Existential therapies: a meta-analysis of their effects on psychological outcomes

Psychodynamic psychotherapy in serious physical illness: A systematic literature review of approaches and techniques for the treatment of existential distress and mental disorders

Individuals with life-limiting physical illness experience lower mental health due to existential distress (e.g., demoralization, death anxiety) and mental disorders (e.g., depression, anxiety). Psychodynamic psychotherapy may be helpful in alleviating such distress by focusing patients' unconscious emotional and relational motivations. There is yet limited knowledge on the application of psychodynamic psychotherapies in this population. We systematically searched electronic databases and analyzed results using meta-ethnography. Of 15,112 identified records, we included 31 qualitative studies applying psychodynamic psychotherapies (n = 69, mean age: 49.3 [SD = 16.9)], 56% female). Psychodynamic treatment in this population can be beneficial when considering modification of the treatment setting to the illness reality, balancing needs for autonomy and separation in light of helplessness and death anxiety, and careful integration of supportive interventions and conflict-oriented interventions (e.g., exploring relational issues that interfere with mourning illness-related loss). We discuss future directions for the development and evaluation of treatments specific to serious physical illness.

Investigating mortality salience as a potential causal influence and moderator of responses to laboratory pain

Background

Because pain can have profound ramifications for quality of life and daily functioning, understanding nuances in the interplay of psychosocial experiences with pain perception is vital for effective pain management. In separate lines of research, pain resilience and mortality salience have emerged as potentially important psychological correlates of reduced pain severity and increased tolerance of pain. However, to date, there has been a paucity of research examining potentially interactive effects of these factors on pain perception. To address this gap, the present experiment investigated mortality salience as a causal influence on tolerance of laboratory pain and a moderator of associations between pain resilience and pain tolerance within a Chinese sample.

Methods

Participants were healthy young Chinese adults (86 women, 84 men) who first completed a brief initial cold pressor test (CPT) followed by measures of demographics and pain resilience. Subsequently, participants randomly assigned to a mortality salience (MS) condition completed two open-ended essay questions in which they wrote about their death as well as a death anxiety scale while those randomly assigned to a control condition completed analogous tasks about watching television. Finally, all participants engaged in a delay task and a second CPT designed to measure post-manipulation pain tolerance and subjective pain intensity levels.

Results

MS condition cohorts showed greater pain tolerance than controls on the post-manipulation CPT, though pain intensity levels did not differ between groups. Moderator analyses indicated that the relationship between the behavior perseverance facet of pain resilience and pain tolerance was significantly stronger among MS condition participants than controls.

Conclusions

This experiment is the first to document potential causal effects of MS on pain tolerance and Ms as a moderator of the association between self-reported behavior perseverance and behavioral pain tolerance. Findings provide foundations for extensions within clinical pain samples.

The evaluation of religious and spirituality-based therapy compared to standard treatment in mental health care: A multi-level meta-analysis of randomized controlled trials

OBJECTIVE

Psychotherapies are increasingly incorporating spiritual and religious systems of belief and practice, which aligns with recent developments toward person-centered treatments. The main objective of this meta-analysis was to compare the efficacy of a religion and spiritually-based (R/S) therapy to non-R/S treatments.

METHOD

A multi-level meta-analysis was conducted to compare randomized controlled studies of the efficacy between R/S-based and regular treatments in mental health care setting. Inclusion criteria were diagnosis, psychotherapeutic treatment, and explicitly religion/spirituality therapy. Outcome was assessed for symptoms and for functioning separately, and combined. We also examined several moderators, such as type of comparison, outcome domain, and diagnosis.

RESULTS

Overall effect sizes obtained from 23 studies and 27 comparison groups indicated that a R/S treatment is moderately more efficacious compared to regular treatments at posttreatment (g = .52, p < .01) and at follow-up (g = .72, p < .01) (only available for symptoms). Results were similar for symptoms (g = .44, p < .01) and functioning (g = .62, p < .01).

CONCLUSION

In patients with a strong religious and spiritual affiliation, treatments with a focus on religious and spiritual issues are more efficacious than non-R/S-based therapy. Limitations as well as future directions are discussed.

User-centered development of an internet-based CBT intervention for the treatment of loneliness in older individuals

Background

Loneliness is a widespread phenomenon associated with a number of negative health outcomes. Older individuals may constitute one important target group with a need for effective interventions. However, despite evidence showing that addressing maladaptive social cognition (e.g., via cognitive behavioral therapy [CBT]) is the most effective intervention strategy for reducing loneliness, most existing programs aimed at older individuals do not use that method. Further, in terms of mental health service use, older individuals have been found to be an extremely undertreated population. When developing interventions, active involvement of end users in the development process is essential to increase later uptake.

Objective

The aim of the present study was to develop an internet-based CBT intervention for loneliness in older individuals (i.e., aged ≥65 years) applying a user-centered design. The present report provides an in-depth description of the development process.

Methods

Two phases of qualitative data collection were conducted in parallel with intervention development using a sample of N = 12 participants including both potential end users (i.e., older adults) as well as experts (i.e., psychotherapists). Measures included semi-structured interviews and usability testing.

Results

In Phase 1 interviews, participants indicated that they were predominantly positive about the idea of an internet-based program for loneliness targeting older individuals. Individualization and interactivity were named as crucial features. In Phase 2, usability testing of a prototype program provided important insights into technical barriers to intervention use. Further, participants reported that they were missing content on philosophy/theology and the role of descendants/relatives. Valuable insights from Phase 1 and Phase 2 were incorporated into the intervention program resulting in a 7-module internet-based self-help CBT intervention.

Discussion

Findings of this study highlight the significance of including relevant stakeholders in the development process of an intervention. Additionally, results emphasize the high acceptance of internet-based interventions in this population, but also underline the need for considering age-specific aspects when developing treatments.

The relationship between nature exposure and depression among Chinese prisoners: a moderated mediation model

Aim

This study examined the association between self-reported nature exposure and depression among Chinese prisoners, as well as the mediating and moderating effects of meaning in life and callous-unemotional (CU) traits, respectively.

Background

Prisoners are more likely to experience depression than any other mental illness. Exposure to nature has been proposed as a highly cost-effective method of treating their depressive symptoms. However, the mechanism underlying the link between nature exposure and depression among prisoners needs further investigation, as the findings may provide new insights into how to address depression in incarcerated populations.

Method

Data were collected through a survey conducted in four prisons in southern China from April to May 2022. The participants were 574 prisoners who anonymously completed four questionnaires about nature exposure, meaning in life, depression, and CU traits.

Results

The results show that: (1) meaning in life significantly mediates the association between nature exposure and depression, and (2) CU traits moderate the connection between nature exposure and meaning in life.

Conclusion

The current study uncovered that prisoners who contact more with the natural environment have a higher meaning in life and lower depression, and individuals with higher CU traits can benefit more from nature exposure.

Spiritual well-being, dignity-related distress and demoralisation at the end of life-effects of dignity therapy: a randomised controlled trial

OBJECTIVES

This single-centre prospective randomised controlled study aimed to investigate the effectiveness of dignity therapy on spiritual well-being, demoralisation and dignity-related distress compared with standard palliative care.

METHODS

A total of 111 terminally ill hospice patients were randomly allocated to one of two groups: dignity therapy plus standard palliative care (intervention group) or standard palliative care alone (control group). The main outcomes were meaning, peace, faith, loss of meaning and purpose, distress and coping ability, existential distress, psychological distress and physical distress. Assessments were conducted at baseline, 7-10 and 15-20 days.

RESULTS

Following randomisation, 11 dropped out before baseline assessment and 33 after post-treatment assessment. A total of 67 patients completed the study, 35 in the experimental group and 32 in the control group. Repeated measures general linear model showed significant differences between groups on peace and psychological distress over time, but not on existential distress, physical distress, meaning and purpose, distress and coping ability, meaning and faith. Specifically, patients in the dignity therapy intervention maintained similar levels of peace from baseline to follow-up, whereas patients in the control group significantly declined in peace during the same time period. Moreover, psychological distress significantly decreased from pretreatment to post-treatment in the intervention group and increased in the control group.

CONCLUSIONS

Dignity therapy may be an effective intervention in maintaining sense of peace for terminally ill patients. The findings of our study are of relevance in palliative care and suggest the potential clinical utility of this psychological intervention.

A systematic review of the effectiveness of meaning-centred psychotherapies in depressed participants

Depression is a mental disorder that is associated with low quality of life, increased risk of suicide and a high economic cost for society. Meta-analyses indicate that Meaning Centred Psychotherapies (MCP) are an efficacious psychotherapy to reduce depression in participants with chronic illness and cancer. However, to date, no systematic review has analysed the effectiveness of MCP in depressed participants who do not have a physical illness or cancer. The objective of this study was to carry out a systematic review to analyse the effectiveness of MCP in participants with depression and no physical illness. The search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Six studies (two randomised controlled trials and four quasi-experimental studies) were included in the systematic review. The results indicate that MCP is more effective than a control group as waitlist (four studies), psychoeducation group (one study), and cognitive behavioural therapy (CBT, one study), in reducing depressive symptoms, improving meaning in life and reducing anxiety in participants without physical illness. MCP would be considered a probably efficacious treatment for depression. However, further research with better experimental designs will be necessary to confirm the effectiveness of MCP for depression.

Identifying significant correlates of purpose in life in older US military veterans: results from the national health and resilience in veterans study

OBJECTIVE

Perceived purpose in life (PIL) has been linked to a broad range of adverse physical, mental, and cognitive outcomes. However, limited research has examined factors associated with PIL that can be targeted in prevention and treatment efforts in aging populations at heightened risk of adverse outcomes. Using data from predominantly older US veterans, we sought to identify important correlates of PIL.

METHODS

Cross-sectional data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 4069 US military veterans (Mage = 62.2). Elastic net and relative importance analyses were conducted to evaluate sociodemographic, military, health, and psychosocial variables that were strongly associated with PIL.

RESULTS

Of the 39 variables entered into an elastic net analysis, 10 were identified as significant correlates of PIL. In order of magnitude, these were resilience (18.7% relative variance explained [RVE]), optimism (12.1%), depressive symptoms (11.3%), community integration (10.7%), gratitude (10.2%), loneliness (9.8%), received social support (8.6%), conscientiousness (8.5%), openness to experience (5.4%), and intrinsic religiosity (4.7%).

CONCLUSIONS

Several modifiable psychosocial factors emerged as significant correlates of PIL in US military veterans. Interventions designed to target these factors may help increase PIL and mitigate risk for adverse health outcomes in this population.

Child and Adolescent Psychological Reactions to Climate Change: A Narrative Review Through an Existential Lens

PURPOSE OF REVIEW

A narrative review was conducted on research surrounding children's and adolescents' experiences of emotional and mental health and wellbeing in relation to climate change; we also explored potential connections to existential themes.

RECENT FINDINGS

Children and adolescents represent a vulnerable group in relation to experiencing negative mental health impacts due to climate change. Further, this population experiences a wide range of emotions in relation to climate change, with most research reporting on worry and anxiety. Several studies that explored associations between such emotions and mental health outcomes found positive associations. Additionally, research suggests that there is an existential underpinning to how climate change is experienced by children and adolescents. Although important contributions have been made in recent years, knowledge gaps remain. An understanding of the psychological responses children and adolescents have in relation to climate change is needed to inform practice and policy. This may be supported by an existential framework.

Death anxiety in connection to anxiety and depressive disorders: A meta-analysis on emotional distress in clinical and community samples

Awareness of one's mortality bears noteworthy implications on psychological functioning, proposing death anxiety as a transdiagnostic construct, with connections to psychopathology. The present meta-analysis investigates the relationship between death anxiety, depression, and anxiety disorders, as well as in symptomatology labeled as emotional distress. A random-effects model was used for extracting the effect size from 105 selected studies, comprising both clinical and community samples (N = 11,803). Results revealed a large overall effect size, g = 1.47 (95% CI [1.27; 1.67]), and a higher effect size favoring anxiety disorders. The instruments evaluating death anxiety and the presence of chronic conditions moderated the relationship. A higher effect size was observed for instruments other than Templer's Death Anxiety Scale, and for participants with chronic/terminal illness compared to healthy samples. Overall, the results highlight the need for a transdiagnostic perspective on death anxiety, as well as for reaching a consensus regarding its conceptualization and measurement.

The effectiveness of Meaning-Centered Group Psychotherapy on improving spiritual well-being and reducing anxiety in Iranian male cardiovascular patients

BACKGROUND AND PURPOSE

Cardiovascular diseases (CVDs) are the most important cause of death in Iran and the Kermanshah province. One of the most important problems that cardiovascular patients are dealing with is the psychological consequences of their illness. This study aimed at investigating the effectiveness of Meaning-Centered Group Psychotherapy (MCGP) intervention in improving spiritual well-being and reducing anxiety in cardiovascular patients.

MATERIALS AND METHODS

The study population included all patients referred to specialized cardiovascular centers in Kermanshah province in 2019. The participants consisted of 30 patients who were randomly assigned into experimental and control groups after the primary and secondary screening. The experimental group received routine treatment + MCGP (8 weeks and 90-120 min per session) and the control group only received routine treatment. The dependent variables were assessed by Spiritual Well-Being Scale and Beck Anxiety Inventory before and after receiving the treatment and 2 months after the treatment. ANCOVA and multivariate analysis of covariance were applied to the data through SPSS-22. IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.

RESULTS

The results of covariance analysis showed that MCGP increased spiritual/existential well-being and decreased anxiety in the experimental group (P < 0.001), while no significant difference was traced in the control group.

CONCLUSION

The findings of this randomized controlled trial provide good evidence for the effectiveness of MCGP as a treatment to improve the psychological and spiritual/existential distress in patients with CVDs.

The Effectiveness of Transactional Analysis Treatments and Their Predictors: A Systematic Literature Review and Explorative Meta-Analysis

Objectives:

Despite many studies on transactional analysis (TA) psychotherapy, there are no comprehensive reviews or meta-analyses on its effectiveness. We conducted a systematic literature review and meta-analysis on TA psychotherapeutic treatments to examine the extent of psychological and psychosocial change in pre-post studies, the effects compared with other treatments in randomized clinical trials, and factors explaining these effects and differences.

Method:

We conducted a systematic literature review and meta-analysis according to Meta-Analysis of Observational Studies in Epidemiolog (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in Pubmed, Medline, PsycInfo, Web-of-Knowledge, and scholar.google.com .

Results:

Overall, 41 clinical trials of TA treatments had moderate to large effects on psychopathology (Hedges’s g = .66), social functioning ( g = .62), self-efficacy ( g = .80), ego-state functioning ( g = .69), well-being ( g = .33), and behavior ( g = .56). Compared with control conditions, TA had moderate to large effects on psychopathology ( g = .61), social functioning ( g = .69), self-efficacy ( g = .88), ego-states ( g = .70), well-being ( g = .85), and behavior ( g = .46). TA was more effective on most outcomes in individuals, groups, and families than in schools or prisons. Psychopathology changes were significantly predicted by improvements in ego-states, self-efficacy, social functioning, and client–practitioner relationship ( r² range = .27–.43). Treatments were more effective if they included systematic assessment, treatment stages, psycho-education, TA-unique techniques, and an experiential focus ( r² range = .03–.31).

Conclusions:

TA may be considered an effective treatment for many clients.

Adjustment to the COVID-19 pandemic: associations with global and situational meaning

COVID-19 has created pervasive upheaval and uncertainty in communities around the world. This investigation evaluated associations between discrete dimensions of personal meaning and psychological adjustment to the pandemic among community residents in a southern US state. In this cross-sectional study, 544 respondents were assessed during a period of reopening but accelerating infection rates. Validated measures were used to evaluate theoretically distinct dimensions of perceived global meaning (Meaning-in-Life Questionnaire) and pandemic-specific meaning (Meaning in Illness Scale). Adjustment outcomes included perceived stress, pandemic-related helplessness, and acceptance of the pandemic. In multivariate models that controlled for demographic and pandemic-related factors, stronger attained global meaning (i.e., perceptions that life is generally meaningful) and attained situational meaning (i.e., perceptions that the pandemic experience was comprehensible) were related to better adjustment on all three outcomes (all p's < .001). In contrast, seeking situational meaning (i.e., ongoing efforts to find coherence in the situation) was associated with poorer adjustment on all indices (all p's < .001). Results offer novel information regarding theoretically salient dimensions of meaning, which may have direct relevance for understanding how community residents adapt to the challenges of a major public health crisis.

Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model

The current standard of care in most uses of psychedelic medicines for the treatment of psychiatric indications includes the provision of a supportive therapeutic context before, during, and after drug administration. A diversity of psychedelic-assisted psychotherapy (PAP) models has been created to meet this need. The current article briefly reviews the strengths and limitations of these models, which are divided into basic support models and EBT-inclusive therapy models. It then discusses several shortcomings both types of models share, including a lack of adequate attention to embodied and relational elements of treatment, and insufficient attention to ethical concerns. The article then introduces the EMBARK model, a transdiagnostic, trans-drug framework for the provision of supportive psychotherapy in PAP clinical trials and the training of study therapists. EMBARK was designed to overcome challenges that prior models have had in conceptualizing therapeutic change in psychedelic treatment, incorporating elements of non-psychedelic evidence-based therapies, incorporating therapists' prior skills and clinical orientations, delimiting therapist interventions for research standardization, and determining specific factors that contribute to treatment outcomes. The article explains EMBARK's six clinical domains, which represent parallel conceptualizations of how therapists may support therapeutic benefit in PAP treatment, and its four care cornerstones, which reflect therapists' broad ethical responsibility to participants. The article describes how these elements of the model come together to structure and inform therapeutic interventions during preparation, medicine, and integration sessions. Additionally, the article will discuss how EMBARK therapist training is organized and conducted. Finally, it will demonstrate the broad applicability of EMBARK by describing several current and upcoming PAP clinical trials that have adopted it as the therapeutic frame.

Relationships Between Mental Health, Emotion Regulation, and Meaning in Life of Frontline Nurses During the COVID-19 Outbreak

BACKGROUND

The sporadic outbreak of COVID-19 and the constant mutation of the virus have put the public in panic. Frontline nurses' appropriate emotional regulation and mental health are the key to win the victory of fighting against the epidemic. The relationships between these variables directly influence the availability of human resources to combat COVID-19.

OBJECTIVE

To investigate the relationship between meaning in life, emotional regulation, and mental health of frontline nurses during the Delta virus epidemic.

METHODS

A cross-sectional survey was conducted in August 2021 among 105 nurses from the Second Xiangya Hospital, Central South University, Changsha, China, who were deployed at the COVID-19 units in Zhangjiajie People's Hospital. The Chinese Meaning in Life Questionnaire, Emotion Regulation Questionnaire, and Psychological Questionnaire for Emergent Events of Public Health were used to evaluate their meaning in life, emotion regulation, and mental health. Their correlation and the moderating effect of emotion regulation were conducted.

RESULTS

In total, 105 (100%) nurses responded. There were 14 men and 91 women and the mean age was (30.295 ± 4.653) years. The average score of meaning in life and mental health of frontline nurses was 49.971 ± 6.386 and 2.755 ± 2.580, respectively. The meaning in life of frontline nurses was positively correlated with cognitive reappraisal and negatively correlated with expressive suppression and mental health. Mental health was negatively correlated with cognitive reappraisal and positively correlated with expressive suppression. The emotional regulation of frontline nurses has a moderating effect between meaning in life and mental health.

CONCLUSION

Meaning in life and emotion regulation of frontline nurses were significantly correlated with mental health under the effects of the COVID-19 pandemic. Changing the emotion regulation of frontline nurses, strengthening cognitive reappraisal, and weakening expressive suppression could reduce the predictive effect of meaning in life on mental health.

Development of a Three-Stage Strength-Based Meaning Intervention to Promote Mental Health Among Individuals with Physical Disabilities in Disadvantaged Communities: A Randomized Controlled Trial

A three-stage strength-based meaning intervention (SMI) was developed in the present study, and its utility in facilitating the mental health of individuals with physical disabilities in low-income communities was tested. A randomized controlled and single-blind trial was adopted. A total of 50 qualified participants (mean age = 42.12, standard deviation = 8.68; 48% males; 26 for the intervention group, 24 for the control group) completed the pre-intervention test, post-intervention test, and three-month follow-up test. No significant difference was observed between the two groups at pre-intervention assessment . After intervention, the results in terms of strength knowledge, strength use, sense of meaning in life and mental health showed a significant improvement in the intervention group, with the changes maintained over three months except mental health. The differences in mental health between the post-intervention test and the three-month follow-up test were not significant in the intervention group. The results imply that the SMI model is a promising approach in promoting the mental health of individuals with physical disabilities in low-income communities as it promotes improved knowledge and use of strength and sense of meaning in life.

Existential Therapy for Children: Impact of a Philosophy for Children Intervention on Positive and Negative Indicators of Mental Health in Elementary School Children

Background: Philosophy for children (P4C) was initially developed in the 1970s and served as an educational program to promote critical thinking, caring, creative reasoning and inquiry in the educational environment. Quasi-experimental research on P4C, a school-based approach that aims to develop children’s capacity to think by and for themselves, has suggested it could be an interesting intervention to foster greater basic psychological need satisfaction in children in school settings. Objective: The goal of the present study was to evaluate the impact of P4C on basic psychological need satisfaction and mental health in elementary school students. Method: Students from grades one to three (N = 57) took part in this study and completed pre- and post-intervention questionnaires. A randomized cluster trial with a wait-list control group was implemented to compare the effects of P4C on students’ mental health. Results: Analyses of covariance (ANCOVAs) revealed a significant effect of group condition on levels of autonomy and anxiety, after controlling for baseline levels. Participants in the experimental group showed higher scores in autonomy, when compared to participants in the control group, and participants in the experimental group showed lower anxiety scores, when compared to participants in the control group. Conclusion: Overall, results from this study show that P4C may be a promising intervention to foster greater autonomy in elementary school children, while also improving mental health.

A Randomized controlled trial of the Sources of Meaning Card Method: A new meaning-oriented approach predicts depression, anxiety, pain acceptance, and crisis of meaning in chronic pain patients

OBJECTIVE

Although considered the first-line psychological treatment of chronic pain, cognitive behavioural therapy has recently been criticized as being too limited, insufficient, and sometimes ineffective in the treatment of chronic pain patients. Moreover, important existential perspectives are sparsely or not at all integrated into CBT. We therefore propose to complement chronic pain treatment with a meaning-based intervention, the Sources of Meaning Card Method (SoMeCaM). This study tested its efficacy.

DESIGN

A randomized controlled trial was conducted with 42 chronic pain patients, comparing an intervention group (standard care and participation in the SoMeCaM, a meaning-oriented approach) with a control group (standard care). We evaluated both groups at baseline, 1 (t1) and 2 months (t2) after the intervention. The primary outcome assessed was pain acceptance, while depression, anxiety, pain intensity, pain medication, satisfaction with life, meaningfulness, and crisis of meaning were examined as secondary outcomes.

RESULTS

Comparisons within and between groups showed significant treatment effects at t1. Higher increases in pain acceptance and decreases in anxiety, depression and crisis of meaning were observed in the intervention group. Improvements in pain acceptance and anxiety persisted until t2, when pain intensity was also lower. Effect sizes at t2 were medium to large.

CONCLUSION

Our preliminary work demonstrates the importance of the existential perspective in chronic pain therapy.

Fear of the unknown as a mechanism of the inverse relation between life meaning and psychological distress

BACKGROUND AND OBJECTIVES

Although there is accumulating evidence for an inverse relation between life meaning and psychological distress, little is known about the mechanisms of this relation. Using cross-sectional, observational methods, this research examined fear of uncertainty as one potential mechanism.

DESIGN AND METHODS

Study 1 (N = 141) was completed with a convenience sample, a unidimensional measure of life meaning, and general measures of anxiety and depression. Study 2 (N = 152) was completed with a sample prescreened for anxiety, a multidimensional measure of life meaning, and clinical measures of anxiety and depression.

RESULTS

The results from both studies generally showed an inverse relation between life meaning and psychological distress. Study 2 further indicated that these relations were stronger for the meaning subscale of perceiving life as coherent/comprehensible than the subscales assessing whether participants' lives are perceived as purposeful or significant. Mediation analyses in both studies showed indirect effects of life meaning on psychological distress through fear of uncertainty.

CONCLUSIONS

These findings support and extend previous research by showing that (i) meaning-as-comprehension may be particularly important in regards to psychological distress, and (ii) fear of uncertainty may mediate the inverse relation between meaning and measures of anxiety and depression.

Meaning Making for Psychological Adjustment and Quality of Life in Older Long-Term Breast Cancer Survivors

Objectives: This study aims to explore in depth the meaning and meaning discrepancies among older Norwegian breast cancer survivors in light of the meaning making model by Park (2013).

Design: We utilized a qualitative design collecting data using semi-structured interviews of 23 elderly breast cancer survivors 7–8 years after treatment. The interviews followed an interview guide structured along three main themes: “everyday life activities,” “follow-up-care experiences” and “health status and QoL.”

Results: Several health problems were reported by the women in the aftermaths of the disease, such as sleeping problems, pain, and fatigue—including cognitive and emotional impairments. Meaning discrepancies were concentrated on six main themes: shifting perspectives and priorities, growing sense of autonomy, widening the limits of normality, dissociating oneself from the disease, embracing alternative health services, and feeling lucky. The women engaged in a wide range of coping techniques as efforts to change global meaning, and to develop a more positive view on the cancer experience. Common coping efforts across the six main themes were social comparison, denial, positive reappraisal, problem-focused coping, and revaluing ordinary events.

Conclusion: Many cancer patients report on unmet needs for help with their meaning making, and the facilitation of meaning making processes is rarely included in the follow-up care of cancer survivors. The findings of the present study may help health care professionals provide care for women who have experienced breast cancer. The concrete knowledge of common coping efforts in the meaning making process may contribute to the development of future interventions and for gaining a deeper understanding for older survivors of breast cancer.

Efficacy of Meaning-Centered Psychotherapy in adult patients with advanced cancer: A systematic review and meta-analysis

Objective: We conducted a PRISMA-compliant systematic review of clinical trials, and a meta-analysis of randomised clinical trials (RCTs) of manualised Meaning-Centered Psychotherapy (MCP) interventions for adult advanced cancer patients. We searched seven databases for trials published in English and Spanish, until March 27, 2021. Results: Seven trials were included in the systematic review, and four in the meta-analysis. The systematic review favoured the effectiveness of MCP for the improvement of spiritual well-being, quality of life (QoL), sense of meaning and psychological distress, although inconsistencies between the trials were found. In pre-post meta-analytic estimates, MCP had a superior therapeutic effect than control conditions for spiritual well-being (d=0.52, p<0.001), QoL (d=0.60, p<0.001), anxiety symptoms (d=-0.47, p<0.001), depressive symptoms (d=-0.50, p<0.001) and desire for hastened death (d=-0.28, p<0.001). No differences were observed in between-group comparisons. MCP was not associated with an increased risk of abandonment at post-treatment (OR=0.86, p=0.57). Conclusion: Manualised MCP interventions are a promising treatment for the improvement of spiritual well-being and quality of life and the reduction of psychological distress in adult patients with advanced cancer. The evidence base is still in an emerging state and should be expanded by higher methodological quality studies.

Reflecting on meaning in an existential-reorientation group psychotherapy approach for cancer patients: A qualitative thematic analysis

OBJECTIVE

The objectives of this study were to evaluate, in the Italian cultural context, breast cancer patients' main meaning themes related to the experience of the disease, on the one side, and to be part of an existentially oriented group intervention, on the other.

METHOD

A short reorientation-existential (RET) group intervention, structured by using some tools and background from cognitive analytic therapy (CAT) and based on the meaning-centered psychotherapy (MCP) existential framework, was delivered to 29 breast cancer patients. The sessions were audio-recorded and transcribed verbatim, with the narratives from reflective exercises (meaning of the journey cancer, meaning of the journey of intervention) uploaded to computer software NVivo 11. Analysis of the transcripts emerged from reflective exercises on the personal meaning of cancer and the letters of meaning (goodbye letter) written by the patients to express the meaning of their experience in the group was conducted through the interpretative phenomenological analysis (IPA) framework.

RESULTS

Four superordinate themes were identified in the exercise meaning of the experience of cancer, namely "sense of stigma and loneliness (the foreigner)," "guilt (unjust guilt and anticipatory guilt)," "reconsidering one's own life and nostalgia," and "rebirth (a new life, life after life)." Three superordinate themes were found in the meaning of the group experience in the letters, namely "togetherness and gratitude," "legacy," and "acceptance."

SIGNIFICANCE OF RESULTS

The study confirmed that a short group intervention, based on the existentially oriented framework and delivered in a public clinical healthcare setting, was enriched by focusing on the personal meaning of cancer. Some themes, such as loneliness, nostalgia, and rebirth, emerged during reflection giving, in written letters to participants, the sense of the group therapeutic experience.

Life After Facing Cancer: Posttraumatic Growth, Meaning in Life and Life Satisfaction

Although it is known that facing cancer may be accompanied by a range of chronic and acute stress reactions, it can also contribute to positive psychological changes and influence one's life perception. The aim of this cross-sectional study was to investigate relationship between posttraumatic growth (PTG), meaning in life and life satisfaction to determine whether the presence of meaning or the search for meaning mediated the relationship between PTG and life satisfaction. The study was conducted with 149 cancer survivors who were at least one-month post-completion of all medical cancer therapy. The results indicate positive associations between PTG, the presence of meaning in life, the search for meaning and life satisfaction. Moreover, the relationship between PTG and life satisfaction could be explained by the mediating effect of the presence of meaning in life. Thus, it is important for clinicians to systematically facilitate PTG, meaning in life and life satisfaction as protective factors to one's daily functioning.

A Meta-Analytic Review of Interventions That Promote Meaning in Life

OBJECTIVE

Increasing meaning in life (MiL) among people experiencing disease or adversity may improve coping and resilience. The purpose of this review is to characterize the effects of MiL interventions.

DATA SOURCE

A systematic search of PubMed, PsycInfo, and Google Scholar was conducted encompassing the following parameters: meaning in life, purpose in life, or sense of purpose with randomized controlled trials.

STUDY INCLUSION & EXCLUSION CRITERIA

Randomized controlled trials (RCTs) of interventions with at least one outcome that measured improvement in MiL and were published in English between January 2000 and January 2020.

DATA EXTRACTION & SYNTHESIS

33 randomized controlled trials (k = 35) were identified. Data were coded by authors and a research assistant for intervention type, control group type, and risk of bias. The random effects model of Review Manager 5.3 was used to produce SMD and evaluate heterogeneity.

RESULTS

The effect size for studies with a passive control group was SMD = 0.85 (95% CI 0.54 to 1.17) and for studies with an active control group was SMD = .032 (95% CI 0.09 to 0.55). Mindfulness programs produced the largest effect size (1.57) compared to passive controls, while narrative programs produced the largest effect relative to active controls (0.61). There was considerable heterogeneity in most estimates.

CONCLUSION

Several interventions increase MiL, including some that are relatively brief and do not require licensed professionals.

The Present State of Existential Interventions Within Palliative Care

Existential psychotherapy is rooted in the European tradition of existential philosophy. Existential philosophers include Husserl and Heidegger, who were German, and Camus, Sartre, de Beauvoir, and Merleau-Ponty, who were French. Their works contain existentially ultimate themes such as death, freedom, meaninglessness, and isolation. Based on their knowledge of existential philosophy, Binswanger, Frankl, and Boss developed the earlier existential psychotherapies such as Dasein-analysis and Logotherapy, while May, Laing, Yalom, May, and Wong started later existential psychotherapies in the British and American culture. Focusing on patients with advanced cancer and/or terminal care, we found nine types of existential psychotherapies which were investigated using randomized controlled trials (RCTs): Meaning-Centered Group Psychotherapy (MCGP), Individual Meaning-Centered Psychotherapy (IMCP), Meaning-Making intervention (MMi), Meaning of Life Intervention, Managing Cancer and Living Meaningfully (CALM), Hope Intervention, Cognitive and Existential Intervention, Dignity Therapy, and Life-Review Interviews, from 19 relevant RCTs. All deal with death, meaninglessness, isolation, and freedom. Particularly, MCGP, IMCP, MMi, Meaning of Life intervention, and CALM emphasize finding and/or making meaning in the individual's life. The effects on existential or spiritual well-being were confirmed in MCGP, IMCP, Meaning of Life intervention, and Life-Review intervention although the number of studies were very few. In the other interventions, there were heterogenous findings and again the number of studies was very small. Further studies are required to investigate the effects of existential psychotherapy on patients with advanced cancer.

The relationship between meaning in life and post-traumatic stress symptoms in US military personnel: A meta-analysis

BACKGROUND

Subjective meaning in life has been theorized to play a critical role in the adjustment to traumatic events. However, its association with post-traumatic stress symptoms has not been quantitatively reviewed.

METHODS

Informed by Park's integrated meaning-making model and evidenced-based psychological treatments for post-traumatic stress disorder, the goals of this meta-analysis were to: (1) to determine the direction and magnitude of the association between meaning in life and post-traumatic stress symptoms; and (2) to examine potential moderators of this association (i.e., age, sex, race, marital status, type of trauma, and meaning in life conceptualization). CINAHL, Embase, PILOT, PsycINFO, PubMed, and Web of Science core collection databases were searched.

RESULTS

A random-effects meta-analysis was conducted on 26 associations (N = 9,751). A significant, moderate, negative relationship was found between meaning in life and post-traumatic stress symptoms (r = -0.41; 95% CI: -0.47 to -0.35, k = 25). No significant moderators were detected.

CONCLUSIONS

Findings suggest that meaning in life plays a crucial role in adjustment to traumatic events. Development and testing of randomized controlled trials to determine whether increases in meaning in life result in reductions of post-traumatic stress in US military personnel may facilitate ongoing efforts aimed at recovery from trauma.

Longitudinal associations of meaning in life and psychosocial adjustment to the COVID-19 outbreak in China

Objective

Literature suggests that ‘meaning in life’ may be a mental strength that enables individuals to function healthily and adaptively in the face of stress events. Therefore, this study aims to examine the longitudinal associations between meaning in life and psychosocial adjustment to the COVID‐19 outbreak among Chinese people.

Methods

A prospective design was adopted. 154 Chinese college students (Mean age = 20.41 ± 1.45 years) completed two waves of the assessment. Participants reported their meaning in life before the outbreak (Time 1) and their psychosocial adjustment 7 weeks later after the outbreak had occurred (Time 2).

Results

Participants’ meaning in life at Time 1 was positively related to life satisfaction and negatively related to depression, anxiety, stress, and negative emotions at Time 2. Additionally, levels of meaning in life at Time 1 were positively associated to COVID‐19‐related behavioural engagement – prosocial behaviour and information addiction at Time 2. Individuals’ perceptions of the outbreak and status of self‐quarantine did not moderate these relationships.

Conclusion

Findings suggest that individuals’ prior level of meaning in life may help them maintain a healthy psychosocial adjustment during disease outbreak, though cautions regarding the possibility to render an addiction to information about the outbreak are warranted.

Are bored minds more likely to be addicted? The relationship between boredom proneness and problematic mobile phone use

BACKGROUND

Boredom proneness has been demonstrated as a salient vulnerability factor for problematic mobile phone use. However, the mediating and moderating mechanisms underlying this relationship are less investigated. In the current study, we constructed an integrative moderated mediation model to test the mediating role of depression and the moderating role of attentional control in the relationship between boredom proneness and problematic mobile phone use.

METHOD

A total of 1099 college students (M_age = 20.04; SD = 1.25) were recruited to fill out the questionnaires measuring boredom proneness, depression, problematic mobile phone use, and attentional control.

RESULTS

Depression partially mediated the relationship between boredom proneness and problematic mobile phone use. Attentional control moderated the indirect relationship between boredom proneness and problematic mobile phone use through depression, with the indirect relationship being weaker for college students with higher levels of attentional control. Moreover, attentional control moderated the direct relationship between boredom proneness and problematic mobile phone use, in that this relationship was stronger for college students with higher levels of attentional control.

CONCLUSIONS

These findings illuminate the pathway through which boredom proneness is linked to problematic mobile phone use (i.e., mediation) and the condition on which the relationship between boredom proneness and problematic mobile phone use depends (i.e., moderation). More importantly, this study revealed the potential "double-edged sword" effect of attentional control. These findings have implications for early intervention and prevention of problematic mobile phone use in college students.

Impact of Caring for Terminally Ill Children on Physicians: A Systematic Scoping Review

INTRODUCTION

Caring for terminally ill children influences nurses' and allied health provider's quality of life, ability to provide personalized, dignified and empathetic care and even their concepts of personhood. In the absence of data this review utilizes the Ring Theory of Personhood (RToP) to evaluate how a physician's concept of personhood is affected caring for terminally ill children in order to better support them holistically.

METHODS

Using PRISMA Guidelines, 14 researchers carried out independent searches of PubMed, CINAHL, PsycINFO, Cochrane Library and gray literature databases for articles published between 2000 to 2019. Concurrent and independent employment of content and thematic analysis (Split Approach) was used to enhance the trustworthiness of the analysis.

RESULTS

13,424 titles and abstracts were retrieved, 188 full texts were evaluated, and 39 articles were included and analyzed. Identical categories and themes identified using the Split Approach suggest that caring for dying children in PPC impacts the physician's professional identity, clinical decision making, personal well-being and relationships. The data also suggests that the magnitude of these effects depends on the presence of protective and risk factors.

CONCLUSION

Aside from providing a novel insight into the upon the physician, this review proffers a unique approach to accounting for the presence, magnitude and influence of incoming catalysts, resultant conflicts, and protective and risk factors upon the physician's personhood. Further studies into the changes in personhood are required. Design of a personalized assessment tool based on the RToP will help direct timely, appropriate and personalized support to these physicians.

When is search for meaning in life beneficial for well-being? A cross-national study

Previous research has found cross-national variations in the association between search for meaning in life (SMIL) and well-being (i.e. SMIL-WB link). This study extended and tested a "self-improvement hypothesis" that accounts for such cross-national variations based on an international database-the sixth wave of World Values Survey. SMIL represents a self-improvement effort which is more demanded in contexts with stronger external constraints. Thus, we expected a stronger positive SMIL-WB link in such contexts. A series of multilevel analyses was used to verify this hypothesis. The results showed that the SMIL-WB link varied across different societies, with well-being indexed by happiness, life satisfaction and subjective health. Moreover, external constraints from cultural, social-institutional, economic and ecological contexts (collectivism, peace threats, economic scarcity and environmental threats) moderated the SMIL-WB links. We thus call for advancing SMIL theory by considering person-context interaction.

Dignity Therapy Helps Terminally Ill Patients Maintain a Sense of Peace: Early Results of a Randomized Controlled Trial

Introduction: Dignity Therapy (DT) is a brief, individualized, narrative psychotherapy developed to reduce psychosocial and existential distress, and promote dignity, meaning, and hope in end of life patients. Previous studies have shown that DT was effective in reducing anxiety and depression, and improving dignity-related distress. However, less is known about its efficacy on spiritual well-being. The aim of this study is to contribute to the existing literature by investigating the effects of DT on specific dimensions of spiritual well-being, demoralization and dignity-related distress in a sample of terminally ill patients. Methods: A randomized, controlled trial was conducted with 64 terminally ill patients who were randomly assigned to the intervention group (DT + standard palliative care) or the control group (standard palliative care alone). The primary outcome measures were Meaning, Peace, and Faith whereas the secondary outcome measures were (loss of) Meaning and purpose, Distress and coping ability, Existential distress, Psychological distress, and Physical distress. All measures were assessed at baseline (before the intervention), 7-10 and 15-20 days after the baseline assessment. The trial was registered with ClinicalTrials.gov (Protocol Record NCT04256239). Results: The MANOVA yielded a significant effect for the Group X Time interaction. ANOVA with repeated measures showed a significant effect of time on peace and a significant Group X Time interaction effect on peace. Post hoc comparisons revealed that, while there was a decrease in peace from pre-treatment to follow-up and from post-treatment to follow-up in the control group, there was no such trend in the intervention group. Discussion: This study provides initial evidence that patients in the DT intervention maintained similar levels of peace from pre-test to follow-up, whereas patients in the control group showed a decrease in peace during the same time period. We did not find significant longitudinal changes in measures of meaning, faith, loss of meaning and purpose, distress and coping ability, existential, psychological and physical distress. The findings of our study are of relevance in palliative care and suggest the potential clinical utility of DT, since they offer evidence for the importance of this intervention in maintaining peace of mind for terminally ill patients.

Anxiety Buffer Disruption: Self-Evaluation, Death Anxiety, and Stressor Appraisals Among Low and High Posttraumatic Stress Symptom Samples

Objective: Research driven by terror management theory suggests sociocultural anxiety-buffer systems typically protect against existential anxiety, whereas anxiety buffer disruption theory suggests traumatic experiences may disrupt that process.

Method: Following posttraumatic stress (PTS) symptom screening (n = 4097), individuals with low (n = 149) and high (n = 120) PTS engaged in either negative or positive self-evaluations, then reported death anxiety and appraised life's stressors as negative/threatening or positive/challenging.

Results: When low PTS participants contemplated their worst (vs. best) selves, they experienced moderately heightened death anxiety yet appraised life's stressors as more positive/challenging than harmful/threatening, reflecting effective existential anxiety buffers. However, high PTS participants reported high death anxiety in both the best-self and worst-self conditions—indicating anxiety buffer disruption—and the worst-self (vs. best self) prompt increased their appraisal of life's stresses as a harmful threat and decreased appraisal as positive/challenging opportunities for growth and well-being.

Discussion: Theoretical and clinical implications are discussed.

Editorial Foreword: Applying Existential Social Psychology to Mental Health

Human existence is characterized by some rather unique psychological challenges. Because people can reflect on their lives and place in the world, they are regularly confronted with a variety of existential concerns: death and mortality; the burdens of freedom; uncertainty regarding one's identity; isolation from others; and indeterminate meaning in life. Existential social psychology (Greenberg, Koole, & Pyszczynski, 2004; Vail & Routledge, 2020) investigates whether and how such existential concerns shape everyday life and, as highlighted in the present special issue, how such processes impact mental health and social functioning.

Long-term efficacy of meaning-centered group psychotherapy for cancer survivors: 2-Year follow-up results of a randomized controlled trial

OBJECTIVE

Meaning-centered group psychotherapy for cancer survivors (MCGP-CS) is an effective intervention to improve personal meaning, psychological well-being, and depressive symptoms until 6 months after the intervention. In this study, the long-term effects of MCGP-CS (i.e., at 1- and 2-year follow-up) on meaning, psychological well-being and posttraumatic growth were assessed, in comparison to supportive group psychotherapy (SGP) and care as usual (CAU).

METHODS

Cancer survivors (n = 170) were randomized into MCGP-CS, SGP, or CAU. Assessments were scheduled at baseline, 1 week, 3 months, 6 months, 1 year, and 2 years postintervention. Outcome measures were the Personal Meaning Profile, Ryff's Scales of Psychological Well-Being (SPWB), the Posttraumatic Growth Inventory, and their subscales. Linear mixed models (LMM) were used and results were both reported on an intention-to-treat (ITT) basis, as well as for intervention completers only.

RESULTS

LMM and post hoc analyses with Bonferroni correction revealed that MCGP-CS participants reported more improvement on positive relations (subscale of SPWB) than CAU participants of 2-year postintervention (ITT analysis, Cohen's d = .82). Completers also reported more personal growth (subscale of SPWB) after MCGP-CS than after SGP 1-year postintervention (Cohen's d = .94). No long-term effects were found on the other outcome measures.

CONCLUSIONS

In the 2 years after MCGP-CS, the short-term significant effects on personal meaning and most positive effects related to psychological well-being faded. However, MCGP-CS had a long-term positive effect on positive relations with others and on survivors' sense of personal growth.

TRIAL REGISTRATION

Netherlands Trial Register: NTR3571.

Dynamics of Existential Personality Fulfillment in the Course of Psychotherapy

The purpose of the study is to explore the clients’ perceptions of therapeutic changes due to their existential fulfillment experience and authenticity in their relationships with the world. The content of the study reveals the subjective perceptions and experiences of clients about the changes in the understanding of themselves and the world in the course of existential psychotherapy. Consideration of the qualitative changes in a person’s life as a result of psychotherapy was based on the concept of existential fulfillment and de-sedimentation of “I-structure”. An opening up of opportunities for experiencing the fullness of human existence, as well as exploring ways of avoiding existential fulfillment, present themselves as key aspects in existential psychotherapy. Research methods are Existence Scale (A. Längle and C. Orgler); semantic differential for measuring therapeutic changes of clients in the course of existential psychotherapy; and factor analysis. Going through a psychotherapeutic experience has a positive effect on the dynamics of self-distancing indices, self-transcendence, freedom, and responsibility. The experience of existential personal fulfillment in psychotherapy leads to changes in human contact with oneself and the ability to successfully interact with the external environment. Experiencing the true existential level of living helps a person to be aware of their needs and to stay in contact with their feelings.

Correlates of perceived death competence: What role does meaning-in-life and quality-of-life play?

Objective

Understanding factors that are associated with more adaptive death attitudes and competencies can inspire future health-promoting palliative care strategies and inform approaches to training and development for health professionals. The potential importance of meaning, purpose, quality, and values in life for promoting adaptive death attitudes has been highlighted, but there is limited research in this area, particularly in relation to death competence. The purpose of this cross-sectional study was to develop an understanding of demographic and life-related factors associated with perceived death competence, such as meaning in life and quality of life.

Method

During the course enrollment period of a Massive-Online-Open-Course about death and dying, 277 participants completed questionnaires on death competence, meaning in life, quality of life, and sociodemographic background.

Result

Findings indicated that greater presence of meaning in life, quality of life, age, death experience, and carer experience were each statistically significant unique predictors of death competence scores. Life-related variables were more strongly associated with death competence than demographic variables. Bereavement experience and experience caring for the dying was associated with greater death competence, but there were no differences on death competence between health professionals and the general community. Above all other factors, the presence of meaning in life was the strongest predictor of higher perceived competence in coping with death.

Significance of results

The findings demonstrate important interconnections between our attitudes about life and death. Knowledge of factors associated with poorer death competence may help identify those at risk of greater distress when facing death, and might prove useful additions to bereavement risk assessments. Understanding factors associated with greater death competence in health professionals and volunteers may help predict or prevent burnout and compassion fatigue, and help identify who would benefit from additional training and support. Future longitudinal studies including both health professionals and the general community are needed to determine the effect adaptive attitudes toward meaning in life can potentially have on bolstering subsequent adaptive coping and competence regarding death and dying.

Existential and Mindfulness-Based Intervention to Increase Self-Compassion in Apparently Healthy Subjects (the EXMIND Study): A Randomized Controlled Trial

Objectives: Mindfulness is a method of training the regulation of attention with non-judgmental acceptance that is linked to beneficial effects on health. The existential approach supports the uniqueness of each individual and helps to provide meaning to their lives. In this randomized controlled trial, we examined whether mindfulness-based intervention (MBI) and the existential approach could be combined sequentially and whether they operated antagonistically or cooperatively. Methods: One hundred thirty-seven participants aged 20 years or older without any severe mental disorders were randomly assigned (1:1), via an envelope method, to receive either 8-week MBI (N = 68) or 4-week MBI followed by 4-week existential approach (EXMIND) (N = 69). Participants were first allocated to a waiting-list group and subsequently randomized to the MBI group or EXMIND group. The primary outcome was self-compassion scale (SCS) total scores at 0, 4, and 8 weeks during intervention or waiting. The analyses were performed by linear mixed models for both primary and secondary outcomes following the intention-to-treat principle. Results: Both MBI and EXMIND groups had significantly increased SCS total scores compared to those of the waiting group, with mean SCS total scores of 2.3 (SD 3.0) in the MBI group and 2.1 (2.9) in the EXMIND group versus 0.3 (2.2) in the waiting group. Conclusions: Our findings suggest that MBI followed by existential approach are not antagonistic and may have cooperative effects, suggesting that EXMIND may be a useful treatment.

Women who suffer from schizophrenia: Critical issues

Many brain diseases, including schizophrenia, affect men and women unequally - either more or less frequently, or at different times in the life cycle, or to varied degrees of severity. With updates from recent findings, this paper reviews the work of my research group over the last 40 years and underscores issues that remain critical to the optimal care of women with schizophrenia, issues that overlap with, but are not identical to, the cares and concerns of men with the same diagnosis. Clinicians need to be alert not only to the overarching needs of diagnostic groups, but also to the often unique needs of women and men.

Horses for courses: choosing an evidence-based psychological therapy for your patient

Choosing an intervention for a patient experiencing distressing symptoms and/or suffering with a mental disorder is part of routine practice for clinicians. While there are now many effective pharmacological and psychological therapies for mental health problems, syndromes and persistent physical symptoms (e.g. chronic pain), choosing the ‘right’ therapy can sometimes be a challenge. This can certainly be the case when it comes to psychological therapies. There are many different approaches to choose from and many have not been subjected to rigorous study.

In this article, we aim to help inform and guide the busy clinician in choosing a psychological therapy for their patient. We give a brief overview of the major psychotherapy modalities and consider which guidelines to refer to and which psychological therapies have been found to be most effective for the presenting problem(s) seen in clinic. Lastly, we discuss the limitations of the current guidelines in relation to comorbid presentations and consider how this can be best addressed.

LEARNING OBJECTIVES

•

DECLARATION OF INTEREST

D. McC. works on research trials funded by the Guy's and St Thomas’ Charity. T. C. receives salary support from the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, and receives several grants for evaluating the efficacy of different cognitive–behavioural approaches. This article received no specific grant from any funding agency, or from the commercial or not-for-profit sectors. The views expressed in this article are those of the authors and not necessarily those of the NIHR or the NHS.