Objectives: Impulsivity is considered a core feature of substance use disorders (SUDs). However, the efficacy of evidence-based treatments for SUDs on this dimension remains a topic of debate, especially considering therapeutic community (TC) interventions for severe forms of these clinical conditions. Therefore, the current study aims at investigating pre- posttreatment changes in levels of impulsivity and related psychological dimensions during a 6-month Dialectical Behavior Therapy skills training program integrated within a TC (DBT-ST-TC) for individuals with severe SUDs. Methods: Impulsivity were assessed through a self-report measure (UPPS-P) and a neuropsychological battery. There were also evaluated levels of mindfulness (FFMQ, MAAS) emotion dysregulation (DERS) and distress tolerance (DTS). Intention-to-treat analysis controlling for baseline levels was performed. Contrast analyses were also conducted in order to compare results of the DBT-ST-TC group with two control groups (i.e., outpatient treatment-seeking individuals with SUDs; healthy controls [HCs]) Results: Sixty-eight patients with SUDs were admitted to the DBT-ST-TC. The clinical control group included 41 treatment-seeking individuals with SUDs. The HC group was composed of 53 participants. Considering pre- posttreatment changes, DBT-ST-TC patients reported that emotion dysregulation slightly improved as well as positive urgency and sensation seeking. Neuropsychological domain of cognitive disinhibition showed the most robust improvement, especially considering no significant differences between DBT-ST-TC group and HCs at the end of 6-month period of observation. Conclusion: The DBT-ST-TC might be a promising intervention for treating impulsivity among patients with severe SUDs. Future long-term outcomes are needed to corroborate and extent these provisional results.

Objectives: Nonsuicidal self-injury is a behavior typically used to regulate emotions, resulting in damage to one’s body without suicidal intent. Self-injury may indicate a need for psychological support, yet stigma is a major barrier to disclosure for many. Despite stigma’s potential impact on help-seeking, recovery, and wellbeing, our understanding of self-injury stigma is limited. While traction is building in this space, few measures of self-injury stigma exist to allow exploration of its impacts. In this study, we outline the preliminary validation of the Self-Injury Stigma Questionnaire (SIS-Q), which was developed to capture the features of self-injury stigma conceptualised in the NSSI Stigma Framework (Staniland et al., 2021). Method: First, we developed item pools representing five stigma perspectives: Public, Personal, Internalized, Anticipated, and Enacted, and reflecting six dimensions of stigma: Origin, Concealability, Aesthetics, Course, Peril, and Disruptiveness. These items were piloted with a sample of 316 ( M age = 32.1, 68% male, 40% with a history of self-injury) participants. Following item reduction, the scales were administered to 722 ( M age = 29.2, 27.3% male, 55.7% with a history of self-injury) participants, and data were analysed for validity, reliability, and invariance. Results: Confirmatory factor analyses revealed four factors: Origin, Concealability, Peril, and Disruption. Internal consistency, convergent and divergent validity, and measurement invariance were demonstrated. Conclusion: The SIS-Q offers a comprehensive and theoretically informed measure to support ongoing efforts investigating the development and persistence of self-injury stigma, and the impact it has on individuals with lived experience of self-injury.

Background: Self-Help Internet Cognitive Behavioural Therapy (iCBT) interventions are highly efficacious and overcome numerous barriers adolescents experience when accessing face-to-face interventions, including stigma, privacy, lengthy wait lists and cost. Despite this, adolescents struggle to engage in Self-Help iCBT, which is problematic given that there is a relationship between higher engagement and better treatment outcomes. The reasons for poor engagement among adolescents are unclear. Using the iCBT program, BRAVE Self-Help as an example, this study explored 1) the barriers to engagement directly from the adolescent’s perspective and, 2) their viewpoints on enhancing engagement in iCBT. Method: Semi-structured interviews were conducted with 14 adolescents aged 12-17 years ( M = 14.36, SD = 2.12) who had participated in BRAVE Self-Help in the previous 12 months. Reflexive thematic analysis was utilised to analyse data. Results: Stigma, program factors (program design, content and length) and environmental factors (competing priorities and distractions), were identified as adolescent barriers to engagement. With respect to strategies to enhance engagement, adolescents identified 1) specific program factors (positive reinforcement and personalisation), and 2) support factors (reminders and optional support). Conclusions: Co-design methods with adolescents at both the design and implementation stages of iCBT programs is imperative for engagement.

not-yet-known not-yet-known not-yet-known unknown Personal recovery narratives in psychiatry have long been used to reduce public stigma. Nowadays, more and more such narratives are shared on social media and collected by content creators and journalists often without basic education in psychology. Although telling one’s story has positive effects on the person sharing, the question of adverse negative effects has been neglected so far. We investigated the impact, whether positive or negative, of telling one’s story in a narrative podcast with a wide audience. Participants (N = 27) were recruited from the guest pool of Les Maux Bleus podcast. They completed an online quantitative and qualitative ad hoc 15-question survey assessing the positive effects of their participation on their well-being, and asking for potential adverse effects they might have encountered after their participation. A third of the sample reported adverse effects of low-to-moderate severity, and 6 persons in the sample stated they felt the need to look for emotional and/or psychological assistance after their participation despite a very precautious process before and after recording. Those results highlight the necessity to elaborate guidelines for content creators collecting and broadcasting such narratives to make them beneficial and avoid potentially severe adverse events occurring.

Background: Young adults diagnosed with severe mental illness (SMI), intellectual disability (ID), and developmental disability (DD) often face challenges in accessing comprehensive sexual health education. The educational Intervention and Training Program on Sexuality and Affectivity (eITPoSA) aims to address this gap by providing tailored psycho-educational interventions. Methods: A pilot study was conducted with 15 participants diagnosed with SMI, ID, and DD. The program comprised six sessions focusing on body knowledge, genital sexuality, privacy awareness, privacy protection, and hygiene and personal care. Pre- and post-intervention evaluations were carried out using monitoring and evaluation grids. Data were analyzed using descriptive statistics, paired-samples t-tests with bootstrapped confidence intervals, and Cohen’s d to assess effect sizes. Additional valuable insights were gained from the open-ended questions designed for Modules 1, 2, and 6, as well as from the qualitative analysis of the Circles in Module 5. Results: The program demonstrated significant improvements in all areas evaluated. Mean scores for body knowledge increased from 31.43% (SD = 25.18) to 86.65% (SD = 23.98), genital sexuality from 15% (SD = 34.81) to 90% (SD = 24.00), privacy awareness from 82.94% (SD = 25.10) to 98.75% (SD = 7.16), privacy protection from 86.11% (SD = 29.65) to 95.95% (SD = 14.45), and hygiene and personal care from 47.27% (SD = 38.23) to 96.36% (SD = 12.06). All improvements were statistically significant with large effect sizes for body knowledge, genital sexuality, and hygiene and personal care. Conclusion: The eITPoSA program significantly enhances sexual and relational knowledge among young adults with SMI, ID, and DD. These results support the efficacy of tailored sexual health education programs. However, further research with larger, more diverse samples is needed to generalize these findings.

Background: Given their modifiable nature, understanding the intrapersonal factors involved in the cessation of non-suicidal self-injury (NSSI) is needed to inform existing therapeutic approaches and explore novel avenues for supporting individuals with NSSI. This study aimed to examine the relative contributions of and interactions among intrapersonal factors (self-concept, emotion regulation, and cognitive flexibility) in distinguishing between ceased and current NSSI. Methods: 202 adults aged 18-71 years ( M = 31.50, SD = 11.23; 74.75% female) were surveyed to compare facets of self-concept, emotion regulation, and cognitive flexibility that contributed most to discriminating those who had ceased NSSI for one year from those who continued. These intrapersonal factors were also explored as potential indirect pathways between identity and NSSI status. Results: Significant differences between ceased and current NSSI groups were observed across all intrapersonal factors, with moderate to large effects. Most differences persisted after accounting for psychological distress. Less identity fragmentation, greater emotional clarity, internal locus of control, self-liking, access to emotion regulation strategies, and impulse control contributed most to discriminating NSSI cessation after accounting for psychological distress. The relationship between lack of identity and NSSI status operated indirectly through lack of emotional clarity and self-liking. Conclusions: Having a coherent sense of identity, emotional clarity, internal locus of control, self-liking, access to emotion regulation strategies, and managing impulsivity relate to NSSI cessation. These modifiable factors denote several promising intervention opportunities and should be considered in the design of NSSI-specific treatments.

This article presents a case study of a 31-year-old woman with a dual diagnosis of Borderline Personality Disorder (BPD) and Eating Disorder Not Otherwise Specified (EDNOS). Paula received a 12-month Dialectical Behavior Therapy (DBT) outpatient treatment. DBT is considered a transdiagnostic treatment approach to address emotion dysregulation, which shifts the therapy focus traditionally placed only on behavioral change towards including also validation and acceptance and dialectical strategies. DBT addresses eating symptomatology as a dysfunctional form of emotional regulation and has shown promising results regarding its efficacy for the treatment of BPD and EDNOS comorbidity. Given the growing evidence, a standard DBT treatment plan was developed for this case. Specifically, pre-treatment and phase 1 of the DBT program are described. During pre-treatment and phase 1, individual therapy aims to improve and maintain client’s motivation to change and engage in treatment, as well as to establish and prioritize treatment goals. As for group therapy, the main goal of the skills training in DBT is to enhance individual’s capability by increasing skillful behavior (mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness skills). Paula received 24 weekly skills training sessions over a year. The results after a 12-month standard DBT treatment showed that Paula no longer met criteria for BPD, she had a significant decrease in difficulties in emotional regulation and impulsiveness and in EDNOS symptomatology. This case study may enhance learning about how to apply a transdiagnostic treatment to address BPD and EDNOS together in clinical practice.

While body experience is a key focus of treatment in psychomotor therapy (PMT), research has largely overlooked this important topic. In this study we explored three domains of body experience – body satisfaction, body attitude, and interoceptive awareness – in individuals with mental disorders in a clinical sample receiving PMT. We expected these patients to have a more negative body experience than non-clinical controls, with PTSD, mood disorders, personality disorders and sex negatively affecting all three domains of body experience. The study involved 235 participants aged 18-59 with various mental disorders that were referred to PMT between 2008 and 2017 at a mental health center in the Netherlands. They completed questionnaires on all three of the aforementioned body experience domains. One sample t-tests revealed that patients had significantly more negative body satisfaction and body attitude than non-clinical control samples obtained from the literature, with no significant difference in interoceptive awareness. Regression analyses within the patient sample revealed that female patients and patients with mood disorders or PTSD, displayed more negative body satisfaction than patients with other mental disorders. Additionally, female patients and patients with mood disorders displayed more negative body attitude. Although the total patient group and controls had comparable interoceptive awareness, only PTSD significantly predicted lower interoceptive awareness. Age and personality disorders did not predict differences on any domain of body experience. This research demonstrates that body experience is disturbed in patients with mental disorders who received PMT, and that there are disorder-specific patterns in disturbances on domains of body experience.

Background Procrastination describes irrational delays of scheduled tasks despite clear awareness of adverse consequences to do so. Although procrastination is well-known to be linked to psychiatric or pathological processes, insights into why procrastination may contribute to psychopathological outcomes has not been fully explored. The aim of the current study was to identify the criterion for “pathological procrastination” and its preclinical correlates. Methods This is a longitudinal and prospective observational study with a five-year interval. Participants ( N = 464) completed measures of trait procrastination in November 2018, with a follow-up conducted in March 2023 ( N = 267) to collect preclinical psychiatric symptoms via self-reported measures. A constrained multivariate direct gradient model (cmDGM) was built to prospectively fit procrastination to the preclinical psychiatric symptomatology that formulated by DSM-5 framework. The 2-stage psychopathological connectome model was further constructed to constitute a “diagnostic criterion” reflecting “pathological procrastination”. Results Procrastination prospectively predicted severe preclinical psychiatric symptoms and unhealthy lifestyles. Preclinical bridge hubs of “failure to self-regulate delays”, “failure to control adverse consequences”, “useless to self-change”, “out-of-control irruptions”, “poor sleep quality” and “negative emotional reactions” were captured for highly local and global disruptions in the psychopathological network of procrastination, and thus constituted the 9-item pathological procrastination diagnostic criterion (3PDC) with good diagnostic performance (AUC = 0.82, p <.01). Conclusions The present study revealed the predictive rol of procrastination for preclinical psychiatric symptomatology, and further established the preclinical 3PDC to lay the foundation for the “diagnostics of pathological procrastinators” by both quantitative measurements and DSM-structured binary schemes.

Eating disorders (ED) and personality disorders (PD) co-occur together frequently, and the latter need to be considered by the treating clinicians as they can hinder treatment effectiveness or, if left unaddressed, can lead to relapse. These persons present with a combination of ED symptoms and behaviours, interpersonal problems and global suffering and often have difficulties forming and sustaining a therapeutic alliance. How can we address this condition so as to make ED treatment more effective? We describe the story of Silvia, a 34 years old woman with Binge Eating Disorder (BED) and PD treated with Metacognitive Interpersonal Therapy. She entered treatment with frequent binges and was seriously overweight (Body Mass Index= 36.7). She had difficulties describing her inner states and understanding why she binged, so she could not control them. During therapy, starting from the information coming from the food diary, she gradually becomes aware of how she processes underlying symptoms and interpersonal behaviour. The therapist used a combination of CBT techniques and experiential work, such as guided imagery, to foster change in both the ED and PD domains. By treatment termination, Sivia no longer suffered from either BED or PD and lost 10kg. This case is an example of how it is possible to combine aspects of treatment targeting ED with attention to PD features in an effective way. It also invites researchers to consider ED/PD comorbidity so as to reduce dropouts and increase treatment effectiveness

Purpose. The Therapeutic Alliance (TA) can be conceptualised in terms of three interrelated elements: (a) agreement between therapist and client about the goals of the treatment, (b) agreement between therapist and client about the necessary tasks to achieve the goals, and (c) a bond between therapist and client (Bordin, 1979, 1994). The aim of this review was to systematically identify and review relevant studies that have explored the association between client-therapist personality similarity on the Therapeutic Alliance. Method. We systematically searched the PsycINFO, MEDLINE, Web of Knowledge, COPAC, CINAHL, and Science Direct databases from 1960 to 2013. Of the 105 articles identified, 6 met inclusion criteria for the review. Of the 6 studies, four were conducted in the USA, one in Israel and one in the Netherlands. Results. One study found that clients reported a better-quality bond with the therapist when client-therapist personality similarity was greater. Five out of the 6 studies reviewed found support for the role of dissimilarity whereby differences between client and therapist were beneficial. Findings appear to differ depending on the characteristic examined, the specific component of TA, gender and whether the measure of TA is client or therapist reported Conclusions. This review has highlighted an under researched area of inquiry. Initial findings suggest that Therapist-Client Personality (dis)similarity is linked to therapeutic alliance. Key methodological and analytical differences across studies were also identified along with key challenges for future research. Practitioner Points: 1) Measurement of client and therapist Therapeutic Alliance is important 2) The differential effects of therapist-client personality (dis)similarity on the various components of TA (e.g., bond, task and goal setting) is important 3) The effect of therapist-client (dis)similarity varies depending on the personality trait being measured

Purpose. The study aimed to investigate how parental history of corporal punishment was related to offspring’s depression symptoms and to examine the role of dissatisfaction with intimate partner relationship . Methods. Data from 2666 dyads of children and parents were retrived from the Taiwan Youth Project, which is a longitudinal project consisting of 9 waves with a 1-year interval between waves. Parents reported their history of corporal punishment at the first wave, and reported their dissatisfaction with intimate partner relationship at the eighth wave. Offspring reported their dissatisfaction with intimate partner relationship and depression symptoms at the nineth wave . Results. Parental history of corporal punishment did not directly predict offspring’s depression symptoms. Parent’s dissatisfaction with intimate partner relationship predicted offspring’s dissatisfaction with intimate parnter relationship. Parental history of corporal punishment negatively and indirectly affected offspring’s depression symptoms through the mediating effect of the continuity of intimate partner relationship dissatisfaction between parents and offspring. Conclusions. The results have important implications for the potential of increased resilience after exposure to corporal punishment in terms of its effect on intimate partner relationship and depression symptoms.

Narcissism is a complex dimension related to the self and characterized by grandiosity and/or vulnerability. Grandiosity is related to explicit dominance, self-importance and entitlement while vulnerability is characterized by the feelings of incompetence, inadequacy and negative affect. According to psychodynamic scholars shame can be considered as the core narcissistic affect, however different dynamics might characterize the experience of shame in grandiose and vulnerable narcissism. Although narcissism and shame have received a certain attention in the literature, a comprehensive review of empirical research examining the relationship between these constructs is still missing. Therefore, our systematic review comprised 25 studies on narcissism in its different manifestations and its relation with shame, as different from guilt. We subdivided our articles in three main clusters: 1) correlational studies of narcissistic personality features, 2) studies on narcissistic personality disorder (NPD) and 3) experimental task studies. Overall our findings show that: i) shame is mainly related to vulnerable narcissism while narcissistic grandiosity seems to be a defensive structure towards threatening affect for the self; ii) guilt doesn’t seem to be consistently related to narcissism across studies; iii) NPD studies confirmed the findings of grandiosity as a defensive structure to preserve the self of the individual, while, on the other hand, when NPD is more vulnerable (e.g., depressive, suicidal, etc.), it seems to be more prone to experience shame; iv) experimental studies investigating narcissism in different scenarios, like performance judgements, dishonesty and spirituality, again confirmed the different dynamics between grandiosity and vulnerability related to shame.

In this case study we present the course of the psychotherapy of Myriam, a 19-year old female with a severe personality disorder and comorbid eating disorder. During the initial assessment she reported high levels of neuroticism that parallel the diagnosis of obsessive-compulsive personality disorder, borderline personality disorder, and anorexia nervosa. Myriam showed a severely impaired personality functioning defined by perfectionism, self-criticism, interpersonal guilt and overcontrol. Her daily experience was shaped by a self-recriminative inner dialogue associated with maladaptive patterns in the form of food, water and sleep restrictions, self-harm behaviors, and suicidal ideation. She accessed an integrative treatment based on individual (Evolutionary Systems Therapy) and group psychotherapy (Mindful Compassion for Perfectionism). At the end of 14-month intervention she remitted from all the categorical diagnoses and showed reliable changes in several measures. These outcomes were maintained at 3-month follow-up. We describe the integrative conceptualization based on Myriam’s perfectionistic self-recrimination patterns, and the consequent treatment that targeted these patterns rather than focusing on symptom reduction exclusively.

Objectives: Thousands of Veterans file claims for military sexual trauma (MST)-related posttraumatic stress disorder (PTSD) disability through the Department of Veterans Affairs’ (VA) Veterans Benefits Administration (VBA) annually to receive covered healthcare benefits and monthly nontaxable compensation for MST-related conditions. Although 72% of MST claims in 2021 were granted, prior reporting found claims had been erroneously denied due to insufficient evidence-gathering and scheduling of disability exams for sufficiently developed claims. The present study explores decision-making processes around evidence-gathering for MST-related disability claims through interviews with VBA and Veterans Health Administration (VHA) staff who develop, rate, and evaluate MST disability claims ( n = 21). Methods: Interviews occurred from October 2021-January 2024 and were analyzed using rapid qualitative methods and inductive coding, revealing themes of ambiguity, beliefs, and discretion. Results: Participants described MST “markers”(e.g., behavioral events or patterns indicating effects of MST) as difficult to reliably identify and demonstrated disagreements about what constituted a marker. Within this ambiguity, factors that shaped participants’ decision-making included beliefs about the MST and its impacts, the veracity of Veteran PTSD and/or MST claims, and the role of VA staff. Participants’ judgments appeared to depend in part on personal beliefs; those who generally believed Veterans advocated for and centered survivors, whereas those who endorsed sexual assault myths or that Veterans were not truthful about PTSD and/or MST were skeptical and tended to gatekeep VA resources for those deserving. Conclusion: Future policy and programming around MST claim processing should focus on reducing ambiguity and impacts of personal beliefs on discretion and objectivity.

Objectives: Although mirror exposure improves treatment outcomes in women with eating disorders, it remains uncertain how the cognitive, emotional, and physiological reactions evoked by this technique differ between women with anorexia nervosa and women with bulimia nervosa. Moreover, it is unclear whether vocal arousal is a psychophysiological correlate of these reactions and how the specific emotions elicited by looking at one’s body change during mirror exposure. Methods: Thus, a total of N = 136 women ( n = 39 with anorexia nervosa, n = 24 with bulimia nervosa, and n = 73 healthy controls) first underwent a non-activating baseline, followed by a mirror exposure condition with the task to freely describe aloud arising thoughts and feelings towards their body. Self-reported arousal, emotional valence, and specific emotions were assessed before, in the middle of, and after each condition. Furthermore, we analyzed fundamental frequency ( f0 mean) as a marker of vocally encoded emotional arousal. Results: Women with both forms of eating disorder showed stronger increases in self-reported arousal and equally high levels of f0 mean in contrast to women without eating disorders. Fear increased in all women, while guilt, hostility, and sadness only increased in women with eating disorders. Conclusion: In sum, findings suggest heightened emotional activation and vocal arousal evoked by mirror exposure, particularly in women with eating disorders. In mirror exposure therapy, addressing varied body-related emotions alongside fear might enhance therapeutic success.

The present study investigates the feasibility and initial efficacy of the Unified Protocol (UP) for anxiety and depressive symptoms in Turkish university students with a pretest-posttest control group research design. Thirty-four undergraduate students with high levels of depressive and/or anxiety symptoms were randomly assigned to one of two study conditions: an intervention group based on the UP (n=17) or a waitlist control group (n=17). To determine the effectiveness of treatment, a 2 (intervention-control group) x 2 (pre-post test) mixed measures variance analysis was applied for the primary outcome measures: degree of anxiety and depressive symptoms as well as positive and negative affect and psychological well-being. The analyses revealed a significant difference between pre- and post-treatment scores on all outcome measures in the intervention group; these improvements were also significantly greater than those in the control group. In other words, participants receiving the Unified Protocol reported lower levels of anxiety and depressive symptoms, decreased negative affect, higher levels of positive affect, and improved psychological well-being compared to the control condition. The findings of this study provide preliminary support for the efficacy of the Unified Protocol in a Turkish sample. The study findings are evaluated in light of the relevant literature and within the scope of the study’s limitations, and suggestions for academic and clinical applications are presented.

Identity disturbance (ID) has been identified as a transdiagnostic contributor to psychiatric symptoms and seems to be comprised of both interpersonal and self-oriented mechanisms. This study developed the identity self-focus experimental task, incorporating personalized adjectives, reflection, and varying conditions by source (Self or Other) of identity adjectives, to better understand the relation between ID and affectivity. University students ( N=97) completed a positive mood induction followed by the experimental manipulation— during which they continuously rated their positive affect. Results implicated specific facets of ID in higher negative and lower positive affect, and ID predicted difficulty regulating positive emotions. Higher ID was also associated with difficulty maintaining consistent positive affect for those in the Self condition and was associated with poorer emotion regulation for those in the Other condition. Findings suggests that ID is implicated in an unhelpful cognitive and affective style, especially for those with high levels of ID. While evidence-based treatments either do not or only indirectly address identity functioning issues, results suggest that measurement of ID and targeted intervention to strengthen identity may support emotional health outcomes of therapeutic treatments.