Clinical Psychology Research Articles

The utility of high-dosage experiments in everyday life to test theories in clinical science.

This viewpoint article discusses the utility of high-dosage experiments (HDEs) in everyday life to test theories in clinical science. HDEs involve experimental manipulations and assessments that occur over much longer periods of time than traditional experiments-generally days or even weeks. By nature, they also occur outside the lab, in the everyday environments of participants. Additionally, as with other experiments, the purpose of the study is concealed from participants. Experimental design is one of the most distinguishable characteristics of psychology that separates it from other behavioral sciences. Studies that rely on experiments are essential for theory testing and establishing the potential causal role of mechanisms that underlie psychopathology. Yet despite the value of experimental research, experimental studies are not currently given special prominence in clinical psychological science. For example, in the Journal of Psychopathology and Clinical Science, of all the empirical studies in the most recent year (2023), only three of 77 incorporated an experimental manipulation. Experimental research appears to be less popular in clinical psychology than in other fields, such as social psychology. What might account for this discrepancy? First, clinical samples are more difficult to recruit. This is important because experimental manipulations may produce small effects that require large samples for detection. Additionally, mechanisms hypothesized to underlie psychopathology are often chronic and intransigent. For example, cognitive factors (e.g., perfectionistic beliefs) could require an especially strong manipulation to modify in isolation. Researchers have argued that psychology has been experiencing a crisis in theory development. Eronen and Bringmann (2021) stated that one major reason for this crisis is the difficulty in establishing causal relationships between psychological constructs. The replication crisis has garnered even more attention (Open Science Collaboration, 2015). HDEs would help address these two crises and provide stronger and more replicable tests of theory. This could allow us to more precisely identify important mechanisms underlying psychopathology, potentially enhancing treatment efficacy, and enabling us to move the field forward. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Marketing mental health services: a mixed-methods analysis of racially and ethnically diverse college students’ engagement with and perspectives on U.S. university mental health clinics’ websites

BackgroundThe United States (U.S.) faces a significant mental health crisis, with around 52.9 million adults experiencing mental health disorders, with young adults (18–25 years old), such as college students, having the highest prevalence and lowest service utilization rates. While efforts to expand mental health services through “push” strategies are in place (e.g., training therapists in evidence-based therapies), limited initial engagement suggests a need for “pull strategies” and targeted marketing that make services attractive to college students and increase demand. This mixed-methods study identifies U.S. university mental health clinic websites and website characteristics that are attractive and engaging to college students interested in seeking mental health services (i.e., students were considering or actively looking for mental health support).MethodsEleven U.S. university websites were chosen (10 randomly and one from the university where students were attending) from a pool of 44 Psychological Clinical Science Accreditation System training clinics websites. Fifty-seven college students (Mage = 20.95, SD = 2.97; 81% female; 68% racial/ethnic minority) were videorecorded engaging with two U.S. university mental health clinic websites, completed self-report engagement measures, and gave detailed feedback about websites through semi-structured interviews.ResultsLikert scale scores revealed moderate engagement with all websites (e.g., they were interesting and helpful). Qualitative results indicated that websites that provided important and easily understood information about key features of services (e.g., types, evidence-base, and cost), therapist backgrounds, psychoeducation, used lay language, and had an appealing website layout (e.g., color, font, images, organization, and interactive components) generated greater consumer interest and trust in their mental health services.ConclusionsThis study emphasizes the importance of using marketing strategies to enhance college students’ engagement through mental health service websites. Salient features, psychoeducation, and effective promotional strategies (e.g., how information is presented) were identified as crucial for website engagement and subsequent mental health service uptake. Using marketing strategies, such as tailoring language to consumer literacy levels, describing the evidence-base of services, and improving website design may address college students’ needs and enhance initial mental health service engagement.

Providing access to cognitive-behavioral therapy for insomnia in cancer care: Preliminary results of an implementation study.

61 Background: Between 30 to 60% of cancer patients display insomnia symptoms. While cognitive-behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for cancer-related insomnia, it remains underutilized due to its limited accessibility. To date, we are unaware of any study that has investigated the implementation of CBT-I in routine clinical care. Our prior work showed that a stepped care approach, combining a web-based CBT-I and 1-3 booster therapy sessions, was not significantly inferior in producing sleep improvements than a standard 6-session CBT-I. The main goals of the IMPACT (Insomnia in Patients with Cancer – Personalized Treatment) program are to assess the feasibility and efficacy of implementing this stepped care CBT-I in four cancer centers in Quebec City, Canada. Methods: The ongoing study uses a stepped wedge cluster non-randomized design implementing the stepped care CBT-I at various time intervals across cancer centers. All first-line cancer providers (e.g., nurses, oncologists, radio-oncology technologists, pharmacists) are met every 3-4 months to present/remind them of the rationale of the project and procedures to refer patients to the IMPACT program. Patients having a score ≥ 4 on the sleep item of the Edmonton System Assessment System-Revised (ESAS-R-sleep) receive a leaflet explaining the stepped care CBT-I and how to access the web-based program (first step). Patients with residual insomnia symptoms after completing this first step are offered 1-3 booster sessions with a clinical psychologist (second step). Uptake and retention rates are the main variables. Results: Across cancer centers, 11.9%-50.8% of patients having a score ≥ 4 on the ESAS-R-sleep item were referred to the IMPACT program. The most common reasons for not referring were: 1) the presence of comorbid anxiety or depression symptoms (they were referred instead to the psychosocial oncology team) and; 2) patients declining help. Registration rates were greater when a brief follow-up phone call was conducted to explain the IMPACT program in more detail (vs. giving only the leaflet). Across cancer centers, 10%-54.9% of referred patients registered with the web-based CBT-I, 83.3%-90% of them initiated it and 26%-42.3% completed it. The most common reasons for not completing the web-based CBT-I were: 1) sleep difficulties improved or remitted (36.2%); and 2) the program did not meet patients’ needs (23.4%). Among completers, 29%-56% had residual insomnia and were offered booster sessions. On average, sleep diary data collected during treatment (N=83) indicated a reduction of sleep-onset latency of 20 min and of wake after sleep onset of 45 min. Sleep efficiency increased from 70 to 85%. Conclusions: Although uptake and retention rates could be improved, these preliminary data suggest that stepped care CBT-I can be implemented in routine cancer care and is effective. Clinical trial information: NCT04817163 .

Improving the provision of emotional support for patients following major lower limb amputation

Major lower limb amputation (MLLA) is a lifesaving but life-altering surgical procedure. Psychological distress is common and typically heightened in the acute postoperative period. Despite the negative impact that poor...

Indonesian Patient Health Questionnaire's Clinical Utility in Psychiatric Outpatients: Ruling Out Conditions per ICD-11 Criteria

This study aimed to assess the diagnostic accuracy of the Patient Health Questionnaire (PHQ) for identifying common mental disorders in an outpatient clinical psychologist office setting in Indonesia. A total of 661 outpatients from a clinical psychology office in Jakarta, Indonesia, participated in the study. The complete PHQ was administered, and its results were compared with diagnoses made by clinical psychologists based on ICD-11 criteria, including somatoform disorder (n = 6), depression (n = 117), Generalized Anxiety Disorder (GAD, n = 50), panic disorder (n = 42), bulimia nervosa (n = 2), binge eating disorder (n = 2), and other diagnoses such as OCD and BPD (n = 442). Receiver operating characteristics were computed to examine cut-off points, and optimal cut-off points based on the Youden Index were identified for somatoform disorder (PHQ-15 ≥ 13), depression (PHQ-9 ≥ 13), GAD (GAD- 7 ≥ 10), and panic disorder (PHQ-PD ≥ 7). Cut-off points for the alcohol abuse and eating disorder modules of the PHQ could not be determined due to a lack of sample, and AUC was suboptimal for PHQ-9, GAD-7, and PHQ-ED. The Indonesian PHQ demonstrated good sensitivity but low specificity in identifying somatoform disorder, depression, GAD, and panic disorders based on ICD-11 criteria among Indonesian clinical psychologist office outpatients. In the Indonesian outpatient psychiatric context, the utility of the Indonesian PHQ appeared to be most effective in ruling out diagnoses.

A Novel Approach to Personalized Personality Assessment with the Attachment-Caregiving Questionnaire: First Evidence in Favor of Interpretation-Oriented Inventory Designs

In clinical psychology and psychiatry, personality is usually assessed using questionnaires developed through factor analysis (FA). Essential domains are identified, which correspond to questions/items defining a (sub)scale, and each question is rigidly assigned to one scale, giving the item the same meaning regardless of how the respondent may interpret it. However, this rigidity might hinder the instrument’s assessment capability. We tested this hypothesis using the Attachment-Caregiving Questionnaire (ACQ), a clinical and personality self-report that—through extra-scale information—allows the clinician to infer the possible different meanings that the subjects attribute to the items. Considering four psychotherapy patients, we compared the scoring of their ACQs provided by expert clinicians to the detailed information gained from therapy and the patients. Our results indicated that questions could be interpreted differently—receiving the same score for different (clinically relevant) reasons—potentially impacting personality assessment and clinical decision-making. Moreover, accounting for multiple interpretations requires a specific questionnaire design. Overall, our analysis suggests that a meaning-sensitive, personalized read of a personality self-report may improve profiling and treatment, implying the necessity of more advanced pattern recognition than the one produced by FA or similarly rigid methods, which artificial intelligence may provide. More evidence is required to support these preliminary findings.

Mishima: Writer of body, life and death

On the basis of a longitudinal study, the aim of this paper is to examine the life and work of Yukio Mishima (1925–1970) in an attempt to understand the creative genius of this renowned Japanese author who took his own life by committing seppuku. Does the key to understanding Mishima lie in his work, in his life, or in his suicide? Was he a manic-depressive? An exhibitionist obsessed with beauty, death and glory? A terrorist? A megalomaniac? Attempts have been made to pigeonhole him into different categories, but he remains an enigma. How can clinical psychologists understand the entangled complexity of all this? What can be deduced from the kaleidoscope of possible diagnoses?

Practices and barriers to cancer care among oncologists for patients with serious mental illness.

171 Background: Serious mental illness (SMI), defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment, that substantially interferes with or limits one or more major life activities, includes schizophrenia, bipolar disorder, and major depression. Patients with SMI and cancer have poor survival rates attributed to inequities in cancer care. Such patients are often diagnosed at an advanced stage and are more likely to have their cancer care interrupted. This study surveyed the general practices oncologists apply to integrate mental health and cancer care in their clinical practice. The study also surveyed perspectives on personalized collaborative care intervention to improve cancer outcomes in patients with SMI while identifying the barriers to adapting such intervention in clinical settings. Methods: In February and March 2024, US-based hematologists/oncologists convened at live meetings to discuss abstracts presented at the 2023 ASCO Quality Care Symposium. An online premeeting survey was used to collect participants’ demographics. Participants’ approach to mental health care for patients with cancer were captured via an audience response system during the live meetings. Responses were aggregated and analyzed using descriptive statistics. Results: Among 125 participants, 77% were community providers. The majority of participants (60%) reported frequently discussing mental health with their patients with cancer. Respondents support the mental health needs of their patients with cancer by utilizing in-house social workers (52%) or in-house counseling services (31%), or by referring to in-house clinical psychologist (40%) or an external psychiatrist (41%). They identified challenges to integrating mental health care into cancer treatment: lack of dedicated staff (54%), high patient volume (44%), and lack of available psychosocial tools (40%). Additionally, a subset of participants was asked about their perspectives on collaborative care intervention for cancer care of patients with SMI, and while most participants were encouraged, they also reported that mental health services should be coordinated primarily through either a psychiatrist (25%) or a social worker (25%). Interestingly, limited access to psychiatric care (78%) and lack of resources to screen patients for SMI (56%) were the primary barriers to adapting a personalized and collaborative care approach in the real-world setting. Conclusions: Participants were inclined to incorporate personalized mental health assessments into routine clinical care for their patients with cancer, however they face several barriers to implementation. Further research is needed to address those modifiable barriers and assess the impact of a personalized and collaborative care approach on timely diagnosis and mitigating inequities in cancer care to improve cancer outcomes in patients with SMI.

Cognitive behavioural therapy for hot flushes and night sweats with breast cancer patients; a radiotherapy and clinical psychology collaboration

Cognitive behavioural therapy for hot flushes and night sweats with breast cancer patients; a radiotherapy and clinical psychology collaboration

Pharmacovigilance: An Ethical Issue for Clinical Psychology, Psychiatry, and Pharmacy?

Pharmacovigilance helps determine when a treatment might cause novel or unintended effects. Patients, clinicians, regulators, and pharmaceutical companies have a stake in determining how the causality of treatment-induced effects should be established and when effects should be noted in settings from the academic literature to a medicine’s label. There have been different approaches to this task in different jurisdictions, with reporting to companies more common in the United States and reporting to regulators more common in Europe. Over time, pharmacovigilance has switched from being primarily a clinical enterprise to being a regulatory one, which has led to the elimination of the names of those suffering from an adverse event and the outsourcing of the job of recording the details of events to private companies, which appears likely to reduce the recognition of adverse events. This article calls for a restoration of clinical input on adverse events aimed at increasing reporting and recognition rates for important behavioral events.

Psychology Students’ Experiences of the Objective Structured Clinical Examination as an Assessment of Professional Skills in Psychology

A challenge for professional psychology programs is the assessment of students’ professional competence. Despite its potential, objective structured clinical examination (OSCE) has not gained widespread use in the psychological field. However, at Umeå University and Örebro University in Sweden, the OSCE has been introduced at the Clinical psychology programs to assess professional competence. The aim of this study was to explore students’ perceptions of whether and how, preparing for and performing the OSCE benefits their professional learning and prepares them for clinical practice. A web-based questionnaire was administered to 88 psychology students who completed the OSCE and field training. Most of the students perceived the OSCE as a valuable experience that benefits their learning. The OSCE prepared them for clinical practice through practical hands-on training, and by providing essential experience in client interaction, increasing students’ confidence in the role as a psychologist. Students also reported that feedback from the OSCE was crucial for their ongoing learning, but that the authenticity of the examination can be improved. Based on these findings, recommendations for future OSCEs in professional psychology include appropriate preparations, providing constructive feedback as well as striving for high authenticity in the tasks of the OSCE stations.

Academic Tutoring and Academic Performance: An Analysis at UNSM

This study explores the relationship between the comprehensive tutoring system and the academic performance of students at the National University of San Martín (UNSM). The study addresses the issues faced by the institution, whose tutoring programme lacks a coordinated approach between faculties, a strong clinical psychology team, and teachers with adequate tutoring skills, resulting in a loss of student interest. The aim was to determine whether there is a significant relationship between the comprehensive tutoring system and academic performance. A quantitative methodology with a non-experimental, cross-sectional design was used. A questionnaire was applied to 342 students selected through stratified probabilistic sampling, and their academic performance was analysed. The results indicated that, although most students perceived the tutoring system as acceptable, no significant correlation with their academic performance was found. In conclusion, the current tutoring system does not appear to directly influence academic performance, suggesting a need to review its structure and integration. This study addresses a gap in the literature by examining the relationship between tutoring and academic performance in Peruvian universities, aligning with SDG 4 (Quality Education). Future studies should investigate contextual and personal factors that may influence academic performance.

Active Inference in Psychology and Psychiatry: Progress to Date?

The free energy principle is a formal theory of adaptive self-organising systems that emerged from statistical thermodynamics, machine learning and theoretical neuroscience and has since been translated into biologically plausible 'process theories' of cognition and behaviour, which fall under the banner of 'active inference'. Despite the promise this theory holds for theorising, research and practical applications in psychology and psychiatry, its impact on these disciplines has only now begun to bear fruit. The aim of this treatment is to consider the extent to which active inference has informed theoretical progress in psychology, before exploring its contributions to our understanding and treatment of psychopathology. Despite facing persistent translational obstacles, progress suggests that active inference has the potential to become a new paradigm that promises to unite psychology's subdisciplines, while readily incorporating the traditionally competing paradigms of evolutionary and developmental psychology. To date, however, progress towards this end has been slow. Meanwhile, the main outstanding question is whether this theory will make a positive difference through applications in clinical psychology, and its sister discipline of psychiatry.

Why we need a stronger focus on women’s health in clinical psychology and psychological treatment

Why we need a stronger focus on women’s health in clinical psychology and psychological treatment

Death Anxiety and Depression among Nurses: The Mediating Role of Empathy

Background: The COVID-19 pandemic significantly affected life all over the world. Death anxiety has a significant impact on the mental health of individuals, especially in the health care professionals. The fear and apprehension surrounding mortality has significantly affected nurses, leading to various mental health challenges, including depression. While the awareness of death can impose substantial psychological strain, it can also foster positive traits essential for patient care, such as empathy. Objective: The study identifies the relationship between death anxiety, depression and empathy. It also explores the mediating role of empathy in the relationship between death anxiety and depression among nurses. Method: A cross-sectional research design and a purposive sampling strategy were used to collect data from nurses (N=200) working at different government and private hospitals in Lahore, Pakistan, during the COVID-19 pandemic. The participants' ages ranged from 23 to 52. The Siddiqui-Shah Depression Scale, Urdu-translated versions of the Death Anxiety Scale, and Jefferson Scale of Empathy were administered to nurses. Results: The results reveal a positive relation between death anxiety with depression (r= .43**) and empathy (r = .31**). Death anxiety and empathy were found to be significant predictors of depression. Furthermore, empathy was found to be a significant mediator between death anxiety and depression. Conclusion: Based on the findings, clinical psychologists may devise various interventions/management plans to manage death anxiety and depression among nurses.

Cross‐sectional online survey on the perspectives of more than 1100 Austrian therapists on integrating nature in psychotherapy

AbstractBackgroundIntegrating natural environments into therapeutic practices is increasingly recognised for its positive effects on mental health recovery. However, there is limited research on how nature is utilised in psychotherapeutic treatments. This study aimed to fill this gap by providing initial data on the frequency and application of nature‐integrating psychotherapy. Additionally, it explores psychotherapists' attitudes towards the potential and limitations of integrating nature into psychotherapy under practical conditions.MethodsA total of N = 1190 Austrian psychotherapists (mean age: 53.75 ± 10.84 years; 74.9% female; 19.9% psychodynamic, 47.9% humanistic, 23.0% systemic, 9.2% behavioural) participated in a cross‐sectional online survey assessing personality traits (Big Five Inventory), connectedness to nature (NCI), professional experiences in integrating aspects of nature in psychotherapy and estimated potentials and risks of nature‐integrating interventions.ResultsThe majority of participating psychotherapists reported experience with conducting psychotherapy in nature (65.9%) and with integrating nature materials into their treatments (79.1%). Differences in some personality traits among psychotherapeutic orientations were observed, whereas the NCI did not differ. Overall, systemic therapists had the most positive attitude towards integrating nature into psychotherapy, whereas the opposite was observed for psychodynamic psychotherapists. Several aspects were found to also be affected by an interaction between orientation and gender.ConclusionsResults indicate that nature‐integrating psychotherapy is both common and valued among Austrian psychotherapists, with differences observed across therapeutic orientations and genders. These differences highlight the need for further research to better understand the factors influencing psychotherapists' approaches to nature integration in clinical practice.

Clinical Health Psychology Perspectives in Diabetes Care: A Retrospective Cohort Study Examining the Role of Depression in Adherence to Visits and Examinations in Type 2 Diabetes Management

Background: Depression in type 2 diabetes mellitus (T2DM) impacts glycemic control and complications. This study examines the influence of depression on compliance with recommended annual diabetes assessments in patients within the Local Healthcare Authority of Romagna. From a clinical health psychology perspective, understanding how depression influences patients’ engagement in managing their conditions is crucial. This insight can help improve healthcare services by ensuring they address mental health needs and thereby enhance treatment effectiveness and overall patient outcomes. Methods: This retrospective cohort study included residents of Romagna with incident T2DM from 2015 to 2017, followed from 1 January 2018 to 31 December 2022. Depression was identified via hospital discharge records or antidepressant prescriptions. Adherence to diabetes care guidelines was measured using the Guideline Composite Indicator (GCI). Results: The study included 13,285 patients, with a mean age of 61.1 years. Prevalence of post-diabetes depression increased from 3.0% in 2018 to 8.9% in 2022. Initial analyses showed higher GCI rates among patients with depression. However, propensity-score adjustment revealed that by 2021–2022, patients with pre-diabetes depression had 5% lower compliance rates (p-value ≤ 0.05). Older adults with depression had reduced adherence, while younger adults with post-diabetes depression had higher adherence rates. Conclusions: Depression significantly affects adherence to diabetes care guidelines in T2DM patients, particularly among older adults. Integrated care models addressing both diabetes and depression are crucial for improving health outcomes.

Use of Telehealth in Autism Spectrum Disorder Assessment in Children: Evaluation of anOnline Diagnostic Protocol Includingthe Brief Observation of Symptoms of Autism.

The COVID-19 pandemic revealed the need to develop the field of remote assessment for autism spectrum disorders (ASD). The purpose of the study was to evaluate an online assessment protocol that includes the Brief Observation of Symptoms of Autism (BOSA). The online protocol consisting of BOSA and the Autism Diagnostic Interview-Revised (ADI-R) was administered by experienced examiners to 29 children with suspected ASD. The participants were then evaluated by clinical psychologists in a standard clinical setting using the Autism Diagnostic Observation Schedule-2 (ADOS-2) and other methods, and the ASD diagnosis was confirmed or ruled out. The results show substantial to moderate inter-rater agreement between the online and face-to-face raters with the value of Cohen's Kappa = 0.66 (P < 0.001); this corresponds with 79.8% agreement. The sensitivity of the protocol was approx. 94.7%, the specificity was 70%, the positive predictive value was 85.7%, and the negative predictive value was 87.5%. Further, direct false positive or false negative diagnostic conclusions based on the online protocol were absent when the possible conclusion of "I cannot decide" was included. The items B9 Showing, B10 Spontaneous Initiation of Joint Attention, B1 Unusual Eye Contact, B3 Facial Expressions Directed to Others, and C2 Imagination/Creativity were shown to be well observable in BOSA when related to ADOS-2 scoring. The results indicate that the protocol consisting of BOSA and ADI-R administered by an experienced examiner is a promising combination of tools for remote autism assessment.

Michael A. (Mick) Smyer (1950-2024).

Memorializes Michael A. (Mick) Smyer (1950-2024). Mick was a clinical psychologist, gerontologist, expert in mental health and aging policy, academic administrator, and climate activist. He contributed importantly to the development of clinical geropsychology from the beginning of its emergence as an organized field. Among many roles and recognitions, Mick was president of Division 20 of the American Psychological Association (APA). He contributed to the founding of the Clinical Geropsychology section of Division 12 and was the section's first president. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The post-Cartesian dilemma: Reuniting the mind and body through psychoneuroimmunology

While today, it might seem absurd to hear anyone claim that stress does not alter all aspects of the human experience, including behavioral, cognitive, affective, and physiological processes. Dr. Janice Kiecolt-Glaser started her career at a time when stress was primarily considered a neuroendocrine response with cardiovascular repercussions. She was part of a small group of innovative scientists who began to push the boundaries of stress research – many contemporary immunologists and virologist disputed their early results in 1980s and 90s – and, yet, they persevered by connecting psychological stress to altered immune function via stress-related neuroendocrine changes. As a clinical psychologist, she focused mainly on human research studies to advance the field of psychoneuroimmunology throughout her career. Her research demonstrates how adversity and psychosocial aspects of human experience alter physiological functioning, primarily immune, and health or, in other words, the embodiment of our lived experiences. This short review is a contextualized synthesis of Dr. Kiecolt-Glaser’s key contributions to the fields of psychoneuroimmunology and health psychology and her influence on my present day thinking and research approaches, as well as potential steps forward in our post-pandemic world.