To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Misophonia is a condition characterised by intense emotional reactions to sounds that would not bother most people. Currently, there is no widely accepted and effective treatment for misophonia. Most published studies on treatment have used behavioural therapy, cognitive interventions, or audiological treatments; however, there is no comparison of the effectiveness of these approaches. This 6-week study aimed to compare the effects of brief, self-administered versions of exposure and tinnitus retraining therapy (TRT) in 58 adults with misophonia. The participants, randomly assigned to the two treatment groups and a wait-list group, were assessed at three time points (baseline, week 3, and week 6). The exposure group was given self-exposure homework assignments, where the patient was expected to self-expose to the live or recorded misophonic sound that was agreed upon during the week 0 assessment, for 20–40 minutes, three times a week. The patients in the TRT group were given a set of pre-recorded music pieces and asked to listen to any piece of their choosing for 20–40 minutes a day, three times a week. Self-report measures of misophonia severity (Misophonia Checklist), and interference due to symptoms were rated at each time point by the patients. The assessor also rated improvement at each time point. The study is registered in ClinicalTrials.gov (registration no. NCT05993286). The Intention to Treat (ITT) analyses revealed no difference between the three groups in terms of self-rated misophonia severity at week 6. The assessor-rated percentage of improvement favoured exposure, although the response rate was very low; only six out of 39 participants were rated as moderately or much improved, five of whom were in the exposure therapy group. The results underscore the need for finding ways to increase treatment response in misophonia.
Key learning aims
(1) To become familiar with the concept of misophonia; i.e. hatred of sounds.
(2) To evaluate the potential effectiveness of existing interventions for the treatment of misophonia.
(3) To gain insight into adapting established therapy methods to novel settings.
This chapter examines the interaction between working memory and emotional wellbeing, highlighting the value of counselling for individuals with dyslexia. The authors stress that working-memory limitations not only affect academic or occupational performance but also contribute to emotional stress, frustration, and anxiety – especially when these difficulties are misunderstood or misattributed. Drawing on psychological theory and clinical experience, the chapter outlines how counselling can support clients in building self-awareness, managing emotional responses, and developing practical coping strategies. The therapeutic process often involves education about thinking, helping individuals understand how working-memory deficits affect their behaviour, and reframing past negative experiences in a more constructive light. Stress, anxiety, and low confidence can exacerbate cognitive overload, creating a feedback loop of underperformance and distress. Counselling can break this cycle by fostering emotional regulation and building self-efficacy. The chapter underscores the importance of a client-centred, non-pathologising approach, where individuals feel listened to and empowered. It also stresses the need for mental health professionals to understand cognitive profiles so that therapeutic interventions are tailored and relevant. Overall, the integration of cognitive and emotional support is shown to be key in helping individuals with dyslexia live more confident, adaptive lives.
Access to evidence-based psychosocial interventions for adults with attention-deficit/hyperactivity disorder (ADHD) remains limited, despite strong patient demand for nonpharmacological options such as cognitive behavioral therapy (CBT). Digital interventions may offer a scalable, low-threshold solution to meet this need and complement existing care. This pragmatic randomized controlled trial evaluated the effectiveness of attexis, a fully self-guided digital intervention based on CBT and mindfulness principles, as an adjunct to treatment as usual (TAU). A total of 337 adults with confirmed ADHD were randomized to either attexis + TAU or TAU alone. The primary outcome was ADHD symptom severity (Adult ADHD Self-Report Scale total score) at 3 months post-randomization (T1). Secondary outcomes included functional impairment, depressive symptoms, self-esteem, and health-related quality of life. Follow-up was conducted at 6 months (T2). Intent-to-treat analyses showed significantly lower ADHD symptom severity in the intervention group at T1 (baseline-adjusted mean difference = −5.0 points; d = 0.85, p < .001). Significant improvements were also observed across all secondary outcomes, and effects remained stable at T2. Responder analyses confirmed the clinical relevance of the findings. Subgroup analyses demonstrated consistent effects across sex, medication use, psychotherapy status, and treatment changes. No adverse events related to attexis were reported. attexis was effective in reducing ADHD symptoms and improving a broad range of functional and psychosocial outcomes. As a safe, low-threshold, fully self-guided intervention, it may serve as a valuable adjunct to routine care and help address existing gaps in access to psychosocial treatment for adults with ADHD.
The chatbot psychosis phenomenon is no longer just a hypothesis. We call for interdisciplinary frameworks to systematically investigate individual characteristics and artificial intelligence related factors which (on their own or in combination) cause or contribute to this phenomenon, underlying mechanisms and the psychoeducation, ethics, policy and practices needed to reduce harm.
Demand currently greatly outweighs supply in teenage mental health, with statutory services and the third sector struggling to cope with the number of referrals. There is increasing interest in the possibility of using schools to provide mental health interventions. This pilot study looked at the feasibility of developing a version of an existing evidence-based transdiagnostic large-class didactic approach widely used in NHS adult services – ‘Stress Control’ – for use with teenagers as a universal early intervention/prevention approach taught by teachers within the Personal and Social Education (PSE) curriculum in a high school in a highly deprived area. PSE teachers were trained, over five hours, to deliver each of the eight sessions in single weekly periods. Measures of anxiety and depression (RCADS) and wellbeing (WEMBWS) were administered at pre- and post-intervention and at 9-month follow-up. Results suggest that teachers reported few problems in delivering the approach, seen as relevant by pupils and showed significant reduction in anxiety and depression and significant gains in wellbeing at post-intervention. These gains were maintained at 9-month follow-up. There appears to be potential in this model. One of its strengths appears to be the positive collaboration between the psychologist, teachers and pupils, which resulted in changes being made to the original model. Limitations of the study and suggestions for future research are given.
Key learning aims
(1) To learn if an evidence-based adult psychoeducational approach can be adapted to meet the needs of teenage pupils in a school in a deprived neighbourhood.
(2) To learn if teachers, with no training in mental health, can deliver this approach.
(3) To test the viability of the approach with an aim of creating a sustainable intervention.
Unhealthy eating patterns, physical inactivity and alcohol misuse are commonly reported by individuals with severe mental illness (SMI) and significantly contribute to premature mortality. People with SMI could benefit from psychoeducational interventions focused on lifestyle modification.
Aims
To evaluate the effectiveness of the LIFESTYLE programme to improve dietary habits and physical activity levels and reduce alcohol use in individuals with SMI versus controls receiving a less structured psychoeducational programme (Italian Ministry of University and Research, trial registration number: 2015C7374S).
Method
This multicentre randomised controlled trial (RCT) was conducted across six Italian universities and included 401 participants diagnosed with SMI, randomly allocated to either the test group or a comparison group.
Results
At 1-year follow-up, generalised estimating equations showed that the trial intervention boosted the likelihood of higher weekly metabolic equivalents of task (METs) expended on total activity (odds ratio 1.43, 95% CI 1.08–1.89; p < 0.01), on walking (odds ratio 1.50, 95% CI 1.18–1.90; p < 0.001) and on moderate activity (odds ratio 1.85, 95% CI 1.24–2.77; p < 0.01). Improvements in dietary habits included increased intake of fish (odds ratio 1.67, 95% CI 1.45–1.97; p < 0.05), fresh fruit (odds ratio 1.36, 95% CI 1.05–1.76; p < 0.05) and vegetables (odds ratio 1.91, 95% CI 1.56–1.96; p < 0.05), along with reduced junk food consumption (OR = 0.81, 95% CI 0.63–0.99; p < 0.05) and daily alcohol use (odds ratio 0.70, 95% CI 0.52–0.95; p < 0.05).
Conclusions
The LIFESTYLE intervention proved effective in promoting healthier lifestyles among individuals with SMI, with sustained benefits at 1 year. This structured programme could be a valuable addition to routine mental healthcare.
Bipolar disorder often goes unrecognised for several years, leading to delayed treatment and negative outcomes. To help address this, we have developed a novel telehealth-based group psychoeducational and resilience enhancement programme for individuals at high risk for bipolar disorder (PREP-BD), aimed at improving help-seeking among adolescents and young adults at risk of developing bipolar disorder.
Aims
The purpose of the current study was to explore the perspectives of at-risk youth, their families and group facilitators who participated in the feasibility trial of PREP-BD.
Method
Group and individual semi-structured feedback sessions were conducted with the participants (n = 21) of the programme, their family members and the facilitators of PREP-BD. The questions covered their experiences, opinions on the programme’s structure and content and suggestions for improvement. Feedback sessions were transcribed and analysed qualitatively using inductive content analysis.
Results
Overall feedback was positive, with participants and facilitators appreciating the informative and engaging nature of the sessions. Some participants desired more actionable resources and complex content. Family members sought greater involvement and information about the programme. The online format was valued for convenience, but was also viewed as a barrier by some to fostering deeper connections.
Conclusions
PREP-BD shows promise as a psychoeducational intervention for individuals at high risk for bipolar disorder. To enhance the programme’s effectiveness, future iterations should incorporate more nuanced content, provide additional practical guidance and address the limitations of the virtual setting. Continued evaluation and optimisation are crucial for ensuring the programme’s effectiveness as a tool for early intervention in bipolar disorder.
The chapter will help you to be able to describe the different techniques available in CBT, consider the purpose of any given technique in relation to the maintenance cycles it interrupts, and tailor interventions to individual patients, considering their unique strengths and needs.
To truly understand the efficacy of attention-deficit hyperactivity disorder (ADHD) psychoeducation, we need to know what is commonly included in it. This scoping review aims to describe the content of psychoeducation interventions for ADHD in published research. A literature search was conducted to identify relevant papers. Descriptions of psychoeducation aimed at children, parents/carers, adults and teachers were identified and compared narratively.
Results
After screening, 57 papers were identified for data extraction and coding. Content themes included ‘information about ADHD’; ‘practical advice’; ‘impact of ADHD’; ‘treatment of ADHD’; ‘co-occurrence’; and ‘self-image/self-esteem’. ‘Information about ADHD’ and ‘practical advice’ were the most common themes, with variance on inclusion of other themes. Most of the identified research involved psychoeducation for parents of children with ADHD.
Clinical implications
This review provides greater understanding of the content and delivery of ADHD psychoeducation. Further research could use this understanding to ascertain the efficacy of different content themes in supporting those with ADHD.
Bipolar disorders are a major cause of disability worldwide, with most of the disease burden attributed to those in low- and middle-income countries, including Nigeria. There is limited evidence on culturally appropriate interventions for bipolar disorders in Nigeria.
Aims
The study aims to examine the feasibility, and acceptability of culturally adapted psychoeducation (CaPE) for treating bipolar disorders.
Method
A randomised controlled trial (RCT) compared CaPE plus treatment as usual (TAU) with TAU alone among 34 persons with bipolar disorders in Jos, Nigeria. CaPE comprised 12 group sessions of in-person psychoeducation lasting approximately 90 min each, delivered on a weekly basis by clinical researchers supervised by clinical psychologists and consultant psychiatrists. The primary outcome was feasibility, measured by participants’ recruitment and retention rates. Other outcomes included acceptability as measured by the Service Satisfaction Scale (SSS), Brief Bipolar Disorder Symptom Scale (BBDSS), Patient Health Questionnaire (PHQ-9) and Quality-of-Life scale (EQ5D). Outcomes were assessed at baseline and weeks 12 and 24. Focus group (n = 10) and individual interviews (n = 5) were conducted with the CaPE + TAU group, recorded, transcribed verbatim and analysed using interpretative phenomenological analysis.
Results
The CaPE+TAU group (n = 17) recorded a high participant recruitment and retention rate of 86% across 12 sessions, and also recorded a higher level of satisfaction with SSS compared with the TAU alone group; 87.5% indicated very satisfied compared with 66.7% indicated not sure in the TAU group. In terms of clinical outcomes, for PHQ-9 scores the intervention group showed a reduction from baseline to end of intervention (EOI) and follow-up, with differences of −12.01 and −7.39, respectively (both P < 0.001). The EQ5D index showed a notable improvement in the intervention group at both EOI and follow-up (P < 0.001). Lastly, BBDS scores decreased significantly in the CaPE+TAU group at both EOI and follow-up, with differences of −21.45 and −15.76 (both P < 0.001).
Conclusions
The RCT of CaPE is a feasible, acceptable and culturally appropriate treatment option for bipolar disorders in Nigeria. Further adequately powered RCTs evaluating the intervention’s clinical and cost-effectiveness are warranted.
High rates of trauma exposure among patients with severe mental illness (SMI) in Botswana highlight the need for appropriate interventions. Culturally adapted interventions have been reported to be more acceptable, effective and feasible. This study aimed to culturally adapt the Brief Relaxation, Education and Trauma Healing (BREATHE), a brief psychological intervention to treat post-traumatic stress disorder (PTSD) among people with SMI in Botswana. The cultural adaptation process followed the steps outlined by previous research. They included a community assessment to identify needs, selecting an appropriate intervention and consultations with experts and stakeholders. Individual interviews and focus groups were conducted with patients living with SMI and mental health professionals, respectively, to inform domains of the intervention to be adapted. BREATHE was adapted to be culturally congruent to Botswana by following the ecological validity model framework and using data from the interviews. Examples of the adaptation include language that was translated to Setswana, and spoken English and the content that was revised to reflect the traumatic experiences and demographics of the Botswana population. The study underscores the utility of using evidence-based frameworks to culturally adapt interventions. The adaptation process resulted in a culturally relevant BREATHE for patients with comorbid PTSD and SMI in Botswana.
Clinical practice guidelines identify several efficacious treatments for posttraumatic stress disorder, including prolonged exposure therapy, cognitive processing therapy, and trauma-focused cognitive-behavioral therapy. Credible components of treatment include psychoeducation, homework, exposure therapy, and cognitive techniques. A sidebar discusses how different categories of traumatic events can influence treatment choices. Another sidebar reviews the controversy over eye movement desensitization and reprocessing.
The most efficacious treatments for bipolar disorder include cognitive-behavioral therapy, family-focused therapy, and systemic care. Credible components of treatment include psychoeducation, cognitive restructuring, social support, and relapse prevention. The chapter also include a sidebar on research therapists and another on overcoming challenges to learning and implementing therapy.
ADHD is a highly prevalent, genetic, brain-based disorder associated with important impairments in academics, socio-emotional, family, and physical aspects of a person´s life. It has been described many years ago, generally starts in childhood, and in 50% of cases persists into adulthood. It has a well-documented safe and effective treatment that includes a multimodal combination on psychoeducation, parent training in behavioral management, academic support, and medication (stimulants or nonstimulants). Early and sustained treatment reduces symptoms, impairment, and negative consequences of complicated ADHD, such as poor academic outcomes, depression and other psychiatric complications, and accidents/injuries.
Family members of people experiencing a first-episode psychosis (FEP) can experience high levels of carer burden, stigma, emotional challenges, and uncertainty. This indicates the need for support and psychoeducation. To address these needs during the COVID-19 pandemic, we developed a multidisciplinary, blended, telehealth intervention, incorporating psychoeducation and peer support, for family members of FEP service users: PERCEPTION (PsychoEducation for Relatives of people Currently Experiencing Psychosis using Telehealth, an In-person meeting, and ONline peer support). The aim of the study was to explore the acceptability of PERCEPTION for family members of people who have experienced an FEP.
Methods:
Ten semi-structured interviews were conducted online via Zoom and audio recorded. Maximum variation sampling was used to recruit a sample balanced across age, gender, relatives’ prior mental health service use experience, and participants’ relationship with the family member experiencing psychosis. Data were analysed by hand using reflexive thematic analysis.
Results:
Four themes were produced: ‘Developing confidence in understanding and responding to psychosis’; ‘Navigating the small challenges of a broadly acceptable and desirable intervention’; ‘Timely support enriches the intervention’s meaning’; and ‘Dealing with the realities of carer burden’.
Conclusions:
Broadly speaking, PERCEPTION was experienced as acceptable, with the convenient, safe, and supportive environment, and challenges in engagement being highlighted by participants. Data point to a gap in service provision for long-term self-care support for relatives to reduce carer burden. Providing both in-person and online interventions, depending on individuals’ preference and needs, may help remove barriers for family members accessing help.
Psychoeducational interventions are a critical aspect of supporting adults with attention-deficit hyperactivity disorder (ADHD). The Understanding and Managing Adult ADHD Programme (UMAAP) is a six-session, group-based webinar intervention that incorporates psychoeducation with acceptance and commitment therapy. UMAAP relies on self-referrals and is facilitated by a charity, to promote accessibility.
Aims
The present study aimed to evaluate the feasibility of UMAAP and explore preliminary effectiveness.
Method
Adults with formally diagnosed or self-identified ADHD (n = 257) participated in an uncontrolled pre–post design. Feasibility was indicated by attendance, confidence in completing the home practice and satisfaction. Quality of life, psychological flexibility, self-acceptance and knowledge of ADHD were assessed at baseline, 1 week post-intervention and 3 months later, to explore preliminary effectiveness.
Results
Feasibility was demonstrated by the high attendance ratings and satisfaction with the intervention, although there was only moderate confidence in the ability to complete the home practices. Quality of life (mean increase 9.69, 95% CI 7.57–11.80), self-acceptance (mean increase 0.19, 95% CI 0.10–0.28) and knowledge of ADHD (mean increase 1.55, 95% CI 1.23–1.82) were significantly improved post-intervention. The effects were maintained at the 3-month follow-up. Psychological flexibility did not significantly change immediately post-intervention, but increased significantly at the 3-month follow-up (mean increase 0.42, 95% CI 0.26–0.58).
Conclusions
Overall, UMAAP is a feasible intervention for adults with ADHD. Findings highlighted the feasibility of delivering psychological interventions online in group settings, to increase access to support for adults with ADHD.
Edited by
David Kingdon, University of Southampton,Paul Rowlands, Derbyshire Healthcare NHS foundation Trust,George Stein, Emeritus of the Princess Royal University Hospital
This chapter gives an overview and update on functional neurological disorder (FND), also known as dissociative neurological symptom disorder and previously known as conversion disorder. FND is the presence of neurological symptoms that are not explained or explainable by a neurological disorder. FND has been assumed to be a purely stress-related psychiatric disorder, but over the recent decades, this simplistic conception has been supplanted by more nuanced models of symptom generation. FND is no longer a diagnosis of exclusion. Instead, wherever possible, it is ruled-in by distinct features of history and examination, the latter known as positive clinical signs. There have been concurrent advances in the biological understanding of FND, exemplified by functional neuroimaging studies that have indicated that FND can be distinguished from, for example, feigned symptoms mimicking the disorder. FND encompasses multiple subtypes, from seizures to motor disorders to sensory abnormalities. Symptoms often co-occur, sometimes in a striking fashion.
Current treatment options for FND are limited, and many patients have severe long-term symptoms despite best-available treatment including psychological therapies and medication. Nevertheless, there are simple, and sometimes effective, steps that clinicians can take to manage and treat patients.
Once a defendant is deemed incompetent to stand trial (IST), the evaluator must indicate whether restoration can occur within the foreseeable future. This restoration must occur in a “reasonable” – but undefined – period. If restorable and the defendant is in the community, an outpatient restoration program might be utilized but only if the defendant does not constitute a physical threat to the community. If the defendant is incarcerated, the restoration process will likely occur in a secure hospital setting or a jail setting. Unfortunately, not every jurisdiction has an outpatient restoration program or a jail restoration program. The nature of the crime often creates what I call a “justice” bias toward competency or the restoration process. The more heinous the crime the more likely the defendant is to be competent or IST but restorable.
Psychological treatments for eating disorders (EDs) and obsessive-compulsive disorder (OCD) have been shown to be effective in many studies. The specific mechanisms of change in treatments for EDs are not entirely clear, but it is suggested that psychoeducation, collaboration, exposure-based interventions, cognitive therapy, interpersonal effectiveness, and value-based interventions may be active treatment ingredients. Psychoeducation and collaboration between patient and therapist are essential to provide information about the disorder and its causes, challenge negative appraisals and self-criticism, and foster a collaborative environment. Exposure and behavioral experiments are often used in the treatment of both disorders. The goals of exposure include reducing anxiety by repeated contact with a feared stimulus and eliminating avoidance, safety, or escape behaviors, as well as increasing distress tolerance and extinction learning. Cognitive therapy, interpersonal effectiveness, and value-based interventions in ED treatment aim to increase self-efficacy and self-esteem through decreasing interpersonal problems and shifting values that are based on appearance.
Some components of commonly used, empirically supported eating disorder treatments (CBT-E and FBT) may not be suitable for patients who also have OCD. These include aspects of parental control in FBT, collaborative weighing, self-monitoring and eating schedules/meal plans, and psychoeducation about food and weight. Achieving weight gain is particularly difficult in anorexia nervosa due to fear and preoccupation with weight, eating and “becoming fat.” Low body weight and malnourishment tends to increase anxiety and obsessionality, so weight gain early on is paramount, especially for individuals with this co-occurring presentation. Through clinical observations, patients have reported that FBT may aggravate OCD symptoms, such as preoccupation with numbers and exactness, and expanding obsessionality to concerns about exercise/movement and other topics within the morality domain of OCD. The lack of control and greater uncertainty that an adolescent experiences while completing FBT may be related to increased OCD symptomatology and poor treatment outcomes.