OBJECTIVE:Type 1 diabetes (T1D) and life-threatening food allergies (FAs) are two diet-dependent chronic illnesses (DDCIs) that require rigorous self-management centered on strict dietary monitoring. Grounded in self-determination theory, this study aimed to investigate differences in motivation for healthy eating and well-being among adolescents coping with DDCI, compared to individuals without DDCI. Additionally, it explored the mediating role of general health practices in the relationship between motivation for healthy eating and well-being. METHODS:A total of N = 116 adolescents, aged 10-18 years (T1D: N = 36, M±SD age = 15.28 ± 1.85; FA: N = 39, M±SD age = 13.31 ± 2.40; no-DDCI: N = 41, M±SD = 14.71 ± 1.76), completed questionnaires assessing motivation for healthy eating, general health practices, and well-being. RESULTS:Internal motivation for healthy eating was positively associated with general health practices in all 3 groups. A moderated-mediation model revealed that among adolescents with DDCI, internal motivation for healthy eating was positively associated with psychological well-being. Internal motivation was also positively associated with physical well-being, but only among adolescents with FA. Conversely, only among adolescents with T1D, external motivation for healthy eating was negatively associated with psychological and physical well-being. Lack of motivation for healthy eating was negatively associated with general health practices among adolescents with T1D and individuals without DDCI. CONCLUSIONS:Adolescents with DDCI face challenges in adhering to healthy eating recommendations and translating knowledge into action. Targeted interventions are necessary to enhance internal and autonomously driven motivation for dietary changes. Personalized nutrition programs for adolescents living with DDCI may effectively promote self-management and overall well-being in this population.

Background: To provide effective mental health care across cultural differences, therapists must develop cultural competencies, including an awareness of and sensitivity to diverse backgrounds. In Israel, secular therapists (STs) working with ultra-orthodox (UO), also referred to as Haredi, clients face challenges due to mutual distrust and sociopolitical tensions between the communities. This study aims to assess Israeli STs’ cross-cultural competencies and attitudes toward Haredi clients, examining the association between perceptions and competencies. Methods: The data were collected from an anonymous, self-administered online survey conducted between April and November 2024 among 70 STs in Israel. The study utilized the Cross-Cultural Competence of Healthcare Professionals (CCCHP-27) scale and a self-developed questionnaire assessing STs’ attitudes toward UO clients. The statistical analysis was performed using JASP 0.18.3. Results: While STs exhibited high general cross-cultural competence, their competence in working with Haredi clients was lower and more complex. Therapists with more experience treating UO clients had more positive attitudes toward them, whereas those working in public settings demonstrated lower cultural awareness. Although STs faced cultural and ideological challenges, many expressed openness and professional growth. Notably, while 57.2% felt that working with UO clients improved their skills, only 37.2% recommended it to others. Similarly, while 52.8% enjoyed working with diverse clients, only 27.2% reported enjoying working with UO clients. A negative correlation was found between the emotions about minorities scale and two UO-related subscales, views (ρ = −0.307, p = 0.01) and awareness (ρ = −0.534, p < 0.001), suggesting that local sociopolitical factors influence attitudes toward the Haredi community. Conclusions: This study highlights a gap between STs’ general cross-cultural competencies and their attitudes toward the Haredi population. The findings underscore the need for continued professional training in culturally competent therapy, as personal interactions play a crucial role in bridging societal divides and improving therapeutic relationships.

Israel's Ultra-Orthodox Jews (Haredi) are a culturally distinct and tightly-knit community. Since their lifestyle, which rests on the strict interpretation of religious sources, sets them as a cultural minority within the dominant secular culture of modern Israeli society, addressing mental health within this group requires tailored approaches that consider the community's values and lifestyle, as well as the distinct social and political dynamics between secular therapists and Haredi clients. However, while Haredi's unique position often becomes a source of tension in Israeli politics and society, it also affects therapeutic encounters between ultra-orthodox clients and secular therapists, as this unique dynamic between religious and secular cultures can lead to ambivalent attitudes toward each other. This study was designed to examine the unique experiences of secular therapists in providing mental health treatment to the ultra-orthodox sector in Israel in the current social-political situation. Twenty-one qualitative semi-structured interviews conducted with secular psychologists and art therapists regarding their experiences with working with ultra-religious clients identified three main themes: (1) a feeling of an outsider, (2) colliding viewpoints, and (3) sameness. While interpretative phenomenological approach was used, the interviews were analysed using thematic analysis based on Colaizzi's approach. These themes highlight the ambivalent experience and illuminate this captivating intersection of therapy, religion, and society. Public workplaces should consider enabling intercultural therapies, acknowledging their benefits and challenges.

The narratives expressed by patients during psychotherapy sessions provide a cognitive framework through which they process their experiences. While these narratives offer therapists valuable insights, automatically detecting them presents unique challenges due to their unstructured nature, parallel storytelling patterns, and frequent interruptions - characteristics distinct from narrative detection in traditional domains like news or social media. This paper first establishes a formal definition of therapeutic narratives as continuous segments containing characters, actions, and consequent changes, situated in specific temporal-spatial contexts. Working with domain experts, we developed and validated annotation guidelines achieving high inter-annotator agreement on a comprehensive corpus of Hebrew psychotherapy sessions. Building on this foundation, we introduce APhyND, a novel layered framework specifically designed for automatic narrative detection in psychotherapy session transcripts. Our framework makes several key innovations: (1) a clinically-informed architecture incorporating therapist-validated narrative criteria and specialized feature extraction for therapeutic discourse (2) integration of deep contextual understanding through BERT with sequence modeling via Conditional Random Fields, specifically adapted for therapeutic discourse, and (3) the first comprehensive solution for narrative detection in Hebrew psychotherapy transcripts, addressing the challenges of morphologically rich languages in therapeutic contexts. The framework employs a clinically-informed architecture incorporating therapist-validated narrative criteria, specialized feature extraction for therapeutic discourse, and adaptive threshold adjustment to handle inherent class imbalance. To evaluate the framework’s effectiveness, we conducted experiments on a dataset of 38,434 sentences from 79 psychotherapy sessions in Hebrew. Our results demonstrate significant improvements over existing approaches, achieving an f1-score of 0.804, with particularly strong performance in handling interrupted narratives and speaker transitions. The framework’s ability to process full therapy sessions in real-time while maintaining high accuracy makes it particularly valuable for clinical applications, addressing a critical gap in automated psychotherapy analysis tools.

Objective: The effectiveness of therapy is correlated with the therapeutic alliance (TA) rating congruence between clients and therapists. The current meta-analysis seeks to determine how clients with eating disorders versus anxiety disorders and their therapists differ in their assessments of the TA. This investigation focuses on two potential moderators: treatment orientation, and measurement time points. Method: Three electronic databases were searched, and a total of 2,688 articles were identified using a combination of search terms. 40 studies (N = 2,727) met the inclusion criteria. Data were coded, and a risk of bias assessment was conducted for each included study. We then analyzed the data using multivariate random effects models. Moderation analyses were conducted with a series of univariate metaregressions. Results: The overall mean therapist-client discrepancy in TA was moderate in size, with clients typically having a higher evaluation, g = 0.41, 95% confidence interval (CI) [0.28, 0.53], SE = 0.06. Furthermore, the effect size for eating disorders samples (g = 0.51, 95% CI [0.31, 0.71], SE = 0.09) was descriptively larger than anxiety disorders samples (g = 0.37, 95% CI [0.21, 0.53], SE = 0.08), but moderation analysis did not reveal any significant moderators of the therapist-client discrepancy in TA assessment. Conclusion: Our analysis shows that therapist-client discrepancy in TA assessment is robust.

Most individuals with serious mental illness (SMI) are advised to take psychiatric medication, but about half of them do not take it as prescribed. The binary concepts of "adherence" and "non-adherence" do not seem to capture the actual patterns of medication use. The current study mapped the different patterns of medication use among people with SMI and explored the characteristics of each pattern. Sixteen participants diagnosed with an SMI that used psychiatric medications for at least one year, were interviewed, and data were analyzed using ideal-type analysis. Analysis revealed four patterns of medication use: (1) adherence without doubt; (2) adherence after attempts to stop/reduce; (3) flexible use over time; and (4) tapering off medication. Individuals may shift between these different patterns in their recovery journey, creating the need for tailored therapeutic interventions that adapt to individuals' evolving needs, beliefs, and preferences.

Research shows that traumatic events may shatter people's perceptions and assumptions about the world, potentially resulting in PTSD symptoms as well as a lack of integration of the event into one's narrative and experiencing the self as flawed, fragmented, and incoherent. Metacognition, the ability to reflect upon oneself and others and the use of this knowledge to respond to challenges, is often impaired among people coping with PTSD. In the current study we explored the association between world assumptions and PTSD symptoms, and whether metacognition moderated this association. Thirty-nine people (age M = 23.67, SD = 2.86) who experienced different types of traumatic events participated in the study and took part in comprehensive interviews. Metacognition was coded via the Metacognition Assessment Scale-Abbreviated (MAS-A) based on the trauma narrative elicited in the interview. World assumptions and PTSD symptoms were assessed via self-report questionnaires. Results showed negative correlations between world assumptions and PTSD symptoms and no relationship between metacognition and PTSD symptoms. Although the overall interaction effects were only marginally significant, conditional effects did show a significant interaction indicating that the presence of different levels of metacognition was related to the association between world assumptions and PTSD symptoms. Accordingly, among participants with high levels of metacognition, positive world assumptions were related to the presence of fewer PTSD symptoms, whereas among participants with lower levels of metacognition, this relationship was not found. Suggestions for further exploring the impact of world assumptions and metacognition on PTSD symptoms are discussed.

Objective: The motivation to change in patients with anorexia nervosa (AN) predicts both treatment outcomes and the therapeutic alliance (TA). In addition, different countertransference patterns have previously been related to the patient's motivation to change and the TA. However, the mechanisms through which these relationships occur are unclear. In this study, we examine the therapists' perspectives on the relationships between all three variables and whether countertransference patterns mediate the relationship between the stage of change and the TA. Method: One hundred and fifty-six AN therapists were recruited from eating disorders recovery centers, conferences, and associations. The participants completed a motivation to change questionnaire (the staging algorithm questionnaire), a countertransference questionnaire, and a TA questionnaire (working alliance inventory short revised), regarding the last patient with AN they had a session with. Results: Motivation to change, as rated by therapists, was strongly related to the TA and to countertransference patterns of hostility, helplessness, and positivity. Countertransference patterns that were hostile, helpless, positive, disengaged, or overwhelmed were related to the TA as rated by therapists. Additionally, three countertransference patterns (positive, hostile, and helpless) mediated the relationship between the motivation to change and the TA. Conclusions: Increasing patients' motivation to change might facilitate alliance development. Furthermore, more attention should be given to therapists' countertransference to account for the motivation to change-TA relationship as perceived by therapists.

Innovative moments (IMs) in psychotherapy contradict or challenge clients' maladaptive patterns of meaning associated with their suffering. IMs are receiving increased theoretical and empirical attention in psychotherapy research and are associated with symptomatic improvement. However, little is known about possible predictors of IMs and their impact beyond their association with outcomes. A therapeutic alliance (TA) that implies a collaborative bond between clients and therapists might set the stage for the occurrence of IMs. Additionally, the occurrence of IMs could serve as a relational experience within the session that strengthens the TA. Thus, in the present study, we examined the association over time between IMs and (i) TA, and (ii) functioning, in a time-limited case study with a good outcome. Furthermore, this study is one of the first to explore IMs in psychodynamic therapy (PDT). Transcriptions of ten randomly selected sessions of PDT of a 43-year-old male with dysthymia were coded using the innovative moment coding system. Self-report measures of function and TA were collected at each session. Data were analyzed using simulation modeling analysis. Consistent with good-outcome cases in other therapeutic approaches, high-level IMs (H-IMs) increased while low-level IMs (L-IMs) decreased throughout treatment. H-IMs predicted a change in functioning in the following session. Finally, H-IMs were associated with higher TA post-session, and specifically with agreement on treatment tasks. To conclude, moments of change in the client's pattern of meaning are related to stronger TA and better treatment outcome. If replicated, these findings may provide important insights regarding the unfolding of therapeutic change.

This study examined the relationship between implicit and explicit levels of change in psychotherapy—the ability to shift between self-states, measured by the Two Person APES (TPA), a relational extension of the Assimilation of Problematic Experiences Scale (APES), and the emergence of exceptions to the problematic self-narrative, measured by the Innovative Moments Coding System (IMCS). The contribution of each of these dimensions of change to session outcome was also examined. Eighty sessions of eight psychodynamic treatments (10 sessions each) were sampled and coded according to the TPA and the IMCS. Session outcome was measured by the Outcome Rating Scale (ORS). A repeated measures correlation approach was used, revealing a positive association between IMs and client TPA. Also, IMs showed stronger correlations with session outcome compared to TPA. These results indicate that a growing ability to shift between self-states in the implicit level is related to the client’s ability to construct new meanings in the explicit level, and that these explicit changes have stronger correlations with functioning improvement at the session level than implicit processes concerning the renewal of dialogue between self-states.

Integrating the selective reconstruction of the past with an imagined future, narrative identity is a person's internalized and evolving story of the self, functioning to provide life with some degree of meaning and purpose (McAdams & McLean, 2013). While narrative identity has been found to be associated with a range of psychological and social phenomena (e.g., Adler et al., 2015; McAdams & Guo, 2015), cross-national variation in narrative identity has been only minimally examined. For the purposes of the current inquiry, 438 adults from the United States (N = 102), Japan (N = 122), Israel (N = 103), and Denmark (N = 111) wrote narratives on adversity (low point and life challenge) and completed self-report measures on psychological well-being. Part 1 examined the narrative topics discussed, the frequency of narrative indices (redemption, contamination, agency, communion, meaning-making), and their relationship to well-being across the four countries, finding the most cultural difference in levels of redemption and meaning-making and the kinds of events narrated. Part 2 involved a qualitative, thematic analysis of the Japanese, Danish, and Israeli narratives to derive a set of narrative indices characterizing each country. Several emerged in the Japanese narratives (acceptance, attribution of blame, unresolved), the Danish narratives (balanced affect, communal growth, normality), and Israeli narratives (collective responsibility). Taken together, our findings regarding narratives of adversity support the idea that narrative identity cannot be fully captured without an understanding of culture but needs to instead be studied in tandem with the cultural context in which stories reside.

ObjectiveStudies indicate a significant challenge for therapists in forming a therapeutic alliance (TA) with patients coping with anorexia nervosa (AN). While TA is a significant predictor of treatment outcomes, and AN treatment has low success rates, little is known about factors that affect the formation of an alliance and its quality in the treatment of AN. This study aimed at examining the factors associated with alliance formation, as perceived by patient-therapist dyads throughout AN therapy. MethodsA total of 18 dyads of patients with AN and their therapists were recruited from an eating disorder unit. The semistructured interviews focussed on the TA between the therapist and patient and examined facilitators towards, and barriers to, TA formation. Data analysis followed a thematic approach. ResultsThe data analysis revealed an overarching theme: the mutual wish of the patient and therapist to form a close relationship and related challenges. This theme was divided into subthemes: (1) the role of self-disclosure of affection; (2) the meaning of the therapeutic setting; (3) coping with relationship ruptures; and (4) the importance of empathic acknowledgements. ConclusionA major barrier to TA formation between patients with AN and their therapists is patients' conflict between a need for meaningful relationships and fear of re-experiencing disappointment and pain. Self-disclosures of affection, flexible treatment setting, acknowledgement of therapists' empathic failures and ability to see things from patients' perspectives are perceived by therapists and patients to facilitate alliance formation. This study also presents practical implications derived from these themes.

ObjectiveAs advances in breast cancer treatment have bolstered survival rates, post-treatment self-management has become crucial for survivors' well-being.MethodsIn the current qualitative research, conducted via content and form analysis of 12 in-depth interviews, the authors explored self-management strategies in the narratives of female breast cancer survivors who underwent mind-body therapy.ResultsThree coping models emerged: (1) an illness-focused story overshadowing the body, (2) a coexistence of illness and body stories, and (3) an embodied illness-story. These self-management models showcase a developmental sequence, reflecting the evolution of coping mechanisms.ConclusionThe study underscores embodiment's significance in fostering agency and well-being, particularly in a societal and medical context where body attention tends to be marginalized.

BACKGROUND:Seeking help for perinatal mood and anxiety disorders is crucial for women's mental health and babies' development, yet many women do not seek help for their condition and remain undiagnosed and untreated. This systematic review of systematic reviews aimed at summarizing and synthesizing findings from all systematic reviews on seeking help for PMAD in the context of interdependence theory, highlighting the interdependent relationship between women and healthcare providers and how it may impact women's seeking-help process. METHODS:Four electronic databases were searched, and 18 studies published up to 2023 met inclusion criteria for review. RESULTS:The capability, opportunity and motivation model of behavior was used as a framework for organizing and presenting the results. Results demonstrate that seeking help for PMAD is a function of the interdependent relationship between perinatal women's and healthcare providers' psychological and physical capabilities, social and physical opportunities, and their reflective and automatic motivation. CONCLUSIONS:Unmet needs in perinatal mental healthcare is an important public health problem. This systematic review of systematic reviews highlights key factors for policymakers, researchers, and practitioners to consider to optimize healthcare systems and interventions in a way that enhances perinatal women's treatment whenever necessary.

BACKGROUND:The delay time from onset of symptoms of a myocardial infarction to seeking medical assistance can have life-threatening consequences. Women delay significantly more often than men do in calling for medical help, once symptoms of a myocardial infarction occur. OBJECTIVES:The current qualitative study's main aim was to explore psychosocial factors that contribute to Israeli women's delaying calls for medical assistance and, by contrast, the motivational factors that encourage them to do so. DESIGN:A qualitative study. METHOD:In total, 12 women were interviewed shortly after experiencing a myocardial infarction. Qualitative data were subjected to thematic analysis. RESULTS:Two major themes emerged describing barriers to seeking help: (1) the use of denial as a defense mechanism and (2) the need for control. The motivational factor which enhanced help-seeking was "fear of death." CONCLUSION:These findings may help in designing gender-sensitive interventions with the aim of minimizing the symptom onset to call time and thus preventing irreversible and life-threatening health damage.

To improve the provision of psychotherapy, many countries have now established clinical practice guidelines for the treatment of specific disorders and mental health concerns. These guidelines have typically been based on evidence from meta-analyses of randomized clinical trials with minimal consideration of findings from qualitative research designs. This said, there has been growing interest in incorporating qualitative research in guideline development processes from both stakeholders and guideline development bodies. In this international collaboration, 19 qualitative psychotherapy researchers from 10 countries articulated the benefits of including qualitative findings within the guideline development process and generated recommendations for guideline developers. The underlying question of this report was "Why and how should qualitative research be used in efforts to develop guidance for psychotherapy practice?" The advantages of reviewing qualitative findings included the ability to identify treatment patterns at the level of in-session dynamics, cultural contexts, interpersonal relationships, and internal experiences, thereby creating guidance that is responsive to clients' needs in the moment-to-moment therapy process. Recommendations are offered at the systemic level (e.g., guideline formation processes, methods of education, research funding priorities). Also, methodological advice is offered for guideline developers when selecting to incorporate qualitative research in the implementation of an expanded guideline development process. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Military personnel transitioning to civilian life have reported significant challenges in reintegrating into civilian culture. Filmmaking has been used as a therapeutic intervention to enhance the community reintegration of veterans, but there are no published quantitative data documenting its impact. The present study provides outcome data on 40 veterans who participated in the I Was There (IWT) filmmaking workshop. This 3-day (20-hr) group intervention involved veterans working in small teams with a film coach, making short films designed to communicate some aspect of their experience during or after military service, and then creating a screening event to show their films to community members. The sample consisted of community-dwelling veterans who reported at least some mental health symptoms and who were not engaged in mental health treatment for those symptoms. Targeted outcomes included engagement in mental health care, symptoms of posttraumatic stress disorder (PTSD) and depression, and reported perception of community interest in their experience as veterans. Fifty-six percent of participants entered treatment within 4 months of participation. Significant decreases were noted in symptoms of PTSD at 1-month follow-up but not at the 4-month follow-up, while changes in depression were not statistically significant. Participation was related to increased perception of community interest in veterans' experience, and increased interest among community members who viewed the films. These data provide initial support for the conclusion that the IWT film workshop is a potentially effective tool for treatment engagement and for community reintegration among veterans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Type 1 diabetes (T1D) is a chronic disease requiring medical adherence. However, among adolescents, non-adherence rates may reach up to 75%. Satisfaction or frustration with psychological needs is a crucial factor in the motivation and management of health-related behaviors. This study aimed to examine the differences in good health practices and psychological and physical well-being among adolescents with and without T1D and the mediating role of satisfaction and frustration of psychological needs on the association between good health practices and well-being in this population. A total of 94 adolescents (42 with T1D, 52 healthy controls, mean age 14.83 ± 1.82 years) completed questionnaires assessing good health practices, satisfaction or frustration of psychological needs, and well-being. Adolescents with T1D reported lower levels of physical well-being compared to healthy controls. Satisfaction or frustration of psychological needs had an effect on good health practices and psychological and physical well-being among healthy controls. Among adolescents with T1D, satisfaction or frustration of psychological needs was related to psychological well-being and partially related to physical well-being, but not to good health practices. The results demonstrate that the satisfaction or frustration of psychological needs has a unique effect on health behaviors and well-being among adolescents with T1D. This calls for further examination of the underlying mechanisms involved in health-related behaviors and well-being among adolescents with T1D.

Hospitalization of children in an inpatient psychiatric ward is stressful for both the children and their parents, and separation from the parents during hospitalization is probably one major cause of this stress. We designated one room in a closed inpatient unit to enable a parent to stay with his/her child, including overnight, during the 1st week of hospitalization. We then examined the parents' experience of the shared parent–child stay. Thirty parents of 16 children aged 6–12 years admitted to our inpatient child psychiatry ward completed in-depth semi-structured interviews after that week's experience. The interviews covered the parents’ experiences of the 1st week in the larger context of pre-hospitalization period, which also includes the decision to hospitalize the child. The contents of the interviews were analyzed by means of independent coders that identified the following major themes: (1) ambivalence and confusion of the parents as related to their decision to hospitalize their child in the time period just before admission; (2) gradual process of separation from the child during the joint stay at the ward; (3) building confidence and trust toward the staff. Themes 2 and 3 express benefits from the joint hospitalization that may have a strong positive impact on the child's and the parent's recovery. These themes warrant further evaluation of the proposed shared stay during hospitalization in future studies.

The harm caused by child sexual abuse (CSA) is well-documented, calling for more awareness and efforts at prevention. However, CSA in closed religious societies is still tightly under wraps, and therefore underreported and understudied. We chose to use the mother's point of view, in order get an estimate of the prevalence, the reporting rates and their psychological wellbeing. The current study aims at addressing this in the Jewish ultra-Orthodox community, an insular religious one, which may thus serve as a test case for understanding other closed, religious communities. Three hundred forty-seven ultra-Orthodox Israeli women completed self-report questionnaires and reported on their, or their children's exposure to CSA sexual abuse, about their emotional coping, and about considerations regarding disclosing the abuse. About 24% the participants reported that they were victims of sexual abuse. Only 24.3% of cases were reported to the police or official welfare services, with cultural reasons offered by the women to explain it. Lower psychological wellbeing was found among mothers who themselves or their children were victims of child sexual abuse, compared to controls. Interestingly, mothers who reported having undergone psychological treatment suffered a higher degree of distress than those who had not. These findings contribute to the understanding of the dynamics of sexual abuse exposure and disclosure in the ultraorthodox community, and in close societies and highlight the changes required to improve safeguarding of children.