The Associations Among Observers' Openness to Experience and Agreeableness With Social Distance: The Moderating Role of Disability Type.

ABSTRACT: Despite abundant literature on personality and stigma, the role of disability type in this relationship has remained unaddressed. In the current study, we examined whether the relationship between observers' openness to experience and agreeableness on the one hand, and social distance on the other, was moderated by the target person's type of disability (psychiatric vs. physical). One hundred thirty-nine participants were randomly assigned to complete a social distance questionnaire referring to a vignette of a person in three conditions (physical disability, psychiatric disability, and control). A main effect of openness on social distance was found. Additionally, we found an interaction effect of agreeableness and the type of disability. Namely, the relationship between agreeableness and social distance was significant only in the physical disability condition but not in the other two conditions. To conclude, the current study emphasizes the role of personality traits in social distance toward individuals with disabilities.

Beyond One's Attitude Toward the Self: The Role of Social Anxiety in Self-Stigma Among Individuals With Schizophrenia.

ABSTRACT: Self-stigma is associated with a variety of negative self-perceptions among people coping with schizophrenia, as well as with different aspects of social behaviors. We explored the associations between self-compassion, self-esteem, social anxiety, and self-stigma among people coping with schizophrenia. The baseline data of 56 adults with schizophrenia who were enrolled in a Metacognitive Reflection and Insight Therapy trial were used. Participants filled out self-report questionnaires measuring self-compassion, self-esteem, social anxiety, and self-stigma. Self-esteem and self-compassion were negatively correlated with self-stigma and social anxiety. Self-compassion was not found to contribute beyond self-esteem to the prediction of self-stigma. Importantly, self-esteem and social anxiety were found to mediate the effects of self-compassion on self-stigma. Thus, it seems that social variables, in addition to self-variables, may lead to the formation of self-stigma among people with schizophrenia. Therefore, alongside addressing self-esteem and self-compassion, integrating therapeutic elements related to coping with social anxiety into interventions would seem to be an important factor in reducing self-stigma among people with serious mental illness.

A unique combination of horror and longing: Traumatic grief in post-October 7, 2023, Israel.

On October 7, 2023 (10/7), Hamas militants brutally attacked Israeli towns and villages surrounding the Gaza Strip, resulting in the killing of more than 1100 people, most of whom were civilians slaughtered in their own homes. The killings occurred under highly traumatic circumstances, including shooting, the burning of homes, hunting down people who attempted to escape, and severe sexual assault. Thus, many Israelis today experience a unique mix of both posttraumatic and severe grief reactions. Traumatic grief (TG) is often defined as a condition that results from the death of a significant other and includes symptoms similar to posttraumatic stress disorder (PTSD) that are specifically related to the deceased, such as intrusive thoughts and memories about the deceased and hypervigilance expressed by constantly looking for them or cues associated with them. However, whereas definitions, phenomenological descriptions, and clinical illustrations of PTSD are abundant and widely validated, TG has yet to receive formal diagnostic status. In this paper, we aim to reexamine TG in the context of post-10/7 Israel. We argue that TG is a critical concept for clinicians working in Israel and other conflict-exposed areas of the world today, as it accurately captures the painful mix of grief- and trauma-related symptoms. We also suggest potential explanations for the lack of acknowledgment of TG as a formal diagnosis and discuss the possible role of historical events in the formation of new, relevant psychiatric diagnoses.

Parents' experience of a shared parent-child stay during the first week of hospitalization in a child psychiatry inpatient ward.

Hospitalization of children in an inpatient psychiatric ward is stressful for both the children and their parents, and separation from the parents during hospitalization is probably one major cause of this stress. We designated one room in a closed inpatient unit to enable a parent to stay with his/her child, including overnight, during the 1st week of hospitalization. We then examined the parents' experience of the shared parent-child stay. Thirty parents of 16 children aged 6-12 years admitted to our inpatient child psychiatry ward completed in-depth semi-structured interviews after that week's experience. The interviews covered the parents' experiences of the 1st week in the larger context of pre-hospitalization period, which also includes the decision to hospitalize the child. The contents of the interviews were analyzed by means of independent coders that identified the following major themes: (1) ambivalence and confusion of the parents as related to their decision to hospitalize their child in the time period just before admission; (2) gradual process of separation from the child during the joint stay at the ward; (3) building confidence and trust toward the staff. Themes 2 and 3 express benefits from the joint hospitalization that may have a strong positive impact on the child's and the parent's recovery. These themes warrant further evaluation of the proposed shared stay during hospitalization in future studies.

Homework assignments in relational psychoanalytic treatment of personality disorders: A case study of a patient with narcissistic personality disorder.

Homework assignments, or specific tasks patients are asked to engage in or complete between sessions, are a controversial topic among psychoanalysts. While many argue these interventions contradict psychoanalytic principles, others believe they can help address problems and promote coping skills. We propose that homework can be a legitimate aspect of relational psychoanalysis when used in a way that is attuned to the patient's experience and that homework may be an important component of treating personality disorders (PD). We present the case of a man diagnosed with narcissistic PD. He often felt superior to and reported that he despised others, though the core self-image was of fragile. He embraced the role of the omnipotent caregiver, which came with boredom and anger and lack of satisfaction in his social life. The patient tried to control therapy, asserting that he could psychoanalyze himself. As a result, therapy was stalled and progress was limited. At this point, the therapist asked him to complete homework assignments that encouraged him to refrain from his compulsive caregiving to better understand what motivated this behavior. Through this process, the patient came to realize he acted out of avoidance, as he did not want to disclose his own vulnerabilities and flaws. At that point he was able to experience relationships while adopting different stances and finding new meanings. We argue that homework can be fully integrated into the relational psychoanalytic repertoire to improve self-reflection and foster change in patients with PD.

Transdiagnostic effects of therapist self-disclosure on diverse emotional experiences of clients with emotional disorders and schizophrenia.

OBJECTIVE: Despite the clinical significance of emotional diversity, also known as emodiversity, there has been limited investigation into the therapeutic interventions that influence this construct. In the current study we examined the association between immediate therapist self-disclosure (TSD) and emodiversity among two diagnostic groups who tend to experience emotional difficulties: people with schizophrenia and people with emotional disorders (i.e., depression and/or anxiety). METHOD: The sample comprised 74 clients (37 diagnosed with schizophrenia and 37 with emotional disorders) treated by 45 therapists in a university clinic setting. Following each session, clients self-reported their emotions, and therapists completed a measure of frequency and centrality of their immediate TSD during the session. RESULTS: Longitudinal multilevel models indicated that immediate TSD was positively associated with clients' global emodiversity, both at the within- and the between-client levels, as well as with clients' negative emodiversity at the between-client level. Moreover, clients with emotional disorders and clients with schizophrenia did not differ in the association between immediate TSD and emodiversity. In addition, across groups, clients treated by therapists who used more immediate TSD on average showed greater increases in global emodiversity during treatment. CONCLUSIONS: immediate TSD is associated with clients' ability to experience rich and diverse emotional experiences across different disorders. The theoretical and clinical implications of these findings are discussed.

Psychotherapy on an Acute Psychiatric Ward: Preliminary Findings From a Controlled Study.

This study investigated the efficacy of psychotherapy during hospitalization on an acute psychiatric ward. A controlled trial was conducted to assess the effects of Metacognitive Reflection and Insight Therapy (MERIT) upon metacognition and psychiatric symptoms. Data from 40 inpatient women were analysed. Findings included significant interaction effects between group (intervention or control group) and time (preintervention and postintervention) in regard to the metacognitive abilities and general psychiatric symptoms. Participating in MERIT seems to improve one's ability to use reflective knowledge to cope with psychological challenges and to improve symptomatology level.

Narrative reconstruction therapy for prolonged grief disorder: Basic interventions and mechanisms of change.

Narrative reconstruction is a time-limited integrative therapy, originally developed in the context of post-traumatic stress disorder and adjusted for the treatment of prolonged grief disorder (PGD). It consists of exposure to the loss memory and narrating a detailed written reconstruction of it. In this paper, we describe narrative reconstruction interventions and modifications for the treatment of PGD as well as the underlying mechanisms of change including integration of the loss episode into the life narrative. A case demonstration of narrative reconstruction with a patient with PGD presented for illustration and the integrative nature of narrative reconstruction for PGD is discussed.

A quasi-experimental trial of narrative reconstruction for prolonged grief disorder: Symptomatic improvement and enhanced memory integration.

BACKGROUND: Prolonged grief disorder (PGD) was recently approved as a formal diagnosis in the DSM-5-TR. The implementation of bereavement interventions is frequently requested, but their effectiveness has been controversial. Narrative reconstruction (NR) is a time-limited integrative therapy, originally developed for the treatment of post-traumatic stress disorder (PTSD) and adapted for the treatment of PGD. NR consists of exposure to the loss memory, a detailed written reconstruction of the loss memory narrative, and an elaboration of the personal significance of that memory for the bereaved. OBJECTIVES: In this study we evaluated the efficacy of NR for PGD. METHOD: In this study, 33 participants with PGD were quasi-randomized-that is, assigned to an immediate (n = 20) or delayed (n = 13) 16-session NR intervention. PGD, intrusion, avoidance and depression symptoms, as well as levels of the loss memory integration, were assessed at pretreatment, post-treatment, and at a 3-month follow-up. RESULTS: Mixed linear models showed significant intervention effects for PGD and intrusive symptomatology. Results also showed an increase in integration of the loss memory, and improvements remained stable for all outcomes at follow-up. CONCLUSION: In this study we established NR as an effective intervention for PGD and call for further validation in future studies. Integrating this intervention into the routine care of people with PGD seems important and beneficial.

Client-therapist temporal congruence in perceiving immediate therapist self-disclosure and its association with treatment outcome.

Objective: Immediate therapist self-disclosure (Im-TSD) can be a powerful intervention. When engaged in judiciously, it can provide clients with a unique opportunity to explore their interpersonal relationship in real time. Relational theories suggest that for Im-TSD to be effective, both client and therapist must have temporally congruent perceptions of its occurrence. The present study examined (a) whether clients and therapists are temporally congruent in their session-by-session ratings of Im-TSD; and (b) whether this congruence is associated with therapy outcomes. Method: After each session, clients (n = 102) and therapists (n = 60) at a university-based clinic indicated whether Im-TSD was present during the session. Before each session, clients self-reported their functioning. They rated session quality after each session. Results: Therapists' ratings of their Im-TSD tended to be temporally congruent with their clients' Im-TSD ratings. Greater temporal congruvdence was associated with greater improvement over time in clients' experience of the session as helpful, but not with changes in clients' functioning. Conclusion: The findings highlight the importance of establishing a stronger temporal congruence of Im-TSD ratings between therapists and clients to further improve clients' experiences in treatment. The findings' implications are discussed as well as situations in which temporal congruence may not be beneficial.

Searching for Certainty During a Pandemic: A Longitudinal Investigation of the Moderating Role of Media Consumption on the Development of Posttraumatic Stress Symptoms During COVID-19.

ABSTRACT: The current study longitudinally examined the moderating effects of consuming different types of media ( i.e. , formal [news] and informal [social media, WhatsApp]) in the association among COVID-19-related worries, intolerance of uncertainty (IU), and posttraumatic stress symptoms (PTSSs). Data were collected at two time points during July and September 2020, with approximately 60 days between measurements. Results showed that both COVID-19-related worries and IU were found to be positively associated with PTSSs. An interaction with formal media consumption was found, so that when one's formal media consumption was high, he or she were most vulnerable to the aforementioned effects on the development of PTSSs. Our findings point to the interactive effects of both COVID-19 worries and IU with media consumption on the development of PTSSs. Although media consumption might provide information during uncertainty, it may also intensify PTSSs during times of crisis. Implications and limitations are discussed.

The experience of divine struggle following child loss: The Case of Israeli bereaved Modern-Orthodox parents.

Child loss may undermine one's faith. Whereas much is known about religion's role following loss, less is known about the experience of divine struggle-namely, struggling with complex God-related emotions/beliefs-particularly among diverse sociocultural samples. Employing a narrative approach, we interviewed 20 bereaved Modern-Orthodox parents. Analysis revealed three types of divine struggle (explicit, implicit/silenced, none) differentiated by four categories: core emotional experience, response type, significance of faith in the coping process, and the impact of grief-induced divine struggle on parent-God relationship. Findings emphasize the need for culturally-sensitive inquiry of divine struggle, that divine struggle may be silenced, and therapists' awareness is critical.

Patient-oncologist working alliance and its relation to locus of control.

OBJECTIVES: In this study, we assessed the patient-oncologist relationship, conceptualized as the working alliance from a dyadic perspective, and its relation to locus of control. METHODS: One hundred and three oncologist-patient dyads were recruited. Measures included a sociodemographic and medical questionnaire; the "internal, powerful others, and chance" locus of control scale; and the working alliance inventory. RESULTS: Application of the actor-partner interdependence model yielded 2 actor effects: a positive association between oncologist "internal" locus of control and oncologist working alliance, and a negative association between oncologist "chance" locus of control and oncologist working alliance. It also yielded one partner effect: a positive association between oncologist "internal" locus of control and patient working alliance. SIGNIFICANCE OF RESULTS: The actor-partner effect suggests that oncologists' locus of control has a role in the establishment of the patient-oncologist working alliance; oncologists' internal locus of control is a dominant factor affecting not only their own perceived alliance but patients' perceived alliance as well.

The association between witnessing patient death and mental health outcomes in frontline COVID-19 healthcare workers.

BACKGROUND: Healthcare workers (HCW) treating coronavirus disease 2019 (COVID-19) patients face high levels of psychological stress. We aimed to compare mental health outcomes, risk and protective factors for posttraumatic stress symptoms (PTSS), probable depression, and anxiety between HCW working in COVID-19 and non-COVID-19 wards. METHODS: A self-report survey, administered in a large tertiary hospital in Israel during the peak of the COVID-19 outbreak was completed by 828 HCW (42.2% physicians, 57.8% nurses. Patient-Reported Outcomes Measurement Information System; the Patient Health Questionnaire-9; the Primary Care-Post Traumatic Stress Disorder Screen for DSM-5 (PC-PTSD-5) were used for assessing anxiety, depression, and PTSS, respectively. Pandemic-related stress factors, negative experiences, and potential protective factors were also assessed. RESULTS: Median PC-PTSD scores differed significantly between study teams (χ2 [5] = 17.24; p = .004). Prevalence of probable depression and anxiety were similar in both groups. Risk factors for mental health outcomes included mental exhaustion, anxiety about being infected and infecting family. Overall, higher proportion of the COVID-19 team witnessed patient deaths as compared to the non-COVID-19 team (50.2% vs. 24.7%). Witnessing patient death at the COVID-19 wards was associated with a four-fold increased likelihood of PTSS (odds ratio [OR] = 3.97; 95% confidence interval [CI], 1.58-9.99; p = .0007), compared with the non-COVID-19 wards (OR 0.91; 95% CI, 0.51-1.61; p = .43). CONCLUSIONS: Witnessing patient death appears to be a risk factor for PTSS unique to HCW directly engaged in treating patients with COVID-19. Our findings suggest that helping HCW cope with COVID-19 related deaths might reduce their risk of posttraumatic stress.

Narrative Reconstruction as an Intervention for Posttraumatic Stress Disorder: A Pilot Delayed Intervention Quasi-Randomized Controlled Trial.

Although empirically supported treatments for posttraumatic stress disorder (PTSD) exist, many patients fail to complete therapy, are nonresponsive, or remain symptomatic following treatment. This paper presents the results of a delayed intervention quasi-randomized controlled study that evaluated the efficacy of narrative reconstruction as an integrative intervention for PTSD. During narrative reconstruction, the patient and therapist reconstruct an organized, coherent, and detailed written narrative of the patient's traumatic experience. Additionally, narrative reconstruction focuses on arriving at the subjective meaning of the traumatic experience for the patient as related to their personal history. Thus, the therapist asks the patient about associations between the traumatic event and other memories and life events. In the present study, 30 participants with PTSD were randomly assigned to an immediate (n = 17) or delayed (n = 13) 15-session narrative reconstruction intervention. Participants in the immediate narrative reconstruction group were evaluated using self-report measures and structured interviews at baseline, posttreatment, and 15-week follow-up. Participants in the delayed narrative reconstruction group were evaluated at baseline, postwaitlist/pretreatment, and posttreatment assessments. Data from the pretreatment evaluation showed no significant differences between groups. Mixed linear models showed significant intervention effects for posttraumatic symptom severity, d = 1.17, from pre- to posttreatment. Although preliminary, these promising findings suggest that narrative reconstruction may be an effective standalone therapy or an add-on to current effective treatment strategies.

Coping With Information Style, Self-Concealment, Internalized Stigma, and Family Burden Among Parents of Children With Psychiatric Disorders.

Parents of children with psychiatric disorders who are hospitalized in a psychiatric unit often experience family burden. Family burden has been found to be affected by many variables related to parents' personal traits and ways of reacting to the disorder. The current study examined the association between information coping styles (monitoring and blunting) and family burden, among parents of children who were hospitalized in a day care unit. The possible role of self-stigma as a mediator between coping style and family burden and the role of self-concealment as a moderator between coping style and self-stigma were examined. A total of 41 parents completed questionnaires assessing their levels of self-stigma, information coping style, self-concealment, and family burden. Self-stigma was found to mediate the positive association between the monitoring coping style and family burden. Moreover, a moderation effect of self-concealment was found, indicating that monitoring parents suffered from higher levels of self-stigma particularly if they had a high tendency toward self-concealment. Taking into account parents' information, coping style, self-stigma, and self-concealment can help professionals tailor family interventions according to parents' diverse needs. A monitoring coping style may not be beneficial especially when combined with concealment, suggesting the need to promote other coping styles.

Los padres de niños con trastornos psiquiátricos que están internados en una clínica psiquiátrica con frecuencia sufren agobio familiar. Se ha descubierto que el agobio familiar está afectado por muchas variables relacionadas con las características personales de los padres y las maneras de reaccionar al trastorno. En el presente estudio se analizó la asociación entre los estilos de afrontamiento de la información (supervisión y evitación) y el agobio familiar entre padres de niños que estaban internados en un hospital de día. Se examinó el posible rol del autoestigma como mediador entre el estilo de afrontamiento y el agobio familiar, y el rol del autoocultamiento como moderador entre el estilo de afrontamiento y el autoestigma. Un total de 41 padres contestaron cuestionarios donde se evaluaron sus niveles de autoestigma, el estilo de afrontamiento de la información, el autoocultamiento y el agobio familiar. Se descubrió que el autoestigma medió la asociación positiva entre el estilo de afrontamiento de supervisión y el agobio familiar. Además, se descubrió un efecto moderador del autoocultamiento, lo cual indica que los padres supervisores sufrían de niveles más altos de autoestigma, particularmente si tenían una alta tendencia hacia el autoocultamiento. Tener en cuenta el estilo de afrontamiento de la información, el autoestigma y el autoocultamiento de los padres puede ayudar a los profesionales a adaptar las intervenciones familiares de acuerdo con las distintas necesidades de los padres. Es posible que un estilo de afrontamiento de supervisión no sea beneficioso, especialmente si está combinado con el ocultamiento, lo cual sugiere la necesidad de promover otros estilos de afrontamiento.

Emerging psychotherapeutic approaches to addressing self-experience in schizophrenia spectrum disorders.

Growing awareness that many who are diagnosed with schizophrenia recover has spurred the development of new psychosocial approaches to treatment. These new approaches include forms of individual and group psychotherapy whose focus extends beyond reducing symptoms and improving skills to subjective outcomes related to sense of self. This paper introduces an issue of In Session which presents six case reports which illustrating these approaches in differing international contexts. First, we explore the larger issues of subjective outcomes from schizophrenia. We then discuss each of the papers separately along with implications of these papers as a group for how treatment might promote the recapturing of a sense of self or place in the world.

Metacognitive reflection and insight therapy in an inpatient setting: Transforming messianism to a coherent mission.

Metacognitive reflection and insight therapy (MERIT) is an integrative form of psychotherapy which seeks to help adults with serious mental illness make sense of the psychosocial challenges and possibilities they face and decide how to respond to them and direct their own recovery. In this article, we present an adaptation of MERIT to the context of an inpatient ward with an accompanied case illustration. Specifically, we describe how this approach is supported by a broad intersubjective framework, followed by a presentation of processes and contents of the treatment. Special attention is given to the concurrent improvements in reflective abilities and overall well-being of the patient. The unique role that psychotherapy in general, and approaches that emphasize reflective processes in particular, play during acute crises in an inpatient setting is discussed.

Longitudinal changes in therapeutic alliance with people with psychosis: Relationship between client and therapist assessments.

Although the clinical significance of therapeutic alliance with people with psychosis is well established, the agreement between client and therapist assessments of therapeutic alliance and the longitudinal changes of both assessments have been rarely addressed. The current study examined client and therapist assessments of therapeutic alliance longitudinally and sought to determine whether insight and severity of symptoms moderated the degree to which therapist and client assessments were in agreement with one another. Forty-five participants diagnosed with a schizophrenia spectrum disorder and their therapists were administered a therapeutic alliance questionnaire (Working Alliance Inventory-Short Form) monthly for 6 months. Baseline symptoms were assessed using the PANSS. Results did not produce evidence that insight into illness moderated the relationship between agreement on the therapeutic alliance. However, symptoms of emotional discomfort at baseline predicted differences in agreement between clients and therapists on the relationship aspect of therapeutic alliance over the course of therapy. These results suggest that the ability to express symptoms of emotional discomfort may affect whether clients and therapists form similar appraisals of the strength of the therapeutic alliance.

When to disclose and to whom? examining within- and between-client moderators of therapist self disclosure-outcome associations in psychodynamic psychotherapy.

Objective: While previous studies have indicated that therapists' self-disclosure (TSD) can have curative effects, the contextual variables that may moderate the link between TSD and treatment outcome have not been sufficiently explored. Using session-by-session psychotherapy data, we examined the extent to which within-client distress and between-clients emotion regulation difficulties moderated the associations between TSD and session outcomes.Method: The sample comprised 68 clients treated according to the principles of psychodynamic psychotherapy by 47 therapists in a university clinic. Emotion regulation difficulties were assessed at the beginning of treatment, and functioning and distress levels as well as symptoms were assessed at the beginning of each session. After each session, therapists completed a measure of frequency and centrality of their immediate and non- immediate self-disclosure interventions during the session.Results: At the within-client level, in sessions marked by high pre-session client distress, immediate TSD was associated with a better next session outcome. At the between-clients level, for clients who had low emotion regulation difficulties, immediate TSD was marginally associated with better outcomes.Conclusion: These findings highlight the importance of considering within-client level as well as between-clients level variables when deciding upon self-disclosure.