Strength-based cognitive-behavioural therapy and peer-to-peer support in the recovery process for people with schizophrenia: A randomised control trial.

BACKGROUND AND AIMS: Dysfunctional cognition and negative symptoms in schizophrenia are associated with persistently low social functioning and quality of life (QoL). Recovery interventions report only a modest effect in improving social functioning and QoL. This study examined the therapeutic effects and pathways of interventions using strength-based cognitive-behavioural therapy (SBCBT) and peer-to-peer support (PSP) approaches. METHODS: A randomised control trial compared SBCBT, PSP and TAU (treatment-as-usual) by recruiting 127 individuals with schizophrenia spectrum disorders and low social functioning. RESULTS: The three-group comparison found SBCBT produced improved social functioning and social support at post-intervention and 6-month follow-up while PSP reported improved social QoL and defeatist beliefs, but none remained at 6-month follow-up. Unsurprising, no improvement was found in any areas for TAU, both at post-test and 6-month follow-up. Regarding mechanisms of change, improvements in hope and personal recovery consistently and significantly accounted for improvements in social functioning and many aspects of QoL of participants, thus indicating the important contribution of hope and personal recovery in strength-based interventions for people with schizophrenia. CONCLUSION: This rigorously designed study provides the first few solid empirical evidence on the effectiveness of SBCBT and PSP in recovery from schizophrenia and provides initial evidence of the linkage between dysfunctional cognition, hope and recovery in schizophrenia.

Towards an integrative hope-dysfunctional beliefs perspective to personal recovery in schizophrenia: a path analysis.

BACKGROUND: Evidence shows that negative symptoms of schizophrenia and underlying dysfunctional cognition are related to persistently low functioning and quality of life. However, despite the abundance of existing recovery programs for people with schizophrenia, few have examined whether and how the widely-adopted hope-motivation recovery pathway and the deficit-oriented cognitive pathway might converge to influence functioning and quality of life. METHODS: A cross-sectional, quantative survey recruited a convenient sample of adult outpatients with DSM-5 schizophrenia spectrum disorders and low social functioning (n = 124). Self-reported measurements included personal recovery (30-item Mental Health Recovery Measure), social functioning (8-item Social Functioning Questionnaire), hope (12-item Hope Scale), quality of life (28-item World Health Organization Quality of Life Scale-Abbreviated Version-Hong Kong), defeatist beliefs (15-item extracted from Dysfunctional Attitude Scale), and asocial beliefs (15-item extracted from Revised Social Anhedonia Scale). Correlation analysis and structural equation modelling was applied to investigate how the two pathways intertwined to predict social functioning and quality of life. RESULTS: Asocial beliefs and hope separately mediated two partial mediation pathways from defeatist beliefs to recovery outcomes (social functioning and personal recovery). Meanwhile, defeatist beliefs, social functioning, and personal recovery further predicted quality of life. CONCLUSIONS: This is one of the very few studies that provides empirical evidence of a deficit-strength linkage in the recovery from schizophrenia. Remediation of dysfunctional beliefs and the injection of hope and successful experiences should be undertaken concurrently in recovery as they are associated with differential effects on enhancing social functioning and personal recovery, which then converge and contribute to a better quality of life.

Adults' and older adults' mental health during COVID-19 in Hong Kong: An ecological analysis of family resilience.

INTRODUCTION: Based on an ecological model of resilience, this study aimed to identify common and differential ecological risk and protective factors influencing the psychological health of general adult population (aged 18-60) and older adults (older than 60) in Hong Kong during the COVID-19 pandemic. METHOD: A population-based random telephone survey was conducted in 2020, and 877 respondents in Hong Kong (308 older adults, i.e., older than 60; 569 adults, i.e., aged 18-60) were interviewed. Multiple group structural equation modeling was used to examine the proposed model. RESULTS: Chinese older adults in Hong Kong reported significantly lower levels of psychological distress than adults, and no difference in levels of family functioning was evident between the two groups. Community resources and family functioning served as important protectors for both groups. Parent-child conflicts were a significant mediator between COVID-19 stressors and psychological distress for adults only, while a decreasing level of outdoor family leisure served as a significant mediator for older adults only. DISCUSSION: The findings highlighted the importance of providing family- and community-based mental health services for Chinese people facing a public health crisis such as COVID-19 in Hong Kong. Mental health services designed for adult and older adult family members should emphasize different components. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effectiveness of an integrated motivational cognitive-behavioral group intervention for adolescents with gaming disorder: a randomized controlled trial.

AIMS, DESIGN AND SETTING: The aim of this study was to test the efficacy of the integrated cognitive-behavioral therapy with a strength-based motivational approach [integrated cognitive-behavioral therapy (ICBT)] intervention to change gaming disorder (GD) symptoms and other outcomes and to study the therapeutic mechanism. A two-arm parallel randomized waiting-list controlled trial with 3- and 6-month follow-ups were conducted in a secondary vocational school in mainland China. PARTICIPANTS: Participants comprised 77 Chinese adolescents with GD symptoms with a mean age of 16.36 years [standard deviation (SD) = 0.93]; 88.3% were male INTERVENTIONS: Participants were randomized into an ICBT group (n = 38) and a waiting-list control (WLC, n = 39) group. ICBT intervention comprised eight weekly sessions to encourage participants to identify their interests and strengths and set goals for developing personally meaningful real-life activities. MEASUREMENTS AND FINDINGS: The outcomes were measured at pre-treatment (t0 ), post-treatment (t1 ), 3-month (t2 ) and 6-month (t3 ) follow-ups. The primary outcome was GD symptoms at t3. Secondary outcomes included GD symptoms at t1 and t2 , and gaming motivation, maladaptive gaming cognition, depression and anxiety symptoms at t1 , t2 and t3 . With the intention-to-treat principle, the GD scores at t3 were significantly different between the CBT and WLC groups [mean difference 62.08 (SD = 10.48) versus 73.64 (SD = 11.70); Hedges' g = 1.15, 95% confidence interval = 0.67-1.62]. Linear mixed-effects modeling showed significant group × time interaction for the secondary outcomes (P < 0.01), with a moderate to strong between-group effect size in the reduction in depression symptoms (g = 0.67-0.84) and anxiety symptoms (g = 0.6-0.64). Path analysis shows ICBT leads to GD reduction through reducing gaming motivation and maladaptive gaming cognition. CONCLUSIONS: An integrated cognitive-behavioral therapy with strength-based motivational approach intervention reduced gaming disorder symptoms and time spent gaming over a 6-month period by decreasing maladaptive gaming motivation and cognition.

Meaning Making as a Lifebuoy in Dementia Caregiving: Predicting Depression from a Generation Perspective Using a Fuzzy-Set Qualitative Comparative Analysis.

Depressive symptomatology is associated with caregiver burden and poor health outcomes among dementia caregivers. Scholars called for a paradigm shift to focus on positive aspects of caregiving, in particular, meaning making during the caregiving journey. This study draws on the meaning making model and a generation perspective to predict depression among dementia caregivers from two generations, including Baby Boomers who were born between 1946 and 1964 and Generation X who were born between 1965 and 1980, using a configuration approach. Data was collected in a two-wave longitudinal design, from December 2019 to March 2021 in Hong Kong. A fuzzy-set qualitative comparative analysis resulted in six configurations with an overall solution consistency and overall solution coverage of 0.867 and 0.488, respectively. These configurations consist of a different combination of conditions that predict high depressive symptomatology among dementia caregivers in two generations. Specifically, generation is related to five out of six configurations. This study is the first to predict depression among dementia caregivers using a meaning making model from a generation perspective. It advances the understanding of factors contributing to high depressive symptomatology among dementia caregivers from two generations, thus contributing to the future development of generation-responsive assessments, interventions, and policies.

Family functioning under COVID-19: An ecological perspective of family resilience of Hong Kong Chinese families.

This study tested an ecological model of resilience that illustrated the influence of COVID-19-related stressors (i.e., social and health stressors) and various socio-ecological factors at microsystem (i.e., parent-child conflicts and couple relationship) and exo-system levels (i.e., the utilization of community resources) on family functioning among Chinese families during COVID-19. An anonymous telephone survey was conducted using random sampling method. The sample contained 322 respondents who were co-habiting with their child(ren) and their partner. Hierarchical regression analysis and structural equation modelling were used to examine the differential impacts of various levels of factors and the model that were proposed. Results showed that 13.2% of the households were categorized as at-risk of poorer family functioning. Couple relationship and stressors significantly accounted for much of the variance in family functioning. While stressors had a significant direct effect on family functioning, couple relationship, but not parent-child conflicts or utilization of community resources, significantly mediated and moderated the impact of stressors on family functioning. The findings highlighted the impacts of both individual and ecological factors on family functioning under COVID-19. Importantly, cultural and contextual factors should be considered when adopting ecological model of resilience to examine family functioning in diverse cultural groups.

Collaborative community mental health and aged care services with peer support to prevent late-life depression: study protocol for a non-randomised controlled trial.

BACKGROUND: Late-life depression is common, modifiable, yet under-treated. Service silos and human resources shortage contribute to insufficient prevention and intervention. We describe an implementation research protocol of collaborative stepped care and peer support model that integrates community mental health and aged care services to address service fragmentation, using productive ageing and recovery principles to involve older people as peer supporters to address human resource issue. METHODS/DESIGN: This is a non-randomised controlled trial examining the effectiveness and cost-effectiveness of the "Jockey Club Holistic Support Project for Elderly Mental Wellness" (JC JoyAge) model versus care as usual (CAU) in community aged care and community mental health service units in 12 months. Older people aged 60 years and over with mild to moderate depressive symptoms or risk factors for developing depression will be included. JoyAge service users will receive group-based activities and psychoeducation, low-intensity psychotherapy, or high-intensity psychotherapy according to the stepped care protocol in addition to usual community mental health or aged care, with support from an older peer supporter. The primary clinical outcome, depressive symptoms, and secondary outcomes, self-harm risk, anxiety symptoms, and loneliness, will be measured with the Patient Health Questionnaire-9 (PHQ-9), Self-Harm Inventory, Generalized Anxiety Disorder 7-item scale (GAD-7), and UCLA Loneliness 3-item scale (UCLA-3) respectively. Cost-effectiveness analysis will assess health-related quality of life using the EQ-5D-5L and service utilisation using the Client Service Receipt Inventory (CSRI). We use multilevel linear mixed models to compare outcomes change between groups and calculate the incremental cost-effectiveness ratio in terms of quality-adjusted life years. DISCUSSION: This study will provide evidence about outcomes for older persons with mental health needs receiving collaborative stepped care service without silos and with trained young-old volunteers to support engagement, treatment, and transitions. Cost-effectiveness findings from this study will inform resource allocation in this under-treated population. TRIAL REGISTRATION: ClinicalTrials.gov NCT03593889. Registered on 20 July 2018.

Risk and protective factors of Internet gaming disorder among Chinese people: A meta-analysis.

OBJECTIVES: Effective prevention and intervention of Internet gaming disorder require the identification of risk and protective factors. This study aims to exhaustively review the risk and protective factors of Internet gaming disorder among Chinese people. METHOD: We searched for articles published from database inception to February 2020 in MEDLINE, PsycINFO, Embase, PubMed, Web of Science and two Chinese databases, CNKI and Wanfang Data. Studies were included in the meta-analysis if they addressed Internet gaming disorder, sampled people in China, presented correlational factors of Internet gaming disorder and reported the effect sizes for correlations. Reviewers independently selected the studies, assessed their validity and extracted the data. Pooled Pearson's correlations were calculated using the random effects model. RESULT: In the meta-analysis, 153 studies covering 115,975 subjects were included. We identified 56 risk factors and 28 protective factors. Most risk factors strongly correlated with Internet gaming disorder fell into the category of maladaptive cognitions and motivations. Other factors that showed high effect sizes fell into various categories, including psychopathological characteristics, personality traits, cognition emotion regulation style and gaming-related factors. The only protective factor strongly correlated with Internet gaming disorder was self-control. We found that the factors related to the 'environments' show modest effect sizes compared to those related to the individual. The pooled effect sizes for most factors were not influenced by outliers and publication bias. CONCLUSION: Factors strongly correlated with Internet gaming disorder, especially maladaptive cognitions and motivations, are more likely to be proximal correlates of Internet gaming disorder and may be considered the focus of interventions. We encourage further empirical and experimental studies to examine the causal pathway and the treatment efficacy.

Barriers to a classroom-based universal prevention program for depressive symptoms in Chinese adolescents: A qualitative study.

Universal prevention is a practical approach to preventing depressive symptoms in adolescents, but barriers might reduce its effectiveness. This study explored possible barriers to universal prevention of depressive symptoms in Chinese adolescents. We interviewed thirteen adolescents who participated in the program. Thematic analysis was used to analyse the data. The results revealed three categories of barriers. The first category was participants' maladaptive coping strategies and beliefs about negative emotions. They tended to use avoidance coping, did not believe that negative emotions can be regulated, and had an unrealistic wish for a quick fix. The second category originated from the prevention contents. The complexity of the psychological techniques and the lack of proficiency among the participants were important barriers. The third category was the setting of the psychological course. Participants were reluctant to invest cognitive effort in the psychological course. The large-size class also made it challenging to have an in-depth exploration into emotions and thoughts. Our study added to the existing literature by providing more knowledge of barriers to universal prevention. Future research and practice need to adequately address these barriers so that universal prevention can be conducted more effectively.

Risk and resilience of vulnerable families in Hong Kong under the impact of COVID-19: an ecological resilience perspective.

PURPOSE: Hong Kong has experienced four waves of COVID-19 since the first case was confirmed in January 2020. Several studies have highlighted the psychological impacts of the outbreak in Hong Kong but have largely ignored the protective factors that contribute to resilience among vulnerable families. This study adopted an ecological resilience framework to explore the impact of this epidemic on members of families with youth with a delinquent tendency/mental health concerns and the ecological protective factors for these vulnerable families. METHODS: Random sampling based on a sampling frame provided by one of the largest local social service organizations in Hong Kong led to the recruitment of 407 respondents who were interviewed using a battery of standardized questionnaires. RESULTS: The results showed that 30.6% and 11.5% of respondents reported a moderate and a severe level of psychological distress, respectively, almost double the percentages reported in a previous study conducted in Hong Kong before the COVID-19 outbreak. Around 36.6% of respondents indicated they had encountered financial problems and almost 40% indicated aggravated financial circumstances since the outbreak. Hierarchical regression analysis revealed that financial stress was the strongest predictor of psychological distress. Structural equation modeling indicated that family support, indoor leisure activities and community resources significantly mediated the negative influence of COVID-19-related stressors on psychological distress of family members. CONCLUSION: Family leisure activities, family support, community spirit and mutual help within the context of social-distancing restrictions may need to be promoted to benefit vulnerable families in Hong Kong under the COVID-19 epidemic.

Culturally sensitive conceptualization of resilience: A multidimensional model of Chinese resilience.

Cultural sensitivity is missing in the widely researched construct of resilience. The assumption that resilience takes the same form in all cultures fails to acknowledge that culture shapes the interpretation and instantiation of resilience. Examining how suffering and adversity are perceived and dealt with in Chinese contexts, can identify cultural concepts related to resilience. In this paper, we examine the ways in which Confucianism, Buddhism, and Taoism, the three main belief systems that have influenced Chinese people's perception of the nature of life, can serve as sources of strength to individuals facing adversity. We summarise three culturally inflected elements of dealing with adversities and compare them with existing, widely researched notions of resilience. Taking a socio-ecological perspective to explore resilience, this paper proposes a multidimensional model that can improve understanding of culturally embedded resilience.

How Intersectional Are Mental Health Interventions for Sexual Minority People? A Systematic Review.

Purpose: Complex and widespread stigma exposes sexual minority people to disproportionate risks for adverse mental health. Intersectionality theory calls for consideration of the unique experiences of living with multiple forms of inequality. Yet, concerns remain regarding the extent to which intersectionality theory has been integrated into mental health interventions for sexual minority populations. This systematic review aims to assess the degree to which available mental health interventions account for intersecting forms of marginalization and to identify methods that facilitate the application of intersectionality. Methods: A search for peer-reviewed English language journal articles was conducted using PsycINFO and PubMed to locate reports of mental health interventions for sexual minority groups. A coding framework was designed to evaluate how interventions incorporated intersectionality theory. Results: Of 1877 potentially eligible articles, forty-three were included in the analysis. They were each classified as low, medium, or high with regard to intersectionality. Thirteen (30.2%) were rated as low on intersectionality for only recruiting a homogeneous group of participants in the interventions; 23 (53.4%) were classified as medium for including additional identities in recruitment without responding to possible intersectional disadvantages; 7 (16.3%) were rated as high with adequate consideration of the complex effects of intersecting positions. In addition, the review identified community-based participatory research as a common and instrumental method to ensure intersectionality. Conclusions: This review highlights the limitations of interventions for sexual minority people in addressing intersectionality. Guidelines are needed for clinical practice and evaluation to adequately incorporate intersectionality theory.

Cognitive-behavior therapy with and without parental involvement for anxious Chinese adolescents: A randomized controlled trial.

This study evaluated the effectiveness of a culturally attuned group cognitive-behavior therapy (CBT) intervention for Chinese adolescents at risk for anxiety disorders in Hong Kong and the additive effects of parental involvement. A randomized controlled design was adopted. Assessments were gathered at pre- and posttreatment, and 6-month follow-up. Participants (N = 136) were randomly assigned to (a) CBT plus parental involvement (CBT-PI) (n = 46), (b) CBT (n = 45), and (c) social activity (n = 45) conditions. Data were analyzed according to the intention-to-treat principle using multilevel modeling. The CBT-PI condition showed a greater reduction in physical injury fears compared with the CBT condition. The current findings suggest that involving parents in CBT for Chinese adolescents with anxiety problems may provide a small improvement in treatment efficacy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Psychosocial risk factors associated with depressive symptoms among adolescents in secondary schools in mainland china: A systematic review and meta-analysis.

BACKGROUND: The objective of the study is to systematically estimate the effect size of psychosocial risk factors for depressive symptoms among adolescents in secondary schools in mainland China. METHOD: A literature search was conducted in both English and Chinese databases. This meta-analysis used a random-effects model to estimate the effect size. RESULTS: Fifteen psychosocial risk factors were identified in a total of 164 articles. The results revealed the absolute value of effect size ranging from 0.16 to 0.43. Among them, poor parent-child communication (r = 0.43), negative life events (r = 0.40), academic pressure (r = 0.40), abuse (r = 0.33), poor family functioning (r = 0.33), bullying (r = 0.32), and poor family cohesion (r = 0.32) were associated with depression with a medium to large effect. Moderator analysis shows that grade, study quality, mean age, and gender were significant moderators of at least one factor for depression. LIMITATIONS: Limitations included the heterogeneity which is largely unexplained, and the inability to investigate the interactions of different factors and to determine the direction of causal relationships between psychosocial factors and depression in the present meta-analysis. CONCLUSIONS: This study suggests that family-related factors and school-related factors may be significantly associated with depressive symptoms in Chinese secondary school students. Further research is needed to develop effective strategies to modify these factors in depression prevention programmes.

Caregiving burden and psychological distress in Chinese spousal caregivers: gender difference in the moderating role of positive aspects of caregiving.

Objectives: This study endeavors to advance the current literature by examining the gender differences in the caregiving experiences and the stress-buffering role of positive aspects of caregiving (PAC) among Chinese spousal caregivers of frail elders in Hong Kong. Method: Forty-nine husband caregivers and 121 wife caregivers of frail elders in Hong Kong (N = 170) responded to the Positive Aspects of Caregiving (PAC) scale, the Zarit Burden Interview (ZBI), the 21-item Depression, Anxiety, and Stress Scales (DASS-21), and demographic questions. These spousal caregivers were diverse in age, and their care receivers were diverse in terms of age and health condition. Results: As predicted, there were significant gender differences in the moderating effects of PAC on the relationships of caregiving burden to depression, anxiety, and overall psychological distress. While PAC significantly buffered the effects of caregiving burden on depression, anxiety, and overall psychological distress for wife caregivers, the moderating effects of PAC were not significant for husband caregivers. Unexpectedly, wife caregivers reported lower PAC, higher caregiving burden, and higher psychological distress. Conclusion: As these findings suggest that PAC is lower but more beneficial for Chinese wife caregivers than Chinese husband caregivers, helping professionals are recommended to use strengths-based interventions that target PAC when working with Chinese wife caregivers.

Prevalence of depressive symptoms among adolescents in secondary school in mainland China: A systematic review and meta-analysis.

BACKGROUND: The objective of the study reported here is to systematically estimate the prevalence of depressive symptoms among adolescents in secondary schools in mainland China. METHOD: Literature searches were conducted in both English and Chinese databases from database inception to January 2018. This meta-analysis used a random-effects model to estimate the prevalence of depressive symptoms. RESULTS: Fifty-one eligible studies (n = 144,060) using probability sampling were identified. The results revealed a pooled prevalence of depressive symptoms of 24.3% (95% CI, 21.3%-27.6%), with high between-studies heterogeneity (Q = 9909, I²â€¯= 99.5%, p < 0.001). The prevalence estimates reported by the individual studies ranged from 6.2% to 64.8%. There was an increased prevalence with increasing grades from year 1 in junior secondary school (24.5%; 95% CI, 17.8%-32.8%) to year 3 in senior secondary school (40.1%; 95% CI, 29.4%-51.9%) (Q = 7.1, p < 0.01). Potential sources of high heterogeneity of prevalence among studies can be accounted for by screening instruments with different cutoffs. Further analysis stratified by gender, grade, household registration (hukou) and number of children in the household were performed. LIMITATIONS: Limitations include the high level of heterogeneity between studies (mainly from the heterogeneity of measurement tools) and stringent inclusion and exclusion criteria. CONCLUSIONS: This study suggests that depressive symptoms are common among Chinese secondary school students. Further research is needed to identify the risk factors and effective strategies for preventing and treating depression among adolescents in secondary schools.

The impact of perceived discrimination on personality among Chinese migrant children: The moderating role of parental support.

BACKGROUND: Previous research has indicated that perceived discrimination has harmful effects on migrant children's physical, mental and behavioral health. However, little is known as to whether these harmful effects cumulate to impact on migrant children's personalities. AIMS: This study examines the effect of perceived discrimination on personality, as well as the moderating role of parental support in the discrimination-personality linkage. METHODS: A purposeful convenience sample of 215 migrant children in Beijing, China, completed a standardized questionnaire. RESULTS: Migrant children experienced a moderate level of perceived discrimination, with Form 8 students experiencing greater discrimination than lower grades and those with lower family incomes also experiencing greater discrimination than those with higher family incomes. Perceived discrimination significantly predicted neuroticism; parental support significantly predicted extraversion, openness, agreeableness and conscientiousness, but the moderating effect of parental support was only marginally significant for the relation between discrimination and conscientiousness. CONCLUSION: This study underlines the need for researchers and policy makers to pay more attention to the impact of perceived discrimination on migrant children's personality development.

Evaluating the Effectiveness of an Integrated Cognitive-Behavioural Intervention (CBI) Model for Male Problem Gamblers in Hong Kong: A Matched-Pair Comparison Design.

Very few clinical cognitive-behavioural intervention (CBI) studies were conducted with the Chinese gamblers. There is a lack of attention paid to intervening in negative emotions that may also adversely affect PGs in current CBI treatment modality. This study is the first attempt to systematically and rigorously evaluate both the short-term and longer-term effects of a culturally-attuned CBI group treatment with an emotion regulation component for a group of Chinese PGs in Hong Kong. A quasi-experimental matched-pairs design was adopted and 84 participants were allocated to the CBI (N = 42) and social activity groups (N = 42). There are 3 assessment points in the study: baseline at recruitment, post-intervention at the end of CBI and social activity groups, and at 6-month follow-up. When compared to the social activity group and after controlling for general group effects, there were significantly greater decreases in the severity of gambling, gambling-related cognitions (i.e. interpretive bias), negative psychological states (i.e. stress) and money spent on gambling in the past month in the CBI group between pre- and post-intervention and between pre-intervention and 6-month follow-up. Results also indicated that both reduction in gambling-related cognitions and negative psychological states could mediate the treatment effect of the CBI on the reduction of problematic gambling behaviours. The culturally attuned integrated CBI group treatment with an emotional regulation component appeared to be effective in treating Chinese problem gamblers in Hong Kong and the effects could be sustained at 6-month follow-up.

Negative Mood States or Dysfunctional Cognitions: Their Independent and Interactional Effects in Influencing Severity of Gambling Among Chinese Problem Gamblers in Hong Kong.

Gambling-related cognitions and negative psychological states have been proposed as major factors in the initiation and maintenance of problem gambling (PG). While there are a substantial number of studies supporting the role of cognitive dysfunctions in the initiation and maintenance of PG, very few empirical studies have explored the specific role of negative psychological states in influencing PG behaviours. In addition, very few studies have examined the interaction effects of cognitive dysfunctions and negative psychological states in exerting influence on PG behaviours. Therefore, the present study aims to examine the main and interaction effects of gambling-related cognitions and psychological states on the gambling severity among a group of problem gamblers in Hong Kong. A cross-sectional research design was adopted. A purposive sample of 177 problem gamblers who sought treatment from a social service organization in Hong Kong completed a battery of standardised questionnaires. While gambling-related cognitions were found to exert significant effects on gambling severity, negative psychological states (i.e. stress) significantly moderated the relationship between gambling cognitions and gambling severity. In essence, those participants who reported a higher level of stress had more stable and serious gambling problems than those who reported a lower level of stress irrespective of the level of gambling-related cognitions. The findings of the moderating role of negative emotions in the relationship between cognitive distortions and severity of gambling provide insight towards developing an integrated intervention model which includes both cognitive-behavioural and emotion regulation strategies in helping people with PG.

The efficacy of cognitive behavioral therapy for Chinese people: A meta-analysis.

OBJECTIVE: Over the past decade, cognitive behavioral therapy has been applied to an increasingly wider range of disorders and problems in Chinese societies. However, no meta-analysis has been conducted to synthesize the studies on cognitive behavioral therapy for Chinese clients. The purpose of this meta-analytic study was to examine the overall efficacy of cognitive behavioral therapy for Chinese people. METHOD: A literature search was conducted using electronic databases, including Web of Science, PsycINFO and PubMed. Pooled mean effect sizes were calculated using the random-effects model. RESULTS: The literature search identified 55 studies with 6763 Chinese participants. The overall short-term effect of cognitive behavioral therapy on the primary outcome was medium in size. Effect sizes were medium for anxiety, depression/well-being and caregiving stress and small for psychotic symptoms and addictive behaviors. The effects of cognitive behavioral therapy on process variables, dysfunctional thoughts and coping, were in the small range. The overall longer-term effect of cognitive behavioral therapy on the primary outcome was medium in size. Moderator analyses showed that the short-term effect was stronger for culturally adapted cognitive behavioral therapy than for unadapted cognitive behavioral therapy. Type of primary outcome, type of control group, recruitment method, study design, the format of delivery and region were found to moderate the efficacy of cognitive behavioral therapy. CONCLUSION: The findings of this study provide evidence for the overall efficacy of cognitive behavioral therapy for Chinese people and the benefit of cultural adaptation of cognitive behavioral therapy to Chinese culture.