Clinical Psychology in Europe

Effectiveness of Attachment-Based Family Therapy for Suicidal Adolescents and Young Adults: A Systematic Review and Meta-Analysis

2024-12-20T00:30:09-08:00

Background: Suicide is a leading cause of death among adolescents and young adults. While only few evidence-based treatments with limited efficacy are available, family processes have recently been posed as a possible alternative target for intervention. Here, we review the evidence for Attachment-Based Family Therapy (ABFT), a guideline-listed treatment targeting intrafamilial ruptures and building protective caregiver-child relationships. Method: PubMed, PsycINFO, Embase, and Scopus were searched for prospective trials on ABFT in youth published up until November 6^th, 2023, and including measures of suicidality. Results were independently screened by two researchers following PRISMA guidelines. Risk of bias was assessed using the Cochrane RoB-2 framework. A random effects meta-analysis was conducted on suicidal ideation and depressive symptoms post-intervention scores in randomized-controlled trials (RCTs). Results: Seven articles reporting on four RCTs (n = 287) and three open trials (n = 45) were identified. Mean age of participants was M_pooled = 15.2 years and the majority identified as female (~80%). Overall, ABFT was not significantly more effective in reducing youth suicidal ideation, g_pooled = 0.40, 95% CI [-0.12, 0.93], nor depressive symptoms, g_pooled = 0.33, 95% CI [-0.18, 0.84], compared to investigated controls (Waitlist, (Enhanced) Treatment as Usual, Family-Enhanced Nondirective Supportive Therapy). Conclusion: Evidence is strongly limited, with few available trials, small sample sizes, high sample heterogeneity, attrition rates, and risk of bias. While not generally superior to other treatments, ABFT might still be a clinically valid option in specific cases and should be further investigated. Clinicians are currently recommended to apply caution when considering ABFT as stand-alone intervention for suicidal youth and to decide on a case-by-case basis.

The History of Clinical Psychology in Greece: A Brief Review – Legal Deficiencies, Practical Dimensions and Challenges for the Future

2024-12-20T00:30:13-08:00

Background: The history of clinical psychology in Greece spans more than 150 years. However, this branch of psychology concerned with the assessment and treatment of mental illness and psychological problems has not yet acquired the institutional and general recognition to which it is entitled. Aims: This article intends to highlight, chronologically, the basic elements of the history of clinical psychology in Greece, beginning with the important contribution of the work of philologist Panagiota Kazolea-Tavoularis. Results: From the first references in the context of medical studies during the 19th century, clinical psychology gradually develops through its application in pedagogical, laboratory, and clinical contexts to become an independent discipline alongside the consolidation of general psychology. Special mention is made of the scientists who pioneered this direction. Conclusion: The present review highlights historical milestones and concludes with the current situation, in which important steps have been taken. However, significant changes are needed at the institutional level.

Assessing Diagnostic Precision: Adaptations of the Hopkins Symptom Checklist (HSCL-5/10/25) Among Tertiary-Level Students in Norway

2024-12-20T00:30:11-08:00

Background: Universities worldwide are witnessing a surge in mental health problems among students, particularly in anxiety and depression. The Hopkins Symptom Checklist (HSCL) is a popular screening tool, but its reliability in identifying mental disorders remains debated. The aim of this study was to evaluate the criterion validity of the HSCL-25, HSCL-10, and HSCL-5 using 30-day prevalence of major depressive episode (MDE) and generalized anxiety disorder (GAD) from a self-administered electronic version of the Composite International Diagnostic Interview, fifth version (CIDI 5.0), as the benchmark. Method: Data stem from a national survey targeting students in higher education in Norway. In a 2023 follow-up study on mental disorders, 5,568 participants completed both the HSCL-25 and the CIDI. Sex-specific optimal thresholds for all HSCL versions in relation to MDE and GAD (from CIDI) were determined using the Youden Index maximization. Results: The optimal cut-off values for detecting MDE or GAD with the HSCL-25 were 1.96 for males and 2.20 for females, displaying a good balance between sensitivity and specificity. Similar high and balanced sensitivity and specificity patterns were found for both the HSCL-10 and HSCL-5. However, all HSCL versions overestimated prevalence rates compared to the self-administered CIDI. Conclusions: All three HSCL versions showed high criterion validity. The data indicate that HSCL may be better as a screening tool than for precise estimation of MDE and GAD prevalence. For improved diagnostic accuracy, future HSCL versions should incorporate functional impairment assessment. This update would bring the HSCL into closer alignment with clinical diagnostic standards.

The Relation Between Social Anxiety and Perceptions of Likeability and Friendship in Adolescents

2024-12-20T00:30:10-08:00

Background: This study investigated how different social anxiety symptoms (i.e., worrying about negative evaluation versus avoidance tendencies) in adolescents are related to the perception accuracy of likeability by peers and friendships with peers. Method: A community sample of 263 adolescents between 12 and 15 years old reported on their social anxiety symptoms. In addition, they estimated how much their peers liked them, indicated how much they liked their peers, and who their friends were in their classroom. Results: Results showed that socially anxious adolescents who mainly worried about negative evaluations, underestimated their likeability by peers. Adolescents with strong social avoidance tendencies had a more accurate perception of their likeability and friendships; they were less liked by their peers and had fewer friends. Conclusion: The results emphasize the importance of treating avoidance behavior in social anxiety since avoidance tendencies may not only maintain the social anxiety symptoms but are also related to a more negative judgment by others.

Examination of Gender Differences: Causal Attributions of Treatment-Seeking Individuals With Overweight and Obesity

2024-12-20T00:30:12-08:00

Background: Addressing patients' perceptions of the causes of their overweight and obesity may be a promising approach to enhance treatment motivation and success. Previous research suggests that there are gender differences in these aspects. The objective of this study was to investigate gender differences in causal attributions among individuals with overweight and obesity who participated in a cognitive-behavioral mobile health (mHealth) intervention. Method: Causal attributions were assessed using the revised Illness Perceptions Questionnaire, which included a rated and open answering section. An ANCOVA was conducted for each causal factor (behavioral, psychological, risk, external) as a dependent variable to determine gender differences, which were analysed with chi-squared tests for open-ended responses. Results: The most frequently mentioned and highly rated cause was behavior for both genders (59.8% of 639 responses). The results indicated that women rated psychological causes, particularly stress-related causes, significantly higher, F(1,211) = 14.88, p < .001, η2 = .07, and were more likely to cite emotional eating than men, χ2(1, N = 639) = 15.06, p < .001. Men rated alcohol stronger as cause than women, t(125.05) = 3.79, p < .001. Conclusion: The findings of this study contribute to the understanding of the gender differences in causal attributions among individuals with overweight or obesity. Implementing stress management interventions with a focus on emotion regulation is pivotal, especially for females. Interventions should focus on sensitizing males to the association between emotions and eating behavior. The causal attributions should be assessed with different survey methods in order to match the patient’s view of their condition.

All I Want for Christmas Is a Loo: Visualizations of Sex and Gender on Toilet Doors

2024-12-20T00:30:09-08:00

No abstract available.

A Systematic Review of Evidence-Based Cognitive and/or Behavioural Interventions Targeting Mental Health in LGBTQ+ Populations

2024-09-30T00:27:52-07:00

Background: Despite a minority stress-related higher risk to develop mental health difficulties, and problematic access to and treatment from healthcare providers, research into LGBTQ+ mental health support is limited. The aims of this systematic review were to explore evidence-based cognitive and/or behavioural interventions and adaptations targeting mental health in LGBTQ+ populations, before providing recommendations for future clinical and research directions. Method: Six databases were searched in February-March 2022 and risk of bias evaluated using the Cochrane RoB 2/ROBINS-I tools. A narrative synthesis following the PICOS framework and the review questions was used to examine the results. Results: Sixteen studies met inclusion criteria, including various interventions and adaptations, mental health difficulties, and other emotion- and minority stress-related processes/constructs. Risk of bias was judged as high, and critical/serious, respectively, in all studies. Outcomes included improvements in symptoms of depression (most statistically/clinically significant effects/large effect sizes), and anxiety, emotion regulation, and internalised homophobia in the pre-post studies. Conclusion: Cognitive/behavioural interventions and adaptations for LGBTQ+ populations feature a range of therapeutic modalities and levels of adaptation, with largely positive effects, in the context of limited and heterogenous literature and risk of bias concerns, as well as limitations related to publication bias and inclusion criteria of the current work. Suggestions for future clinical and research directions include a focus on generic therapeutic competencies and metacompetencies, and affirmative, potentially more holistic approaches, as well as more consistency in methodology, more focus on underserved LGBTQ+ populations and intersectionality, and more detailed investigations into mechanisms of change.

Does Practice Make Perfect? The Effects of an Eight-Week Manualized Deliberate Practice Course With Peer Feedback on Patient-Rated Working Alliance in Adults: A Pilot Randomized Controlled Trial

2024-09-30T00:27:49-07:00

Background: Deliberate Practice (DP), which underscores the importance of expert mentorship, personalized learning objectives, feedback, and repetition, has been suggested as a method to enhance the effectiveness of therapists. Method: The study tested the efficacy of an eight-week, structured, group-based online course, enriched with peer feedback, for 37 Cognitive Behavioral Therapists. The goal was to assess whether this intervention could boost the quality of therapist-patient alliances, as compared to a control group. To measure this, therapists had their patients anonymously fill out the Session Alliance Inventory both before and after the course. The trial encompassed 120 patient alliance ratings at baseline and 64 at the post-course measurement. The DP course was comprised of a 75-minute remote video workshop each week for eight weeks, supplemented by related study materials. Each workshop focused on a specific skill, such as responding to client resistance, and included 55 minutes of concentrated role-play activities, providing ample opportunities for repetition and feedback. Results: Using a linear mixed model we did not find an effect on patient alliance ratings. However, we observed a trend (p = .054) indicating that the DP group decreased their alliance ratings (Cohen’s d = -0.40), while the control group demonstrated an increase in their scores (d = 0.49). Conclusion: This pilot study did not find support for DP leading to better patient-rated alliance compared to a waitlist control. However, the study had several methodological limitations. Further and more rigorous investigation of the effects of DP on patient outcomes is recommended.

The Effects of Mindfulness-Focused Internet-Based Cognitive Behavioral Therapy on Elevated Levels of Stress and Symptoms of Exhaustion Disorder: A Randomized Controlled Trial

2024-09-30T00:27:49-07:00

Background: Internet-based Cognitive Behavior Therapy (ICBT) and mindfulness interventions are commonly used to treat elevated levels of stress. There are however few high-quality studies that examine ICBT with integrated mindfulness components for symptoms of stress and exhaustion, and the role of mindfulness exercises in digital treatment. Method: The aim of the present study was to evaluate if a mindfulness-focused ICBT-program could reduce symptoms of stress and exhaustion, and increase quality of life, in a randomized controlled trial including 97 self-referred participants between 18 and 65 years who experienced elevated levels of stress. Results: The intervention group had significantly reduced symptoms of stress and exhaustion, and increased quality of life, compared to the control group. Compared with the controls, participants in the intervention group showed a significant improvement with moderate to large effects on the primary outcome measure perceived stress (d = 0.79), and the secondary outcomes, exhaustion (d = 0.65), and quality of life (d = 0.40). Participants in the ICBT group also increased their level of mindfulness (d = 0.66) during the program. The amount of mindfulness training was significantly associated with an increased level of mindfulness, which in turn was significantly associated with reduced stress symptoms. Conclusions: Mindfulness-focused ICBT can be an effective method to reduce stress-related mental health problems and the amount of mindfulness training seems to be of importance to increase the level of experienced mindfulness after treatment.

Longitudinal Associations of Experiential and Reflective Dimensions of Meaning in Life With Psychopathological Symptoms

2024-09-30T00:27:50-07:00

Background: Rather than being rooted in deliberate reflection, the experience of meaning has been shown to evolve from intuitive processes (Heintzelman & King, 2013b, https://doi.org/10.1007/978-94-007-6527-6_7). Accordingly, experiential and reflective dimensions of meaning in life can be distinguished (Hill et al., 2019, https://doi.org/10.1080/09515070.2018.1434483). In this preregistered study, we explored how these dimensions are longitudinally associated with psychopathological symptoms. We expected that experiencing more meaning would predict fewer depressive symptoms and fewer personality functioning impairments six months later, whereas reflecting about meaning would predict more psychopathological symptoms. Method: A German-speaking sample of N = 388 completed self-report measures assessing meaning in life, depression, and personality functioning at baseline and six months later. Results: Controlling for depression at baseline, elevated levels of experiencing meaning in life predicted a decrease in depressive symptoms. Experiencing meaning did not predict personality functioning impairments six months later. However, exploratory analyses with a larger sample tentatively showed that experiencing meaning in life predicted less impairments in personality functioning. Evidence supporting the hypothesized association between reflection and future depression as well as future personality functioning impairments was discerned through exploratory analyses. Generalizability of results to clinical care settings is limited due to the studied non-clinical sample. No causal conclusions can be drawn from the data because the study employed an observational design with two assessment points. Conclusion: Experiencing meaning in life emerged as a potential protective factor against future psychopathological symptoms, whereas exploratory analyses pointed to an opposite relationship for reflection about meaning in life. Results are discussed with regard to clinical implications and directions for future research.