Temperament is a heterogenous construct that captures individual differences in reactivity and regulation. Traditionally, dimensions of temperament are used over temperament types that may better capture heterogeneity. Using a racially/ethnically and socioeconomically diverse sample of twins (N=997 twins; 51.4% female; 58.5% white, 24.0% Hispanic; 28.7% at or below the poverty line), we modeled associations between primary-caregiver-reported temperament (M age = 8.43) and later cross-reporter factors of anxiety, depression, externalizing, and ADHD symptoms (M age = 10.88) and estimated latent genetic effects using temperament dimensions and types. The dimension of effortful control was negatively associated with all psychopathology symptoms over and above negative emotionality and surgency whereas temperament types yielded more nuanced results. We also uncovered a larger role of the shared environment for temperament and symptoms of psychopathology independently and in their relation than previous research has suggested. Findings provide greater specificity to current understanding of the relation between temperament and psychopathology.
Stress generation describes that people with mental-health problems actively contribute to the occurrence of stressful events in their lives, which can lead to detrimental cycles between stress and mental health. However, existing research has mostly focused on long-term stress generation. Here, we aimed to advance the understanding of how stress generation unfolds across different timescales by combining experience-sampling, daily diary, and 1-month longitudinal data ( N = 403). We found that between-persons differences in depression, rumination, reassurance seeking, and neuroticism were linked to the occurrence of daily hassles over hours and days as well as major life stressors over a month. Furthermore, momentary neuroticism and rumination prospectively predicted the reporting of daily hassles over several hours. Finally, some indicators of hourly and daily stress generation prospectively predicted the occurrence of major life stressors. These findings provide the starting point for a thorough understanding of how stress generation unfolds over time.
Suicidal thoughts and behaviors (STBs) are an urgent concern, and there is elevated risk in individuals with attention-deficit/hyperactivity disorder (ADHD). Drawing on the developmental-psychopathology framework and socio-ecological model of suicide risk, in this study, we examined trajectories of STBs in youths with and without ADHD and their prediction via individual and interpersonal factors. Data from 849 participants (with ADHD: n = 509), ages 7 to 13, were collected over 13 years using multiple informants (parent, teacher, youth) and methods (cognitive tasks, self-report, Five Minute Speech Sample). Trajectories were best captured by a piecewise latent-growth-curve model representing STBs in childhood and adolescence. Higher parental criticism predicted persisting childhood STBs. In adolescence, female sex and less temperamental fear predicted increasing adolescent STBs, and greater temperamental openness predicted increasing adolescent STBs for females and youths with lower baseline working memory. ADHD symptoms alone did not drive risk; instead, individual and interpersonal factors emerged as key predictors. Prevention efforts should integrate these multidimensional considerations.
Is a more empathic therapist more effective? Classic models in clinical science rightfully describe empathy as an important therapeutic tool, but emerging evidence indicates that it can interfere with therapeutic goals in some settings. Here, we provide a contemporary framework that addresses this tension. We propose a model in which empathy and emotion regulation combine to create a “therapeutic emotional circuit” in which emotions flow from therapist to client and back to the therapist again via empathy. Critically, therapists can use empathy regulation to modulate this emotional flow to achieve specific goals for both their own and their clients’ emotional experiences. We then illustrate how optimal empathy regulation diverges across two empirically supported interventions: To best support clients, exposure therapy requires down-regulating affect sharing, whereas motivational interviewing requires up-regulating this empathic process. This model challenges classic intuition, revealing new directions for clinical research, training, and practice.
The COVID-19 pandemic increased the global prevalence of depression and anxiety, and emotion regulation (ER) was a key risk or protective factor for symptoms. In this systematic review, we explore the association between ER and depressive and/or anxious symptoms during the pandemic. We examined a range of ER strategies and considered whether their adaptiveness varied across contexts (e.g., cultures). We also investigated whether ER moderated the association between pandemic-related stress and symptoms. In addition, we assessed whether ER mediated this association. Of the 504 identified articles, 47 articles from countries worldwide met eligibility criteria. We found that traditionally maladaptive ER strategies were associated with greater symptoms and that findings for traditionally adaptive strategies were mixed. ER strategies also played a role in the link between pandemic-related stress and symptoms. This review showed that ER strategies during a naturalistic global stressor have real-world implications for mental health that extend beyond geographical location or culture.
Social comparison can fundamentally shape health perceptions. Building on existing literature, we first introduce a process model of health-related social comparison that consists of (a) seeking or encountering self-relevant social information, (b) evaluating self-attributes relative to social standards and generating a posterior target construal, (c) valuation of the comparison outcome based on personal motives and coping, and (d) affective, cognitive, and behavior responses. Second, we conducted a systematic review and meta-analysis to summarize existing knowledge about social comparison in populations with mental disorders. We systematically searched Medline, PsycInfo, and Web of Science. The included 72 studies suggest a strong correlation between social comparison and mental health. However, there is lack of research addressing the appraisal of the comparison outcomes and the reciprocal, longitudinal relationship between social comparison and health. Last, based on our model and meta-analytical results, we offer recommendations to inform future investigations of social comparison in mental health.
Attention-deficit/hyperactivity disorder (ADHD) is often characterized as having clinically relevant sex-differentiated correlates. We revisited this popular conjecture and examined, in exploratory fashion, whether ADHD symptoms’ associations with 88 theoretically relevant external validators (e.g., psychopathology, neurocognitive tasks) varied by sex. To do so, we used four waves of data from a large community sample of youths ( N = 11,878, ages: 9–13). Only 4.1% of tests (157/3,760) supported significant sex-differentiated correlates of ADHD or its individual symptoms. ADHD and some of its symptoms (e.g., inattentive, impulsive, hyperactive) were more strongly associated with externalizing in boys than girls, but ADHD and other symptoms (i.e., inattentive, acted young) were also more associated with internalizing and thought problems in boys than girls. Most observed sex-differentiated correlates were very small to small in magnitude, suggesting sex-differentiated correlates of ADHD may be the exception rather than the rule across youths’ development.
In this study, we investigate mechanisms underlying transdiagnostic written-exposure therapy (WET), a novel, scalable, online intervention for pathological-anxiety symptoms. In a randomized controlled trial with 89 participants, WET produced significant anxiety reduction that continued through 2-month follow-up (standardized mean difference [SMD] = 0.85). We systematically evaluated multiple potential mechanisms across cognitive, emotional, and behavioral domains. From this broad assessment, two candidate mechanisms emerged as both significantly affected by treatment and correlated with symptom improvement: enhanced distress tolerance ( r = –.35) and decreased anxious responses to core threats ( r = .39). This suggests exposure therapy might operate through dual pathways: improving distress tolerance and reducing anxious responses. A neutral-imagery control condition showed immediate but nonsustained anxiety reduction and actually decreased distress tolerance, revealing distinct therapeutic trajectories between neutral-imagery-based versus exposure-based interventions. This research advances understanding of mechanisms of exposure while highlighting specific targets for enhancing interventions.
The field of mental-health care continues to face the challenge of translating conceptual approaches into the idiographic reality of everyday clinical practice. For any framework to be both meaningful and useful to individual cases, it must account for the contextual, interconnected, temporal, and granular nature of such problems and prioritize clinical utility by design. In this narrative review, we aim to bridge this gap by proposing a workable framework building on these premises. Our proposal centers on the concept of “problem-sustaining patterns,” which aligns with the ongoing trend toward complexity thinking while offering sufficient clinical utility in practice. We advocate for a collaborative approach in which professionals and help-seeking individuals co-construct these models. Furthermore, we discuss the need for new digital tools to facilitate the procedural steps while also enabling development of generative models as clinical decision-making support tools, which could significantly enhance the feasibility of embracing complexity in clinical practice.
Interpretation biases (IBs) play a central role in cognitive models of anxiety disorders and are considered a transdiagnostic feature across anxiety disorders and severity levels. However, the magnitude of this bias in anxiety and modulating factors are largely unknown. In this three-level meta-analysis, we investigated the associations between IBs and symptoms of anxiety. Database searches (PsycINFO, PubMed, ProQuest Dissertations) led to 295 samples with 1,450 contrasts. An overall medium effect size ( g = 0.48, 95% confidence interval = [0.43, 0.52]) was found. Equivalent effect sizes were found for youths and adults and different disorder categories and clinical statuses. Effect sizes were larger for studies using direct measures, verbal stimuli, disorder-specific stimuli, and negative (as opposed to positive) stimuli. Overall, results are consistent with the view that anxiety is associated with IBs across different disorders and severity levels. These findings have implications for cognitive theories of anxiety and clinical interventions.
The central goal of clinical psychology is to alleviate the suffering caused by mental illness. Anxiety, mood, psychosis, substance use, and other mental disorders impose an immense burden on public health and the economy. Alleviating this burden demands a better understanding of the underlying mechanisms and the development and dissemination of interventions that are effective, sustainable, acceptable, and equitable. Clinical psychology, a field anchored since its inception on the close integration of basic science and clinical practice, is uniquely poised to serve as a hub for this intrinsically multidisciplinary endeavor. Nevertheless, multidisciplinary research is notoriously challenging, and many clinical psychological scientists remain isolated from other areas of psychology and other scientific disciplines. In this special issue, we hope to provide illustrative examples of cutting-edge multidisciplinary clinical psychological research, outline key barriers to multidisciplinary training and collaboration, and provide specific recommendations for a range of stakeholders.
Psychological clinical science might be one of the most uniquely multidisciplinary fields in science given the wide range of collaborations and outstanding integrative research produced by clinical scientists and their collaborators. However, despite the rich body of work being produced through such multidisciplinary efforts, there are ongoing challenges to supporting this type of collaborative work that the field must address, including how to provide the training needed to engage in this type of research, differences in dissemination approaches and venues, credit assignment for team science, and the need to value collaborative team science in the promotion and tenure process.
Reflections over the course of my 50-year career in interdisciplinary clinical-psychological science are offered. Using several examples drawn from my life’s work, I highlight the importance of interdisciplinarity in developing novel insights into clinically relevant phenomena. When questions demand expertise and methods beyond those researchers possess themselves, collaboration is key. Examples of highly novel and productive collaborations from my career are provided. Finally, I conclude with six specific points of advice for the younger generation of scientists, and I advocate for a clinical-psychological science that focuses on human flourishing. Such a focus is critically needed to address the major challenges facing the world today.
In the United States, there are persistent disparities in mental-health services for linguistically and culturally minoritized groups. We examined whether bilinguals reported psychological symptoms differently when assessed across their two languages. Japanese-English bilinguals completed anxiety-symptom (State-Trait Anxiety Inventory [STAI]) and depression-symptom (Beck Depression Inventory [BDI-II]) scales in Japanese and English, counterbalanced across 2 days. Bilinguals reported higher total anxiety scores but not total depression scores in first-language Japanese than in second-language English. Suicidal thoughts (BDI-II Item 9) were rated higher in Japanese. Bicultural bilinguals who lived in balanced language environments had greater cross-linguistic differences in anxiety and depression symptoms compared with bilinguals who lived in Japanese-dominant environments. Bilinguals may express symptoms differently as a function of language because of varying degrees of emotional reactivity across their first and second languages and associated cultural norms. We conclude that clinicians must consider multilingual assessments to implement equitable and effective mental-health services.
Air pollution is a leading threat to human health but has been largely overlooked in the study of psychopathology. As the burden of poor mental health grows, a consideration of new contributors to psychopathology is needed to identify novel prevention and intervention approaches. Consequently, collaboration between clinical-psychological scientists and experts in atmospheric research, pollution, and built environments holds great potential for advancing knowledge and addressing these threats. In the current project, we bring together a cross-disciplinary team to summarize the state of existing research linking air quality to the development and maintenance of psychopathology. We then identify some traditional challenges to collaboration across disciplines before identifying promising areas for future research and providing concrete advice to psychological scientists interested in similar collaborations, including recommendations for the measurement and application of outdoor and indoor air quality, ways to strengthen causal inference, and considerations for environmental justice.
Since its inception, psychoneuroimmunology has been a multidisciplinary field. With the immune system increasingly implicated in mental illnesses such as depression and schizophrenia, multidisciplinary teams including clinical psychologists will be needed to advance clinical psychological science. Challenges in this field include acquiring the basic content knowledge to communicate and collaborate with immunologists and assessing immune activity in the brain. Opportunities include better understanding of the etiology, presentation, and options for personalized treatment in mental illness. Multidisciplinary work is challenging but also exciting and rewarding.
Clinical-psychological research stands to benefit greatly from collaborations that incorporate perspectives from other disciplines. However, the challenges of such collaborative efforts are immense. In this commentary, we provide the perspectives of five frequent collaborators from distinct disciplines (clinical psychology, linguistics, affective and developmental science, vision science, and cognitive neuroscience). We outline three overarching challenges we have encountered during our collaborations: disciplinary bias (i.e., implicit and explicit beliefs about the best ways to gain knowledge), lack of multidisciplinary fluency (i.e., difficulty effectively communicating across disciplines), and inherent risk (i.e., the speculative nature and uncertain career prospects of multidisciplinary pursuits). We then discuss potential solutions to these challenges. We hope that by sharing our experiences and insights, we can promote more productive and impactful clinical science.
Developing and disseminating effective treatments requires collaborative partnerships at every phase of intervention implementation. We discuss how a multidisciplinary team of clinical psychologists, public-health faculty, probation officers, and victim-advocacy organizations developed and implemented a novel acceptance-and-commitment-therapy-based intervention for intimate partner violence. Specifically, we discuss the contributions of each discipline at each stage of intervention development and implementation, highlighting ways in which having a multidisciplinary team was necessary in both shaping the effectiveness of the program and making it workable in a nonclinical setting. We argue that these kinds of multidisciplinary partnerships offer a solution for closing the gap that exists between developing empirically supported treatments and translating them into real-world settings. Finally, we discuss the promise and challenges of working in a multidisciplinary team and the unique ways in which clinical psychologists are positioned to engage in this work.
Clinical psychological science combines multiple measurement traditions, which can create hidden translational gaps in which mismatches in methods and constructs go unnoticed. Here, I discuss reliability as an example of a hidden gap between disciplines, drawing from my own career adapting experimental cognitive tasks for clinical research and the personal challenges of confronting methods limitations. Now, as the field moves toward within-person (e.g., idiographic) approaches, researchers face potential new gaps as they adapt measures from experimental and individual differences research. Bridging these gaps will require even broader multidisciplinary collaboration and awareness of the boundaries between methods.
Asian Americans/Pacific Islanders (AAPIs) are the fastest growing ethnic/racial group in the United States but experience difficulties accessing and engaging in mental-health care. Limited clarity around applied cultural adaptations for evidence-based psychotherapies (EBPs) and biases in the psychological field may hinder innovations in care. In this qualitative study, we explore adaptations to existing EBP intervention frameworks by synthesizing perspectives of experts in AAPI issues from both mental-health and non-mental-health fields. In-depth interviews were conducted with mental-health researchers and clinicians who focus on AAPI issues ( N = 24) and nonpsychology experts ( N = 12) in Asian and AAPI issues, drawing from fields including ethnic studies, history, diaspora studies, cultural sociology, political science, literature, and film studies. Thematic analyses yielded eight key themes that informed peripheral and core modifications and goals to existing EBPs. This expanded EBP psychotherapeutic framework may improve clinical applications of cultural adaptations.
