Aspects of prosody, such as speech rate and pitch, influence how speakers are perceived and are likely to be relevant in psychotherapy. However, the role of prosody in therapy and how therapists use it is not well understood. This study aims to understand how therapists experience the role that their prosody plays in their daily work. We conducted 25 semi-structured interviews and analyzed accounts by therapists from different theoretical backgrounds. Responses were analyzed using reflexive thematic analysis. Therapists attributed important functions to their use of voice and variations in prosody during therapeutic interactions. We describe key functions of prosody in five themes: Theme I: creating a feeling of calm, safety, consolation and benevolence; Theme II: making patients feel acknowledged and understood empathically; Theme III: providing a holding and stable counterpart; Theme IV: Create space and awareness for new depth; Theme V: Model affectivity. Prosodic variations that respond to patients' needs are thought to facilitate emotion regulation and insight. Studying prosody in therapy enables researchers to examine micro-level processes and unconscious dynamics.
This cross-sectional study examined the impact of parental marital conflict on adolescent anxiety and the moderating roles of physical activity and gender, with additional gender-stratified analyses to test differences between boys and girls. A total of 3974 adolescents participated in this study. Standardized questionnaires assessed perceived parental marital conflict, anxiety symptoms and physical activity behaviours. Stepwise regression analyses were conducted using SPSS to examine associations among parental marital conflict, anxiety, physical activity and gender. The findings revealed that parental marital conflict was positively associated with adolescent anxiety ( r = .344, p < .001) and negatively associated with physical activity ( r = −.047, p < .01), while physical activity was inversely related to anxiety ( r = −.087, p < .001). Moderation analyses showed that physical activity exerted a significant buffering effect on the relationship between parental marital conflict and anxiety ( β = −.040, p < .01). Gender also moderated this association ( β = .045, p < .01), with girls being more vulnerable to anxiety under parental marital conflict. Gender-stratified analyses indicated that the buffering effect of physical activity was more pronounced among boys than girls. This study suggested that physical activity may support the alleviation of adolescent anxiety related to parental marital conflict; however, its effects are limited and subject to individual differences. Accordingly, interventions should not rely solely on physical activity but adopt more comprehensive strategies that consider gender differences and psychological vulnerability to promote adolescents' mental health under family stress.
Intimate partner violence (IPV) is a serious health worldwide issue, and current treatment options are far from satisfactory. In this case series, we focused on male domestic offenders (MDO) as they are the most frequently responsible for IPV and targeted individuals displaying personality disorders (PDs) features and emotion dysregulation who were willing to accept court-mandated treatment. The underlying idea was that addressing PD factors through a specific treatment would help form and sustain a working alliance, understand the psychological triggers of violent behaviours, and then develop strategies to reduce them. We evaluated an adaptation of metacognitive interpersonal therapy (MIT) for MDO. The primary qualitative outcome was a reduction in violent behaviour. The main quantitative outcome was the reduction in manifestations of PD features. Secondary outcomes were reductions in global symptoms and interpersonal problems. We also analysed changes in emotion dysregulation, impulsivity and metacognition. In a case series design, three court-mandated MDO underwent 24 individual sessions of MIT-MDO. They were assessed at baseline, post-treatment and 3-month follow-up. All participants ceased all forms of violence post-treatment, and results were stable at follow-up, reported by both participants and their partners. Two participants achieved significant reductions in PD scores, global symptoms and interpersonal problems. MIT-MDO is a promising new approach for tailoring treatment for MDO willing to undergo psychological treatment. MIT-MDO is a suitable candidate for further evaluation in larger effectiveness studies.
Experience of child psychological abuse in college students is likely to increase their risk of depression, but the potential psychological mechanisms between the two require further exploration. This study supplemented the risk and protective factors between child psychological abuse and depression in college students by introducing social network sites addiction (SNSA) as a mediating factor and psychological flexibility as a moderating factor. A cross-sectional survey was conducted on 655 college students from two universities in Hunan Province, China. Self-reported measures included childhood psychological abuse, depression, SNSA, and psychological flexibility. Descriptive and correlational analyses were performed on these variables, followed by the establishment of a structural equation model. Child psychological abuse was positively associated with depression ( r = .507, p < .001) and SNSA ( r = .208, p < .001) in college students and negatively associated with psychological flexibility ( r = −.293, p < .001). SNSA played a mediating role between childhood psychological abuse and depression ( β = .170, SE = 0.035, p < .001) in college students, while psychological flexibility attenuated the strength of the relationship between the latter two ( β = −.095, SE = 0.031, p < .01). The study further elucidates the psychological mechanisms underlying the relationship between childhood psychological abuse and depression in college students. SNSA may mediate the relationship between the two, while psychological flexibility may buffer the strength of the relationship between them. Future research should explore interventions enhancing college students' psychological flexibility after childhood psychological abuse to cut the risk of depression.
Many people who engage in non-suicidal self-injury (NSSI) do not access support from health services, and evidence regarding the effectiveness of interventions is mixed. Despite this, NSSI prevalence rates decrease from adolescence into adulthood. Little is known about what helps alleviate difficulties with NSSI beyond psychological or medical intervention. This study sought to understand factors influencing naturalistic improvements in NSSI. Semi-structured interviews were conducted over video call with 16 participants who believed their difficulties with NSSI had improved due to factors not attributed to psychological or medical intervention. Interviews were audio recorded and transcribed verbatim for analysis. A reflexive thematic analysis revealed four main themes. Increased insight into NSSI experiences promoted self-compassion and self-acceptance and enabled participants to reflect on the conflicting role of NSSI. Safe and supportive relationships helped alleviate loneliness, and developing alternative coping strategies enhanced feelings of control over self-injury. Creating a life guided by personal values promoted independence, choice, and self-esteem. The findings of the study highlight several internal and external naturalistic processes deemed meaningful in improving difficulties with NSSI. Clinical implications include the importance of developing and embedding these approaches within services and interventions to improve outcomes for individuals who self-injure while promoting a person-centred approach.
This systematic review investigated the qualitative experiences of sexual abuse survivors in talking therapy treatments with respect to the helpful and hindering aspects of therapy. Searches were conducted on five databases; PubMed, Web of Science, PyscInfo, PsycArticles and PsycExtra and through searching reference lists. Papers were included where they provided qualitative primary data of client experiences of therapy, did not involve specialist clinical populations and were written in English. Papers were included irrespective of whether study participants had experienced sexual abuse in childhood, adulthood or both. Studies were appraised using the Critical Appraisal Skills Programme (CASP) qualitative checklist. Meta-study was used to analyse the results. Four themes were generated: (1) helpful therapy relies on choice, autonomy, and the freedom to choose when to speak and what to speak on, (2) engagement relies on considerations of the complexity of recovery from sexual abuse, (3) feeling cared for and connected with the therapist is important and (4) a sensitive and thoughtful end of therapy can bring positive holistic emotional and lifestyle changes. This study provides clinical insights into the helpful aspects of therapy, facilitating a safe therapeutic engagement, and managing an effective and sensitive transition into recovery. These themes are considered in relation to understanding supportive factors in therapy.
Psychological inflexibility, the model of psychopathology underlying Acceptance and Commitment Therapy (ACT), has been linked to a broad range of psychological problems, but its link with sleep quality is not well understood. This study aimed to identify relationships between psychological inflexibility processes (cognitive fusion, experiential avoidance, limited perspective-taking, lack of present moment awareness and inaction) and sleep quality, investigating pre-sleep arousal and anxiety symptomatology as mechanisms mediating these relationships. A correlational, cross-sectional design was used to test two statistical models. Participants ( N = 704) from a general population sample completed an online survey, reporting on sleep quality, pre-sleep arousal, anxiety and measures of psychological inflexibility. Data were analysed using correlations and path analyses. All psychological inflexibility processes were moderate to strongly correlated with sleep quality. Path analysis showed cognitive fusion, lack of present moment awareness and experiential avoidance, mediated by pre-sleep cognitive and somatic arousal, explained 49% of the variance in sleep quality (Model 1). Cognitive fusion via pre-sleep cognitive arousal had the largest effect. Anxiety preceding pre-sleep arousal (Model 2) explained no additional variance, and model fit was poorer than Model 1. These findings highlight the role of psychological inflexibility processes in disrupting the de-arousal process needed for healthy sleep, supporting evidence for ACT as a treatment for sleep disturbance.
Exposure to racism is repeatedly experienced by individuals from racially minoritised backgrounds, and has a range of negative emotional, physical and social consequences; however, its traumatising effects are under-recognised. Further, psychological therapists often lack sufficient knowledge, training and confidence to sensitively manage conversations about racism. As this has important implications for the standards of care this population receives, this study explored how racially minoritised clients experience disclosing, or attempting to disclose racial trauma in psychological therapy. The study utilised an online qualitative survey design. Participants were 28 adults who identified as belonging to minoritised racial groups and had engaged in psychological therapy in the UK. Therapy spanned a range of modalities, and providers included the NHS, private therapists/organisations, charities and university services. Data were analysed using thematic analysis. Three superordinate themes were constructed: The Dangers of Disclosure ; Holding the Burden ; and Feeling Heard and Held . These demonstrated both the range of potential harms and burdens associated with disclosures of racial trauma in therapy, and examples of meaningful, validating therapist responses to disclosure. Therapists, regardless of racial heritage, have the potential to both perpetuate harm and provide meaningful support in response to disclosures of racial trauma. Racial reflexivity and education on racism and racial trauma are essential to ethical and antiracist therapeutic practice, and crucial to safeguarding racially minoritised clients from racial harm in therapy. These must be embedded in training, practice and policy for meaningful improvements in racially minoritised clients' experiences of therapy to occur.
Huntington's disease (HD) is a hereditary neurodegenerative disorder characterized by a range of motor, cognitive, and psychiatric symptoms. Psychological symptoms can arise from being at risk for the disease and from its manifestation, necessitating psychological interventions to address the evolving burden, even before onset. This qualitative study explores the psychological interventions used for HD within the Dutch health care context and identifies barriers and facilitators for their implementation across the different HD disease stages. A qualitative approach using semi-structured interviews was employed, involving 13 experienced psychologists from HD health care facilities in the Netherlands. Thematic analysis was conducted to explore the types of psychological interventions used and the facilitators and barriers affecting their implementation. The study identified a range of generic and more specific interventions, with their application varying according to the stages of HD. Early interventions focus on genetic counselling and trauma therapy, while mid to late-stage care incorporates acceptance and commitment therapy (ACT) and cognitive behavioural therapy (CBT) for managing psychological symptoms. Late-stage interventions shift to mediated approaches involving family and care teams. Key barriers include cognitive impairments and difficulties in referring patients to other mental health care providers, while key facilitators include multidisciplinary collaboration and preventive interventions. Psychological interventions for HD in the Netherlands are adapted to the disease progression, emphasizing the need for stage-specific and personalized care. The findings highlight best-care practices and the importance of early intervention, multidisciplinary collaboration, and evaluation while identifying areas for further research and improvement in care quality.
The current study aimed to examine: (1.1) causal beliefs about adolescent depression in a sample of adolescents with a clinical depression and their mothers and fathers; (1.2) within-family overlap of causal beliefs; (2.1) mothers' and fathers' reflected causal beliefs about their child's perspective; (2.2) the accuracy of mothers' and fathers' reflected causal beliefs as related to their child's causal beliefs. Qualitative study using a within-family approach. Adolescents with a current clinical depression (MDD/dysthymia; N = 34) and their parents ( N = 34 mothers, N = 26 fathers) were independently interviewed about their causal beliefs about the adolescents' depression. Parents were additionally interviewed about their perception of their child's causal beliefs (i.e., reflected causal beliefs). The causal beliefs most frequently mentioned by adolescents, mothers and fathers are: characteristics of the child, social factors, school and various stressful experiences. Parent–child overlap was relatively low, specifically for the themes of bewilderment, cumulative effect and stressful life events, whereas overlap was relatively high for themes of social factors, school and stressful experiences outside of the family. Parents were relatively accurate in their reflected causal beliefs, but tended to underestimate their child's insights into possible causes of their depression. Accuracy of parents' reflected causal beliefs was particularly low for the theme cumulative effect and high for social factors. The various causal beliefs of adolescents and their parents could be used in therapeutic setting. Future research could examine whether (guided) conversations may promote alignment within families and treatment efficacy.
The present demand for child and adolescent mental health services exceeds the capacity for service provision. Greater research is required to understand the utility of accessible self-help interventions, such as mobile apps. This study sought to investigate whether use of a mental health app, underpinned by CBT, led to changes in psychological distress amongst adolescents. Mechanisms of change were examined, specifically whether changes are attributable to cognitive strategies. This study utilised a multiple-baseline single-case experimental design, tracking variables across baseline and intervention phases. Surveys assessing participant experience were also administered. Five participants with moderate-to-severe levels of psychological distress engaged with a CBT-based app over five weeks. Participants were recruited from both a well-being service and the general population. Supplementary weekly calls to participants offered clarification of app content. A small overall effect of the intervention of psychological distress was evident; however, outcomes were dependent on the analysis conducted. The intervention appeared to promote an increase in use of adaptive cognitive strategies but not negative thinking styles. The CBT app did not promote changes in participant well-being. Participant feedback highlighted practical challenges of utilising the app. The clinical benefits of app-based CBT were small, and a range of barriers to engagement were recognised. While further research is required, caution should be exercised in the interpretation of studies reporting on app effectiveness.
There is growing recognition of the value of researching anomalous experiences in the general population to aid our understanding of the psychosis continuum. There are key differences in aims, foci and epistemologies of existing measures, with varying utility for specific research designs. This study addresses gaps in the literature by developing a measure of anomalous experiences with utility for longitudinal (time-sensitive) research, and with particular reliability for people towards the upper (high scoring) end of the continuum. An online sample was recruited from the general population to provide questionnaire data for two study parts: (A) item selection and (B) psychometric evaluation. For Part A, both classical test theory and item response theory methods were used to select which items to be included from an initial pool of 57, generated from individuals with persistent anomalous experiences. For Part B, psychometric properties of the resulting measure were evaluated using exploratory and confirmatory factor analysis and tests of reliability and validity. Scores were provided by 532 participants, from which a 19-item scale, the Transpersonal Experiences Questionnaire (TEQ), was developed. The TEQ was found to be a unidimensional scale, with satisfactory internal consistency (0.85), good test–retest reliability and convergent validity. The TEQ can be used as a unidimensional scale to detect anomalous experiences in the general population, with particular reliability for people with higher incidence of these experiences.
Practising compassion increases well-being and reduces depression, anxiety, and psychological distress among clinical and non-clinical populations. There is a rapid increase in compassion-based interventions within the past two decades. However, the reviews are limited to predominantly Western cultures. Therefore, this meta-analysis aimed to evaluate the literature attempting to promote and increase compassion in Asian communities. Eight randomised controlled trials (RCTs) conducted between 2016 to 2021 were included in the meta-analysis with data from 1012 participants across Thailand, Japan, China and Hong Kong. Effect sizes were calculated to test the efficacy of the compassion-based interventions on the self-compassion outcome. Intervention efficacy was tested by comparing the intervention groups against control groups (wait-list control and active control groups) at pre- and post-interventions. Significant between-group differences in change scores were found on self-report measures of self-compassion with large effect sizes in interventions with wait-list control groups ( d = .86) and small effect sizes in interventions with active-control groups ( d = .19). Although compassion-based interventions are heterogeneous in nature and limited in scope, there is promising evidence of improving self-compassion in Asian communities. This supports for the cross-cultural applicability of compassion-based interventions. However, research within the Asian context is limited and at an infancy stage, signifying the importance of conducting further compassion-based interventions in clinical and non-clinical groups living in the Asian communities.
Objectives: Persons with schizophrenia, schizoaffective, or bipolar I disorder are more likely to die by suicide compared to the general population. Dysfunctional attitudes have been shown to be significant predictors of cognitive vulnerability to depression, hopelessness, and poor problem-solving skills, which predict suicidal ideation. Dysfunctional attitudes are common in persons with schizophrenia spectrum disorders (SSDs) and bipolar I. The Reasons for Living Inventory (RFLI) examines distinct reasons for not dying by suicide. This study's objectives were to examine the relationship between the RFLI subscales and dysfunctional attitudes among persons with SSDs and bipolar I. We hypothesized significant positive correlations between two RFLI subscales (Fear of Suicide and Fear of Social Disapproval) and total score on the Dysfunctional Attitude Scale (DAS). We did not expect significant correlations between other subscales. Design and Methods: This correlational, cross-sectional study examined baseline scores on the RFLI and dysfunctional attitudes (DAS) among N = 102 outpatients with SSDs or bipolar I. Results: Significant positive correlations were observed between RFLI subscales Fear of Suicide and Fear of Social Disapproval and DAS total scores. No other significant relationships were observed. Conclusions: Certain reasons for living (i.e. fear of suicide and social disapproval) may be associated with dysfunctional attitudes among persons with SSDs or bipolar I. These, in turn, may place these individuals at a greater risk for suicide by increasing their cognitive vulnerability. These findings may inform clinical treatment targets for persons with SSDs and bipolar I.
There is a considerable debate regarding the possible dependence between depression and suicidal ideation treatments. The present study used a novel mediation approach in a randomized comparison of pharmacotherapy and combined therapy to explore whether depressive symptoms mediate the association between treatment and suicidal ideation and whether it depends on the treatment condition. This study is a randomized, controlled, parallel group (1:1), clinical trial using a novel mediation approach for longitudinal data. Latent difference score modelling was utilized to investigate whether changes in depressive symptoms drive subsequent changes in suicide ideation. Participants were 94 depressive suicidal outpatients who were assessed regarding depressive symptoms and suicidal ideation over the course of an experiment (0–2-7 months). Direct and indirect associations between (change in) depressive symptoms and (change in) suicidal ideation were explored using Pearson's correlations and latent difference score model. The results showed that depression treatment affects not only suicidal ideation directly but also its influence on suicidal ideation occurs via improvement in depressive symptoms. It was found a more significant effect of combining pharmacotherapy and PPT (in comparison with the pharmacotherapy alone) on the early and late improvements of suicidal ideation (Δ 0–2 and Δ 2–7) via the early improvement of depressive symptoms (Δ 0–2). The findings indicate that changes in depressive symptoms preceded changes in suicidal ideation. Our results highlighted that improving depressive symptoms could be a primary target in treating patients with depression experiencing suicidal thoughts.
While one third of people with a psychotic disorder are a parent, there has been little research to date examining the consequences of this from a whole family perspective. This study investigates families where a parent has experienced an episode of psychosis and compares and contrasts the family members' perspectives. This study was rooted in phenomenology and data were derived from in-depth semi-structured interviews. Parents with a psychotic disorder who had a child aged between 3 and 11 in a UK NHS Trust were invited to take part in the study. Semi-structured interviews were conducted with these parents, with their child (if they were between the ages of 8 and 11), and with their partner or another close family member. Data were analysed using multiperspectival interpretive phenomenological analysis (m-IPA). Thirteen participants took part comprising of five parents, four children, three partners and one grandmother. Four themes were developed using m-IPA: (1) Parental psychosis impacts the whole family, (2) Psychosis and my role as a parent, (3) Secrecy and concealment surrounding parental psychosis, and (4) Pressures and vulnerabilities within the family system. Psychosis had a negative impact on all family members and secrecy existed between family members. The children in particular only had partial information about their parent's mental illness, which left them worried and confused. More work is needed to support these families to explain psychosis to the children.
At least one in four persons with bipolar disorder (BD) are estimated to have experienced auditory verbal hallucinations (AVH) or heard voices at some point. Yet few studies have investigated AVH in detail in this population. This preliminary study examined the phenomenology of AVH in BD to identify commonalities and differences relative to other psychiatric disorders where AVH are commonly reported. Twenty-one participants diagnosed with BD were recruited across two international sites in the UK and Australia. All participants underwent a structured clinical interview to verify psychiatric diagnosis and completed standardised measures of symptomatology, including mood states. Phenomenological information of AVH was gathered using select questions from the comprehensive Mental Health Research Institute Unusual Perceptual Schedule (MUPS). AVH experienced by this BD sample were broadly similar in form and content to characterisations reported in the schizophrenia spectrum disorders (SSD) in prior literature, with some exceptions including frequency, duration and the changeability of tone and content. The study highlights possibly subtle differences in the experience of AVH in BD, including the potential influence of mood congruence as a pertinent clinical feature. Further research into these differences might inform adaptations to existing AVH interventions to ensure they are relevant for BD.
Suicide is a leading cause of death worldwide. People experiencing psychosis are at increased risk of death by suicide. Talking therapies can alleviate suicidal thoughts, plans, and attempts. Therapies need to also be acceptable to recipients. The aim of this study was to investigate the views on psychological therapy for people experiencing psychosis and suicidality using the Theoretical Framework of Acceptability. Qualitative interview study. Participants were recruited from a randomised controlled trial comparing suicide prevention psychological therapy with treatment as usual. Individuals had a diagnosis of non-affective psychosis and experience of suicidal thoughts, plans and/or attempts. To assess the acceptability of the therapy, semi-structured interviews were conducted with 20 participants randomised to receive therapy. Data were deductively analysed using an adaptation of the Theoretical Framework of Acceptability. Interviews ( Mean = 45 min) were conducted and audio recorded with 21 participants. Data were organised into six themes: 1. Affective attitude, 2. Burden, 3. Alliance, 4. Intervention coherence, 5. Perceived effectiveness, and 6. Self-efficacy. There was no evidence of issues relating to domains of ethicality and opportunity costs associated with receiving therapy. Talking about suicide was difficult and, at times, distressing, but it was perceived to be useful for understanding experiences. To be acceptable, it is important for therapists to ensure that clients' understanding of therapy aligns with expectations of effectiveness and to invest in building strong therapeutic alliances. Future research will benefit from examining therapists' experiences of delivering therapy through different modes (e.g. online, telephone).
There is a significant risk of negative outcomes for families when a parent experiences serious mental illness. Family-focused practice (FFP) emphasises the “whole family” as the unit of care and has been found to improve outcomes for service users and their families. Despite its benefits, FFP is not routinely implemented in UK adult mental health services. This study explores adult mental health practitioners' experiences and views of FFP within Early Intervention Psychosis Services in the UK. Sixteen adult mental health practitioners employed in three Early Intervention Psychosis teams in the Northwest of England were interviewed. Interview data were analysed using thematic analysis. Five core themes were generated: (1) A limited understanding of FFP, (2) Our practitioners, (3) Our approach, (4) Our families and (5) Our services. Practitioners' understanding of FFP was limited and typically excluded dependent children. Practitioners' age, professional and personal experience, and preconceptions of families influenced delivery, and in turn, the engagement approach they adopted impacted families' responsiveness. The diversity and dynamics of service user families such as age, socioeconomic status, culture and stigma impacted FFP. An operational context characterised by insufficient resources reduced FFP; however, organisational structures such as leadership, clinical supervision and multi-disciplinary teams facilitated FFP. FFP is not yet embedded within Early Intervention Services. Practice recommendations include agreeing on a formal definition of FFP and its scope; the development of FFP policy; clarity in relation to staff responsibilities and identities; the adoption of a collaborative approach which encourages service user choice and for time to be ring-fenced to prioritise FFP. Future research should ascertain service user and family views on the facilitators and barriers to engaging with FFP in Early Intervention Services.
