The COVID-19 pandemic posed a threat to public health and psychological functioning, with early studies documenting higher rates of psychopathology within the United States and globally. Hope and optimism promote adjustment and are associated with positive physical and mental health outcomes. Thus, individual differences in hope and optimism may also foster resilience during a global health crisis.

Depressive symptoms, goal progress, and goal characteristics are interrelated, but the directionality of these relationships is unclear.

The present randomized controlled study aimed to evaluate the effects of two interventions on emotional dysregulation as a primary outcome and on depression, anxiety, stress, well-being, self-compassion and emotional competencies as secondary outcomes. Finally, the mediating role of emotional dysregulation as a core process in the effect of interventions on anxiety-depressive and stress symptoms was evaluated.

Complex Posttraumatic Stress Disorder (CPTSD) is a condition resulting from exposure to chronic, interpersonal traumatic events, in which some form of control or power dynamics existed. Its clinical picture includes the main symptom clusters of posttraumatic stress disorder, accompanied by dysregulated emotion, problems in interpersonal relationships, and difficulties in identity integration. In addition, both clinical work and research have shown CPTSD to include highly distressing and complicated psychological phenomena, such as identification with the aggressor, various forms of dissociation, self-harm and self-destructive behaviors, and more. Due to this highly complex and multilayered clinical picture, the treatment of CPTSD poses a significant clinical challenge to therapists. In this special issue of In Session, we present a series of case studies, each representing a different therapeutic approach to CPTSD (e.g., skills training for affective and interpersonal regulation, Eye Movement Desensitization and Reprocessing, psychodynamic, integrative psychotherapy). These cases also represent a wide variety of patient populations, as well as different types of underlying traumatic events. Together, they reveal the breadth of clinical possibilities currently available to trauma therapists encountering cases of CPTSD. They also highlight the challenges and dilemmas that clinicians often face when treating this condition, as well as ways to overcome those.

In the context of the legacy of deficit-focused research and application of theoretical models in research on minoritized groups that are underrepresented in the literature, we explored the strengths-based literature among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people of color to develop a more inclusive and relevant understanding of how posttraumatic growth (PTG) occurs in this population. Our intersectional PTG model is tailored to the experiences of LGBTQ+ people of color that builds upon previous models of PTG, intersectionality theory, and empirical findings of trauma and PTG among LGBTQ+ people of color. Our intersectional PTG model incorporates the unique intrapersonal, interpersonal, institutional, and cultural factors that are unique to this population and contribute to PTG. We challenge the limited scope of Criterion A traumatic events and emphasize empirical findings that support that LGBTQ+ people of color often experience posttraumatic stress after oppression and discrimination. Our model also recognizes the impact of intersecting risk factors, such as gendered racism, that may occur on various levels. Our model acknowledges that LGBTQ+ people of color have often demonstrated PTG in the face of adversity. Intrapersonal factors such as cognitive flexibility, interpersonal factors such as social support, and institutional and cultural factors such as identity-related activism are identified as key contributors to resilience. We discuss practice implications, highlighting that clinicians should recognize limitations of traditional trauma frameworks and adopt culturally sensitive approaches when working with LGBTQ+ people of color. Overall, our model provides a foundation for strengths-based interventions and research, emphasizing resiliency and potential for PTG in this population.

Trauma exposure, particularly interpersonal trauma, is prevalent among individuals with eating disorders (EDs), and trauma exposure and the subsequent development of posttraumatic stress disorder have been associated with poorer outcomes for ED treatment. To our knowledge, there are no published investigations of trauma exposure among individuals with avoidant/restrictive food intake disorder (ARFID), a new diagnosis introduced by the Diagnostic and Statistical Manual of Mental Disorders-5. We investigated associations between trauma exposure and ARFID profiles in a sample of U.S. military veteran men and women.

This study explores the experience of Israeli therapists who both worked with clients in emergency interventions during the third week following the Hamas attack on Israel on October 7, 2023, and were themselves exposed, to one extent or another, to the terrifying events.

Virtual reality exposure therapy (VRE) has been used in the treatment of combat-related PTSD since the late 1990s and was recently adapted to treat PTSD due to military sexual trauma (MST). With content specifically tailored to MST-related contexts, we present the case study of a military veteran who participated in the open clinical trial examining the feasibility of VRE in the treatment of MST-related PTSD (Loucks et al. 2019). We illustrate VRE's use in activating the trauma memory to facilitate therapeutic emotional processing across sessions and overall symptom reduction. The case study includes common challenges that may occur during VRE and relevant recommendations. The discussion will include lessons learned from the case study and the open clinical trial, recommendations for the flexible application of VRE, and the ongoing developments in the latest version of the VRE system, informed by feedback acquired from the clinicians and patients who experienced it in the initial clinical trial.

Compulsive Online Shopping (COS) is considered a technological addiction, characterized by excessive engagement in online shopping behaviors that can cause economic, social, and emotional impairments in an individual's life. Among the theoretical models aimed at conceptualizing addictive behaviors, the metacognitive model has gained increased attention. However, no previous study has investigated the role of metacognitions in COS. The current study was aimed at clarifying the contribution of metacognitions about online shopping as potential mediating variables in the relationship between some well-established psychological correlates (i.e., boredom proneness, impulsivity, materialism, negative affect) and COS.

Problematic alcohol use is a recognized risk factor for suicidal thoughts and behaviors. Individuals who misuse alcohol and those experiencing suicidal ideation (SI) often exhibit elevated impulsivity, suggesting that impulsivity may be an underlying mechanism. Impulsivity fluctuates considerably within individuals over short periods, particularly among those engaged in episodic heavy drinking, college students, and those with SI. While impulsivity is associated with suicidal thinking at a trait level, its relationship with SI on a momentary level remains relatively unexplored. This study aimed to (a) replicate cross-sectional findings linking impulsivity and SI in those with problematic alcohol use, and (b) extend these findings to examine the momentary associations between impulsivity and SI within this population.

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.

The present study evaluated sex differences in the direct and indirect links between depressive symptoms, coping motives to drink, and alcohol use severity among Latinos who drink.

Radically open dialectical behaviour therapy (RO DBT) is a transdiagnostic treatment, originally developed as a variant of dialectical behaviour therapy (DBT), that emerged as a novel treatment approach for those presenting with excessive or maladaptive overcontrol. Despite RO DBT's growing popularity among clinicians as a treatment for chronic depression, personality disorders and eating disorders, to date, no systematic review has been conducted to summarise the evidence on this therapy. Therefore, the aim of this study was to systematically review the literature to provide a current and comprehensive summary of the available evidence on the clinical applications and efficacy of RO DBT. Articles were included if they were original research studies that described the use of RO DBT in the treatment of any psychological disorder, condition or symptom, published in the English language in a peer-reviewed journal. Four electronic databases were searched, and screening, selection, risk of bias assessment and data extraction were all conducted by two independent reviewers. Fourteen articles were included in this review, including two qualitative articles, one case study, five case series studies, four quasi-experimental studies, and two articles describing one randomized control trial. Findings indicated there is emerging evidence for the use of RO DBT in both adolescents and adults, for disorders characterized by excessive self-control, such as anorexia nervosa and autism, as well as for treatment-resistant depression. While RO DBT shows promise as a treatment for disorders of overcontrol, further research is needed. This review outlines current gaps and identifies areas for future research.

Personality disorders (PD) are based not just on maladaptive ideas about self and others, they also are grounded on embodied patterns of behaviors and reactions to interpersonal stressors. There is growing interest in working with the body and through the body so to address automatisms that lead to suffering and dysfunctional social action. In this issue of the Journal of Clinical Psychology: In-Session the use of art and psychomotor therapies for these patients was explored by seven different clinical perspectives. Patients described presented with different PD and associated symptoms. The arts and psychomotor therapies deployed in personality disorder treatment are: (visual) art therapy, music therapy, drama therapy, dance (movement) therapy, and psychomotor therapy making psychotherapeutic use of the different modalities: art, music, play, role-play, performance, improvisation, dance, body awareness and movement. Interventions provide kinesthetic, sensory, perceptual, and symbolic opportunities to invite alternative modes of meaning-making, accessing own needs and wishes, and communicating them to others. In this commentary we summarize some of the different topics covered by the clinical-based papers, including working mechanisms of arts and psychomotor therapies, the importance of bottom-up emotion regulation processes, how to treat trauma in the presence of a PD, how to integrate art and psychomotor therapies in a fine-grained formulation and how to understand the process of change. Although there is a need for more empirical research, we hope this issue makes a solid case that clinicians can effectively include art and psychomotor therapies when treating the full range of PD.

The primary objective of the present study is to validate the Difficulty in Emotion Regulation Scale-Short Form (DERS-SF) in a sample of Italian adolescents. Additionally, we aim to evaluate its factorial structure by examining the contribution of each subscale (i.e., Nonacceptance, Clarity, Awareness, Goals, Impulse, Strategy) on the general factor using bi-factor models by replicating a past study.

Adverse childhood experiences (ACEs) are psychosocial factors acknowledged as significant contributors to health consequences later in adolescence, including psychological maladjustment. The research suggests that, at a transdiagnostic and transtheoretical level, working on restoring epistemic trust (ET), mentalized affectivity (MA), and reflective functioning (RF) in adolescents with ACEs assumes a central role in the therapeutic process. However, there are still few studies that attempted to investigate the specific role of these sociocognitive factors in the detrimental positive association between levels of experienced ACEs during childhood and psychological maladjustment in nonclinical adolescents.

Disrupted interoception has been found in individuals with body image concerns and related psychiatric conditions (i.e., eating disorders, body dysmorphic disorder). However, few studies have explored the role of interoception in the relationship between body image concern and self-objectification (SO). As components of the bodily self, interoception and body image may also contribute to the fostering of self-consciousness.

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 toward 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, pretreatment and phase 1 of the DBT program are described. During pretreatment 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.

Clinical psychologists are increasingly urged to recognize and understand the significance of societal factors such as marginalization experiences, within themselves and among the individuals and communities they serve. At the same time, there is a dearth of research in the field to guide this pursuit, and especially so in European contexts. We conducted an online survey (N = 646) to assess the social identities of clinical psychologists (graduate and trainees) in Germany and their incorporation of societal challenges in therapy and training. Overall, our sample was demographically rather homogenous and privileged: Clinical psychologists tended to be white (91%), nonmigrant (77.6%), female (74.5%), cis-gender (93.8%), heterosexual (75.4%), able-bodied (56.0%), and grew up in families with an academic background (68%). Although the majority of participants expressed a tendency to contemplate their identity when it came to their psychotherapeutic practices and believed that discussing societal challenges in therapy was pertinent, only a small proportion (~5%) reported actively introducing related subjects during therapy sessions or taking them into account during initial case conceptualization (~8%). The majority of participants indicated a lack of coverage of related topics in standard clinical psychological curricula. Greater perceived competence in addressing these topics was linked to clinicians initiating discussions about marginalization or discrimination in therapy. We explore the implications for future training aimed at fostering equitable, effective, and diversity-sensitive therapeutic practices.

Quality of life (QOL) is a multidimensional construct including emotional well-being, life satisfaction, and physical health. Individuals with posttraumatic stress disorder (PTSD) consistently report low QOL, highlighting the importance of assessing the effectiveness of first-line PTSD treatments (e.g., exposure-based therapies) on QOL. This meta-analysis examined the efficacy of exposure therapy for PTSD on QOL compared to control conditions (e.g., waitlist, medication, treatment-as-usual) at posttreatment and follow-up (ranging from 1 month to 2 years).

Cognitive theories emphasize the central role of anger and anger suppression in obsessive-compulsive disorder (OCD). According to these theories, anger suppression is seen as a consequence of OCD, whereas cognitive beliefs, such as an inflated sense of responsibility, are seen as antecedent factors. To extend the findings from cross-sectional studies, the current study investigated the temporal associations between OCD symptoms, an inflated sense of responsibility, and anger suppression. Consistent with cognitive considerations, we hypothesized that OCD symptoms mediate the association between feelings of responsibility and anger suppression. These associations were also explored in patients presenting particularly high checking-related symptoms. Further, the stability of effects beyond controlling for depressive symptoms and medication intake was explored.

The use of intensive time sampling methods, such as ecological momentary assessment (EMA), has increased in clinical, and specifically suicide, research during the past decade. While EMA can capture dynamic intraindividual processes, repeated assessments increase participant burden, potentially resulting in low compliance. This study aimed to shed light on study-level and psychological variables, including suicidal ideation (SI), that may predict momentary prompt (i.e., prompt-to-prompt) completion. We combined data from three EMA studies examining mental health difficulties (N = 103; 10,656 prompts; 7144 completed), using multilevel models and machine learning to determine how well we can predict prompt-to-prompt completion and which variables are most important. The two most important variables in prompt-to-prompt completion were hours since the last prompt and time in study. Psychological variables added little predictive validity; similarly, trait-level SI demonstrated a small effect on prompt-to-prompt completion. Our study showed how study-level characteristics can be used to explain prompt-to-prompt compliance rates in EMA research, highlighting the potential for developing adaptive assessment schedules to improve compliance.

We aim to uncover the hot topics and development trends in clinical psychology research in the United States.

Dialectical behavior therapy (DBT) is an evidence-based treatment for people with emerging borderline personality disorder (BPD). In "real world" clinical settings, standard DBT is resource intensive. Emerging evidence suggests that group-based DBT skills training alone can lead to promising outcomes. This hybrid type 1 effectiveness-implementation trial directly compared the effectiveness of an 8-week group DBT-skills training program and a 16-week DBT-informed program including individual treatment and group-based skills training.

The current study examined the association between the possession of personal growth initiative (PGI) skills and symptoms of mental illness (i.e., depression, anxiety, and stress) and the potential mediating role of daily engagement of PGI skills during the COVID-19 pandemic.

Internet-delivered cognitive-behavioral therapy (ICBT) is an effective treatment for obsessive-compulsive disorder (OCD). ICBT can be delivered in a self-guided or clinician-guided format. While a literature is emerging on the predictors of response to clinician-guided ICBT, there is a lack of research examining the predictors of response to self-guided ICBT. The aim of the present study was to examine predictors of outcome in a large sample of participants with OCD who commenced a self-guided ICBT intervention. One hundred and fifty-seven participants (M = 34.82; SD = 10.49; 78% female) were included in the study. Regression analyses were conducted to determine clinical and demographic predictors of (1) posttreatment symptom severity and (2) a clinically meaningful treatment response for both the intention-to-treat (ITT) and completer samples. The regression models significantly predicted posttreatment outcome for both the ITT (F = 15.844, p < .001) and completer sample (F = 5.929, p < .001), explaining 46% and 34% of the variance respectively. Higher baseline OCD severity, younger age, experiencing higher contamination or symmetry symptoms, and a history of past treatment were all found to be significantly associated with higher posttreatment severity in the ITT sample. In the completer sample only higher baseline OCD severity and severity of harm-related obsessions and checking compulsions was significantly associated with higher posttreatment severity. When predicting treatment response the regression models for both the ITT and completer sample were nonsignificant.

Attachment theory has served as an influential framework for understanding psychopathology, partly due to reliable assessment methodology. The influence of insecure attachment on attitudes toward the body and the impact this might have for the development of psychopathology is however less well elucidated.

Clinical high-risk of psychosis (CHRp) samples can be heterogeneous, consisting essentially of people with not only psychotic-like experiences but also nonspecific symptoms that may reflect common mental disorders such as depression, anxiety, or substance abuse pathologies. Few studies have attempted to analyze and understand psychosis risk in relation to both environmental (ER) and psychopathological risk (PsR) factors. This study aimed to determine the clinical risk of psychosis in adolescents.

Guilt and shame are emotions that, albeit subjectively negative, help humans adapt to their social environment. However, in some cases, there are pathogenic beliefs, shaped over the lifespan that sustain them and make them a source of psychopathological suffering. In this paper we will first briefly show how Control-Mastery Theory (CMT) considers several types of pathogenic beliefs shaped by traumatic experiences that underly chronic feelings of guilt and shame. We then focus on a clinical case of Livia, a 28 year-old woman with relational and academic problems suffering mainly from two such types of pathogenic beliefs: burdening guilt and disloyalty guilt. We describe how a) Livia was driven by adverse and traumatic experiences to form some of these pathogenic beliefs, b) how she tested the therapist in order to discover whether he would disconfirm these beliefs, and c) how the therapist was able to successfully pass these tests and provide her with new and healthier interpersonal experiences. The case of Livia will highlight therapists' ability to accurately formulate patients' goals, pathogenic beliefs-including types of guilt- and shame-related beliefs-and traumas. Moreover, the case will illustrate how therapists can pass patients' tests and adopt the right attitude to help patients disprove their pathogenic beliefs and overcome problematic experiences of guilt and shame.

Individuals diagnosed with Complex PTSD (C-PTSD) have experienced repeated and often prolonged traumatic events. From a therapeutic perspective this can lead to difficulties in emotion regulation within-session, challenges with patient-therapist attunement, and impaired coregulation of emotions during therapeutic interactions. As a result, frequent therapeutic alliance ruptures can emerge, which in turn pose challenges for symptom-focused work. We describe a case study involving a 38-year-old woman presenting with C-PTSD, dissociation, anxiety and borderline and dependent personality disorder traits. We explore how difficulties in attunement and emotion regulation during therapy were mostly attributable to (i) maladaptive ideas regarding the self and others; and (ii) difficulties in recognizing both her own mental states and those of her therapist. For instance, the patient believed that the therapist was distant and critical; which she held to be fact rather than reflective of a mental state. We show how the therapist addressed these difficulties, incorporating repair of the therapeutic alliance, which enabled a return to symptom focused work. The case description offers guidance on how to maintain a dual focus on therapeutic alliance alongside symptoms when treating C-PTSD (with or without comorbidity).