Assessing therapy-relevant cognitive capacities in young people: development and psychometric evaluation of the self-reflection and insight scale for youth

Self-compassion defuses the aggression triggered by social exclusion

Social exclusion is a pervasive phenomenon that can have profound psychological consequences, including increased aggression. Self-compassion can promote psychological resilience, which helps individuals cope with challenges and may help mitigate the aggression triggered by social exclusion. This study aims to explore the relationship between self-compassion and aggression in the context of social exclusion from both state and trait perspectives. First, a cross-sectional study (Study 1) was conducted; the findings revealed that social exclusion is associated with higher levels of aggression, while self-compassion is linked to lower levels of social exclusion and aggression. Further division of self-compassion into its constituent components (self-kindness, mindfulness, and common humanity) revealed additional insights into the specific roles played by these factors. Self-kindness and mindfulness were found to moderate the relationship between social exclusion and aggression, while common humanity was observed to mediate this relationship. To determine the causal relationships among variables in further detail, an experimental study (Study 2) was designed. This study utilized a recall writing task to induce feelings of social exclusion and employed self-compassion writing tasks to elicit self-compassionate responses from participants. The results of this experiment indicated that self-compassion can significantly reduce the aggression triggered by social exclusion, thus suggesting that self-compassion may help alleviate the distress caused by individuals' experiences of social exclusion. The findings of this research have important implications for the development of clinical interventions aimed at reducing the adverse effects of social exclusion.

Reliability and validity of the Self-Reflection and Insight Scale for psychologists and the development and validation of the revised short version

Self-reflection is broadly considered a core competency for psychologists; however, there is an absence of measures of self-reflection, limiting the extent to which self-reflection can be assessed in both research and practice contexts. Whilst the Self-Reflection and Insight Scale (Grant et al., 2002) has been validated in a range of formats with different populations, it has not yet been validated with psychologists. Further, the psychometric properties of a short version of the scale (Silvia, 2021) have not been examined for use with psychologists. This study tested the factor structure, internal consistency and convergent and divergent validity of the Self-Reflection and Insight Scale with registered psychologists (N = 123), finding both the full scale and short version to have sound psychometrics. However, as there were low loading items across both versions of the measure, and the short version also excluded high-loading items, the SRIS-Revised (SRIS-R) was formed through model improvement, retaining a total of 14 items. This revised version of the scale captures high loading items without redundancy of low-loading items, resulting in a measure that parsimoniously captures the construct of self-reflection as relevant to psychologists. The SRIS-R demonstrated good internal consistency (α = .882), convergent, divergent and construct validity. Scores on the SRIS-R were used to test whether there was a correlation between self-reflection and years of professional registration, with this not being significant.

Efficacy of Intellect's self-guided anxiety and worry mobile health programme: A randomized controlled trial with an active control and a 2-week follow-up

Digital self-guided mobile health [mHealth] applications are cost-effective, accessible, and well-suited to improve mental health at scale. This randomized controlled trial [RCT] evaluated the efficacy of a recently developed mHealth programme based on cognitive-behavioral therapy [CBT] principles in improving worry and anxiety. We also examined psychological mindedness [PM] as a mediator by which app engagement is thought to improve outcomes. The Intervention group completed a 2-week "Anxiety and Worry" programme with daily CBT-informed activities, while the active waitlist-control completed a matched 2-week mHealth programme on procrastination. Participants filled out the Generalized Anxiety Disorder [GAD-7], Patient Health Questionnaire [PHQ-9], and Psychological Mindedness Scale [PMS] at baseline, post-intervention, and 2-week follow-up. App engagement was measured at post-intervention only. Contrary to prediction, the Intervention group did not perform better than the Active Control group; both groups showed significant improvements on anxiety and depressive symptoms from baseline to follow-up. From post-intervention to follow-up, only the Intervention group showed further improvements for anxiety symptoms. Higher engagement with the mHealth app predicted lower anxiety and depressive symptoms at follow-up, and this relationship was fully mediated by psychological mindedness. This study provides evidence that [a] engaging in a CBT mHealth programme can reduce anxiety and worry, and [b] Psychological mindedness is a potential pathway by which engaging with a mHealth app improves anxiety and depressive symptoms. While overall effect sizes were small, at the population level, these can make significant contributions to public mental health.

Writing Yourself Well: Dispositional Self-Reflection Moderates the Effect of a Smartphone App-Based Journaling Intervention on Psychological Wellbeing across Time

Self-reflection is often viewed positively; paradoxically, however, it is also associated with distress, potentially because of its relationship with rumination. Focusing self-reflection on positive themes may be one way to promote adaptive self-reflection. This study examined whether the disposition to engage in self-reflection motivates use of a journal containing positively focused writing prompts and moderates the benefit gained from it, specifically when rumination is controlled for. For 28 days, participants (N = 152) accessed an app-based mental health intervention containing various features, including the aforementioned journal. Outcomes of self-regulation and psychological wellbeing were assessed, controlling for time spent using other app features. As expected, journaling was associated with improvements in psychological wellbeing but only when baseline self-reflection was average or higher. Journaling was also initially associated with improvements in self-regulation, but this was diminished after controlling for time spent using other app features. Findings suggest self-reflection could be a strength for fostering wellbeing when it is directed in a positive way.

Parallel Changes in Positive Youth Development and Self-awareness: the Role of Emotional Self-regulation, Self-esteem, and Self-reflection

The aim of the present study was to examine whether early adolescents’ positive development (i.e., resilience and psychological wellbeing) could be enhanced by stimulating three dimensions of self-awareness: emotional self-regulation, self-esteem, and self-reflection. An experimental field study (randomized controlled trial) was conducted. Seventh grade students (N = 1299; M_age = 12.38; 54% boys) completed multiple assessments at the beginning, during, and immediately after the intervention or at parallel time points for students in the control condition. Changes in the assessed constructs were examined with parallel process latent growth curve models. The results showed that increases in emotional self-regulation and self-esteem were related to concurrent increases in both resilience and psychological wellbeing. Changes in self-reflection were, however, not related to changes in these outcomes. The trajectories of change and parallel processes were similar in the intervention and control condition. These findings suggest that interventions aiming to stimulate positive youth development might be optimized by also focusing on youth’s self-awareness, though more knowledge about how self-awareness can be stimulated best is needed. This trial was registered in the Dutch Trial Register, number NL6371 (old number: NTR6554), on July 3, 2017.

Effects of a virtual reality-based training program for adolescents with disruptive behaviour problems on cognitive distortions and treatment motivation: Protocol for a multiple baseline Single-Case Experimental Design (Preprint)

Background

Serious disruptive behavior among adolescents is a prevalent and often persistent problem. This highlights the importance of adequate and effective treatment to help adolescents with disruptive behavior problems react less hostile and aggressive. In order to create a treatment environment in which behavioral change can be enhanced, treatment motivation plays an essential role. Regarding treatment itself, a focus on challenging self-serving cognitive distortions in order to achieve behavioral change is important. Street Temptations (ST) is a new training program that was developed to address both treatment motivation and cognitive distortions in adolescents with disruptive behavior problems. One of the innovative aspects of ST is the use of virtual reality (VR) techniques to provide adolescents during treatment with visually presented daily social scenarios to activate emotional engagement and dysfunctional cognitions. By using the VR scenarios as an integral starting point of ST’s sessions and transferring the power of the VR experience into playful and dynamic exercises to practice social perspective–taking, adolescents are encouraged to reflect on both their own behavior and that of others. This focus on reflection is grounded in ST’s main treatment mechanism to influence treatment motivation and cognitive distortions, namely, mentalizing (ie, reflective functioning).

Objective

The aim of this study is to describe the research protocol to evaluate the effects of ST on treatment motivation and cognitive distortions. We take a closer look at the use of ST and the methodology used, namely, the repeated single-case experimental design (SCED).

Methods

The effects of ST are studied through a multiple baseline SCED, using both quantitative and qualitative data. In total, 18 adolescents from secure residential youth care facilities and secondary special education schools are randomly assigned to 1 of the 3 different baseline conditions. Throughout the baseline phase (1, 2, or 3 weeks), intervention phase (4 weeks), and follow-up phase (1, 2, or 3 weeks), daily measurements on treatment motivation and cognitive distortions are conducted. Secondary study parameters are assessed before baseline, after intervention, and after follow-up. Qualitative data are collected after intervention, as well as at 3 months and 6 months after the intervention.

Results

Data collection for this study started in November 2021 and is planned to be completed by August 2023. The results will be published in peer-reviewed journals and presented at national and international conferences.

Conclusions

ST aims to improve the disruptive behavior problems of adolescents. This study will be the first to gain insights into the effectiveness of ST. The strengths of this study include its thorough and individually focused design (SCED), the focus on a residential as well as a secondary special education setting, and the ecological validity. The implications for practice are discussed.

Trial Registration

Central Committee on Research Involving Human Subjects NL75545.029.20. Netherlands Trial Register NL9639; https://www.trialregister.nl/trial/9639

International Registered Report Identifier (IRRID)

PRR1-10.2196/33555

Person-Environment Fit and Positive Youth Development in the Context of High School Gay-Straight Alliances

Drawing from a person-environment fit framework, we identified profiles of youth in gay-straight alliances (GSAs) based on the extent to which they received information/resources, socializing/support, and advocacy opportunities in their GSAs and the extent to which this matched what they desired from their GSA along these three functions. Further, we examined profile differences in positive developmental competencies while accounting for community-contextual factors. In a sample of 290 youth from 42 Massachusetts GSAs, latent profile analyses identified five subgroups. Overall, youth receiving less from their GSAs than they desired, particularly regarding opportunities for advocacy, reported lower levels of self-reflection, bravery, civic engagement, and agency than youth who received information, socializing/support, and advocacy that matched or exceeded what they desired.

Private Self-consciousness, Self-reflection, Insight and Alcohol Consumption Among Young People and Adults

Abstract Private self-consciousness is a relevant metacognitive capacity in the self-regulation process, with possible implications in alcohol consumption. This research verified the influence of self-reflection and insight, dimensions of private self-consciousness, on drinking behavior. A total of 523 Brazilians, aged from 20 to 39 years old, participated in a survey by answering the Self-Reflection and Insight Scale and the AUDIT test. The results showed that women have higher levels of self-reflection, whereas men have higher levels of insight. With regard to alcohol consumption, young people drink at higher risk levels than adults. Self-reflection and insight were negatively correlated with alcohol consumption. Age and gender differences in the intensity of the correlation between variables and the influence of environmental factors on the regulation of drinking behavior are discussed.

Critical reflection, unlearning, and engagement

Although individual unlearning is believed to play a critical role in promoting higher-order learning, there has been little quantitative research on this process. This article aimed to investigate the antecedents and consequences of individual unlearning based on transformative learning theory. A survey was conducted among 301 employees working in various occupations and organizations in the United States. The results of structural equation modeling indicated that unlearning mediated the relationship between critical reflection and work engagement and that critical reflection mediated reflection and unlearning. This study contributes to the literature by quantitatively demonstrating the direct and indirect influences of critical reflection on work engagement through individual unlearning, which has been discussed only conceptually and qualitatively in the extant transformative learning literature.

The effectiveness of Rock and Water in improving students' socio-emotional adjustment and social safety: study protocol for a randomized controlled trial

Background

Students following a low education track have an increased risk for developing problem behaviors. Rock and Water is a widespread, but still poorly evaluated, intervention that aims to improve students’ socio-emotional adjustment and social safety. The aims of this study are to evaluate (1) the effectiveness of Rock and Water on socio-emotional adjustment (i.e., psychosocial wellbeing, sexual autonomy, and resilience) and social safety (i.e., perceived social security in the classroom, aggression, and bullying) and to examine (2) moderators and (3) mediators of its effects.

Methods

Schools are randomly assigned into four conditions: ‘Light’ (a core team of teachers is trained), ‘Standard’ (a core team of teachers and the whole school team is trained), ‘Plus’ (a core team of teachers, the whole school team is trained, and parents are involved), or ‘Control condition’ (Care As Usual). We aim to include 180 7th Grade students in each condition (N = 720) across all waves. A multi-informant (i.e., students, parents, and teachers) approach is used to assess the outcomes (socio-emotional adjustment and social safety), moderators (student, trainer, and parent characteristics) and mediators (self-control, self-reflection, self-esteem, and emotion regulation). Video-observations will be analyzed in a subsample to study the possible mediating effect of changes in deviant and prosocial communication among students on the effect on social safety.

Discussion

This project will provide information on the effectiveness of (different levels of school and parental involvement in) Rock and Water, which can be used by schools to decide upon the most efficient way to improve the care for the students. We will be able to shed more light on what works for whom and the working mechanisms of Rock and Water.

Trial registration

Dutch Trial Registration number 6554, registered on the 3rd of July 2017. The design of this study was approved by the Ethical Committee of the Faculty of Social and Behavioral Sciences of Utrecht University (FETC17–015). This study is financially supported by a grant from The Netherlands Organization for Health Research and Development, grant number 531001106.

Electronic supplementary material

The online version of this article (10.1186/s40359-018-0247-y) contains supplementary material, which is available to authorized users.

Fostering youth self-efficacy to address transgender and racial diversity issues: The role of gay-straight alliances

Gay-Straight Alliances (GSAs) aspire to empower youth to address multiple systems of oppression, including those affecting transgender and racial/ethnic minority youth, yet there is little indication of factors contributing to youths' self-efficacy to do so. We examined individual and group factors predicting self-efficacy to address transgender and racial issues among 295 youth in 33 high school GSAs. Multilevel results indicated that level of GSA engagement, individual and collective involvement in transgender- and race-specific discussions, and in some cases intergroup friendships were associated with each form of self-efficacy. The association between GSA engagement and transgender self-efficacy was stronger for youth in GSAs with greater collective transgender-specific discussions. Associations with racial self-efficacy differed based on youths' race/ethnicity. Continued research needs to identify how GSAs and similar youth programs promote self-efficacy to address diversity issues. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Depression and anxiety symptoms during the transition to early adulthood for people with intellectual disabilities

BACKGROUND

The transition to adulthood is a major developmental milestone; a time of self-discovery and increased independence. For young adults (YA) with intellectual disabilities (ID), however, this period is especially challenging. The increased incidence of mental health disorders in this population, such as depression and anxiety, make this transition even more difficult, increasing caregiver burden at a time when the young adult would traditionally be gaining independence. It is not clear, however, why YA with ID are more susceptible and what factors may predict mental health symptoms.

METHOD

Potential risk and protective factors (demographic variables, coping styles, sense of hopelessness, unmet achievement of adulthood milestones, self-reflection and insight) of anxiety and depression symptoms were assessed in 55 YA with ID and a sample of age-matched controls.

RESULTS

Insight was the strongest predictor of anxiety (with gender in the controls) for YA with and without ID, with increased insight predicting fewer anxiety symptoms. However, YA with ID had significantly less insight than their aged-matched counterparts and significantly higher levels of anxiety. They were also less likely to have achieved traditional adulthood milestones. Maladaptive coping was the strongest predictor of depression for YA with ID. In comparison, both maladaptive coping and insight predicted depression in controls. More maladaptive coping predicted increased depressive symptoms in both populations, whilst increased insight predicted fewer depressive symptoms in controls.

CONCLUSIONS

Insight and maladaptive coping are potential targets in the treatment of anxiety and depression among YA with ID. Longitudinal intervention studies exploring the efficacy of such targeted programmes in reducing mental health symptoms and improving the transition to adulthood for these young people are recommended.

Assessing maladaptive repetitive thought in clinical disorders: A critical review of existing measures

Rumination and worry have recently been grouped under the broader transdiagnostic construct of repetitive thought (Watkins, 2008). The purpose of this review is to provide an overview of scales used to assess repetitive thinking across a broad range of contexts: depression, anxiety, trauma, stress, illness, interpersonal difficulties, positive affect, and so forth. We also include scales developed or adapted for children and adolescents. In the extant literature, measures of repetitive thinking generally show small-to-moderate correlations with measures of psychopathology. This review highlights problems with the content validity of existing instruments; for example, confounds between repetitive thought and symptomatology, metacognitive beliefs, and affect. This review also builds on previous reviews by including newer transdiagnostic measures of repetitive thinking. We hope that this review will help to expand our understanding of repetitive thinking beyond the mood and anxiety disorders, and suggest ways forward in the measurement of repetitive thinking in individuals with comorbid conditions.

Developmentally sensitive cognitive behavioral therapy for adolescent school refusal: rationale and case illustration

School refusal can be difficult to treat and the poorest treatment response is observed among older school refusers. This poor response may be explained, in part, by the impact of developmental transitions and tasks upon the young person, their family, and the treatment process. This paper describes and illustrates the @school program, a cognitive behavioral therapy (CBT) designed to promote developmental sensitivity when planning and delivering treatment for adolescent school refusal. Treatment is modularized and it incorporates progress reviews, fostering a planned yet flexible approach to CBT. The treatment is illustrated in the case of Allison, a 16-year-old female presenting with major depressive disorder and generalized anxiety disorder. A case formulation guided the selection, sequencing, and pacing of modules targeting predisposing, precipitating, perpetuating, and protective factors. Treatment comprised 16 sessions with Allison (interventions addressing depression, anxiety, and school attendance) and 15 concurrent sessions with her mother (strategies to facilitate an adolescent's school attendance), including two sessions with Allison and mother together (family communication and problem solving to reduce parent-adolescent conflict). Two treatment-related consultations were also conducted with Allison's homeroom teacher. Allison's school attendance improved during the course of treatment. By post-treatment, there was a decrease in internalizing behavior, an increase in self-efficacy, and remission of depressive disorder and anxiety disorder. Clinically significant treatment gains were maintained at 2-month follow-up. Factors influencing outcome may include those inherent to the @school program together with less specific factors. Special consideration is given to parents' use of both authoritative and autonomy-granting approaches when helping an adolescent to attend school.

Individual Psychological Factors and Complex Interpersonal Conditions that Predict LGBT-Affirming Behavior

To counter homophobic behavior in schools, research is needed on heterosexual youth who act as allies to lesbian, gay, bisexual, and transgender (LGBT) youth by engaging in LGBT-affirming behavior (e.g., voicing support, engaging in advocacy, countering homophobia). Among 624 heterosexual high school students (M age = 16.11; 53 % female; 88 % white), this study found that critical thinking, self-reflection, lower sexual prejudice, having more LGBT friends, and having sexual orientation-based discussions with peers were associated with engaging in more LGBT-affirming behavior. Several factors moderated the association between having sexual orientation-based discussions and LGBT-affirming behavior: the association was stronger among youth who described the tone of these discussions as more positive, who more often used positive problem-solving strategies, and who reported low sexual prejudice. The degree to which conversations were challenging did not moderate this association. Finally, having LGBT friends was more strongly associated with affirming behavior for youth who felt more connected and had more sexual orientation-based discussions with these friends. The findings underscore the need for research to identify other factors that prompt heterosexual youth to act as allies to LGBT youth.

Self-generated thoughts and depression: from daydreaming to depressive symptoms

Human minds often engage in thoughts and feelings that are self-generated rather than stimulus-dependent, such as daydreaming. Recent research suggests that under certain circumstances, daydreaming is associated with adverse effects on cognition and affect. Based on recent literature about the influence of resting mind in relation to rumination and depression, this questionnaire study investigated mechanisms linking daydreaming to depressive symptoms. Specifically, an indirect effect model was tested in which daydreaming influences depressive symptoms through enhancing self-focus and ruminative thought. Results were in line with the hypothesis and several alternative pathways were ruled out. The results provide initial supportive evidence that daydreaming can influence depressive symptoms through influences on self-focus and rumination. Further research should use prospective or experimental designs to further validate and strengthen these conclusions.

Peeking into personality test answers: inter- and intraindividual variety in item interpretations

Personality research of today applies basically inventories having neither unambiguously interpretable items nor responses. The substantive process of generating the test answer is rarely investigated and thus the possible field of meanings, out of which the answer is created, remains hidden. In order to investigate the possible array of spontaneous answers to personality test items, a situative open-ended personality inventory was developed to determine individuals' ways of interpreting personality test items and relevant personality descriptions for individuals. The children's sample (N = 704 of 10-13 year olds) answered five free-response contextualized personality test questions, each related to one of the Five Factor Model personality dimensions. It was revealed that there is no universal interpretation of an item. First, different children's answers to same question described different personality dimensions - substantial number of the respondents' answers did not reflect the personality domain assumed in an item. So there are several ways to interpret test questions; answers may refer to different personality dimensions and not necessarily the one assumed by the researcher. Second, a number of children mentioned more than one personality trait for one item, indicating that even within one person there may be several relevant interpretations of the same item. Considering personality traits as occurring one by one and mutually exclusively during personality test answering may be artificial; in reality trait combinations may reflect actual reaction. In sum, the results suggest there is no single predictable interpretational trajectory in meaning construction process if semiotically mediated constructs, e.g., personality reflection, are assessed.

A model of therapist competencies for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders

While a plethora of cognitive behavioral empirically supported treatments (ESTs) are available for treating child and adolescent anxiety and depressive disorders, research has shown that these are not as effective when implemented in routine practice settings. Research is now indicating that is partly due to ineffective EST training methods, resulting in a lack of therapist competence. However, at present, the specific competencies that are required for the effective implementation of ESTs for this population are unknown, making the development of more effective EST training difficult. This study therefore aimed to develop a model of therapist competencies for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders using a version of the well-established Delphi technique. In doing so, the authors: (1) identified and reviewed cognitive behavioral ESTs for child and adolescent anxiety and depressive disorders, (2) extracted therapist competencies required to implement each treatment effectively, (3) validated these competency lists with EST authors, (4) consulted with a panel of relevant local experts to generate an overall model of therapist competence for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders, and (5) validated the overall model with EST manual authors and relevant international experts. The resultant model offers an empirically derived set of competencies necessary for effectively treating children and adolescents with anxiety and depressive disorders and has wide implications for the development of therapist training, competence assessment measures, and evidence-based practice guidelines for working with this population. This model thus brings us one step closer to bridging the gap between science and practice when treating child and adolescent anxiety and depression.

Cognitive behavior therapy for anxious adolescents: developmental influences on treatment design and delivery

Anxiety disorders in adolescence are common and disruptive, pointing to a need for effective treatments for this age group. Cognitive behavior therapy (CBT) is one of the most popular interventions for adolescent anxiety, and there is empirical support for its application. However, a significant proportion of adolescent clients continue to report anxiety symptoms post-treatment. This paper underscores the need to attend to the unique developmental characteristics of the adolescent period when designing and delivering treatment, in an effort to enhance treatment effectiveness. Informed by the literature from developmental psychology, developmental psychopathology, and clinical child and adolescent psychology, we review the 'why' and the 'how' of developmentally appropriate CBT for anxious adolescents. 'Why' it is important to consider developmental factors in designing and delivering CBT for anxious adolescents is addressed by examining the age-related findings of treatment outcome studies and exploring the influence of developmental factors, including cognitive capacities, on engagement in CBT. 'How' clinicians can developmentally tailor CBT for anxious adolescents in six key domains of treatment design and delivery is illustrated with suggestions drawn from both clinically and research-oriented literature. Finally, recommendations are made for research into developmentally appropriate CBT for anxious adolescents.