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Autistic adolescents are at increased risk of developing mental health problems. Improving psychological well-being could reduce the likelihood of such problems developing. Research has tended to prioritise the voices of non-autistic people and has neglected to consult autistic young people themselves. Our meta-synthesis aimed to systematically review qualitative research on the perspectives of autistic young people and their parents on the lived experience of psychological well-being. We conducted a pre-planned systematic search which identified 2552 papers, with 37 of those meeting full inclusion criteria. Included papers were published between 2008 and 2023, with three-quarters published since 2018. We extracted qualitative data from each paper pertaining to the lived experience of psychological well-being in autistic young people and conducted a thematic synthesis. We identified three themes; Walking a tightrope: the need for growth versus recharging through rest and familiarity; Developing a positive sense of self in the social world; Internally driven sources of happiness. Psychological interventions aiming to improve well-being in autistic young people should respect their autonomy and need for rest whilst encouraging growth and skills development, provide opportunities to understand social needs and differences, and promote opportunities to enjoy special interests. • A systematic review of the lived experience of well-being in autistic adolescents. • 37 papers published between 2008 and 2023 were included in a thematic synthesis. • Results give new insights into factors contributing to psychological well-being. • Psychological interventions should be designed based on lived experience. [ABSTRACT FROM AUTHOR]

Many youth experience mental health problems and digital games hold potential as mental health interventions. This systematic review provides an overview of randomised controlled studies assessing the effectiveness of digital applied and casual games for improving mental health in youth aged 6–24 years. A systematic search of PsycINFO, Web of Science and Pubmed yielded 145 eligible studies. Studies on (sub)clinical participant samples (n = 75) most often focused on attention-deficit/hyperactivity disorder (ADHD), autism and anxiety. Applied games were found most effective for improving social skills, verbal memory and anxiety, whereas casual games were found most effective for improving depression, anxiety and ADHD. Studies involving healthy youth (n = 70) were grouped into papers examining anxiety in medical settings, momentary effects on positive and negative affect, and papers employing a longitudinal design measuring mental health trait outcomes. Promising results were found for the use of games as distraction tools in medical settings, and for applied and casual games for improving momentary affect. Overall, our findings demonstrate the potential of digital games for improving mental health. Implications and recommendations for future research are discussed, such as developing evaluation guidelines, clearly defining applied games, harmonising outcome measures, including positive outcomes, and examining nonspecific factors that may influence symptom improvement as well. • This review included 145 randomised controlled studies on applied and casual games for youth mental health. • In clinical samples, games were effective for social skills, verbal memory, anxiety, depression and ADHD. • In healthy samples, games were promising in medical settings and for improving affect. • Future work on harmonising outcome measures, positive outcomes and nonspecific factors is needed. [ABSTRACT FROM AUTHOR]

Mental health problems affect people with intellectual disabilities (ID) at rates similar to or in excess of the non-ID population. People with severe ID are likely to have persistent mental health problems. In this systematic review (PROSPERO 2015:CRD42015024469), we identify and evaluate the methodological quality of available measures of mental health problems or well-being in individuals with severe or profound ID. Electronic searches of ten databases identified relevant publications. Two reviewers independently reviewed titles and abstracts of retrieved records (n = 41,232) and full-text articles (n = 573). Data were extracted and the quality of included papers was appraised. Thirty-two papers reporting on 12 measures were included. Nine measures addressed a broad spectrum of mental health problems, and were largely observational. One physiological measure of well-being was included. The Aberrant Behavior Checklist, Diagnostic Assessment for the Severely Handicapped Scale-II and Mood, Interest and Pleasure Questionnaire are reliable measures in this population. However, the psychometric properties of six other measures were only considered within a single study – indicating a lack of research replication. Few mental health measures are available for people with severe or profound ID, particularly lacking are tools measuring well-being. Assessment methods that do not rely on proxy reports should be explored further. [ABSTRACT FROM AUTHOR]

Coherence in the science and practice of mental health assessment depends upon a tight connection between psychopathology concepts that are used and the way those concepts are operationalized and defined. In contrast, the use of the same word to mean more than one thing contributes to incoherence, inefficiency, and confusion. In this paper, we review three possible meanings of the word "dimension" as it relates to the assessment of psychopathology and describe how the indiscriminate use of this word has caused confusion in the general context of the transition to a more evidence-based approach to mental health diagnosis. We attempt to disambiguate the term "dimension" by demarcating three concepts that can be distinguished based on different empirical standards: continuous variables, unidimensional dimensions, and distinct dimensions. • The word dimension is used to mean different things in the psychopathology literature • This has contributed to confusion and has slowed progress in advancing towards evidence-based diagnosis • We distinguish three meanings of dimension: 1) continuous, 2) homogeneous, and 3) distinct • We offer a framework for establishing dimensionality and discuss implications for clinical research [ABSTRACT FROM AUTHOR]

The patterns of long-term psychological response after disasters and pandemics remain unclear. We aimed to determine the trajectories for post-traumatic stress symptoms (PTSS), depression and anxiety prevalence following disasters and pandemic exposure; and identify associated risk and protective factors. A systematic review of the English, Chinese, and Japanese longitudinal mental health literature was conducted. We searched Cochrane, MEDLINE, ProQuest, PsycINFO, PubMed, Web of Science, and CINAHL (English), CNKI and SINOMED (Chinese) and CiNii (Japanese) for studies published between January 2000 and May 2022. Following a pre-specified protocol (PROSPERO: CRD42020206424), conditional linear growth curve models and ANOVA analyses were conducted. The search identified 77,891 papers, with a final sample of 234: 206 English, 24 Chinese, and 4 Japanese-language papers. PTSS rates improved for all ages (p =.018, eta2 = 0.035). In contrast, depression and anxiety prevalence remained elevated for years following exposure (p =.424, eta2 = 0.019 and p =.051, eta2 = 0.064, respectively), with significantly higher rates for children and adolescents (p <.005, eta2 > 0.056). Earthquakes and pandemics were associated with higher prevalence of PTSS (p <.019, eta2 > 0.019). Multi-level risk and protective factors were identified. The chronicity of mental health outcomes highlights a critical need for tailored, sustainable mental health services, particularly for children and adolescents, in disaster- and pandemic-affected settings. • Trajectories of psychological recovery after disasters and pandemics varied by disorder, age and disaster type. • The prevalence of post-traumatic stress symptoms improved over time for all ages. • Depression and anxiety remained elevated for years following disasters and pandemics. • Children reported significantly higher depressive and anxiety symptoms than adults after disasters. • Earthquakes and pandemics were associated with higher rates of PTSS and anxiety. [ABSTRACT FROM AUTHOR]

Over 60 years of research reveal that informants who observe youth in clinically relevant contexts (e.g., home, school)—typically parents, teachers, and youth clients themselves—often hold discrepant views about that client's needs for mental health services (i.e., informant discrepancies). The last 10 years of research reveal that these discrepancies reflect the reality that (a) youth clients' needs may vary within and across contexts and (b) informants may vary in their expertise for observing youth clients within specific contexts. Accordingly, collecting and interpreting multi-informant data comprise "best practices" in research and clinical care. Yet, professionals across settings (e.g., health, mental health, school) vary in their use of multi-informant data. Specifically, professionals differ in how or to what degree they leverage multi-informant data to determine the goals of services designed to meet youth clients' needs. Further, even when professionals have access to multiple informants' reports, their clinical decisions often signal reliance on one informant's report, thereby omitting reports from other informants. Together, these issues highlight an understudied research-to-practice gap that limits the quality of services for youth. We advance a framework—the Needs-to-Goals Gap —to characterize the role of informant discrepancies in identifying youth clients' needs and the goals of services to meet those needs. This framework connects the utility of multi-informant data with the reality that services often target an array of needs within and across contexts, and that making decisions without accurately integrating multiple informants' reports may result in suboptimal care. We review evidence supporting the framework and outline directions for future research. • Service professionals assess youth mental health using multiple informants. • Multiple informants' reports commonly result in discrepant outcomes. • This paper describes the Needs-to-Goals Gap framework. • This paper links work on informant discrepancies to implementation science. • The framework describes how informant discrepancies impact individual clients. [ABSTRACT FROM AUTHOR]

Abstract: This paper systematically reviews the relationship between personal unsecured debt and health. Psychinfo, Embase and Medline were searched and 52 papers were accepted. A hand and cited-by search produced an additional 13 references leading to 65 papers in total. Panel surveys, nationally representative epidemiological surveys and psychological autopsy studies have examined the relationship, as have studies on specific populations such as university students, debt management clients and older adults. Most studies examined relationships with mental health and depression in particular. Studies of physical health have also shown a relationship with self-rated health and outcomes such as obesity. There is also a strong relationship with suicide completion, and relationships with drug and alcohol abuse. The majority of studies found that more severe debt is related to worse health; however causality is hard to establish. A meta-analysis of pooled odds ratios showed a significant relationship between debt and mental disorder (OR=3.24), depression (OR=2.77), suicide completion (OR=7.9), suicide completion or attempt (OR=5.76), problem drinking (OR=2.68), drug dependence (OR=8.57), neurotic disorder (OR=3.21) and psychotic disorders (OR=4.03). There was no significant relationship with smoking (OR=1.35, p>.05). Future longitudinal research is needed to determine causality and establish potential mechanisms and mediators of the relationship. [Copyright &y& Elsevier]

Abstract: Recent military operations in Afghanistan and Iraq have involved multiple deployments and significant combat exposure, resulting in high rates of mental health problems. However, rates of treatment-seeking among military personnel are relatively low, and the military environment poses several obstacles to engaging in effective clinical interventions. The current paper first reviews barriers and facilitators of treatment-seeking and engagement among military personnel, including stigma, practical barriers, perceptions of mental health problems, and attitudes towards treatment. Next, this paper reviews treatment adaptations and other interventions that are intended to reduce barriers to care among active duty and returning military personnel. These include early interventions, brief formats, integrating clinicians into the medical and military context, technology-based interventions, addressing negative treatment perceptions, screening/early identification, and enlisting unit support. [Copyright &y& Elsevier]

Abstract: A large amount of studies and literature reviews on the consequences of child sexual abuse has appeared over the past twenty years. To prevent that the inconsistency in their conclusions along with their methodological differences and limitations may create interpretative difficulties, mistaken beliefs, or confusion among all professionals who turn to this literature for guidance, this paper addresses the best available scientific evidence on the topic, by providing a systematic review of the several reviews that have investigated the literature on the effects of child sexual abuse. Seven databases were searched, supplemented with hand-search of reference lists from retrieved papers. The author and a psychiatrist independently evaluated the eligibility of all studies identified, abstracted data, and assessed study quality. Disagreements were resolved by consensus. Fourteen reviews, including more than 270,000 subjects from 587 studies, were analyzed. There is evidence that survivors of childhood sexual abuse are significantly at risk of a wide range of medical, psychological, behavioral, and sexual disorders. Relationships are small to medium in magnitudes and moderated by sample source and size. Child sexual abuse should be considered as a general, nonspecific risk factor for psychopathology. The implications for research, treatment, and health policy are discussed. [Copyright &y& Elsevier]

Abstract: Exposure to potentially traumatic events is a common occurrence. Most individuals exposed to such an event are resilient or recover rapidly, although some individuals develop psychological problems that warrant treatment. However, a small percentage of individuals seek traditional treatment, thereby calling for novel approaches or methodologies of treatment. The present paper provides a comprehensive and critical review of the extant literature on computerized and internet-based interventions (IBIs) for traumatic stress-related conditions (i.e., panic disorder, posttraumatic stress disorder/complicated grief, depression, comorbid anxiety and depression, alcohol abuse, smoking cessation). Generally, computerized or IBIs for depression and anxiety are yielding effect sizes that are comparable to traditional psychosocial treatment. Interventions aimed at alcohol and smoking cessation generally have lower effect sizes than do IBIs for anxiety and depression. Most interventions reviewed in this paper included common components (e.g., were developed through a cognitive behavioral framework and included psychoeducation, cognitive restructuring, goal setting, exposure). Therefore, it is possible that these shared features may in part account for symptom reduction. Little is known regarding mechanisms of change. Future directions for novel web-based approaches to treatment are provided. [Copyright &y& Elsevier]

Abstract: This special issue is devoted to the topic of medically unexplained symptoms (MUS), a heterogeneous group of conditions characterized by persistent physical symptoms that cannot be explained by medical illness or injury. Although psychological factors have long been regarded as central to these problems, patients with MUS have typically been managed within medical settings and referrals to mental health services have been relatively rare. In recent years, however, interest in the psychological nature and treatment of MUS has expanded, culminating in the development of tailored psychological interventions for these conditions. This, coupled with the increasing willingness of practitioners to diagnose conditions such as chronic fatigue syndrome, fibromyalgia and irritable bowel syndrome, has led to an increase in the number of patients who are referred for psychological treatment. At present, however, many psychological therapists are unfamiliar with the literature on MUS. With this in mind, this special issue presents a series of papers that provide an overview of what is known about the nature, aetiology and treatment of medically unexplained illness. This introductory paper provides general information about the clinical presentation, diagnosis, classification, terminology and epidemiology of MUS in adults, and concludes with an examination of important areas for future development in the field. Subsequent papers address the psychological mechanisms [Deary, V., Chalder, T., & Sharpe, M. (2007-this issue). The cognitive behavioural model of medically unexplained symptoms: A theoretical and empirical review. Clinical Psychology Review; Iverson, A., Chalder, T., & Wessely, S. (2007-this issue). Gulf war illness: Lessons from medically unexplained illness. Clinical Psychology Review; Rief, W., & Broadbent, E. (2007-this issue). Explaining medically unexplained symptoms: Models and mechanisms. Clinical Psychology Review; Roelofs, K., & Spinhoven, P. (2007-this issue). Trauma and medically unexplained symptoms: Towards an integration of cognitive and neuro-biological accounts. Clinical Psychology Review] and management [Deary, V., Chalder, T., & Sharpe, M. (2007-this issue). The cognitive behavioural model of medically unexplained symptoms: A theoretical and empirical review. Clinical Psychology Review] of these conditions. A separate overview of the literature on MUS in children and adolescents is provided by Eminson [Eminson, J. (2007-this issue). Medically unexplained symptoms in children and adolescents. Clinical Psychology Review]. [Copyright &y& Elsevier]

This paper explores the complex interplay between stressors and marital functioning, beginning with a discussion of how key concepts from the stress and coping literature can be extended to the study of dyads. Five essential questions are outlined as a means of advancing research in this domain, addressing protective dyadic processes, the competing demands of individual and dyadic coping agendas, the role of individual well-being in couples'' stress and coping, stress in the broader context of couples'' lives, and prospects for intervention. Following an overview of methodological and procedural challenges, the paper concludes by noting that research devoted to understanding marriages in the context of stress is at a crossroads, poised between a set of provocative questions, preliminary findings, and intervention possibilities on one hand, and important theoretical and empirical challenges on the other. [Copyright &y& Elsevier]

Disturbances in affect recognition may be one of the most pervasive and serious aspects of the schizophrenic patient''s interpersonal problems. Interest in the decoding of emotional information in schizophrenia has focused on facial affect recognition with 29 experimental papers on that topic published since 1987. A smaller literature exists on the topic of recognition of affect in speech and there are at least seven studies, which have examined both face and voice perception in the same individuals with schizophrenia. This paper includes a comprehensive analysis of the schizophrenia facial affect recognition research over the past decade and the schizophrenia literature on affective prosody, and provides the first review of the schizophrenia literature on multichannel emotion recognition research. The weight of evidence would suggest that individuals with schizophrenia experience problems in the perception of emotional material; however, the specificity, extent, and nature of the deficits are unclear. Emotion recognition research in schizophrenia should be informed by the general literature on emotion recognition with serious attention paid to methodological issues. [Copyright &y& Elsevier]

Family carers of people who have long term illness often experience physical and mental health morbidities, and burden. While there is good evidence to suggest that carers benefit from psychosocial interventions, these have primarily been delivered via face-to-face individual or group-formats. eHealth interventions offer a novel, accessible and self-paced approach to care delivery. Whether these are effective for carers' wellbeing has been little explored. This paper reports the first comprehensive systematic review in this area. A total of 78 studies, describing 62 discrete interventions, were identified. Interventions commonly aimed to promote carers' knowledge, self-efficacy, caregiving appraisal, and reduce global health morbidities. Interventions were offered to carers of people with a wide range of long term illness; dementia has been the most researched area, as reported in 40% of studies. Clinical and methodological heterogeneity in interventions precluded meta-analyses, and so data were analysed narratively. The most popular approach has comprised psychoeducational interventions delivered via an enriched online environment with supplementary modes of communication, such as network support with professionals and peers. Overall, carers appreciate the flexibility and self-paced nature of eHealth interventions, with high rates of satisfaction and acceptability. More studies using robust designs are needed to extend the evidence base. [ABSTRACT FROM AUTHOR]

The person-centred typological approach to personality makes the distinction between overcontrolled and undercontrolled personality types. This review systematically searched for research on the utility of these personality types in adult mental health. A total of 43 papers were included, which were divided broadly into cross-sectional studies, longitudinal studies and studies with clinical populations. Three personality types have been largely replicated in both normal and clinical populations: resilients, overcontrollers and undercontrollers. These types show utility in predicting long-term functioning and mental health, understanding heterogeneous personalities within clinical subgroups and have implications for treatment. Some disagreement on the number of personality types deemed replicable across samples and differing methodologies do exist, with some finding a dimensional approach to personality to have greater predictive utility. These personality types have been shown to be important in a number of mental health problems such as eating disorders, which may prove helpful in developing new psychological interventions. These studies point to the importance of overcontrolled personality types as well as undercontrolled in mental health. More research is needed with a greater range of clinical populations. [ABSTRACT FROM AUTHOR]

Gender dysphoria is distress due to a discrepancy between one's assigned gender and gender identity. Adults who wish to access gender clinics are assessed to ensure they meet the diagnostic criteria for gender dysphoria. Therefore, the definition of gender dysphoria has a significant impact on the lives of individuals who wish to undergo physical gender transition. This systematic review aimed to identify and synthesize all existing qualitative research literature about the lived experience of gender dysphoria in adults. A pre-planned systematic search identified 1491 papers, with 20 of those meeting full inclusion criteria, and a quality assessment of each paper was conducted. Data pertaining to the lived experience of gender dysphoria were extracted from each paper and a meta-ethnographic synthesis was conducted. Four overarching concepts were identified; distress due to dissonance of assigned and experienced gender; interface of assigned gender, gender identity and society; social consequences of gender identity; internal processing of rejection, and transphobia. A key finding was the reciprocal relationship between an individual's feelings about their gender and societal responses to transgender people. Other subthemes contributing to distress were misgendering, mismatch between gender identity and societal expectations, and hypervigilance for transphobia. • A systematic review of all papers on the lived experience of gender dysphoria • Twenty papers with 1606 participants were included in a meta-ethnographic synthesis. • Distress was due to gender and sex incongruence, as well as social factors. • Results give new insights into the relationships between factors causing distress. [ABSTRACT FROM AUTHOR]

As a field, mental healthcare is faced with major challenges as it attempts to close the huge gap between those who need services and those who receive services. In recent decades, technological advances have provided exciting new resources in this battle. Socially assistive robotics (SAR) is a particularly promising area that has expanded into several exciting mental healthcare applications. Indeed, a growing literature highlights the variety of clinically relevant functions that these robots can serve, from companion to therapeutic play partner. This paper reviews the ways that SAR have already been used in mental health service and research and discusses ways that these applications can be expanded. We also outline the challenges and limitations associated with further integrating SAR into mental healthcare. SAR is not proposed as a replacement for specially trained and knowledgeable professionals nor is it seen as a panacea for all mental healthcare needs. Instead, robots can serve as clinical tools and assistants in a wide range of settings. Given the dramatic growth in this area, now is a critical moment for individuals in the mental healthcare community to become engaged in this research and steer it toward our field's most pressing clinical needs. [ABSTRACT FROM AUTHOR]

Abstract: There is growing evidence that mindfulness and acceptance-based interventions have positive consequences for psychological and physical health. The most well-established of these interventions typically involve relatively large resource commitments, in terms of both the provider and participant. A number of recent studies have begun to explore whether the benefits of such interventions can be generalised to less intensive methods. Methods include pure and guided self-help utilising resources such as books and workbooks, computer programmes and applications and audio-visual materials. This paper presents a systematic review and meta-analysis of studies that have evaluated the effectiveness and acceptability of low-intensity interventions including mindfulness and acceptance-based components. Fifteen RCTs (7 ACT-based, 4 mindfulness-based and 4 multi-component interventions including elements of mindfulness and/or acceptance) were identified and reviewed. Interventions that included mindfulness and/or acceptance-based components produced significant benefits in comparison to control conditions on measures of mindfulness/acceptance, depression and anxiety with small to medium effect sizes. Engagement with the self-help interventions varied but on average two-thirds of participants completed post-intervention measures. Emerging research into low-intensity mindfulness and acceptance-based interventions is hopeful. Recommendations for research and practice are presented. [Copyright &y& Elsevier]

Abstract: Obsessive–compulsive disorder (OCD) is a disabling mental health condition. Despite effective psychological treatments for OCD, a significant percentage of patients fail to experience lasting benefit. Factors underlying variable treatment response are poorly understood. Moderators of outcome can help understand “for whom” and “under what circumstances” an intervention works best and thus improve service effectiveness. This paper synthesizes the evidence on predictors and moderators and assesses the quality of reporting of related analyses in psychological therapies for adults with OCD. Trials were identified through electronic searches (CENTRAL, MEDLINE, PsycINFO, EMBASE), key author, and reference list searches of relevant systematic reviews. Fifty five percent (38/69) of relevant trials reported baseline factors associated with outcome; these encompassed clinical, demographic, interpersonal, OCD symptom-specific, psychological/psychosocial, and treatment-specific variables. Predictors were commonly assessed via a validated pre-randomization measure, though few trials adopted best practice by stating a priori hypotheses or conducting a test of interaction. Potential associations emerged between worse OCD treatment outcome and the following factors: hoarding pathology, increased anxiety and OCD symptom severity, certain OCD symptom subtypes, unemployment, and being single/not married. However, the applied utility of these analyses is currently limited by methodological weaknesses. [Copyright &y& Elsevier]

Abstract: The present paper reviews the literature that has assessed the psychological impact of political violence on children. Concern for those growing up in situations of political violence has resulted in two areas of research within psychology: the first considers children as victims of conflict and considers the mental health consequences of political violence. The second considers children as protagonists or aggressors in conflict and considers related moral and attitudinal consequences of exposure to political violence. These two literatures are most often considered separately. Here the two strands of research are brought together using a social identity framework, allowing apparently divergent findings to be integrated into a more coherent understanding of the totality of consequences for children and young people growing up in situations of armed conflict. [Copyright &y& Elsevier]

Abstract: Research has demonstrated an association between intimate partner abuse and suicidality, presenting a serious mental health issue. However, studies have differed widely in the samples and methods employed, and in the depth of the investigation. Given the level of heterogeneity in the literature, this systematic review examines, for the first time, the nature of the relationship between intimate partner abuse and suicidality. The three main psychological and medical databases (PsychInfo 1887—March 2011; Medline, 1966—March 2011; Web of Knowledge 1981—March 2011) were searched. Thirty-seven papers on the topic of intimate partner abuse and suicidality were found. With only one exception, all of the studies found a strong and consistent association between intimate partner abuse and suicidality. Significantly, this relationship held irrespective of study design, sample and measurement of abuse and suicidality, thus demonstrating a consistently strong relationship between intimate partner abuse and suicidality. This review highlights that intimate partner abuse is a significant risk factor for suicidal thoughts and behaviours, which has important clinical implications. [Copyright &y& Elsevier]

Abstract: Although the bulk of the research literature on the construct of perfectionism and its relationship to mental health in the last 20years has focused predominantly on Caucasian American samples, researchers are paying increasing attention to understanding perfectionism''s dimensions across ethnicities. Given this momentum, the purpose of this paper is to use a cross-cultural framework to review published studies assessing perfectionism in members of an ethnic minority group living in the United States. Research to date has focused exclusively on Asian and African American samples and we organize our review by separating this literature into those studies that use level and structure-oriented cross-cultural approaches. Structure-oriented approaches empirically explore the phenomenology and/or correlates of perfectionism within each ethnic group whereas level-oriented approaches examine the relative magnitude of perfectionism''s levels across groups. The last section of the review critically examines the strength of the evidence in support of researchers’ arguments that certain sociocultural factors, such as collectivism and parenting style, influence perfectionism''s expression and implications for ethnic minorities. Throughout the review, we offer a series of steps researchers can take to foster our understanding of perfectionism and its impacts using a cross-cultural perspective. [Copyright &y& Elsevier]

Abstract: This paper reviews empirical evidence of the association between suicide-related behaviors and anxiety among children and adolescents. It begins with a review of suicide-related behaviors and anxiety, discusses methodological issues related to measurement, and reviews empirical findings published since the last review of this topic in 1988. Evidence is summarized on four criteria necessary to establish anxiety as a causal risk factor for suicide-related behaviors among children and adolescents. There is consistent evidence for a significant association between anxiety and suicide-related behaviors (Criterion 1). Evidence that the influence of anxiety on suicide-related behaviors is not due to a third variable (Criterion 2) is mixed and hindered by methodological limitations. The literature is also unclear as to whether anxiety temporally precedes suicide-related behaviors (Criterion 3). Finally, this review found no evidence to support or refute anxiety''s stability independent of and across instances of suicide-related behaviors (Criterion 4). Theoretical and clinical implications of these findings and directions for future research are discussed. [Copyright &y& Elsevier]

Abstract: The introduction of “dual diagnosis” had the merit of drawing attention on substance use among patients with mental illness. In due course, as what often happens with innovations, the concept of dual diagnosis displayed considerable limitations and was progressively replaced by comorbidity. This paper critically reviews the limitations of dual diagnosis and comorbidity and formulates an alternative proposal based on clinimetric methods. In many instances of diagnostic reasoning in psychiatry and in clinical psychology, the process ends with the identification of the disorders and their diagnoses. However, diagnostic end-points, the customary guidance of diagnostic reasoning, should be replaced by the conceptualization of disorders as “transfer stations,” which are amenable to longitudinal verification and modification. Indeed, diagnoses might encompass a wide range of manifestations, seriousness, prognosis, and response to treatment that need to be evaluated. A new clinimetric approach which takes advantage of clinimetric methods (including macro-analysis, micro-analysis, staging, and evaluation of subclinical symptoms) is proposed. This approach may allow an accurate analysis of the different problem areas of each patient and their hierarchical organization and may yield important implications for mental health and substance abuse clinics. [Copyright &y& Elsevier]

Abstract: Several models have been proposed to conceptualize psychological representations of health, illness, and bodily sensations. These models differ as to the cognitive and affective components they include, whether they study the interaction of these components, and whether associations between psychological representations of bodily states and affective and behavioral reactions to these representations are considered conditional. These different conceptualizations and corresponding measurement approaches exist in parallel without resulting in synergistic effects or theoretical advancements within the field. In this paper, we review theoretical models on perception and attitudes and construct an integrative theoretical framework on psychological representation of bodily symptoms as well as more abstract representations of health and disease. The aim of this combination of approaches is to unify the strengths of different research domains in the conceptualization and measurement of mental representations of bodily states. Furthermore, the aim is to specify new, testable predictions and implications about the (conditional) relationship of these mental representations and affective and behavioral consequences. A core element in this integrative model is comparison. We review how comparison processes can change the cognitive and affective reference frame for illness and symptom perception and in turn affective and behavioral reactions. We discuss implications for measurement of illness and symptom representations as well as implications for clinical practice. Finally, we make suggestions for a research agenda to validate the proposed model as well as to address new questions derived from it. [Copyright &y& Elsevier]

Abstract: Although affective and substance use disorders frequently co-occur, the role of affective dysregulation in addiction is often overlooked. This paper reviews the role of affective dysregulation in the initiation and maintenance of substance use disorders (SUDs), presenting evidence for a relationship between SUD and three biologically-based dimensions of affective temperament and behaviour: negative affect (NA), positive affect (PA), and effortful control (EC). High NA, low EC, and both high and low PA were each found to play a role in conferring risk and maintaining substance use behaviours, although the strength of their influence differed depending on stage of illness (i.e., early onset use through to addiction). Given these findings, we argue that future research should explicitly consider how changes within affective systems may underlie the development of SUDs. A better understanding of the role of affective dysregulation in addiction will aid in clarifying how risk is conferred, as well as how addictive behaviours are maintained, thereby informing the development of preventative strategies and novel treatments. Future studies should continue to examine the role of high NA in SUDs, and further examine the respective roles of high PA, low PA, and low EC, as well as identifying the affective characteristics that predispose high-risk individuals to later substance use problems. [Copyright &y& Elsevier]

Abstract: Traditionally, positive emotions and thoughts, strengths, and the satisfaction of basic psychological needs for belonging, competence, and autonomy have been seen as the cornerstones of psychological health. Without disputing their importance, these foci fail to capture many of the fluctuating, conflicting forces that are readily apparent when people navigate the environment and social world. In this paper, we review literature to offer evidence for the prominence of psychological flexibility in understanding psychological health. Thus far, the importance of psychological flexibility has been obscured by the isolation and disconnection of research conducted on this topic. Psychological flexibility spans a wide range of human abilities to: recognize and adapt to various situational demands; shift mindsets or behavioral repertoires when these strategies compromise personal or social functioning; maintain balance among important life domains; and be aware, open, and committed to behaviors that are congruent with deeply held values. In many forms of psychopathology, these flexibility processes are absent. In hopes of creating a more coherent understanding, we synthesize work in emotion regulation, mindfulness and acceptance, social and personality psychology, and neuropsychology. Basic research findings provide insight into the nature, correlates, and consequences of psychological flexibility and applied research provides details on promising interventions. Throughout, we emphasize dynamic approaches that might capture this fluid construct in the real-world. [Copyright &y& Elsevier]

Abstract: Clinical psychology is in a unique position to move beyond a simplistic agenda of outcome assessment to translating that information into a sustainable model of evidence-based practice. The scientist–practitioner model is no longer limited to use of evidence-based treatments in practice, but can extend to using innovative methodologies to assess rates of recovery, monitor patient progress, intervene in the face of poor response, and contribute to the benchmarking of risk-adjusted outcomes. As the scientific conversation about outcomes moves to encompass feedback of information in order to refine management and practice; researchers, policy-makers, clinicians and patients are poised to look further than average group effects. A new emphasis on individual outcome, taking account of clinical characteristics and risk variables, has generated a clinical outcomes agenda that may be directly translated from “bench to bedside”. The current paper addresses the status of evidence-based treatments, measurement of change, patient-focused research and the public availability of risk-adjusted outcomes data; as well as challenges that remain. [Copyright &y& Elsevier]

Abstract: Children exhibiting sexual behavior have increasingly gained the attention of child welfare and mental health systems, as well as the scientific community. While a heterogeneous group, children with sexual behavior problems consistently demonstrate a number of problems related to adjustment and overall development. In order to appropriately intervene with these children, a comprehensive understanding of etiology is imperative. The overarching goal of the present paper is to review the extant research on mechanisms associated with the development of problematic sexual behavior in childhood within a developmental psychopathology framework. What is known about normative and nonnormative sexual behavior in childhood is reviewed, highlighting definitional challenges and age-related developmental differences. Further, the relationship between child sexual abuse and child sexual behavior problems is discussed, drawing attention to factors impacting this relationship. Risk factors for child sexual behavior problems, beyond that of sexual abuse, are also reviewed utilizing a transactional–ecological framework. Finally, we conclude with a discussion of implications of a developmental psychopathology perspective on problematic child sexual behaviors to inform future research and intervention efforts. Such implications include the need for attention to normative childhood sexual behavior, developmental sensitivity, and examinations of ecological domain in concert. [Copyright &y& Elsevier]

Abstract: Outcomes in depression treatment research include both changes in symptom severity and functional impairment. Symptom measures tend to be the standard outcome but we argue that there are benefits to considering functional outcomes. An exhaustive literature review shows that the relationship between symptoms and functioning remains unexpectedly weak and often bidirectional. Changes in functioning often lag symptom changes. As a result, functional outcomes might offer depression researchers more critical feedback and better guidance when studying depression treatment outcomes. The paper presents a case for the necessity of both functional and symptom outcomes in depression treatment research by addressing three aims—1) review the research relating symptoms and functioning, 2) provide a rationale for measuring both outcomes, and 3) discuss potential artifacts in measuring functional outcomes. The three aims are supported by an empirical review of the treatment outcome and epidemiological literatures. [Copyright &y& Elsevier]

Abstract: The self-help treatment (SHT) studies for other psychological problems significantly outweigh those for problem gambling. Currently, very little is published about the application and efficacy of various forms of SHTs for problem gambling. Thus, this paper reviews the self-help literature (using the PsycINFO database — all years up to April 2008) to stimulate further research in this area for problem gambling. The findings show that SHTs in problem gambling are still in their infancy. Although the problem gambling literature has mainly reported on two forms of SHTs with problem gamblers (i.e. use of self-help manuals and audiotapes), the review discuss utilizing a wide range of SHTs with problem gamblers. These include written materials (e.g. self-help books and treatment manuals), audiotapes, videotapes, computer-based SHTs implemented on palmtop computers, desktop computers, via telephone (Interactive Voice Response systems — IVR) or via the Internet and virtual reality applications. These SHTs would suit those problem gamblers who are not accessing professional treatment due to shame, guilt, fear of stigma, privacy concerns or financial difficulties, as well as those living in rural areas or with less severe gambling problems. The review also suggest future protocols for conducting further research in this area with problem gamblers, highlighting a need for a cohesive theory to guide research. [Copyright &y& Elsevier]

Abstract: Recognition of ethnic/racial disparities in mental health services has not directly resulted in the development of culturally responsive psychosocial interventions. There remains a fundamental need for assessment of sociocultural issues that have been linked with the expectations, needs, and goals of culturally diverse consumers with severe and persistent mental illness. The authors posit that embedding the assessment of sociocultural issues into psychosocial rehabilitation practice is one step in designing culturally relevant empirically supported practices. It becomes a foundation on which practitioners can examine the relevance of their interventions to the diversity encountered in everyday practice. This paper provides an overview of the need for culturally and clinically relevant assessment practices and asserts that by improving the assessment of sociocultural issues the clinical competence of service providers is enhanced. The authors offer a conceptual framework for linking clinical assessment of sociocultural issues to consumer outcomes and introduce an assessment tool adapted to facilitate the process in psychosocial rehabilitation settings. Emphasizing competent clinical assessment skills will ultimately offer a strategy to address disparities in treatment outcomes for understudied populations of culturally diverse consumers with severe and persistent mental illness. [Copyright &y& Elsevier]

Abstract: Borderline Personality Disorder (BPD) has long been considered a mental health problem that results in considerable costs in terms of human suffering and psychiatric expenses among adult patients. Although the diagnosis of BPD for adolescents is frequently used in clinical settings, the field of mental health has questioned whether one should diagnose BPD among adolescents. This paper reviews the recent empirical literature (identified through PsycINFO 1980 to present) to evaluate prevalence, reliability, and validity of a BPD diagnosis in adolescents. It is concluded that the features BPD diagnoses in adolescents are comparable to those in adults. Furthermore, there appears to be a legitimate subgroup of adolescents for whom the diagnosis remains stable over time as well as a less severe subgroup that moves in and out of the diagnosis. While caution is warranted, formal assessment of BPD in adolescents may yield more accurate and effective treatment for adolescents experiencing BPD symptomatology. More longitudinal research is necessary to further explicate the issues of diagnosing BPD in adolescents. [Copyright &y& Elsevier]

Abstract: Posttraumatic nightmares (PTNMs) are a highly prevalent and distressing symptom of posttraumatic stress disorder (PTSD), yet have been subject to limited phenomenological investigation. As a result, the parameters of the symptom required to meet diagnostic criterion for PTSD are unclear and their relationship with normal dreams following trauma is not known. A categorical distinction between PTNMs and normal dreams has been assumed, explicitly within dreaming theories and perhaps implicitly within the PTSD field, but lacks empirical support. This paper reviews the current understanding of PTNMs and normal dreams following trauma within the PTSD and dreaming fields respectively. It is argued that models of PTSD can readily account for repetitive PTNMs that accurately replay the traumatic event, but not those that are symbolic of the traumatic event. On the other hand, theories of dreaming that propose a psychologically adaptive function of dreams can account for both replay and symbolic nightmares that evolve over time, but not those that are stuck in repetition. It is concluded that there is no adequate explanation for the range of dreams following trauma including the PTNM of PTSD that is both symbolic and repetitive. Three alternate explanatory models are proposed that draw on existing knowledge within both the PTSD and dreaming fields to explain the full range of nightmares following trauma. [Copyright &y& Elsevier]

Abstract: Although research from numerous investigations indicates that there is substantial overlap in anxiety and depressive symptoms and comorbid diagnoses in youth, these constructs can be adequately differentiated. Clark and Watson [Clark, L. A. & Watson, D., (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316–336] proposed a tripartite model to account for the symptom overlap and diagnostic comorbidity between anxiety and depression. This tripartite model posits that anxiety and depression share a common component of negative affect, but can be differentiated by low positive affect associated with depression and high physiological hyperarousal associated with anxiety. The present article reviews initial research which has supported the utility of the tripartite model for explaining the association between anxiety and depression in adult and youth samples. Following that review, more recent investigations which have called into question the applicability of the tripartite constructs for youth are presented. Finally, the paper reviews evidence suggesting that the tripartite factors may not function similarly across all anxiety and depressive disorders. This article concludes by suggesting that more research is necessary with children and adolescents in order to determine the functioning of tripartite constructs across anxiety disorders in youth. [Copyright &y& Elsevier]

Abstract: The longitudinal dimension of schizophrenia and related severe mental illness is a key component of theoretical models of recovery. However, empirical longitudinal investigations have been underrepresented in the psychopathology of schizophrenia. Similarly, traditional approaches to longitudinal analysis of psychopathological data have had serious limitations. The utilization of modern longitudinal methods is necessary to capture the complexity of biopsychosocial models of treatment and recovery in schizophrenia. The present paper summarizes empirical data from traditional longitudinal research investigating recovery in symptoms, neurocognition, and social functioning. Studies conducted under treatment as usual conditions are compared to psychosocial intervention studies and potential treatment mechanisms of psychosocial interventions are discussed. Investigations of rehabilitation for schizophrenia using the longitudinal analytic strategies of growth curve and time series analysis are demonstrated. The respective advantages and disadvantages of these modern methods are highlighted. Their potential use for future research of treatment effects and recovery in schizophrenia is also discussed. [Copyright &y& Elsevier]

Abstract: This paper reviews the literature investigating relapse to alcohol and drug use among individuals dually diagnosed with a substance use and a co-occurring mood, anxiety, schizophrenia-spectrum, or personality disorder. Prevalence rates for each co-occurring set of disorders are discussed, followed by research studies that examine predictors of relapse to substance use within these groups. Relevant conceptual models well-suited to incorporating relapse as an outcome variable, and psychiatric factors both as predictor and outcome variables, are presented. Suggestions for future studies are provided. A priority area is developing and using consistent and well-articulated definitions of relapse across studies. Several diagnostic issues surfaced such as using structured clinical interviews to determine diagnosis (preferably following detoxification from alcohol and/or drugs), separating individuals with only alcohol use disorders from those with alcohol and drug use disorders in analyses, reporting the rates and types of overlap in mental health diagnoses, and conducting analyses that include and exclude multiply disordered individuals. Finally, future studies that focus on isolating predictors of relapse and abstinence could make substantive contributions to improving treatment for individuals with co-occurring substance use and mental health disorders. [Copyright &y& Elsevier]

Abstract: The use of standardized tools for the assessment of competency is vital, given that informal assessments performed by physicians are idiosyncratic and unreliable []. A number of instruments have been developed for this purpose, which are outlined in the following review. For the most part, these tools rest on a definition of competency put forward by Appelbaum and Roth [Appelbaum, P. S., & Roth, L. H. (1982). Competency to consent to research. A psychiatric overview. Archives of General Psychiatry, 39, 951–958], which incorporates various legal standards. Therefore, the present review will summarize current thinking on competence as well as the strengths, weaknesses, and psychometric properties of existing measures. As competency assessment will be more or less necessary depending on the patient population, another goal of the paper was to assemble the major findings pertaining to patient groups that have impairments in capacity. Although competency varies between and within diagnostic groups, empirical studies consistently demonstrate increased risk for some populations, and clinicians or researchers should be aware of this information. As such, this review may be useful as an initial source for interested researchers or clinicians. [Copyright &y& Elsevier]

Religion''s effects on mental health have been debated for years, yet only in the last half century have these theories been empirically tested. While a number of mental health constructs have been linked to religion, one of the most prevalent and debilitating mental health indices, anxiety, has been largely ignored. This paper categorizes and critically reviews the current literature on religion and general indices of anxiety in terms of findings linking decreased anxiety to religiosity, increased anxiety to religiosity, and those finding no relation between anxiety and religiosity. Results from 17 studies are described and synthesized. Conceptual and methodological weaknesses that potentially threaten the validity and generalizability of the findings are discussed. Finally, conclusions and directions for future research are provided. [Copyright &y& Elsevier]

In the past decade, there has been renewed interest in the feasibility and efficacy of purely behavioral treatments for clinical depression. Emphasizing the functional aspects of depressive and nondepressive behavior, these treatments focus on the concept of behavioral activation, which guides implementation of procedures aimed at increasing patient activity and access to reinforcement. Although researchers have provided positive preliminary support for behavioral activation-based interventions, many fundamental issues concerning strategies, principles, and change processes involved in behavioral activation have yet to be addressed. In this paper, we compare and contrast contemporary behavioral activation interventions, explore strategies and process of change issues, clarify the basic behavioral principles underlying activation strategies, and outline questions that need to be addressed to improve outcomes and better understand the potential significance of behavioral activation as it pertains to the future of behavior therapy for depression. [Copyright &y& Elsevier]

The ways in which people think about illness experiences have been associated with a variety of important behaviours and emotional responses in patients, carers, and professionals. Some of these responses have been shown to be related to outcome. Explicit models such as the self-regulation model (SRM) [Leventhal, H., Nerenz, D. R., & Steele, D. F. (1984). Illness representations and coping with health threats. In A. Baum & J. Singer (Eds.), A handbook of psychology and health. Hillsdale, NJ: Erlbaum, 219–252.] have been shown to be useful in highlighting key beliefs across a wide range of different physical illnesses. The specific beliefs about mental illness that have been assessed have been varied and largely without a common theoretical framework. This has resulted in a literature from which it is difficult to draw firm conclusions. The central aim of this paper is to assess the applicability of the SRM to mental illness. To this end, we review studies to date that have examined the beliefs that people with a mental illness have about their experiences. In addition, we review studies that have examined the beliefs of relatives of people with a mental illness and professionals who work with this population. We assess to what extent these studies are consistent with the SRM before suggesting ways in which the model could be further developed and tested. The SRM is presented as a useful framework for more advanced investigations into the function of beliefs about mental illness and how these can be modified in order to effect outcome. Developing psychological theories common to both physical and mental health may eventually result in an integrated approach in which mental illness becomes less stigmatised within the treatment setting. [Copyright &y& Elsevier]

Self-focused attention is an awareness of self-referent information and is present in many emotional disorders. This review concentrates on the role of self-focused attention in social anxiety with particular reference to the Clark and Wells [Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. R. G. Heimberg, M. Liebowitz, D. A. Hope, & S. Scheier (Eds.), Social phobia: diagnosis, assessment and treatment. New York: Guilford.] model of social phobia. According to Clark and Wells, self-focused attention is an important maintaining factor in the disorder because it increases access to negative thoughts and feelings, can interfere with performance, and prevents the individual from observing external information that might disconfirm his or her fears. Clark and Wells also propose that socially phobic individuals construct a distorted impression of themselves, based on internally generated information, that takes the form of a visual image (often seen from the perspective of an observer) or felt sense. This paper describes the model and then reviews other theories of self-focused attention, and empirical evidence on self-focused attention. Two types of evidence are reviewed: one, studies that have been conducted from a variety of theoretical perspectives that have relevance either to social anxiety in general or to the Clark and Wells model in particular; two, studies that were designed as a direct test of Clark and Wells'' predictions. The final section of the review summarizes the conclusions and suggests areas for future examination. [Copyright &y& Elsevier]

Information-processing models of emotional disorders suggest that anxious individuals may be characterized by a memory bias for threat-relevant information. This paper reviews and synthesizes evidence for explicit (conscious) and implicit (unconscious) memory biases in the anxiety disorders. Our review suggests variations among the anxiety disorders for explicit memory biases. Specifically, there is support for explicit memory biases for threat-relevant information in panic disorder (PD), particularly when information has been deeply encoded, but not in social phobia (SP) or generalized anxiety disorder (GAD). The few available studies suggest the presence of explicit memory biases in posttraumatic stress disorder (PTSD) and obsessive–compulsive disorder (OCD), but further research is needed. In contrast, some degree of support for implicit memory biases has been demonstrated for each of the anxiety disorders. Inconsistencies in the existing literature, topics worthy of future research attention, and directions for revising existing information-processing models of anxiety are discussed. [Copyright &y& Elsevier]

Whilst it is generally accepted that supportive relationships facilitate recovery from psychosis, much less is known about the role of romantic relationships in people with psychosis. This review aimed to synthesise quantitative literature regarding the impact of romantic relationships on the mental health and general wellbeing of people who experience psychosis. A systematic review of electronic databases (PsychINFO, PubMed, Web of Science) was carried out using search terms relating to psychosis and romantic relationships. Papers were selected for inclusion by independent reviewers. Quality assessment was completed and a narrative synthesis produced. Fifty-eight studies reporting the association between romantic relationships and psychotic symptoms, depression, posttraumatic stress disorder, suicidality, quality of life, satisfaction with life and self-esteem were included. Results were mixed but indicated having a romantic partner may be associated with reduced positive and negative symptoms of psychosis, but increased depressive symptoms. Tentative explanations for these findings, such as functioning prior to onset of psychosis, social support and relationship quality are explored. Findings highlight the importance of this often-overlooked area in clinical practice. Studies with robust design, which specifically aim to understand the relationship between romantic relationships and wellbeing for people who experience psychosis are needed. • Having a partner may be linked to fewer symptoms of psychosis. • Romantic relationships may be particularly beneficial for young adults. • Having a partner or having ever been in a relationship is linked to depression. • The mechanisms responsible for improved outcomes require further scrutiny. • More research is needed on intimate relationships, sexuality & mental wellbeing. [ABSTRACT FROM AUTHOR]

This paper describes a reformulated contextual model that uses cognitive theory (dual process theory), motivation theory (personality) and behavioral adaptation (self-correcting control systems) to show how anxiety and depression are caused, treated and prevented by an interaction between people and contexts. Depression and anxiety are the result of implicit beliefs (not cognitions) that all experience is unrewarding and threatening, these being components of the implicit belief that life is bad. Implicit beliefs are formed automatically from contextual cues and in healthy individuals are consistent with rational appraisal. They become more negative than reality through a process of adaptation when behaviors, directed by rational thinking, repeatedly create cues that signify lack of reward or threat. Such behaviors occur when social or other obligations lead people to choose behaviors that fail to satisfy their own unique goals in life and approach threatening situations, contrary to their automatic reactions. Therapeutic interventions and lifestyle change reverse these adaptive processes by positive experiences that create positive implicit beliefs, a change effected in different ways by contextual and specific mechanisms both of which correct the same fault of negative implicit beliefs. Effective therapeutic relationships and interventions are achieved by detecting and responding to a patient's unique needs and goals and their associated implicit beliefs. Mental health requires not only that people experience life as good as defined by their own goals and beliefs but also the avoidance of contexts where social and other pressures induce people to behave in ways inconsistent with their automatically generated feelings. • Depression and anxiety are caused by negative implicit beliefs not cognitions. • Implicit beliefs differ from reality through a process of adaptation. • Therapy reverses the process of adaptation making negative implicit beliefs positive. • Contextual and specific mechanisms both change implicit beliefs. [ABSTRACT FROM AUTHOR]

Self-criticism involves constant and harsh self-scrutiny, overly critical evaluations of one's own behavior, and negative reactions to perceived failures in terms of active self-bashing. Self-criticism is associated with various mental disorders and psychotherapy outcome. This paper provides (1) a meta-analysis of the association between pre-treatment self-criticism and multiple treatment outcomes, and (2) a systematic review of the association between change in self-criticism and therapy outcome. Based on a systematic literature search, 49 longitudinal studies (56 independent effect sizes; 3277 patients) were included in the meta-analysis and 7 studies were identified for the additional systematic review. A random-effects meta-analysis was performed to assess the magnitude of the association between self-criticism and outcome, also considering potential moderators. The overall association between pre-treatment self-criticism and psychotherapy outcome was r = –.20 (95% CI = –.25 – –.16, p <.0001), suggesting that higher levels of self-criticism are related to poorer outcome. Although effect sizes showed little heterogeneity, the association varied by type of mental health problem and indicated stronger associations with certain disorders (e.g., eating disorders). The review based on change scores yielded inconsistent results. Our findings support the relevance of self-criticism for psychotherapy outcome. • This is the first meta-analysis examining self-criticism and therapy outcome. • The higher the level of pre-treatment self-criticism, the poorer the outcome. • The negative association between self-criticism and outcome appears especially strong for eating disorders. • Paying attention to self-criticism in clinical practice is recommended. [ABSTRACT FROM AUTHOR]