Introduction and objective: This study presents findings from a clustered randomised controlled trial evaluating the Support for Students Exposed to Trauma (SSET) intervention among trauma-exposed adolescents in public schools of Azad Jammu and Kashmir, Pakistan. Against a backdrop of political unrest, war-related escalations, disasters, and chronic displacement, children in this region face heightened psychological vulnerability. The 10-week intervention was designed to address core trauma-related difficulties using structured, evidence-informed techniques appropriate for low-resource educational settings. Materials and methods: A total of 131 students aged 10–16 were assigned to intervention and control clusters. To assess the effectiveness of SSET, five outcome domains – post-traumatic stress symptoms, psychological distress, behavioural/emotional problems, perceived social support, and resilience – were measured at pre-, post-, and 3-month follow-up stages. These indicators were selected based on the SSET programme’s theoretical foundations in cognitive-behavioural and trauma-informed approaches, each targeting specific emotional and interpersonal capacities expected to change through intervention. Results: Statistical analysis using mixed-design ANOVA revealed significant improvements across all five indicators in the intervention group. Notably, reductions in post-traumatic stress disorder symptoms, emotional/behavioural problems, and psychological distress were accompanied by increased perceptions of social support and resilience. Conclusions: The findings provide strong evidence of the intervention’s effectiveness and demonstrate how schools in under-resourced regions can serve as vital platforms for delivering early psychological interventions.
Introduction and objective: This study aimed to explore relational depth as a key indicator of the development of group processes during a five-day interpersonal training. The focus was placed on how participants’ experiences of relational depth changed from day to day throughout the training. In addition, the study examined whether specific relational qualities – such as openness, empathy, and understanding – could serve as early predictors of increased relational depth on subsequent days. Materials and methods: Data were collected from 278 adult participants who completed the Relational Depth Frequency Scale (RDFS) daily over the five-day group training. To examine trends over time and predictive relationships across days, repeated-measures ANOVA and stepwise multiple regression were applied. Results: Perceived relational depth increased significantly over time, F(4, 268) = 262.34, p < 0.001, η2 = 0.797, with a strong linear trend. However, regression analyses showed that relational qualities from prior days had limited predictive power. Only specific aspects – such as “understanding” on Day 1 and “openness” on Day 3 – emerged as significant predictors of later relational depth, yet the overall explained variance remained below 10%. Conclusions: The findings support the effectiveness of group-based interpersonal training in deepening relational experience. However, the results also point to the contextual and emergent nature of relational depth, which appears to depend less on prior relational states and more on present-moment dynamics.
Introduction and objective: Mental disorders are a major global health concern, with psychodynamic psychotherapy recognised as an important treatment option. The optimal duration of psychodynamic therapy – short-term (≤6 months) vs. long-term (>6 months) – remains a subject of debate, with implications for clinical practice, treatment outcomes, and healthcare resource allocation. Materials and methods: This systematic review was conducted in accordance with the PRISMA 2020 guidelines, synthesising randomised controlled trials published between 2000 and 2025 that directly compared short-term and long-term psychodynamic psychotherapy in adults with mental disorders. Two studies involving 493 participants met the inclusion criteria. Outcomes included symptom severity, interpersonal and psychosocial functioning, remission rates, and treatment dropout. Results: Both short-term and long-term psychodynamic psychotherapy resulted in significant symptom reduction. Short-term therapy led to faster initial improvement (15–27% greater reduction during the first year), whereas after three years, long-term therapy demonstrated superior outcomes (14–37% greater reduction; higher remission rates at ten-year follow-up). The presence of a personality disorder moderated treatment efficacy: patients with personality disorders benefited more from long-term therapy, whereas those without personality disorders achieved similar outcomes with either treatment duration. High levels of social support were associated with better long-term outcomes; low social support favoured short-term therapy. Long-term therapy was associated with higher dropout rates (33% vs. 9%). Conclusions: Comparative efficacy of psychodynamic psychotherapy depends on patient characteristics and the timing of outcome assessment. Long-term therapy is recommended for patients with personality disorders; short-term therapy may be sufficient for other patients. Personalised treatment selection and strategies to support treatment continuation are essential for optimising outcomes and healthcare resource use.
Introduction and objective: Assessing the effectiveness of integrative psychotherapy is a key element of both clinical practice and scientific research. The aim of the study was to evaluate the effectiveness of integrative psychotherapy in reducing psychopathological symptoms in patients undergoing long-term individual therapy. Materials and methods: This longitudinal study was conducted at the “Ogród” Centre for Psychotherapy and Health Promotion (Non-Public Healthcare Facility) in Warsaw between 2005 and 2023. It involved a group of 127 patients who completed a full cycle of psychotherapy delivered by integrative-modality psychotherapists. The SCL-90 questionnaire was used to assess the severity of psychopathological symptoms. Measurements were taken twice for each participant: before the start of treatment and after its completion. The normality of distribution for each scale was evaluated using the Shapiro–Wilk test. Due to significant deviations from normality in most variables, the nonparametric Wilcoxon signed-rank test for dependent samples was applied to compare the results. Results: Following the completion of therapy, lower values were observed across all scales of the SCL-90 questionnaire compared with baseline. The severity of all psychopathological symptoms decreased, and the differences were statistically significant. The direction of change indicates improvement across all analysed domains of psychological functioning. Furthermore, the findings show that, in addition to statistical significance, strong therapeutic effects occurred. Effect sizes point to substantial clinical relevance of the observed changes. Conclusions: The findings suggest that the therapeutic intervention was effective in a multidimensional manner. Improvements across all scales indicate that integrative psychotherapy may have a broad impact on patients’ psychological functioning.
Introduction and objective: Psychotherapy efficacy and effectiveness are traditionally assessed using pre-post symptom reports, which often fail to capture the dynamic nature of therapeutic change and may overlook individual patterns of interaction between symptoms and psychological processes. Experience sampling methods (ESM), encompassing daily diaries, ecological momentary assessment (EMA), and ambulatory assessment via wearable devices, address this limitation by collecting real-time, in-situ data on symptoms and psychological processes through mobile technologies. This approach enables the development of personalised models of patient functioning and dynamically tracks changes during psychotherapy, offering a more nuanced understanding of treatment mechanisms. Despite increasing recommendations for their use in clinical practice and exponential growth in access to technology, ESM remains relatively underutilised in evaluating psychotherapy efficacy and effectiveness. Materials and methods: This paper provides a narrative review exploring the opportunities and challenges of using ESM to assess psychotherapy effectiveness and efficacy. Results: ESM is shown to complement, rather than replace, traditional methods by capturing dynamic changes and contextual factors, recognising that retrospective self-reported questionnaires and ESM data do not always measure the same aspects of a given psychological process. The review outlines key areas, including an overview of ESM methodologies, the rationale for their use in psychotherapy evaluation, user experience and methodological challenges (e.g. compliance, UX, Open Science principles, and participatory approaches), data structure and analytical approaches (such as multilevel and network models), and ethical considerations related to ESM. Conclusions: Practical recommendations for integrating ESM into psychotherapy research are presented, drawing on general ESM guidelines (e.g. Löchner et al., 2025) and the findings of this review.
Introduction and objective: This article aims to examine how psychotherapeutic approaches that diverge from traditional theories of change and emphasise non-pathological indicators of effectiveness, such as solution-focused brief therapy, can gain wide recognition within mental health care. Materials and methods: For this purpose, indicators and criteria of effectiveness proposed within mainstream therapeutic approaches are contrasted with a model whose theory of change and clinical practice depart from traditional frameworks. Solution-focused brief therapy was used as an illustrative example, given the dominant position it has achieved in Finland following its inclusion in the public health system. This approach is grounded in clinical observation and informed by a theory rooted in social constructionism. Results: Solution-focused brief therapy demonstrated effectiveness both through client-centred measures and classical indicators of efficacy. Nevertheless, the approach encountered various challenges on its path to wider recognition. The promoted indicators of effectiveness vary from those of the medical model by prioritising clients’ feedback related to progress towards goals and personal strengths instead of pathology. However, it cannot be assumed that similar alignment will characterise other emerging therapeutic modalities. This raises critical questions about whether legislation and policymakers should continue to privilege established frameworks or instead create more flexible pathways for evaluating and adopting new treatments. Conclusions: Arguments for a balanced perspective that values rigorous evidence while also fostering openness to innovation and diversity were put forward in order to encourage continuous development of psychotherapy to better respond to the evolving needs of clients.
The article presents a theoretical analysis of the functioning of individuals with autism spectrum disorder who received their diagnosis as adults. It includes a short description of the main psychological difficulties observed in individuals with late autism diagnosis, an overview of general indicators of effective and efficient cognitive and behavioural treatment methods, and proposals for general standards necessary for an effective neurodiversity-affirming therapeutic approach. The article may serve as a starting point for the currently much-needed empirical research on neurodiversity-affirmative therapies.
Introduction and objective: Process-oriented psychology is a contemporary psychotherapeutic method that combines the principles and techniques of various therapeutic approaches – primarily Jungian psychoanalysis and the humanistic-experiential approach – with its own theoretical and practical framework. The method focuses on expanding the client’s awareness by working with their experiences. Given its relatively recent emergence, comprehensive scientific descriptions of process-oriented psychology remain limited. This review aimed to identify current approaches to measuring its effectiveness and to outline directions for future research. Articles describing applications, interventions, and outcomes in process-oriented psychology were collected and analysed. Materials and methods: To illustrate how changes resulting from process-oriented psychology interventions have been measured, a wide range of diverse studies was reviewed. Changes in psychotherapeutic, psychoeducational, and developmental processes were described both qualitatively and quantitatively, and concerned individual as well as group interventions. Peer-reviewed scientific articles, conference presentations, and theses were included. Results: Findings indicate that research on process-oriented psychology most often assesses clients’ functioning, symptom severity, and well-being, typically using self-report measures. Evidence suggests that process-oriented psychology may be effective in reducing depressive and anxiety symptoms and in enhancing self-esteem, sense of coherence, functioning, and overall well-being. Conclusions: Further research is needed to strengthen the empirical foundation of process-oriented psychology. Future studies should employ widely used measures of psychotherapy effectiveness to enable comparison with other therapeutic methods. Particularly valuable would be large-scale quantitative studies across multiple centres practising classical process-oriented psychology, as well as randomised controlled trials of standardised techniques, followed by meta-analyses.
Introduction and objective: The aim of this study was to evaluate the level of knowledge about kidney transplantation among Polish patients awaiting kidney transplantation and to determine whether this knowledge is associated with anxiety, stress, and the severity of depressive symptoms. Materials and methods: The study involved 44 patients undergoing dialysis who were currently on the National Waiting List for Transplantation. Participants completed an original questionnaire assessing general knowledge of the kidney transplantation process, as well as standardised instruments: the Hospital Anxiety and Depression Scale and the State-Trait Anxiety Inventory. Results: The level of knowledge about kidney transplantation significantly differentiated the patient groups depending on their awareness of being placed on the waiting list. Patients who were on the list for the second time or more demonstrated the highest level of transplantation knowledge (p < 0.05). More than half of the participants scored high on the Hospital Anxiety and Depression Scale (M = 10.61). When patients were compared according to their awareness of being on the waiting list and their Hospital Anxiety and Depression Scale scores, those listed for the first time tended to score higher than those who believed they were not on the list (p = 0.052). Furthermore, results from the State-Trait Anxiety Inventory showed that state anxiety was significantly higher in women than in men (p = 0.019). Conclusions: The presented results highlight the need to develop a standardised system for delivering and monitoring patient knowledge, as well as for providing psychological support throughout the treatment process.
Purpose: This article aims to provide a comprehensive overview of risky sexual behaviour, emphasising its multifaceted nature, underlying mechanisms, and effective intervention strategies. It also highlights critical gaps in existing research to guide future inquiry and public health policy development. Views: Risky sexual behaviour remains a major global concern, especially among adolescents and young adults, significantly affecting not only individuals but also populations worldwide. Understanding this issue is complicated by the diversity of definitions and the multitude of factors influencing it at the individual, social, and environmental levels. The consequences of such behaviour are serious, impacting not only physical health but also social well-being. This article explores the definitions and multifaceted causes behind risky sexual actions. It also reviews key theories that help explain why individuals engage in such behaviour. Conclusion: Understanding and addressing risky sexual behaviour is challenging due to its intricate nature and the diverse range of contributing factors. However, this article underscores that a multifaceted approach, integrating theoretical insights with evidence-based interventions, holds significant potential for mitigating its adverse impacts. The lack of research based on large global datasets leads to interpretive limitations and highlights the need for further research in this area.
Introduction and objective: The main aim of this study was to provide indicators of mental health in the Polish population and to examine the need for different kinds of support (psychological, financial, educational, work-related, etc.) during the first phase of the COVID-19 pandemic. Materials and methods: The study used demographic measures and questions specific to the COVID-19 pandemic. The General Functioning Questionnaire (GFQ-58) and the State-Trait Anxiety Inventory (STAI) were used to assess mental health and psychosomatic functioning. Additionally, participants selected psychological and somatic symptoms they experienced. Results: Participants reported numerous psychological and somatic symptoms associated with the COVID-19 pandemic. Stepwise regression analyses revealed significant predictors of mental health, anxiety, and psychological/somatic symptoms. Risk indicators included current psychiatric treatment, prior psychiatric history, receiving psychiatric or psychological treatment during the pandemic, limitations in interpersonal contacts and physical activity, need for financial assistance, need for support at work and in education, unemployment, and female sex. There were many specific sex differences, but women generally reported higher intensity of psychological/somatic symptoms. Women experienced symptoms directly linked to the pandemic, whereas men experienced the consequences of the pandemic in a more indirect way. They did not openly attribute their symptoms to the pandemic; however, its consequences affected men’s mental health and general psychosocial functioning to a greater extent. Conclusions: The COVID-19 pandemic has had a substantial impact on general psychosomatic functioning, but this impact differs for women and men. It is possible to identify specific risk indicators which are responsible for reduced mental health during the COVID-19 pandemic.
Introduction: Women are twice as likely to suffer from depression as men. Discrimination based on female sex is a common stress factor. Previous literature has demonstrated that overt forms of sexism, such as physical violence, are associated with higher depression rates among women. However, little research has focused on everyday sexism and women’s depression. Everyday sexism refers to interpersonal experiences of sexism in daily life, which are not violent but nonetheless result in inequality in the relationship and chronic stress due to repeated exposure, primarily in workplaces and public environments. The present systematic review aimed to assess the relationship between everyday sexism and women’s depression. Method: Research articles indexed in PubMed, Web of Science, and Scopus electronic databases were included based on keyword searches. The inclusion criteria for the present study were: research articles in English, published between 1 January 2004 and 31 August 2024, and studies addressing the relationship between sexism and women’s depression in the adult female population. Sixteen studies were included. Results: Exposure to sexist discrimination is associated with depressive symptomatology among adult women across age groups. Internalised sexist beliefs, on the other hand, vary regarding the ambivalent sexism approach. Internalised hostile sexist beliefs were related to depression, whereas internalised benevolent sexism did not show such a relationship with depressive symptomatology. Conclusion: Exposure to sexism and internalisation of hostile sexist beliefs are related to depressive symptoms among women.
This literature review examines the role of physical activity in the treatment of anxiety disorders and depression, with a particular focus on both neurobiological and cultural mechanisms, enabling a deeper understanding of this issue. Current research indicates that regular physical activity increases levels of neurotransmitters including serotonin and dopamine, as well as neuromodulatory molecules including endorphins, brain-derived neurotrophic factor, and adipomyokines such as irisin - all of which contribute to improved mood, reduced anxiety, and enhanced cognitive function. Furthermore, cultural practices such as yoga and tai chi promote mental balance and may serve as valuable adjunct therapies in the treatment of anxiety disorders and depression. This detailed literature review critically analyses how regular physical activity can not only complement traditional forms of treatment, such as pharmacology and psychotherapy, which have long been considered the gold standard in the therapy of mental disorders, but in some cases can serve as an equally valuable alternative, offering patients additional health benefits and improved quality of life. The article critically synthesises findings from studies published between 2008 and 2024, focusing mainly on the neurobiological impact of exercise on mental health, with additional perspectives on historical and cultural practices related to physical activity. The current body of evidence clearly indicates that physical activity is a particularly effective method in the treatment of mild to moderate depression, offering patients an integrative approach that supports both mental and physical well-being.
Cenesthopathy, a subclinical symptom of schizophrenia, often appears years before full-blown psychosis. The paper outlines the role of normative cenesthesia and its disruptions in self-regulation processes, the differentiation of mental representations, and identity, all structured within the model of the bodily self. Although bizarre bodily sensations are present in various psychiatric and somatic illnesses, the analysis of the narratives makes it possible to distinguish schizophrenia-specific characteristics of cenesthopathy, such as difficulty verbalising sensations and identifying their causes, their uncanny and enigmatic nature, problems coping with these sensations, and their catastrophic interpretation. Empirical evidence confirms the association of cenesthopathy with disturbances in subsystems of the bodily self, including the interpretation and regulation of bodily states, body representations, and identity. Thus, the presence of cenesthopathic sensations in schizophrenia disrupts the differentiation of stable representations of bodily states and characteristics, resulting in the disintegration of identity. This disintegration is associated with a state of disorientation, anxiety, and a sense of detachment from one’s own body. The conceptualisation of cenesthopathy in schizophrenia in relation to disembodiment and disruptions of the bodily self leads to the following practical conclusions: 1) interview-based assessment of cenesthopathy is useful for diagnosing the prodrome of schizophrenia; 2) caution is advised regarding techniques that enhance bodily awareness; 3) enhancing self-representations and identity processes in therapy helps mitigate the alienation caused by cenesthetic sensations; and 4) self-diagnoses, whose function is to attribute meaning to bodily sensations, should not be dismissed, even if they appear surprising to the clinician.
Selective mutism is a childhood anxiety disorder characterised by a consistent failure to speak in specific social situations despite intact speech and language abilities in other contexts. The aim of the present study was to examine social functioning in Polish children up to 5.5 years of age, diagnosed with selective mutism, and to evaluate their risk of developmental difficulties, with particular emphasis on socio-emotional functioning. Data were collected using the Adaptation Style Questionnaire developed by Anna I. Brzeziriska and Magdalena Czub, which assesses two domains of social functioning (socialisation and externalising behaviours), and the Concentration Scale developed by Anna I. Brzeziriska, Magdalena Czub, and Konrad Piotrowski. The study included 664 mothers of children aged 3.5-5.5 years with a formal diagnosis of selective mutism. Findings indicate that children with selective mutism demonstrate an elevated risk of developmental difficulties across multiple domains, with the most pronounced deficits observed in socialisation and externalising behaviour. Although heterogeneity in developmental profiles was observed, impairments in socio-emotional functioning appear to be central features associated with increased vulnerability to broader developmental difficulties. These results are consistent with the conceptualisation of selective mutism as a disorder involving significant functional impairment in social contexts and highlight the clinical relevance of socio-emotional competencies. The findings support the need for further research using standardised clinical and diagnostic methodologies to refine understanding of developmental profiles and associated risk factors in children with selective mutism.
Alzheimer’s disease is the leading cause of dementia and represents a growing global health challenge. The disease is neuropathologically defined by extracellular amyloid beta deposits and intracellular neurofibrillary tangles composed of hyperphosphorylated tau protein. However, decades of research demonstrate that these hallmarks alone cannot fully account for the clinical and biological complexity of Alzheimer’s disease. Advanced glycation end-products, formed through non-enzymatic glycation and oxidation of proteins, lipids, and nucleic acids, have emerged as key contributors to neurodegeneration. Advanced glycation end-products accumulate progressively with age, and their formation is intensified by hyperglycaemia and oxidative stress. Their presence has been demonstrated in both senile plaques and neurofibrillary tangles. By irreversibly modifying long-lived proteins, advanced glycation end-products alter their structural and enzymatic properties, promote amyloid aggregation, and predispose tau to hyperphosphorylation. Importantly, their interaction with the receptor for advanced glycation end-products initiates signalling cascades that amplify oxidative stress, inflammation, mitochondrial dysfunction, and synaptic impairment. Beyond their direct neuronal effects, advanced glycation end-products link Alzheimer’s disease with systemic comorbidities such as diabetes, vascular disease, and chronic kidney disease, all of which further increase dementia risk. Clinical studies report elevated levels of advanced glycation end-products in serum, cerebrospinal fluid, and brain tissue of Alzheimer’s disease patients, suggesting their utility as potential biomarkers. Therapeutic strategies, including advanced glycation end-products inhibitors, cross-link breakers, receptor for advanced glycation end-products antagonists, antioxidant compounds, and dietary interventions, are currently under investigation, although their clinical efficacy remains limited. This review highlights the multifaceted role of advanced glycation end-products in the pathogenesis of Alzheimer’s disease, underscores their clinical relevance, and points to future research directions in diagnosis, prevention, and treatment.
Introduction and objective: In recent decades, research has generated a substantial body of clinically relevant knowledge about the effectiveness of psychotherapy and the role of both specific and common therapeutic factors in facilitating change. This article is intended for practising psychotherapists seeking to assess the effectiveness of their clinical work in light of current research. We reflect on what is empirically supported, what remains uncertain, and how to avoid overinterpreting findings when evaluating therapeutic outcomes. Materials and methods: We highlight the need to consider the ontological and epistemological assumptions underlying different research methodologies. We also examine how therapeutic change is defined and measured, emphasising that psychotherapy research is diverse and different studies illuminate various aspects of change in patients with different disorders. We advocate integrating scientific knowledge with clinical judgment and patient preferences, while warning against the uncritical application of guidelines based solely on empirical data. Results: Despite substantial progress, many questions remain open. Hopes are placed in the treatment personalisation and advancement of methods for studying psychotherapy, which – in our view – should always be accompanied by a reflective approach to areas of uncertainty that constitute an inherent element of therapeutic practice. Conclusions: We argue that research provides necessary support for clinical practice, but should be interpreted in light of its methodological limitations, patient characteristics, and the therapist’s personal qualities, which are best understood through self-reflection, personal therapy, and supervision. The capacity to tolerate uncertainty emerges as a key therapeutic competence.
Introduction and objective: This study examines the bodily experience of individuals with schizophrenia, focusing in particular on movement and temporality. The articulation between these experiential dimensions provides evidence for resting-state fMRI research on triple network disturbance, complemented by a phenomenologically informed approach. Materials and methods: Fourteen patients with schizophrenia (PANSS score ≥40) completed a survey with questions addressing their lived experience of temporality and movement. Participants were recruited from the General Psychiatry Unit, Neuropsychiatric Center in Kościan, and the Community Psychiatry and Psychosis Research Center at the Jagiellonian University Medical College in Kraków. Patients were selected through an inclusion criterion of a PANSS score ≥40, mainly experiencing positive symptoms (at least one), and an exclusion criterion of past or present comorbid neurological disease and significant psychiatric comorbidity. Results: A Fisher’s exact test was applied to compare the variables (PANSS score) and the survey items, revealing a significant association between difficulty in abstract thinking and components related to a disturbed sense of agency, the temporal structure of experience, and the integration of bodily experience (p < 0.05). Conclusion: The findings indicate a disruption in the sense of body structure among schizophrenia patients and suggest that this disturbed structure is grounded in temporal and movement experience.
Introduction and objective: The aim of the article is to introduce a Polish adaptation of the Interpersonal Cognitive Distortions Scale (ICDS) created by Hamamc & imath; and B & uuml;y & uuml;k & ouml;zt & uuml;rk in 2004, including psychometric properties of the method. Materials and methods: The survey included 595 participants aged 14-38 (M = 20.02; SD = 4.56), with 73.4% women. Participants completed the ICDS, the Personality Inventory (PID-5-BF+), Adaptive and Maladaptive Perfectionism Questionnaire (Kwestionariusz Perfekcjonizmu Adaptacyjnego i Dezadaptacyjnego, KPAD), and the Multidimensional Measure of Parasocial Relationships (MMPR). Results: Both exploratory and confirmatory analyses were used to verify the internal structure of the ICDS. In the exploratory factor analysis, the original structure was not correctly reflected; a four-factor model appears to be a better fit. In contrast, in the confirmatory factor analysis the model with the best (though still questionable) fit is a four-factor model, but with items of low factor loadings removed, differing in structure from the original model. The model best fitted to the data is one based on the original model with items having low factor loadings removed. The remaining items form a shortened version of the measurement scale, with a similar number of items in the subscales, characterised by good measurement reliability. Conclusions: The indicators of the short form ICDS show that the scale can be used in therapeutic and research processes on cognitive distortions.
Introduction and objective: The growing emphasis on evidence-based practice in psychotherapy has increased the demand for high-quality empirical data supporting treatments for personality disorders. Long-term psychotherapy presents unique challenges in this area, especially in designing and implementing randomised controlled trials. At the conceptual level, these challenges arise from the multiplicity of mechanisms and the complex, time-extended trajectory of change. At the organisational level, such research requires elaborate procedures and substantial financial and human resources. A recent additional difficulty is selecting primary outcomes and appropriate assessment methods amid a field-wide shift from categorical to dimensional models of personality pathology. Materials and methods: This article outlines key considerations in designing and implementing randomised controlled trials evaluating long-term psychotherapy for personality disorders. Results: Four critical domains are discussed: (a) selecting a trial design that is appropriately aligned with the underlying research question, (b) the influence of the theoretical framework on conceptualisations of change and outcome selection, (c) the methodological and clinical implications of operationalising change, including the use of valid, reliable, and theoretically congruent assessment tools, and (d) the impact of procedural decisions on outcome validity – particularly concerning the temporal dynamics of change, early effects, and the divergent priorities of key stakeholders such as patients, clinicians, researchers, funders, and policymakers. Conclusions: The article emphasises the need for pragmatic adaptations that preserve scientific rigour while enhancing clinical and translational relevance. It aims to inform future efforts to develop theory-driven, methodologically sound trials of psychotherapy for personality disorders.
