Search

Cognitive fusion occurs when people experience their thoughts as literally true and allow them to dictate behavior. Fusion has been shown to be associated with increased symptoms of post-traumatic stress disorder (PTSD) and depression; however, the association between change in cognitive fusion, PTSD, and depression symptoms has been relatively uninvestigated. Our study aims to examine the associations between PTSD, depression symptoms, and cognitive fusion in Canadian veterans from pre- to post-treatment. Clients (N = 287) completed measures of PTSD symptom severity, depression symptom severity, and cognitive fusion at pre- and post-treatment. Our results supported that pretreatment PTSD and depression symptom severity were found to be negatively associated with changes in pre- to post-treatment cognitive fusion, while pretreatment cognitive fusion was not associated with changes in depression or PTSD symptoms. Furthermore, pretreatment depression symptoms predicted pre- to post-treatment changes in PTSD symptoms. However, pretreatment PTSD symptoms did not predict changes in depression symptoms. These findings highlight the importance of understanding the bidirectional associations between PTSD, depression, and cognitive fusion. Furthermore, our results are indicative of PTSD and depression symptoms playing a role in the change in cognitive fusion (e.g., defusion) and of depression playing a larger role in the maintenance of PTSD symptoms. Theoretical and practical implications are discussed. [ABSTRACT FROM AUTHOR]

The desire to die by suicide has been linked with interpersonal difficulties and impeded clinical outcomes. Despite the emphasis on the therapeutic relationship in clinical guidelines for working with suicidal clients, little is known about how suicidal clients' interpersonal difficulties manifest in clinical contexts. Additionally, there is limited understanding of the therapeutic relationship in single-session suicidal crisis contexts. Our aim was to examine the trajectory of the therapeutic bond in mediating clients' suicidal desire and outcome in single-session suicidal crisis intervention. Single-session online text-based crisis intervention sessions (N = 354; Mage = 29.43, SD = 9.15; 64.5% women) were coded for suicidal desire, therapeutic bond (each quarter), and outcome. We examined the proposed sequential mediating model (suicidal desire to early bond to bond change to outcome) using structural equation modeling. The proposed sequential mediation model fits the data well, χ2(11) = 22.030, p =.0241, root-mean-square error of approximation =.053, 90% CI [.019,.085], comparative fit index =.983, Tucker–Lewis index =.977, and was a better fit than several alternative models. Further, the indirect effect from suicidal desire to outcome through early bond and bond change was significant (b = −0.474, 99% CI [−0.782, −0.203]). Our findings indicate that therapeutic bonds were beneficial for clients with elevated suicidal desire—and—elevated suicidal desire was negatively associated with therapeutic bonds. These findings highlight the importance of training clinicians to navigate the unique challenges of developing therapeutic bonds with acutely suicidal clients. Public Significance Statement: Contemporary suicide theory has emphasized the interpersonal challenges that those with suicidal desire often experience. Our findings indicate that these challenges extend into the clinical context—greater suicidal desire was associated with poorer therapeutic bonds. Despite the difficulty in developing strong therapeutic relationships with suicidal clients, it is important that clinicians prioritize these relationships as we found a strong link between the therapeutic bond and suicidal clients' outcomes. [ABSTRACT FROM AUTHOR]

Sexual and gender minorities (SGM) experience higher rates of psychological distress and seek psychotherapy at higher rates compared to their heterosexual and cisgender counterparts. However, few therapists are trained on how to provide effective psychotherapy with SGM clients. The multicultural orientation (MCO) framework, which has been linked to improved therapeutic processes and outcomes, may be a valuable tool for working with SGM clients. The primary aim of this systematic review was to link the MCO framework to existing empirical psychotherapy research with SGM clients. A secondary aim was to examine how MCO constructs that we identified within the SGM literature have been associated with therapeutic processes and outcomes with SGM clients. A systematic search of five databases yielded 61 studies that were included in the review. Framework analysis was used to extract data and identify themes and subthemes related to MCO constructs from included studies. Results of the review demonstrate how the MCO framework can be used to conceptualize psychotherapy with SGM clients and-using the MCO framework-highlight potential beneficial and harmful therapist qualities and actions when working with SGM clients. Implications for future research and psychotherapy practice with SGM clients are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).