OBJECTIVES:Nature exposure may support young women in improving their relationship with their body, enhancing positive body image. However, the mechanisms remain still largely underexplored. A few qualitative studies provided valuable insights, but they lacked generalizability to the broader population of young women, since they often relied on similar samples (e.g. North American individuals, individuals recovering from an eating disorder) or did not accurately represent young women (e.g. too broad age range). Therefore, the current study aimed to qualitatively explore how nature exposure could improve positive body image relying on a sample of young women recruited from the general Italian population, who self-report to expose themselves to natural environments. DESIGN:A qualitative study using focus groups composed of young women who expose themselves to natural environments. METHODS:Six focus groups were conducted with 19 young Italian women (Mdnage = 25 years; range = 22-35 years). The transcripts were analysed using reflexive thematic analysis. RESULTS:Three main themes were developed: (1) Nature strengthens a connection with the body, (2) nature reduces emphasis on appearance and (3) nature as a catalyst for self-(re)connection. These three themes suggest novel possible mechanisms involved in the relationship between nature exposure and positive body image (e.g. positive embodiment) and capture some cultural nuances (e.g. the role of beaches). CONCLUSIONS:Overall, this study offers meaningful directions for future studies, which could quantitatively examine the identified mechanisms. Moreover, it informs prevention strategies and psychological interventions aimed at improving young women's relationship with their bodies utilizing nature exposure.
BACKGROUND:Mentalization, the ability to understand one's own and another's thoughts and feelings, is considered important for couple functioning. Many couple-focused interventions aim to improve mentalization, either as the process through which change occurs or as a central goal of treatment. We aimed to examine (a) associations between mentalization and couple relationship processes and (b) the impact of interventions designed to enhance mentalization in couples. METHODS:We included studies of adult romantic couples that assessed associations between mentalization and relationship outcomes or evaluated interventions incorporating mentalization. We searched 6 databases (last search: 20th October 2025), identifying 72 publications to include. Sixty-four publications examined associations, of which 24 were included in a meta-analysis, and eight studies examined interventions. Risk of bias was assessed using CASP checklists. RESULTS:Higher mentalization was moderately associated with greater relationship satisfaction (k = 24, ρ = 0.31, 95% CI [0.24, 0.37]), although findings were significantly heterogeneous (I2 = 91.1%). Narrative synthesis indicated that higher mentalization was also associated with adaptive relational processes, whereas lower mentalization was associated with conflict and intimate partner violence. Intervention studies showed improvements in satisfaction, intimacy, empathy and conflict reduction, although effects were heterogeneous and constrained by small samples and inconsistent measures. DISCUSSION:Mentalization is a robust correlate of couple functioning and a promising but undertested intervention target. Causal mechanisms remain unclear, and the evidence base is limited by heterogeneity and modest methodological quality. More rigorous, diverse trials are needed to establish effectiveness, mechanisms and sustainability of mentalization-based interventions for couples.
OBJECTIVES:Psychological formulation helps to develop an understanding of an individual's experiences and how they make sense of these. There is limited research around staff's perspectives of psychological formulation within the Children and Young People Secure Estate (CYPSE). The aim of this research was to explore residential staff's lived experiences of utilising and applying formulation into their practice, discover the impact on working relationships with young people (YP) and identify what role formulation has for future practice and policy. DESIGN AND METHODS:Nine qualitative semi-structured interviews were facilitated with residential staff in two secure children's homes (SCH) in England. An interpretative phenomenological analysis approach was utilised, and five themes were developed. RESULTS:Psychological formulation enhanced trauma-informed understandings, promoted collaboration among professionals, helped to develop therapeutic relationships with YP, created psychological safety and promoted empowerment. Additionally, formulation processes were flexible, which helped staff to adapt their approaches to be more trauma-informed and person-centred. CONCLUSIONS:Future practice/policy should consider systemic challenges limiting engagement and prioritise YP's views on being involved in the formulation process. Implications for clinical practice are discussed as well as recommendations for future research.
OBJECTIVES:Visual hallucinations (visions) in people with psychosis are common and often distressing. Cognitive theory emphasises a central role of appraisals in determining distress. We explored how people made sense of their visions to inform the development of targeted cognitive treatments for visions. DESIGN:Semi-structured interviews were conducted with 12 participants with psychosis recently reporting visions. METHODS:Reflexive thematic analysis was utilised. RESULTS:There was an overarching theme that participants lacked convincing and acceptable explanations as to why they saw visions. The absence of credible explanations led people to rely on two types of themes of how to make sense of their experiences. Theme one was 'Unconvincing but acceptable' appraisals-such as visions were internally generated in some way, perhaps owing to poor sleep or stress. These were unconvincing as they did not account for the complexity and life-like reality of visions. Theme two was 'Convincing but unacceptable' appraisals. These were typically threat-based interpretations-such as 'It's real' or 'It's here to harm'. These appraisals were often more believable, yet incurred higher levels of distress. Appraisals were not static. They changed in response to dynamic factors such as the presence of visions and the participants' emotional state. CONCLUSIONS:Participants described a need to understand why they see visions. Yet, the most convincing explanations often led to high levels of distress. Generating credible and acceptable ways to explain visions and understanding the dynamic factors that drive vision-specific appraisals may provide a potential route to improve cognitive treatments for these.
OBJECTIVES:The therapeutic alliance is a critical predictor of psychotherapy outcomes, yet little is known about the child-specific interpersonal factors influencing its early development in child psychotherapy. This study aimed to examine whether children's pre-treatment attachment security and reflective functioning (RF) skills predict the strength of early therapeutic alliance. DESIGN:The study was part of a randomized controlled trial measuring the effectiveness of Mentalization-Based Treatment for Children (MBT-C). METHODS:Participants were 71 children aged 7-12 who received the MBT-C intervention. Pre-treatment assessments included the Attachment Doll Story Completion Task to measure attachment security, and the Child Reflective Functioning Scale to assess RF skills. Early therapeutic alliance was evaluated at the third week of treatment using the self-report scale of Therapeutic Alliance Scale for Children (both child and therapist forms). RESULTS:Results from the mediation model showed that children's reflective functioning skills significantly mediated the relationship between attachment security and early alliance rated by children. Therapist-rated alliance was found to be insignificant. CONCLUSIONS:Findings highlight reflective functioning as a central mechanism linking attachment security to children's perceptions of therapeutic alliance in MBT-C. This suggests that children's capacity to understand others' mental states is critical for establishing early alliance.
OBJECTIVES:This study aimed to identify psychosocial profiles among Colombian adolescents living in environmentally transformed territories and to examine whether solastalgia was associated with profile membership and territorial variation. DESIGN:A cross-sectional, person-centred analytical study was conducted with school-attending adolescents from four Colombian contexts affected by urban construction-related change, agricultural transformation, extractive activity, and Indigenous displacement. METHODS:The sample included 1064 adolescents. Four standardized domains were constructed: well-being capacities, school health, symptom and clinical-risk burden, and protective family-system functioning. Solastalgia was introduced as an external predictor rather than as a profile indicator. Latent profile analysis identified psychosocial profiles, and multinomial models examined the association between solastalgia and profile membership. Territorial profile differences and BSS × territory patterns were examined descriptively. RESULTS:A five-profile solution was retained: Contextually Flourishing, 25.7%; Supported Low-Capacity, 18.0%; School-Strained Resourced, 25.0%; Family-Strained Distress, 27.0%; and Multisystem Vulnerability, 4.3%. Higher solastalgia was most clearly associated with Family-Strained Distress relative to Contextually Flourishing, RRR = 1.25, 95% CI [1.05, 1.49], p = .011. Profile distribution differed by territory, χ2(12) = 437.64, p < .001, Cramér's V = .37, whereas territorial moderation remained exploratory because of sparse profile-territory combinations. CONCLUSIONS:Solastalgia was not a general marker of psychosocial risk. Its clinical significance was most evident when environmental suffering co-occurred with elevated symptoms and weaker family-system protection. Adolescent environmental distress should be assessed through ecological, person-centred formulations that integrate symptoms, family containment, school experience, and preserved resources.
OBJECTIVES:Miscarriage is a common reproductive loss that can have significant psychological consequences, including post-traumatic stress disorder (PTSD). The present study aimed to examine the association between attachment anxiety, attachment avoidance, post-loss period and gestational stage at pregnancy loss with PTSD symptom severity among women who have experienced miscarriage in Cyprus. METHODOLOGY:A cross-sectional study employing convenience sampling was conducted. A total of 176 women who had experienced a miscarriage completed an online questionnaire. PTSD symptoms were assessed using the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5), while romantic attachment anxiety and attachment avoidance were measured using the Experiences in Close Relationships-Revised (ECR-R) questionnaire. Participants also provided demographic information, including gestational stage at miscarriage and post-loss period. Descriptive statistics, Pearson correlation analyses and multiple linear regression analyses were conducted to examine predictors of PTSD symptom severity. RESULTS:Attachment anxiety and attachment avoidance were both significantly associated with increased PTSD symptom severity following miscarriage. Women who had experienced a miscarriage within the previous 12 months as well as women who experienced later miscarriage reported significantly higher PTSD symptoms. Multiple regression analysis further demonstrated that attachment anxiety, attachment avoidance, post-loss period and gestational stage independently predicted PTSD symptom severity. CONCLUSIONS:The findings indicate that partner attachment anxiety, attachment avoidance, post-loss period and gestational stage are important factors associated with PTSD symptom severity following miscarriage. These results highlight the importance of early psychological screening and attachment-informed support following miscarriage, particularly within the first year after loss.
PURPOSE:Attachment insecurity has been theorised to be associated with the development and maintenance of negative symptoms. Previous reviews examining the relationship between attachment insecurity and negative symptoms of psychosis have produced conflicting findings. Using meta-analytic techniques, the current study sought to systematically appraise the relationship between attachment insecurity dimensions, total negative symptoms and domains of negative symptoms. METHODS:A systematic review of literature published on electronic databases (PubMed, Ovid MEDLINE, EMBASE, PsycINFO) up to October 2025. RESULTS:Twenty-two studies met inclusion criteria (n = 6507; mean age 27.76 years; 35.1% male) and comprised clinical samples (k = 14) and non-clinical samples (k = 9). Five studies achieved a low risk of bias score. A small, significant average association was found between negative symptoms and attachment anxiety in clinical and non-clinical samples. A small, significant average association was found between attachment avoidance and negative symptoms in clinical samples, while a moderate-sized, significant average association was found in non-clinical samples. Differing strengths of association were found between attachment dimensions and each of the negative symptom domains. CONCLUSION:Future research should use measures that adhere to the NIMH consensus definition and should also explore the impact of attachment insecurity on individual negative symptoms. PRISMA/PROSPERO:This review was conducted in line with PRISMA guidance. The review protocol was registered on Prospero on the 16 August 2022. https://www.crd.york.ac.uk/PROSPERO/view/CRD42022353927.
OBJECTIVE:To determine the feasibility and acceptability of a cluster RCT comparing school-based humanistic counselling (SBHC) plus a goal-based task (SBHC+G) with SBHC alone. A secondary aim was to establish preliminary indicators of change on measures of psychological distress and life functioning. DESIGN:This was a pilot cluster randomised controlled trial. METHOD:Recruitment and retention of counsellors and young people, as well as measure completion rates and session attendance, were analysed as indicators of acceptability feasibility. ANCOVA tests were used to compare endpoint scores between conditions, controlling for baseline scores, on measures of psychological distress (YP-CORE) and life functioning (ORS). RESULTS:Recruitment, retention and measure completion rates were acceptable. There were no statistically significant differences between conditions on YP-CORE or ORS scores at end point. Those in the SBHC+G condition missed significantly fewer sessions (M = 1.7) than those in the SBHC only condition (M = 3.2, p = .04). CONCLUSION:The trial design was feasible and acceptable and has the potential to be scaled up to a larger, adequately powered study.
AIM:The aim of this study was to look for factors protecting from developing severe premenstrual symptoms in high risk individuals. We tested if sense of coherence, mindfulness skills and self-compassion moderate the relationship between trauma and increased perceived stress and the symptoms of premenstrual disorders (premenstrual syndrome [PMS] and premenstrual dysphoric disorder [PMDD]). METHODS:The study comprised two stages with a retrospective (N = 228) and a prospective (N = 90) measures of premenstrual symptoms. Correlation and moderation analyses were performed. RESULTS:All variables were significantly correlated. Self-compassion, four out of five mindfulness skills, and sense of coherence (albeit, in the case of the retrospective measure, only two of its components) moderated the relationship between stress and premenstrual disorders. Only two mindfulness skills moderated the effect of trauma on premenstrual symptoms (Non-Judging in the retrospective measure, Describing in the prospective part of the study). CONCLUSIONS:These results suggest that a more understanding, mindful and compassionate attitude towards oneself may benefit individuals with severe premenstrual symptoms, especially in the face of increased stress. The findings may be used to improve the treatment of PMDD and PMS by including approaches and interventions aimed at increasing sense of coherence, self-compassion and mastering mindfulness skills.
OBJECTIVE:To develop and validate the Counselling Session Benefits Scale (CSBS), a self-report measure for assessing counselling benefits. METHOD:In Study 1, expert evaluation and exploratory factor analysis (EFA) were conducted among university clients in China to establish content validity and factor structure. Besides, confirmatory factor analysis (CFA) and internal consistency were assessed. In Study 2, the scale's factor structure, internal consistency, validity and measurement invariance were examined among clients in general hospitals in China. RESULTS:The 23-item CSBS identified five factors: emotional release, cognitive changes, increase in coping skills, increase in confidence and self-acceptance. Both samples showed acceptable Cronbach's α coefficients, and EFA/CFA confirmed the scale's factor structure. Further, the CSBS correlated positively with working alliance and demonstrated measurement invariance across gender, medication use, psychotherapy experience and time. CONCLUSION:The CSBS is a reliable and valid tool for evaluating client gains after a single counselling session in university and clinical settings. Research is needed to validate the CSBS in western countries using a representative sample.
OBJECTIVES:While rates of self-harm are rising in the United Kingdom, people who self-harm can often struggle to access appropriate treatment. This study sought to explore adult stakeholders' perspectives and experiences of the barriers to, and facilitators of, accessing support for self-harm and also how services could be better tailored to meet needs. DESIGN:A cross-sectional qualitative study. METHODS:Semi-structured interviews were conducted remotely with 19 participants in the United Kingdom, including 10 individuals with lived experience of self-harm and nine mental health professionals that worked with people who self-harm. Reflexive thematic analysis was used to analyse the data. Normalisation Process Theory (NPT) was used as a guiding framework throughout the study. RESULTS:Both stakeholder groups felt that services did not offer appropriate support; there were system-level challenges and a sense of associated powerlessness. It was important to understand the person behind the behaviour, as a lack of understanding was reported to increase feelings of shame. Services that prioritise person-centred care, expert-by-experience involvement and early intervention were valued. Professionals outlined the positives of brief interventions, while individuals who self-harm held concerns about whether briefer interventions addressed complex difficulties. CONCLUSIONS:Findings highlight important organisational barriers and potential facilitators that individuals who self-harm may face when accessing psychological interventions. Results prompt the need for inclusive and easily accessible services.
OBJECTIVES:Psychedelic-assisted therapy (PAT) frequently utilises a "cotherapy" model, in which two therapists jointly support participants throughout dosing and psychotherapy sessions. While common in clinical trials, participant experiences of cotherapy remain underexplored. This study explored cotherapy experiences in PAT with psilocybin for Generalised Anxiety Disorder (GAD). DESIGN:Longitudinal qualitative analysis of participants sampled from a large randomised, open-label, phase 2 clinical trial of psilocybin-assisted therapy for GAD, delivered by clinicians with high levels of qualification, training and supervision. METHODS:Qualitative data were collected from n = 18 participants via 29 semi-structured interviews, conducted before and after dosing sessions. Interviews examined experiences of PAT with a cotherapy dyad. Data were analysed thematically, guided by Affordance Theory to consider how cotherapy dynamics shaped therapeutic possibilities. RESULTS:Three major themes were developed: (1) dose day cotherapy: safety, trust and the realities of access; (2) cotherapy influences therapeutic processes; and (3) cotherapy shapes the impact and credibility of therapeutic insights. CONCLUSIONS:Cotherapy in PAT can be both a safety and supportive measure, and a potentiator of therapeutic processes. Insights from this study can guide clinical practice and future research to harness the potential safety and therapeutic benefits afforded by cotherapy while considering feasibility and accessibility.
Interoception has been recognized as a key process linking bodily regulation, emotional experience and psychological well-being, yet its role within psychotherapy remains theoretically and empirically fragmented. Beyond outcome variability, this fragmentation reflects differences in how interoception is conceptualized and operationalized in psychotherapy research. OBJECTIVE:This systematic review examined associations between interoceptive processes and psychotherapeutic outcomes-including interoception as a pre-therapy client factor, as a pre-post change measure and as a therapeutic outcome in itself-and identified intervention protocols promoting interoceptive abilities, while evaluating how interoception is defined and measured within psychotherapy. METHOD:Following PRISMA 2020 guidelines and PROSPERO registration, searches were conducted in PubMed, PsycINFO, CINAHL, Web of Science and Scopus. Eligible studies involved adults undergoing psychotherapy, assessed interoception using validated self-report or physiological measures, and reported therapeutic outcomes. Twenty-one studies were synthesized using thematic analysis and the PICO framework. RESULTS:Improvements in interoceptive functioning, particularly interoceptive awareness, bodily trust and self-regulation, were associated with reductions in psychological symptoms, including eating disorder pathology, depression, anxiety and distress. Interoception emerged as a transdiagnostic process across diagnostic groups. CONCLUSION:Interoception is clinically relevant in psychotherapy, yet evidence is shaped by predominantly top-down conceptualizations. Integrating behavioural and psychophysiological measures may clarify bottom-up mechanisms of therapeutic change. This integration can inform assessment strategies and support more embodied, process-oriented psychotherapeutic research in practice.
INTRODUCTION:People with Hoarding Disorder (PWHD) can experience enforced removal of their possessions by others, often with the intention of trying to improve an individual's situation. To date, there has been no research exploring PWHD's experiences of this. The study qualitatively explored people's experiences of forced clearances within the context of HD. METHODS:Nine participants meeting DSM-5 criteria for HD completed a semi-structured interview about their experience of forced clearances; this included a description of the clearance, impact upon self and hoarding behaviours and recommendations on what improved support could look like. Participants also completed questionnaires measuring hoarding severity and distress caused by a forced clearance. RESULTS:Three themes and six subthemes were generated: (1) Power Imbalance (subthemes: Criminalisation of Mental Health Difficulties; Clearance as the Lesser of Two Evils); (2) The Trauma of Clearance (subthemes: Losing Belongings is Like Losing Myself; 'Trauma on top of Trauma'); (3) Picking Up the Pieces (subthemes: Clearance Weighs Heavily on the Mind; Replacing the Shield). Participant recommendations included the importance of early intervention, the need to build trust and seeing the person behind the belongings. Most scores on the measure of distress were high, consistent with participant reports that the event was typically a traumatic experience. CONCLUSION:Findings suggest that forced clearances are a traumatic experience with a long-lasting impact for PWHD. The study has theoretical implications for how traumatic events are defined in the context of HD and clinical implications for how to support PWHD and their experience of forced clearances.
OBJECTIVES:Exploring how Turkish-speaking immigrants understand and express common mental health conditions is crucial, as discrepancies in this area have real-life consequences for treatment. Some key concepts to examine within this are the long-standing belief that Turkish-speaking immigrants somatise emotional difficulties and cannot identify them, and that they predominantly rely on traditional explanatory models of mental health. Accordingly, this study aimed to explore how this population experiences, expresses and understands these conditions and to examine their coping resources and help-seeking attitudes. DESIGN:Qualitative design. METHODS:Semi-structured interviews were conducted in Turkish with 18 Turkish-speaking immigrants who self-identified as having experienced common mental health difficulties. Data were analysed inductively using reflexive thematic analysis within a critical realist framework. RESULTS:Four themes with ten subthemes were generated: symptom presentation, explanatory models, coping strategies and help-seeking attitudes. Participants reported both emotional and physical symptoms, often expressed through rich idioms and metaphors. They attributed their distress to upbringing, traumatic events, chronic adversities, discrimination, interpersonal relationships and their own perceived shortcomings. Coping included personal, interpersonal, community and religious resources alongside lay resources. While most participants were open to professional help, all expressed distrust towards UK services and many preferred Turkish-speaking professionals. CONCLUSIONS:Contrary to popular belief, Turkish-speaking immigrants articulated distress in both emotional and physical terms. Their explanatory model was mainly psychosocial but also included biological and traditional elements, reflecting a dynamic, multi-model approach. Moving beyond reductive stereotypes about Turkish-speaking immigrants and Global South populations is crucial for providing meaningful and effective care.
OBJECTIVES:Despite recognised cognitive deficits related to substance use, as well as high mortality and treatment attrition rates, metacognition has never been studied in patients with opioid use disorder (OUD) undergoing opioid maintenance treatment (OMT). DESIGN:This exploratory pilot study used a quantitative longitudinal design to assess metacognition in patients with opioid use disorder at treatment initiation and at a one-year follow-up and to explore its association with executive functioning. METHODS:Forty-eight adults initiating OMT were enrolled in the study. All participants completed the Indiana Psychiatric Illness Interview (IPII), and recorded transcripts were analysed with the metacognition assessment scale (MAS-A). Additionally, measures of executive function, as well as sociodemographic, psychiatric comorbidity and substance use, were obtained within two weeks of OMT initiation. IPII and MAS-A were repeated at a one-year follow-up. RESULTS:Participants displayed widespread performance of metacognition in the four subscales self-reflectivity, understanding others' minds, decentration and notably, low levels of mastery. Self-reflectivity and mastery were significantly positively correlated with verbal fluency. Higher levels of decentration were associated with fewer self-reported executive function difficulties. No significant changes in metacognition were detected at the one-year follow-up. CONCLUSIONS:This longitudinal pilot study provides the first evidence of metacognitive functioning in OMT patients. Metacognitive performance was characterised by low levels of mastery, limited correlation with executive function and no improvement observed over the one-year follow-up period. The preliminary findings are interpreted and discussed with caution, emphasising the relevance of metacognition for future research and clinical interventions in OUD populations.
OBJECTIVES:This study examines how individuals "do gender" in their help-seeking for psychotherapy, focusing on the facilitators that support entry into treatment and the ways these are articulated by women and men. DESIGN:A qualitative study design was adopted, guided by the theoretical framework of doing gender and complemented by a mixed-methods component. METHODS:Narratives from 43 psychotherapy patients who identified as female or male were analysed using qualitative content analysis. This was supplemented by a word count analysis. RESULTS:Women often relied on female social and professional networks, valued empathy and emotional sensitivity, and described their treatment choices in a more assertive way. Men more frequently adopted structured, problem-focused reasoning, at times linking therapy to the restoration of social and professional functioning and invested more effort in selecting a therapeutic approach. CONCLUSIONS:Findings highlight the importance of gender-responsive communication strategies in mental health care: relational and empathetic aspects may resonate more strongly with women, whereas practical, goal-oriented benefits may be particularly effective for men. At the same time, approaches must remain flexible to account for diversity and fluidity in gender identities. Future research should include younger, non-binary and gender-diverse groups.
OBJECTIVES:To examine how parents mentalise climate change during parent-child climate conversations and clarify the relational processes through which such conversations may support regulation, meaning-making or escalation of distress. DESIGN:Qualitative cross-sectional study. METHODS:Forty-five Italian parents of at least one child aged 6-18 years participated in online semi-structured interviews. Eligible participants had discussed climate change with their child at least once in the last six months. Interviews explored how parents understood the child's climate-related thoughts and emotions, responded to dysregulation or rupture, handled uncertainty and conflicting information, interpreted social influences and discussed responsibility, action and future-oriented concerns. Data were analysed using Reflexive Thematic Analysis. RESULTS:Four themes were generated. Theme 1, Mentalisation under climate threat, captured how parents identified children's climate-related imaginaries, contained affect and repaired non-mentalising shifts. Theme 2, Epistemic regulation in climate talk, concerned how parents evaluated climate claims, calibrated trust and handled uncertainty without false reassurance or catastrophic certainty. Theme 3, Climate talk in a wider social world, described how parents helped children think about denial, ridicule, peer belonging and moral outrage. Theme 4, Agency and future meaning in climate contexts, concerned how parents calibrated action, protected children from responsibility-saturated coping and responded to climate-shaped future thinking. CONCLUSIONS:Parent-child climate conversations function less as information exchange than as relational episodes in which affect regulation, epistemic trust, social meaning-making, and responsibility are negotiated. The findings support parental climate mentalising as a clinically relevant form of parental reflective functioning under ecological stress.
