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Abstract The aim of this scoping review was to synthesize published studies and ongoing clinical trials of psychological interventions for mental health problems associated with COVID‐19 infection. The study protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) Extension for Scoping Reviews. We conducted systematic searches for studies published or registered between January 2020 and October 2022 using eight scientific databases and clinical trial registries, which identified 40 complete published studies and 53 ongoing clinical trials. We found that most studies were randomized controlled trials (74%) while the remaining used study designs of lower methodological quality. Most studies investigated interventions for acute COVID‐19 patients (74%) and others explored post‐COVID conditions (PCC) or recovered patients. Cognitive and behavioral therapies were the main intervention approaches (31%), followed by multidisciplinary programs (21%) and mindfulness (17%). The most frequently evaluated outcomes were anxiety (33%), depression (26%), quality of life (13%), and insomnia (10%). No studies on youths, older people, or marginalized communities were found. These findings summarize the burgeoning research on a range of psychological interventions for individuals infected with COVID‐19. However, the field is in its infancy and further research to develop an evidence base for targeted care is necessary. The gaps identified in the current study also highlight the need for more research on youths, older people, and members of marginalized communities, and PCC patients. It is important to ascertain interventions and delivery strategies that are not only effective and affordable but also allow high scalability and accessibility.

Key Clinical Message Elective amputation as a treatment for Body Integrity Identity Disorder (BIID) or Body Integrity Dysphoria (BID) where noninvasive treatments prove ineffective and the patient's distress is substantial, may permit long‐term remission of symptoms at follow‐up. Abstract We present the one‐year follow‐up post‐surgery of an ambidextrous male who sought elective amputation of his left hand's fourth and fifth fingers after an unsuccessful trial of psychotherapy and pharmacotherapy for Body Integrity Dysphoria. He had no psychiatric comorbidities. At one‐year follow‐up, his dysphoria was still in remission. He exhibited full adaptation in his social and occupational life, demonstrating increased ease in hand use compared to pre‐amputation. He reported sleeping well, happiness, good health and continued acceptance by friends and family. This one‐year post‐surgery follow‐up, at 22 years old, underscores the efficacy of amputation as a curative treatment, high patient satisfaction, and the quality of life gained through the procedure.

Key Clinical Message In select cases of body integrity identity disorder or body integrity dysphoria where noninvasive treatments prove ineffective and the patient's distress is substantial, elective amputation may serve as a viable and highly satisfying intervention, aligning the individual's physical self with their perceived identity. Abstract This case report presents an illustration of body integrity identity disorder (BIID), wherein a 20 years old ambidextrous male experiencing profound distress over his left hand's fourth and fifth fingers sought elective amputation after noninvasive treatments proved unsuccessful. Despite ethical concerns and limited literature on BIID, the decision to proceed with elective surgery was based on the patient's sustained desire, potential risks of self‐harm, and the distinct presentation involving two fingers rather than a complete limb. Following amputation, the patient experienced immediate relief, with nightmares ceasing, emotional distress subsiding, and improved functionality. This case highlights the potential efficacy and patient satisfaction associated with elective amputation in specific BIID presentations, shedding light on the unique challenges faced by affected individuals and emphasizing the importance of understanding, support, and inclusive healthcare practices.

Abstract Introduction Psychological trauma is an established risk factor for psychosis. Trauma‐focused psychotherapies (TFPT) have been suggested as a potential treatment for reducing psychotic symptoms in those who have experienced trauma. We therefore sought to investigate the effectiveness, tolerability, and acceptability of TFPT for psychotic symptoms. Methods We conducted a systematic review of studies of any form of TFPT that measured psychotic symptoms across a broad range of diagnoses. Results From 2584 papers initially identified, 17 studies (857 participants) met eligibility criteria. TFPT were found to be well tolerated, with very few adverse events. Acceptability was also high, with a mean dropout rate of 20%. Conclusions Whilst the evidence of effectiveness for TFPT in reducing psychotic symptoms is weak, we found tentative evidence in favour of exposure‐based interventions. Methodologically rigorous trials investigating the efficacy of TFPT for the treatment of psychotic symptoms are needed to assess this promising intervention.

Abstract Introduction Sense of control is an integral part of well‐being. Studies have reported on the connection between loss of control and psychological symptoms. However, loss of sense of control has not yet been studied from the perspective of psychotherapists. Methods This study had three research objectives: to find out how psychotherapists define loss of sense of control, whether they consider loss of sense of control to play a role in the start of psychological symptoms, and, if so, in what cases. Lebanese psychotherapists were interviewed and the data were then analyzed using frame analysis. Results The analysis revealed two definitions for loss of sense of control and conflicting views on whether it plays a role in the onset of disorders. Problems within relationships and stress were the most mentioned examples of loss of sense of control. Conclusion The findings shed light on psychotherapists’ diverse opinions and explanations regarding the role of loss of sense of control in the development of psychological symptoms.

Abstract Objective Many people, including patients with eating disorders (EDs), experience an increased urge for physical activity. “Trait”‐like activity in patients with EDs is assessed by existing questionnaires, but there are few clinically validated assessments of a “state” urge to be physically active. Here, we developed and validated the State Urge to be Physically Active‐Questionnaire (SUPA‐Q). Methods After developing and piloting the items, N = 126 patients with EDs (mostly anorexia nervosa and bulimia nervosa) took part in our mixed‐longitudinal validation study with one primary assessment for all patients and a secondary assessment for a subsample of patients. Cronbach's α and split‐half‐methods served as measures of consistency and reliability. Correlations with other questionnaires were used to determine convergent and divergent validity, and confirmatory factor analysis was used for investigating factorial validity. We used paired‐samples t‐tests for repeated assessments to investigate change sensitivity. Results We found the SUPA‐Q to be highly consistent, and reliable and to demonstrate convergent, divergent, and factorial validity. The comparison of SUPA‐Q scores from repeated assessments within a subsample of patients demonstrated the questionnaire's change sensitivity, Cohen's d = 0.48. Moreover, an increase in SUPA‐Q scores was associated with a less positive mood, more anxiety, more body dissatisfaction, more tenseness, less feelings of control, and more stress. Discussion The newly developed SUPA‐Q may help to accentuate the necessity to evaluate and address the acute urge to engage in physical activity in patients with EDs in clinical practice and ultimately support tailoring treatments to patients’ unique symptom patterns. The questionnaire is available at https://doi.org/10.17605/OSF.IO/G2YBC.

Abstract Background Family‐based treatment (FBT) is effective for the treatment of anorexia nervosa (AN) in children and adolescents. However, its availability in Japan is limited because it requires adherence to specific guidelines, commitment of sufficient time for frequent outpatient treatment, as well as the entire family's participation. We present a case of a patient with AN who was treated with modified FBT during hospitalization. Case Presentation Our patient was a 14‐year‐old girl with AN. She was hospitalized for malnutrition and dehydration, and was introduced to FBT during this period. After discharge, she continued FBT on an outpatient basis and was in remission 1 year later. Conclusion This case shows that initiation of FBT during hospitalization may be useful in patients with physically severe AN. Flexible adaptation to each of the diverse healthcare systems and cultural differences may be necessary for the widespread use of FBT.

Abstract Background Side effects in psychotherapy are common and have a negative impact on patients or clients. However, effective evaluation tools are still lacking and have not been fully studied. The present study aims to develop a scale with good reliability and validity to measure the side effects of psychotherapy. Methods The 25 items in the Psychotherapy Side Effects Scale (PSES) were condensed and distributed to 420 subjects online to test its psychometric properties. Results The internal consistency of the PSES was satisfactory to excellent (Cronbach's ɑ coefficient was .95, and the Guttman split‐half coefficient was 0.88). A statistically significant negative correlation between the satisfaction score and the total score of the PSES was shown (r = −0.51, p

Clinical psychologists are increasingly urged to recognize and understand the significance of societal factors such as marginalization experiences, within themselves and among the individuals and communities they serve. At the same time, there is a dearth of research in the field to guide this pursuit, and especially so in European contexts. We conducted an online survey (N = 646) to assess the social identities of clinical psychologists (graduate and trainees) in Germany and their incorporation of societal challenges in therapy and training. Overall, our sample was demographically rather homogenous and privileged: Clinical psychologists tended to be white (91%), nonmigrant (77.6%), female (74.5%), cis-gender (93.8%), heterosexual (75.4%), able-bodied (56.0%), and grew up in families with an academic background (68%). Although the majority of participants expressed a tendency to contemplate their identity when it came to their psychotherapeutic practices and believed that discussing societal challenges in therapy was pertinent, only a small proportion (~5%) reported actively introducing related subjects during therapy sessions or taking them into account during initial case conceptualization (~8%). The majority of participants indicated a lack of coverage of related topics in standard clinical psychological curricula. Greater perceived competence in addressing these topics was linked to clinicians initiating discussions about marginalization or discrimination in therapy. We explore the implications for future training aimed at fostering equitable, effective, and diversity-sensitive therapeutic practices., (© 2024 Wiley Periodicals LLC.)

Objective: Treatment for anorexia nervosa (AN) remains challenging; there are no approved psychopharmacological interventions and psychotherapeutic strategies have variable efficacy. The investigation of evidence-based treatments has so far been compounded by an underdeveloped understanding into the neurobiological changes associated with the acute stages of AN. There is converging evidence of deficiencies in neuroplasticity in AN., Method: This paper provides an overview of neuroimaging, neuropsychological, molecular and qualitative findings relating to neuroplasticity in AN, translating these findings to the identification of novel biological and psychotherapeutic strategies., Results: Novel psychopharmacological approaches that may ameliorate deficiencies in neuroplasticity include medications such as ketamine, psilocybin and human recombinant leptin. Anti-inflammatory medications and brain-derived neurotrophic factor mimetics may emerge as potential treatments following further research. Psychotherapeutic strategies that may target neuroplastic deficiencies, as well as having wider effects on identity, include imagery rescripting, memory specificity training, cognitive remediation therapy, exposure therapies, narrative therapies, cultural interventions (e.g. music and arts therapies) and yoga/mindfulness-based interventions., Conclusions: Treatments specifically targeted towards mitigating the neurobiological sequalae of AN are warranted, and emerging neurobiological and neuropsychological research utilising longitudinal designs and large sample sizes, as well as initial feasibility studies, are necessitated to bolster translational efforts., (© 2023 The Authors. European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.)

Objective: Despite an increase in eating disorder (ED) cases during the COVID-19 pandemic, there are limited longitudinal studies exploring treatment outcomes. The aims of the present study were: (1) to compare the clinical features of patients with EDs whose onset was during the COVID-19 lockdown (pandemic cohort) against patients with EDs whose onset was prior to the pandemic (pre-pandemic cohort) and, (2) to compare therapy responses between the cohorts., Method: The sample consisted of 115 adult women with an ED. N = 37 new ED cases (pandemic cohort) were diagnosed and included in the study during the pandemic (May 2020-May 2021); these patients did not have any previous history of an ED. We also included N = 78 ED cases (pre-pandemic cohort) diagnosed prior to the COVID-19 pandemic breakout (prior to March 2020). All ED subtypes were considered in both groups and several clinical variables were assessed., Results: At baseline, pandemic cohort reported lower levels of impulsivity and higher emotional regulation capacities than the pre-pandemic cohort; however, no differences were found in aspects of general psychopathology and ED related severity. Following treatment, the pandemic cohort showed higher rates of good outcome and lower rates of dropouts than the pre-pandemic cohort., Conclusions: Although both cohorts showed similar ED-related symptoms and general psychopathology scores, treatment outcomes were more favourable in the pandemic cohort., (© 2024 The Author(s). European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.)

Early weight gain is a primary goal in the treatment of anorexia nervosa (AN) and associated with more favorable discharge weights and clinical outcomes. Activity urges, that is, a motivational state to engage in activity, have been suspected to delay early weight gain, but their prognostic role remains barely explored. Here, we investigated whether acute (state-like) activity urges at treatment onset would predict within-person weight gain in patients with AN during the initial 2 weeks of inpatient treatment. Adults with AN from an inpatient unit (N = 53) completed an activity urges measure at treatment onset, and weight changes were monitored for the duration of their treatment. Regression analyses, controlling for admission body mass index and other patient variables (i.e., patient age and AN subtype), found that higher state activity urges were associated with lower initial weight gain. Mediation analyses showed that differences in early weight changes further linked higher activity urges at admission to lower discharge weights. An activity urge cutoff value of 2.76 for distinguishing between cases with optimal and suboptimal initial weight gain is proposed. We discuss potential mechanisms of the link between activity urges and early weight gain and the implications of activity urges as a prognostic factor for improving weight restoration during AN treatment., (© 2024 The Author(s). International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Abstract Aim Previous research shows that telephone consultation is useful in suicide prevention, substance use disorder, and other mental illnesses. However, no study has been conducted with a specific focus on telephone consultation for patients with bipolar disorder (BPD). Therefore, this study investigates the utilization of telephone consultation by patients with BPD and their families and analyzes the consultation contents to identify specific issues that they face. Methods We investigated a record book of telephone consultation conducted between 2013 and 2019 provided by the Japanese Alliance of Bipolar Disorder, which is a self‐help group in Japan specializing in BPD. The main themes regarding consultation were extracted and labelled as diagnosis, symptoms, treatment, laws and social support, interpersonal relations, social life, other people with BPD, and others, with up to three items being labeled per consultation. Results A total of 3540 consultations were sought, and consulters who were patients accounted for 74% of the calls. The largest number of consultations were those related to symptoms (1522), followed by interpersonal relations (1003), social life (896), and treatment (797). There was a significant difference in the distribution of consultation contents between patients and their families (χ2 = 44.595, p

Summary Objectives The Psychology Task Force of the Medical Therapies Commission of the International League Against Epilepsy (ILAE) has been charged with taking steps to improve global mental health care for people with epilepsy. This study aimed to inform the direction and priorities of the Task Force by examining epilepsy healthcare providers’ current practical experiences, barriers, and unmet needs around addressing depression and anxiety in their patients. Methods A voluntary 27‐item online survey was distributed via ILAE chapters and networks. It assessed practices in the areas of screening, referral, management, and psychological care for depression and anxiety. A total of 445 participants, from 67 countries (68% high income), commenced the survey, with 87% completing all components. Most respondents (80%) were either neurologists or epileptologists. Results Less than half of respondents felt adequately resourced to manage depression and anxiety. There was a lack of consensus about which health professionals were responsible for screening and management of these comorbidities. About a third only assessed for depression and anxiety following spontaneous report and lack of time was a common barrier (>50%). Routine referrals to psychiatrists (>55%) and psychologists (>41%) were common, but approximately one third relied on watchful waiting. A lack of both trained mental health specialists (>55%) and standardized procedures (>38%) was common barriers to referral practices. The majority (>75%) of respondents’ patients identified with depression or anxiety had previously accessed psychotropic medications or psychological treatments. However, multiple barriers to psychological treatments were endorsed, including accessibility difficulties (52%). Significance The findings suggest that while the importance of managing depression and anxiety in patients with epilepsy is being recognized, there are ongoing barriers to effective mental health care. Key future directions include the need for updated protocols in this area and the integration of mental health professionals within epilepsy settings.

Complex Posttraumatic Stress Disorder (CPTSD) is a condition resulting from exposure to chronic, interpersonal traumatic events, in which some form of control or power dynamics existed. Its clinical picture includes the main symptom clusters of posttraumatic stress disorder, accompanied by dysregulated emotion, problems in interpersonal relationships, and difficulties in identity integration. In addition, both clinical work and research have shown CPTSD to include highly distressing and complicated psychological phenomena, such as identification with the aggressor, various forms of dissociation, self-harm and self-destructive behaviors, and more. Due to this highly complex and multilayered clinical picture, the treatment of CPTSD poses a significant clinical challenge to therapists. In this special issue of In Session, we present a series of case studies, each representing a different therapeutic approach to CPTSD (e.g., skills training for affective and interpersonal regulation, Eye Movement Desensitization and Reprocessing, psychodynamic, integrative psychotherapy). These cases also represent a wide variety of patient populations, as well as different types of underlying traumatic events. Together, they reveal the breadth of clinical possibilities currently available to trauma therapists encountering cases of CPTSD. They also highlight the challenges and dilemmas that clinicians often face when treating this condition, as well as ways to overcome those., (© 2024 Wiley Periodicals LLC.)

Objective: Eating disorders (EDs) increasingly emerge as a health risk in men, but there is concern that men's symptoms go unnoticed due to stereotypical perceptions and gender-related differences in symptom presentation. Novel assessments focused particularly on attitudes and behaviours towards increasing muscle size and definition. Using network analysis, this study aimed to corroborate and extend previous findings on disordered eating presentation in men by examining the role of muscularity concerns among an extended range of disordered eating symptoms., Method: N = 294 adult men (18 years or older) completed muscularity-related and disordered eating assessments, among which we included assessments for orthorexic eating and Avoidant/Restrictive Food Intake Disorder for the first time. We selected symptoms empirically, estimated a regularised network, identified symptom communities, evaluated network loadings and bridge centrality estimates, and compared network structures between different groups of participants., Results: We identified five symptom communities related to muscularity-related concerns, features of core ED psychopathology, and selective eating. Symptoms regarding ruminating about healthy eating, guilt for unhealthy eating, weight overvaluation, concerns about muscularity, and selective eating emerged as highly central., Discussion: The results largely corroborate previous observations but suggest that muscle-building behaviours are part of a broader cluster of male body shaping and rule-based dieting behaviours., (© 2024 The Author(s). European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.)

The aim of this scoping review was to synthesize published studies and ongoing clinical trials of psychological interventions for mental health problems associated with COVID-19 infection. The study protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. We conducted systematic searches for studies published or registered between January 2020 and October 2022 using eight scientific databases and clinical trial registries, which identified 40 complete published studies and 53 ongoing clinical trials. We found that most studies were randomized controlled trials (74%) while the remaining used study designs of lower methodological quality. Most studies investigated interventions for acute COVID-19 patients (74%) and others explored post-COVID conditions (PCC) or recovered patients. Cognitive and behavioral therapies were the main intervention approaches (31%), followed by multidisciplinary programs (21%) and mindfulness (17%). The most frequently evaluated outcomes were anxiety (33%), depression (26%), quality of life (13%), and insomnia (10%). No studies on youths, older people, or marginalized communities were found. These findings summarize the burgeoning research on a range of psychological interventions for individuals infected with COVID-19. However, the field is in its infancy and further research to develop an evidence base for targeted care is necessary. The gaps identified in the current study also highlight the need for more research on youths, older people, and members of marginalized communities, and PCC patients. It is important to ascertain interventions and delivery strategies that are not only effective and affordable but also allow high scalability and accessibility., Competing Interests: Masaya Ito has received royalties for books and writings on psychological treatment from Shindan to Chiryo sha, Sogen sha, and several publishing companies in Japan. He has also received honorariums for workshops and supervision related to psychological treatments. Hironori Kuga is an Editorial Board member of Psychiatry and Clinical Neurosciences Reports and a co‐author of this article. To minimize bias, they were excluded from all editorial decision‐making related to the acceptance of this article for publication., (© 2024 The Author(s). Psychiatry and Clinical Neurosciences Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.)

Objective: Conventional randomized controlled trials (RCTs) have long served as the foundation of research in clinical psychology; however, most treatments for eating disorders show only modest effects on reduction of symptoms and maintenance of long-term remission. New options for psychotherapy treatment development research, beyond continuing to pursue additive or subpopulation approaches, are needed., Methods: One option is to apply dose-response designs, which are commonplace in studies of pharmacology, toxicology, and medical research, and characterized by the evaluation of the amount of exposure (dose) to an intervention, and the resulting changes in body function or health (response)., Results: Eating disorder interventions are particularly well-suited for dose-response treatment designs. The deadly nature of eating disorders makes it imperative that patients are not turned away for not being "ready" to engage with treatment. By identifying optimal doses, research will likely yield a more parsimonious course of treatment, which will lend itself to reduced costs, greater uptake, and reduced drop-out., Discussion: Limited use of within-subject designs in trials for patients with eating disorders has produced fast-track efficacy studies and omitted key elements in the treatment development pathway. To decrease reliance on RCT's, dose-response methods should be applied as an alternative study design., Public Significance: Eating disorders are associated with medical and psychiatric comorbidities, poor quality of life, and high mortality. Access to evidence-based services for patients with eating disorders is limited, and identifying additional effective treatment options can be difficult because of challenges inherent to randomized-controlled trials. This manuscript describes an alternative trial methodology to maximize the information that can be gathered prior to utilizing a standard large-scale efficacy design., (© 2023 Wiley Periodicals LLC.)

Drawing from literature on measurement-based care and prognostic indices in eating disorder (ED) treatment, Wade et al. offer an algorithm for treating co-occurring mental-health conditions (i.e., psychiatric comorbidity) in people with EDs, and for studying effects of comorbidity-oriented treatments. Advocating session-by-session measurement to inform adaptive treatment, their proposal outlines a process for adjusting conventional ED treatment to situations in which comorbidity impedes treatment progress. The plan is methodical and responsive to evidence suggesting that peoples' early in-treatment change has more power, prognostically, than do indices of comorbidity. In the absence of data to inform practices in some areas, the authors intentionally leave key questions unanswered until future results are in. But this means that they reserve comment on how to determine that comorbidity is interfering with treatment response, or to select the best-fitting of available comorbidity-oriented options. Likewise, the proposal draws most of its inspiration from literature on individual (mainly cognitive-behavioral) psychotherapy and, as a result, does not fully represent biopsychosocial perspectives, or elaborate upon the place in comorbidity management of biological treatments, family, and carer involvement, or more complex integrated approaches. Considerations on how to apply the latter methods would broaden the plan's scope., (© 2023 Wiley Periodicals LLC.)

Abstract Background Obsessive‐compulsive disorder (OCD) tends to be treatment refractory. Recently, cognitive‐coping therapy (CCT) for OCD is reported to be an efficacious psychotherapy. However, the underlying neurophysiological mechanism remains unknown. Here, the effects of CCT on OCD and the resting‐state brain function were investigated. Methods Fifty‐nine OCD patients underwent CCT, pharmacotherapy plus CCT (pCCT), or pharmacotherapy. Before and after a 4‐week treatment, Yale‐Brown obsessive‐compulsive scale (Y‐BOCS) was evaluated and resting‐state functional magnetic resonance imaging (rs‐fMRI) was scanned. Results Compared with the baseline, significant reduction of Y‐BOCS scores was found after four‐week treatment (p

Background: Meta-analyses on the relative efficacy of psychodynamic psychotherapy (PDT) and cognitive behavioral therapy (CBT) for depressive disorders are limited by heterogeneity in diagnostic samples and comparators and a lack of equivalence testing., Objective: We addressed this through a meta-analytic test of the equivalence of manualized PDT and CBT in treating adults with depressive disorders as determined by diagnostic interviews. Sensitivity analyses evaluated the impact of pretreatment differences, mixed diagnostic samples, author allegiance, study quality, year of publication and outliers on findings., Method: A comprehensive literature search across multiple databases using reliable screening methods identified nine randomized controlled trials directly comparing manualized PDT and CBT for diagnosed depressive disorders in adults. Following pre-registration, we employed random effect models for our meta-analyses and two one-sided test procedures for equivalence testing., Results: Independent raters determined that all studies were of adequate quality. Immediately posttreatment, depressive symptoms were statistically equivalent across PDT and CBT (k = 9; g = -0.11, 90% confidence interval [90% CI]: -0.24 to 0.02, p equivalence  = .048, p NHST  = .212, I 2  = 32.7). At follow-up, the longest time point within a year, depressive symptoms were neither statistically equivalent nor statistically different (k = 6; g = -0.16, 90% CI: -0.31 to -0.02, p equivalence  = .184, p NHST  = .126, I 2  = 0.00)., Conclusion: The efficacy of manualized PDT is equal to manualized CBT immediately at posttreatment for depressive disorders in the adult general population. Nevertheless, insufficient data exists to reach a conclusion regarding equivalence at follow-up., (© 2024 The Authors. Journal of Clinical Psychology published by Wiley Periodicals LLC.)

Persons with pathological narcissism (PN) or narcissistic personality disorder present with a wide array of symptoms and social problems. They need effective psychotherapies but empirical evidence for what works with them is mostly lacking. In this issue of the Journal and Clinical Psychology: In Session four authors from different orientations described single cases of patients suffering from different manifestations of PN. In this commentary we reviewed in detail the four cases and tried to distill (a) the treatment principles adopted; (b) the actual mechanisms of therapeutic change. We hope that the list of principles and mechanisms and change we identified here can help both clinicians and researchers develop and test effective options for persons with PN who are difficult to treat but do have chances to change in a meaningful way in treatment., (© 2024 Wiley Periodicals LLC.)

In order to effectively treat individuals suffering from Narcissistic Personality Disorder (NPD), it is crucial to establish therapeutic goals and identify tasks to achieve them. However, this is a challenging process with NPD patients because they often struggle to find meaningful goals beyond the pursuit of status. Moreover, in order to change Furthermore, to promote change, they must confront painful emotions such as shame, guilt, or fear, which they habitually try to avoid. Additionally, they face difficulties in forming a positive perception of their therapists and cooperating towards mutually agreed-upon goals and tasks. As a consequence, NPD patients ask for change but hardly engage themselves in the work necessary to achieve it. Therapists therefore need to pay the uttermost attention to drafting, negotiating and continuously updating a reasonable and realistic therapeutic contract. In this paper we describe the story of a man in his thirties with NPD who was ridden with depression, guilt, envy and anger and did not find ways to pursue the healthy and adaptive behaviors he would need to pursue in order to leave a richer social life. The therapist overcame ruptures in the therapeutic alliance and then involved the patient in a process where they set the steps to follow, making sure the patient was convinced they made sense. After a contract was reached progress became possible. Implications for the role of the therapeutic contract in NPD treatment are discussed., (© 2023 Wiley Periodicals LLC.)

Pathological narcissism is a personality constellation comprising distorted self-image, maladaptive self-esteem regulation, and difficulties in intimate relationships. Patients with elevated pathological narcissism may not necessarily meet criteria for narcissistic personality disorder, and may seek treatment for a range of mental health concerns across various clinical settings. An understanding of key principles of control-mastery theory (CMT) can help clinicians understand the specific goals and challenges of the individual patient with pathological narcissism, and can illuminate ways in which the patient may work in psychotherapy. This paper outlines how patients with pathological narcissism may engage in testing of their pathogenic beliefs, and how therapists can respond in ways that facilitate the patient's sense of safety and foster psychological work. The role of the therapist's attitude is highlighted as a means for countering pathogenic beliefs associated with pathological narcissism. Clinical material from a single case of time-limited supportive psychotherapy will be used to illustrate these principles and associated therapeutic processes. Insights from CMT regarding pathogenic beliefs and the patient's plan for addressing them can help to explain how therapy works or does not work for patients with pathological narcissism., (© 2023 Wiley Periodicals LLC.)

Treatment of patients with pathological narcissism presents several challenges and there is paucity of published case reports that document meaningful and durable change in patients suffering from this condition. Using descriptive and atheoretical language, this paper presents a treatment of a young man in his transition from young adulthood to middle adulthood while he was negotiating complex residues of his experiences of growing up along with developmental challenges related to work and love. Against the backdrop of these transitions, the patient was working through various aspects of functioning related to pathological narcissism. Initially, given academic pressures and past romantic disappointments, he was confronting issues related to perfectionism, self-criticism, and avoidance. While he was able to move past some of these dynamics and function academically, later challenges related to becoming an independent adult led to a retreat into an avoidant state of futility and pessimism. Working through painful family dynamics related to not being seen and controlled, along with a deepening attachment in therapy as well as confrontation with realities of his life, led him to take steps toward greater independence. Thereafter, his treatment focused on learning from life experiences such as a newly developed career and romantic life, accepting the complexity of self and others, and tolerating disillusionments., (© 2023 Wiley Periodicals LLC.)

Background: The present study explored the acceptability of psilocybin-assisted group therapy from the perspective of patients with cancer and depression who participated in a clinical trial assessing the safety and efficacy of this novel intervention., Methods: Guided by the conceptual framework of acceptability, the authors conducted semi-structured interviews with participants of the psilocybin trial. Data were analyzed using template and thematic analyses., Results: Participants' (n = 28) perspectives on the acceptability of the group and simultaneous sessions was generally positive, both in terms of safety and efficacy: first, the groups contributed to increase participants' sense of safety and preparedness as they were engaging in the therapy; and second, the groups fostered a sense of connection and of belonging, which served to enrich and deepen the meaning of participants' experience, ultimately opening a dimension of self-transcendence and compassion. Other subthemes related to factors influencing the acceptability of the group approach included: 1) the importance of the therapeutic framework, 2) the complementary value of individual sessions, 3) disruptive factors related to the group and/or simultaneous setting, and 4) opportunities and challenges related to group size and how to structure interactions., Conclusions: This study enhances understanding of what promotes acceptability of the psilocybin-assisted therapy group model for the treatment of MDD in cancer patients., Plain Language Summary: We conducted exit interviews with participants of a phase 2 trial of psilocybin-assisted therapy (PAT) conducted in a community cancer center, to assess the acceptability of a novel psilocybin delivery model combining simultaneous individual therapy and group sessions. Our findings support the acceptability of this intervention and suggest that in addition to being feasible, it might also enhance participants' perceived safety and efficacy compared to uniquely individual or group delivery models of PAT. Our analysis highlights critical factors conditioning acceptability and suggests new ways PAT may be scaled and integrated into cancer care., (© 2023 American Cancer Society.)

Eye movement desensitization and reprocessing (EMDR) therapy is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD), with support from more than 30 published randomized controlled trials (RCTs) demonstrating its effectiveness in both adults and children. Most international clinical practice guidelines recommend EMDR therapy as a first-line treatment for PTSD. This paper describes the current state of the evidence for EMDR therapy. We begin with a brief description of EMDR therapy and its theoretical framework. Next, we summarize the scientific support for its efficacy, effectiveness, and safety and discuss its applicability across cultures and with diverse populations. We conclude with suggestions for future directions to develop the research base and applications of EMDR therapy., (© 2024 The Authors. Journal of Traumatic Stress published by Wiley Periodicals LLC on behalf of International Society for Traumatic Stress Studies.)

Background: Depression is common in patients with cancer and is associated with lower treatment adherence and reduced quality of life. Antidepressants and psychotherapy have limited success in improving depression among patients with cancer. This study explored the safety, feasibility, and efficacy of psilocybin-assisted therapy in patients with cancer and major depressive disorder., Methods: This phase 2, open-label trial enrolled patients with curable and noncurable cancer and major depressive disorder at a single community oncology practice site. A single 25-mg dose of psilocybin was administered simultaneously to cohorts of three to four participants with individual (4.25 hours in 1:1 therapist-to-patient ratio) and group therapeutic support (3.75 hours) before, during, and after psilocybin administration. Outcomes included depression severity, anxiety, pain, demoralization, and disability., Results: Thirty participants completed the study. No psilocybin-related serious adverse events occurred; treatment-related adverse events (e.g., nausea, headache) were generally mild and expected. There were no laboratory or electrocardiogram abnormalities. No suicidality was reported. Efficacy was suggested with a robust reduction in depression severity scores from baseline to posttreatment of 19.1 points (95% CI, 22.3 to -16.0; p < .0001) by week 8. Eighty percent of participants demonstrated a sustained response to psilocybin treatment; 50% showed full remission of depressive symptoms at week 1, which was sustained for 8 weeks., Conclusions: Psilocybin-assisted therapy in group cohort administration was safe and feasible in patients with cancer and depression. Efficacy was suggested based on clinically meaningful reductions in depressive symptoms. The novel, group-oriented format, compact delivery time, community cancer center setting, and one-to-one therapist-to-patient ratio could also add to therapeutic gains and efficiency of administration., Trial Registration: NCT04593563., Plain Language Summary: Depression is common in patients with cancer and associated with lower treatment adherence, reduced quality of life, and limited response to antidepressants and psychotherapy. We conducted a phase 2 trial to study a single dose of psilocybin administered in a group therapy setting with one-to-one therapist-to-participant psychological support to patients with curable and noncurable cancer and major depressive disorder. Findings of the study showed safety (no treatment-related serious adverse events or suicidality) with psilocybin and suggested efficacy, with a significant reduction in depression severity scores from baseline to posttreatment. Further investigation is warranted., (© 2023 American Cancer Society.)

Objective: This quasi-experimental study aimed to compare the outcome of patients with Anorexia Nervosa (AN) reporting moderate/severe childhood maltreatment (CM) treated exclusively with Enhanced Cognitive Behaviour Therapy (CBT-E) or with CBT-E plus Eye Movement Desensitisation and Reprocessing (EMDR)., Method: A total of 75 patients with AN reporting moderate/severe CM were initially assessed regarding body mass index (BMI), general and eating disorder (ED)-specific psychopathology, and dissociative symptoms, and re-evaluated after 40 CBT-E sessions (T1). Then, 18 patients received EMDR, whereas the others were placed on a waiting list and continued CBT-E. T2 assessment was performed after 20-25 sessions of EMDR or CBT-E. A control group of 67 patients without CM was also enroled and treated with CBT-E., Results: Contrary to patients without CM, neither of the traumatised groups improved in BMI, general and ED psychopathology, or dissociation at T1. However, at T2, both traumatised groups improved in BMI and ED-specific psychopathology, with the CBT + EMDR group demonstrating greater improvements. Moreover, only the CBT + EMDR group improved in general psychopathology and dissociative symptoms. The reduction of ED symptoms in traumatised patients was mediated by the amelioration of dissociation., Discussion: The addition of EMDR to CBT-E may benefit patients with AN reporting moderate/severe CM., (© 2023 The Authors. European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.)

Self-injurious thoughts and behaviors (SITBs), including suicidal thoughts, suicide attempts, and nonsuicidal self-injury, are highly prevalent among adolescents. Identifying adolescents at risk for SITBs relies on their disclosure, and these disclosures commonly occur in therapy context. Moreover, therapists often breach confidentiality to inform adolescents' parent or guardian when they disclose SITBs. Research has explored rates of and barriers to disclosure among adolescents, yet no studies have examined adolescents' experiences of disclosure in the therapy context. Further, no studies have examined adolescents' experiences when their parents are then informed. In this study, we examined qualitative responses from 1495 adolescents who had experienced a SITB disclosure in the therapy context. Qualitative questions included asking adolescents to describe how the SITB disclosure occurred, how their parents were informed, and their parents' reactions. Using open and axial coding, several themes emerged. Adolescents described therapist breaches of confidentiality as collaborative, noncollaborative, or unclear. Adolescents described their parents' affective responses, communication about SITBs, validating and invalidating responses, treatment-oriented responses, and ways that parents restricted their access to people, places, and activities. Findings have implications for the development of clinical guidelines when adolescents disclose SITBs in therapy and highlight areas for future research in adolescent SITB disclosure., (© 2023 Wiley Periodicals LLC.)

Objective: Investigate the acceptability of Specialist Psychotherapy with Emotion for Anorexia in Kent and Sussex (SPEAKS), a novel intervention for anorexia nervosa (AN), conducted as a feasibility trial to provide an initial test of the intervention., Methods: SPEAKS therapy lasting 9-12 months was provided to 34 people with AN or atypical AN by eight specialist eating disorder therapists trained in the model across two NHS Trusts in the UK (Kent and Sussex) during a feasibility trial. All participants were offered a post-therapy interview; sixteen patients and six therapists agreed. All patient participants were adult females. Interviews were semi-structured and asked questions around individuals' experience of SPEAKS, the acceptability of the intervention and of the research methods. Interviews were analyzed using thematic analysis., Results: Key areas explored in line with research questions led to 5 overarching themes and 14 subthemes: (1) shift in treatment focus and experience, (2) balancing resources and treatment outcomes, (3) navigating the online treatment environment, (4) therapist adaptation and professional development, and (5) research processes., Discussion: SPEAKS was found to be an acceptable intervention for treating AN from the perspective of patients and therapists. The findings provide strong support for delivery of a larger scale randomized control trial. Recommendations for future improvements, particularly pertaining to therapist understanding of the treatment model are detailed, alongside broader clinical implications., Public Significance: We aimed to evaluate the acceptability of a new anorexia nervosa treatment called SPEAKS. Interviews were conducted with patients and therapists involved in the pilot study and responses were analyzed. Results showed that both patients and therapists found SPEAKS to be an acceptable treatment for anorexia nervosa. The study suggests that SPEAKS meets the criteria for moving forward with a larger trial to assess its effectiveness., (© 2024 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Objective: Despite the clinical significance of emotional diversity, also known as emodiversity, there has been limited investigation into the therapeutic interventions that influence this construct. In the current study we examined the association between immediate therapist self-disclosure (TSD) and emodiversity among two diagnostic groups who tend to experience emotional difficulties: people with schizophrenia and people with emotional disorders (i.e., depression and/or anxiety)., Method: The sample comprised 74 clients (37 diagnosed with schizophrenia and 37 with emotional disorders) treated by 45 therapists in a university clinic setting. Following each session, clients self-reported their emotions, and therapists completed a measure of frequency and centrality of their immediate TSD during the session., Results: Longitudinal multilevel models indicated that immediate TSD was positively associated with clients' global emodiversity, both at the within- and the between-client levels, as well as with clients' negative emodiversity at the between-client level. Moreover, clients with emotional disorders and clients with schizophrenia did not differ in the association between immediate TSD and emodiversity. In addition, across groups, clients treated by therapists who used more immediate TSD on average showed greater increases in global emodiversity during treatment., Conclusions: immediate TSD is associated with clients' ability to experience rich and diverse emotional experiences across different disorders. The theoretical and clinical implications of these findings are discussed., (© 2024 The Authors. Journal of Clinical Psychology published by Wiley Periodicals LLC.)

Abstract Depression in patients with cardiovascular disease is independently associated with progression of heart disease, major adverse cardiac events, and mortality. A wide variety of depression treatment strategies have been studied in randomized controlled trials as the field works to identify optimal depression treatments in this population. A contemporary scoping review of the literature can help to consolidate and synthesize the growing and disparate literature on depression treatment trials in people with cardiovascular disease. We conducted a scoping review utilizing a systematic search of the literature via 4 databases (PubMed, PsycINFO, EMBASE, and Google Scholar) from database inception to March 2020. We identified 42 relevant randomized controlled trials of depression treatment interventions in patients with cardiac disease (n=9181 patients with coronary artery disease, n=1981 patients with heart failure). Selective serotonin reuptake inhibitors appear to be safe in patients with cardiac disease and to have beneficial effects on depression (and some suggestion of cardiac benefit) in patients with coronary artery disease, with less evidence of their efficacy in heart failure. In contrast, psychotherapy appears to be effective for depression in coronary artery disease and heart failure, but with less evidence of cardiac benefit. Newer multimodal depression care management approaches that utilize flexible approaches to patients' care have been less studied but appear promising across cardiac patient groups. Selective serotonin reuptake inhibitors may be preferred in the treatment of patients with coronary artery disease, psychotherapy may be preferred in heart failure, and more flexible depression care management approaches have shown promise by potentially using both approaches based on patient needs.

Abstract Objective While the efficacy of psychotherapy in the treatment of mental disorders is well examined, systematic research into negative effects of psychotherapy seems comparatively rare. Therefore, this review evaluates instruments for assessing negative effects of psychotherapy in order to create a consensus framework and make recommendations for their assessment. Methods The study selection procedure follows current best‐practice guidelines for conducting systematic reviews, with 10 included studies in three databases (PsycINFO, PubMed, and Web of Science). The nine instruments identified were each critically reviewed concerning the theoretical orientation, including the assessed domains of negative effects, psychometric properties, and diagnostic characteristics. Results Seventeen domains of negative effects of psychotherapy were identified but inconsistently assessed by the nine instruments. Most instruments provide some initial data on their psychometric properties. Regarding diagnostic characteristics, different item‐response formats are used but often with reference to “attribution to therapy.” Conclusion This review indicates that the existing instruments for assessing negative effects of psychotherapy cover a wide range of relevant domains without any consensus on the most important ones and their psychometric properties are usually unsatisfactory. A framework for consensus, building on the definition and conceptualization of negative effects, is synthesized, and recommendations for improving the assessment are derived.