Person, Population, Mechanism. A Rejoinder to Critics and an Elaboration of the Three-Branch Model.

In a previous paper (Lundh, 2023), it was argued that psychological science can be seen as having three main branches, corresponding to three levels of research: research at the person level, at the population level, and at the mechanism level. The purpose of the present paper is to discuss the critique that has been raised against this model by Lamiell (2024) and Nilsson (2024) and to elaborate and specify the three-branch model in more detail. This is done by an incorporation of Nilsson's concept of person-sensitivity into the model, and by a clearer differentiation between the two contrasts involved: (1) the methodological focus either on individual persons or on populations of individuals; and (2) the theoretical focus either on whole-person functioning or on sub-personal mechanisms.

Mindfulness, Phenomenology, and Psychological Science.

Most present-day research on mindfulness treats mindfulness as a variable that is studied in relation to other variables. Although this research may provide us with important knowledge at the population level and mechanism level, it contributes little to our understanding of the phenomenon of mindfulness as it is experienced and enacted at the person level. The present paper takes a person-oriented phenomenological perspective on mindfulness, comparing this perspective with that of von Fircks' (2023). In a first part of the paper, mindfulness is discussed as a phenomenological practice that can be studied by means of experimental phenomenology. It is argued that there is room for the development of an immense variety of personalized mindfulness practices that may serve people's health and well-being. The second part of the paper contains a brief discussion of the possible role of mindful observation and reflection in psychological research. It is argued that mindfulness skills may be important both for improving the quality of phenomenological observation and to facilitate creative thinking in connection with the development of psychological theory. A main implication is that an integration between mindfulness and phenomenology may serve as an important part of this process.

Disordered eating in a 10-year perspective from adolescence to young adulthood: Stability, change, and body dissatisfaction as a predictor.

INTRODUCTION: Although there are many studies of disordered eating (DE) in adolescence, studies examining the longitudinal stability and change of DE and its longitudinal associations with other factors are still rather scarce. Such studies are important to inform parents and clinicians how stable DE is and to what extent it will go away with increased maturity. Longitudinal studies may also be of help in establishing predictors of long-term problems. The purpose of the present study was to investigate the stability of DE over a 10-year period from early adolescence to young adulthood, and to explore body dissatisfaction as a predictor in a 10-year perspective. METHODS: Data were taken from a three-wave longitudinal project (SoL) with survey data collected among the students in Grades 7and 8 in a Swedish municipality in 2007 (T1), 1 year later (T2), and in a 10-year follow-up in 2017 (T3). DE was measured by the eight-item version of the Risk Behaviour Related to Eating Disorders (RiBED-8), and a quasi-clinical criterion of six or more critical answers on the RiBED-8 was used to classify DE cases. RESULTS: Of the girls, 5.8% passed the cutoff for DE at T1, whereas 9.1% did so at T2 and 7.9% at T3. The boys showed markedly lower figures: 0.5% both at T1 and T2, and 1.5% at T3. There was significant individual stability of DE over the 10-year period, with almost 30% of the girls who passed the cutoff for DE at T1 also doing so 10 years later. Body dissatisfaction in early adolescence predicted the incidence of new cases of DE 10 years later, even when controlling for degree of DE in early adolescence. The results also indicate that DE in early adolescence may be a passing phase among adolescents who express relatively high body satisfaction. CONCLUSIONS: The present results show a complex picture of different individual trajectories of DE, with degree of body satisfaction playing a significant role for the outcome in a 10-year perspective. Body dissatisfaction appears to be a risk factor for the development of new cases of DE, whereas body satisfaction may protect against the continuation of DE into adulthood.

Person, Population, Mechanism. Three Main Branches of Psychological Science.

There are different ways of dividing psychology into subdisciplines. The purpose of the present paper is to explore one specific meta-perspective on psychological science, seen as having three main branches: person psychology, population psychology, and mechanism psychology, linked to three different levels of research. Person-level research focuses on psychological phenomena as experienced and enacted by individual persons in their interaction with other persons and other parts of the environment, and in their development over time. Population-level research focuses on populations of individuals, frequencies of various psychological phenomena in a population, risk factors, and population-level effects of various psychological interventions. Mechanism-level research focuses on psychological functioning as explained in terms of neurophysiological mechanisms and information processes at a sub-personal level. It is argued that the failure to differentiate clearly between research questions at these three levels lead to questionable research practices. Most notably, a failure to differentiate clearly between the population level and the person level leads to problem-method mismatches in the form of researchers trying to answer questions about persons by research on populations. Also, because of a failure to differentiate between the person level and the mechanism level, explanations in terms of sub-personal mechanisms are too often seen as providing answers about what occurs at the person level, thereby failing to study persons as intentional agents in interaction with other persons and other parts of the environment. It is argued that a clear differentiation between three levels of psychological science - population, person, and mechanism - may contribute to an increased clarity in these matters and may thereby contribute to the development and maturation of psychological science.

Developmental pathways of repetitive non-suicidal self-injury: predictors in adolescence and psychological outcomes in young adulthood.

BACKGROUND: Much longitudinal research has been carried out on non-suicidal self-injury (NSSI) during the last decades, but there still is a lack of studies of the individual developmental pathways of NSSI from adolescence into young adulthood. The aim of the present study was to investigate individual developmental pathways of repetitive non-suicidal self-injury (repNSSI) from adolescence into young adulthood, including adolescent predictors and psychological outcomes in young adulthood. Three developmental pathways were targeted: stable adolescence-limited repNSSI; repNSSI prolonged into young adulthood; and late-onset repNSSI; with no repNSSI as comparison. METHODS: Data were taken from a cohort of compulsory school students (N = 1064) in grades 7-8 in a Swedish municipality. The cohort was followed longitudinally, and this study included all individuals (n = 475) with NSSI data from three waves: T1 (when they were 13-15 years old); T2 (one year later); and T3 (ten years later). RepNSSI was operationalized as self-reports of at least 5 instances of NSSI during the past six/twelve months. RESULTS: The two pathways that involved stable repNSSI were observed significantly more often than expected by chance, with the strongest overrepresentation for the Prolonged RepNSSI pathway. Still, most adolescents who engaged in stable repNSSI stopped this before reaching young adulthood. Those who stopped did not, however, show a significantly better psychological adjustment in young adulthood than those who continued. Compared to participants with no repNSSI, participants who had stopped still reported significantly more stress, anxiety, and emotional dysregulation. As to the prediction of late onset NSSI, the findings were less robust, but sporadic NSSI at T1 and poor sleep at T2 were significant predictors, whereas depressive symptoms fell just short of significance at both timepoints. CONCLUSIONS: The present results indicate that among adolescents who engage in stable adolescent repNSSI (1) significantly more individuals than expected by chance still engage in repNSSI ten years later, and (2) those who stop engaging in repNSSI do not show significantly better psychological adjustment than those who still engage in it. The present findings also indicate that late onset of repNSSI as reported in young adulthood to some extent is predictable from symptom measures ten years earlier.

Childhood maltreatment and self-hatred as distinguishing characteristics of psychiatric patients with self-harm: A comparison with clinical and healthy controls.

INTRODUCTION: Deliberate self-harm (DSH) is common in clinical populations. Childhood maltreatment (CM) and attitudes both towards oneself and towards DSH may be of importance for the development of DSH. This study aimed to test whether patients with DSH report more CM, more negative attitudes towards oneself and more positive attitudes towards DSH than a clinical and a healthy comparison group, and whether the effects of CM are mediated by negative attitudes towards oneself. METHOD: Females with DSH and psychiatric disorders (n = 34), females without DSH but with psychiatric disorders (n = 31) and healthy female individuals (n = 29) were compared regarding DSH, CM, attitudes towards the self and attitudes towards self-harm. RESULTS: Females with DSH reported more emotional abuse and more self-hatred as compared to both comparison groups. The effect of emotional abuse was mediated by self-hatred. The DSH-group had significantly more positive attitudes towards DSH than the healthy comparison group. CONCLUSION: Self-hatred and CM in the form of emotional abuse may be distinguishing characteristics of female patients with DSH in psychiatric settings. The present results are compatible with the hypothesis that emotional abuse leads to DSH via self-hatred, but the cross-sectional nature of the study precludes any causal conclusions. The clinical utility of the results is discussed.

The emancipation of mindfulness from its religious context.

The present paper argues that if the so-called mindfulness movement is to reach its full potential it needs to emancipate from its religious context and ally itself fully with psychological science. The argument that mindfulness meditation needs a religious context for ethical reasons is untenable. Although mindfulness skills may well be used for un-ethical purposes, this applies equally to both religious (e.g., Buddhist) and secular contexts, and is best handled by an open-minded philosophical-ethical discussion. One problem with present mindfulness-based treatments and mindfulness research is that they are still partly enmeshed with Buddhist conceptualizations of the world, which are thought to represent "seeing things as they are". If the full potential of mindfulness meditation is to be understood, research methods are needed which focus on the phenomenological practices involved in terms of psychological processes such as the regulation of attention and attitudes.

Functional Disability in Psychiatric Patients With Deliberate Self-Harm as Compared to a Clinical Control Group.

Background: Deliberate self-harm (DSH) is a common behavior in psychiatric populations. However, little is known regarding how DSH impacts daily life. The concept of functional disability, adopted by the World Health Organization (WHO), refers to the impact of disorders on six domains of daily functioning. The aim of the current study was to explore the functional disability of psychiatric patients with DSH as compared to a psychiatric control group. Methods: 32 psychiatric patients with DSH and 31 psychiatric patients without DSH were assessed with regards to demographic information, functional disability, psychiatric illness, DSH, general cognitive functioning, and measures of psychopathology. Group comparisons were made by means of t-tests, Mann-Whitney-tests, and Chi-square tests. Correlation analyses were done to assess the association between measures of psychopathology and functional disability. Results: The results indicated that patients with DSH had a lower ability to self-care as compared to the patients without DSH (p = 0.001, d = 0.90). Also, the patients with DSH reported a significantly higher number of days when they were totally unable to carry out usual activities in the past month (p = 0.008, d = 0.70) and that they were admitted in an inpatient setting significantly more days over the past year compared to the patients without DSH (p < 0.001, d = 0.58). The group with DSH was significantly younger (t = 3.00, p = 0.004) and reported significantly more BPD-symptoms (p = 0.013, d = 0.64) as well as higher current suicidality (p < 0.001, d = 1.32) compared to the group without DSH. The group with DSH also included a significantly higher number of patients diagnosed with borderline personality disorder (χ2 = 13.72, p < 0.001). There were no differences between the groups regarding general cognitive functioning or severity of depression. More research is needed to understand the underlying factors involved.

Persons and Genes. Is a Gene-Centered Evolutionary Psychology Compatible with a Person-Oriented Approach to Psychological Science?

According to Zagaria et al. (2020), evolutionary psychology may be the meta-theory that is needed if psychological science is to enter a paradigmatic stage. Other writers have suggested that what is needed is a person-oriented approach, which focuses on the person as a complex system that needs to be studied (1) as a whole (holism), (2) as an intentional agent in interaction with its environment (interactionism), and (3) in terms of his or her individual characteristics and development (idiographic focus). The purpose of the present paper is to discuss the compatibility of these two suggestions. A brief analysis of some formulations central to Dawkins' gene-centered approach (e.g., "the intricate interdependence of genes", and the dependence of genes on their environment) suggests that it is quite compatible with holism and interactionism; and applications such as genetic genealogy illustrate the possibility of a person-oriented genetics. It is argued that these two perspectives are not only compatible, but also complementary. Without a complement in the form of a person-oriented perspective, a gene-centered evolutionary psychology will at best be able to produce a general understanding of the psychological potentials that inhere in the human gene pool. It will not, however, lead to any understanding of the unique profiles of psychological potentials that are produced by a re-combination of autosomal DNA at the origin of each specific individual person, and that develop over time in interaction with the environment. The latter requires that the gene-centered view is complemented with a person-oriented approach.

What happens to young adults who have engaged in self-injurious behavior as adolescents? A 10-year follow-up.

This study examined the longitudinal associations between non-suicidal self-injury (NSSI) in early adolescence and various positive and negative aspects of mental health in young adulthood. The participants were a cohort of regular school students (n = 1064) in grades 7-8 from a Swedish municipality. Nine hundred and ninety-one of these completed an 11-page questionnaire (T1: Mage = 13.7; 50.3% girls); 1 year later, 984 students completed the questionnaire again (T2: Mage = 14.8; 51.1% girls); and 10 years later, 557 took part (T3: Mage = 25.3; 59.2% women). The prevalence of any NSSI (≥ 1 instance) decreased from about 40% in adolescence to 18.7% in young adulthood, while the prevalence of repetitive NSSI (≥ 5 instances) decreased from about 18 to 10%. Compared to individuals who reported no NSSI as adolescents, and controlling for gender and psychological difficulties in adolescence, adolescents with stable repetitive NSSI (i.e., repetitive NSSI at both T1 and T2) showed significantly higher levels of stress, anxiety, NSSI, and difficulties in emotion regulation 10 years later. Even infrequent and unstable repetitive NSSI in adolescence was associated with negative outcomes in young adulthood. These results suggest that stable repetitive NSSI in adolescence is a strong risk factor for mental health problems in young adulthood and that occasional engagement in NSSI in adolescence is an indicator of vulnerability for poorer mental health in young adulthood.

Experimental Phenomenology as an Approach to the Study of Contemplative Practices.

During history humans have developed a large variety of contemplative practices, in many different areas of life, and as part of many different traditions and contexts. Although some contemplative practices are very old, the research field of Contemplation Studies is young, and there are no agreed-upon definitions of central concepts such as contemplative practices and contemplative experiences. The present paper focuses on contemplative practices, defined as practices that are engaged in for the sake of the contemplative experiences they afford (e.g., the contemplation of nature, or the contemplation of various aspects of being-in-the world). The purpose of the present paper is to discuss the potential of experimental phenomenology to contribute to the development of the research field of Contemplation Studies. Experimental phenomenology is defined as the investigation of phenomenological practices and their effects on experience. Phenomenological practices involve intentional variations of experiencing by means of changes in the direction of attention and the choice of attitude, typically as guided by verbal instructions or self-instructions. It is suggested that contemplative practices represent a subcategory of phenomenological practices. Two different varieties of experimental phenomenology are described and illustrated in the present paper: (1) an informal variety which involves the development of new phenomenological practices by creative variation of procedures and observation of effects; and (2) a more rigorously scientific variety, which involves the systematic variation of phenomenological practices in accordance with experimental designs to study their experiential effects. It is suggested that the development of contemplative practices during the ages is the result of an informal experimenting of the first kind; this variety of experimental phenomenology can also be used to develop personalized health interventions in a clinical setting. As to the more rigorously scientific experimental phenomenology, it is possible that it may lead not only to an improved understanding of general principles underlying contemplative practices, but also to a more systematic development of new contemplative practices. The experimental-phenomenological approach to contemplative practices is illustrated by various examples involving mindfulness, gratitude, receiving and giving.

Adolescents' Emotion Regulation Strategies Questionnaire: Initial Validation and Prospective Associations With Nonsuicidal Self-Injury and Other Mental Health Problems in Adolescence and Young Adulthood in a Swedish Youth Cohort.

Although there is extensive research indicating the vital role of functional emotion regulation (ER) in healthy psychological development, such research has neglected examination of adolescents. One potential reason for this neglect is the lack of valid ER instruments developed specifically for adolescents. Further, the available ER instruments for adolescents usually require elaborate forms of cognitive reasoning about the internal sequences of cognitions and emotions. To address these limitations, we developed the Adolescents' Emotion Regulation Strategies Questionnaire (AERSQ), a self-report instrument of adolescents' commonly used ER strategies in daily life and examined its psychometric characteristics in a 10-year, three-wave cohort of Swedish youths (original N = 991, mean age = 13.7, 14.8, and 25.3 at waves 1, 2, and 3, respectively). Exploratory (wave 1 data) and confirmatory (wave 2 data) factor analyses revealed a five-factor structure for the AERSQ: rumination/negative thinking, positive reorientation, communication, distraction, and cultural activities. We observed gender differences for most ER strategies in adolescence. We also evaluated the associations between the AERSQ subscales and mental health (self-harm; psychological difficulties including hyperactivity, conduct problems, emotional problems, and peer problems; prosocial behavior; depression; anxiety; stress; flourishing; and life satisfaction) across the three time points. Rumination/negative thinking had the strongest relationships with these mental health indicators, both cross-sectionally and longitudinally, in both genders. Distraction and cultural activities were less related to mental health, especially prospectively. Although the AERSQ showed good test-retest reliability and predictive validity over a 10-year period, the low internal consistency of two of its subscales (distraction and cultural activities) indicates that it may benefit from further development both in terms of the included items and psychometric testing.

"Voluntarily Admitted Against My Will": Patient Perspectives on Effects of, and Alternatives to, Coercion in Psychiatric Care for Self-Injury.

INTRODUCTION: Various forms of coercion are used in the psychiatric care of patients with self-injurious behaviors, but there is little research on how these are perceived by the patients. The aim of this study was to investigate how 6 patients, who had received care for self-injurious behavior, perceived coercion and how they think coercion could be avoided. METHODS: This study employed a qualitative design with 6 semistructured interviews and interpretative phenomenological analysis. RESULTS: Three main themes were identified: keep voluntary care voluntary, apportioning control and responsibility, and dialogue and participation. Constant supervision was described as the most destructive form of coercion. To enable self-responsibility, a reduction of control and supervision was advocated. Calls were made for a treatment based on the assumption that there is a desire, on behalf of the patients, to get better. CONCLUSIONS: The use of coercion in the psychiatric care of patients with self-injurious behavior can be reduced by increasing predictability, by listening to the patient with genuine interest, and by involving the patient in decisions regarding their treatment.

Family Connections in different settings and intensities for underserved and geographically isolated families: a non-randomised comparison study.

BACKGROUND: Family Connections (FC) is a multi-family skills training program for relatives of individuals with borderline personality disorder (BPD) and related difficulties, typically offered once per week for 12-14 weeks. Families with loved ones receiving residential Dialectical Behaviour Therapy DBT (DBT-R) in a different community, or those with multiple caregiving demands may have difficulty participating in weekly standard FC (FC-S). The aims of this paper are to: 1) Evaluate the results of the FC-S approach compared with an intensified weekend FC model developed for family members whose relatives are in DBT-R (FC-R); 2) Evaluate outcomes of FC-R for families with loved ones returning home from DBT-R, as little is known about how this population fares. METHODS: Data were collected at pre-treatment (T1), post-treatment (T2), and at six-to-seven-month follow-up (T3) in this non-randomized comparison study. A total of 82 family members participated, 34 of whom completed the FC-S program and 48 of whom completed the FC-R program. The evaluation was based upon outcomes derived from a standard battery used in FC research, analyzed by time and treatment setting. A composite score to evaluate family distress was generated. Two-way mixed multivariate analyses of variance (MANOVA) were employed to evaluate time (pre-versus-post versus follow-up) and group (FC-S versus FC-R). RESULTS: Scores on measures of mental health difficulties (General Severity Index), sense of burden (Burden Assessment Scale), and Global Family Functioning showed improvement over time. Having a loved one return home from DBT-R was associated with worsening on the GSI and the BAS at post-test. Notably, this deterioration was not found at follow-up. CONCLUSIONS: Little is known about families with loved ones receiving DBT-R other than the fact that their loved ones had not responded to previous services, which suggests greater complexity and chronicity. Because the family members receiving the weekend intensive FC-R version of FC demonstrated improvement, preliminary support exists for service providers to use the weekend intensive FC-R model as a time-and-cost efficient option whenever barriers exist to participating in weekly FC-S. Our findings also suggest that booster sessions may be indicated for families receiving loved ones home from DBT-R programs.

Effectiveness of guided internet-delivered cognitive behavior therapy for depression in routine psychiatry: A randomized controlled trial.

Depression is one of the most common health problems worldwide but is often undertreated. Internet-delivered cognitive behavioral therapy (ICBT) appears to be an effective treatment option, with the potential to reach a larger proportion of individuals suffering from depression. While many studies have examined the efficacy of ICBT for depression in randomized controlled trials, fewer have focused on the effectiveness of ICBT when used as an integral part of routine health care. In this study the effectiveness of an 8-week ICBT program was examined when delivered in a routine psychiatric setting. A total of 108 patients were referred and 54 were then included and randomized to either ICBT or a waitlist control condition. The sample had a lower education level and a higher proportion of individuals were on sick leave than comparable previous efficacy trials of ICBT for depression conducted in Sweden. Measures assessing depression, anxiety and psychiatric symptoms were administered before and after treatment, follow up was performed at 6- and 12 months after treatment had ended. ICBT resulted in significant reductions of depressive symptoms in the treatment group when compared to a waitlist control group with a large effect size (Cohen's d = 1.6). Treatment gains were maintained at 6- and 12 months after the treatment had ended. In terms of clinical significance, 58% of the sample had improved or recovered after treatment. The study was small, and patients received general psychiatric care after the ICBT treatment had ended which limits the implications. We conclude that ICBT appears to be an effective treatment for depression when delivered as an integral part of routine psychiatric care.

Imagery rescripting of early memories in health anxiety disorder: A feasibility and non-randomized pilot study.

BACKGROUND AND OBJECTIVES: Health anxiety is a common problem and is associated with frequent primary care visits, increased health care costs, and poor prognosis and low recovery rates. Previous research shows that imagery rescripting (IR) is a promising treatment technique for various disorders. To date, IR has not been examined as a viable treatment for health anxiety. The purpose of the present feasibility and pilot study was to test one session of IR of early anxiety-laden health-related memories in a small sample of patients suffering from HA. METHODS: A within-groups design was used with a sample of 18 patients suffering from HA, who first underwent a control condition (reading about CBT), and then one week later a session of IR. After another week, the effects were measured on self-reported health anxiety and early anxiety provoking health-related mental images (memories). RESULTS: After the IR intervention, significant reductions of health anxiety and health worry, as well as image and memory distress, vividness and frequency were observed. LIMITATIONS: Among the most important limitations are the absence of an active control group, the small size of the sample, the absence of a longer follow-up, and the use of only self-report measures. CONCLUSIONS: The results suggest that IR is a feasible technique in the treatment of health anxiety, and that more controlled research along these lines may be worthwhile.

Brief Therapist-Guided Exposure Treatment of Panic Attacks: A Pilot Study.

A three-session therapist-guided exposure treatment was tested in a consecutive series of eight primary health care patients suffering from panic attacks who specifically used distraction techniques as their primary safety behavior. The Panic Disorder Severity Scale Self-Report (PDSS-SR) was administered at baseline (1-3 weeks before the first session), and 1, 2, and 3 weeks after treatment. Weekly ratings on the Body Sensations Questionnaire (BSQ) and the Agoraphobic Cognitions Questionnaire (ACQ) during treatment were undertaken to explore when reliable change took place on these measures. The results showed a large within-group effect size on PDSS-SR ( d = 1.63); six of the eight patients were classified as responders, and four of them showed remission. Large effect sizes ( ds between 1.17 and 3.00) were seen also on BSQ and ACQ, as well as on agoraphobic avoidance, general level of anxiety, and depression. The results on BSQ and ACQ suggest that the fear of body sensations in most cases was reduced before a change occurred in agoraphobic cognitions. These results indicate that a brief three-session exposure-based treatment may be sufficient for this subgroup of panic patients. The findings need to be replicated under controlled conditions with larger samples and different therapists before more firm conclusions can be drawn. Future research should also focus on the relevance of dividing patients into subgroups based on type of safety behavior.

Countertransference in Swedish psychotherapists: testing the factor structure of the Therapist Response Questionnaire.

Questionnaires need testing of reliability and factor structure before clinical use or research in new languages or cultures. The aim of this study was to evaluate the Therapist Response Questionnaire (TRQ) in Sweden compared to corresponding factor analyses in USA and Italy. A national sample of psychotherapists (N=242) registered their countertransference with a single client using TRQ. The data were analyzed with confirmatory factor analysis (CFA) to test factor structures from previous studies, and exploratory factor analysis (EFA). The CFA did not verify the factor structure from the previous studies. The EFA extracted seven factors as the best solution: Helpless/Inadequate, Overwhelmed/Disorganized, Hostile/Angry, Parental/Protective, Disengaged, Special/Overinvolved, Sexualized. Analysis of convergent validity indicated that five of these could be considered equivalent to factors in the previous studies, and the remaining two were conceptually related to corresponding factors. Even though the factor structure was not confirmed by the CFA, the concordance was large, indicating a reliable self-report instrument with promising validity for measurement of complex aspects of countertransference. Common countertransference themes can inform psychotherapy supervision and education, give feedback to the therapist, and lay ground for a taxonomy for therapist reactions and feelings.