnosis of borderline perso...
OBJECTIVE: The aim of this study was to evaluate the effectiveness of Road Maps, a short-term therapy group program (i.e., 12 weeks) as part of an intermediate step in care for adults with a diagnosis of borderline personality disorder (BPD). METHOD: A pragmatic non-randomized clinical trial study design was utilized to examine the effectiveness of Road Maps in a publicly funded community mental health care setting. First, we examined whether participation in the short-term group intervention (n = 80) resulted in significantly greater reductions in psychopathology and improved psychosocial functioning compared to waiting for the intervention (n = 41). The waitlist condition was naturalistic (> 28 days) in that there was no specific allocation to conditions and all people on the waitlist had the opportunity to participate in the next available group. Second, we examined whether therapeutic gains were maintained at 6-month follow-up across the entire sample (N = 121). Finally, we analysed the proportion of respondents who demonstrated clinically significant change. RESULTS: Relative to people on the waitlist for the intervention, those who participated in the group demonstrated a significantly greater reduction in the primary outcomes of borderline symptom severity and personality dysfunction (e.g., both self and interpersonal functioning) and secondary outcomes (e.g., emotion regulation, reflective functioning, and psychosocial functioning). Therapeutic gains were maintained at 6-month follow-up. CONCLUSION: Short-term therapy groups such as Road Maps may be a useful intermediate step in a broader model of stepped care aimed at increasing treatment accessibility in resource-constrained environments. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12622000849796/retrospectively registered 16th June 2022.
A Scoping Review of Eating Disorder Clinicians' Experiences, Needs, Views and Wellbeing.
Novogrudsky K, Treasure J, Rø Ø … +1 more , Schmidt U
J Clin Psychol · 2025 Oct · PMID 40519159 · Full text
BACKGROUND: Eating disorders (ED) are pervasive and severe mental illnesses affecting up to 15% of females and 5% of males internationally with rates sharply rising in recent decades, especially since the COVID-19 pandem...
BACKGROUND: Eating disorders (ED) are pervasive and severe mental illnesses affecting up to 15% of females and 5% of males internationally with rates sharply rising in recent decades, especially since the COVID-19 pandemic. As a result, workload pressures on ED services have surged. The impact of this on ED clinicians and their wellbeing has not recently been investigated. This scoping review examines recent literature on ED clinicians' experiences, needs, and wellbeing to identify areas for future research and intervention. The goal is to improve clinician support, quality of life, and patient outcomes. METHODS: Following PRISMA guidelines, eight databases and gray literature sources were searched for studies published from 2014 to 2024. Papers were assessed for quality and risk of bias, and mixed-methods data were analyzed using narrative synthesis. RESULTS: Sixty-three studies, encompassing 3,152 multidisciplinary ED clinicians, were included. Clinicians worked across diverse settings with patients of varied presentations. Analyzes suggest that whilst job satisfaction amongst ED clinicians is high and attitudes are generally positive, workplace demands and stressors have a negative impact on clinician wellbeing. Several areas require clearer guidance and further clinician training. Clinicians' affect is mixed, and an 'emotional rollercoaster' is experienced at work. Many clinicians mention a lack of resources as a frustrating obstacle to an optimally operating service. CONCLUSIONS: Clinicians experience working with ED patients as emotionally challenging and occasionally fatiguing, but attitudes are generally positive. However, clinicians are hindered by organizational factors and a lack of resources, including those pertaining to staffing and training.
Psychotherapists' and Trainees' Experiences With Co-Therapy in a Training Setting: Roles, Benefits, Challenges, and Teamwork Strategies.
Valdiviezo-Oña J, Moreno-Oliva M, Trujillo J … +3 more , Unda-López A, Ortiz-Mancheno N, Paz C
J Clin Psychol · 2025 Oct · PMID 40516112 · Publisher ↗
OBJECTIVE: To explore therapists' and trainees' experiences using co-therapy in a university psychotherapy training service. METHODS: Therapists (n = 18) and trainees (n = 19) aged 21-36 from an outpatient psychotherapy...
OBJECTIVE: To explore therapists' and trainees' experiences using co-therapy in a university psychotherapy training service. METHODS: Therapists (n = 18) and trainees (n = 19) aged 21-36 from an outpatient psychotherapy service located in Ecuador participated in the study. All participants took part in semi-structured interviews. Data were analyzed using the framework analysis approach. RESULTS: Most therapists and trainees had not prior experience with co-therapy. Therapists' roles at this service often involved guiding trainees and fostering mutual learning and support. Trainees also highlighted the learning opportunities that co-therapy provided; however, they expressed discomfort with administrative burdens. Co-therapy was seen as beneficial for offering diverse perspectives, for collaborative discussion and for guided intervention. Challenges included communication issues and clients feeling intimidated. Both groups emphasized the need for open communication and collaborative planning. CONCLUSION: From therapists' and trainees' perspectives, co-therapy is a feasible approach for both training and conducting psychotherapy. It can enhance therapeutic outcomes by integrating multiple perspectives on case formulation, progress assessment, and therapeutic direction. For trainees, co-therapy provides real-world exposure to diverse therapeutic approaches, helps understand relational dynamics, and offers continuous support from a therapy partner and network. Other training services may implement structured co-therapy programs for training, prioritizing effective communication and collaboration, and providing clear guidelines to manage challenges. Co-therapy teams should consider clients' preferences and comfort levels.
Theory of Mind and Neurocognition in Bipolar Mania Patients and Their Unaffected First-Degree Relatives.
Zeng J, Liu TB, Liu YH
J Clin Psychol · 2025 Sep · PMID 40493687 · Publisher ↗
BACKGROUND: Cognitive impairment in manic patients involves neurocognitive and theory of mind (ToM) impairments. This study aims to investigate cognitive impairment among manic patients and their first-degree relatives (...
BACKGROUND: Cognitive impairment in manic patients involves neurocognitive and theory of mind (ToM) impairments. This study aims to investigate cognitive impairment among manic patients and their first-degree relatives (FDRs). METHODS: A total of 31 manic inpatients, 31 unaffected relatives, and 30 healthy controls (HCs) were investigated using the Reading the Mind in Eye Test (RMET) and Hinting Task (HT). The intelligence quotient (IQ), attention, working memory, executive functions, fluency and processing speed were also assessed. RESULTS: Patients and their relatives scored lower than controls on Theory of Mind reasoning and several neurocognitive measures. Regression analysis of the total sample indicated that a mania diagnosis or a FDR was strongly related to lower ToM reasoning performance. The deficits in ToM among patients were related to years of education. CONCLUSIONS: Due to the comparable performance of ToM between patients and their relatives, the reasoning aspect of ToM may represent a trait marker for bipolar disorder (BD). The deficits in ToM in patients with BD are partly independent of neurocognition.
Virtual Reality in Psychotherapy: A Three-Dimensional Framework to Navigate Immersive Clinical Applications.
Montesano A, Seinfeld S
J Clin Psychol · 2025 Sep · PMID 40483725 · Publisher ↗
Virtual Reality (VR) is becoming an increasingly prominent tool in psychotherapy, offering immersive and personalized experiences that can enhance therapeutic processes. However, the diversity and complexity of VR-based...
Virtual Reality (VR) is becoming an increasingly prominent tool in psychotherapy, offering immersive and personalized experiences that can enhance therapeutic processes. However, the diversity and complexity of VR-based interventions pose challenges for clinicians and researchers seeking to understand and apply this technology effectively. This article introduces a three-dimensional conceptual framework to support the analysis, classification, and design of VR interventions in psychotherapy. The framework is organized around three axes: Strategy (the therapeutic purpose of the VR experience: exposure, training, and exploration), Focus (the psychological domain being targeted: symptoms, attitudes, and identity/flourishing), and Perspective (the point of view or identity adopted within the virtual environment: self, other, witness, and multi-perspective). Drawing on five clinical case reports, including chronic pain, PTSD, social anxiety, depression, and psychosis, this In Session issue illustrates how VR can be harnessed across diverse therapeutic aims and models (cognitive-behavioral therapy, acceptance and commitment therapy, systemic therapy, and personal construct therapy) to foster therapeutic breakthroughs. By presenting both well-established and innovative uses of VR, this issue offers valuable insights into how virtual environments can extend the boundaries of psychotherapy and address complex psychological challenges in novel, impactful, and transformative ways.
One Simple Question Predicts Well-Being in Radiation Therapy: The Role of Desire for Psychological Intervention and Perceived Social Support.
Laslo-Roth R, George-Levi S, Loncich YG … +3 more , Sultan M, Wiskop-Farkash N, Sapir E
J Clin Psychol · 2025 Sep · PMID 40465823 · Full text
Radiation therapy (RT) is a critical part of cancer treatment often accompanied by heightened anxiety, depression, and reduced life satisfaction. Although psycho-oncological (PO) interventions and social support can alle...
Radiation therapy (RT) is a critical part of cancer treatment often accompanied by heightened anxiety, depression, and reduced life satisfaction. Although psycho-oncological (PO) interventions and social support can alleviate distress, it is unclear whether patients' desire for PO intervention reflects temporary or ongoing distress and whether all patients benefit from social support or only those seeking help. In this study we examined whether the desire for PO intervention during the start of RT predicted anxiety, depression, and life satisfaction at the start and end of RT and whether perceived social support moderated these effects. One-hundred-and-forty-six patients completed questionnaires at three time-points (pre-treatment, first treatment, and last treatment). Results showed that patients desiring PO intervention reported higher anxiety and depression at the start and end of RT. Higher perceived social support predicted lower depression and improved life satisfaction but only for patients expressing a desire for PO intervention. Screening for psychological distress is standard in oncology but often limited by time and resources during RT. The current study findings suggest that a single, straightforward question at the start of RT could identify at-risk patients, enabling proactive intervention. Moreover, fostering perceptions of social support may help mitigate negative outcomes in the absence of professional intervention.
Virtual Reality in Psychotherapy: A Commentary on Strategies, Interventions, and Perspectives From Five Clinical Reports.
Seinfeld S, Montesano A
J Clin Psychol · 2025 Sep · PMID 40460333 · Full text
Virtual reality (VR) applications have shown significant potential in enhancing psychological interventions by evoking vivid emotional reactions and creating immersive environments. This commentary provides an overview o...
Virtual reality (VR) applications have shown significant potential in enhancing psychological interventions by evoking vivid emotional reactions and creating immersive environments. This commentary provides an overview of five clinical case reports illustrating the advantages and pitfalls of VR-enhanced psychotherapy in social anxiety disorder, PTSD due to military trauma, auditory hallucinations, depression, and chronic pain. The case reports are analyzed with a dimensional framework designed to evaluate VR applications to be used in psychotherapy. The framework is based on three key dimensions: Strategy (e.g., Exposure, Training, Exploration), Focus (Symptom, Attitudes, Identity and Flourishing), and Perspective (Self, Other, Witness, Multiperspective). For example, the use of VR-based body scan exercises in chronic pain management can enable the training of body-related attentional skills helping individuals to not only focus on pain sensations, while VR exposure therapy helps clients with social anxiety or PTSD to confront feared situations, reprocess traumatic experiences, and develop coping skills. VR Avatar Therapy, on the other hand, enables individuals with auditory hallucinations to actually have a dialogue with the voices they hear since these are embodied in avatars controlled by therapists, promoting symptom externalization and self-identity exploration. Finally, the Explore Your Meanings tool enables immersive multi-perspective exploration of self-identity in 3D immersive spaces where it is easy to visualize the differences between the perceived and ideal self. The cases demonstrate VR's unique ability to provide real-time, dynamic treatment personalization, aligning with the trend toward individualized care in psychotherapy.
Exploring Typologies of Immediacy Events in Psychodynamic Therapy: A Latent Class Analysis.
Mylona A, Avdi E, Vaiopoulou J
J Clin Psychol · 2025 Sep · PMID 40445777 · Full text
Immediacy is a therapeutic intervention that entails the explicit discussion between therapist and client about their relationship in the here-and-now. It is considered a potentially powerful intervention that can facili...
Immediacy is a therapeutic intervention that entails the explicit discussion between therapist and client about their relationship in the here-and-now. It is considered a potentially powerful intervention that can facilitate relational processing, especially in psychodynamic psychotherapies. Τhis study aims to explore the use of immediacy in psychodynamic psychotherapy through a case-series analysis. Videos of 139 sessions, drawn from 7 psychotherapies with 2 therapists, were coded in terms of the type of immediacy used and its immediate effects, as reflected in the client's response. A total of 121 immediacy events were identified in 57 sessions, occupying 8% of the total therapy time; the majority were initiated by the therapist. A Latent Class Analysis was conducted to explore where there exist clusters of immediacy events that share patterns of immediacy type and effect. Two distinct clusters of immediacy events were identified. The most common group, which we termed 'limited engagement in immediacy', was characterised by a primarily insight-oriented agenda on the therapist's part, smooth collaboration during the immediacy event, and limited engagement on the client's part. The second cluster, termed 'mutual engagement in immediacy,' reflected more complex processes characterised by conflict, with the therapist using a range of interventions (from alliance-building to insight-oriented interventions), evidence of disruption in the therapist-client collaboration, and the client showing increased engagement and reporting improvement. The findings are discussed drawing upon the literature on the processes of repairing ruptures in the therapeutic alliance and clinical implications regarding the use of immediacy.
A Longitudinal Examination of the Predictive Effects of Alexithymia on Nonsuicidal Self-Injury Among Emerging Adults.
Leving L, Wong TK, Hamza CA
J Clin Psychol · 2025 Sep · PMID 40392138 · Publisher ↗
OBJECTIVES: Emerging evidence suggests that alexithymia, a psychological construct defined by the inability to describe emotion, differentiate feelings, and think in an internally oriented way, may be relevant in underst...
OBJECTIVES: Emerging evidence suggests that alexithymia, a psychological construct defined by the inability to describe emotion, differentiate feelings, and think in an internally oriented way, may be relevant in understanding engagement in nonsuicidal self-injury (NSSI). However, there is a paucity of longitudinal work on alexithymia and NSSI, which is necessary to discern whether alexithymia may heighten risk for NSSI over time. METHODS: In the present study, the association between alexithymia and NSSI was examined among 1125 emerging adults (Mage = 17.96, 72% female), who completed a survey at two time points 4 months apart. RESULTS: Participants with a history of NSSI reported higher levels of alexithymia than those with no NSSI engagement. A zero-inflated negative binomial regression model revealed that higher alexithymia at Time 1 predicted greater diversity in NSSI methods (i.e., NSSI versatility), but not NSSI frequency, at Time 2, for those already engaging in NSSI (p < 0.01, controlling for NSSI history at Time 1, emotion regulation difficulties, age, and gender). Significant differences were found in NSSI functions based on alexithymia among individuals with a lifetime history of NSSI at both time points. Among participants with a history of NSSI, alexithymia was most strongly correlated with anti-dissociation, sensation seeking, self-punishment, toughness, and interpersonal boundaries NSSI functions. CONCLUSION: Findings underscore that alexithymia may be relevant to understanding NSSI severity.
A Case Study on Transforming Shame: The Role of Acceptance and Commitment Therapy in Fostering Psychological Flexibility and Self-Compassion.
Lear MK, Luoma JB
J Clin Psychol · 2025 Sep · PMID 40377201 · Publisher ↗
Shame is related to a host of social and psychological problems including depression, PTSD, social anxiety, substance misuse, borderline personality disorder, eating disorders, and self-directed violence. Shame is an acu...
Shame is related to a host of social and psychological problems including depression, PTSD, social anxiety, substance misuse, borderline personality disorder, eating disorders, and self-directed violence. Shame is an acutely painful emotion that motivates humans to protect the "flawed" or "fragile" self, often through withdrawal or avoidance. Consequently, many clients who frequently and intensely experience shame persistently avoid life situations where shame could be triggered and engage in frequent self-criticism geared toward self-improvement. Though well-intentioned, these repeated attempts to reduce or avoid shame can exacerbate the sense of being defective, other, or unworthy already associated with shame and prevent people from living out their values in relationship with themselves and important others. Acceptance and Commitment Therapy (ACT) is a transdiagnostic treatment approach that aims to promote psychological and behavioral flexibility in response to painful internal experiences, like shame. This case illustration depicts how ACT can be applied to target shame by incorporating a collaborative case conceptualization process and principles from affective science to help the client respond more flexibly to shame when it is cued, and take steps to cultivate a more compassionate, values-driven relationship with self and others. The client, Courtney, was an adult heterosexual cisgender white woman working in secondary education. She presented to therapy with symptoms of anxiety, depression, and self-esteem issues and underwent 20 sessions of ACT for shame. By the final session, Courtney reported significantly reduced shame and self-criticism and increased self-compassion.
Indirect Pathways From Dysfunctional Attitudes and Attributional Style to Depressive Symptoms Through Imposter Phenomenon.
Whisman MA
J Clin Psychol · 2025 Aug · PMID 40364610 · Publisher ↗
OBJECTIVES: Cognitive theories of depression focus on how cognitive vulnerabilities increase risk for depression in the context of negative life events. To complement this perspective, two studies were conducted to exami...
OBJECTIVES: Cognitive theories of depression focus on how cognitive vulnerabilities increase risk for depression in the context of negative life events. To complement this perspective, two studies were conducted to examine associations among cognitive vulnerabilities, imposter phenomenon, and depressive symptoms to better understand how cognitively vulnerable individuals may respond to positive life events in ways that minimize their potential benefits. METHODS: Study 1 (N = 395 undergraduates) examined associations among dysfunctional attitudes, attributional style, imposter phenomenon, and depressive symptoms, whereas Study 2 (N = 443 undergraduates) examined associations among dysfunctional attitudes regarding performance evaluation and approval by others, imposter phenomenon, and depressive symptoms. RESULTS: Dysfunctional attitudes and, to a lesser degree, negative causal attributions for positive life events, were significantly and positively associated with imposter phenomenon, which served as an indirect pathway linking cognitive vulnerabilities with depressive symptoms (Study 1). Dysfunctional attitudes regarding performance evaluation were more strongly associated with imposter phenomenon than those regarding approval by others, and imposter phenomenon served as an indirect pathway linking dysfunctional attitudes with depressive symptoms (Study 2). CONCLUSION: Minimizing achievements and successes in ways characterized by imposter phenomenon may be one pathway by which people with cognitive vulnerabilities, particularly dysfunctional attitudes regarding performance evaluation, are vulnerable to depression.
Long-Term Improvements of Complex Post-Traumatic Stress Disorder (CPTSD) Symptoms After Multimodal Psychodynamic Inpatient Rehabilitation Treatment-An Observational Single Center Pilot Study.
Riedl D, Thaler J, Kirchhoff C … +7 more , Kampling H, Kruse J, Nolte T, Campbell C, Grote V, Fischer MJ, Lampe A
J Clin Psychol · 2025 Aug · PMID 40353723 · Full text
BACKGROUND: Complex post-traumatic stress disorder (CPTSD) is a severely disabling mental health condition, frequently observed in survivors of prolonged, repeated or multiple traumatic stressors. While studies indicate...
BACKGROUND: Complex post-traumatic stress disorder (CPTSD) is a severely disabling mental health condition, frequently observed in survivors of prolonged, repeated or multiple traumatic stressors. While studies indicate that engaging in psychotherapy can reduce CPTSD symptom severity, data on long-term effectiveness of interventions is scarce. The aim of this study was to evaluate long-term CPTSD trajectories of affected individuals after a 6-week multimodal psychodynamic inpatient rehabilitation treatment. METHODS: In this observational single center study participants completed questionnaires on CPTSD symptoms (ITQ), anxiety, depression, and somatization (BSI-18), functional impairment (WHODAS-12), mentalizing (MZQ-6) and epistemic trust, mistrust and credulity (ETMCQ) before (T1) and at the end of treatment (T2) as well as > 12 months after treatment. Repeated measures analyses of variance (ANOVAs) and reliable change index (RCIs) for the ITQ as primary outcome variable were calculated to evaluate mean symptom change. The influence of a range of potential factors affecting change was evaluated using correlation coefficients and ANOVAs. RESULTS: A total of n = 38 individuals diagnosed with CPTSD completed the questionnaires 14-28 (median: 21.2) months after treatment. Participants reported a significant reduction of CPTSD symptoms with large effect sizes at follow-up (p < 0.001, d = 1.70) as well as reduced symptoms of depression (p = 0.009, d = 0.84) and anxiety (p = 0.009, d = 0.1.24) and improved social participation (p = 0.012, d = 1.06). At follow-up, 59% of participants no longer fulfilled CPTSD criteria. Improved epistemic trust (r = -0.43, p = 0.007), and reduced epistemic credulity (r = 0.44, p = 0.006) were associated with reduced CPTSD symptoms. DISCUSSION: To the authors knowledge, this is the first study to report long-term CPTSD symptom trajectories after psychodynamic inpatient treatment. The results indicate lasting symptom change and identify improvements in epistemic trust as associated with symptom change. Due to the observational nature of the study, no causal attributions as to the effectiveness of the treatment can be drawn.
Psychological First Aid by AI: Proof-of-Concept and Comparative Performance of ChatGPT-4 and Gemini in Different Disaster Scenarios.
Tan JT, Gan RK, Alsua C … +5 more , Peterson M, Sales RÚ, Gan AZ, Cernuda Martínez JA, González PA
J Clin Psychol · 2025 Aug · PMID 40347026 · Full text
OBJECTIVE: This study aimed to evaluate the performance and proof-of-concept of psychological first aid (PFA) provided by two AI chatbots, ChatGPT-4 and Gemini. METHODS: A mixed-method cross-sectional analysis was conduc...
OBJECTIVE: This study aimed to evaluate the performance and proof-of-concept of psychological first aid (PFA) provided by two AI chatbots, ChatGPT-4 and Gemini. METHODS: A mixed-method cross-sectional analysis was conducted using validated PFA scenarios from the Institute for Disaster Mental Health. Five scenarios representing different disaster contexts were selected. Data were collected by prompting both chatbots to perform PFA based on these scenarios. Quantitative performance was assessed using the PFA principles of Look, Listen, and Link, with scores assigned using IFRC's PFA scoring template. Qualitative analysis involved content analysis for AI hallucination, coding responses, and thematic analysis to identify key subthemes and themes. RESULTS: ChatGPT-4 outperformed Gemini, achieving an overall score of 90% (CI: 86%-93%) compared to Gemini's 73% (CI: 67%-79%), a statistically significant difference (p = 0.01). In the Look domain, ChatGPT-4 scored higher (p = 0.02), while both performed equally in the Listen and Link domain. The content analysis of AI hallucinations reveals that ChatGPT-4 has a relative frequency of 18.4% (CI: 12%-25%), while Gemini exhibits a relative frequency of 50.0% (CI: 26.6%-71.3%), (p < 0.01). Five themes emerged from the qualitative analysis: Look, Listen, Link, Professionalism, Mental Health, and Psychosocial Support. CONCLUSION: ChatGPT-4 demonstrated superior performance in providing PFA compared to Gemini. While AI chatbots show potential as supportive tools for PFA providers, concerns regarding AI hallucinations highlight the need for cautious implementation. Further research is necessary to enhance the reliability and safety of AI-assisted PFA, particularly by eliminating hallucinations, and to integrate the current advances in voice-based chatbot functionality.
Using Photovoice Methods to Set Research Priorities With Autistic People With Experience of an Eating Disorder.
Nimbley E, Buchan K, Maloney E … +4 more , Kettley S, Sader M, Duffy F, Gillespie-Smith K
J Clin Psychol · 2025 Aug · PMID 40318197 · Full text
OBJECTIVE(S): Autism and Autistic traits are heightened in individuals with eating disorders (EDs), with Autistic people reporting poorer treatment outcomes and experiences. Despite this, mechanisms of this overlap remai...
OBJECTIVE(S): Autism and Autistic traits are heightened in individuals with eating disorders (EDs), with Autistic people reporting poorer treatment outcomes and experiences. Despite this, mechanisms of this overlap remain poorly understood, perhaps due to an exclusion of lived experience perspectives in setting research agendas. The study therefore sought to identify research priorities for Autistic people with an eating disorder (ED) by using accessible and inclusive arts-based research methodologies. METHODS: Research questions were explored using Photovoice, a creative research methodology involving the creation and discussion of images. 14 participants attended group workshops, in two of which they explored research priorities for Autistic people with an ED. Images and transcripts were analysed using an adapted Photovoice Question Matrix (production, content and meaning of the image) and thematic analysis. Participants had the opportunity to provide feedback on emerging themes before themes were finalised. RESULTS: Five themes were identified that highlighted research priorities for Autistic people with an ED: (1) Impact of early experiences (with subthemes Internalizing of socio-cultural food and body narratives and generational cycles); (2) Function of the ED (with sub-themes ED as a regulatory strategy and ED as a social acceptance strategy); (3) Barriers and facilitators to ED recovery (with sub-themes Autistic traits as barriers, Autistic traits as facilitators and Help and harm of unravelling); (4) Understanding and accommodating for complexity (with sub-themes Co-occurring conditions and Intersectionality); and (5) Changing research culture (with sub-themes Inclusive and participatory research and Nonclinical support). DISCUSSION: Study findings are contextualised within existing autism and ED research, highlighting avenues for future research and making recommendations for future research questions. By identifying community-driven research priorities, it is hoped that study findings will inspire novel, interdisciplinary and co-produced research that will serve as a meaningful evidence base towards improving the lives of Autistic people with an ED.
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