Journal of Clinical Psychology最新文献

{"title":"«Scaringly Safe»: Therapeutic Processes in Longstanding Eating Disorders With Comorbid Avoidant Personality Disorders in the Recovered Case of Jade","authors":"Hanna P. Eielsen,&nbsp;KariAnne Vrabel,&nbsp;Malin E. Olofsson","doi":"10.1002/jclp.23805","DOIUrl":"10.1002/jclp.23805","url":null,"abstract":"<div>\u0000 \u0000 <p>Personality disorders (PD) are highly prevalent among patients with eating disorders (ED) and are often associated with unfavorable treatment outcomes. This may be due to poor engagement in therapy, interpersonal difficulties hampering the treatment alliance, and emotional instability overshadowing the ED symptoms. However, the patients' perspectives on these processes are understudied. To illustrate the potential of addressing personality vulnerabilities and relational issues in ED treatment, we present the case of Jade, a 29-year-old female with longstanding bulimia nervosa, major depressive disorder, and posttraumatic stress disorder following childhood maltreatment. Jade had been diagnosed with multiple PD such as paranoid, borderline, and avoidant PD, and at the time of treatment, she fulfilled the diagnostic criteria for the latter. Jade participated in a 12-week Cognitive Behavioral Therapy (CBT) inpatient program in a specialized ED unit. The treatment focused on the complex symptom interplay, specifically connecting early memories to current reactions, coping strategies, and relationship patterns. Jade normalized her eating patterns and trauma symptoms decreased. She highlighted being able to trust the staff and the treatment program as a prerequisite for ED improvement. Her narrative was triangulated with real-time self-report data examining ED symptoms (EDE-Q), interpersonal patterns (IIP-64), and trauma symptoms (PSS-SR) at assessment, admission, discharge, and 1-year follow-up. Jade was fully recovered from the ED at 1-year follow-up, however, the avoidant PD persisted. Considering the frequent ED-PD co-occurrence, the patient perspective may provide valuable insight to reduce long-term suffering by guiding tailored treatment approaches to improve outcomes for these difficult-to-treat patients.</p>\u0000 <p><b>Trial Registration:</b> NCT02649114</p>\u0000 </div>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":"81 8","pages":"694-705"},"PeriodicalIF":2.5,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“When Standard Treatments Are Not Enough” – Showcasing Schema Therapy for the Treatment of Anorexia Nervosa and Borderline Personality Disorder","authors":"Natasha S. Hepworth,&nbsp;Susan G. Simpson","doi":"10.1002/jclp.23801","DOIUrl":"10.1002/jclp.23801","url":null,"abstract":"<div>\u0000 \u0000 <p>Whilst standard cognitive and behavioural treatments lead to clinical improvement for approximately half of the people with eating disorders, preliminary evidence indicates that complex comorbidity, including personality difficulties, insecure attachment patterns and Posttraumatic stress disorder, may hinder treatment engagement and outcomes. Such comorbidities tend to be associated with increased emotional dysregulation, rigidity of beliefs, and dissociation. Schema Therapy is a transdiagnostic approach that interweaves the treatment of current eating disorder symptomatology and comorbid presentations through addressing early maladaptive schemas linked to unmet attachment needs and traumas. The goals are to promote integration, coherence, and resilience of self, whilst reducing reliance on the eating disorder as a means of self-regulation and substitute identity. In this case example, we follow a 27-year-old woman with an eating disorder (Anorexia Nervosa) and comorbid personality disorder (Borderline Personality Disorder), illustrating how Schema Therapy can effectively treat both conditions by healing the underlying schemas. This case study highlights the ways in which the therapeutic ‘limited reparenting’ approach is used to interweave cognitive, experiential, and behavioural techniques that address clients’ chronically unmet emotional needs, and the importance of enhancing the individual's Healthy Adult mode to facilitate self-regulation and the client's capacity to effectively manage their own psychological needs in the future.</p>\u0000 </div>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":"81 8","pages":"755-767"},"PeriodicalIF":2.5,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age Disparities in the Association Between Leisure-Time Physical Activity and Depression Among American Adults","authors":"Juxiang Yang,&nbsp;Xi Zheng,&nbsp;Yi Wang,&nbsp;Hongchu Wang,&nbsp;Gang Song","doi":"10.1002/jclp.23804","DOIUrl":"10.1002/jclp.23804","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aims to investigate the association between leisure-time physical activity (LTPA), age, and depressive symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included and analyzed data from 18,052 participants (age ≥ 20 years) from the cross-sectional National Health and Nutrition Examination Survey (NHANES) (2007−2014). Multivariable logistic regression was employed to assess the independent associations between physical activity and household income with depressive symptoms. Restricted cubic spline plots were utilized to analyze the non-linear relationship between LTPA and depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 18,052 participants, 1,676 (9.28%) were defined as having depressive symptoms. We found: 1. Age exhibits a non-linear relationship with depression, with a turning point around 40 years. 2. Compared to those with no LTPA, individuals with higher levels of LTPA (Q3) in both younger and older age groups experienced the lowest risk of depression, with risk reductions of 53% (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.33−0.67) and 74% (OR 0.26, 95% CI 0.14−0.50), respectively. Conversely, in the middle-aged group, those with the highest level of LTPA (Q4) experienced the greatest reduction in depression risk, by 67% (OR 0.33, 95% CI 0.21−0.53). 3. A U-shaped relationship between LTPA and depression risk was observed in younger and older age groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The risk of depression peaks around the age of 40 in adults. For middle-aged individuals, greater engagement in LTPA is associated with reduced depression risk. Conversely, higher levels of LTPA in younger and older adults may not confer additional protective effects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":"81 8","pages":"706-714"},"PeriodicalIF":2.5,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metacognitive Interpersonal Therapy-Eating Disorder (MIT-ED) in the Case of a Woman With Binge Eating Disorder and Avoidant and Obsessive-Compulsive Personality Disorders","authors":"Gloria Fioravanti,&nbsp;Raffaele Popolo,&nbsp;Giancarlo Dimaggio","doi":"10.1002/jclp.23800","DOIUrl":"10.1002/jclp.23800","url":null,"abstract":"<div>\u0000 \u0000 <p>Binge Eating Disorder (BED) needs more effective empirically supported treatments, given problems with attrition from and response to available options. One avenue to improve adherence and response is considering comorbid personality disorders, given their impact on the therapy relationship and on patients' capacities to comply with homework, for example, regularizing eating habits or abstaining from bingeing. We describe here the case of a woman in her thirties suffering from BED, and avoidant and obsessive-compulsive personality disorders, treated with Metacognitive Interpersonal Therapy for Eating Disorders (MIT-ED), a psychotherapy that has begun to gather empirical support. Silvia is a 34 year old married woman with two children. She begins psychotherapy to lose weight but she oscillates between restriction and daily binges, in the last 2 years she has gained 30 kg. During 20 sessions of MIT-ED Silvia realized that she tended to binge because she thought she was unworthy and unable to put boundaries to her mother's criticism and intrusions. The therapist helped her realize that following psychoeducation about eating made her feeling controlled, and that was the reason for initial noncompliance with behavioral tasks. During the therapy she formed more adaptive ideas of herself as worthy and autonomous and become able to put boundaries to her mother. At the end of the therapy, Silvia no longer suffered from BED as evident from Eating Disorder Examination Questionnaire (Fairburn and Beglin 2008) and from the Binge Eating Scale (Gormally et al. 1982). Implications for further application of MIT-ED across ED are discussed.</p>\u0000 </div>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":"81 8","pages":"665-676"},"PeriodicalIF":2.5,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treating Patients With Comorbid Eating Disorders and Personality Disorders: A Rationale","authors":"Gloria Fioravanti,&nbsp;Giancarlo Dimaggio,&nbsp;Liv Sand","doi":"10.1002/jclp.23803","DOIUrl":"10.1002/jclp.23803","url":null,"abstract":"<div>\u0000 \u0000 <p>Eating disorders (ED) have heightened risk for both psychiatric and medical complications, and they require more effective psychological interventions, in light of evidence saying that treatment response is often incomplete, and attrition is significant. One possible avenue to improve treatment effectiveness is address the frequent co-occurrence with personality disorders (PD). When persons suffer from both ED and PD they would present with complex manifestations and serious interpersonal problems. In parallel, their capacity to form a solid working alliance can be limited. They are likely to have difficulty trusting clinicians and engaging in the necessary work needed to counteract their maladaptive ideas about food, weight and body image, and to change their problematic eating habits. This introduction of the issue of the <i>Journal of Clinical Psychology: In Session</i> devoted to treating patients with comorbid ED and PD describe the rationale for why it is necessary to assess and treat PD symptoms integrated with appropriate ED focused treatment.</p>\u0000 </div>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":"81 8","pages":"659-664"},"PeriodicalIF":2.5,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Ambivalence Is Indirectly Associated With Obsessive-Compulsive and Eating Disorder Symptoms Through Different Feared Self-Themes","authors":"Samantha Wilson,&nbsp;Nesrine Mesli,&nbsp;Adrienne Mehak,&nbsp;Sarah E. Racine","doi":"10.1002/jclp.23798","DOIUrl":"10.1002/jclp.23798","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Uncertainty regarding the self and fear of self have been independently identified as relevant to both obsessive-compulsive disorder (OCD) and eating disorders (EDs). The present study aimed to examine self-ambivalence (an indicator of uncertainty regarding the self often characterized by conflicting self-beliefs) as a potential transdiagnostic factor associated with both OCD and EDs and to determine whether differences in the thematic content of the feared self may be linked to the experience of symptoms of one disorder over another despite common co-occurrence and shared processes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Undergraduate and community women (<i>N</i> = 138) completed a battery of questionnaires, which included measures of self-ambivalence, fear of self (assessing three feared self-themes: feared corrupted self, feared culpable self, and feared unattractive self), and OCD and ED symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A path analysis revealed that self-ambivalence was directly associated with OCD and ED symptoms. Self-ambivalence was also indirectly associated with OCD symptoms via the feared corrupted self and with ED symptoms via the feared unattractive self. There was no indirect path through the feared culpable self.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Self-ambivalence warrants additional investigation as a factor associated with multiple forms of psychopathology, representing a potentially valuable target for both intervention and prevention efforts. Differences in the content of the feared self may contribute to our understanding of divergent trajectories (why one individual may develop an ED while another develops OCD). Overall, research of this kind contributes to the development and improvement of transdiagnostic models of psychopathology integrating the self.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":"81 7","pages":"619-627"},"PeriodicalIF":2.5,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jclp.23798","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Therapeutic Community Integrated With a DBT Skills Training Program for Substance Use Disorders: The Initial Efficacy for the Treatment of Impulsivity and Related Dimensions","authors":"Marco Cavicchioli,&nbsp;Jessica Mambreani,&nbsp;Giorgia Conti,&nbsp;Serena Mazoli,&nbsp;Federica Galli,&nbsp;Marco Begarani","doi":"10.1002/jclp.23799","DOIUrl":"10.1002/jclp.23799","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aims at investigating the initial efficacy of a 6-month therapeutic community (TC) intervention integrated with a standard Dialectical Behavior Therapy Skills Training (DBT-ST) program (DBT-ST-TC) for treating impulsivity among patients with SUDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Impulsivity was assessed through self-report (UPPS-P) and neuropsychological (Attentional Network Test [ANT]-conflict monitoring, Go/No-Go, Iowa Gambling Task) measures. Furthermore, mindfulness (FFMQ, MAAS) emotion dysregulation (DERS) and distress tolerance (DTS) were evaluated. Intention-to-treat analysis was performed to evaluate pre- post-treatment changes controlling for baseline levels. Pre- and post-treatment results of the DBT-ST-TC group were also compared to baseline levels of variables of interest measured in two control groups (i.e., untreated outpatient with SUDs; healthy controls [HCs]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-eight patients with SUDs were screened and admitted to the DBT-ST-TC. Thirty-eight (55.9%) patients completed the first cycle of DBT-ST-TC. The clinical control group included 41 untreated individuals with SUDs. The HC group was composed of 53 participants. DBT-ST-TC patients reported pre- post-treatment improvements of emotion dysregulation (<i>t</i> ₍₆₇₎ = −2.10; <i>p</i> = 0.04), positive urgency (<i>t</i> ₍₆₇₎ = −3.27; <i>p</i> = 0.002) and sensation seeking (<i>t</i> ₍₆₇₎ = −2.08; <i>p</i> = 0.04). The improvement of ANT-conflict monitoring performances was the most relevant pre- posttreatment change (<i>t </i>₍₆₇₎ = −2.98; <i>p</i> = 0.005): no significant differences between posttreatment performances of the DBT-ST-TC group and HCs were detected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The DBT-ST-TC might be a promising intervention for treating patients with SUDs. Future long-term outcomes are needed to corroborate and extend these provisional results.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":"81 7","pages":"628-642"},"PeriodicalIF":2.5,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exposure and Response Prevention in OCD: A Framework to Capitalize Change","authors":"Divo Faustino,&nbsp;Miguel M. Gonçalves,&nbsp;Rui Braga,&nbsp;Maria João Faria,&nbsp;João Tiago Oliveira","doi":"10.1002/jclp.23797","DOIUrl":"10.1002/jclp.23797","url":null,"abstract":"<div>\u0000 \u0000 <p>Exposure and response prevention (ERP) constitutes the first-line treatment for obsessive-compulsive disorder (OCD). Despite robust empirical evidence supporting its efficacy, ERP has challenges, including high attrition rates and difficulty sustaining engagement. Research suggests that focusing on clients' strengths while addressing their difficulties can enhance therapy effectiveness. The present article details the case of a young adult with OCD characterized by sexual obsessions and mental compulsions, who initially underwent 12 sessions of cognitive-behavioral therapy (CBT) with limited progress. A subsequent transition to ERP throughout nine sessions resulted in positive treatment outcomes. The article illustrates how ERP may be coupled with a framework that capitalizes change using Innovative Moments (IMs)—changes in clients' discourse that reflect progress in therapy as manifested by new and adaptive ways of acting, feeling, or thinking. Therapists can be attentive, detect, and explore these moments to expand and promote further change. By attuning to and reinforcing IMs during ERP, the therapist assisted the client in disengaging from compulsions, increasing exposure tolerance, and consolidating therapeutic gains. This case underscores a practical strategy for clinicians: therapists can leverage naturally occurring change markers to enhance motivation and deepen learning in ERP rather than solely correcting dysfunctional patterns. The recognition and expansion of IMs have the potential to assist clients in maintaining engagement, tolerating distress, and cultivating more flexible responses to intrusive thoughts, which are all pivotal factors in the effective treatment of OCD.</p>\u0000 </div>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":"81 7","pages":"643-651"},"PeriodicalIF":2.5,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Client Attraction to Therapists – A Mixed Methods Study of Therapist Experiences","authors":"Ana Rabasco,&nbsp;Sarah C. Jessup,&nbsp;Amy Mariaskin,&nbsp;Dean McKay","doi":"10.1002/jclp.23795","DOIUrl":"10.1002/jclp.23795","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>There is a paucity of qualitative and quantitative work exploring characteristics of client attraction towards therapists (CATT) and strategies for handling those situations. The present study aimed to explore CATT using mixed methods, including providing updated rates of client attraction in the therapeutic relationship and examining characteristics of CATT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A sample of 204 therapists (74% female; M_age = 36.74) completed an online survey with multiple-choice and open-ended questions on therapist demographics and experiences with clients endorsing attraction (including client disclosure, therapist emotional reaction, strategies for addressing, conceptualization, and supervision). 77% of respondents reported a cognitive-behavioral (CBT) theoretical orientation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>54% (<i>n</i> = 111) of respondents had a client express CATT, and anxiety was the most commonly reported emotional reaction. Qualitative results suggested that CATT was complex and multifaceted, that therapist and client identities played a key role in CATT, and that therapists often feel uncomfortable and/or unequipped to manage the situation. Therapist respondents reported using a variety of strategies to address the disclosure (e.g., normalization, setting boundaries). Supervision was reported to be useful, but at times insufficient.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The present research showed that CATT was a common clinical experience; yet therapists often feel anxious or unequipped to manage the situation. This study highlights the importance of clinical training on managing client attraction, especially from a CBT perspective. Directions for future research include further exploration of the intersection of client and therapist cultural and identity factors in the development and characteristics of CATT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":"81 7","pages":"595-608"},"PeriodicalIF":2.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanisms of Action of Combination Motivational Interviewing-Cognitive Behavior Therapy for Reversing Medication Non-Adherence in Patients With Multiple Sclerosis","authors":"Rachel Schoor,&nbsp;Jared M. Bruce,&nbsp;Vincent S. Staggs,&nbsp;Andrew T. Fox,&nbsp;Amanda Bruce,&nbsp;Sharon Lynch,&nbsp;Delwyn Catley","doi":"10.1002/jclp.23796","DOIUrl":"10.1002/jclp.23796","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Despite disease modifying therapies' (DMT) demonstrated efficacy for treating relapsing MS, around 40% of patients discontinue use. This study aimed to understand the mechanism of action of Motivational Interviewing plus cognitive behavioral therapy (MI-CBT) in a previously conducted randomized controlled trial in which the MI-CBT intervention successfully promoted DMT re-initiation of participants compared to a treatment as usual (TAU) condition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This secondary analysis (<i>N</i> = 91) explored changes in motivation (a single item motivation “ruler” [Mot∆], and the Brief Motivation Scale [BMS∆]), autonomous motivation (AR∆), personal control (PC∆), treatment control (TC∆), and confidence to reinitiate (Con∆) as potential mediators of the treatment effect, using logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Logistic regression analysis including all potential mediators as predictors of initiation indicated the BMS∆ was the only statistically significant predictor (<i>OR</i> = 1.61, <i>p</i> = 0.010). When BMS∆ was removed Mot∆ (<i>OR</i> = 1.22, <i>p</i> = 0.002) and PC∆ (<i>OR</i> = 1.67, <i>p</i> = 0.002) were statistically significant predictors of initiation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The MI-CBT intervention appeared to work primarily by increasing motivation to initiate DMT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15395,"journal":{"name":"Journal of Clinical Psychology","volume":"81 7","pages":"609-618"},"PeriodicalIF":2.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}