Wiley: Journal of Clinical Psychology: Table of Contents

Role of Depression and Anxiety in Eating Disorder Symptomatology in Higher Levels of Care for Girls With Anorexia Nervosa

Jasmine Ghannadpour, Savannah Dieste, Stephen Buerkert, Sunita M. Stewart — Tue, 09 Jun 2026 13:15:21 -0700

ABSTRACT

Objectives

Although the prevalence of affective comorbidities with eating disorders (ED) has been well established, the three-way relation between ED, depression, and anxiety symptoms has not been explored in an intensive adolescent treatment setting.

Methods

This study analyzed data from a sample of teenage girls with anorexia nervosa in higher levels of care (n = 457) to assess the relations between changes in ED symptoms, depression, and anxiety over the course of ED treatment.

Results

This study demonstrated that improvements in depression and anxiety are significantly associated with improvement in ED symptoms.

Conclusion

Findings support the importance of routine assessments for depression and anxiety among adolescents with anorexia nervosa in higher levels of care and a transdiagnostic approach to treatment that addresses shared underlying mechanisms. Future research that aims to uncover mediators and moderators of these relations is warranted to enhance clinical efforts.

Sense of Coherence in the Perinatal Period: A Longitudinal Growth Mixture Modeling Analysis

Sat, 06 Jun 2026 10:54:28 -0700

ABSTRACT

Objectives

Previous studies have established that higher Sense of Coherence (SoC) predicts lower pregnancy-specific distress, fewer delivery complications, and increased birth satisfaction. However, less is known about how SoC typically changes over pregnancy, birth, and postnatally and the risk factors and protective factors contributing to SoC trajectory during the perinatal period. In this study, we aim to describe and predict common trajectories of SoC in the perinatal period.

Methods

680 women in the Mercy Pregnancy and Emotional Wellbeing Study completed measures of SoC on four occasions across pregnancy and the postpartum. Predictors included history of childhood trauma, expectations and outcomes from birth and the postpartum, and postpartum social support. Depression was assessed by structured clinical interview in early pregnancy. Growth mixture modeling was used to classify participants into trajectories of SoC, and multinomial logistic regression models predicted class membership.

Results

Four trajectories were identified: (1) High (67%), (2) Low (21%), (3) Rising (8%), (4) Falling (3%). The strongest predictors of class were depression diagnosis, associated with Low and Rising trajectories, and a history of childhood trauma, associated with Low and Falling trajectories.

Conclusion

Childhood trauma was thus predictive of a poor SoC at 12 months postpartum, suggesting that pregnancy and birth have a negative impact on women's resilience resources, whereas depression in early pregnancy is more predictive of poorer starting point of SoC. Targeted mental health support in the perinatal period may ensure individuals have adequate coping resources.

Losing One's Partner, Losing One's Self: Helping a Patient Process the End of an Early Romantic Relationship Through Psychodynamic Psychotherapy

Barry A. Farber, Mossie Lierle — Sat, 06 Jun 2026 10:50:34 -0700

ABSTRACT

The literature on the psychotherapeutic treatment of individuals suffering from the dissolution of a significant romantic relationship is sparse, especially with regard to those who continue to reflect upon and struggle with a romantic breakup long after the event itself. The present case study explores the psychodynamically-oriented treatment of a young adult patient, with a focus on helping the patient process the ending of a significant romantic relationship from her late adolescence. A twice-weekly, long-term treatment provided a collaborative space to mourn the lost relationship, while facilitating a deepening understanding of the meaning and intensity of this relationship and its enduring effects on the patient's identity, agency, and subsequent romantic relationships. This case highlights the transformative potential of psychodynamic psychotherapy to foster a patient's growth following the dissolution of a romantic relationship.

Rumination and Rejection Sensitivity: A Meta‐Analysis

Lindsey C. Stewart, Samantha D. Sorid, Thomas M. Olino — Sat, 06 Jun 2026 10:50:34 -0700

ABSTRACT

Rumination and rejection sensitivity are positively associated with maladaptive outcomes and have been identified as vulnerability factors for psychological disorders, such as depression and anxiety. These constructs share cognitive features, including negative biases and repetitive self-focused thinking, though they are described as conceptually distinct. Several studies have evaluated the association between these constructs, although there is no consensus on the degree of overlap across findings. The present meta-analytic study examined the relationship between rumination and rejection sensitivity across 21 studies (N = 6868) and examined potential moderators that may influence the magnitude of the relationship between these constructs. A moderate positive association (r = 0.43) was found between rumination and rejection sensitivity. The association was not significantly influenced by age, sex, the conceptualization of rumination (sadness/depressive rumination vs. another type of rumination) or the conceptualization of interpersonal functioning (rejection sensitivity vs. interpersonal sensitivity). These findings support that rumination and rejection sensitivity overlap significantly, yet are distinguishable constructs. The evidenced association between these constructs may inform treatment and prevention efforts aimed at reducing psychological vulnerability. It is possible that the estimated association between rumination and rejection sensitivity generalizes across the study and sample features examined; however, it is challenging to draw this conclusion due to limits on predictive power in our moderator analyses. Further research is needed to clarify the association between rumination and rejection sensitivity, particularly over time and across development, and to identify factors that influence the association between these constructs.

Cross‐Cultural Influences on the Association Between Rumination and Psychopathology: A Systematic Review

James Haoxiang Li, Julian Madsen, Joshua Wong, Belinda Liddell, Laura Jobson — Sat, 06 Jun 2026 10:50:34 -0700

ABSTRACT

Rumination is a transdiagnostic process associated with psychopathology. While culture shapes cognitive and emotion processing, cultural influences on rumination remain unclear. Therefore, this systematic review aimed to examine cultural differences in the association between rumination and psychopathology. To address this aim, we conducted a literature search (May 2024), which identified 24 eligible studies. We conducted an exploratory meta-analysis examining whether cultural group moderated the association between rumination and psychopathology. First, we found cultural differences in the association between rumination and psychopathology under certain conditions. Second, we identified three culture-specific mechanisms that may shape the relationships between rumination and psychopathology: (1) social support was less eroded by rumination in Japanese versus German participants and correlated with weaker rumination-wellbeing associations; (2) self-doubt attributions mediated the association between rumination and depression symptoms in European Americans but not Asians; and (3) happiness levels moderated the relationship between rumination and depression symptoms in European Americans but not Asian Americans. Third, given the limited studies available, meta-analyses could only be conducted comparing Western and Asian samples for depression symptoms. This exploratory analysis highlighted cultural group did not significantly moderate the relationship between rumination and depression. Finally, the review highlighted the scarcity of sufficient studies to draw definitive conclusions about the role of culture in rumination and psychopathology and the need for research focusing on diverse cultural groups, clinical samples and disorder-specific measures of rumination. Advancing this research is crucial for informing the integration of culture into theories of rumination and enhancing cultural tailoring of interventions.

Psychological Inflexibility's Associations With Lifetime Anxiety Disorders

Sat, 06 Jun 2026 10:50:34 -0700

ABSTRACT

Background

Anxiety has protective functions and could be considered evolutionarily adaptive. Yet, anxiety can also become problematic, and anxiety disorders are common and costly. The present study tested a transdiagnostic conceptualization of anxiety disorders that suggests anxiety disorders are associated with inflexible responding to anxiety, even after controlling for anxiety symptom severity.

Methods

A total of 1118 participants across two samples (n = 853 undergraduates; n = 265 community members) completed a battery of self-report measures, including demographics, anxiety (DASS-21), psychological inflexibility (MPFI), and reported lifetime anxiety-related diagnoses.

Results

A series of logistic regressions in each sample showed that anxiety was associated with increased odds of endorsing any and each additional lifetime anxiety-related diagnosis, and that psychological inflexibility was incrementally associated above and beyond anxiety severity with greater odds of endorsing any and each additional disorder.

Conclusions

Findings replicated across samples, supporting the conceptualization that one's response to anxiety, beyond how severe that anxiety is, may be an important factor for understanding the degree to which anxiety would interfere in someone's life (i.e., anxiety disorder). Clinically targeting one's response to anxiety may be an important component of mitigating anxiety-related suffering.

Depressive Symptoms, Hazardous Alcohol Use, and Suicidality in Bipolar Disorder

Jasmin L. Katz, Martha L. Fiskeaux, Dorian A. Lamis — Sat, 06 Jun 2026 10:50:34 -0700

ABSTRACT

Introduction

Bipolar disorder is linked to elevated rates of suicidal thoughts, behavior, and death by suicide. The objective of this study was to examine the contribution of depressive symptoms and hazardous alcohol use to suicidality within a predominantly low-income African American sample of individuals with bipolar disorder.

Method

We recruited 204 patients with bipolar disorder from an urban public hospital's outpatient clinic in the Southeastern U.S. Multiple regression examined associations between depressive symptoms, hazardous alcohol use, and suicidality among past-year drinkers, controlling for gender.

Results

The regression model revealed that male gender, depressive symptoms, and hazardous alcohol use accounted for a significant amount of the variance in suicidality. Depressive symptoms exhibited the strongest association (β = 0.367, p < 0.001), followed by hazardous alcohol use (β = 0.171, p = 0.042) and male gender (β = 0.227, p = 0.012). Collectively, these factors accounted for 24.1% of the variance in suicidality (R² = 0.241), underscoring their role in suicide risk among individuals with bipolar disorder.

Conclusions

Findings highlight significant associations between depressive symptoms, hazardous alcohol use, and suicidality in low-income African American individuals with bipolar disorder. Clinical interventions should prioritize comprehensive screening and targeted approaches to address these interconnected risk factors.

Interpersonal Profiles in Social Anxiety Disorder: Different Settings, Different Outcomes?

Sat, 06 Jun 2026 10:50:34 -0700

ABSTRACT

Objective

Social anxiety disorder (SAD) is one of the most common mental disorders, with the majority of those affected not receiving primary care or psychotherapy. Internet-based treatments may be an alternative for individuals with SAD. We hypothesize that interpersonal characteristics differ between SAD patients in face-to-face (ftf) and online treatments, and that these factors predict treatment outcomes.

Methods

The sample consisted of 539 patients with SAD from four different online treatment studies (N = 376) and one university outpatient clinic in Europe (N = 163) who received integrative CBT. Interpersonal problems were assessed at baseline and symptom severity at baseline and treatment termination.

Results

Results showed similar interpersonal patterns of being nonassertive and socially inhibited in both treatment groups at baseline, with patients in online treatment being more severely affected than those in ftf therapy. Interpersonal problems of communion were predictive of outcome in both treatments. Low communion reflects interpersonal coldness, distance, and difficulty forming close bonds, whereas high communion reflects excessive dependence, submissiveness, and overinvolvement with others. Patients with interpersonal problems of low communion benefited more from ftf therapy, while patients with interpersonal problems of high communion benefited more from online therapy.

Conclusion

These findings underscore the importance of considering interpersonal problems when planning and evaluating treatment for SAD. In the future, it may be possible to predict if a particular SAD patient benefits more from online versus ftf treatment from their baseline interpersonal problems and recommend the suitable treatment.

The Role of Self‐Compassion and Experience in Psychologists' Latent Emotional Labour Strategy Profiles

James J. Clarke, Vincent O. Mancini, Clare S. Rees, Lauren J. Breen — Sat, 06 Jun 2026 10:50:34 -0700

ABSTRACT

Objective

Emotional labour has long been associated with personal and organizational outcomes such as burnout. However, theoretically dichotomising regulation into surface and deep acting may constrain the ecological validity of research as iterative and person-centered approaches to emotion regulation are not considered. Furthermore, recent research suggests self-compassion and experience may predict emotional labour regulation in psychologists, but specific mechanisms accounting for this relationship are unknown. We addressed these concerns by examining how self-compassion and career experience predict latent profiles of emotional labour regulation strategies in psychologists and subsequent burnout.

Method

We performed latent profile analysis, multinomial logistic regression, and a one-way between-groups ANOVA on data from 232 international psychologists across two time points.

Results

We found a similar but not identical pattern of latent profiles when compared to previous studies in different occupations. Self-compassion and career experience significantly predicted subsequent profile membership and profiles characterized by less surface acting and more authentic and genuine emotional displays had statistically significantly lower levels of emotional exhaustion.

Conclusions

Our findings suggest that self-compassion promotes adaptive emotional labour regulation strategies in psychologists, that experienced clinicians express emotion more authentically, and that regulation that involves authentic and genuine expression is linked with lower emotional exhaustion.

Preliminary Findings on the Unified Protocol for Transdiagnostic Treatment: A Pilot Trial on Its Effectiveness on Anxiety and Depressive Symptoms for Turkish Adults

Özge Erarslan‐İngeç, Orçun Yorulmaz, Todd J. Farchione, Madison Boschulte — Sat, 06 Jun 2026 10:50:34 -0700

ABSTRACT

The present study investigates the feasibility and initial efficacy of the Unified Protocol (UP) as a pilot trial 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. These outcomes included 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.

The Paradox of Acceptance: A Longitudinal Study on Acceptance, Depression, and the Moderating Role of Anger Suppression Within an ACT Framework

Izabela Kaźmierczak, David Lacko — Sat, 06 Jun 2026 10:50:34 -0700

ABSTRACT

Objectives

This longitudinal study examined the associations between acceptance of reality and depressive symptoms, in light of inconsistent findings in prior research. Existing studies—mostly cross-sectional—have reported negative, positive, or nonsignificant correlations, leaving the role of acceptance in depression unclear. Despite its prominence in third-wave cognitive-behavioral therapies (Hofmann and Asmundson 2008) such as Acceptance and Commitment Therapy (ACT; Hayes et al. 1999), the nature of this association remains debated. To address these gaps, we explored whether levels of acceptance were related to depressive symptoms over time, and whether anger suppression moderated this relationship.

Methods

Self-report data from N = 344 participants who completed the online survey three times, with 2-month intervals between assessments.

Results

Higher individual tendency to accept reality was associated with lower depression symptoms. However, elevating acceptance beyond typical thresholds resulted in higher levels of depressive symptoms at subsequent time points, and no relationship between these variables was identified within measurements. Additionally, anger suppression emerged as a moderator of the negative relationship between an individual's tendency to accept reality and depressive symptoms.

Conclusions

These findings help clarify prior inconsistencies by showing that the acceptance–depression link varies with the level of acceptance, temporal perspective, and anger regulation strategies. Interpreted within the ACT framework, the results highlight that elevated acceptance does not always reflect psychological flexibility, and can co-occur with increased depressive symptoms. We highlight the need for further research to explore the mechanisms behind these patterns and examine whether supportive interventions may assist individuals during such phases.

Relative Contributions of Gastrointestinal‐Specific Hypervigilance and Anxiety in Explaining Eating Disorder Symptoms

Sat, 06 Jun 2026 10:50:34 -0700

ABSTRACT

Objective

Gastrointestinal (GI) disturbances and eating disorder symptoms commonly co-occur. Hypervigilance and anxiety about GI symptoms may motivate eating disorder behaviors to manage and/or avoid GI symptoms. We hypothesized that GI-specific anxiety would be more strongly associated with dietary restriction and purging than GI-specific hypervigilance. Further, we hypothesized that distinguishing between GI-specific anxiety and hypervigilance would have incremental validity over using an existing measure of GI-anxiety and related constructs initially developed for patients with irritable bowel syndrome, the Visceral Sensitivity Index.

Methods

Three hundred and eighty-two undergraduate students with elevated eating pathology (83.5% female, 87.4% White) completed questionnaires assessing GI-specific hypervigilance and anxiety, the Visceral Sensitivity Index, and eating disorder symptoms. Participants were recruited with elevated shape/weight-oriented eating pathology (N = 309) and elevated avoidant/restrictive food intake disorder-related eating pathology (N = 73). Analyses were pre-registered.

Results

Regarding dietary restriction, the relative weight of GI-specific anxiety did not differ from that of GI-specific hypervigilance. Further, neither variable provided incremental validity over the Visceral Sensitivity Index in understanding restriction. Regarding purging, GI-specific anxiety was not more strongly associated with purging than GI-specific hypervigilance. However, GI-specific anxiety, but not GI-specific hypervigilance, demonstrated incremental validity over the Visceral Sensitivity Index in explaining purging.

Conclusion

Distinguishing between GI-specific hypervigilance and anxiety adds incremental validity in understanding purging but not restriction. Future research should examine whether addressing anxious cognitions about GI symptoms improves purging outcomes.

Issue Information

Sat, 06 Jun 2026 10:50:34 -0700

Journal of Clinical Psychology, Volume 82, Issue 7, Page 989-994, July 2026.

The Effect of Intolerance of Uncertainty on Indecisiveness in Anxiety and Obsessive‐Compulsive Disorders

Helmut Appel, André Mattes, Alexander L. Gerlach — Fri, 05 Jun 2026 13:19:31 -0700

ABSTRACT

Objectives

Intolerance of uncertainty (IU) describes a dispositional aversion to uncertainty. Recent research has identified IU as a causal contributor to pervasive decision difficulties (indecisiveness). Given that IU and indecisiveness occur across mental disorders, understanding whether IU's causal role in indecisiveness extends to clinical populations is critical. This study therefore tested the effect of IU on indecisiveness in a clinical sample.

Methods

In this pre-registered experiment, N = 154 individuals with formally diagnosed obsessive-compulsive and/or anxiety disorders were randomly assigned to a condition aimed at either increasing or decreasing IU. Subsequently, participants reported their current levels of (situational) IU and their indecisiveness regarding two personally relevant decisions.

Results

While the manipulation had no main effect on indecisiveness, it influenced situational IU levels, which were positively associated with indecisiveness. Mediation analysis indicated a significant indirect effect of the experimental condition on indecisiveness via situational IU.

Limitations

Compared to preceding research, effect sizes were small and the effect of IU on indecisiveness only manifested itself indirectly. More robust interventions may be necessary to induce more pronounced changes in IU within clinical populations. The reliance on a heterogeneous sample with various diagnoses limits the disorder-specificity of the findings.

Conclusions

These results tentatively extend the causal role of IU in indecisiveness to mental disorders. The findings suggest IU as a potential approach for addressing clinically relevant indecisiveness if future research corroborates the evidence.

Psychometric Evaluation of the Norwegian Difficulties in Emotion Regulation Scale in a Multi‐Site Sample of Patients With Personality Disorders and Personality Problems

Fri, 05 Jun 2026 12:33:22 -0700

ABSTRACT

Objective

The validity and psychometric qualities of the Difficulties in Emotion Regulation Scale (DERS) in populations with a broader range of personality disorders (PDs) are still unclear. The aim of the current study was to analyze the factor structure and validity of DERS and two of its short-forms (DERS-SF and DERS-18), their relation to PD features and personality functioning, gender differences, and the overlap between concepts of alexithymia and emotion regulation.

Method

Data were extracted from a multi-site clinical sample of patients with PDs or personality related problems referred to specialist mental health services (n = 2093). Confirmatory factor analyses (CFA)—specifically first-order correlated and bifactor analysis, as well as analysis of measurement invariance—were applied. Linear associations and group differences were investigated by correlational analysis and independent samples t-tests. DERS and its shortforms were validated through associations with PD features (PD criteria), measures of personality functioning (LPFS-BF), and alexithymia (TAS-20).

Results

CFA of the short forms revealed good model fit, while the full version of DERS showed poorer fit. None of the bifactor analyses supported a strong general factor. Gender differences were prominent, and substantial associations were found between DERS and PD criteria, LPFS-BF, and TAS-20.

Conclusion

DERS and its short forms demonstrated acceptable reliability and validity in a sample of patients with PDs and personality related problems. Without support for a general factor, interpretation of the total scores of DERS should be conducted with care, especially if the subscales Awareness and Clarity are included. Given the advantages of the short forms, the selection of one version over another seems to be of limited consequence.

Development and Initial Validation of the Response to Suicidal Ideation Inventory (RSII)

Si Ning Yeo, Jeremy G. Stewart — Fri, 05 Jun 2026 01:54:41 -0700

ABSTRACT

Objectives

Young adults (18–29 years old) often report difficulties coping during suicide crises. However, the responses that young adults employ to manage suicidal ideation (SI) are underexplored. This study developed a new measure to quantify how young adults with a history of suicidal thoughts and behaviors (STBs) respond to their SI, and conducted an initial evaluation of the measure's psychometric properties.

Methods

Using inductive and deductive approaches, we developed a preliminary item set (n = 79) for the Response to Suicide Ideation Inventory (RSII). Thereafter, 491 participants (M _age = 22.0, SD_age = 3.3, 18–29 years old), completed the RSII, as well as questionnaires assessing the RSII's content validity, general coping, emotion dysregulation, history of STBs, reasons for living, and future expectations of engaging in STBs.

Results

Results from an exploratory factor analysis indicated that a 43-item, seven-factor solution was an appropriate fit to the data. The RSII and its subscales showed acceptable reliability, as well as preliminary content validity. The RSII's subscales also demonstrated medium-sized positive correlations with measures of general coping, and weak associations with emotion dysregulation, suicide resilience, and expectations of future STBs.

Conclusions

Our results point to some important directions for refining the RSII. Exploring the range and types of responses young adults engage in to manage their SI may improve our understanding of, and ability to predict, fluctuations in SI severity.

“Back to the Future”: Testing the “Individual Problems and Strengths” Scale With a Stepwise Confirmatory Factor Analysis Approach

Rune Zahl‐Olsen, Nicolay Gausel, Åshild Tellefsen Håland, Terje Tilden — Fri, 05 Jun 2026 00:51:13 -0700

ABSTRACT

Routine Outcome Monitoring systems have been developed to monitor how clients' lives change over the course of therapy. However, for such systems to be effective, they must possess sufficient construct validity and scale-reliability to warrant their use. In this study, using a sample of 841 Norwegian clients, we performed the first independent test of the construct validity and scale-reliability of the “Individual Problems and Strengths” (IPS) scale, a subsection of the “Systemic Therapy Inventory of Change.” We used a stepwise Confirmatory Factor Analysis approach specifically designed to test the construct validity of the measurement scales. We found satisfactory support for the construct validity of the original “8-factor” version of the IPS; however, its scale reliability received poor to mixed support. Furthermore, we failed to find support for all other previously or recently suggested factorial alternatives to the original 8-factor model. Our analysis leads us to conclude that the developers of the IPS should return “back to the future” by refining their original 8-factor structure of the IPS, while disregarding other proposed versions.

Trial Registration

The data stems from an RCT study registered at ClinicalTrials.gov (NCT01873742) as well as from a prior pilot study (Tilden et al. 2015).

Commentary: Making Patient Data Count—Opportunities and Challenges for Open Science in Clinical Psychology

Fri, 05 Jun 2026 00:26:03 -0700

ABSTRACT

Open science practices—such as preregistration, data and material sharing, and open-access dissemination—are increasingly promoted across psychology, yet their specific value for clinical psychology has often been overlooked. This commentary argues that open science is particularly crucial for clinical psychology, where studies rely on small, hard-to-recruit patient samples, ethically sensitive data, and complex psychotherapeutic interventions. However, applying open science practices in one's research can be challenging. And yet, it is becoming increasingly necessary to take a stance on this. To support our colleagues in clinical psychology to take a stance on open science practices and to motivate them to apply these practices in their research, we describe here how the use of open science practices benefits or can benefit clinical psychology science and practice and provide some perspective on why we believe that the increasing use of open science practices is consistent with good scientific practice and the ethical standards of our profession. In addition, we discuss how calls for increased implementation of open science practices in psychological research can be reconciled with some of the challenges, concerns, and conflicts that can arise around open science practices, especially in clinical psychology. Finally, we extend open science's inclusive and collaborative stance to include “experts by experience” in the research process. Including our research topics in the research process is a specific facet of the open science approach in clinical psychology that has been overlooked.

Predicting Change in Brief Treatment for BPD: The Role of Defensive Functioning and Pervasiveness in Relationship Patterns

Tue, 02 Jun 2026 14:23:23 -0700

ABSTRACT

Background

Borderline personality disorder (BPD) is marked by unstable relationships and maladaptive defense mechanisms. This study examined whether defensive functioning and the pervasiveness of core conflictual relationship themes (CCRT) predict symptom change following 10-session General Psychiatric Management (GPM) versus Treatment as Usual (TAU) in patients with BPD.

Method

Sixty patients with BPD (75% female, mean age 29.6) in a randomized controlled trial completed the Relationship Anecdote Paradigm at pretreatment. Interviews were coded using the Defense Mechanisms Rating Scale-Q-sort and the CCRT method. Symptom severity change was assessed using the Zanarini Rating Scale for BPD as post–pre score differences for total and subscale measures. Multiple linear regressions were used for analysis.

Results

Neither overall defensive functioning (ODF) (b = −1.59, p = 0.36) nor overall CCRT pervasiveness (OCP) (b = 2.10, p = 0.46) predicted change in borderline symptom severity. However, the interaction between OCP and treatment was significant for affective disturbance (b = 13.55, p = 0.03): patients with low OCP ( < 70%) improved more under GPM, while those with high OCP benefited more from TAU. In TAU, low OCP ( < 50%) was associated with worsening affective symptoms.

Conclusions

Patients with BPD whose relational patterns were less pervasive and who primarily seek relief from affective distress may particularly benefit from GPM. The preliminary findings further suggest that heightened caution may be warranted when providing TAU to patients with low CCRT pervasiveness.

Trial Registration: ClinicalTrials.gov Identifier: NCT03717818.

An Ecological Momentary Assessment Study of the Influence of Psychic Pain on Suicidal Ideation and Planning

Sat, 30 May 2026 04:36:32 -0700

ABSTRACT

Psychic pain (PsyPn) refers to intense emotional suffering that is experienced as both unbearable and irreversible. PsyPn has been shown in cross-sectional studies to be associated with greater depression, distress, and suicide risk. Although PsyPn is frequently discussed as a primary driver of suicide, few studies have evaluated its short-term predictive value for detecting changes in risk, and few have examined how PsyPn influences risk in interaction with other established factors, such as hopelessness. To address these gaps, the current study utilized ecological momentary assessment (EMA) to identify links between PsyPn, well-established psychosocial risk factors for suicide (hopelessness, loneliness, and burdensomeness), and the short-term emergence of suicidal ideation (SI) and planning. Thirty-nine adults across three clinical sites enrolled in the study after being identified during prescreen as being at elevated suicide risk. Subjects completed a baseline measure of vulnerability to PsyPn (Psychic Pain Scale), followed by an EMA protocol evaluating negative mental states, PsyPn, and SI and planning six times daily over a 14-day period. Multilevel modeling was used to estimate both within-and between-person associations between PsyPn, negative mental states, and SI and planning. Across suicide-related outcomes and timescales, PsyPn was associated with increased suicide risk, and greater PsyPn at both baseline and near-term levels amplified the influence of other daily living risk factors on suicide-related outcomes. The implications of these findings for suicide risk assessment and intervention are discussed, particularly in terms of informing specific targets and timescales of interventions.

Distinct Longitudinal Contributions of Social Anxiety and Self‐Consciousness to Interpersonal Dysfunction

Joseph Maffly‐Kipp, Kaitlyn Nagel, Jay C. Fournier — Fri, 29 May 2026 04:52:39 -0700

ABSTRACT

We examined whether social anxiety (SA) and self-consciousness (SC) predicted unique variance in functioning among young adults with internalizing symptoms. We hypothesized that each would independently predict poorer interpersonal functioning and quality of life cross-sectionally and over 12 months. Participants (N = 152; ages: 18–30) included individuals with elevated depression and anxiety symptoms as well as healthy controls. At baseline, participants completed measures of SA, SC, and assessments of quality of life, social/leisure satisfaction, and four domains of interpersonal problems, with reassessments at 6 and 12 months. Baseline SA and SC both uniquely predicted greater interpersonal problems, and SA predicted lower social satisfaction, controlling for depression and anxiety severity. Quality of life was more strongly associated with SC than SA. However, in longitudinal models, all significant effects of baseline SA diminished over time and were no longer significant at the 12-month follow-up. In contrast, baseline SC demonstrated more stable relationships with impaired social functioning across the longitudinal period. Our findings suggest that SA may reflect a more state-like vulnerability that varies with time and circumstances, while SC may be associated with more stable interpersonal problems. These distinctions may ultimately allow clinicians to more effectively separate features associated with shorter-term interpersonal challenges from those associated with longer-term problems, and therefore to select more targeted and appropriate treatments.

Assessing the Czech Version of the Inventory of Personality Organization in Relation to Borderline Personality Disorder in the ICD‐11

Karel D. Riegel, Albert J. Ksinan — Thu, 28 May 2026 00:00:00 -0700

ABSTRACT

Objectives

This study assessed the Czech version of the Inventory of Personality Organization (IPO-CZ) in relation to borderline personality disorder (BPD) as defined in the ICD-11 model for PDs and defensive functioning in BPDs. The IPO-CZ was used as a proxy measure of personality functioning (PF), although not fully identical to the conception of PF within the ICD-11 framework defined by the severity of self-other impairment.

Methods

The IPO-57, Borderline Personality Questionnaire, and Defense Style Questionnaire were administered to general population volunteers (n = 371) and mixed psychiatric patients (n = 293).

Results

Three-factor solution of the IPO-CZ (i.e., Instability of self and others [ISO]; Instability of goals and behaviors [IGB]; and Psychosis) was confirmed, to a large extent reflecting Kernberg's initial concept of personality organization. Since the measurement invariance of the 57-item version was not confirmed across samples, a 14-item version of the IPO-CZ was developed. ISO was strongly associated with self-other pathology in both samples, IGB showed to be an indicator of immature defensive functioning in both samples and mature-neurotic defenses in clinical sample when IPO-14 was used.

Conclusion

While ISO appears to be an indicator of PF in terms of general self-other disturbance, IGB may be considered a specifier of the defense mechanism-based management of impulsive aggression typical of BPD patients that should not be ignored. Moreover, the study found measurement invariance across general and clinical sample for IPO-14.

A Longitudinal Analysis of Self‐Rated Health Correlates and Predictors in Hurricane Survivors

Sat, 23 May 2026 12:55:09 -0700

ABSTRACT

Introduction

Poor self-rated health (i.e., perceived health status relative to same-aged individuals) is associated with elevated all-cause mortality. Research examining post-disaster self-rated health is limited but could inform disaster theory and interventions. Identifying and subsequently mitigating individual and contextual determinants of self-rated health could address adverse, downstream effects.

Method

The current study includes secondary analyses from a randomized controlled trial of a digital mental health intervention in a diverse sample of 1357 hurricane-affected adults (49.5% Latine ethnicity). We examined longitudinal relations between baseline (post-disaster) mental health outcomes, baseline social support, demographics, and baseline and follow-up self-rated health (calculated as a change score and 12-month follow-up score). We hypothesized those with elevated baseline psychopathology would be more likely to select the “fair/poor” health category (relative to “good/very good/excellent” self-rated health), and that greater social support would longitudinally predict improved self-rated health. Older individuals were also expected to select the “fair/poor” health category.

Results

Individuals with higher baseline depressive symptoms and sleep disturbances were more likely to report “fair/poor” self-rated health at baseline and 12 months. Controlling for baseline self-rated health, depression remained a significant predictor of worse 12-month self-rated health in binary and ordinal logistic regressions. Social support did not predict baseline or 12-month self-rated health. Age and gender were non-significant moderators; no variables predicted change scores.

Conclusion

Depressive symptoms appear to be a key predictor of self-rated health one year post-disaster. Addressing depression post-disaster may mitigate adverse health outcomes.

Engagement With Online Sexual Trauma‐Related Content Among Women Who Have Experienced Sexual Trauma

Caterina Obenauf, Gina P. Owens, Hannah Shinew, Logan Mitchell — Tue, 19 May 2026 11:34:41 -0700

ABSTRACT

Seeking online social support has become increasingly common due to widespread use of social media; however, little is known about the experiences of women survivors of sexual trauma who engage with online sexual trauma-related content and whether this has implications for physical and mental health. This mixed-methods study examined somatic and posttraumatic stress symptoms (PTSS) among 173 women (mean age = 37) with a history of unwanted sexual contact, comparing those who engaged with online trauma-related content to those who did not. Women were asked about their online experiences to gain a better understanding of their perceptions of engagement with this content via an online survey, which also included measures of somatic symptoms, PTSS, stress reactivity, emotion regulation, mindfulness, and meaning made. Many identities were represented in the sample (17% non-cisgender, 35% non-heterosexual, and 34% racial/ethnic minorities). Results revealed that meaning-making was associated with fewer somatic symptoms, while stress reactivity predicted greater PTSS and somatic symptoms among women engaging with online sexual trauma-related content. Qualitative findings identified three themes with corresponding subthemes: (1) Intrapersonal experiences (positive affective experiences, negative affective experiences, meaning-making, skill development), (2) Interpersonal experiences (healing through community, barriers to interpersonal interaction, disengagement from community), and (3) Engagement with the online modality. Results underscore the clinical importance of addressing social media use in trauma recovery and inform the development of trauma-informed, evidence-based digital tools for survivors.

The Helping Alliance Questionnaire for Children and Their Caregivers—Validation in a German Sample of Pediatric Chronic Pain Patients

Lisa‐Marie Rau, Amelie Florentine Schmidt, Julia Wager — Thu, 07 May 2026 04:10:07 -0700

ABSTRACT

Objectives

The “helping alliance” between patients, caregivers, and healthcare professionals (HCPs) plays an important role in the evaluation of therapeutic interventions. The aim of this study was to develop a German version of the Helping Alliance Questionnaire for pediatric patients (HAQ-P) and caregivers (HAQ-CG).

Methods

The questionnaire was adapted from the original version of the HAQ for adults and improved using feedback from HCPs, patients with chronic pain and their caregivers. It was then validated in a sample of N = 216 patients with chronic pain aged 8–17 years, along with their caregivers and HCPs.

Results

Confirmatory factor analysis revealed a good model fit for the 2-factor structure of the HAQ-P and HAQ-CG, with the two subscales relationship and outcome satisfaction demonstrating good to excellent internal consistency across all subgroups. Multi-group analyses showed that the model structure was similar for patients, caregivers, and HCPs. However, means of the three groups differed systematically (e.g., caregivers reported higher satisfaction), thus not allowing for direct comparison of group means.

Conclusions

The HAQ-P and HAQ-CG have strong psychometric properties, and may be useful in clinical practice and research for monitoring, predicting, and improving therapeutic outcomes.

Investigating Suicidal Ideation in Iranian Individuals With Emotional Disorders Through the Lens of the Three‐Step Theory

Wed, 06 May 2026 00:14:23 -0700

ABSTRACT

Objective

Suicidal ideation (SI) in emotional disorders has received increasing attention in recent decades, but the specific psychological factors associated with SI in emotional disorders according to recent theories are not well understood. The current study sought to assess the emotional pain × hopelessness in relation to the three-step theory (3ST) among individuals with emotional disorders.

Methods

Participants who were diagnosed with emotional disorders (n = 119) completed self-report measures assessing SI, hopelessness, emotional pain, and connectedness. Regression analysis was conducted to examine the association of the interaction of emotional pain and hopelessness with SI. The potential moderating role of connectedness was also assessed.

Results

Findings indicated that a substantial variance of SI (45%) was explained by an interactive model of emotional pain and hopelessness ( F 3.115 = 31.39 , p < 0.001 ) $(F3.115=31.39,\,p\lt 0.001)$. Additionally, connectedness did not moderate the association between emotional pain and SI ( p = 0.808 ) $(p\,=0.808)$. An exploratory three-way interaction (i.e., emotional pain × hopelessness × connectedness) was marginally significant ( β = 0.19 , p = 0.053 ) $(\beta \,=0.19,\,p\,=0.053)$, suggesting its role may depend on hopelessness levels.

Conclusion

The findings offer novel insights into the psychological correlates of SI in emotional disorders by underscoring the significant association of emotional pain and hopelessness. Despite that, the factors related to SI in individuals with emotional disorders are complex and warrants further evaluation through longitudinal studies.

Lessons Learned: A Straight Therapist's Perspective on Treating a Gay Woman's Romantic Breakup

Devlin A. Jackson — Thu, 30 Apr 2026 05:49:50 -0700

ABSTRACT

This article presents the retrospective insights of a straight female psychologist working with a gay female patient through the emotional aftermath of a romantic breakup. Central to this case study is the therapist's journey toward understanding the culturally specific dynamics that shape the breakup experiences of non-heterosexual individuals differently from those of heterosexual individuals. In addition to deepening her understanding of important therapeutic considerations unique to a non-heterosexual breakup, the author explores how certain cultural norms within the queer community, including close-knit support systems and the prevalence of post-breakup friendships, may intensify and prolong the grieving process. In addition, the author identifies universal aspects of romantic breakups, including loss, betrayal, and self-reconstruction. The author's reflections highlight several key areas of learning: the necessity of recognizing one's own assumptions and biases, the importance of creating a supportive and non-judgmental therapeutic environment, and the critical role of culturally competent practice. The author covers the therapeutic techniques employed, adaptations made to standard practice, and the role of ongoing education and consultation in enhancing therapeutic outcomes. By integrating personal observations with existing literature, the therapist provides a candid account of the professional growth experienced through this case. This article contributes to the broader dialogue on how therapists can more effectively address the needs of patients from diverse sexual backgrounds, advocating for a more informed approach to psychological practice.

Highest Columbia‐Suicide Severity Rating Scale (C‐SSRS) Screener Item Endorsed by Individuals Who Attempted Suicide Within 30 Days of Pretrial Detention

Tue, 28 Apr 2026 11:43:47 -0700

ABSTRACT

Objectives

The Columbia Suicide Severity Rating Scale (Posner et al.; C-SSRS) is a widely used measure, both in research and clinical practice, for the detection of suicide risk. The current study examines responses to the C-SSRS by individuals who attempted suicide in the 30 days before pre-trial jail detention.

Methods

Data were analyzed from the Suicide Prevention Intervention for at-Risk Individuals in Transition (SPIRIT) trial, which was conducted from May 2016 to November 2018 and included 800 individuals in pretrial jail detention with the primary inclusion criterion being endorsement of suicidal ideation with some intent to act (endorsement of C-SSRS C4 or C5) and/or a suicide attempt in the past month. This paper focuses on the first five screener items of the C-SSRS, which assess the highest level of suicidal ideation in the past month.

Results

Most (65%) individuals who reported making a past 30-day suicide attempt indicated their highest level of suicidal ideation at the time of attempt was at the C4 (active suicidal ideation with some intent to act, without a specific plan), rather than the C5 level (active suicidal ideation with a specific plan and intent).

Conclusion

Fewer than one-third of individuals who had made at least one past 30-day suicide attempt in our sample had made specific plans. Findings highlight the unplanned nature of many suicide attempts and the risk for suicide among individuals without detailed suicide plans.

Trial Registration

The SPIRIT (Suicide Prevention Intervention for at-Risk Individuals in Transition) trial is registered at clinicaltrials.gov (NCT02759172), Registered 3 May, 2016.

Compassion Focused Therapy to Address Shame and Guilt: A Case Study of a Client With Complex PTSD

Deborah Lee, Dorothy King, James N. Kirby — Tue, 28 Apr 2026 11:25:39 -0700

ABSTRACT

This paper presents the case of “Ava” a woman in her late 40s diagnosed with ICD-11 Complex Posttraumatic Stress Disorder (CPTSD), whose life was shaped by chronic childhood abuse, pervasive shame, and intense self-criticism. Ava struggled with intrusive trauma memories, relational hypervigilance, fears of compassion, and enduring guilt regarding the impact of past substance misuse on her children. A phased Compassion Focused Therapy (CFT) approach was implemented to address her chronic threat state (persistent hypervigilance and relational alarm) and facilitate a shift from shame-based self-attack toward compassionate self-relating. Phase 1 involved 12 group sessions focused on developing compassionate resilience and social safeness. Phase 2 consisted of 28 individual sessions integrating trauma memory processing with compassion focused interventions. Phase 3 included an optional, pilot 8-session group, consolidating compassionate identity and values-based living. The therapeutic journey involved relational challenges, including fears of judgment, ambivalence about relinquishing self-criticism and moments of alliance strain. Over the course of treatment, Ava demonstrated clinically significant reductions in CPTSD symptoms and trauma related shame, alongside increased self-reassurance, emotional regulation, and consolidation of a compassionate identity. Clinical implications of trauma focused CFT for those with complex PTSD are discussed.

The Comparative Effectiveness of a Group Therapy for Overcontrol (Group Radical Openness) When Delivered In‐Person vs. Remotely: Findings from a Retrospective Naturalistic Service Evaluation

Conal Twomey, Siobhan Duffy, Rachel Egan — Mon, 27 Apr 2026 11:34:23 -0700

ABSTRACT

Objectives

Group Radical Openness (GRO) is a group therapy for the treatment of costly and harmful overcontrol. The COVID-19 pandemic necessitated the remote delivery of GRO, notwithstanding its highly interpersonal therapeutic focus. Based on positive service user feedback, the option to attend remotely was maintained after the pandemic. This service review evaluates this continued provision, through an assessment of the comparative effectiveness of GRO within in-person and videoconferencing (VC) formats.

Methods

A retrospective naturalistic evaluation of routine pre- and post- clinical outcome data was conducted at a not-for-profit mental health service in Ireland. The in-person and VC-GRO comparison groups arose organically in the context of responsiveness to service user preference.

Results

The sample consisted of 101 GRO participants (72 in-person and 29 VC), aged between 18 and 68 years (M = 41.2 years, SD = 13.00). Based on main effect interpretations from ANOVAs, the overall effectiveness of GRO was supported for both primary outcomes: difficulties associated with overcontrol (F (1, 100) = 84.92; p < 0.01); and general psychological distress (F (1, 100) = 44.32; p < 0.01). There were no significant differences between the in-person and VC groups for any of GRO's primary or secondary outcomes. Concerns that more avoidant participants might opt for VC-GRO over in-person attendance were also not supported, as the groups presented similarly in terms of clinical and demographic characteristics at baseline.

Conclusion

These preliminary and naturalistic findings support the effective delivery of GRO both in-person and remotely. This should allay any concerns surrounding the potential unhelpful impact of delivering GRO remotely. These findings are applicable to similar VC therapy groups.

Non‐Suicidal Self‐Injury as a Low‐Effort Strategy for Avoiding Negative Affect

Chloe Roske, Regina Musicaro, Peter J. Franz — Mon, 27 Apr 2026 11:15:30 -0700

ABSTRACT

Background

Non-suicidal self-injury (NSSI) is primarily performed for negative reinforcement, which may be accomplished by facilitating avoidance of negative affect. This study aimed to identify whether an aversion to cognitive effort in the form of effort discounting underlies NSSI and other avoidant emotion regulation strategies.

Methods

Adults (N = 149), 52% with a history of NSSI, completed a behavioral measure of effort discounting, the preference to expend less effort despite attaining less relief from an aversive experience. We used confirmatory factor analysis to identify dimensions of avoidant and engagement-oriented affect regulation strategies, and we extracted factor scores from these dimensions. Participants self-reported their past engagement in NSSI, perception of the effort required by non-NSSI affect regulation strategies, and past use of such strategies.

Results

Effort discounting was not significantly associated with avoidant affect regulation strategy use but was modestly associated with lower engagement-oriented coping. Avoidant affect regulation strategy use was not positively associated with NSSI frequency, and this association did not vary based on whether individuals reported engaging in NSSI for affect regulation. In contrast, endorsement of NSSI for negative reinforcement was strongly associated with greater NSSI frequency. Among participants with a history of NSSI, greater NSSI frequency was associated with perceiving non-NSSI affect regulation strategies as more effortful.

Conclusions

Rather than reflecting a general tendency toward avoidant coping, more frequent NSSI appears to be linked to its negative reinforcement value and to perceptions that alternative emotion regulation strategies require greater effort.

Combining Mindfulness‐Based Cognitive Therapy With Escitalopram for Cognitive and Emotional Recovery in Older Adults With Treatment‐Resistant Depression

Zhaohui Wei, Shuxin Zhang, Jia Ma, Yue Zhang, Yanhong Li, Aiping Wen — Thu, 23 Apr 2026 04:36:07 -0700

ABSTRACT

Objectives

This study investigates the adjunctive effects of mindfulness-based cognitive therapy (MBCT) combined with escitalopram hydrobromide on cognitive function and emotional well-being in older adults with treatment-resistant depression (TRD). We hypothesized that this combined approach would lead to greater enhancements in cognitive abilities and overall well-being compared to escitalopram hydrobromide alone in this vulnerable population.

Methods

A total of 230 older adults with TRD and cognitive impairment were randomly assigned into two groups: an experimental group receiving MBCT plus escitalopram (n = 115) and a control group receiving escitalopram alone (n = 115). Cognitive function, depression severity, and quality of life were assessed at baseline, 6 weeks, and 12 weeks using the Montreal Cognitive Assessment (MoCA), Hamilton Depression Rating Scale (HAM-D), and General Quality of Life Index-74 (GQOLI-74).

Results

The experimental group demonstrated significant improvements in cognitive function (MoCA scores) and quality of life (GQOLI-74 scores) compared to the control group at both 6 and 12 weeks (p < 0.05). Additionally, depression severity (HAM-D scores) was significantly reduced in the experimental group (p < 0.05). The combined therapy also resulted in higher rates of significant and effective treatment outcomes, with fewer cases of average or ineffective responses (p < 0.05).

Conclusions

The integration of MBCT with escitalopram hydrobromide significantly enhances cognitive function, reduces depressive symptoms, and improves quality of life in older adults with TRD.

Clinical Implications

Clinicians should consider incorporating mindfulness-based interventions alongside pharmacological treatments for older adults with TRD.

Trial Registration

The trial was retrospectively registered with ClinicalTrials. gov (Identifier: NCT07077291).

Body Image and Paranoia—Findings From a Large‐Scale Community Sample Using Network Analysis

Justyna Piwińska, Paulina Bagrowska, Łukasz Gawęda — Fri, 17 Apr 2026 22:45:59 -0700

ABSTRACT

Background

Body image - the way individuals perceive, think, and feel about their own body, is a subjective psychological construct shaped by biological, psychological, and sociocultural factors. Negative body image is linked not only to psychological distress and reduced quality of life, but also to paranoia-like thoughts. However, the underlying mechanisms remain poorly understood.

Objective

This study applied a network approach to psychopathology, to explore the associations among negative body image, paranoia, and related psychological constructs.

Methods

A large non-clinical sample of 2605 participants (51.6% female, mean age = 46.96) completed the online study.

Results

The network analysis revealed a highly interconnected structure with no isolated nodes, supporting the hypothesis that all included variables: negative body image, paranoia-like thoughts, self-esteem, negative affect, sleep quality, interoceptive awareness, self-focused attention, trauma, and internalized stigma, form a single cohesive system. Body image emerged as the most central node, indicating strong associations with multiple psychological variables. Additionally, body image had one of the highest predictability values, just behind self-esteem and emotional dysregulation.

Conclusion

These findings suggest that negative body image may play a central role as a vulnerability factor linking internal experiences with paranoia. Furthermore, a comparison between male and female networks revealed that the female network was more strongly centered on body image and negative emotions, whereas the male network showed greater centrality around paranoia and emotion regulation. The results highlight the importance of targeting body image, self-esteem, and emotion regulation in preventive and therapeutic efforts aimed at reducing paranoia and enhancing psychological well-being.

Differentiating the Course of Symptom Improvement Between Two Treatments for Childhood Anxiety Disorders

Stephen P. H. Whiteside, Lilianne M. Gloe, Bridget K. Biggs — Fri, 10 Apr 2026 07:29:57 -0700

ABSTRACT

Objectives

Cognitive behavioral therapy (CBT) is the most researched treatment for childhood anxiety disorders (CADs). Improving outcomes and efficiency of CBT will require identifying and optimizing the most efficacious therapeutic components. Towards this end, a recent randomized controlled trial (RCT) found that Parent Coached Exposure Therapy (PCET) led to greater symptom improvement in less time than traditional CBT. To better understand and maximize these advantages, the current study explores the timing and course of symptom improvement in these two treatments for CADs, CBT, and PCET.

Methods

In this secondary analysis of data from the RCT, 56 youth aged 7−17 years (73.2% female) and a parent provided weekly ratings of anxiety symptom severity.

Results

The mean anxiety severity ratings decreased significantly in both conditions, but a significant condition by time interaction suggested that the pace of change differed between treatment for parent report, F (6.2, 335) = 2.96, p = 0.007. A series of post-hoc comparisons indicated that the ratings became significantly lower in the PCET group beginning in session 3 (effect size = 0.77) through post-treatment assessment. In addition, within each treatment condition the largest change in severity ratings occurred after the introduction of exposure, effect sizes of 0.68 for PCET and 0.56 for CBT. The child severity ratings followed a similar pattern but did not reach statistical significance.

Discussion

The implications of these exploratory and hypothesis-generating findings for designing treatment protocols to deliver exposure in a manner to maximize the amount, and pace, of improvement are discussed.

Are Online Social Experiences Associated With General Interpersonal Problems? A Circumplex Assessment

Fri, 03 Apr 2026 10:15:54 -0700

ABSTRACT

Objective

Social media use can promote social connection but also often includes negative experiences, raising questions about its associations with broader interpersonal functioning.

Methods

This preregistered study used the interpersonal circumplex (IPC) to examine associations of self-reported online social support and negativity, and excessive social media use with self-reports of general interpersonal problems, compared to associations for offline support and social anxiety, in a representative sample of U.S. adult social media users (n = 1356; mean age = 44.9; 52% women; 61.9% non-Hispanic White; median income $50k–75k).

Results

Online negativity and excessive social media use were strongly associated with more severe general interpersonal problems; online support had a small positive association with greater problems. These associations were stronger for men than women, and weaker for older participants. In contrast to online support, off-line social support was inversely associated with interpersonal problems, and the positive association for social anxiety was similar in magnitude to those for online negativity and excessive social media use.

Conclusions

Findings suggest that online social experiences and excessive social media use are associated with broader interpersonal difficulties, and that the interpersonal perspective may be useful in understanding psychosocial issues emerging in the digital age.

Psychometric Evaluation and Clinical Norms of a Dutch Version of the Body Uneasiness Test Among Individuals With Self‐Reported Eating Disorder Pathology

Lanaya M. van Uffelen, Edwin de Beurs, Bernou Melisse — Fri, 03 Apr 2026 09:45:40 -0700

ABSTRACT

Introduction

The present study evaluates the psychometric properties and provides normative data for the Dutch Body Uneasiness Test. The instrument was administered to a clinical sample (N = 448) and a community-based sample (N = 223). The Body Uneasiness Test was translated and back-translated.

Methods

Internal consistency, item-rest correlation, test-retest reliability, and concurrent validity were assessed. The Body Shape Questionnaire and the Eating Disorder Examination-Shape concern subscale were used as reference measures. To establish criterion validity, a receiver-operating-characteristic curve-analysis was performed using both groups as reference groups. Confirmatory factor analysis tested five- and eight-factor structures. Norms (population-based T-scores and percentile scores) were established.

Results

The psychometric properties were good, with the Body Uneasiness Test distinguishing well between individuals with and without eating disorder pathology (area-under-the-curve value = 0.77–0.88). The Body Uneasiness Test-A had a five-factor structure, and the Body Uneasiness Test-B had an eight-factor structure. In accordance with other samples, clinical cut-off for the Body Uneasiness Test A was 1.2.

Conclusions

These results suggested that the Dutch Body Uneasiness Test is a useful tool for screening various aspects of body image in individuals with eating disorder pathology in research and in clinical practice.

Association of Online Parent‐Child Interactions With Depressive Symptoms Among Middle‐Aged and Older Empty Nesters in China

Wing‐yin Leung, Peiyi Lu — Mon, 30 Mar 2026 07:56:08 -0700

ABSTRACT

Objective

Depression is prevalent among empty nest older adults who do not live with their children. With rapid technological development, online interaction presents a new opportunity to improve older adults' mental health. However, the relationship of online parent-child interaction with depressive symptoms among empty nesters remains under-examined. Guided by the social support theory, this cross-sectional study examined the association between online parent-child interaction and depressive symptoms among middle-aged and older Chinese empty nesters.

Methods

A total of 5198 Chinese empty nesters aged 45+ from the 2018 China Health and Retirement Longitudinal Study were included. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Participants reported the frequency they contacted their children via online. Negative binomial and Poisson regression were utilized. Interaction terms examined the moderation role of gender, marital status, and education in the relationship.

Results

36.5% of participants reported elevated depressive symptoms and 59.8% of them contacted their children weekly or biweekly. More frequent online parent-child interaction was significantly associated with lower risk of depressive symptoms (incident rate ratio = 0.981, 95% CI = 0.972, 0.990; relative risk = 0.978, 95% CI = 0.963, 0.993). The moderation role of gender and education was not significant (p > 0.05). However, married/partnered participants had stronger association than their partnerless counterparts.

Conclusion

Online parent-child interaction was associated with fewer depressive symptoms among Chinese empty nesters in this cross-sectional study. These findings suggest that digital family communication may be a meaningful social context to understand their psychological well‑being.

Developing a Six‐Item Short Form of Ryff's Psychological Well‐Being Measure: Demonstration of Short Form Development Using Exhaustive Search

Mohsen Joshanloo — Fri, 27 Mar 2026 12:43:42 -0700

ABSTRACT

Using the Midlife in the United States data, this study developed a 6-item short form of Ryff's six-dimensional measure of psychological well-being, with a single item selected to represent each dimension. The study demonstrated the utility of an exhaustive search framework in which all permissible item combinations were systematically evaluated to identify an optimal ultra-short version. Model performance was assessed using global goodness of fit indices (e.g., RMSEA, CFI, SRMR), standardized factor loadings, and coefficient omega to ensure adequate construct representation, unidimensionality, and internal consistency. The resulting short form showed excellent model fit, strong internal consistency, and satisfactory representation of the targeted construct across the development sample and an independent replication sample. Measurement invariance analyses supported full invariance across gender and race, and partial invariance across age and education. Taken together, the findings indicate that the proposed ultra-short scale provides a valid and reliable index of global psychological well-being and is suitable for settings in which domain-level scores are not required and in which time or resource constraints preclude administration of longer measures.