The therapeutic alliance plays a key role in enabling symptom improvement in CBT for psychosis. However, so far it remains unclear which therapist characteristics are particularly relevant for building alliance in CBT for psychosis compared to CBT for other diagnoses. Participants with psychotic disorders (PSY, n = 102) and other mental disorders (CG, n = 64) received disorder specific variants of CBT. We used structural equation models (SEM) with multiple-group comparisons to assess differences between PSY and CG in associations between patients’ perceptions of therapists’ empathy, genuineness, positive regard, competence, and convincingness at baseline and the therapeutic alliance after 5 therapy sessions. In SEM-based mediation analyses, we tested whether latent symptom change was predicted by perceived therapist characteristics via the therapeutic alliance and whether these associations differed between PSY and CG. Multiple-group SEM revealed partial invariance across diagnostic groups, with perceived genuineness showing a stronger association with therapeutic alliance in PSY than in CG. Perceived positive regard was positively associated with the therapeutic alliance across groups. There were no direct, indirect, or total effects of perceived therapist characteristics via the therapeutic alliance on symptom change. Perceived therapist genuineness seems to be particularly important for a strong alliance in CBT for psychosis and could therefore be addressed in CBT training and supervision.
Interpersonal emotion regulation (IER) is increasingly recognized as a clinically relevant socio-emotional process, particularly during adolescence and young adulthood. This study examined the psychometric properties of the Spanish Interpersonal Emotion Regulation Questionnaire (IERQ-S) in adolescents and young adults. A total of 2262 Spanish participants aged 14–27 years completed the IERQ-S and measures of wellbeing, self-esteem, loneliness, emotion regulation, reflective functioning, psychological difficulties, suicidal ideation, and technology-related behaviors. The sample was randomly split for cross-validation. Exploratory factor analysis was conducted in Subsample A, whereas confirmatory factor analysis, competing structural models, and ordinal measurement invariance across gender and age groups were tested in Subsample B. The correlated four-factor and bifactor models showed similar relative performance, although absolute fit was mixed. Ordinal measurement invariance was supported across gender and age groups. Internal consistency was adequate to good across subscales and demographic strata. Associations with external indicators were generally small and require cautious interpretation. Age- and gender-stratified normative percentiles were also generated. The IERQ-S appears to be a reliable and valid measure for assessing interpersonal emotion regulation strategies in Spanish adolescents and young adults. Its use may support research on socio-emotional functioning, transdiagnostic regulatory processes, and youth mental health assessment.
Ecological momentary assessment (EMA) enables real-time observation of emotion regulation processes, such as avoidance, in daily life. Prior EMA research on avoidance has been limited, with minimal attention to momentary cognitions relevant to avoidance, such as appraisals of emotions as threatening or intolerable. The purpose of the current study was to explore the within-person associations among cognitive, emotional, and behavioral components of avoidance using EMA. Adults recently discharged from psychiatric hospitalization (N = 30) completed EMA evaluating momentary negative affect, appraisals of current emotions (e.g., “My emotions are getting in the way”), and urges to avoid 4x/day for 28 days. Multilevel models predicting urges to avoid examined main and interaction effects between affect and appraisals. Urges to avoid were concurrently associated with more intense negative emotions (b = 0.49–0.55, ps < 0.001) and more critical appraisals of those emotions and one’s capacity to manage them (b = 0.14–0.20, ps ≤ 0.022). An interaction effect was observed between affect and appraisals, suggesting that negative emotion intensity and critical appraisals have a transactional effect on urges to avoid, such that at heightened levels of either, the relationship between avoidance and the other weakens. This interaction was observed for appraisals of the emotion itself (b = − 0.05– −0.03, ps ≤ 0.007), but not for appraisals of one’s capacity to handle that emotion. These findings highlight the complex interplay between cognitive, affective, and behavioral facets of avoidance and provide a greater understanding of how emotion regulation plays out in daily life for individuals with serious mental health problems.
The failure to meet early emotional needs is associated with the use of emotion regulation strategies. Numerous studies in the child and adolescent literature have demonstrated the relationship between early schemas and emotion regulation strategies. However, the role of metacognitive awareness, which we hypothesize might be one of the mediating mechanisms in this relationship, has not been sufficiently clarified. The aim of this study is to examine the direct and indirect role of metacognitive awareness in the relationship between early emotional deprivation schema and emotion regulation strategies in children and adolescents. Data were collected from 814 (aged 10–15, Avg = 12, SD = 1.04) middle school students selected using convenient sampling methods.The participants did not have any diagnosed mental health problems. The mediating role of metacognitive awareness between emotional deprivation and reappraisal and supression strategies was investigated using structural equation modeling. Emotional deprivation is indirectly related to reappraisal through metacognitive awareness. The direct relationship between these two variables is insignificant, indicating that metacognitive awareness plays a full mediating role (λ = − 0.16, 95
The sequence in which psychological interventions are delivered may influence their efficacy. Therefore, the current study investigated the sequencing effect of cognitive restructuring (CR) and detached mindfulness (DM), hypothesizing that only the sequence of CR-DM would lead to additional improvement. Across two experiments, 188 participants from a community sample underwent a speech (Experiment A) or worry (Experiment B) manipulation and were then introduced to CR and DM in a counterbalanced order. Primary outcomes were state anxiety (Experiment A) and worry (Experiment B). Multilevel models revealed that when delivered alone, the two techniques produced similar changes in the outcome measures across both experiments. When delivered as the second technique, there was a statistically significant sequencing effect in Experiment B, t(93.0) = 2.0, p = .048, d = 0.42 in the predicted direction, showing further reduction in worry in participants receiving CR-DM but not those receiving DM-CR. Due to a lack of manipulation effect in the second speech of Experiment A, sequencing effects could not fully be explored here. The findings suggest that, in a worry context, there may be little reason to use the sequence of DM-CR, whereas there may be further benefit of the CR-DM sequence. For Experiment A, the lack of manipulation effects precludes conclusions regarding sequencing effects. The results should be understood in light of the community sample and lack of neutral control condition but offer a useful starting point for further examining sequencing effects in clinical populations.
