Clinical Psychology in Europe

Are You Really Paranoid, Just Because They Are After You? Exploring the Underlying Sensitization Processes of Intersectional Discrimination on Everyday-Life Paranoia

2026-05-29T07:33:01+00:00

Background: Elevated paranoia levels have been found in discriminated, minoritized groups. Social-cognitive models of paranoia posit that experiences of discrimination strengthen negative core beliefs, which in turn foster clinical paranoia. In contrast, the healthy cultural mistrust hypothesis proposes that elevated paranoia in minoritized groups reflects an adaptive response to increased exploitation/discrimination. To explore whether elevated paranoia in discriminated groups can be fully understood within clinical models, we tested whether a history of discrimination amplifies the association between everyday-life stressors and subsequent state-paranoia and whether this moderation effect remains when controlling for established cognitive risk factors for paranoia (i.e., dysfunctional beliefs). Method: A general population sample (n = 108) answered a baseline self-report questionnaire of lifetime discrimination experiences (LDE) and core beliefs about oneself and others. Next, they reported state-paranoia, negative affect, and exclusion experiences in 2.5h intervals for seven days of ambulatory assessment. LDE and core-beliefs were tested as concurrent moderators for the associations between state-paranoia and putative triggers (negative-affect, exclusion) using multilevel regression. Results: More LDE amplified the association between paranoia, negative affect, and exclusion experiences. When controlling for the moderation effects of negative beliefs, effect sizes for the LDE moderation were lower but largely remained significant. Conclusions: Increased state-paranoia in the daily lives of people with discrimination experiences can be partially, but not fully, explained by clinical, cognitive risk factors. Consequently, healthy cultural mistrust can be considered an additional contributing factor to higher mistrust/paranoia in minoritized groups. Future in-depth research needs to disentangle mechanisms of emerging paranoia and adaptive mistrust in minoritized groups.

How to Define Psychological Therapy and Psychotherapy? – An Interdisciplinary Proposal

2026-05-29T07:32:56+00:00

Background: The definition of psychological treatments and psychotherapy has various implications for communication within research and clinical care, as well as for legal issues — particularly in countries with psychotherapy acts. It can define what should be covered by public healthcare systems and who should be permitted to provide these services. Method: We assembled a group of psychotherapists in Germany to develop an inclusive, scientific definition of psychotherapy. This definition should serve as an umbrella that is not limited to traditional treatment schools and is suitable for science, clinical care and legal acts. The group comprised people with different therapeutic backgrounds (e.g., CBT, psychodynamic and systemic therapy), experts from various disciplines (e.g., psychology, psychiatry and psychosomatic medicine), people focusing on different age groups (e.g., adults and youth), individuals with lived experience of psychotherapy and early career clinicians. Results: A literature review led us to consider four aspects of a definition. What are the treatment means or 'tools'? (modality of treatment); how does the treatment work? (Proposed change mechanisms, assumptions about causal and evidence-based processes and concepts); who receives psychotherapy? (target group); and who provides psychotherapy? (Provider). Based on these aspects, we offer a definition of psychological therapy. Discussion: Our suggested definition is not bound to specific treatment orientations, but is intended to encompass both traditional approaches and innovative developments. Our aim is to promote the evidence-based provision of psychological therapy within healthcare systems and legal frameworks.

Repeated Mirror Exposure in Individuals With Body Dysmorphic Symptoms

2026-05-29T07:33:01+00:00

Background: Mirror exposure represents a common component in treatment of body dysmorphic disorder (BDD). However, the benefits of repeated mirror exposure have not been investigated as a standalone intervention for BDD. This study aimed to examine the cognitive and affective response to mirror exposure in individuals with high and low levels of body dysmorphic symptoms. Method: Fifty women participated in two guided full-body mirror exposures (approx. 32 minutes each). Participants were divided into two groups based on the severity of their BDD symptoms. Twenty-three participants reported elevated, not primarily weight related, body dysmorphic symptoms. Body satisfaction and affective responses were assessed before and after the exposure, affective responses were further assessed during the exposure. Post-event processing related to the experience was rated the day afterwards. Results: Participants with body dysmorphic symptoms reported lower state body satisfaction and higher shame in both sessions, sadness was elevated in the first session only. State body satisfaction dropped from pre to post exposure but improved from the first to the second session. Negative affects did not decrease within but between the two sessions. Post-event processing after the first exposure predicted negative affect at the beginning of the second session. Conclusion: The results support a positive effect of repeated mirror exposure across sessions, without improvement within the session. They point towards the detrimental role of mental post-processing.

Adaptive and Maladaptive Networks Using Ecological Momentary Assessment

2026-05-29T07:32:58+00:00

Background: A person’s ability to adapt to a given context is a critical determinant of mental health and psychopathology, which has been redefined by network approaches and Ecological Momentary Assessment (EMA). This study examined whether including adaptive processes in EMA enhances the informational value of idiographic network models. Method: Forty-five university students participated in a multi-week EMA protocol assessing psychological dimensions using bipolar visual analogue scales ranging from maladaptive to adaptive. Participants were randomly assigned to two groups: one assessed only maladaptive processes; the other included both maladaptive and adaptive processes. Results: Network analyses indicated higher density and connectivity in the adaptive–maladaptive group, as well as significantly reduced floor effects across all variables. Greater response dispersion was associated with more differentiated network structures. Motivation emerged as the most central node across conditions, highlighting its relevance as a transdiagnostic treatment target. Cognitive processing showed strong associations with other variables, underlining its clinical importance. Conclusion: The findings suggest that incorporating adaptive dimensions into EMA facilitates a more comprehensive understanding of psychological functioning and improves the interpretability of idiographic models. The study represents an initial feasibility investigation and a basis for further investigations in clinical practice.

A Scoping Review of Amenable Patient-Specific Predictors of Treatment Failure in the Treatment of Anxiety and Depressive Disorders

2026-05-29T07:32:57+00:00

Background: By identifying predictors of treatment failure that are susceptible to change (amenable), we can move towards studying ways to decrease the odds of treatment failure, e.g., by targeting these predictors before treatment, adapting interventions, accordingly, choosing more suitable treatments, or preparing patients better for psychotherapy. While treatment success, within anxiety and depressive disorders, has been studied extensively, it seems that treatment failure is overlooked, even while we know that about one third of the treatment population shows no benefit in treatment. Method: In order to review the available body of knowledge concerning amenable patient-specific predictors for treatment failure, we conducted a literature search in PubMed, PsycInfo, Embase, and Medline, following the Prisma-ScR guidelines. Thirty articles met the inclusion criteria and are summarized in this review. Conclusions were drawn for scientific and clinical implications. Results: Predictors of treatment failure that are replicated or are significant in multiple studies are low treatment expectancy, high neuroticism, low use of social support, low outcome expectancy, and low perceived social support. Treatment failure is hard to define, and very few studies are replicated. There are predictors that are studied in multiple articles, but they are measured with different instruments, or in very small or specific patient samples, therefore it is difficult to compare findings from different studies. Conclusions: There are no predictors that stand out as overall strong amenable predictors of treatment failure. Possible predictors are high neuroticism, low treatment expectancies, and low use of social support. Future research should focus on replicating studies to confirm these predictors of treatment failure.

Promoting Flexibility in Expectations: A Randomized-Controlled Online-Intervention Study for Mild Psychopathological Symptoms

2026-05-29T07:33:02+00:00

Background: Research demonstrates that mental disorders are associated with specific dysfunctional expectations and a reduced ability to adjust them, even after expectation-violating experiences. The ViolEx (violated expectation) model offers a framework to explain why expectations persist or change, introducing the concept of cognitive immunization as a potential explanation for differences in information processes. Expectation-focused psychological interventions (EFPI) aim to promote expectation adaptation. Method: This study examines the effectiveness of an online EFPI platform for individuals with mild depressive and/or anxiety symptoms. A total of 128 participants, screened with the PHQ-9 (scores 5-9) and/or BAI (scores 8-25), were randomly assigned to one of three groups. The EFPI group and the active control group (ACG) received a psychoeducational video about expectations and their influence on behavior. Over four weeks, the EFPI group completed behavioral experiments to test their personal expectations, while the ACG used only cognitive strategies to challenge personal expectations. A third group (control group; CG) received no intervention. Surveys were administered at baseline, four weeks, and eight weeks after the initial assessment. Results: A significant reduction in cognitive immunization was observed over measurement timepoints, with a significant difference to the CG at the follow-up. Anxiety symptoms appear to moderate this effect, whereas EFPI did not influence depressive symptoms, nor did depressive symptoms moderate changes in cognitive immunization. Conclusion: This study is the first to evaluate online EFPI for mild depression and/or anxiety symptoms, suggesting that EFPI may reduce cognitive immunization. Future studies should investigate therapist-delivered EFPI in clinical populations with more severe symptoms.

Preliminary Evaluation of the Psychometric Properties of the Ukrainian Traumatic Grief Inventory-Self Report Plus (TGI-SR+)

2026-05-29T07:32:59+00:00

Background: Prolonged Grief Disorder (PGD) was included in the DSM-5-TR and ICD-11. The Traumatic Grief Inventory Self-Report Plus (TGI-SR+) is a self-report measure to assess PGD symptoms in accordance with both classification systems. It has been translated into various languages and validated across different contexts. Objective: Evaluating the psychometric properties of the Ukrainian TGI-SR+. Method: Participants were Ukrainian adults who had lost a loved one at least 6 months ago. One hundred ninety-eight participants completed the TGI-SR+ and measures assessing posttraumatic stress and depression. We examined the factor structure, internal consistency, convergent validity, and known-groups validity of the TGI-SR+. Moreover, rates of probable PGD caseness were calculated, and provisional cut-off scores were determined based on Receiver Operating Characteristic (ROC) analyses. Results: The one-factor model showed an acceptable fit for DSM-5-TR, but not for ICD-11 PGD symptoms. While some of the factor loadings were low for both criteria sets, the items demonstrated good internal consistency. Convergent validity was supported by strong associations between symptom levels of DSM-5-TR and ICD-11 PGD and posttraumatic stress and depression severity scores. Known-groups validity was partially supported by DSM-5-TR and ICD-11 PGD severity being related to both cause of death and kinship to the deceased. The provisional cut-off score for detecting both probable DSM-5-TR and ICD-11 PGD caseness, when summing all TGI-SR + items, was ≥ 75. Conclusion: The psychometric properties of the Ukrainian TGI-SR+ were mixed. However, pending further research in different and larger samples of Ukrainian bereaved people, this instrument can be used to assess PGD severity in Ukrainians.

Conducting Behavioural Experiments Using an App-Based Self-Help Program for Social Anxiety Disorder (SMASH): Outcomes of a Quasi-Experimental Pre-Post Pilot Trial

2026-02-27T00:35:19+00:00

Background: Social Anxiety Disorder (SAD) is a prevalent mental disorder characterised by fear of negative evaluation. Although effective treatment approaches are available, access remains limited due to psychological and organisational barriers. Internet-based cognitive behavioural therapy (iCBT) has shown promising results and may facilitate an easy and more resource-efficient access to treatment. Method: We developed an app-based self-help intervention for SAD based on the Clark and Wells treatment program, implemented as an unguided smartphone application, which was evaluated in this quasi-experimental pre-post pilot study consisting of N = 33 patients with a primary diagnosis of SAD. Feasibility was assessed through usage parameters and qualitative feedback. Effectiveness was evaluated in regard to SAD and depression, using clinician-rated measures (LSAS, QIDS-C) at post-treatment (12 weeks) and self-report measures (SPIN, SCQ, BDI-FS) at midpoint and post-treatment. Additionally, moderating effects of usage parameters on symptom reduction were examined. Results: Clinician- and self-reported SAD symptoms were significantly reduced at post-measurement (within-group effect sizes LSAS: η2 = .54; SPIN: η2 = .47), with 52% of patients achieving a clinically significant improvement. Despite moderate overall adherence, the amount of conducted behavioural experiments moderated reduction in self-reported SAD symptom severity and SAD-related cognitions. Open feedback supported feasibility and acceptability of the app. Conclusion: In conclusion, findings provide preliminary support for feasibility, acceptability, and potential effectiveness of Mindable: Soziale Phobie. A randomised controlled trial will further evaluate the effectiveness and explore the impact of therapist guidance.

Theoretical Orientations and the Stereotype Content Model – Are Prejudices Barriers to Psychotherapy Integration?

2026-02-27T00:35:15+00:00

Background: Despite efforts to integrate psychotherapy, the field remains fragmented into distinct theoretical orientations and practical approaches. Prejudices held by psychotherapists towards those from other theoretical orientations may hinder cooperation in research and clinical practice. This study examines stereotypes among psychotherapists from different theoretical orientations and practical approaches (‘psychotherapy schools’) towards their in-group and out-group colleagues. Method: The cross-sectional online study assessed socially shared evaluations of ‘warmth’ and ‘competence’ from the stereotype content model in a sample of 586 German psychotherapists (60.9% licensed; 39.1% in training) from different psychotherapy schools (34.5% psychoanalytic and psychodynamic psychotherapists, 19.8% psychodynamic psychotherapists, 28.7% cognitive behavioural therapists, and 17.1% systemic therapists). Linear mixed-effects models were used to examine differences in evaluations based on the rater’s and the rated psychotherapy school. Results: The psychotherapists' assumed socially shared evaluations of ‘warmth’ and ‘competence’ varied depending on their psychotherapy school affiliation, with significantly higher evaluations assigned to their in-groups than to their out-groups. Conclusion: The results indicate in-group biases in the social perception of psychotherapists with different theoretical orientations, representing potential barriers to inter-group contact and collaboration. Addressing prejudices is key to strengthening integrative competence in both research and clinical practice.

Mental Health Professionals’ Attitudes Towards the Network Theory of Mental Disorders

2026-02-27T00:35:16+00:00

Background: The network theory describes mental disorders as a network of interacting symptoms. While most research on the network theory is based on network analyses of symptom data, little is known about mental health professionals´ attitudes towards this theory. Clinical expertise could offer a valuable additional perspective on the validity of the theory and its applications to clinical practice. Method: Mental health professionals rated their agreement with propositions of the network theory regarding the phenomenology, aetiology, and treatment of mental disorders in an online survey. Further, the acceptability and appropriateness of possible applications were evaluated. We calculated descriptive statistics and examined associated factors with regression analyses. Results: The participating psychotherapists (n = 183), specialized physicians (n = 45), and clinical psychologists (n = 29, total n = 257) largely agreed with the network theory’s propositions regarding the phenomenology of mental disorders and treatment effects. Appraisal of the network theory regarding the aetiology of mental disorders, regarding important treatment targets, and regarding acceptability and appropriateness of possible applications was mixed. A theoretical background in cognitive behavioural therapy and previous knowledge of the network theory were associated with a stronger agreement in most domains. Conclusions: The fundamental assumptions of the network approach seem to resonate with mental health professionals, while the consequences for the diagnosis and treatment of mental disorders were questioned. Our findings indicate that the general conceptualization of mental disorders as symptom networks seems to align with mental health professionals’ perceptions but, at the same time, emphasizes the novelty and limited specificity of the theory’s implications for clinical practice.