The Awareness, Courage, and Love (ACL) model of identifying Clinically Relevant Behavior in Functional Analytic Psychotherapy is thought to have enormous potential for enhancing social connection and mitigating loneliness. Informed by the ACL model, non-therapeutic social groups have emerged with the explicit goal of creating connection between members of the group, thus mitigating societal-level loneliness and social isolation. However, little is known about the efficacy or effectiveness of these groups in achieving their goal. In order to enhance understanding of the effects of attending these groups, we conducted two studies investigating ACL group processes and outcomes. In Study 1, 34 participants were randomly assigned to either a six-week ACL intervention group or a control group, where participants watched and discussed meetings. Findings suggested individuals in the experimental group were able to create connection and occasionally engage in essential processes during meetings. However, participants did not seem to generalize the changes to their day-to-day environment. In Study 2, we randomized 36 young adults to either an intervention group or a control group. In Study 2, we enhanced measurement techniques, assessed variables that might interfere with generalizing newly developed skills, and addressed several methodological limitations of Study 1. Findings suggested that behavior changes occurred in the group, and that difficulties in generalizing the newly developed repertoire may be partially explained by participant depression and anxiety. Key words: Functional Analytic Psychotherapy, interpersonal intimacy, loneliness, contextual behavioral intervention, randomized controlled trial.
In Latin America, where child protection services often face resource constraints and systemic delays, the implementation of structured, evidence-based approaches is both challenging and urgently needed. This case study illustrates the implementation of Trauma-Focused Cognitive Behavioral Therapy in Chile with an 11-year-old girl in foster care who presented complex trauma. The aim is to highlight the integration of Trauma-Focused Cognitive Behavioral Therapy with crisis intervention, supportive therapy, and creative expression in a challenging cultural and systemic context. The intervention spanned 25 months. Assessment tools included self-reported measures of depression, anxiety, post-traumatic stress symptoms, and clinical interviews. Creative strategies such as songwriting and audiovisual storytelling were incorporated to construct the trauma narrative and strengthen engagement. During treatment symptoms decreased to non-clinical levels, suicidal ideation resolved, and emotional regulation improved. Despite multiple protective placement changes, systemic delays, and judicial revictimization, the patient achieved greater stability, renewed trust in protective figures, and an increased sense of self efficacy. This case underscores the adaptability of Trauma-Focused Cognitive Behavioral Therapy in real-world contexts and the value of integrating crisis intervention, supportive therapy, and culturally sensitive creative expression.
This article examined how religious orientation and socioeconomic status affect married couples' attitudes toward contraceptive use in Anambra State, Nigeria. A total of 397 married people took part in the study. Descriptive analysis showed a wide age span (Mage= 42.46 years), various lengths of marriage, and a moderate spread in religiosity and socioeconomic class. Pearson correlation analysis showed a significant positive link between religious orientation and socioeconomic class (r= 0.216, p <.01), a small but statistically significant negative link between religious orientation and contraceptive attitude (r= 0.104, p <.05), and a non-significant link between socioeconomic class and contraceptive attitude (r= 0.064). Hierarchical multiple regression analysis was done in three models: Model 1 (demographics) explained 49.4 of the variation in contraceptive attitudes r r2 r2= 0.506; Model 2 (adding religious orientation) raised the explained variation to 54.2, Ar2= 0.037, with religious orientation having a significant negative effect /3 /3= 0.245, p <.001; Model 3 (adding socioeconomic status) bumped the explanatory power further to 59.2, r r2 r2= 0.592, with socioeconomic status positively predicting contraceptive attitude /3 /3= 0.416, p <.001. The results shows that greater religiosity has the tendency to undermine positive views of contraception, but greater socioeconomic resources have the tendency to foster positive views of contraception. The combined influence of religious orientation and socioeconomic status indicates that reproductive health interventions in Nigeria should traverse the nexus of faith and economic context to shape contraceptive perceptions among married couples.
Repetitive negative thinking (RNT) has been identified as a transdiagnostic process that may sustain burnout symptoms in healthcare professionals. This pilot study aimed to evaluate the feasibility and preliminary efficacy of a brief, three-session Acceptance and Commitment Therapy (ACT) protocol focused on RNT, delivered individually via videoconference, in healthcare professionals experiencing burnout. A randomized nonconcurrent multiple-baseline single-case experimental design across participants was employed, with baseline durations randomly assigned and a four-week follow-up phase. Three female healthcare professionals (aged 22-26 years) completed the intervention. Burnout symptoms, RNT, work-related psychological flexibility, valued actions, and emotional symptoms were assessed through daily ecological momentary measures and weekly self-report instruments, including the Maslach Burnout Inventory-General Survey, the Perseverative Thinking Questionnaire, and the Depression Anxiety and Stress Scale-21. Data were analyzed through visual inspection, the Tau-U nonparametric statistic, and a design-comparable standardized mean difference. Daily and weekly assessments showed slight discrepancies in some variables, particularly for one participant; however, clinically relevant improvements were observed across all participants, including reductions in emotional exhaustion, cynicism, RNT, and emotional distress. Effect sizes were large for burnout symptoms, RNT, and emotional symptoms. These findings provide preliminary evidence for the feasibility, acceptability, and potential efficacy of a brief RNT-focused ACT protocol in reducing burnout-related symptoms among healthcare professionals.
The study aimed to identify psychological characteristics associated with susceptibility to alcohol abuse and to analyze the heterogeneity of psychological profiles among military personnel who commit alcohol-related incidents while performing their official duties. The study was conducted between 2022 and 2025, and the respondents were military personnel from the Ukrainian security and defense sector. The total sample consisted of 1,760 participants, including 950 military personnel assigned to a control group characterized by normative behavior and the absence of alcohol-related incidents, and 810 military personnel who had been subject to disciplinary or administrative responsibility for offenses committed while intoxicated. Within the Case Group, several psychologically distinct subgroups were identified, exhibiting varying levels of adaptive potential, self-regulation, motivational characteristics, and resilience to combat-related stress. The results revealed substantial differences between the Control and Case groups. Military personnel without alcohol-related incidents showed a more balanced psychological profile, higher levels of self-regulation, adaptive resources, and intrinsically driven professional motivation. In contrast, the group of military personnel with alcohol-related incidents showed reduced adaptive potential, impaired self-regulation mechanisms, motivational disorganization, and increased emotional tension in the context of accumulated combat stress. The study's findings highlight the heterogeneity of the psychological pathways leading to alcohol-related behavior in wartime, confirming the multidimensionality of the psychological determinants of alcohol-related incidents in combat military personnel. The results support the conclusion that alcohol-related incidents in the military context should not be considered a uniform or merely disciplinary phenomenon, requiring psychological analysis and specific psychological support measures. They also allow for discussion of the practical importance of the study, its possible application to the development of programs for the psychological prevention of addictive behaviors, the promotion of self-regulation, and the maintenance of the psychological resilience of military personnel during prolonged wars.
To evaluate the effectiveness of an 8-week, 30-hour Mindfulness-Based Cognitive Therapy (MBCT) training program in improving mindfulness, reducing perceived stress, and reducing burnout-related outcomes among healthcare professionals. A prospective within-subject study with pre-intervention and 12-week post-intervention assessments. Fifty-one healthcare professionals completed the MBCT program. Participants completed the Maslach Burnout Inventory, the Five Facet Mindfulness Questionnaire (FFMQ), and the Perceived Stress Scale. Course satisfaction, perceived usefulness, and self-reported home practice were also recorded. Participants rated the course highly in terms of both personal and professional utility, with high levels of attendance. Significant improvements were observed in mindfulness facets (Observing, Describing, Non-judging, and Non-reactivity) and in the total FFMQ score at follow-up. Emotional exhaustion and perceived stress decreased significantly. Depersonalization decreased and personal accomplishment increased, although these changes did not reach statistical significance. Overall course evaluation was associated with greater improvements in mindfulness and stress-related outcomes, whereas home practice adherence at follow-up was not significantly associated with outcome changes. MBCT appears to be a feasible and well-accepted intervention to improve mindfulness and reduce perceived stress and emotional exhaustion among healthcare professionals. Standardized MBCT training may be considered for integration into continuing professional education programs.
Conventional approaches often frame low mental health help-seeking as a literacy deficit, viewing traditional beliefs merely as barriers. This overlooks the profound cultural and spiritual significance of local healing practices. Moving beyond the deficit model, this study explores the lived experience of cultural dissonance-the tension arising from navigating competing biomedical and traditional frameworks-and the resulting adaptive strategies. A 12-month integrated qualitative study, combining Critical Ethnography and Interpretative Phenomenological Analysis. Participants (N= 42) included patients, family caregivers, traditional healers (bomoh), and healthcare providers. Data were gathered through 1,200 hours of immersive observation, semi-structured interviews, and visual narrative elicitation. Findings reveal three dimensions of cultural dissonance: Compartmentalized Compliance, where patients lead a double life by presenting a clinical self in biomedical settings and a spiritual village self at home; Semantic Dissonance, the reframing of diagnoses into culturally meaningful terms to preserve identity; and Silent Betrayal, where accepting biomedical treatment is perceived as a transgression of faith or filial loyalty. Resolution occurs primarily through cultural authorization, where trusted authorities (ustaz, bomoh, elders) legitimize medical care within a spiritual framework. Consequently, stigma and non-compliance are often expressions of unresolved dissonance. To be effective, mental health systems must shift from purely educational campaigns toward culturally embedded collaboration, partnering with traditional and religious authorities to create hybrid, acceptable pathways to care.
Psychotherapy has gained social acceptance as a means of providing support during mental health crises. Despite the growing number of publications on psychotherapy for different patient groups, scientific research on therapy for nuns (especially in Poland) remains scarce. The subject remains taboo; many nuns view emotional problems as a sign of weakness and a shameful topic-much like psychotherapy itself. This article therefore highlights significant challenges in therapy with nuns. We conducted a multiple case study to investigate the topic and work towards recurring patterns faced during therapy with such patients. The study is based on work conducted at the Day Treatment Unit for Emotional and Mood Disorders at the University Hospital in Krakow, Poland. Over a tenyear period, we collected and analyzed data from intake interviews and therapy sessions of twelve Catholic nuns (ages 38-53) diagnosed with major depressive disorder or mixed depressive and anxiety disorder. During psychotherapeutic treatment, the therapists mainly used clarification, interpretation, reflection, containment, and confrontation techniques. Our observations highlight the unique nature of resistance and counter-resistance in therapy with nuns, which hinders the establishment of an open therapeutic dialogue. Nuns undergoing psychotherapeutic treatment are a special group of patients due to their social roles. At the same time, however, they are "ordinary" people in terms of the emotions they experience, their daily concerns, crises, and difficulties that manifest in social interactions. Behaviors, reactions to stressful situations, and emotional states that appear to lack an adaptive function are often reinforced by the rules of religious life or develop based on generally accepted principles within the religious congregation. Therefore, the specific nature of therapeutic work with nuns requires consideration of their daily reality. The study revealed significant issues and challenges in the psychotherapy of nuns, underscoring the necessity of further research and exploration in this clinically understudied area in Poland.
Digital gaming has emerged as a form of recreation among adolescents, combining entertainment with interactive learning opportunities. While gaming can foster entertainment and cognitive engagement, excessive use has been linked to academic disruption, emotional dysregulation, and behavioural dependence. The present study aimed to examine the prevalence, patterns, and psychosocial correlates of gaming usage behaviour among Indian adolescents. A cross-sectional survey was conducted among 2,632 adolescents (aged 13-19 years) from schools across India using the Gaming Usage Questionnaire. Descriptive statistics and chi-square analyses were performed to assess associations between gaming duration, gamer typology, interference with daily activities, and emotional experiences. The majority of adolescents identified as casual gamers (61.6%), with 60.9% reporting less than one hour of gaming per day. However, approximately 26.3% indicated interference of gaming with daily life, and 58.4% reported emotional changes associated with gaming. Longer gaming durations and higher gamer typologies (professional/expert) were significantly associated with interference and emotional fluctuation. The findings highlight that while gaming is largely recreational for most adolescents, a subset exhibits patterns suggestive of emerging problematic use. Preventive measures through school-based digital wellness and self-regulation programs are essential to foster balanced and healthy gaming behaviours among adolescents.
This article examines the complex relationships between sex, condom use, and human flourishing; challenging the conventional wisdom that condom use undermines sexual pleasure and intimacy. Drawing on existential and feminist theories, we argue that condoms can empower individuals to navigate the paradox of pleasure and protection, fostering a sense of autonomy, agency, and well-being. We propose a framework that integrates three interconnected concepts: (1) embodied subjectivity, highlighting the intricate relationships between bodily experiences, emotions, and desires; (2) relational ethics, emphasizing the importance of mutual respect, trust, and communication in sexual encounters; and (3) ontological security, exploring the ways in which condom use can provide a sense of safety and security, enabling individuals to engage in sexual activities with greater confidence and pleasure. These three pillars form an integrated system wherein embodied awareness enables ethical relating, which in turn generates ontological security. Thus, creating a cycle that enhances sexual flourishing. While this work is theoretically generalizable across cultural contexts, we illustrate its application through the Nigerian context, where cultural misconceptions about condom use remain particularly salient despite high rates of sexually transmitted infections. We argue that condom use can be a powerful tool for promoting sexual health, autonomy, and human flourishing, and should be celebrated as a responsible and empowered choice.
Psychotic experiences are manifestations involving subclinical alterations in thought and perception that have been associated with adverse mental health outcomes. University students are in a vital transitional stage characterized by high exposure to internal and external challenges, making them a population at greater risk for mental health problems and with a significant prevalence of psychological difficulties. The probability of presenting psychotic experiences is higher in young people; in university populations, their presence has been associated with lower life satisfaction and self-esteem. However, the mechanisms involved in the relationship between psychotic experiences and mental well-being are not clear. To understand this association, it is useful to explore the role of transdiagnostic factors such as psychological inflexibility, which is defined as the rigid dominance of psychological reactions over chosen values and contingencies in guiding action. This study aimed to explore the mediating role of psychological inflexibility between different subtypes of psychotic experiences (paranoid ideation, bizarre experiences, and perceptual anomalies) and mental well-being in a sample of university students. It was found that psychological inflexibility fully mediates the association of psychotic experiences and their subtypes with mental well-being. These results suggest that the presence of psychotic experiences and the use of psychological inflexibility strategies to cope with them are vulnerability factors linked with lower mental well-being. Interventions that encourage psychological flexibility could promote greater mental well-being in university students with psychotic experiences.
This study aimed to perform a cross-cultural adaptation of the English version of the Personalized Psychological Flexibility Index into Turkish (T-PPFI). It was conducted among 604 disaster search and rescue volunteers who participated in the 2023 Kahramanmara & sect; earthquakes in Tiirkiye. Exploratory factor analysis supported a three-factor, 15-item structure, and confirmatory factor analysis indicated good fit for the three-factor model. Convergent and divergent validity were supported by a positive correlation with the Comprehensive Assessment of Acceptance and Commitment Therapy Processes (CompACT) and negative correlations with the Acceptance and Action Questionnaire-II (AAQ-II) and the Depression Anxiety and Stress Scales-21 (DASS-21). The T-PPFI showed acceptable internal consistency (total score a= .727; w= .712) and high test-retest reliability over 14 days (r= .962). Gender measurement invariance analyses supported comparability of T-PPFI scores across men and women. Hierarchical regression analyses provided evidence for the incremental validity of the T-PPFI beyond AAQ-II and CompACT in predicting DASS-21 outcomes, and higher-order EFA supported construct-level discriminant validity. The findings suggest that the 15-item T-PPFI is a reliable and valid measure of psychological flexibility in Turkish disaster search and rescue volunteers.
Few empirical studies have examined adolescent mental health in Central Asia, and data from Uzbekistan are especially scarce. This study aims to assess the prevalence of stress, anxiety, and depression among adolescents and to investigate the impact of school climate on their mental health. This research employed a quantitative survey approach. A total of 22,854 adolescents aged 12-18 across 299 schools in urban and rural areas of Uzbekistan were surveyed. The findings indicate that a considerable proportion of students showed elevated levels of stress (16%), anxiety (22%), and depression (18%), which is consistent with similar studies in other countries. Moderate negative correlations were observed between these levels and perceptions and attitudes towards teachers, peers, social connectedness, and exams. In the context of ongoing reforms in Uzbekistan, the findings provide an empirical baseline for designing school-based interventions and offer a broader understanding of adolescents' mental health in non-Western contexts.
Stroke is a major cause of morbidity and mortality, often resulting in long-term complications. Post-stroke depression, anxiety, and adjustment disorder are common psychiatric conditions that affect recovery and quality of life. This prospective study examined the incidence of depression and anxiety during the first year after stroke, with attention to demographic, functional, and stroke-related risk factors. A total of 69 stroke patients were followed at Ibn Rochd University Hospital in Casablanca at 1-, 3-, 6-, and 12-months post-stroke. Depression and adjustment disorders were diagnosed using the Mini International Neuropsychiatric Interview (MINI), and anxiety was assessed with the Hamilton Anxiety Scale. Functional and cognitive outcomes were evaluated using the National Institutes of Health Stroke Scale, Modified Rankin Scale, Instrumental Activities of Daily Living scale, and Mini-Mental State Examination. Depression affected 13% of patients at one month, decreasing over time. Anxiety was observed in 14.5% of patients at one month and was associated with cognitive decline (p <.001). Adjustment disorder was diagnosed in 11.6% of patients, particularly among those with major functional dependency (p= .005). These findings underscore the burden of psychological complications following stroke and emphasize the importance of early screening and psychological/ psychiatric intervention to enhance recovery and quality of life.
Perspective-taking is a social skill that allows an individual to put themselves in another's place and understand how that person would act in a given situation. Previous research has shown that various populations-including people with intellectual disabilities-may experience difficulties deploying this skill. From a behavioral perspective, this repertoire emerges from a set of learned relations among stimuli that enable the individual to locate themself in relation to other people, places, or points in time. Relational Frame Theory proposes that deictic and hierarchical frames underlie this ability. The present study introduces a training protocol designed to teach responses to deictic and hierarchical discriminations through a series of activities carried out in a naturalistic context with three adults with Down syndrome. The results showed that all three participants improved their performance on the trained discriminations. The study provides exploratory evidence supporting the utility of teaching deictic and hierarchical relations-using differential reinforcement and various types of prompts and aids-for learning complex perspective-taking skills in individuals with cognitive developmental difficulties.
The aim of the study was to assess the role of four interrelated core behavioral patterns related to psychological distress, framed under the term psychological inflexibility by the principles of Acceptance and Commitment Therapy, in predicting clinical problems related to anxiety, depression and stress. To attempt said purpose a study based on discriminant analysis was conducted using a total sample of 372 participants. A series of psychometric instruments were employed to subdivide the total sample in clinical and non-clinical groups, and to assess each pattern. Depression, Anxiety and Stress Scale, Cognitive Fusion Questionnaire Argentine Version, Acceptance and Action Questionnaire-Argentina Version, Pennsylvania State Worry Questionnaire, and Valuing Questionnaire. The results suggest a complex inflexibility pattern in the case of depression, in which every measure of core behavioral pattern proved relevant in the task of discriminating clinical from non-clinical cases, with strong emphasis on the role of Experiential avoidance and values measures. On the other hand, strong similarities were found in the stress and anxiety models, characterized by a similar pattern in which Cognitive fusion and Worry measures demonstrated greater relevance, leaving the rest of the measures out of the discriminant function.
Sleep disorders among healthcare workers, often underestimated, significantly impact their physical and mental well-being and professional performance. The current study aims to assess their frequency, consequences, and associated factors. Interns and residents from a Moroccan university hospital participated in an assessment of sleep quality (Pittsburgh Sleep Quality Index-PSQI) and the impact of shifts on their professional and personal lives. Among the 238 surveyed physicians, 62.2% presented a pathological PSQI score (PSQI >5) with an average of 6.68. Prevalent issues included poor daytime function (44%), sleep duration (27.7%), subjective sleep quality (24.4%), sleep latency (23.5%), sleep disturbances (19.3%) and use of sleep medication (15%). While 59.2% experienced impaired professional performance due to poor sleep quality. After shift, 83.7 % felt fatigue, 57.1% headaches, and 35.3% reported diffuse pain. Mood disorders affected 56.3%, and psychological symptoms affected 65.5%. These percentages illustrate the negative impact of stress and fatigue related to shifts on physician's mental health, exacerbated by coffee use (56.3%) and smoking (10.9%). The current study highlights the high prevalence of sleep disorders among healthcare workers and suggests a potential link between sleep health and professional performance among interns and residents in developing countries.
This study analyzes the psychometric properties of the Spanish adaptation of the Relational Abilities Index (RAI) among university students in Mexico. The study employed a version of the RAI consisting of 128 items distributed across eight types of relational responses. The study evaluates its concurrent validity by calculating the relationship between relational abilities and intelligence, measured through the Wechsler Adult Intelligence Scale IV (WAIS-IV) and the G Factor test. The sample consisted of 40 university students, selected through non-probabilistic sampling. Results indicated moderate correlations between RAI scores and WAIS-IV subscale scores, particularly with visuospatial and abstract reasoning skills. Analyses of internal consistency of the RAI yielded a high Cronbach's alpha coefficient, although split-half reliability was low, suggesting a need to review item homogeneity. This study provides preliminary evidence on the validity and reliability of the RAI in a Mexican context, pointing out the importance of adjusting item difficulty and discrimination to enhance psychometric accuracy. Implications for the assessment and training of relational skills in educational and clinical settings are discussed.
The affect-as-information hypothesis states that negative mood results in a more analytic and positive mood in a more heuristic processing style. Evidence comes from a wide range of research areas, e.g., on memory or person perception. Studies on implicit learning, however, are scarce and evidence mixed. Therefore, the present study examined the influence of mood on implicit sequence learning and the formation of explicit knowledge. An incidental sequence learning task was used during which negative, neutral, and positive background pictures were used to induce mood states in three groups of participants. Consistent with the affect-as-information hypothesis, the results show that a less positive mood resulted in more explicit sequence knowledge. In contrast, positive mood did not enhance implicit learning. It is speculated that implicit regularity learning as an automatic by-product of task processing might be less susceptible to affective processing biases than other, more complex types of cognitive processing.
The aim of this study was to determine the feasibility and preliminary efficacy of online-delivered paradoxical intention therapy (PI) among adults with insomnia symptoms and high sleep effort. A two-arm randomised controlled trial was conducted. Twenty-six adults (18-54 years) were randomly allocated to receive either PI (n= 13) or sleep hygiene instructions (n= 13). PI sessions were delivered via the Internet across two hour-long sessions over two weeks whereas sleep hygiene instructions sessions were one-off. Participants completed 5 consecutive days of wrist actigraphy and sleep diary, the Glasgow Sleep Effort Scale (GSES), Pittsburgh Sleep Quality Index (PSQI) and Patient Health Questionnaire (PHQ-9) at baseline, post-intervention (2 weeks) and follow-up (1 month). Thirtyfive adults of the 46 recruited (76%) presented with insomnia symptoms and high sleep effort. The randomised participants who persisted with the study (n= 24) showed good adherence (85%-100%) throughout the intervention and follow-up periods. Significant reductions were observed on the GSES indicating the role of PI in reducing sleep effort. Findings also show that PI significantly improved self-reported sleep parameters (sleep onset latency, wake after sleep onset, sleep efficiency), and sleep quality measured by PSQI, yielding moderate to large effect sizes. Preliminary findings indicate that PI is a feasible, standalone psychological intervention for insomnia symptoms that can be administered successfully via the Internet. Future trials are needed to address the sustained efficacy of online PI on both objective and self-reported sleep quality, sleep effort and depression outcomes.
