OBJECTIVES:Theoretical models implicate social anxiety and worry as potential drivers of paranoia; however, it is unknown which aspect of anxiety relates more strongly to paranoia, whether these relationships differ in clinical versus non-clinical populations and how these variables relate to one another over time. METHODS:143 schizophrenia spectrum disorder (SSD) and 89 non-clinical comparison (NCC) participants completed assessments of worry (Dunn Worry Questionnaire), social anxiety (Liebowitz Social Anxiety Scale) and paranoia (Revised-Green Paranoid Thoughts Scale). A subset (72 SSDs; 66 NCCs) completed longitudinal assessments over 6 months. Hierarchical regression was used to analyze the relative contribution of worry and social anxiety on paranoia severity within each group, for cross-sectional and longitudinal analyses. RESULTS:Worry, social anxiety, and paranoia were significantly elevated in SSD and intercorrelated. In NCCs, social anxiety accounted for more variance in paranoia than worry (16% vs. 3% in R2-change), but in SSDs, worry accounted for more variance in paranoia than social anxiety (14% vs. 5% R2-change). Longitudinal associations followed a similar pattern. In NCCs, change in social anxiety explained more variance than change in worry (18.5% vs. 6%), and in SSDs, change in worry explained more variance than change in social anxiety (26.5% vs. 0.5%), with social anxiety not adding meaningful variance to paranoia severity, above and beyond worry. DISCUSSION:Social anxiety and worry are both highly relevant for paranoia. In sub-clinical samples, paranoia may be more related to social anxiety, whereas worry may relate more to paranoia in clinical samples. These findings can inform intervention.
OBJECTIVE:AI chatbots are increasingly becoming a first common point of mental health disclosure for adolescents, suggesting a potential 'Step 0' within stepped-care pathways prior access to professional help. This study examined how daydreaming styles and self-compassion relate to adolescents' disclosure of inner thoughts to an AI 'listener', and whether these psychological processes differ among young people with ADHD, for whom spontaneous mind wandering and attentional control difficulties may be especially salient. DESIGN:A large-scale cross-sectional online survey was conducted with adolescents and young people from the United States and Hong Kong. METHODS:Participants were 2115 adolescents with and without ADHD identification. Structural equation modelling was used to test hypothesized pathways between daydreaming styles, self-compassion and AI disclosure with multi-group analyses (ADHD vs. peers). RESULTS:Youth with ADHD differed markedly from their peers in daydreaming styles and self-compassion. Pathways from daydreaming styles to AI disclosure also differed by ADHD status. Self-compassion showed context-dependent associations. Among youth with ADHD, higher self-compassion predicted reduced AI disclosure. In the general population group, self-compassion amplified disclosure associated with positive-constructive daydreaming, while constraining disclosure linked to guilty-dysphoric daydreaming and poor attentional-control daydreaming. CONCLUSIONS:Self-compassion and daydreaming styles jointly influence adolescents' tendencies to disclose mental health-related experiences to AI chatbots, with substantially different patterns among youth with ADHD. These findings suggest that AI-based 'Step 0' disclosures should be interpreted within stepped-care models with attention to individual differences and neurodiversity. Tailored, neurodiversity-informed approaches may be needed when integrating AI disclosure into youth mental health support pathways.
OBJECTIVES:People who hear voices commonly experience high levels of shame. This study builds on evolutionary theories by investigating how feelings of shame are associated with the nature of the voice-person relationship. Researchers aim to understand whether increased feelings of external shame are associated with voice-hearers adopting a subordinating relationship to the voice(s), assigning the voice a higher social rank. The research also explored whether voice content, operationalized as the ways in which voices address the person (e.g. making requests, demands, forbidding actions, asking questions), is associated with this relationship as a potential mediator. METHODS:The study implements a cross-sectional design, using an online survey. Fifty-six voice-hearers completed a series of questionnaires related to voice-hearing, external shame and perceived social rank, along with additional control variables online or via the telephone. RESULTS:After controlling for confounders, external shame was significantly associated with perceived social rank, with higher levels of external shame corresponding to a lower perception of one's own social rank compared with the voice. Results did not suggest that voice content mediates this relationship. CONCLUSIONS:Findings align with evolutionary theories on shame in voice-hearers and build on previous research by offering greater specificity in understanding the relationship between external shame and social rank, suggesting that interventions targeting external shame may be relevant, while future longitudinal research is needed to clarify the direction of the association. However, the cross-sectional study design precludes conclusions about directionality or causality, and self-selecting recruitment may limit the generalizability of results.
BACKGROUND:Adolescence is a period of heightened vulnerability to depression, particularly in females. Motivational deficits are a hallmark of depression, yet the cognitive mechanisms underlying impaired effort-based decision-making (EBDM) in female adolescents remain poorly understood. Computational psychiatry addresses this by fitting mathematical models to behavioural data and extracting latent parameters, offering a more mechanistic view. METHODS:This study used computational modelling to investigate the distinct effects of apathy and anhedonia on effort-based decision-making in adolescent girls with depression. Thirty-two adolescent girls with depression and 33 matched healthy controls performed a physical effort-based decision-making task. Participants accepted or rejected to exert different levels of physical effort to obtain different magnitudes of rewards or to avoid loss. Group differences were analysed utilizing a hierarchical Bayesian discounting model. RESULTS:The depression group exhibited a significantly reduced willingness to exert effort to obtain rewards, reflected by a lower accept rate and longer response time compared to the healthy control group. In line with this, the discounting model showed that the depression group had a higher effort sensitivity. Moreover, in the healthy control group, higher apathy levels were associated with a lower accept rate, whereas no such associations were observed for anhedonia; in the depression group, no significant associations were found for either apathy or anhedonia. CONCLUSIONS:This study identifies a computational signature of motivational deficits in female adolescent depression, characterized by oversensitivity to effort expenditure and modulated by apathy severity. By focusing on female adolescents, our findings highlight sex-specific mechanisms underpinning vulnerability to depression.
OBJECTIVES:The feared self-concept, the self that a person fears they may be or could become, has been increasingly shown to drive the development and maintenance of obsessive-compulsive disorder (OCD). It is proposed that the feared self develops from a vulnerable self-concept, which itself is a result of normative self-concept development being disrupted by negative early life experiences. However, it is currently unclear which experiences lead to the development of vulnerable self-concept in people with OCD. This study aimed to describe the events and life experiences that people with OCD report as influential in the development of their vulnerable and feared self-concepts. METHODS:Sixteen participants with OCD participated in semi-structured interviews. Reflexive thematic analysis was used to analyse interview transcripts. RESULTS:Traumatic experiences and rejection shaping self-concept were generated as major themes. Subthemes of traumatic experiences included early abuse informs the corrupted feared self, harassment fosters a feared self, and parental neglect informs the manifestation of the culpable feared self. Subthemes of rejection included interpersonal betrayal instigates self-doubt, not living up to parental expectations instigates self-doubt and parental neglect fosters vulnerable self-concept. These findings suggest that, for individuals with OCD, traumatic and rejection experiences were integrated into their self-concept resulting in its vulnerability and taking on feared aspects. CONCLUSIONS:These findings may be able to inform future research investigating prevention and treatment strategies that focus on the identification and treatment value of traumatic and rejection experiences.
BACKGROUND:Eating disorder (ED) symptoms and mental wellbeing are related but distinct dimensions of mental health. However, little is known about their longitudinal relationship, which is essential for understanding prevention and intervention targets. This study examined temporal relationships between ED symptoms and mental wellbeing over 12 months in young women, including which wellbeing dimensions (psychological, emotional, social) most strongly predicted ED symptoms. DESIGN AND METHODS:Young women (n = 552) completed measures of ED symptoms and mental wellbeing at three timepoints over 12 months. Latent growth curve and cross-lagged panel models examined change trajectories and temporal dynamics. RESULTS:ED symptoms and mental wellbeing showed moderate baseline correlation (16% shared variance) with 86% of change trajectories operating independently. Cross-lagged analyses revealed asymmetric bidirectional relationships: ED symptoms predicted wellbeing (T1 → T2: β = -.10, p = .039), then wellbeing predicted ED symptoms (T2 → T3: β = -.14, p = .001). Only psychological wellbeing showed bidirectional relationships with ED symptoms. CONCLUSIONS:In young women, ED symptoms predicted subsequent reductions in mental wellbeing, which in turn predicted later symptom worsening. Mental wellbeing, particularly psychological wellbeing, may therefore contribute to symptom persistence if depleted. The findings suggest that mental wellbeing and its relationship to ED symptoms may warrant consideration alongside symptom reduction in research and intervention contexts.
OBJECTIVES:Internet-delivered cognitive-behavioural therapy (ICBT) is demonstrated to be an effective treatment for obsessive-compulsive disorder (OCD). However, not all individuals who commence ICBT respond well to treatment and thus understanding predictors of outcome is crucial for informing best-practice treatment planning. The aim of this study was to provide a preliminary synthesis of predictors of treatment outcomes of ICBT for OCD. METHODS:Eight studies (n = 1010; mean age range 30.05-37.08 years; 54.0%-78.3% female) were included in this review. Predictors of 1) post-treatment severity, 2) post-treatment change score and 3) post-treatment remission were examined. RESULTS:Based on the available data, significant predictors of post-treatment severity included age, baseline OCD severity, baseline responsibility/checking symptoms, baseline ordering/symmetry symptoms, baseline avoidance, working alliance, past psychological treatment, disgust severity and change in depressive symptoms. For post-treatment change score, significant predictors were baseline OCD severity, motivation to reduce avoidance, baseline incompleteness, working alliance, engagement with a clinician, baseline depression severity, pharmacotherapy use and disgust severity. Finally, for responder status, significant predictors included age, motivation to reduce compulsions, engagement with a clinician and past psychological treatment. CONCLUSIONS:While preliminary, these findings contribute to the emerging literature on predictors of ICBT treatment outcomes for individuals with OCD. However, given the limited literature, future research is necessary to replicate and build on these findings.
BACKGROUND:Although vulnerability factors for cognitive impairment in older adults are well established, the influence of early psychological factors, such as the quality of parental bonds in early childhood, on later-life cognitive performance has been little studied. This study assessed the associations of the quality of perceived maternal and paternal bonding elicited at baseline with subsequent cognitive complaints and objective cognitive performance in older adults after adjustment for sociodemographic characteristics, anxiety or major depressive disorders, and personality traits. METHODS:For this prospective analysis we used data from 943 participants of the population-based CoLaus|PsyCoLaus cohort who had completed the Parental Bonding Instrument (PBI) at baseline, and who participated in the first psychiatric evaluation after the age of 65 years involving the completion of a cognitive complaint questionnaire and an objective cognitive exam. Linear regression models were applied to assess the associations of parental bonding quality categories according to the combination of the three dichotomized PBI dimensions with the presence of reported cognitive complaints and measured cognitive performance. RESULTS:Individuals who rated their maternal bonding as least appropriate, characterized by low care, high denial of autonomy and low encouragement of behavioural freedom, reported cognitive complaints more frequently than those who had rated their maternal bonding as most adequate after multiple adjustments. Such an association was not found with respect to paternal bonding. Moreover, parental bonding was not associated with objective cognitive performance. CONCLUSION:Perceived maternal bonding may influence perceived cognitive abilities later in life, but not objective cognitive performance.
OBJECTIVES:Parental health literacy is an important issue in paediatric chronic disease, but its role in attention deficit hyperactivity disorder (ADHD) treatment remains underexplored. This study aimed to investigate health literacy levels among parents of children diagnosed with ADHD and to evaluate the relationships between these levels, parents' decisions to accept or refuse pharmacotherapy for their children's ADHD treatment, and their children's ADHD symptoms. DESIGN:A total of 133 children with ADHD and their parents (mothers and fathers) participated in this single-centre observational study. Participants were divided into two groups: Group 1 (n = 68): parents who accepted pharmacotherapy and their children who started treatment; Group 2 (n = 65): parents who refused pharmacotherapy and their children who did not start treatment. METHODS:Parental health literacy was assessed using the European Health Literacy Survey Questionnaire (HLS-EU-Q), and ADHD children's clinical characteristics were evaluated using the Conners' Parent Rating Scale-Revised/Long (CPRS-R/L) and the Clinical Global Impression (CGI) Scale. RESULTS:Both groups had similar sociodemographic characteristics and maternal and paternal health literacy levels. In Group 1, positive correlations were found between maternal and paternal health literacy indices, as well as between CGI-I and many subscales of the CPRS-R/L (change scores = post-treatment-pre-treatment). Additionally, in Group 1, relationships were identified between maternal and paternal health literacy indices and many subscales of the CPRS-R/L (pre-treatment/post-treatment/change scores), but no relationships were found between these indices and CGI-I scores. CONCLUSIONS:These findings may suggest that assessing parental health literacy and promoting interventions to improve it could be helpful in the management of paediatric ADHD treatment.
OBJECTIVE:The therapeutic alliance is an important part of psychotherapy, with a breakdown in the alliance negatively impacting therapy outcomes. This review aimed to synthesize qualitative studies exploring both therapist and client lived experiences of alliance ruptures in therapy. METHODS:Four databases (MEDLINE, CINAHL, APA PsycInfo, Web of Science) were systematically searched for relevant studies. Qualitative, peer-reviewed studies written in English were included. Findings of the included studies were synthesized using Thematic Synthesis. GRADE-CERQual was used to assess confidence in the findings. RESULTS:Ten studies were included in the synthesis and assessed using the Critical Appraisal Skills Programme. Thematic Synthesis resulted in three themes: (1) Experiencing ruptures as threats to relational safety, trust and hope; (2) Making sense of ruptures; and (3) Rupture repair as strengthening the alliance and developing a shared understanding. CONCLUSION:Findings highlighted that ruptures are experienced by both therapists' and clients' as embodied, emotionally charged threats to relational safety, trust and hope for therapy. It was also seen as important for therapists to regulate their own emotions and maintain reflexive capacity. Overall, it was found that rupture and repair can result in therapeutic change.
OBJECTIVES:This pilot randomized controlled trial (RCT) evaluated feasibility, acceptability, and preliminary clinical benefits of ACTCOM-I, a novel intervention combining Acceptance and Commitment Therapy with behavioural strategies and self-compassion, compared with CBT-I. METHODS:An analytic sample of 19 participants (63% women; M = 43.26 years, SD = 12.77) with chronic insomnia was randomized to ACTCOM-I (n = 10) or CBT-I (n = 9). Assessments occurred at baseline (T0), post-treatment (T1), 3-months (T2) and 6-months (T3) follow-ups. Measures included insomnia severity, beliefs, pre-sleep arousal, sleep effort, sleep diary, anxiety/depression, affect, quality of life, mindfulness, psychological flexibility, cognitive fusion, progress/obstructions to valued living, and self-compassion. RESULTS:Linear mixed models showed significant Time effects for insomnia severity (p < .001), with large within-group effect sizes maintained at follow-up. No significant between-group differences were found (p = .88), indicating similar improvement trajectories over time. Reliable change analysis (RCI) confirmed that 90% of ACTCOM-I and 89% of CBT-I participants achieved clinically significant improvements at post-treatment, with high response and remission rates. No participants deteriorated. Both interventions also led to comparable improvements in secondary sleep-related outcomes, anxiety/depression, and positive affect, while negative affect remained stable. Most process-related measures showed significant Time effects but no TimeXGroup interactions, further supporting similar patterns of change. Within-group analyses suggested greater improvements in psychological flexibility, cognitive fusion, obstructions to valued living and self-compassion in ACTCOM-I, particularly at follow-up. Despite high attrition, ACTCOM-I was feasible, well-accepted, and thematic analysis identified six overarching themes. CONCLUSIONS:Results suggest that ACTCOM-I is feasible, well-accepted, and preliminary findings support further studies on its potential as a complementary treatment to chronic insomnia.
OBJECTIVES:Difficulties in emotion regulation are well-established correlates of depressive symptoms, yet the role of resilience in these associations remains unclear. This study examined whether the relationship between emotion regulation and depressive symptoms differs across levels of resilience and whether this pattern varies across specific domains of emotion regulation. DESIGN:Cross-sectional study examining interactions between emotion regulation and resilience in relation to depressive symptoms during late adolescence and young adulthood. METHODS:2155 individuals (ages 17-23) completed measures of emotion regulation, resilience and depressive symptoms. The Difficulties in Emotion Regulation Scale (DERS-SF) and the Emotion Regulation Questionnaire (ERQ) were used to assess multiple domains of emotion regulation. Models controlled for age, sex and shared variance across emotion regulation constructs, with correction for multiple comparisons. RESULTS:Resilience was associated with differences in the strength of the relationship between emotion regulation and depressive symptoms. Across all DERS-SF subscales and the total DERS-SF score, the association between emotion regulation difficulties and depressive symptoms was stronger at lower levels of resilience. A similar pattern was observed for cognitive reappraisal, whereas expressive suppression did not show a significant interaction. Interaction effects across DERS-SF domains were similar in magnitude, while cognitive reappraisal showed the strongest association. CONCLUSIONS:Findings indicate that the association between emotion regulation and depressive symptoms varies across levels of resilience. These results highlight the importance of considering both general emotion regulation difficulties and broader adaptive capacities when examining variability in depressive symptoms during late adolescence and young adulthood.
INTRODUCTION:This is the first clinical pilot to explore the feasibility, acceptability and preliminary efficacy of imagery rescripting in individuals with a diagnosis of generalized anxiety disorder (GAD). METHODS:Participants with GAD (N = 18) attended assessment and 10 weekly sessions of imagery rescripting with a psychologist in person or via Telehealth. The protocol was based on Arntz's phased protocol and common rescripting procedures with adaptations to target the future orientation of worry. Measures of trait worry and GAD symptoms were administered pre-baseline (before a two-week baseline monitoring period), pre-, mid- and post-treatment, and at 3-month follow-up. RESULTS:As hypothesized, linear mixed models revealed large change over time between baseline and post-treatment on all measures (PSWQ: d = -1.18; GAD-7: d = -1.04; PHQ-9: d = -.79), and no significant change in these measures between baseline and pre-treatment. Results were maintained at follow-up. Change in PSWQ and GAD-7 scores were clinically and reliably significant for over half the sample (59% and 53%, respectively). On a measure of credibility of the intervention completed after the first session, participants reported a mean score of 36.34 (SD = 6.38) out of 45. On a measure of patient satisfaction post-treatment, participants reported a mean score of 8.94 (SD = 1.35) out of 12, indicating high credibility and satisfaction. No adverse experiences were reported. CONCLUSIONS:This pilot provides evidence that imagery rescripting is feasible and acceptable and improves symptoms of anxiety and worry in individuals with GAD. Future studies should evaluate the intervention in a randomized controlled trial.
OBJECTIVES:The purpose of this study was to examine the extent to which the primary mechanisms implicated in leading models of Generalized Anxiety Disorder (GAD) (i.e. cognitive avoidance, metacognitive beliefs and intolerance of uncertainty) uniquely predict reassurance seeking and other behaviours associated with worry (e.g. checking and avoidance). We hypothesized that each of these mechanisms would uniquely contribute to higher levels of reassurance seeking and other worry behaviours. We also hypothesized that all three mechanisms would interact to predict the highest levels of these behaviours. METHODS:Undergraduate students (N = 204) who self-reported high levels of worry on the Penn State Worry Questionnaire were administered measures of cognitive mechanisms implicated in GAD (Cognitive Avoidance Questionnaire, Metacognitions Questionnaire, Intolerance of Uncertainty Scale), reassurance seeking (Covert and Overt Reassurance Seeking Inventory) and worry-related safety behaviours and avoidance (Worry Behaviours Inventory). Hypotheses were tested via multiple regression. RESULTS:Consistent with the first hypothesis, cognitive avoidance and intolerance of uncertainty uniquely predicted reassurance seeking and worry behaviours; however, metacognitions significantly contributed to reassurance seeking only. Exploratory analyses using the Worry Behaviours Inventory subscales (avoidance vs. safety behaviours) as outcomes demonstrated that the effects of some mechanisms depended on the type of behavioural strategy. Contrary to the second hypothesis, there was no evidence of interactions among the predictors. CONCLUSIONS:All three of the main theorized mechanisms of GAD were sufficient to predict reassurance and at least one type of worry behaviour. Future directions and clinical implications that follow from the results are highlighted.
BACKGROUND:Contentious debate persists over whether the stigma of borderline personality disorder (BPD) stems from the diagnostic label itself or the behaviours commonly associated with it. At the same time, it remains unclear whether old age identities exacerbate such stigma, raising concerns surrounding the quality of care experienced by the burgeoning population of older adults-both diagnosed and undiagnosed-presenting to mental health services with BPD symptoms. METHOD:Using a 2 × 2 between-subjects experimental design, participants were randomized equally to one of four conditions varying by age (27 vs. 70 years) and diagnostic label (BPD vs. no diagnosis). The study used two-way independent-measures ANOVAs to examine 242 clinical psychology trainees' treatment beliefs, as well as their cognitive, emotional and behavioural reactions to a vignette character presenting with BPD symptoms. RESULTS:Contrary to expectations, participants reported more favourable treatment beliefs about patients with a BPD diagnosis relative to undiagnosed patients with identical BPD symptoms, as indicated by more positive beliefs about their therapeutic relationships, and more conviction in their treatability. Additionally, participants anticipated that they would exhibit more infantilising behaviours (i.e., child-like speech patterns) toward older adult patients than toward younger patients, independent of diagnostic label. CONCLUSIONS:A BPD diagnostic label can improve clinical psychology trainees' expectations about the treatability of affected individuals and may have a positive influence on beliefs about the therapeutic relationship with younger adult patients in particular. Thus, the label may now be less stigmatising among current clinical psychology trainees compared to previous generations.
OBJECTIVES:This study examined real-time, unobtrusive accounts of suicidal distress shared by online forum users and developed a process framework to advance understanding and inform prevention efforts. DESIGN:A large pro-choice suicide discussion forum (150,000+ users) was selected to capture and analyse contemporaneous accounts of the suicide process, offering real-time, anonymous and minimally filtered disclosures less influenced by recall bias than retrospective interviews. METHODS:A directed qualitative content analysis was conducted on publicly available posts (N = 526) describing suicidal distress or behaviour, categorizing content into current states (e.g. ideation, action), associated emotions and motivations. RESULTS:The Cyclical Model of Suicide (CMS) emerged as a non-linear, bidirectional framework characterized by non-sequential state transitions and recurrent movement. The model includes six states (non-suicidal distress, suicidal ideation, ambivalence, resolution, suicide in progress and recovery), a Reversal mechanism (regression to prior states) and 'incident drivers' (triggering shifts to higher-distress states and contributing to recurrence and state-bypassing). CONCLUSIONS:This study offers four insights. First, it uses in-the-moment accounts to propose a process-oriented framework rather than relying on retrospective reports. Second, it highlights recurrence language, with users describing experiences as cyclical. Third, it captures Reversal as a short-term shift away from action. Finally, it emphasizes the use of anonymous pro-choice suicide online spaces for venting and support before suicidal desire crystallizes into intent, highlighting that many users may be turning to these platforms instead of traditional therapeutic settings.
OBJECTIVE:Ultra-brief treatments (i.e., three or fewer sessions/modules) are associated with reductions in depression and anxiety symptoms, though the mechanisms underlying their effects are unclear. Research has yet to compare how perceptions of treatment credibility and outcome expectancy (i.e., how suitable and effective the treatment will be) may differ between ultra-brief and standard-length digital treatments. METHODS:In a secondary analysis of a randomized controlled trial (N = 152), the current study examined the distribution of credibility and expectancy prior to receiving either an ultra-brief or standard-length digital transdiagnostic treatment based on cognitive behaviour therapy and explored whether these variables predicted improvement in anxiety or depression symptoms. RESULTS:There were no differences in how credible and effective participants perceived the two treatment options. In binary logistic regressions, higher credibility and expectancy were associated with greater odds of experiencing a clinically meaningful improvement (≥ 30% reduction) in anxiety (credibility OR = 1.68 [95% CI 1.15, 2.44]; expectancy OR = 1.50 [95% CI 1.11, 2.02]) and depression symptoms (credibility OR = 1.45 [95% CI 1.02, 2.05]; expectancy OR = 1.34 [95% CI 1.03, 1.76]) for the standard-length treatment only. The predictive value of these two variables diminished when they were entered into the models together, highlighting their conceptual overlap. Findings also indicated a potential moderating role for treatment preference. CONCLUSION:Credibility and expectancy predict treatment outcomes for standard-length digital treatment. Their influence on outcomes in ultra-brief digital treatment is unclear and further research with larger samples is warranted.
OBJECTIVES:Insomnia is associated with mental ill health, worry and rumination-the two latter contribute to pre-sleep cognitive arousal. These variables also associate with psychological inflexibility, including cognitive fusion (CF), a literal attachment to unhelpful thoughts, patterns and rules. Good sleepers generally have low CF, good sleep hygiene and a belief in sleep control, but individuals high in CF may have unhelpful beliefs about sleep hygiene and sleep control. METHODS:We investigated associations between CF, sleep hygiene and sleep control, hypothesizing that each would contribute significant variance to insomnia and mediate the relationship between CF and insomnia. RESULTS:Participants were 411 adults (Mage = 45.9 years, SD = 15.6) completing an online survey including demographics, and questionnaires about insomnia (ISI), CF (CFQ), sleep hygiene (SHS) and sleep control (BRISC). Hierarchical regression accounted for 34% of variance in insomnia (p < .001), showing that after controlling for demographic variables, CF, sleep hygiene and sleep control each accounted for significant variance in insomnia, with sleep control the strongest predictor (β = -.304). Parallel mediation modelling accounting for 22.2% of variance in insomnia (p < .001) showed both sleep hygiene and sleep control partially mediated the CF and insomnia relationship. CONCLUSIONS:Our study shows for the first time that CF, sleep hygiene and sleep control beliefs are inter-related in their impact on insomnia. As CF is a core component of psychological inflexibility, ACT plus behaviour therapy (ACT-I) may be a more suitable insomnia intervention than CBT plus behaviour therapy (CBT-I) for some people.
OBJECTIVE:Our systematic review and meta-analysis aimed to investigate how Cognitive-Behavioural Therapy (CBT) performs against control conditions, such as waiting-list, self-help interventions, psychological and pill placebos and treatment as usual (TAU) in Bulimia Nervosa (BN) and Binge Eating Disorder (BED). METHODS:We systematically searched MEDLINE, Embase, PsycINFO, Cochrane CENTRAL, WHO ICTRP, ClinicalTrials.gov for randomized controlled trials (RCTs) comparing CBT to any control condition, in patients with BED and BN. Analyses employed random-effects models, calculating risk ratios (RR) for dichotomous outcomes, weighted mean differences (MD) for continuous outcomes and standardized mean differences (SMD) when scales varied. The primary outcomes were remission and binge eating frequency. Subgroup and sensitivity analyses assessed robustness. RESULTS:42 RCTs (2807 participants randomized) were included. CBT demonstrated superiority over waitlists in achieving remission (RR = 3.21, 95% CI: 2.15; 4.81) and in reducing binge-eating frequency (SMD = -.88, 95% CI: -1.08; -.69). However, compared to self-help, effects were attenuated for remission (RR = 1.53, 95% CI 1.19; 1.95) and were not significant for binge frequency (SMD = -.14, 95% CI: -.32; .04). Data were scarce for other inactive comparators. DISCUSSION:The superiority of CBT is contingent on the comparator used, highlighting the necessity for rigorous controls such as a psychological placebo or other therapy modalities.
OBJECTIVES:To synthesize current evidence and provide clinically actionable recommendations for integrating menstrual cycle-related processes-particularly hormone sensitivity, Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Exacerbation (PME)-into psychological assessment, formulation and treatment. DESIGN:Narrative, clinically oriented review. METHODS:We integrated findings from experimental, longitudinal and clinical studies on menstrual cycle physiology, hormone sensitivity, PMDD and PME, with a focus on evidence relevant to psychological practice. Emphasis was placed on gold-standard methodologies (e.g., prospective symptom assessment, biologically anchored cycle phase determination) and on translational relevance for clinical decision-making. RESULTS:A substantial minority of naturally cycling individuals show sensitivity to normative hormonal fluctuations, resulting in clinically significant distress or impairment. PMDD affects approximately 3-8% of menstruating individuals and is characterissed by severe, luteal-phase-specific symptoms and elevated suicidality risk. PME appears even more prevalent, affecting up to 50-60% of individuals with mood disorders. Despite this, menstrual cycle-related symptom patterns are rarely assessed or incorporated into routine care. The literature supports several key clinical strategies: (1) prospective daily symptom tracking across at least two menstrual cycles; (2) cycle-informed case formulations integrating timing and symptom expression; and (3) adaptation of evidence-based interventions to predictable cyclical patterns. Clinician-ready tools and case-based approaches facilitate implementation. CONCLUSIONS:The menstrual cycle represents a clinically meaningful yet underrecognized source of within-person variability in mental health. Integrating cycle-informed approaches into psychological care can enhance diagnostic precision, improve personalized formulations and optimize treatment outcomes for individuals affected by PMDD and PME.
