Family cohesion, shame-proneness, expressive suppression, and adolescent mental health-A path model approach.

Objective: The family remains one of the most important relationship systems into early adulthood and provides an important foundation for lifelong mental health. Dysfunctional family cohesion can promote adjustment problems in adolescents and might also affect adolescents' self-concept and strategies for coping with emotional distress. To test these relationships and the underlying mechanisms, we proposed a dual mediation model describing the associations between family cohesion and internalizing and externalizing problems, mediated by shame-proneness and expressive suppression. Methods: A sample of 526 German-speaking adolescents aged 14 to 18 years from Austria, Germany, and Switzerland participated in an online self-report survey encompassing questionnaires on family cohesion, shame-proneness, expressive suppression, and psychological problems. We tested a path model to examine the indirect pathways of the associations between family cohesion and internalizing and externalizing problems via shame-proneness and expressive suppression, while controlling for age, gender, and guilt-proneness. Results: We found a significant dual mediation of the associations between family cohesion and internalizing and externalizing problems by shame-proneness and expressive suppression. The indirect pathways were all significant, except for the indirect pathway from family cohesion to externalizing problems via shame-proneness. Discussion: Our results provide a model for the mechanisms by which disrupted family cohesion can be related to psychological problems in adolescents. Expressive suppression emerged as crucial when considering the consequences of shame-proneness in adolescents, as it was only indirectly related to externalizing problems via expressive suppression.

Virtual reality exposure therapy for posttraumatic stress disorder (PTSD): a meta-analysis.

Contrary to specific phobias, for which Virtual Reality Exposure Therapy (VRET) constitutes an effective treatment, uncertainty still exists regarding the usefulness of VRET for posttraumatic stress disorder (PTSD). Therefore, this meta-analysis investigated the efficacy of VRET for PTSD as compared to waitlist and active comparators. A literature search yielded nine controlled studies encompassing 296 participants (124 VRET, 172 controls). The differences between conditions regarding the primary outcome of PTSD symptom severity and the secondary outcome of depressive and anxiety symptoms post-treatment were calculated using Hedges' g. Compared to waitlist controls, VRET showed a significantly better outcome for PTSD symptoms (g = 0.62, p = .017) and depressive symptoms (g = 0.50, p = .008). There was no significant difference between VRET and active comparators regarding PTSD symptoms (g = 0.25, p = .356) and depressive symptoms (g = 0.24, p = .340) post-treatment. No significant effects emerged for anxiety symptoms. These findings suggest that VRET may be as effective as active comparators for PTSD patients. However, the results must be interpreted with caution due to the limited number of trials and the substantial number of - predominantly male - military service members studied. Additional controlled trials, considering a wider range of trauma types and balanced gender, are required to strengthen the evidence.

Al contrario de las fobias específicas, para las cuales la Terapia de Exposición de Realidad Virtual (VRET en sus siglas en inglés) constituye un tratamiento efectivo, existe todavía incertidumbre con respecto a la utilidad de la VRET para el trastorno de estrés postraumático (TEPT). Por lo tanto, este meta-análisis investigó la efectividad de la VRET para el TEPT en comparación con la lista de espera y los comparadores activos. Una búsqueda de literatura arrojó nueve estudios controlados involucrando a 296 participantes (124 VRET, 172 controles). Las diferencias entre las condiciones con respecto al resultado principal de la severidad de los síntomas del TEPT y el resultado secundario de los síntomas depresivos y ansiosos luego del tratamiento, fueron calculados usando la g de Hedges. En comparación a los controles de lista de espera, la VRET mostró un resultado significativamente mejor para los síntomas del TEPT (g=0.62, p=.017) y los síntomas depresivos (g=0.50, p=.008). No hubo diferencias significativas entre la VRET y los comparadores activos con respecto a los síntomas del TEPT (g=0.25, p=.356) y los síntomas depresivos (g=0.24, p=.340) luego del tratamiento. No surgieron efectos significativos para los síntomas ansiosos. Estos hallazgos sugieren que la VRET podría ser tan efectiva como los comparadores activos para los pacientes con TEPT. Sin embargo, los resultados deben ser interpretados con cautela debido al número limitado de ensayos y el sustancial número de miembros del servicio militar ­predominantemente hombres- estudiados. Ensayos controlados adicionales, que consideren un rango más amplio de tipos de trauma y balanceados en género, son requeridos para fortalecer la evidencia.