Clinical Psychology in Europe (E-Journal)
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Cultural Adaptation of Scalable Psychological Interventions: A New Conceptual Framework
No full textBackground: The worldwide mental health treatment gap calls for scaling-up psychological interventions, which requires effective implementation in diverse cultural settings. Evidence from the field of global mental health and cultural clinical psychology indicates cultural variation in how symptoms of common mental disorders are expressed, and how culturally diverse groups explain the emergence of such symptoms. An increasing number of studies have examined to what extent cultural adaptation enhances the acceptability and effectiveness of psychological interventions among culturally diverse groups. To date, this evidence is inconclusive, and there is a lack of studies that dismantle the multiple types of modifications involved in cultural adaptation.Method: Based on empirical evidence from ethnopsychological studies, cultural adaptation research, and psychotherapy research, the present paper offers a new conceptual framework for cultural adaptation that lays the groundwork for future empirical research.Results: The cultural adaptation framework encompasses three elements: i) cultural concepts of distress; ii) treatment components; and iii) treatment delivery. These three elements have been discussed in literature but rarely tested in methodologically rigorous studies. Innovative research designs are needed to empirically test the relevance of these adaptation elements, to better understand the substantial modifications that enhance acceptability and effectiveness of psychological interventions.Conclusion: Using a theory-driven approach and innovative experimental designs, research on cultural adaptation has the potential not only to make psychological treatments more accessible for culturally adverse groups, but also to further advance empirical research on the basic question about the “key ingredients” of psychotherapy
An Overview of the Evidence for Psychological Interventions for Psychosis: Results From Meta-Analyses
No full textBackground: There are numerous psychological approaches to psychosis that differ in focus, specificity and formats. These include psychodynamic, humanistic, cognitive-behavioural and third-wave-approaches, psychoeducation, various types of training-based approaches and family interventions.Method: We briefly describe the main aims and focus of each of these approaches, followed by a review of their evidence-base in regard to improvement in symptoms, relapse and functioning. We conducted a systematic search for meta-analyses dating to 2017 for each of the approaches reviewed. Where numerous meta-analyses for an approach were available, we selected the most recent, comprehensive and methodologically sound ones.Results: We found convincing short- and long-term evidence for cognitive behavioural approaches if the main aim is to reduce symptom distress. Evidence is also strong for psychoeducative family interventions that include skills training if the main aim is to reduce relapse and rehospitalisation. Acceptance and commitment therapy, mindfulness-based approaches, meta-cognitive and social skills training, as well as systemic family interventions, were also found to be efficacious, depending on the outcome of interest, but meta-analyses for these approaches were based on a comparatively lower number of outcome studies and a narrower selection of outcome measures. We found no convincing evidence for psychodynamic approaches, humanistic approaches or patient-directed psychoeducation (without including the family).Conclusions: An array of evidence-based psychological therapies is available for psychotic disorders from which clinicians and patients can choose, guided by the strength of the evidence and depending on the outcome area focused on. Increased effort is needed in terms of dissemination and implementation of these therapies into clinical practice
Further Specifying the Cognitive Model of Depression: Situational Expectations and Global Cognitions as Predictors of Depressive Symptoms
No full textObjectives: The cognitive model of depression assumes that depressive symptoms are influenced by dysfunctional cognitions. To further specify this model, the present study aimed to examine the influence of different types of cognitions on depressive symptoms, i.e., situational expectations and global cognitions. It was hypothesized that situational expectations predict depressive symptoms beyond global cognitions.Design: The present study examined a clinical (N = 91) and a healthy sample (N = 80) using longitudinal data with a baseline assessment and a follow-up five months later. Although the study was not designed as an interventional trial, participants from the clinical study received nonmanualized cognitive-behavioral treatment after the baseline assessment.Methods: We examined situational expectations, intermediate beliefs, dispositional optimism, and generalized expectancies for negative mood regulation as predictors of depressive symptoms. Hypotheses were tested using multiple hierarchical linear regression analyses.Results: Results indicate that, although there were significant correlations between the cognitive factors and depressive symptoms, in both samples neither global cognitions, nor situational expectations significantly predicted depressive symptoms at the five-month follow-up.Conclusions: The present study could, contrary to the hypotheses, not provide evidence for a significant impact of cognitive vulnerabilities on depressive symptoms, presumably due to high drop-out rates at follow-up. Limitations of the study and directions for future research are critically discussed
Developments in Psychotraumatology: A Conceptual, Biological, and Cultural Update
No full textBackground: This report discusses recent developments of psychotraumatology mainly related to the recently published ICD-11, but also from a societal point of view.Methods: The selected aspects of the development of this field will be presented as a scoping review.Results: In the first section, the new concept of disorders specifically associated with stress and its relevant diagnostic groups (posttraumatic stress disorder [PTSD], complex PTSD, prolonged grief disorder, and adjustment disorder) are presented, with an emphasis on PTSD. The second section embeds these diagnostic concepts within a broader context. In particular, the concept of psychotraumatology is applied to the impact of adverse childhood experiences. More specifically, recent scientific developments are discussed with respect to biological stress research. In a third section, a global perspective is applied that reflects psychotraumatology as embedded in culturally-specific concepts. Lastly, societal developments are taken into consideration. This section focusses on recent processes of victim acknowledgement and compensation taking place in Europe and beyond. Examples are provided for how traumatic stress is perceived and processed in society. Concepts such as continuous stress and historical trauma are also discussed.Conclusion: Demands and opportunities of basic research and psychological interventions with a global focus are outlined
Third Wave Treatments for Functional Somatic Syndromes and Health Anxiety Across the Age Span: A Narrative Review
No full textBackground: Functional disorders (FD) are present across the age span and are commonly encountered in somatic health care. Psychological therapies have proven effective, but mostly the effects are slight to moderate. The advent of third wave cognitive behavioural therapies launched an opportunity to potentially improve treatments for FD.Method: A narrative review of the literature on the application of mindfulness-based therapies (MBT) and Acceptance & Commitment Therapy (ACT) in children and adult populations with FD.Results: There were very few and mainly preliminary feasibility studies in children and adolescents. For adults there were relatively few trials of moderate to high methodological quality. Ten MBT randomised trials and 15 ACT randomised trials of which 8 were internet-delivered were identified for more detailed descriptive analysis. There was no evidence to suggest higher effects of third wave treatments as compared to CBT. For MBT, there seemed to be minor effects comparable to active control conditions. A few interventions combining second and third wave techniques found larger effects, but differences in outcomes, formats and dosage hamper comparability.Conclusions: Third wave treatments are getting established in treatment delivery and may contribute to existing treatments for FD. Future developments could further integrate second and third wave treatments across the age span. Elements unambiguously targeting specific illness beliefs and exposure should be included. The benefit of actively engaging close relatives in the treatment not only among younger age groups but also in adults, as well as the effect of more multimodal treatment programmes including active rehabilitation, needs to be further explored
Competences of Clinical Psychologists
No full textBackground: Politicians, societies, stakeholders, health care systems, patients, their relatives, their employers, and the general population need to know what they can expect from clinical psychologists. Even more, for our self-definition as a professional group, we should share a common understanding of the competence profile that characterises our qualifications. This understanding of the competence profile of clinical psychology leads directly to the content that should be taught in university curricula and postgraduate trainings for clinical psychology. The following discussion paper attempts to offer a general European framework for defining the competence profile of clinical psychologists.
Method: A group of European specialists developed this discussion paper under the umbrella of the European Association of Clinical Psychology and Psychological Treatment (EACLIPT). Representatives with different treatment orientations, of basic science and clinical applications, and from East to Western European countries, were part of the group.
Results: We present a list of competences that should be acquired during regular studies of psychology with a clinical specialisation. Additionally, further competences should be acquired either during studying, or during postgraduate trainings.
Conclusion: Clinical psychologists are experts in mental and behavioural disorders, their underlying psychological, social and neurobiological processes, corresponding assessments/diagnostic tools, and evidence-based psychological treatments. While we provide a list with all competences of clinical psychologists, we do not consider this proposal as a final list of criteria, but rather as a living discussion paper that could be updated regularly. Therefore, we invite our colleagues to contribute to this discussion, and to submit comments via email to the corresponding author
Towards Integration and Impact: Clinical Psychology Takes Action for Mental Health in Europe
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The Heterogeneity of National Regulations in Clinical Psychology and Psychological Treatment in Europe
No full textBackground: The Bologna Process was initiated to harmonize study processes and contents throughout Europe in order to facilitate communication and cross-border study exchange. However, when it comes to postgraduate education and practical work in clinical psychology, no such harmonization exists - there is still significant heterogeneity between European countries.Method: To initiate the section Politics and Education, we analysed the current situation in Europe with regard to national regulations on education, training and practice in clinical psychology and psychological treatment and give a brief summary on the status quo.Results: There are extensive differences across Europe regarding governmental and national regulations for psychologists in general, and clinical psychologists in particular. Whereas some countries have very detailed regulations including a description of reserved activities for clinical psychologists, others leave the profession widely unregulated. When it comes to psychological treatment, some countries define it as an independent activity allowed to be applied by different professions, others clearly restrict access to the profession of psychotherapists.Conclusion: A great diversity in national regulations and practical issues related to clinical psychology and psychological treatment exists across Europe. Our results underline the importance of the Politics and Education section in the journal Clinical Psychology in Europe in order to strengthen the development of an international perspective on clinical psychology
Psychoneuroendocrinology and Clinical Psychology
No full textBackground: Hormones impact on cognition, emotions, and behaviour. Given that mental disorders are defined by abnormalities in these very same domains, clinical psychologists may benefit from learning more about alterations in endocrine systems, how they can contribute to symptoms commonly experienced by patients, and how such knowledge may be put to use in clinical practice.
Method: The aim of the present scientific update was to provide a brief overview of endocrine research relevant to the aetiology, diagnostics, and treatment of mental disorders, including some of the latest studies in this area.
Results: Hormones appear to be intrinsic to the development and maintenance of mental disorders. Oxytocin is involved in social cognition and behaviour and as such may be relevant to mental disorders characterised by social deficits (e.g., autism spectrum disorder and schizophrenia). Stress and sex steroids exert demonstrable effects on mood and cognition. In patients with depression and anxiety disorders, initial attempts to lower/enhance such hormones have thus been undertaken within conventional therapies in order to improve outcomes. Finally, hunger and satiety hormones may be involved in the vicious circle of dysfunctional eating behaviours and weight loss/gain in anorexia or bulimia nervosa.
Conclusion: Three conclusions can be drawn from this review: First, endocrine research should be considered when patients and clinicians are developing multidimensional illness models together. Second, endocrine markers can complement conventional assessments to provide a more comprehensive account of a patient’s current state. Third, endocrine testing may guide treatment choices and inform the development of novel treatments
The Phenomenon of Treatment Dropout, Reasons and Moderators in Acceptance and Commitment Therapy and Other Active Treatments: A Meta-Analytic Review
No full textBackground: Treatment dropout is one of the most crucial issues that a therapist has to face on a daily basis. The negative effects of premature termination impact the client who is usually found to demonstrate poorer treatment outcomes. This meta-analysis reviewed and systematically examined dropout effects of Acceptance and Commitment Therapy (ACT) as compared to other active treatments. The goals of this study were to compare treatment dropout rates and dropout reasons, examine the influence of demographic variables and identify possible therapy moderators associated with dropout.
Method: The current meta-analysis reviewed 76 studies of ACT reporting dropout rates for various psychological and health-related conditions.
Results: Across reviewed studies (N = 76), the overall weighted mean dropout rate was 17.95% (ACT = 17.35% vs. comparison conditions = 18.62%). Type of disorder, recruitment setting and therapists’ experience level were significant moderators of dropout. The most frequently reported reasons for dropout from ACT were lost contact, personal and transportation difficulties, whereas for comparative treatments they were lost contact, therapy factors and time demands.
Conclusion: Given that most moderators of influence are not amenable to direct changes by clinicians, mediation variables should also be explored. Overall, results suggest that ACT appears to present some benefits in dropout rates for specific disorders, settings and therapists