Clinical Psychology in Europe

From Goals to Gains: Therapy Goal Selection, Attainment, and Their Association With Psychotherapy Outcomes

Mon, 31 Aug 2026 00:00:00 +0000

Background: Therapy goals are central to psychotherapeutic interventions. While symptom-specific goals are commonly emphasized, patients often set diverse goals that may not align with standardized symptom measures. This study examines how patient characteristics are associated with the selection of specific therapy goal content categories and whether attainment in these domains shows associations with different psychotherapy outcomes. Method: Therapy goals from 645 patients undergoing cognitive-behavioral therapy in an outpatient clinic were categorized using the Bern Inventory of Treatment Goals and analyzed. Baseline predictors of therapy goal selection and diversity were examined using multilevel logistic and ordinal regression models. The association between goal selection and their goal attainment with residualized post-treatment scores in symptoms, global functioning, and end-of-treatment patient satisfaction were assessed using Bayesian multilevel regression models. Results: Baseline patient characteristics were associated with the selection of specific therapy goal categories, alongside substantial therapist-level effects in several categories. Goal-category attainment showed differential associations with psychotherapy outcomes, with the strongest and most consistent effects observed for symptom-related outcomes. Conclusion: These findings indicate that the attainment of specific therapy goal categories is meaningfully reflected in standardized outcome measures, but in a category-sensitive rather than uniform way. Combining therapy goal-based and standardized assessments may improve the alignment between patient priorities and outcome evaluation in routine psychotherapy.

The Impact of Societal Challenges on Mental Health Conditions: Implications for Research and Psychotherapy?

Claudi Bockting — Mon, 31 Aug 2026 00:00:00 +0000

Mental health conditions cannot be studied in isolation and are increasingly studied as a complex system. Societal changes and challenges (the digital AI and social media era, climate change, inequality, polarization, war in Europe) have an impact on mental health, as well as the prevalence of mental health conditions. We have no idea what the accumulating effects of the combination of these societal challenges are on the prevalence of mental health conditions. At the same time, we need a mentally resilient population to deal with these societal challenges. Therefore, it is evident that mental health research as well as timely access to psychological interventions need to be prioritised. We need to study the onset and maintenance of mental health conditions, incorporating the impact of these societal challenges. Theory development is needed to identify feedback loops that can be targeted with interventions as well as policy making. The expertise of clinical psychologists is of value for policy making, and clinical psychologists might have to consider engaging more in policy making, also in dealing with societal challenges. In clinical practice, we might have to integrate the public mental health impact of current societal challenges in our diagnostics, prevention and treatment, as well as acknowledge to the individual that seeks treatment that these societal factors do affect people’s mental health.

Correction of Bettina Hufschmidt et al. (2026). Adaptive and Maladaptive Networks Using Ecological Momentary Assessment

The Journal Editors — Mon, 31 Aug 2026 00:00:00 +0000

Correction to: Hufschmidt, B., Ebert, M., Nemani, A., Kohl, V., Pahlen, L., Müller, S., Hofmann, S. G., & Stangier, U. (2026). Adaptive and maladaptive networks using ecological momentary assessment. Clinical Psychology in Europe, 8(2), Article e17891. https://doi.org/10.32872/cpe.17891

Online Application of Imagery Rescripting for Pathological Affective Dependence (ImRs-PAD) in Survivors of Intimate Partner Violence: Results From a Multiple Case Series

Erica Pugliese, Allison Uvelli, Arnold A. P. van Emmerik, Arnoud Arntz — Mon, 31 Aug 2026 00:00:00 +0000

Background: This study examined the feasibility and preliminary clinical indications of an imagery rescripting intervention integrating the Pathological Affective Dependence framework (ImRs-PAD) in survivors of Intimate Partner Violence (IPV). Pathological Affective Dependence (PAD) refers to a trauma-related relational vulnerability associated with difficulties in disengaging from abusive intimate relationships. Method: A multiple case series design was used with three female IPV survivors referred by a mental health center in Italy (mean age = 31.3 years, SD = 2.08). All participants reported histories of abusive relationships, marked difficulties with separation, and clinically significant levels of PAD. Participants received an online ImRs-PAD intervention. Repeated self-report measures assessed changes in PAD, trauma-related symptoms, depression, anxiety, somatic symptoms, resilience, self-compassion, and psychological well-being. Results: Across cases, reductions were observed in PAD, depressive and anxiety symptoms, and trauma-related and somatic complaints, alongside increases in resilience, self-compassion, and overall psychological well-being. The online delivery of the intervention was feasible, with no technical or safety issues reported. Conclusion: The findings provide preliminary support for the potential clinical relevance of ImRs-PAD for IPV survivors. Addressing PAD may facilitate disengagement from violent partners and reduce the risk of re-exposure to severe forms of violence.

Generative AI Chatbots Could Take Over Our Emotional Lives: The Potential and Challenges of Generative AI for Health Globally

Claudi Bockting, Athanasios V. Vasilakos, Caroline Figueroa — Mon, 31 Aug 2026 00:00:00 +0000

No abstract available.

No Cognitive Scarring Over 20 Years in Recurrent Depression: Bidirectionality of Cognitive Functioning and Depression

Mon, 31 Aug 2026 00:00:00 +0000

Background: Cognitive deficits are prevalent in major depressive disorder (MDD), span multiple cognitive domains, and often persist during remission. However, long-term associations between cognitive functioning and depression remain unclear. This study explores bidirectional associations using 20-year longitudinal data, providing follow-up twice as long as previously reported. Method: Individuals in remission of recurrent MDD underwent neuropsychological assessments at baseline (n = 137, 21-65 years) and 20-year follow-up (n = 33), covering multiple domains. Psychiatric assessments occurred at eight time points. Cox proportional hazard models and linear mixed-effects models tested bidirectional associations between cognitive functioning and depression. Group-level cognitive change was tested using paired sample t-tests and Bayesian analyses, and individual-level change using reliable change indices (RCI’s). Results: No cognitive domains significantly predicted time-to-depressive-relapse, the number of depressive episodes, or total time depressed over 20 years. Similarly, the number of episodes, total time depressed, and changes in depression severity did not significantly predict cognitive changes. At follow-up, we observed declines in speed of information processing (p < .001, d = -0.73, RCI: 32.1% deteriorated) and speed of memory processing (p = .015, d = -0.49, RCI: 39.3% deteriorated). Learning and memory improved (p < .001, d = 1.19, RCI: 28.6% improved). Working memory and executive functioning remained stable. Findings were not explained by selective drop-out. Conclusions: We found only minor long-term cognitive change, with no clear worsening or evidence of scarring and state effects. Cognitive functioning remained relatively stable, and we observed no link to depression trajectories over 20 years, providing a more optimistic outlook for depressed patients.

Sleep Quality, Relationship Functioning, and Health-Related Quality of Life in Partners of CPAP-Treated OSA Patients

Mon, 31 Aug 2026 00:00:00 +0000

Background: Obstructive Sleep Apnea Syndrome (OSAS) is a chronic condition that negatively affects not only the patient but also the partner, influencing their sleep quality, psychological well-being, and couple relationship. However, scientific literature has given little attention to the partner's experience, especially regarding the impact of Continuous Positive Airway Pressure (CPAP) treatment on their partners’ health. The aim of the present study is to investigate sleep quality, couple relationship quality, and quality of life (QoL) in Italian-speaking partners of patients with OSAS treated with CPAP, compared to partners of healthy individuals. Method: The study involved 100 participants, with a final sample of 48 partners of OSA patients and 49 partners of healthy subjects as a control group, assessed using the Pittsburgh Sleep Quality Index (PSQI), the Dyadic Adjustment Scale (DAS), and the SF-36 Health Survey. Statistical analysis included independent samples t-tests and Pearson’s correlations. Results: Partners of patients with OSAS reported significantly poorer sleep quality (PSQI), lower levels of dyadic consensus and cohesion (DAS), and reduced perception of physical and mental health (SF-36) compared to the control group. Correlations revealed that sleep quality was negatively associated with relationship quality and perceived health, while years of relationship were positively associated with affection and cohesion, but negatively with sleep quality. Conclusions: The findings confirm the interconnection between sleep quality and relationship functioning. A clinical approach that includes the partner in OSA treatment pathways may improve the overall well-being of the dyad.

Trusting the Psychotherapist, Trusting the Governmental System and Perhaps Trusting the Neighbor Next Door: Exploring the Institutional Nature of Trust in Psychotherapists and Examining Different Groups of Trusters in a Large German Patient Sample

Mon, 31 Aug 2026 00:00:00 +0000

Background: Trust in psychotherapists is considered primarily interpersonal. However, psychotherapists could be viewed as representatives of the (healthcare) system. In this study, we investigated whether trust in psychotherapists is more closely linked to interpersonal or institutional trust. Furthermore, we explored whether people can be distinguished into different trust groups. Method: In a German cross-sectional study sample, we identified 1,300 persons (61.7% female; M = 48.46 years; SD = 14.45 years) indicating experiences with psychotherapy (current and/or in the past). Correlation and linear regression analysis were applied to explore connections between interpersonal (SOEP Interpersonal Trust Scale), institutional (ALLBUS Institutional Trust Scale), and trust in psychotherapists (IIV Psychotherapists). Then, hierarchical cluster analysis was used to identify profiles of interpersonal, institutional, and trust in psychotherapists. Group differences of the cluster solution were analyzed for dimensions that are important for trust and psychotherapy such as having experienced trauma. Results: Trust in psychotherapists is not solely associated with interpersonal factors but is also modestly associated with institutional trust. Furthermore, a three-cluster solution emerged with different trust profiles: low trusters (30%) with low scores for all trust measures, high trusters (49%) with the highest values, and system trusters (21%) with the highest trust scores in psychotherapists and institutions, but lower interpersonal trust values. The three groups showed different manifestations of e.g., trauma (LEC-5 Personal Experienced Subscale). Conclusion: There is an institutional nature of trust in psychotherapists, which should be reflected and included in research and practice. Implications could include the common measurement of trust in psychotherapists in therapy and broadening psychotherapeutic interventions according to trust needs. To this end, new ways of building trust both in psychotherapy and institutions in general should be explored.

Can a Variant of the Implicit Association Test Detect Nonsuicidal Self-Injury in a Clinical Population? A Registered Report

Femke Cathelyn, Pieter Van Dessel, Tilia Linthout, Laurence Claes, Jan De Houwer — Mon, 31 Aug 2026 00:00:00 +0000

Background: Nonsuicidal self-injury (NSSI) is a severe and prevalent mental health problem. Measures to detect which individuals are at risk of engaging in NSSI would be valuable for clinical practice. However, we still lack strong predictors of future NSSI behaviour, with the most notable exception being prior NSSI behaviour. Yet, the measurement of prior NSSI behaviour with self-report measures can be difficult because individuals may be motivated to conceal this harmful behaviour. To overcome this problem, an implicit measure was developed that assesses automatic responding to statements about prior NSSI behaviour (i.e., the Past Nonsuicidal Self-Injury Implicit Association Test: P-NSSI-IAT). Previous studies tested the predictive utility of this measure in online studies with samples of at-risk participants and produced promising results. The current study examines the predictive utility of the P-NSSI-IAT for NSSI in clinical samples. Method: Outpatients (N = 68) completed the P-NSSI-IAT and reported on past-year and past-month NSSI, as well as perceived likelihood of future NSSI. Results: Patients with recent NSSI had significantly higher IAT scores than those without a history of NSSI. The P-NSSI-IAT predicted past-year NSSI but did not significantly predict past-month NSSI or perceived future likelihood of NSSI. It did not add predictive value beyond self-report risk factors in multivariate models. Conclusion: These findings suggest that the P-NSSI-IAT may help detect prior NSSI in clinical contexts but offers limited added value for the prediction of NSSI beyond existing self-report measures.

Adaptive and Maladaptive Networks Using Ecological Momentary Assessment

Fri, 29 May 2026 00:00:00 +0000

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.