The failure to meet early emotional needs is associated with the use of emotion regulation strategies. Numerous studies in the child and adolescent literature have demonstrated the relationship between early schemas and emotion regulation strategies. However, the role of metacognitive awareness, which we hypothesize might be one of the mediating mechanisms in this relationship, has not been sufficiently clarified. The aim of this study is to examine the direct and indirect role of metacognitive awareness in the relationship between early emotional deprivation schema and emotion regulation strategies in children and adolescents. Data were collected from 814 (aged 10–15, Avg = 12, SD = 1.04) middle school students selected using convenient sampling methods.The participants did not have any diagnosed mental health problems. The mediating role of metacognitive awareness between emotional deprivation and reappraisal and supression strategies was investigated using structural equation modeling. Emotional deprivation is indirectly related to reappraisal through metacognitive awareness. The direct relationship between these two variables is insignificant, indicating that metacognitive awareness plays a full mediating role (λ = − 0.16, 95
The sequence in which psychological interventions are delivered may influence their efficacy. Therefore, the current study investigated the sequencing effect of cognitive restructuring (CR) and detached mindfulness (DM), hypothesizing that only the sequence of CR-DM would lead to additional improvement. Across two experiments, 188 participants from a community sample underwent a speech (Experiment A) or worry (Experiment B) manipulation and were then introduced to CR and DM in a counterbalanced order. Primary outcomes were state anxiety (Experiment A) and worry (Experiment B). Multilevel models revealed that when delivered alone, the two techniques produced similar changes in the outcome measures across both experiments. When delivered as the second technique, there was a statistically significant sequencing effect in Experiment B, t(93.0) = 2.0, p = .048, d = 0.42 in the predicted direction, showing further reduction in worry in participants receiving CR-DM but not those receiving DM-CR. Due to a lack of manipulation effect in the second speech of Experiment A, sequencing effects could not fully be explored here. The findings suggest that, in a worry context, there may be little reason to use the sequence of DM-CR, whereas there may be further benefit of the CR-DM sequence. For Experiment A, the lack of manipulation effects precludes conclusions regarding sequencing effects. The results should be understood in light of the community sample and lack of neutral control condition but offer a useful starting point for further examining sequencing effects in clinical populations.
Rumination is a well-established cognitive vulnerability for depression. Poorer inhibition of emotional distraction may further exacerbate the maladaptive correlates of rumination by undermining attentional control. This study tested a longitudinal model in which rumination and emotional inhibitory control interacted to predict subsequent attentional control and depressive symptoms. A total of 188 participants completed baseline assessments of rumination, depressive symptoms, and emotional antisaccade performance using an eye-tracking task. Emotional antisaccade cost, calculated as the difference in directional error rates between antisaccade and prosaccade trials, was used as an objective index of emotional inhibitory control. Approximately one year later, participants completed follow-up measures of self-reported attentional control and depressive symptoms. Baseline rumination was associated with lower attentional control and higher depressive symptoms at follow-up. Follow-up attentional control statistically accounted for part of the association between baseline rumination and follow-up depressive symptoms. Moreover, emotional antisaccade costs for both sad and happy cues moderated the association between baseline rumination and follow-up attentional control, with the indirect association emerging only at higher levels of emotional antisaccade cost. These findings are consistent with a risk amplification model, suggesting that rumination and poorer emotional inhibitory control may jointly contribute to elevated depressive symptoms.
Mindfulness-Based Stress Reduction (MBSR) and escitalopram are evidence-based treatments for anxiety disorders and can improve emotion regulation. Limited research has examined emotion regulation as a potential process associated with change in anxiety symptoms for these two treatments. We examined if emotion regulation deficits improved across treatments, acted as a potential process associated with change for anxiety symptom severity, and explored the impact of levels of change in emotion regulation deficits on anxiety severity outcomes. The current study was a secondary analysis of a randomized clinical trial examining the comparative effectiveness of an 8 week online-delivered group MBSR versus escitalopram for anxiety disorders. Participants (N = 148; Mage = 35.2, 72.3
Excessive appearance concerns represent a transdiagnostic construct that is likely maintained by appearance-related safety behaviors (ARSBs). ARSBs consist of mirror checking, camouflaging and other behaviors which are used to prevent negative evaluation based on appearance. Social comparison is one additional type of ARSB that has been given substantial research attention and has been hypothesized to contribute to a range of disorders. We leveraged data (N = 203) from a previously published randomized controlled trial of two digital interventions to examine whether changes in social comparisons explain treatment effects on clinical outcomes in women elevated in appearance concerns. Participants were randomized to one of two interventions where participants were either instructed to reduce ARSBs or general unhealthy behaviors. Relative to control, targeting ARSBs led to lower social comparisons, and these changes mediated the effect of treatment on appearance concerns, eating disorder symptoms, social anxiety, and appearance importance. Changes in comparisons also predicted changes in symptom outcomes, regardless of treatment condition. These findings provide novel evidence for the potential role of social comparisons in appearance-related psychopathology. Further work will be necessary to confirm the maintaining role this behavior plays in symptoms of appearance-related psychopathology.
Treatment response in posttraumatic stress disorder (PTSD) varies widely. Intelligence has been proposed as a potential predictor, particularly in cognitively demanding interventions such as Cognitive Processing Therapy (CPT), but evidence remains limited and mixed. To examine whether pretreatment verbal crystallized IQ (cIQ) is associated with treatment outcome and dropout in individuals with childhood abuse-related PTSD receiving CPT or Dialectical Behavior Therapy for PTSD (DBT-PTSD). Participants (N = 193) from a randomized controlled trial completed a verbal crystallized intelligence test (MWT-B) at baseline. PTSD severity was assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). General linear models tested associations between cIQ and symptom reduction; probit models examined dropout. Higher cIQ was associated with greater PTSD symptom reduction. Post-hoc analyses indicated that this effect was primarily observed in the CPT group. No clear association was found in the DBT-PTSD group. Verbal cIQ did not predict dropout. Verbal cIQ may be associated with treatment outcomes in cognitively demanding interventions such as CPT. If this post-hoc finding is replicated in independent studies, it will refine our understanding for whom e.g., CPT works best.
Refugees are often exposed to injustice across the displacement journey, leading to persistent difficulties in social functioning. It is important to understand environmental and psychological factors driving processes like trust and cooperation to inform efforts to improve social functioning. In this study, we investigated whether cognitive styles and daily injustices were relevant factors influencing trust and cooperation in refugees. Participants were 102 refugees from Arabic- and Farsi-speaking backgrounds resettled in Australia. Participants completed a self-report measure of justice-related cognitive styles (specifically victim and perpetrator sensitivity) and then were randomly allocated to one of two conditions where they were primed with an audio scenario representing daily injustices (unjust condition), or a neutral audio scenario (neutral condition). Participants then completed behavioural tasks to index interpersonal trust (Trust Game) and cooperation (Ultimatum Game). Multiple regression analyses indicated that justice-related cognitive styles predicted trust behaviour. Specifically, victim sensitivity predicted lower trust behaviour, while perpetrator sensitivity predicted greater trust behaviour. Being primed with a daily injustice predicted reduced cooperation behaviour. There were no significant interactions between being primed with injustice and justice-related cognitive styles. These results highlight the relevance of justice-related constructs for adaptive social functioning in refugees. This includes experimental evidence for the differential influence of cognitive styles and daily injustices on trust and cooperation. The findings raise important implications for resettlement programming and clinical practice as they suggest both internal (e.g., cognitive styles) and external factors (e.g., experiences of injustice) should be targeted to support refugee wellbeing.
University students show elevated rates of social anxiety, yet most never access treatment, and brief scalable formats remain underdeveloped. This study developed and evaluated a 14-day fully self-help internet-based cognitive behavioral therapy (iCBT) intervention for university students with subclinical social anxiety. A second aim was to examine the timing of symptom change across the program. A third was an exploratory cross-study comparison with a previous virtual reality exposure therapy (VRET) self-help intervention. In a randomized controlled trial, 61 students were allocated to the iCBT intervention or a waitlist control condition. Fifty-seven were included in the final analysis. Social anxiety, psychological distress, and positive and negative affect were assessed at pretest and posttest. The iCBT group was additionally assessed on Days 6 and 10 and at 1-month follow-up. Compared with waitlist control, iCBT produced significantly greater reductions in social anxiety and psychological distress. Effect sizes were large, though the waitlist comparator likely inflates this magnitude. Negative affect decreased significantly. Positive affect did not change. Uncontrolled within-group analyses in the iCBT arm tracked the timing of change: global social anxiety and psychological distress improved by Day 6, and reductions in social fear/anxiety and avoidance were clearer by post-intervention. Most within-group gains held at 1-month follow-up. These timing patterns lack a control group at the intermediate and follow-up points and are therefore descriptive. An exploratory between-study comparison with a prior VRET self-help intervention suggested broadly similar overall improvement, but the non-randomized, cross-sample design does not support claims about which intervention performed better on any domain. A brief, fully self-help iCBT format reduced social anxiety and psychological distress relative to waitlist control in university students with subclinical symptoms. Retention was high (57 of 61). Whether the format is low-burden, scalable, or superior to existing self-help options remains untested here and requires direct comparison and dedicated feasibility outcomes.
The looming cognitive style (LCS) is a cognitive vulnerability involving the tendency to perceive threats as rapidly escalating. A recent meta-analysis by Yeo et al. (2020) found that LCS is strongly and predominantly linked to anxiety but is also significantly, though less robustly, associated with depression. This study investigated whether ruminative thinking mediates the relationship between LCS and depression using a prospective longitudinal design. We hypothesized that rumination would mediate the path from LCS to depression, but not the path to anxiety, given rumination’s stronger associations with depressive symptoms. University students (N = 247; 77
During Imagery Rescripting (IR), individuals relive a distressing memory and intervene within the scene to modify its meaning, typically from the perspective of their current self. The present pilot randomized study compared self-based rescripting with a newly developed supportive-other protocol designed for cases in which self-directed intervention may be limited. The aim was to examine whether both conditions would be associated with reductions in trait anxiety and changes in maladaptive core beliefs. Forty participants completed a single-session IR intervention and were randomly assigned to rescript a distressing autobiographical memory from the perspective of their current self (n = 19) or a supportive other (n = 21). Trait anxiety and core beliefs were assessed at baseline, post-intervention, and one-week follow-up. Both IR-conditions showed significant and sustained reductions in trait anxiety and maladaptive core belief ratings. Reductions in the perceived truth and daily impact of core beliefs were associated with reductions in trait anxiety. Neither anxious nor avoidant attachment orientations moderated symptom improvement. These findings suggest that symptom improvement and belief updating during IR may operate through shared pathways, highlighting belief change as a candidate process warranting further investigation.
Supportive accountability is a theoretical model positing that human support can increase user engagement and adherence to digital health interventions when coaches provide clear expectations, monitor progress, and are perceived as legitimate. Few studies to date have used validated measures to examine supportive accountability and its relationships with user outcomes. This study investigated whether supportive accountability predicted client engagement and satisfaction in a real-world clinic delivering digital cognitive-behavioral therapy (CBT). In this secondary analysis, we analyzed data from adult clients enrolled in a digital CBT clinic (N = 104, 83
Depressive symptoms in older adults represent a significant concern with major life impact. This uncontrolled pilot study evaluated the safety, feasibility and acceptance of metacognitive training for depression in later life (MCT-Silver) among Portuguese older adults. MCT-Silver is an 8-week psychological group intervention targeting (meta)cognitive beliefs to reduce depressive symptoms. The study also assessed changes in depressive symptoms, metacognitive beliefs, quality of life, ruminative responses, self-esteem, and dysfunctional attitudes. A pilot, uncontrolled, single-group study with twenty-nine participants aged ≥ 60 years without cognitive impairment and beck depression inventory-II (BDI-II) scores ≥ 14 were included. Blinded assessments occurred at baseline and post-intervention using patient health questionnaire-9 (PHQ-9) (depression), metacognitions questionnaire-30 (MCQ-30) (metacognitive beliefs), world health organization quality of life instruments-Bref, item 1 (WHOQOL-Bref) (quality of life), ruminative responses scale (RRS-10) (ruminative responses), Rosenberg self-esteem scale (RSE) (self-esteem), and dysfunctional attitudes scale-18B (DAS-18B) (dysfunctional attitudes). Acceptance was assessed with a 21-item questionnaire. Participants attended an average of 6 sessions (75
While research on the network approach to psychopathology has surged and clinical applications of this approach are frequently discussed, several key conceptual and methodological challenges remain. This collection aimed to bring together studies that advance knowledge on the network theory and its application to clinical practice. In this Editorial, we reflect on conceptual and methodological issues that are investigated in the 14 studies included in the collection. We discuss the distinction of idiographic and nomothetic inference with individual- and group-level analysis, and evaluate how different approaches can meaningfully inform clinical research. Considering methodological challenges of different network analyses, we also address measurement, robustness, and alternative ways of network construction. Finally, we critically explore the potential and limitations of various study types adopting the network approach for informing clinical practice. Expanding on the insights that emerge from the collection as a whole, we identify important directions forward. Specifically, nomothetic or idiographic aims and the level of analysis need to be clearly defined in future studies, the methodological soundness of network analyses needs to be further improved and it needs to be continuously evaluated if and how findings from network analyses can be translated into clinical practice. Together, such advances can hopefully help to use the potential of the network approach for a better understanding, prevention and treatment of mental disorders.
Negative core beliefs are central to cognitive formulations of depression, yet repeated or multi-wave studies are often constrained by questionnaire length. This study developed and validated a brief version of the 32-item Negative Core Beliefs Inventory (NCBI), the Brief NCBI (B-NCBI). Scale reduction and validation were conducted across independent datasets (total N = 3,025): exploratory factor analysis (n = 850), confirmatory factor analysis with item response theory calibration (n = 1,446), convergent and discriminant validation (n = 399), case-control comparison (n = 240), and test-retest reliability (n = 90). Analyses supported a 16-item structure with a Self-domain (12 items) comprising four facets (Helplessness/Inferiority, Hopelessness/Vulnerability, Unlovability, Worthlessness) and an Others domain (4 items). Model fit was excellent, χ²(99) = 339.76, RMSEA = 0.041, CFI = 0.98, TLI = 0.97. Graded response model parameters indicated adequate discrimination (a = 1.22 to 2.44). The B-NCBI correlated strongly with the full NCBI (r = .97) and showed expected associations with distress (DASS-21 total r = .66) and well-being (Satisfaction with Life Scale r = − .37; Subjective Happiness Scale r = − .29). Case-control analyses showed large group differences (d = 3.08) and near-perfect discrimination (area under the curve = 0.99). The B-NCBI retains the psychometric strengths of the full scale while reducing respondent burden, supporting its use in research and assessment of negative core beliefs among individuals with elevated perceived depressive symptoms.
Loneliness is associated with poor health and impaired sleep quality with evidence suggesting a bidirectional relationship between sleep and loneliness, where loneliness may disrupt sleep, and likewise time awake at night may enhance feelings of loneliness. In this study, we investigated the role of brooding rumination and anxiety sensitivity in moderating (amplifying) the association between loneliness and sleep quality and duration. We examined these associations in a sample of 81 college-aged adults, a population often characterized by higher rates of both loneliness and sleep disruption. Consistent with a previous study, we found that self-reported loneliness was associated with poor sleep quality but not sleep duration. As hypothesized, we found that this relationship was moderated by level of brooding rumination, with associations between loneliness and impaired sleep quality evident only for individuals with higher levels of brooding. Levels of depression did not account for these findings. We could not confirm a similar role for anxiety sensitivity in amplifying the association between loneliness and sleep disruption. Brooding rumination is a modifiable treatment target; replication of these findings in a longitudinal study offers the ability to examine potential feed-forward relationships among variables, and to help confirm the potential relevance of targeting brooding rumination to benefit sleep quality in populations with elevated loneliness.
Anxiety disorders are the most prevalent form of psychopathology and place a high burden on youth transitioning into adulthood. Scalable, effective, and appealing early interventions are urgently needed. We take initial steps to precisely target a key cognitive mechanism–future, distressing, and imagery-based mental simulations (“flashforwards”). A digital, game-based, single-session, researcher-guided intervention was administered over videoconferencing. It involved brief flashforward recall followed by a cognitive task (playing Tetris to tax working memory). In a translational case series, 20 young adults (aged 16–24), with anxiety problems and recurrent flashforwards, received the intervention. Participants tracked daily flashforwards during Week 1 (pre-intervention), completed the guided session, and continued tracking during Weeks 2 (post-intervention) and 5 (follow-up). A nonconcurrent, fixed-baseline, repeated-measures AB design was used to demonstrate preliminary target engagement, contrasting daily flashforwards between Weeks 1 and 2 while accounting for baseline time trends. Anxiety symptoms (GAD-7), broader clinical impact, and acceptability feedback were also collected. Intervention and procedures were rated as highly acceptable. Flashforward frequency showed a mean reduction of 33.96
To propose a diagnosis-specific, testable recursive affective-regulatory framework explaining why compulsions persist despite preserved insight in obsessive–compulsive disorder (OCD). Conceptual synthesis of cognitive, habit-learning, and affect-regulation literatures, translated into operational definitions, falsifiable predictions, and pragmatic treatment implications. The present paper proposes that preserved-insight OCD arises from a recursive failure of affective symbolization in which proto-symbolic dissonance is sealed by shame, organized via magical thinking, amplified through responsibility valuation, maintained by pathological discursive saturation (rumination, mental checking, reassurance loops), and stabilized by habit-like proceduralization. The paper provides an operationalization table, 12 numbered falsifiable predictions, and three study designs (ecological momentary assessment, habit-bias paradigm, brief desaturation trial). By distinguishing pathological from therapeutic discursive saturation and specifying measurable pathways, the framework clarifies mechanism, generates testable hypotheses, and motivates a preliminary three-phase sequencing proposal that may support exposure and response prevention (ERP) preparedness.
To review the evolution of the DSM diagnostic tradition and compare the diagnostic traditions of DSM-III through DSM-5 to a 35-article sample taken from the Treatment Resistant Depression (TRD) diagnostic literature. The major conclusion drawn is that the TRD diagnostic literature is seriously flawed due to a design error that renders the literature uninterpretable. Finally, to counter the design error and answer the implicit question that the TRD literature raises, we recommend three alternative strategies to answer the question: What are the best treatments for the DSM-5 unipolar mood disorders? The paper is a Review Paper comparing the DSM diagnostic tradition with the diagnostic tradition in the TRD literature. We propose three alternative recommendations to the flawed TRD tradition that addresses the issue of treatment efficacy for the DSM-5 unipolar mood disorders. We respond to the design limitations of the TRD diagnostic literature and propose alternative approaches to the treatment non-response issue. We offer a viable alternative to TRD’s diagnostic concern with non-response when it comes to the DSM-5 unipolar mood disorders.
Cognitive dysfunction is the most typical symptom of Alzheimer’s disease and a pending problem that has been the focus of the medical field. High-frequency repetitive transcranial magnetic stimulation is a clinical intervention method that has been studied a lot these years. The present meta-analytic review synthesizes the intervention effect of high-frequency repetitive transcranial magnetic stimulation on cognitive function in patients with Alzheimer’s disease. A total of nine Chinese and English databases was used to search for randomised controlled clinical trials on high-frequency repetitive transcranial magnetic stimulation interventions for Alzheimer’s disease from the time of database construction to 30 June 2024. Cochrane risk of bias assessment tool was used for literature quality analysis and Revman software and Stata software for Meta-analysis. A total of 20 papers with 1218 patients were included. Compared with the control group, high-frequency repetitive transcranial magnetic stimulation improved cognitive function in patients with Alzheimer’s disease, ADAS-Cog score (MD = − 3.26, 95
In-Home Cognitive Behavioral Therapy (IH-CBT) was developed to treat the high rates of perinatal depression seen in mothers living in poverty, leveraging their involvement in home visiting programs to improve engagement, retention, and outcomes. Little is known about dropout, service disruptions, and outcomes of depressed mothers with low incomes treated in a naturalistic setting. Mothers with low incomes (N = 353) enrolled in a multi-site home visiting program and with a diagnosis of major depressive disorder received IH-CBT treatment (15 sessions). Treatment completion, service disruptions (e.g., no shows), and session at which subclinical threshold for depression was reached were documented. Baseline depression, history of trauma, and baseline social support and parenting stress were examined as predictors of dropout and improvement. In the sample, 63 mothers dropped out after the assessment, 194 partially completed treatment, and 96 completed treatment. Those who dropped out after the assessment had lower baseline depression scores than partial and full completers. Completion was associated with older maternal age, fewer service disruptions, and reaching an asymptomatic level of symptoms. Asymptomatic depression levels were reached by 50.0
