INTRODUCTION:Psychopathology research typically relies on nomothetic (group-level) data to infer idiographic (person-level) processes, limiting clinical relevance, and failing to capture complex individual presentations. Conversely, idiographic approaches capture within-person dynamics but often lack theoretical structure to support generalization, creating a nomothetic-idiographic gap. This study addresses this gap by operationalising Ehlers and Clark's (E&C) Cognitive Model of Posttraumatic Stress Disorder (PTSD) within a theory-guided idiographic network framework. METHODS:Study 1 used simulations to establish data requirements for reliably testing model-derived hypotheses. Study 2 applied this framework to intensive longitudinal data from trauma-exposed individuals. Fifty-five participants (31 with PTSD, 24 with clinical-level symptoms) selected personalized items reflecting core model components: negative appraisals, trauma memory, triggers, sense of current threat, and maladaptive strategies. A subsample of 41 participants completed 3 weeks of Ecological Momentary Assessment, yielding 2,594 observations (M = 63.2 per participant). Individualized items were mapped onto shared theoretical constructs and analyzed using complementary network models. RESULTS:Findings provided empirical support for key assumptions of the E&C model, particularly the central role of sense of current threat and its associations with trauma memory, negative appraisals, triggers, and maladaptive strategies. Clustering of individual networks identified four recurring formulation subtypes characterized by threat reactivity, appraisal centrality, memory centrality, or trigger-threat association. CONCLUSION:We demonstrate a method for bridging individualized assessment with theory-driven analysis. By combining personalized data collection with a shared mechanistic framework, idiographic networks can extend beyond single-case descriptions to identify common clinical patterns, with potential implications for formulation, intervention planning, and evaluation.

Background. Idiographic approaches to case formulation often combine ecological momentary assessment (EMA) with network analysis. Traditional network models require large amounts of data and are largely theory-agnostic, whereas approaches based on perceived causal relationships are weakly constrained and highly exploratory. Both often generate unstable networks that are difficult to compare across individuals. We introduce Momentary Structured Networks (MSN), an EMA framework that combines theory-based structure with self-reported causal relations to generate individualised network representations. Method. Forty-six individuals with posttraumatic stress disorder (PTSD) completed EMA over three weeks (2–5 daily assessments). Participants reported perceived causal relations between personalised items drawn from the Ehlers and Clark cognitive model of PTSD. Directional edges were estimated as conditional probabilities and compared to association-based Ising models. Results. MSN networks consistently showed dense and complex structures, even with limited data. MSN identified most of the relations identified by Ising models while capturing additional ones, resulting in higher network complexity. Complexity was independent of the number of individual assessments, and network structure stabilised quickly, with over 90% of edges recovered using 60% of the data. A clinical case study showed how MSN can track changes in network dynamics during therapy and generate hypotheses about the processes underlying clinical improvement. Conclusion. MSN provides a practical approach for measuring case formulation and tracking change over time by reducing combinatorial complexity while retaining sensitivity to individual variation. Although demonstrated in PTSD, it can extend to other conditions and theoretical models, offering a new framework for evaluating clinical theory and therapeutic change.

Understanding the mechanisms that maintain mental disorders at the individual level is essential for personalised psychological treatment, yet existing approaches rely on burdensome questionnaires or statistical models that infer causal relationships indirectly. Here we present CONCORD, an AI–supported conversational framework that continuously constructs individualised causal case formulations from natural patient conversations. Eleven people with posttraumatic stress disorder engaged in daily conversations over three weeks while also completing ecological momentary assessments and causal surveys for validation, generating 1,629 interactions across methods. CONCORD recovered individualised causal structures that closely matched patient-reported causal formulations while substantially exceeding the complexity captured by conventional correlational network models. The resulting networks closely conformed to a leading cognitive theory of posttraumatic stress disorder, accurately identifying trauma-related triggers as primary causal drivers and maladaptive coping strategies as downstream consequences. Because each inferred relationship is traceable to the underlying conversation, the framework remains transparent and clinically interpretable despite relying on AI. These findings demonstrate that natural conversation can provide a practical route to continuous, theory-guided case formulation, offering a scalable framework for ecological patient monitoring and personalised precision mental health.

Around half of all eating disorder cases start during emerging adulthood (i.e., 18–25 years of age). This is an important time of change in interpersonal relationships, marked by individuation from the family of origin. Interpersonal relationships have long featured in theories of eating disorder maintenance and recovery. Increased understanding of the interplay between eating disorders and changes in the interpersonal domain may be key to improving the efficacy of existing treatments and developing novel interventions for this population group. This study aimed to explore experiences of support from family and friends amongst emerging adults with anorexia nervosa. A convenience sample of emerging adults who had received specialist treatment for anorexia nervosa in the United Kingdom (N = 10) was recruited via advertisements on social media. Semi-structured interviews were conducted focusing on experiences of support from family and friends during their eating disorder. Data were analysed using Interpretative Phenomenological Analysis. Five key themes in participants’ experiences were identified: (i) feeling isolated and lacking close friends; (ii) resisting involvement of family due to perceiving them as part of the problem; (iii) feeling family and friends’ feelings; (iv) desiring flexible boundaries, and (v) feeling ambivalent towards family and friends’ lived experience. Findings suggest a complex entanglement of development of and recovery from AN with the process of individuating from parents during emerging adulthood. Clinicians may find benefit in helping emerging adults to develop their independence and supporting parents to adopt helpful emotional and behavioural postures that tackle the AN maintenance cycle, for example developing parental emotion regulation skills and supporting parents to facilitate age-appropriate levels of independence and responsibility. Eating disorders are common in young people aged 18 to 25 years old. This is also a time young people start to rely more on friends and partners for support, and less on family. We wanted to know what it was like when support changed in this way for people this age with anorexia nervosa. We spoke to ten such people and recorded what they said. We looked for themes in each interview. We matched these themes with similar themes in other peoples’ interviews. These young people spoke about having few friends and relying on family for support. They told us they felt difficult family relationships was one of the reasons for having an eating disorder. It was important to them for family and friends to remain calm and control their own emotions so that young people could take the lead in their recovery. They told of mixed experiences when their family or friends had their own experience of eating disorders. Some thought this was helpful for their own recovery. Others said this was unhelpful. We hope these findings will help clinicians and policymakers to think about how they can help people with eating disorders get the most out of support from family and friends.

Background and Objective. The network approach to psychopathology views mental disorders as dynamic interactions between symptoms, challenging traditional latent-cause models. We applied this approach to individuals with PTSD, using ecological momentary assessment (EMA) data to build personalized contemporaneous and directed symptom networks. Our primary aim was to assess whether these network-derived formulations aligned with clinician-generated cognitive formulations. We also tested whether cognitive variables predicted affective variables over time, consistent with the Ehlers and Clark (2000) cognitive model of PTSD. Method. Five participants completed 14-21 days of EMA (response rate=90.2+5.48%), yielding 348 observations total. Items were tailored to each patient’s lived experience and mapped to Ehlers and Clark components. Written formulations from patients and clinicians were compared to EMA-based networks generated by three network algorithms. Results. Network-derived formulations shared some features with patient and clinician-derived formulations but often diverged in complexity and specific predictions. Data-driven networks had good precision (0.64-0.86) but low sensitivity (0.31-0.35), showing better agreement with patient self-formulations than with clinician models. Evidence for lead-lag effects between cognitive and affective variables was limited. Trauma memory emerged as the most central component, with its association to sense of current threat and matching triggers being the most prominent. Conclusion. Network analysis may refine clinical hypotheses but has limitations in replicating comprehensive formulations. Instead, we recommend its use for clinical hypothesis testing of specific predictions. Further studies, including randomized trials, are needed to test its clinical utility and contribution to treatment outcomes.

Background. Research on posttraumatic stress disorder (PTSD) often relies on nomothetic (group-level) data to infer idiographic (person-level) processes, limiting its clinical relevance. While idiographic studies do capture individual dynamics, they lack a theoretical framework that enables generalization beyond single cases. This study aimed at bridging this gap by operationalizing Ehlers and Clark’s cognitive model of PTSD within an idiographic network framework. Method. In Study 1, a large simulation analysis determined the minimum data requirements for reliably testing model-derived hypotheses. Study 2 applied this approach to intensive longitudinal data from trauma-exposed individuals. Fifty-five participants (31 diagnosed with PTSD, 24 with clinical-level symptoms) provided personalized items reflecting higher-order components of the model—negative appraisals, trauma memory, triggers, sense of current threat, and maladaptive strategies. A subsample of 41 individuals (23 diagnosed, 18 clinical-level symptoms) completed a 3-week Ecological Momentary Assessments (EMA), yielding 2,594 observations (M=63.2 ± 32.1 per participant over 22.8 ± 10.6 days). We applied various nested network algorithms to explore dynamic PTSD mechanisms. Results. We found strong empirical support for the Cognitive Model’s core assumptions, particularly the central role of sense of current threat and its robust associations with trauma memory, negative appraisals, matching triggers, and maladaptive strategies. Cluster analyses of individual networks revealed four common PTSD formulation profiles: threat reactivity, cognitive, re-experiencing, and trigger-threat subtype. Conclusions. These findings demonstrate how idiographic network analysis can extend beyond single-case formulations to identify reproducible clinical patterns. Integrating theoretically grounded constructs with individualized data collection offers a scalable path toward bridging research and practice in PTSD.

The Stoic Attitudes and Behaviours Scale (SABS) was developed to measure Stoicism as a life philosophy. In contrast, previous scales purporting to assess Stoicism have typically relied on a colloquial understanding of ‘stoic’—a concept distinct from philosophical Stoicism and often linked to poorer health outcomes. Philosophy and psychotherapy experts iteratively developed five versions of SABS, identifying six core Stoic dimensions. The final 60-item version was completed by over 8000 participants across 116 countries. Subsamples also completed validated measures of life satisfaction, flourishing, affect balance, and emotional functioning. Exploratory graph analysis and confirmatory factor analysis supported a seven-factor, 40-item solution with good internal consistency. Factors reflected Stoic dimensions including beliefs about happiness, virtue, benevolence and compassion, and ethical development. SABS scores were positively correlated with flourishing, resilience, and positive affect, and negatively correlated with anger and negative emotions. The SABS is the first validated instrument to assess philosophical Stoicism, clearly distinguishing it from colloquial ‘stoicism’. While Stoicism is associated with well-being and emotional balance, colloquial ‘stoicism’ correlates with poorer outcomes. Further research should examine the SABS in clinical and general population samples.

OBJECTIVES:Recovery from sexual trauma can be complex and multi-faceted. Most current psychological treatment protocols for trauma use a cognitive model of post-traumatic stress disorder (PTSD). However, sexual trauma may include specific complexities beyond that of a cognitive model of PTSD, such as relational factors. The distress experienced after sexual abuse may involve variables not exclusive to a PTSD model. Compassion focused therapy (CFT) is an approach that incorporates evolutionary, relational and social perspectives. This study explored the relationships between variables associated with CFT, PTSD and distress in survivors of sexual abuse to determine the role of CFT-related variables. METHODS:155 adults who had experienced sexual abuse or any unwanted sexual experience at any point in their lives completed online questionnaires pertaining to various CFT variables (self-compassion, receiving compassion from others, having a fear of compassion from others, having a fear of compassion from the self, shame and self-criticism) and questionnaires measuring global distress as the outcome of sexual abuse and PTSD symptoms. RESULTS:An exploratory model involving CFT-related variables explained significantly more of the variance (4.4%) in global distress than PTSD symptomology alone. Self-criticism was found to be the variable with significant contribution. CONCLUSIONS:That CFT treatments, targeting self-criticism, should be developed alongside the standard cognitive model of PTSD based treatments for survivors of sexual abuse was supported. Future research may explore experimental designs utilizing CFT in this population, as well as further investigations on the roles of these specific CFT variables.

There is a treatment gap for Common Mental Disorders (CMDs) such as anxiety, depression, and post-traumatic stress disorder (PTSD), as well as non-specific psychological distress (NPD) in low- and middle-income countries (LAMIC), due to the lack of available clinicians and locally appropriate interventions. Task-shifting using non-specialist providers (NSP) and transdiagnostic approaches may address this. Transdiagnostic approaches can be effective at treating CMDs and NPD in high-income countries (HIC), but currently, there is no comprehensive synthesis of evidence regarding their effectiveness in LAMICs. This review addressed this gap by examining the effectiveness of transdiagnostic psychological interventions for symptoms of CMDs and NPD delivered by NSPs in LAMICs. Three databases were searched (Embase, PsycInfo, and PubMed). Hedge's g's were calculated using random-effect models to correct for small sample bias. Twenty-one transdiagnostic interventions across 20 studies were included. Moderate reductions at posttreatment were found in psychological distress (g = -0.64; 95% CI: -0.81 to -0.46), symptoms of anxiety (g = -0.61; 95% CI: -0.80 to -0.42), depression (g = -0.59; 95% CI: -0.75 to -0.44), and PTSD/trauma (g = -0.38; 95% CI: -0.59 to -0.16), with significant small reductions maintained at follow-up ranging from 13 to 26 weeks for NPD (SMD = - 0.37; 95% CI: -0.57 to -0.17), anxiety (g = - 0.41; 95% CI: -0.91 to 0.09), depression (g = -0.38; 95% CI: -0.59 to -0.16), and trauma symptoms (g = -0.23; 95% CI: -0.42 to -0.05). These findings are important and suggest that transdiagnostic approaches delivered by NSPs are effective at treating symptoms of CMDs and NPD in LAMICs. Future research should consider comparing task-shifting approaches with disorder-specific interventions and explore the effectiveness of longer sessions across various mental health conditions.

Background. The ability to formulate presenting problems in psychotherapy is widely acknowledged, but little is known about the skills involved. Treatment manuals are necessarily directed to the general form of a problem and need to be invidualised to the specific needs and circumstance of someone seeking treatment through formulation. The individual case formulation (ICF) approach is based on the functional analysis tradition within behavior therapy but aims to employ clinical descriptions that are theory-free. Formulations are depicted in diagrams constructed according to a set of basic conventions. Aims. Following on previous preparatory studies, the present paper reports on a test of whether this method of analysis and representation could be taught and if the quality of the resulting diagrams could be reliably rated. Method. Participants (N = 40) participated in a training course in formulation for posttraumatic stress disorder that was either self administered or presented live online. Results. A draft rating scale was refined in the course of rating the resulting formulation diagrams and basic inter-rater reliability established, despite a relatively high rate of formulations that did not meet minimal standards. Exploratory analyses examined the relation of derived scores to participant professional characteristics. Discussion. Results of the study support further development of the ICF approach.

•Personalizing psychological treatments means to customize treatment for individuals to enhance outcomes.•The application of precision methods to clinical psychology has led to data-driven psychological therapies.•Applying data-informed psychological therapies involves clinical, technical, statistical, and contextual aspects.

Background: Little is known about the skills involved in clinical formulation. The individual case formulation (ICF) approach, based on functional analysis, employs clinical descriptions that are theory-free and depicts formulations constructed according to a set of basic conventions. Aims: We report a test of whether this method could be taught and if the quality of the resulting diagrams could be reliably rated. Method: Participants ( n =40) participated in a training course in formulation. A draft rating scale was refined in the course of rating formulation diagrams and basic inter-rater reliability established. Results: Results of the study support further development of the ICF approach.

Imagery rescripting (ImRs) is a therapy technique that, unlike traditional re-living techniques, focuses less on exposure and verbal challenging of cognitions and instead encourages patients to directly transform the intrusive imagery to change the depicted course of events in a more desired direction. However, a comprehensive account of how and in what circumstances ImRs brings about therapeutic change is required if treatment is to be optimised, and this is yet to be developed. The present study reports on the development of a coding scheme of ImRs psychotherapy elements identified in the literature as potential ImRs mechanisms. The codes were assessed in relation to short-term outcomes of 27 individuals undergoing ImRs for post-traumatic stress disorder. The timing of the change in the image, degree of activation of the new image and associated cognitive, emotional and physiological processes, self-guided rescripting, rescript believability, narrative coherence and cognitive and emotional shift were identified as being related to symptom change and so are potentially important factors for the re-scripting process.

A generalized climate of distrust in political institutions is not functional to healthy democracies. With the advent of social media, recent scholarly efforts attempt to better understand people’s conspiracy theory beliefs in inhibiting institutional trust. This study contributes to this literature by considering the direct antecedent effects of uncertainty avoidance and the moderating role of active social media use— SMU (i.e., interactional SMU, informational SMU, and political expressive SMU). The former is theorized to enable conspiracy theories to thrive, while the latter should cushion the negative effects of conspiracy beliefs on institutional trust. Relying on diverse survey data across different cultures from Europe, the Americas, and New Zealand (N = 11,958) and applying structural equation modeling, findings supported the hypothesized model. In high uncertainty-avoidance societies, where less well- known situations are perceived as uncomfortable or downright threatening, conspiracy beliefs proliferate and negatively impact institutional trust. Active SMU attenuates these effects. Via social media, citizens have the ability to strengthen social relationships (interactional SMU), keep themselves informed about the community (informational SMU), and engage in political self- expression (political expressive SMU), which mitigate conspiracy- belief negative effects on institutional trust. Future research implications and key limitations of the study are all discussed.

The Dysfunctional Attitude Scale measures depression related enduring beliefs and is one of the central measures of cognitive behavioral (CBT) research and theory. It has been the central marker of etiological claims of CBT, and so any change to the understanding of the composition of the DAS would have potentially far-reaching implications for a large body of literature. We sought to capitalize on advances in psychometric techniques since the original 100-item DAS was last analyzed in a sufficiently large clinical sample to provide a definitive measurement model of this important instrument. Beyond the two dimensions usually found on the shorter forms of the scale, we identified the following subscales: Imperatives, Cognitive Flexibility, and Negative Expectancy. This richer and more precise DAS structure renews its potential to meet the challenge of predicting who is prone to develop depression or experience a recurrence.

BACKGROUND:A key clinical issue is how to maximise the belief change central to cognitive therapy. Physiological arousal is a key internal cue confirming threat beliefs in anxiety disorders. Deeper extinction of anxiety may occur if catastrophizing responses to physiological arousal are inhibited prior to joint exposure with external phobic stimuli. The aim of the study was to test whether increasing physiological arousal using exercise increases the benefits of behavioural tests. METHODS:Sixty individuals with a fear of heights had one session of VR cognitive treatment. They were randomised to have the treatment either with periods of intense physical exercise (cycling at 80% of maximum heart rate) prior to exposures or without. Linear mixed effects models were used to check the manipulation and test the primary hypothesis of a group difference in degree of conviction in the phobic threat belief. RESULTS:Heart rate was significantly higher in the exercise group throughout compared with the control group. Both groups showed significant reductions in threat beliefs after the VR treatment (d = 1.0, p < 0.001) but there was no significant group difference (d = 0.1, p = 0.56). DISCUSSION:An increase in physiological arousal achieved via exercise did not enhance cognitive change in beliefs about feared stimuli.

Childhood ITP is often considered to be a relatively mild haematological disorder, with only a minority of patients requiring treatment for troublesome bleeding. Over recent years, wider effects of the condition have been identified in some adults, particularly relating to fatigue and cognitive impairment. In this study, we sought to investigate such effects in a group of children with ITP and further our understanding of their psychological profile. Children attending routine haematology outpatient clinics and their parents were asked to complete standardised questionnaires designed to assess a range of psychological and cognitive factors. Although the majority of children had some scores within the normal range, a significantly high proportion had difficulties with fatigue (70·6%), emotional and behavioural symptoms (25·7%) or executive functioning (19·4%). Quality of life and subjective evaluation of the illness (appraisal) correlated significantly with each of these domains, but bleeding severity and platelet count did not. Our findings provide valuable insight into the broader impact of childhood ITP, which could aid in providing holistic care, potentially contribute to decisions regarding medical treatment, and guide future research.

BACKGROUND:Imagery rescripting (ImRs) is an experiential therapy technique used to change the content and meaning of intrusive imagery in post-traumatic stress disorder (PTSD) by imagining alternative endings to traumatic events. There is growing evidence that ImRs is an effective treatment for PTSD; however, little is known about how it brings about change.AIMS:This study aimed to explore the role of mental simulation as a candidate mechanism of action in ImRs, and, specifically, whether well-simulated imagery rescripts are associated with greater change in symptom severity during ImRs.METHOD:Using a single-case experimental design, seven participants receiving cognitive therapy for PTSD were assessed before, during and after sessions of imagery rescripting for one intrusive image. Participants completed continuous symptom severity measures. Sessions were recorded, then coded for goodness of simulation (GOS) as well as additional factors (e.g. rescript believability, vividness).RESULTS:Participants were divided into high- and low-responders and coding was compared across groups. Correlational analyses were supported by descriptive analysis of individual sessions. High-responders' rescripts tended to be rated as well-simulated compared with those of low-responders. Specific factors (e.g. intensity of thoughts/emotions related to original and new imagery elements, level of cognitive and emotional shift and belief in the resultant rescript) were also associated with reductions in symptom severity.CONCLUSIONS:There was tentative evidence that well-simulated rescripted images tended to be associated with greater reductions in symptom severity of the target image. Clinical implications and avenues for further research are discussed.