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Complex post‐traumatic stress disorder (CPTSD) was introduced in the International Classification of Diseases (ICD) 11 in 2013 to simplify diagnosis and increase clinical utility. Given the recent ICD‐11 conceptualisation, there is no standard approach for its assessment, and a review of research is necessary. This systematic review focuses on ICD‐11 CPTSD assessment in young people aged 7 to 17 and adults aged 18 and above, examining measures, differentiating features and clinical considerations. Data from five databases are reviewed using a narrative synthesis approach and the quality of evidence is assessed and discussed. A total of 36 studies involving 5901 participants recruited from clinical settings and 1458 professionals with CPTSD assessment experience were included. Studies predominantly focused on adults, and the most used measure for assessment was the International Trauma Questionnaire. Papers focusing on differentiating features highlighted increased symptom severity, impairment and difficulties in individuals with CPTSD, compared to those with PTSD across various characteristics in both young people and adults. This review also identified the importance of a sensitive clinical approach with adaptations based on culture and age. Although gold‐standard recommendations cannot be made, this paper offers tentative clinical practice recommendations and considerations regarding ICD‐11 CPTSD assessment. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) are identified with increased risk of adult mental health difficulties and negative impacts on well‐being. However, there is a need to go beyond simple associations and identify candidate mechanisms underpinning the ACEs–mental health relationship. Further methodological heterogeneity points to issues around the operationalization of ACEs and the importance of modelling data using robust research designs. The aim of the current review was to synthesize studies that utilized formal mediation and/or moderation analyses to explore psychological and social variables on the pathway between clearly defined ACEs (as measured by the ACE questionnaire and Childhood Trauma Questionnaire [CTQ]) and common mental health outcomes (depressive, anxiety and post‐traumatic stress disorder [PTSD] symptoms) across community samples aged over 18. A total of 31 papers were retrieved for critical appraisal. The majority of the studies explored factors mediating/moderating the link between child adversity and depression and less on anxiety and trauma. Most mechanisms were tested in only single studies, limiting the consistency of evidence. Evidence indicated that the mechanisms underlying associations between ACEs and adult mental health are likely to reflect multiple intervening variables. Further, there are substantial methodological limitations in the extant literature including the proliferation of causal inferences from cross‐sectional designs and both measurement and conceptual issues in operationalizing adversity. Consistent transdiagnostic mechanisms relevant to common mental health problems were identified, including perceived social support, emotion regulation and negative cognitive appraisals/beliefs. Further research using longitudinal design is required to delineate the potential contribution of the identified mechanisms. [ABSTRACT FROM AUTHOR]

Previous studies have found an association between therapeutic alliance and treatment outcome, but only recently have researchers begun to analyse time‐lagged relationships between session‐to‐session measures of alliance and outcomes with hierarchical linear modelling (HLM). HLM assumes simple correlation structures between any two measurements from the same client. In this paper, we suggest that this assumption might be problematic. Session‐to‐session measurements of outcomes (Outcome Questionnaire‐10.2) and alliance (Working Alliance Inventory) in a sample (N = 63) were used to perform HLM analyses to test time‐lagged (lag +1) relations between outcomes and alliance in both directions. A first set of analyses replicated the models consistently used in the literature, whereas a second set of models considered a correlation structure as a function of time. A correlation independent of time distance resulted in a bidirectional influence between alliance and outcomes (the model commonly used in the literature), but when considering a correlation structure as a function of time, only the outcomes were predictive of alliance. Considering a more complex correlation structure as a function of time seems to be an important analytical strategy for addressing the issue of variability in within‐client measurements over time. This study highlights how the misspecification of a statistical model, namely, not considering a time‐dependent correlation structure of the response variable, may lead to misleading findings in HLM studies. This is particularly relevant in process–outcome research, such as studies analysing the impact of therapeutic alliance on clinical outcomes. [ABSTRACT FROM AUTHOR]

Specific phobia of vomiting (also known as emetophobia) is a relatively understudied phobia with respect to its aetiology, clinical features and treatment. In this stage, research is mostly based on people with self-reported fear of vomiting. This paper presents a survey on the clinical features of fear of vomiting of individuals. Self-reported vomit-fearful subjects from the Dutch community and from an Internet support group are included. Both vomit-fearful groups were characterized by high reports of fear, the presence of panic symptoms, and by extensive avoidance and safety behaviours. They also reported other psychiatric complaints, which were measured with a structured screening instrument. Vomiting complaints started mostly in late puberty. A significant proportion of the vomit-fearful participants had a treatment history. The prevalence rate of fear of vomiting in the community sample was established at 8.8% (female : male ratio = 4:1). Overall, results show that fear of vomiting is a common phenomenon, which can seriously impair daily functioning. Finally, clinical questions to be addressed in future research are formulated. Copyright © 2011 John Wiley & Sons, Ltd. Key Practitioner Message Specific phobia of vomiting (also known as emetophobia) is among the least studied phobias., Most clinical data come from research with self-described fear of vomiting., This paper presents data on the clinical features, prevalence and additional psychiatric complaints of fear of vomiting in two vomit-fearful samples and one control sample with no fear of vomiting., Estimates of prevalence of fear of vomiting in a Dutch community sample were established at 1.8% for men and 7% for women., Evidence suggests that fear of vomiting is a chronic and disabling condition that may cause significant impairment in daily functioning. [ABSTRACT FROM AUTHOR]

The current paper introduces the notion of clinically relevant subtypes of emotion regulation behaviours. A new measure of emotion regulation, the Complexity of Emotional Regulation Scale (CERS), was established as psychometrically sound. It was positively correlated with a measure of emotional awareness ( r = 0.28, p < 0.001) and negatively correlated with measures of self-criticism ( r = −0.28, p < 0.001) and depression ( r = −0.35, p = 0.025), among others. Participants were drawn from two samples: clients from a university counselling centre and a non-clinical student sample. Comparisons were conducted between non-clinical and clinical samples to determine the effects of depression and other symptoms of psychopathology on participant's generation of strategies for emotion regulation. Participants in the clinical sample more often identified an intention to soothe but did not follow through as compared with the non-clinical group, F(1, 198) = 4.662, p < 0.04. Furthermore, individuals in the non-clinical sample were more likely to engage in specific, meaning-making strategies when compared with the clinical group, F(1, 198) = 5.875, p < 0.02. Implications from the current studies suggest the possible applicability of the CERS to clinical settings using an interview rather than questionnaire format. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message: Emotion regulation should be thought of as being on a continuum of complexity, where strategies range from general ('one size fits all') action to specific ('personal and idiosyncratic') meaning. The best emotion regulation strategy depends on a client's presenting difficulty and level of distress. [ABSTRACT FROM AUTHOR]

Objective The objective of this paper was to examine the relationships between perceived parental bonding, Early Maladaptive Schemas (Young et al., 2003), and outcome of schema therapy of Cluster C personality problems and whether the perceptions of parental bonding could be influenced by schema therapy. Method The sample consisted of 45 patients with panic disorder and/or agoraphobia and Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Cluster C personality traits who participated in an 11-week inpatient programme consisting of two phases; the first was a 5-week panic/agoraphobia-focused cognitive therapy, whereas the second phase was a personality-focused schema therapy. The patients were assessed at pre-treatment, mid-treatment and post-treatment and at 1-year follow-up. Results Opposite to our hypothesis, lower paternal care at pre-treatment was related to more reduction in Cluster C personality traits from pre-treatment to 1-year follow-up. Maternal protection was related to the schema domains of impaired autonomy and exaggerated standards. Overall schema severity and the schema emotional inhibition at pre-treatment were associated with less change in Cluster C traits. Perceived maternal care was reduced from pre-treatment to 1-year follow-up, and more reduction in maternal care was related to less reduction in Cluster C traits. Discussion Parental bonding failed to predict treatment outcome in the expected direction, but maternal protection was related to two of the schema domains. Overall schema severity and the particular schema emotional inhibition predicted outcome. Furthermore, perceived maternal care was reduced from before to after treatment. Future studies should examine these questions in larger samples of Cluster C patients receiving schema therapy of a longer duration. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Most schemas within the impaired autonomy domain and the schema self-sacrifice seem to be related to low perceived maternal protection., Overall schema severity and the schema emotional inhibition predict a poorer outcome of schema therapy of Cluster C personality problems, and therapy should give priority to emotional inhibition when this schema is endorsed., Therapists should be aware that schema therapy carries the risk to lead to a more negative view of mother's care during upbringing and this risk is accentuated with less benefit of therapy. [ABSTRACT FROM AUTHOR]

Migraine has close associations with depression and anxiety. Catastrophizing, an alarmist reaction to pain, has been proposed as one of the mediators in the relationship between headache and emotional distress. However, much experimental evidence is needed to make such a view more validated. The aims of this study are to examine the effects of mood induction on the pain responses and to investigate the role of pain catastrophizing in the relationship between pain and mood amongst a sample of patients with migraine. For this purpose, 60 patients with migraine were recruited from a headache clinic in Tehran-Iran and were randomly assigned into one of three groups: negative mood induced group, positive mood induced group and control group. The following instruments and measures were used in this study: mood induction by presenting different types of films (positive, negative), a computerized cognitive task to elicit pain, Beck Depression Inventory and Pain Catastrophizing Scale. The results showed that while the induction of depressed mood increased the pain intensity, the induction of positive mood reduced it significantly ( p < 0.05). Further analyses revealed that catastrophizing is as a confounding factor in the relationship between pain and mood. Once catastrophizing scores were entered into the analyses as a covariate, the significant effect of mood on the pain intensity reduced. In conclusion, both mood and catastrophizing are important factors in understanding the migraine pain. Clinical implications of these findings are discussed in the paper. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message Pain-related catastrophizing and mood induction are important factors in understanding pain intensity amongst patients with migraine pain., Catastrophizing as a confounding factor in the relationship between pain and mood may partially mediate the relationship between mood and pain., Therapeutic interventions should focus on the reduction of depression and catastrophizing. [ABSTRACT FROM AUTHOR]

This article presents a novel clinical application of questionnaire feedback, which focuses on change at the individual question level rather than the totalmean or clinical score level. We termthe approach 'TrackingResponses to Items inMeasures' (TRIM) and promote the key aims to be (1) providing both client and practitioner with feedback on areas of positive change that may be masked by numerical feedback, (2) reinforcingclient strengthsandself-efficacy, (3) exploringpotential extra-therapeutic factors thatmay contribute to the lack of change or deterioration onindividualquestions and(4) establishinga collaborativedialogue relating clients' problems to their goals and the consequent aims of treatment. This paper profiles the clinical origins and technical development of TRIMas a clear, user-friendly display of item change across sessions using colour codes and illustrates the clinical utility through two clinical vignettes. Although the profile of the TRIM method herein uses the Clinical Outcomes in Routine Evaluation OutcomeMeasure, we believe themethod could easily be used with other measures. These could include Generalized Anxiety Disorder 7 and Patient HealthQuestionnaire 9 used in English NationalHealth Service primary care Improving Access to Psychological Therapies services, or disorder specificmeasures for particular problems commonly used in National Health Service specialist services. We suggest TRIMis a practical complement to existing feedback systems, especially in work with clients who may be less likely to show empirically meaningful change on mean itemor clinical score levels. [ABSTRACT FROM AUTHOR]

Objective This paper presents the development and preliminary validation of a self-report instrument designed to measure metacognitions pertaining to symptoms control in the form of the following: (1) symptoms focusing and (2) symptoms conceptual thinking. Methods A total of 124 patients (95 female and 29 male) presenting with chronic fatigue syndrome (CFS) contributed data to the study to test the structure and psychometric properties of the Metacognitions about Symptoms Control Scale (MaSCS). Results A principal components factor analysis indicated that a two-factor solution best fitted the data. The factors were labelled positive and negative metacognitions about symptoms control. Further analyses revealed that both factors had good internal consistency. Correlation analyses established preliminary concurrent validity, indicating that both positive and negative metacognitions about symptoms control were significantly associated with levels of fatigue in CFS. Regression analysis revealed that positive and negative metacognitions about symptoms control significantly predicted fatigue severity when controlling for anxiety and depression. Conclusions The newly developed instrument may help future research that examines the role of metacognitions in CFS, as well as aiding clinical assessment and case formulation. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message The MaSCS is a useful first instrument to assess metacognitions in CFS., The MaSCS may help to deepen our understanding of symptoms control (symptoms focusing and conceptual thinking about symptoms) in the experience of CFS symptoms., Assessing and conceptualizing symptoms control through the MaSCS may aid treatment of CFS. [ABSTRACT FROM AUTHOR]

Knowledge about typical change patterns of psychotherapy patients can help to improve treatment guidelines for psychological disorders. Recent studies showed that it is possible to identify several patient subgroups with regard to their early change pattern. However, although focusing on the early phase of treatment, change patterns in later stages have hardly been investigated yet. In this study, Growth Mixture Modelling was used to identify latent change classes in different phases of therapy in a naturalistic sample of 1229 psychotherapy outpatients. Furthermore, this paper inquired into the relation between the change patterns in different phases as well as their predictive power for therapy length and outcome. Results revealed different change patterns for the three investigated phases. While in an early treatment phase, (sessions one-six) five different change patterns could be identified: the number of change classes decreased considerably over time, resulting in three patterns in the second (sessions 7-12) and two in the third phase (sessions 13-18). In each phase, by far, the biggest class showed a pattern of good progress with small/no further improvements. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Messages Most change in patients' progress estimates took place in an early phase of the treatment and levelled out on a relatively high level in later phases of the treatment., Substantial improvements were still present in later phases of the treatment but occurred less frequent than in early stages., Continuous outcome monitoring and feedback systems should integrate progress measures to monitor patients progress especially in the early phase of the treatment and feed the so gained information back to therapists. [ABSTRACT FROM AUTHOR]

Background This paper describes the development and psychometric properties of the Health and Functioning ICF-60 (HF-ICF-60) measure, based on the World Health Organization (WHO) 'International Classification of Functioning, Disability and Health: ICF' (2001). The aims of the present study were to test psychometric properties of the HF-ICF-60, developed as a measure that would be responsive to change in functioning through changes in health and nutritional status, as a prospective measure to monitor health and nutritional status of populations and to explore the relationship of the HF-ICF-60 with quality of life measures such as the World Health Organization WHOQOL-BREF quality of life assessment in relation to non-communicable diseases. Methods The HF-ICF-60 measure consists of 60 items selected from the ICF by an expert panel, which included 18 items that cover Body Functions, 21 items that cover Activities and Participation, rated on five-point scales, and 21 items that cover Environmental Factors (seven items cover Individual Environmental Factors and 14 items cover Societal Environmental Factors), rated on nine-point scales. The HF-ICF-60 measure was administered to the Russian nationally representative sample within the Russian National Population Quality of Life, Health and Nutrition Survey, in 2004 ( n = 9807) and 2005 ( n = 9560), as part of the two waves of the Russian Longitudinal Monitoring Survey (RLMS). The statistical analyses were carried out with the use of both classical and modern psychometric methods, such as factor analysis, and based on Item Response Theory, respectively. Results The HF-ICF-60 questionnaire is a new measure derived directly from the ICF and covers the ICF components as follows: Body Functions, Activities and Participation, and Environmental Factors (Individual Environmental Factors and Societal Environmental Factors). The results from the factor analyses (both Exploratory Factor Analyses and Confirmatory Factor Analyses) show good support for the proposed structure together with an overall higher-order factor for each scale of the measure. The measure has good reliability and validity, and sensitivity to change in the health and nutritional status of respondents over time. Normative values were developed for the Russian adult population. Conclusions The HF-ICF-60 has shown good psychometric properties in the two waves of the nationally representative RLMS, which provided considerable support to using the HF-ICF-60 data as the normative health and functioning values for the Russian population. Similarly, the administration of the WHOQOL-BREF in the same two waves of the nationally representative RLMS has allowed the normative quality of life values for the Russian population to be obtained. Therefore, the objective assessment of health and functioning of the HF-ICF-60 could be mapped onto the subjective evaluation of quality of life of the WHOQOL-BREF to increase the potential usefulness of the surveys in relation to non-communicable diseases. © 2014 The Authors. Clinical Psychology & Psychotherapy. Published by John Wiley & Sons, Ltd. Key Practitioner Message The HF-ICF-60 offers a new perspective in measuring change in functioning through changes in lifestyle and diet., The HF-ICF-60 can be combined with the WHOQOL-BREF to map the objective assessment of health and functioning onto the subjective evaluation of quality of life., Combined use of the HF-ICF-60 and the WHOQOL-BREF can be especially useful for national and global monitoring and surveillance of implementation of measures to reduce risk factors of non-communicable diseases and to promote healthy lifestyles and healthy diets. [ABSTRACT FROM AUTHOR]

This paper examines the contribution of incompleteness/'not just right experiences' (NJREs) to an understanding of the relationship between obsessive-compulsive disorder (OCD) and obsessive-compulsive personality traits (OCPTs). It investigates the association of specific OCD symptom dimensions with OCPTs, conceptualized as continuous phenomena that are also observable below the diagnostic threshold. As empirical findings and clinical observation suggest that incompleteness feelings/NJREs may play a significant affective and motivational role for certain OCD subtypes, but also for patients with accentuated OCPTs, we hypothesized that OCPTs are selectively linked with incompleteness-associated OCD symptom dimensions (ordering, checking, hoarding and counting). Moreover, we assumed that this selective relationship cannot be demonstrated any more after statistical control of incompleteness, whereas it is preserved after statistical control of anxiety, depression, pathological worry and harm avoidance. Results from a study with a large clinical sample ( n = 185) partially support these hypotheses and suggest that NJREs may be an important connecting link between specific OCD symptom dimensions, in particular ordering and checking, and accentuated OCPTs. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Obsessive-compulsive personality traits (OCPTs) are positively related to obsessive-compulsive disorder symptom dimensions (ordering, checking, hoarding and counting) hypothesized or found to be associated with incompleteness/'not just right experiences' (NJREs), but not to washing and obsessions., This positive relationship, which is strongest for ordering and checking, is eliminated when NJREs are statistically controlled., Ordering, checking and accentuated OCPTs may share NJREs as a common affective-motivational underpinning., Dysfunctional behaviour patterns of people with accentuated OCPTs or obsessive-compulsive personality disorder (OCPD) may be viewed as efforts to avoid or reduce subjectively intolerable NJREs., On the basis of such a conceptualization of OCPD as an emotional disorder, a novel treatment approach for OCPD focusing on habituation to NJREs could be developed. [ABSTRACT FROM AUTHOR]

The built environment (BE) impacts on people's disability and health, in terms of overweight, depression, alcohol abuse, poor self-rated health and presence of psychological symptoms; it is reasonable to assume that BE also impacts on participation levels. This paper presents the validation of the COURAGE Built Environment Self-Reported Questionnaire (CBE-SR), an instrument designed to evaluate BE in the context of health and disability. Subjects participating to COURAGE, a cross-sectional study conducted on 10 800 citizens of Poland, Finland and Spain, completed a protocol inclusive of the CBE-SR. Psychometric properties and factor structure were analysed, and factor scores created. Gender differences, differences between persons from different age groups and persons reporting the environment as facilitating, hindering or neutral were calculated. Eight items were deleted so that the final version of CBE-SR comprises 19 items. Cronbach's alpha ranged from 0.743 to 0.906, and test-retest stability was demonstrated for the majority of items. Four subscales were identified: Usability of the neighbourhood environment; Hindrance of walkable environment; Easiness of use of public buildings, places and facilities; and Risk of accidents and usability of the living place. Younger respondents reported their neighbourhood as more usable but perceived walkways as more hindering and public buildings as less easy to use; gender differences were almost inexistent. The CBE-SR is a four-scale instrument with good psychometric properties that measures the person-environment interaction. It is sensitive across age groups and is consistent with the subject's overall judgement of the degree to which the environment is facilitating or hindering. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Poor built environments have a negative impact on the level of a person's participation. However, instruments measuring the person-environment interaction are lacking., The CBE-SR is a valid and reliable instrument that researchers can use to assess the relationships between the intrinsic health state and the objective features of the environment., Understanding this relationship would provide further insight into the need of addressing the individual's functioning either by means of interventions directed to the individual or by making changes to the individual's environment. [ABSTRACT FROM AUTHOR]

This paper compares and contrasts the underlying principles of two conceptual systems-the interpersonal circle and the interpersonal octagon-for classifying and measuring a person's interpersonal tendencies. Both systems have been represented by two intersecting axes: a horizontal one extending from close/warm involvement to distant/cold separation and a vertical one extending from upper/control to lower/submission. In both systems, intermediate axes have been inserted between these two main ones. Where the circle would appear to be concerned with traits, the octagon is concerned with what have been termed states of relatedness. The two systems differ in their explanation and definition of adaptive and maladaptive relating behaviour. Whereas the circle has been closely aligned with the establishment of a bipolar relationship between the poles of the axes and with the mathematical model that is called the circumplex, the octagon has not. The most widely used circle-based measure is the circumplex version of the Inventory of Interpersonal Problems. It generates high positive correlations between scales and a large, first general factor, but these imperfections have been corrected by the statistical procedure called ipsatization. The principal octagon-based measure is the Person's Relating to Others Questionnaire. A number of high positive correlations have been demonstrated between the scales of the Inventory of Interpersonal Problems and the corresponding scales of the Person's Relating to Others Questionnaire. Therefore, despite there being differences in the underlying theories, the two questionnaires would appear to be measuring similar constructs. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message: The interpersonal circle and the interpersonal octagon are two separate theoretical systems for representing a person's relating tendencies., Both systems are constructed around a horizontal, close-distant axis and a vertical, upper-lower axis., Both systems acknowledge that relating can be either adaptive or maladaptive, but where the circle incorporates both adaptive and maladaptive forms of relating within the same theoretical structure, there is a separate, adaptive (positive) octagon and and a separate, maladaptive (negative) octagon., Both systems have a questionnaire for the measurement of a person's general relating tendencies, but the octagon-based questionnaire is designed specifically to measure maladaptive (negative) relating., Interrelating concerns the relating that occurs between two specified individuals. Questionnaires have been developed by which each individual can record how, within the framework of the octagon, s/he relates (negatively) to the other and how s/he considers that the other relates (negatively) to her/him. There is no interrelating measure that is based upon the circle. [ABSTRACT FROM AUTHOR]

A randomized controlled trial is reported in which three treatments were compared for the management of depression in Primary Care. The treatments were Treatment As Usual (TAU) carried out by the General Practitioners, Cognitive-Behaviour Therapy (CBT) or Interpersonal Psychotherapy (IPT). Measurements of depressive symptomatology were taken at Baseline (Time1), at end of treatment (Time2), and at 5-month follow-up (Time3). An initial analysis of the longitudinal data revealed that there were a significant number of missing values, especially in the Time3 follow-up for the TAU group. That is, the missing data were not missing at random within the dataset, which is one of the considerations for usual procedures for replacement of missing values (RMV). The paper presents, therefore, the outcome of different approaches to RMV and their consequences for conclusions about the relative efficacy of the treatment conditions. The results showed that clients in all conditions improved significantly, with at least some analyses showing superiority of IPT and CBT at end of treatment Time 2. However, by the follow-up clients in all conditions performed equally well. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Depression is a major problem for mental health. Empirical studies and clinical observations have shown that the symptoms of depression occur across four main domains-emotional, cognitive, somatic and interpersonal. However, commonly used depression assessment scales fail to address the evaluation of interpersonal symptoms, as summarized in this paper. Therefore, a new depression assessment scale, which aimed to evaluate all four domains of depressive symptomatology, was developed. In an initial analysis, a pilot 85-item questionnaire containing possible depressive symptoms was distributed for evaluation to experts from different mental health professions, from which 52 items were subsequently selected for the new multidimensional depression assessment scale. One hundred community participants completed the questionnaire along with the Beck Depression Inventory-II. The results indicated that the new depression scale had good psychometric properties. It was found to be reliable and valid for the assessment of depression severity and symptomatology, though it is emphasized that these data are only preliminary and based on a relatively healthy sample. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message [ABSTRACT FROM AUTHOR]

Auditory hallucinations are a common and troubling symptom in psychotic disorders. We aimed to identify measures that could be used by clinicians and researchers to assess the experience of auditory hallucinations. A literature review was conducted to identify auditory hallucination measures that were developed since the last such review in 1998. We identified 10 tools: eight self-report measures and two clinical interviews. The scales measured diverse constructs and are divided into four categories for review: multidimensional assessment, coping strategies, rating of beliefs and acceptance or mindfulness. Evidence of the measures' reliability, validity and sensitivity to change are discussed. There has been an expansion in the range of instruments available, particularly in self-report questionnaires and in measures that focus on psychological aspects such as attitudes and beliefs regarding voices. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: • A wide variety of measures of auditory hallucinations has been developed in recent years. • The majority of measures reviewed here are relevant to psychological therapies. • This paper provides a resource to help practitioners select appropriate measures to assess auditory hallucinations and their sequalae. [ABSTRACT FROM AUTHOR]

There has been little research into the association of shame and other self-conscious emotions in bipolar disorder, although there is evidence linking shame to various psychopathologies. Objectives: This research investigates the levels of shame in individuals with bipolar disorder. Design and Methods: A cross-sectional design was used to compare 24 individuals with a diagnosis of bipolar disorder to a clinical control group of 18 individuals with unipolar depression, and 23 age-matched non-psychiatric controls on measures of mood (Beck Depression Inventory [BDI] and Self Report Manic Inventory [SRMI]) and of self-conscious emotions (Internalized Shame Scale and Test of Self-Conscious Affect). Results: Higher levels of trait shame and lower guilt-proneness were found in the bipolar group. Higher levels of shame-proneness were found in the unipolar group in comparison to the bipolar and control groups. BDI scores positively correlated with trait shame and shame-proneness, and accounted for a large proportion of the variance in these scores. SRMI scores positively correlated with trait (internalized) shame and negatively correlated with guilt-proneness. Conclusions: There was evidence for the presence of shame within bipolar disorder, but this differed to the evidence for shame in individuals with unipolar depression. Clinical implications are discussed. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: • Evidence suggests that cognitive–behavioural therapy is not effective in individuals with bipolar disorder with more than 12 illness episodes. • Shame has been elucidated as a factor is some chronic mental health problems, including depression. • Compassionate mind training has recently been developed to address experience of shame and is designed as an adjunct to cognitive–behavioural approaches. • This paper finds evidence for the presence of shame within bipolar disorder, but with a different manifestation than that found in individuals with depression. • This suggests that clinicians should consider shame as a factor for exploration within therapy, possibly using compassionate mind therapy, and its inclusion may improve on therapeutic outcome. [ABSTRACT FROM AUTHOR]

Personality traits underlying both anxiety disorders and depression are more malleable than previously presumed. This study examined associations between changes in personality traits (i.e. negative affectivity and detachment) and alleviation of anxiety and depression symptoms following cognitive behaviour therapy (CBT). We hypothesized that decreases in negative affectivity would predict alleviation of depression and anxiety symptoms and decreases in detachment would predict decreases in depression and, to a lesser degree, anxiety symptoms. Data (N = 156) were collected in a randomized controlled trial comparing transdiagnostic and diagnosis‐specific group CBT for patients with major depressive disorder, social anxiety disorder, panic disorder or agoraphobia. We assessed personality traits using the Personality Inventory for DSM‐5 (PID‐5) and symptoms with the Hopkins Symptom Checklist 25‐item scale (SCL). Prediction was based on regression analyses. We found that decreases in negative affectivity predicted lower levels of depression and anxiety symptoms while decreases in detachment only predicted lower levels of depression symptoms. The findings substantiate current efforts to explicate the dynamic interplay between personality traits and symptoms and support the existing focus on targeting negative affectivity and detachment in therapy for anxiety disorders and depression. The trial is registered at clinicaltrials.gov (ID NCT02954731). [ABSTRACT FROM AUTHOR]

The current paper describes the results of a questionnaire survey of the record-keeping practices of clinical psychologists working in one NHS region in the UK. Issues explored include the reasons given for keeping case-notes; the content of notes; security, access, retrieval and destruction of notes; requests for access to notes and knowledge of note-keeping policy. The analysis of data includes a breakdown by years in profession and by speciality. The results are based on 123 returns and indicate some commonly held views and practice, for example that note-keeping is generally regarded as a requirement of professional practice, that notes act for the majority of respondents as an aide mémoire and that clinical psychologists almost universally keep their notes in a specific psychology file even if they also keep notes elsewhere. The results also show much individual diversity and uncertainty as to what constitutes good practice. The authors conclude that despite recent guidance from the Division of Clinical Psychology and the Department of Health, many issues with regard to note-keeping are unresolved, ambiguous and subject to individual and local decision-making. Copyright © 1999 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Psychological problems-from the most minor such as exams anxiety to the more severe such as personality disorders-are not rare in young adults. University Counselling Services often present the only opportunity for undergraduates to meet health professionals and to be confronted with their difficulties in a non-clinical setting or-in cases of more severe psychopathology-to be referred to mental health services. Recent research attests to the increasing severity of psychological problems among undergraduate and graduate university students. The question necessarily arises as to whether this trend is replicated in the general population being referred to mental health services and, if such is the case, whether there are differences between the two populations. This paper analyses the change in the severity of self-reported symptoms in a sample of 194 students attending a University Counselling Service over a course of 5 years (2010-2014). Clinical severity was assessed in both groups by Symptoms Check List 90-Revised, Clinical Outcome in Routine Evaluation-Outcome Measure, and Emotion Regulation Questionnaire scores. Results show a substantial stability in severity level across time, and a comparison with an age-matched sample of patients referred to a public hospital clinical psychology service shows overlapping data with respect to disease severity level. As the mental health of university students is an important public health issue, the implications for the organization and structure of university counselling services and the connection with public mental health hospital centres are discussed. [ABSTRACT FROM AUTHOR]

With the rise in efforts to evaluate the quality of mental health care and its outcomes, the measurement of change has become an important topic. This paper hacks the creation of a new instrument designed to assess psychotherapy outcome. The Outcome Questionnaire (OQ) was designed to include items relevant to three domains central to mental health: subjective discomfort, interpersonal relations, and social role performance. This study describes the theoretical development and psychometric properties of the OQ Psychometric properties were assessed using clinical, community, and undergraduate samples. The OQ appears to have high reliability and evidence to suggest good concurrent and construct validity of the total score. The data presented show that it distinguishes patient from non-patient samples, is sensitive to change, and correlates with other measures of patient distress. [ABSTRACT FROM AUTHOR]

Kohut (1984) conceptualized that the self has three components reflective of three types of human needs: mirroring, idealization, and twinship. These concepts have found strong support and use in the clinical literature, and hence an instrument that can measure these needs objectively would be extremely useful. This paper presents a series of studies with the purpose of developing such a Self Psychology Questionnaire. Beginning with 75 original items, a final three-scale, 24-item instrument was developed with good internal consistency, split-half reliability, and concurrent validity. The final three scales were labelled Need for Nurturance (a mirroring concept), Need for Guidance (an idealization concept), and Social Isolation (a twinship concept). © 1997 by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We aimed to validate cross‐culturally the Turkish, Moroccan Arabic and Moroccan Berber versions of the 48‐item Symptom Questionnaire (SQ‐48). Its psychometric properties were assessed in four samples: patients (n = 150) and controls (n = 103) with Turkish or Moroccan origins (n = 103) and patients (n = 189) and controls (n = 463) with native Dutch origins. Internal consistency and discriminatory power of SQ‐48 subscales across groups were adequate to high. However, immigrant groups scored on average higher than Dutch native groups, but there was full configural, metric and partial scalar invariance in the immigrant groups. Although the SQ‐48 is a valid measure of psychopathology in immigrant groups of Turkish and Moroccan origins, their cut‐off values should likely be higher compared to natives. [ABSTRACT FROM AUTHOR]

Clinicians can rely on the Impact Message Inventory‐Circumplex (IMI‐C) to map their emotional reactions to their patients' communication style in octant and main dimension scores on the two‐dimensional interpersonal circle, based on affiliation (AFF) and control (CON) as the underlying main dimensions. However, modern emotion theories distinguish three, rather than two, robust dimensions of emotional experience and the perception of interpersonal behaviours: (1) positive versus negative evaluation (related to AFF), (2) strong versus weak (related to CON) and (3) active versus passive (arousal). In a large Dutch patient sample (N = 1,001), we first tested whether the two‐dimensional circumplex structure of the IMI‐C could be replicated using Browne's circumplex model. Then we explored whether a third dimension could be retrieved from therapists' IMI‐C responses using exploratory factor analysis, followed by orthogonal target rotation towards a partially specified target matrix, with the first two factors specified according to the circumplex structure, and the other factor(s) left free. The two‐dimensional circumplex of the IMI‐C could be validated to a fair extent. Using exploratory factor models, we found supporting evidence for a third factor, which could be interpreted as reflecting reactance ('active' vs. 'passive' opposition). We recommend to extend the current two‐dimensional interpretation to a three‐dimensional interpretation of IMI‐C responses, by adding a reactance dimension. [ABSTRACT FROM AUTHOR]

This study aimed to estimate the frequency of maladaptive daydreaming and to explore the pathological personality traits of probable maladaptive daydreamers. Our sample consisted of 239 psychiatric patients. After screening, 42 persons were probable maladaptive, while 197 participants prove to be normal daydreamers. Two pathological domains and three facets measured by the Personality Inventory for DSM‐5 showed a moderate significant correlation with the Maladaptive Daydreaming Scale. The score of nearly every domain and facet was slightly higher among probable maladaptive daydreamers. To quantify the difference between the groups, effect sizes were calculated: Significant difference was found on the domain level in Antagonism, while on the facet level in Hostility, Grandiosity, Attention Seeking, Unusual Beliefs and Experiences, Cognitive and Perceptual Dysregulation. The group of probable maladaptive daydreamers was further examined to identify potential subgroups. Cluster analysis revealed heterogeneity in the severeness and patterns of pathological personality domains. Cluster 1 showed higher mean scores on the PID domains and on the MDS compared to Cluster 2. Clusters 1 and 2 broke further down into two subclusters: Cluster 1a and Cluster 1b differed in their mean scores on the domains of Antagonism and Detachment; the mean scores of Cluster 2a were uniformly low on each domain, while the mean values of Cluster 2b were scattered in a mixed way on the domains. Our results suggest that maladaptive daydreaming might manifest with differently pathological personality profiles in the background. This aspect might worth considering in planning treatment. [ABSTRACT FROM AUTHOR]

Objective: The current study aimed to examine the relationship between early adaptive schemas and eating disorder symptomatology in adults. Method: A cross‐sectional, correlational design was used to collect data from 352 females and 36 males aged between 18 and 49 years (M = 25.70, SD = 7.04). Participants completed an online questionnaire, which included The Young Positive Schema Questionnaire (YPSQ), Eating Disorder Examination‐Questionnaire (EDE‐Q) and demographic measures. Results: Four separate hierarchical multiple regression analyses showed that high levels of Healthy Boundaries and low levels of Optimism significantly predicted lower Restraint, Eating Concern, Shape Concern and Weight Concern scores. Additionally, higher scores in Emotional Openness and Social Belonging significantly predicted lower Eating Concern, while higher scores in Self‐Care significantly predicted lower levels of Shape Concern. Conclusion: The findings highlight the protective function that certain early adaptive schemas may play in mitigating eating disorder symptomatology. Moreover, the findings allude to potential modifiable therapy targets in the treatment of eating disorders. Further research is needed to investigate any differences in early adaptive schemas between eating disorder diagnoses. [ABSTRACT FROM AUTHOR]

Objective: Psychotherapy of chronic depression has remained a challenge due to limited prognosis and high rates of recurrence. We present 5‐year outcome data from a multicentre trial comparing psychoanalytic (PAT) and cognitive‐behavioural (CBT) long‐term treatments with randomized and preferred allocations analysing symptom (N = 227) and structural change (N = 134) trajectories. Method: Self‐ and blinded expert ratings of depression symptoms were performed at yearly intervals using the Beck Depression Inventory‐II (BDI‐II) and Quick Inventory of Depressive Symptoms (QIDS‐C). Blinded expert ratings of Operationalized Psychodynamic Diagnosis (OPD) and the Heidelberg Restructuring Scale (HRS) at baseline, 1, 3, and 5 years assessed structural change in a subsample. Results: Lasting and comparable symptom changes were achieved by PAT and CBT. However, compared to CBT, PAT was more successful in restructuring, a major goal of long‐term psychodynamic treatments with high frequency and duration. Limitations: Due to practical reasons, the time criterion for chronic depression of an acute phase had to be defined for over 1 year in the present study, which does not correspond to the DSM‐5 criterion of 2 years. Therapy duration and session frequency were not incorporated into the statistical models. Conclusion: Long‐term psychotherapy helps patients with a yearlong history of depression and often multiple unsuccessful treatment attempts to achieve lasting symptom changes. Future follow‐up will clarify whether restructuring promotes further sustainable improvements. [ABSTRACT FROM AUTHOR]

Introduction: Transference (meant in this context, as the patient relational patterns expressed towards the clinician) and therapeutic alliance play a crucial role in the treatment of personality pathology. To date, no empirical study examined the association between these two dimensions of the clinical relationship and patients' personality maladaptive traits in psychotherapy. Methods: A national sample of therapists (N = 100) of different theoretical orientations assessed dysfunctional personality features of a patient in their care using a comprehensive and empirically grounded dimensional diagnostic approach from the Shedler–Westen Assessment Procedure‐200 (SWAP‐200). Moreover, they filled in the Psychotherapy Relationship Questionnaire (PRQ) to identify interpersonal patterns expressed early in treatment by the patients and the Working Alliance Inventory (WAI‐T) to evaluate quality of therapeutic alliance. Results: Overall, the most severe and maladaptive dimensions of patients' personality were associated with more negative clinician–patient dynamics and poorer levels of therapeutic alliance in statistically significant and clinically relevant ways. Notably, the hostile transference was predicted by both SWAP Hostility and Psychopathy, whereas the SWAP Narcissism was the strongest predictor of the special/entitled transference. The latter was also predicted by SWAP Emotional Dysregulation; conversely, the SWAP Dysphoria was the most robust predictor of anxious/preoccupied pattern. The SWAP Schizoid Orientation and Psychopathy predicted avoidant/dismissing attachment pattern; moreover, they were strongly and negatively related to the SWAP Psychological Health that was the best predictor of positive transference and alliance. Conclusions: Findings support that therapists' careful understanding of patients' interpersonal ways during early treatment stages may meaningfully inform diagnostic and therapeutic processes. [ABSTRACT FROM AUTHOR]

Purpose: This study investigates the feeling of emptiness in patients with borderline personality disorder (BPD) and patients with eating disorder (ED) and its relationship with suicidal behaviour and childhood traumatic events. Methodology: One hundred three BPD patients and 107 ED patients were assessed with the Feeling of Emptiness Scale (FES) and the Traumatic Experiences Questionnaire (TQ). Suicidal behaviour was assessed with a specific interview for frequency and intensity of suicidal behaviour. Results: Significant differences were found between the different factors of the FES between BPD patients and ED patients. A significant relationship was observed between Factors 1 and 4 of the FES and suicidal behaviour scores in both groups. Traumatic experiences were more strongly related to Factors 1, 2 and 4 in BPD patients. Conclusions: BPD patients and ED patients show similar scores in the global construct of feeling of emptiness. However, results suggest some qualitatively difference between the nature of feeling of emptiness in BPD and in ED. As expected, suicidal behaviour is most frequently in BPD patients, and is significantly associated with Factors 1 and 4 of the FES in both groups. Therefore, feeling of emptiness could be a predictor of suicidal behaviours in patients with emotional and behavioural instability. [ABSTRACT FROM AUTHOR]

Background: Secure attachment in adulthood is associated with many markers of adaptive functioning. Valid and reliable self‐report measures of attachment security could provide a practical tool to help advance strengths‐based research and clinical work. Previous reviews have not specifically examined the psychometric properties of self‐report instruments with respect to secure attachment or systematically appraised the methodological quality of relevant validation studies. Method: A systematic review was completed in accordance with the COSMIN guidelines for reviews of patient‐reported outcome measures. The methodological quality of individual studies was evaluated, and results were rated against criteria for good measurement properties. Results: A total of 40 studies were included in the review, which collectively reported on 24 self‐report instruments. The methodological quality of individual studies was variable, and no single instrument was identified as having sufficient evidence of a range of psychometric properties. However, the Attachment Style Questionnaire‐Short Form (ASQ‐SF), the Cartes‐Modèles Individuels de Relations (CAMIR), Cartes‐Modèles Individuels de Relations‐Reduced (CAMIR‐R), and the Psychological Treatment Inventory‐Attachment Style Scales (PTI‐ASS) had the most robust evidence for the properties assessed. Conclusion: Existing self‐report measures assessing adult secure attachment have limited psychometric support. More methodologically robust studies of content validity, reliability, measurement invariance, and construct validity in particular are needed. [ABSTRACT FROM AUTHOR]

More recently, the prolonged grief disorder (PGD) has been recognized as a mental health disorder following bereavement, which is distinct from depression and PTSD. However, the number and proposed symptom items vary across the ICD‐11 and the DSM‐5‐TR criteria for PG. The Traumatic Grief Inventory‐Self Report Plus (TGI‐SR+), which is an updated version of the TGI‐SR, is currently the only robust instrument that assesses PG according to the ICD‐11 and DSM‐5‐TR criteria. For research and clinical use among French‐speaking countries, the forward‐backward procedure was applied to translate the TGI‐SR+ into French language. Exploratory factor analysis and parallel analysis converged towards a two‐dimensional structure for the TGI‐SR+, representing adaptation difficulties and traumatic separation distress. However, items mapping onto ICD‐11 and DSM‐5‐TR criteria for PG represented a one‐dimensional structure. Findings based on item response theory method provided strong evidence for discriminative characteristics of the items. The internal reliability was excellent for the TGI‐SR+ (McDonald's ω = 0.97) and ICD‐11 and DSM‐5‐TR criteria for PGD (McDonald's ω = 0.95). We also demonstrated a very high temporal stability for the TGI‐SR+ total score (ICC =.91, p < 0.0001) and ICD‐11 PGD and DSM‐5‐TR PGD (ICC = 0.90, and ICC = 0.88, ps < 0.0001, respectively). The concurrent validity of the instrument was also demonstrated, such that the TGI‐SR+ total score and all combinations were positively and significantly associated with the levels of depression, anxiety and post‐traumatic stress symptoms. However, the effect sizes were moderate. We conclude that for research and clinical use among French bereaved populations, the TGI‐SR+ is a sound tool with very good psychometric properties. [ABSTRACT FROM AUTHOR]

Objective: To investigate post‐treatment relapse and remission rates 3, 6 and 9 months after completion of an acute phase of a clinician‐supported internet‐delivered cognitive‐behavioural therapy (iCBT) for anxiety and depressive symptoms, within a routine care setting. Method: Secondary analysis from a 12‐month pragmatic randomized‐controlled trial delivered within the Improving Access to Psychological Therapies (IAPT) programme in England. Participants in the intervention arm were included if they met criteria for reliable recovery from depression (PHQ‐9) and anxiety (GAD‐7) at post‐treatment assessment. Survival analysis was used to assess durability of treatment effects and determine predictors to relapse at 3‐, 6‐ and 9‐month follow‐up. Hazard ratios predicting time‐to‐relapse were estimated with semi‐parametric Cox proportional hazards model. Results: Of the 241 participants in the intervention arm, 89 participants met the criteria for reliable recovery from depression and anxiety at the post‐treatment assessment. Of these 89 eligible cases, 29.2% relapsed within the 9‐month period, with 70.8% remaining in remission at 9 months post‐treatment. Of those who relapsed, 53.8% experienced a relapse of depression and anxiety; 7.7% experienced a relapse of depression only; and 38.4% experienced a relapse of anxiety only. Younger age, having a long‐term condition, and residual symptoms of anxiety at end‐of‐treatment were all significant predictors of relapse. Conclusions: This study is the first to explore the remission and relapse rates after an acute phase of iCBT treatment, within a routine, stepped‐care setting. The results add to the scarce literature on the durability of the effects of iCBT treatment in routine care settings, where patients are not typically followed up after receiving a completed course of treatment. [ABSTRACT FROM AUTHOR]

Objective: The aim of this research was to examine relationships between attachment insecurity and suicidal ideation and behaviour. Secondary aims were to explore the mediating role of emotion dysregulation and the moderating role of betrayal trauma in explaining hypothesised relationships. Method: Sixty‐five participants with experience of suicidal ideation completed questionnaire measures assessing attachment security, suicide ideation, emotion regulation, betrayal trauma, depressive symptoms and hopelessness. Results: A direct relationship was found between avoidant attachment and suicide ideation after controlling for age and gender. Multiple suicide attempters had higher anxious attachment. Anxious and avoidant attachment, suicide ideation and betrayal trauma were associated with emotion dysregulation. The relationship between attachment insecurity and suicide ideation was not mediated by emotion dysregulation. In the mediation model, only anxious attachment remained a significant predictor of emotion regulation and there was no significant effect of emotion regulation nor betrayal trauma, on suicide ideation. Conclusion: Suicidal individuals may benefit from therapeutic intervention that explores attachment‐related difficulties and therapies such as dialectical behavioural therapy, which support skills in emotional regulation. Future longitudinal research should identify other important mediators of the association between attachment and suicidality to develop more targeted psychological interventions for suicidality. [ABSTRACT FROM AUTHOR]

This single‐arm, repeated measures study investigated the impact caregiver trauma history may have on treatment response following an intensive, 2‐day Emotion Focused Family Therapy (EFFT) caregiver workshop. Caregivers (n = 243) completed questionnaires regarding their child's emotion regulation and clinical symptoms, as well as their own childhood trauma history (i.e., exposure to various forms of child maltreatment), caregiver self‐efficacy and caregiver blocks (e.g., fears) to support their child's treatment and recovery. Questionnaires were administered prior to and immediately following the workshop and again 4, 8 and 12 months later. At baseline, caregivers who reported experiences of childhood maltreatment demonstrated more blocks compared with caregivers who did not (B = 6.35, SE = 2.62, p < 0.05). Results indicated that caregivers with and without maltreatment histories reported similar, significant gains in their child's total difficulties (B = 0.64, SE = 0.41, p = 0.12) and emotional negativity and lability (B = 0.51, SE = 0.48, p = 0.29) at 12‐month post‐workshop. Caregivers with maltreatment histories reported greater improvements in caregiver blocks (B = 5.15, SE = 1.34, p < 0.001) and child emotion regulation (B = 0.90, SE = 0.18, p < 0.001) than caregivers without maltreatment histories. They also report less, but still significant, improvement in parental self‐efficacy (B = −0.68, SE = 0.26, p < 0.01) when compared with caregivers without maltreatment histories. Findings suggest that EFFT workshops may be an acceptable and effective trans‐diagnostic intervention for families presenting with complex histories, including caregiver exposure to childhood maltreatment. [ABSTRACT FROM AUTHOR]

Objective: The Coronavirus disease 2019 (COVID‐19) pandemic was previously associated with psychopathological symptoms. However, the psychological mechanisms underlying these associations are largely unexplored. Previous studies suggested associations between metacognitive abilities (e.g., mastery) and symptomatology, which may have impacts on COVID‐19 perceptions. This study aims to explore, using path analysis, the mediational role of Critical Distance (differentiation and decentration abilities) and Mastery on the relationships between COVID‐19 perceptions and psychological well‐being and distress. Methods: In a cross‐sectional design, 227 participants (M = 34.21, SD = 10.9) filled self‐report questionnaires. Results: Metacognitive abilities were negatively correlated with psychopathological symptoms. Both Critical Distance and Mastery mediated the path from COVID‐19 perceived severity and anxiety to psychological distress and well‐being. Critical Distance seems to augment Mastery which tends to increase psychological well‐being and limited psychological distress. Conclusions: Metacognition seems to play a mediational role on the relationship between COVID‐19 perceptions and mental health. Clinical psychologists and psychotherapists may enhance psychological interventions regarding COVID‐19 psychopathological symptomatology by working on metacognitive Critical Distance and Mastery abilities. [ABSTRACT FROM AUTHOR]

Affective styles are assumed to play an important role in maintaining negative affect, including anxiety and depression. However, little is known about the longitudinal relationship between affective styles and symptoms. Therefore, we conducted a longitudinal study to examine the influence of affective styles, assessed using the Affective Style Questionnaire, on anxiety and depression among clinical populations in Japan. Using an online survey, 1521 participants (406 with major depressive disorder; 479 with one or more anxiety disorders; and 636 with both) answered the Affective Style Questionnaire and measures of emotion regulation, anxiety and depression symptoms. Data were collected twice over 2 months. Confirmatory factor analyses replicated the same four‐factor structure found in a previous sample of Japanese university students. Hierarchical regression analyses revealed that the affective styles had a slightly greater effect on anxiety symptoms but not on depression compared to other common emotion regulation strategies, such as suppression and reappraisal measured by the Emotion Regulation Questionnaire (ERQ). Limitations of this study were that it used online surveys, in which, participants' diagnostic statuses were based on unverifiable self‐reports. In conclusion, the association of affective styles with anxiety and depression among the clinical populations was prospectively confirmed. Further study is needed to examine the association considering the combination or profiles of affective styles among different emotional disorders. [ABSTRACT FROM AUTHOR]

Increases in positive emotions may not only be indicators of progress in therapy but also precursors to that improvement. Conducted in a psychology training clinic, this naturalistic, repeated‐measures study tracked changes over the course of therapy in 34 clients' emotional experience and two of the primary targets of clinical interventions, symptom distress and relationship functioning. During treatment, positive emotions increased, negative emotions decreased, and improvements were seen in therapeutic outcomes. Positive and negative emotions were correlated, as were changes in positive and negative emotions. However, despite this association, increases in positive emotions were a significant predictor of concurrent improvements in symptom distress and relationship functioning, even when decreases in negative emotions were included in the same model. Additionally, positive emotions not only predicted change in these treatment outcomes over the same time period, but they also predicted future change. This study contributes to research on the critical role positive emotions play in psychotherapy and may encourage the development of interventions focusing on increasing positive emotions. These findings highlight the distinct functioning of positive emotions separate from negative and the value of attending to positive emotions during therapy. [ABSTRACT FROM AUTHOR]

Pathological grief has received increasing attention in recent years, as about 10% of the bereaved suffer from one kind of it. Pathological grief in the form of prolonged grief disorder (PGD) is a relatively new diagnostic category which will be included into the upcoming ICD‐11. To date, various risk and protective factors, as well as treatment options for pathological grief, have been proposed. Nevertheless, empirical evidence in that area is still scarce. Our aim was to identify the association of interpersonal closeness with the deceased and bereavement outcome. Interpersonal closeness with the deceased in 54 participants (27 patients suffering from PGD and 27 bereaved healthy controls) was assessed as the overlap of pictured identities via the inclusion of the other in the self scale (IOS scale). In addition to that, data on PGD symptomatology, general mental distress and depression were collected. Patients suffering from PGD reported higher inclusion of the deceased in the self. By contrast, they reported feeling less close towards another living close person. Results of the IOS scale were associated with PGD severity, general mental distress and depression. Inclusion of the deceased in the self is a significant statistical predictor for PGD caseness. [ABSTRACT FROM AUTHOR]

The revised Helping Alliance Questionnaire (HAq‐II) is among the most used instruments that measure therapeutic alliance. Despite its use in research, this instrument is not validated for the Brazilian population. The aim of this study was to explore the evidence of validity of the HAq‐II based on the internal structure in a sample of Brazilian psychiatric patients. An ambulatory convenience sample of 204 patients with major depressive disorder (MDD) and 81 patients with obsessive–compulsive disorder (OCD) was randomized between two different types of treatment. The HAq‐II was completed by patients (patient version) and by 33 therapists who performed the interventions (therapist version) between the second and third sessions. We used confirmatory factor analysis (CFA) to investigate two models: (1) a one‐dimensional therapeutic alliance model and (2) a two‐dimensional model considering the factors 'positive alliance' and 'negative alliance'. The internal consistency of the HAq‐II was measured by Cronbach's alpha. To investigate discriminant validity, we used the t‐test for independent samples, ANOVA and Pearson's correlation coefficient. The analysis showed that the best model of the instrument was one‐dimensional. Cronbach's alpha for both versions displayed values above 0.89. The Brazilian version of the HAq‐II presented properties similar to those found in the original version. However, studies related to the one‐dimensional model with other samples are necessary. [ABSTRACT FROM AUTHOR]

The Typical Beliefs Questionnaire (TBQ) assesses common grief‐related cognitions, which demonstrated satisfactory psychometric properties in a treatment‐seeking sample with prolonged grief disorder (PGD). Chinese shidu parents (bereaved parents over the age of 49 who have lost their only child) are at a high risk of PGD. The current study aimed to examine psychometric properties of the Chinese version of the TBQ (TBQ‐C) in a community sample of shidu parents with and without PGD, to compare this to the original validation clinical sample in the United States bereaved of any close relationship and to consider its use as a clinical tool. We examined the rate of positive endorsement, factor structure, internal consistency and validity of the TBQ‐C in 310 community‐based shidu parents (including 102 who met the criteria for PGD). Results showed that the rate of positive endorsement for each item ranged from 7.2% to 48.6% among non‐PGD participants and from 20.6% to 92.2% among PGD participants. Confirmatory factor analysis indicated that the original five‐factor structure fit both the non‐PGD and PGD shidu parents. The TBQ‐C showed acceptable internal consistency and satisfactory convergent and concurrent validity in both groups. It had good discriminant validity and can be helpful in distinguishing shidu parents with and without PGD. The TBQ‐C can be used to investigate common grief‐related beliefs that may be problematic for both shidu parents with and without PGD. [ABSTRACT FROM AUTHOR]

Intolerance of uncertainty (IU) is the inability to tolerate distress that arises in response to the absence of important information. The level of IU has been investigated across various psychological disorders; however, few studies have examined IU in trauma‐affected samples. We aimed to investigate the relationship between IU and posttraumatic stress disorder (PTSD) across the course of treatment. Participants (n = 106) had a diagnosis of PTSD and were from first responder, military, and occupational injury backgrounds. Participants completed self‐report questionnaires pre‐ and post‐engagement in an inpatient group trauma‐informed psychoeducation and skills (TIPS) intervention. Regression analyses indicated that decreases in overall and inhibitory IU were associated with decreases in PTSD severity overall and at the symptom cluster level. However, prospective IU was only associated with changes in the re‐experiencing, avoidance, and arousal PTSD symptom clusters. Our findings are congruent with the nascent literature indicating that IU may be a maintaining factor for PTSD, suggesting clinical relevance for attendance to IU within the course of treatment. [ABSTRACT FROM AUTHOR]

Objective: The main purpose of this study was to evaluate the association between age at onset and social support in outpatients with bipolar disorder who were in the recovery phase. We also investigated the association between age at onset and disability. Methods: A total of 180 bipolar disorder I outpatients, of whom 50 had early onset with age at onset ≤18 years old, 108 had middle onset with age at onset between 19 and 39 years old, and 22 had late onset with age at onset ≥40 years old, were assessed with the Medical Outcomes Study Social Support Scale and Sheehan Disability Scale. Results: The early onset group had lower tangible social support, longer length of illness, more childless participants, lower income and more suicide attempters than the late onset group. Conclusions: Early onset seems to have inferior outcomes in tangible social support than late onset, but this trend should be considered as a starting point for future studies. [ABSTRACT FROM AUTHOR]

The current study aimed to investigate the mediating role of metacognitions, intolerance of uncertainty and emotion regulation in the relationship between fear of COVID‐19 (FC‐19) and health anxiety, among families with COVID‐19 infected. Participants were 541 individuals from family members of patients with COVID‐19 (F = 52.3%, mean age = 41.3 ± 13.2 years). Data were collected with a packet including sociodemographic and risk factors, the Fear of COVID‐19 Scale, the Short Health Anxiety Inventory, the Metacognitions Questionnaire 30, the Intolerance of Uncertainty Scale‐12 and the Emotion Regulation Questionnaire. Structural equation modelling analyses revealed a full mediation of metacognitions (i.e., positive beliefs about worry, negative beliefs about thoughts concerning uncontrollability and danger, cognitive confidence and beliefs about the need to control thoughts), intolerance of uncertainty and expressive suppression in the relation between FC‐19 and health anxiety. Moreover, the strongest indirect links were found between FC‐19 and health anxiety through negative beliefs about thoughts concerning uncontrollability and danger and intolerance of uncertainty. These associations were independent of gender and risk status. The final model accounted for 71% of the variance of health anxiety. These findings suggest that particularly metacognitions, intolerance of uncertainty and expressive suppression play a full mediational role in the relation between FC‐19 and health anxiety. [ABSTRACT FROM AUTHOR]

Both elevated intolerance of uncertainty (IU) and maladaptive metacognitive beliefs (MBs) were associated with depression. However, the relationship between MBs and IU in clinical depression is unclear. The current study aimed to investigate the putative impairment of MBs and IU in major depressive disorder (MDD) and explore the relationship between these two factors with depressive symptoms. Metacognition Questionnaire—30 Items (MCQ‐30), Intolerance of Uncertainty Scale—Short Form (IUS‐12) and clinical rating scales were administered to 53 patients with MDD and 56 healthy controls (HCs). Stepwise regressions were performed to explore independent contributions of MBs and IU on depression. Mediation analysis was used to examine associations among variables. Patients with MDD reported higher IUS‐12 and MCQ‐30 scores than HCs. Stepwise regressions revealed a unique contribution of negative MBs concerning the consequences of not controlling thoughts (MCQ‐NC) on depression symptoms while controlling the effects of age, gender, anxiety symptoms and IU. MCQ‐NC and negative MBs concerning the uncontrollability and danger of negative thinking (MCQ‐NEG) completely mediated the effects of IU on depression and anxiety symptoms. Our results provided clear evidence that maladaptive negative MBs are directly associated with depression symptoms, and mediated the effect of IU on depression and anxiety symptoms, suggesting that IU and MBs influence clinical symptoms in a hierarchical manner. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Problematic internet use (PIU) has become public health concern, particularly among adolescents and emerging adults. There is growing interest concerning the potential impacts of early maladaptive schemas (EMSs) on PIU and its most severe manifestation internet addiction (IA). However, a deeper understanding of these relationships is needed regarding of effects of schemas on IA. The purpose of the present study was to explore the role of EMSs among adults. Methods: The sample comprised 714 Iranian participants who completed a self‐report survey comprising sociodemographic variables, the Internet Addiction Test (IAT), and the Young Schema Questionnaire–Short Form (YSQ‐SF). The data were analysed using partial least squares structural equation modelling (PLS‐SEM). Results: Findings indicated that there was a positive and significant relationship between EMS domains and IA. The results confirmed that disconnection/rejection schema domains and impaired autonomy/performance schema domains were significantly related with IA. The results of the analysis of convergent validity and discriminant validity were acceptable among the nine reflective constructs. Conclusion: Findings of the present study indicated that existence of underlying EMSs may be a vulnerability factor for developing IA and adds to the growing body of cyberpsychology literature that has examined the relationships between the EMSs and IA. [ABSTRACT FROM AUTHOR]

Although existing research recognized the associations between early maladaptive schemas (EMSs) of parents and their adult children, the mechanisms that underpin these associations were not fully understood. Therefore, the purpose of the current study was to explore the role of defence styles (DSs) on the associations between two EMS domains (Disconnection/Rejection and Impaired Autonomy) of parents and their adult children. Two hundred and fifteen families (i.e., mother, father, and their adult children) participated in the study. Both parents and their adult children were asked to complete Young Schema Questionnaire‐Short Form (YSQ‐SF) and Defence Style Questionnaire (DSQ) to assess their EMS domains and DSs. According to the results of the current study, there were significant associations between Disconnection/Rejection and Impaired Autonomy EMS domains of parents and their adult children, and these associations were mediated by only immature DS of parents and their adult children in a serial mediation model. These results contributed to our understanding of the associations between EMS domains of parents and their adult children through immature DSs. Moreover, our findings highlighted the importance of synthesizing the concepts of different theories to enhance our understanding of mental representations in families. [ABSTRACT FROM AUTHOR]

This study provides the results from the implementation of a highly structured therapist‐guided iCBT programme for people with work‐related anxiety and depression, in terms of programme efficacy, participants' adherence and satisfaction. Seventy‐seven national police workers were randomly allocated to one of two groups: without additional videoconference sessions (web platform with guidance of therapist) and with additional videoconference sessions (same intervention as the previous group, plus two videoconference guidance sessions with a psychologist). The intervention was composed of 12 sessions and took place for 17–20 weeks. We found an adherence rate of 36.4%, with no differences between groups. All participants endorsed lower depression (BDI‐II F(1) = 36.98, p <.001; ATQ F(1) = 24.22, p <.001), and anxiety (STAI‐State F(1) = 76.62, p <.001) after the programme. As a variable related to anxiety and depression in workplace, participants also showed higher assertiveness levels (RAS F(1) = 8.96, p <.001). A significant reduction of the mean level of anxiety perceived by participants as the intervention programme progressed was observed in both groups (F(2) = 7.44; p =.003). Participants were satisfied with the therapists' intervention and with the programme. No significant group effects were found for any of the measures. Reduction in depression levels was maintained in the 12‐month follow‐up, but levels of anxiety increased. This study is innovative, as it is the first controlled trial to analyse the effect of two added videoconference sessions, and it includes short‐ and long‐term measures, which is not usual. The results are discussed to clarify the role of the contact with the therapist to improve treatment adherence. [ABSTRACT FROM AUTHOR]

Severe dissociation is trauma‐related, but a range of dissociative experiences are also prevalent in clinical populations that are not necessarily trauma‐based (e.g., depression, anxiety disorders, and obsessive–compulsive disorders). These remain poorly understood as the dominant etiological model for dissociation relies on trauma. Importantly, dissociation in such samples predicts poor prognosis and high drop‐out rates. We set out to better understand the aetiology of dissociative experiences in a mixed clinical (anxiety and depression) and community sample by exploring between‐ and within‐subjects effects of two domains: psychological distress or negative affectivity (operationalized as anxiety and depression symptoms), and poor sleep quality, including disturbed dreaming. The idea that negative affectivity triggers dissociation (Distress Model) is inspired by the trauma model. The idea that poor sleep and unusual dreaming underlie dissociation (Sleep Model) has been suggested as a competing theory. We examined both models by exploring which domains oscillate alongside dissociative experiences. N = 98 adults, half of them diagnosed with depression and anxiety and half community controls, underwent a structured clinical interview and completed questionnaires monthly for 6 months. Support was found for both models in that each domain had a unique explanatory contribution. Distress evinced consistent effects that could not be explained by sleep or dreaming, both between individuals and across time. Oscillations in dissociation across months, when taking psychological distress into account, were better explained by unusual dreaming than traditional sleep quality measures. These findings cannot be generalized to highly‐traumatized samples. A complex, integrated etiological model for dissociative experiences is warranted. [ABSTRACT FROM AUTHOR]

Purpose Recent intervention research for burnout amongst those working in health and social care contexts has found acceptance and commitment therapy (ACT) interventions to be of use but has provided less clarity on the role of psychological flexibility (a key ACT construct). This study further evaluated the usefulness of ACT for burnout and work‐engagement and assessed the role of psychological flexibility in contributing to therapeutic change. Procedure: A nonconcurrent multiple‐baseline across‐participants single‐case experimental design was used. Four participants were recruited from a homelessness organization in the East Midlands, England. The ACT‐intervention was split into three modules to reflect the three aspects of the ACT triflex, and the sequence of delivery was randomized for each participant in order to test the relationship between these aspects. Findings Support was found for the ACT intervention reducing exhaustion and increasing work‐engagement. Psychological Flexibility increased in all participants and was temporally related to increases in other outcome variables in some instances. Delivery of the intervention focussed on any given aspect of the ACT triflex could increase different domains of psychological flexibility. Implications: This study adds to the growing body of research in favour of ACT interventions for burnout and adds to the understanding of psychological flexibility as a mediating variable. [ABSTRACT FROM AUTHOR]