Although psychological science has contributed enormously to our understanding of the development of psychopathology and to interventions to treat psychiatric disorders, it has not successfully reduced the burden of mental illness in American communities. Factors include the lack of a mandate of population impact, stigma attached to mental health intervention, difficulty scaling up interventions, and problems in financing prevention. The concept of primary mental health care is introduced as a possible solution; components could include universal reach, universal brief interventions, screening and referral, ongoing support to all individuals, an infrastructure of specialized services, and an integrated data system. Promising examples of the primary mental health care approach are described, including PROSPER, Communities That Care, Triple P, Family Check-Up, HealthySteps, Family Connects, and Community Navigation. For these efforts to succeed, challenges must be overcome in labor force participation, reaching the full population, novel approaches to delivery of interventions, cultural adaptation, community-level interventions, financing, and scientific inquiry.

In this career-review-as-memoir, I interweave the deeply personal/familial roots of my abiding interests in developmental psychopathology, clinical trials, and reduction of mental illness stigma and discrimination with an overview of my variegated research on youth and young adults. I also discuss mentoring, teaching, lab-building, leadership, collaboration, synthesis, and serendipitous ideas. Lived experience and personal interest can and should inform discovery phases of scientific efforts, whereas objectivity and disinterest are essential for justification aspects. My long-term aim has been to bridge science and humanization. Although progress in clinical psychology is apparent, even passing recognition of current mental health challenges-especially for adolescents/young adults-provides an urgent call for () integration of genetic/biological risk with contextual and cultural factors; () provision of supportive settings, plus evidence-based treatments, for individuals and families in need; and () recruiting and mentoring new generations of scholar-clinicians who will continue these essential efforts.

Clinical psychological assessment often relies on self-report, interviews, and behavioral observation, methods that pose challenges for reliability, validity, and scalability. Computational approaches offer new opportunities to analyze expressive behavior (e.g., facial expressions, vocal prosody, language use) with greater precision and efficiency. This review provides an accessible conceptual framework for understanding how methods from computer vision, speech signal processing, and natural language processing can enhance clinical assessment. We outline the goals, frameworks, and methods of both clinical and computational approaches and present an illustrative review of interdisciplinary research applying these techniques across a range of mental health conditions. We also examine key challenges related to data quality, measurement, interdisciplinarity, and ethics. Finally, we highlight future directions for building systems that are robust, interpretable, and clinically meaningful. This review is intended to support dialogue between clinical and computational communities and to guide ongoing research and development at their intersection.

Fear extinction is foundational to exposure therapy; therefore, the study of strategies to optimize fear extinction is relevant for clinical practice. This article provides a critical review of translational research on pharmacological enhancement of fear extinction, concentrating mostly on d-cycloserine, the agent with the most extensive evidence base across levels of analyses. Despite early promise, results across preclinical, human laboratory, and clinical trials have been mixed. We identify factors that may account for these inconsistent findings, including differences in study design, selection of subjects, sample size, and measurement approaches. We emphasize the need for a rigorous mechanistic research agenda that both assesses extinction processes-acquisition, consolidation, and retrieval-as distinct mechanistic targets and examines the relation between changes in these fear extinction processes and clinical outcomes. Finally, we discuss opportunities to advance translational research in this area by leveraging extant collaborative infrastructures to improve the quality, the efficiency, and ultimately the availability of effective clinical strategies.

Schizophrenia-spectrum disorders (SSD) are characterized by interruptions in one's sense of self, cognitive dysfunction, disorganized thinking, belief inflexibility, and unusual experiences such as hallucinations and delusions. Disruptions in metacognition-skill in reflecting upon one's own and other's thought processes-have increasingly been viewed as a core foundation of these features of SSD. We focus this review on Metacognitive Reflection and Insight Therapy (MERIT) and Metacognitive Training (MCT), two metacognitive therapies for SSD designed to improve integration in perceptions of self and others, and to gain greater awareness of biases and the fallibility of cognitions, respectively. We explicate their theoretical underpinnings, treatment targets, and commonly used techniques and summarize their evidence base. We also provide a brief overview of two related therapies, cognitive remediation and cognitive behavioral therapy, with a focus on identifying their metacognitive components, and we compare mechanisms of action, efficacy, and evidence base across these different approaches.

Youth suicide remains a leading cause of death in the United States and is especially pronounced in populations that have been historically underserved. Multipronged public health strategies aimed at addressing suicide may be particularly effective in pediatric medical settings, as most youth who die by suicide have visited a health care provider prior to their death. The finding that most youth suicide decedents have no mental illness diagnosis further underscores the importance of screening. This review highlights universal screening as a strategy to improve detection and management of at-risk youth. We present current research on evidence-based screening tools, clinical pathways to support the feasibility and fidelity of screening, brief interventions for managing positive screens, issues regarding screening and health equity, considerations for diverse populations, current innovations, and future directions for research and clinical practice. Evidence supports universal suicide risk screening through feasible clinical pathways that leverage pediatric health care providers as partners in suicide prevention.

Research based on intensive longitudinal data (ILD)-consisting of many repeated measures from one or multiple individuals-is rapidly gaining popularity in psychological science. To appreciate the unique potential of ILD research for clinical psychology, this review begins by examining how our three traditional research approaches fall short when the goal is to investigate processes. It then explores how the analysis of ILD can be used to study a process as it unfolds within a specific person over time but also to study average process features or individual differences therein. By emphasizing the alignment between research questions, data collection, and analytical strategies, the potential of ILD research is further highlighted. It is argued that for future progress it is essential to integrate machine learning and causal inference methods with statistical techniques for ILD and to become more explicit about timescales, time frames, and dynamics in psychological theories.

As the numbers of older adults continue to increase globally, the need for facilitating healthy aging has become critical. While a physically healthy lifestyle, including exercise and diet, is important, recent research has highlighted a major impact of psychosocial determinants of health, such as resilience, wisdom, positive social connections, and mental well-being, on whole health. This article focuses on keeping the mind and brain healthy with psychosocially active aging. It has six sections: Philosophy Concepts of Wisdom, Resilience, and Well-Being; Wisdom: Clinical, Neurobiological, and Evolutionary Perspectives; Resilience, Adaptation, and Augmentation; Psychological Resilience, Brain Health, and Whole Person Health; Preventing Depression and Promoting Resilience and Well-Being in Old Age; and The Centenarian as a Model of Resilience and Well-Being. We discuss the biopsychosocial mechanisms and effectiveness of healthy lifestyle strategies and propose a framework for future research and its practical implications for promoting wisdom, resilience, and well-being at the individual, societal, and policy levels.

Climate change negatively threatens mental health through acute, chronic, indirect, and vicarious pathways. Though these psychological consequences will be felt globally, specific populations are at increased risk. This article describes the complex and diverse ways in which climate change can affect mental health and the resulting challenges that health care services will inevitably face. In responding to these threats, both prevention and intervention are urgently needed. Although mitigating the extent of climate change is crucial, we can also foster resilience to climate change-the ability to manage, respond to, and prepare for climate-related adversity-at the systemic, community, and individual levels. The mental health field must prepare for the significant burden that climate change will place on population health and well-being in the long term. In this review, we aim to inform and provide examples of how decision makers, the mental health discipline, and mental health professionals can respond.

Researchers, interventionists, and clinicians are increasingly recognizing the importance of structural stigma in elevating the risk of mental illnesses (MIs) and substance use disorders (SUDs) and in undermining MI/SUD treatment and recovery. Yet, the pathways through which structural stigma influences MI/SUD-related outcomes remain unclear. In this review, we aim to address this gap by summarizing scholarship on structural MI/SUD stigma and identifying pathways whereby structural stigma affects MI/SUD-related outcomes. We introduce a conceptual framework that describes how structural-level stigma mechanisms influence the MI/SUD treatment cascade via () interpersonal- and individual-level stigma mechanisms and () mediating processes among people with MI/SUD (i.e., access to resources, psychological responses, behavioral responses, social isolation). We consider intersections between MI/SUD stigma and stigma based on race/ethnicity, gender identity, and sexual orientation. Finally, we discuss the implications of this review for future research, interventions, and clinical practice.

Autism is a neurodevelopmental condition that affects individuals worldwide throughout their lives. Copious advances in research have enhanced our understanding of autism significantly since Dr. Leo Kanner's first description of the condition in 1943. This review aims to provide an overview of our current knowledge of autism, examining its manifestations across age, race, gender, and co-occurring conditions (e.g., intellectual disability) from childhood through adulthood. We also focus on the identification and diagnosis of autism, long-term outcomes with a spotlight on adulthood, and appropriate supports and interventions across different developmental stages for autistic individuals and their families. We stress the importance of a lifespan perspective that considers the evolving needs of individuals with autism as they age, and we highlight the role of longitudinal research.

Most people with mental health needs cannot access treatment; among those who do, many access services only once. Accordingly, single-session interventions (SSIs) may help bridge the treatment gap. We conducted the first umbrella review synthesizing research on SSIs for mental health problems and service engagement in youth and adults. Our search yielded 24 systematic reviews of SSIs, which included 415 unique trials. Twenty reviews (83.33%) reported significant, positive effects of SSIs for one or more outcomes (anxiety, depression, externalizing problems, eating problems, substance use, treatment engagement or uptake). Across 12 reviews that meta-analytically examined SSIs' effectiveness relative to controls, SSIs showed a positive effect across outcomes and age groups (standardized mean difference = -0.25, 2 = 43.17%). Per AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews), some methodological concerns emerged across reviews, such as low rates of preregistration. Overall, findings support the clinical utility of SSIs for certain psychological problems and populations. Implementation research is needed to integrate effective SSIs into systems of care.

Major depressive disorder (MDD), bipolar disorder, and schizophrenia involve disruptions in processing rewarding stimuli. In this review, we propose that distinct mechanistic pathways underlie these disruptions in mood disorders versus schizophrenia, and we highlight the importance of understanding these differences for developing personalized treatments. We summarize evidence suggesting that reward processing abnormalities in mood disorders are driven by dysregulated motivational systems; MDD is characterized by blunted responses to reward cues, and bipolar disorder is characterized by heightened responses. In contrast, we argue that reward processing disruptions in schizophrenia do not reflect abnormalities in motivation or hedonic experience; rather, they reflect impairments in the cognitive representation of past and future rewards as well as misdirected attention to irrelevant stimuli. To integrate these findings, we present a neurodevelopmental framework for the onset of mood and psychotic disorders and explore how disruptions in normative brain development contribute to their pathophysiology, timing, and onset. Additionally, we move beyond viewing these conditions as homogeneous disorders and discuss how reward processing profiles may align with specific symptom dimensions.

A global mental health crisis is threatening a generation of young people with a lifetime of symptoms that do not fit neatly into diagnostic systems. Optimal decisions regarding treatments, services, research, and policies are critically needed, yet such decisions are based on idiosyncratic categorization of clinical courses. This review suggests clinical staging approaches may unite mental health stakeholders around shared targets to reduce mental illness. It first presents key approaches to clinical staging and then outlines how clinical knowledge has been translated into a unified transdiagnostic staging heuristic and clinical service structure over the past 30 years. Directions for short-, medium-, and long-term action are recommended with global community engagement. With investment from the mental health community, staging could reduce suffering through the use of an ethical, organized, and targeted system of communication.

Almost all countries in the world have witnessed a rapid increase in levels of economic inequality, a measure of the distribution of income and wealth across the population, since the advent of neoliberal economic policies in the 1970s. In this review, we conceptualize inequality as an ecological construct and discuss why it matters for the mental health of populations and for individual clinical outcomes. We then discuss some of the key mechanisms through which economic inequality influences mental health beyond poverty itself: social comparison and social capital. We also consider how the effect might vary across specific vulnerable groups in the population, such as young people and minoritized communities. Finally, we discuss methodological challenges in studying the relationship between inequality and mental health and conclude by outlining future research directions and possible interventions at the governmental, community, and individual levels to mitigate the negative mental health consequences of economic inequality.

Moral injury (MI) is a potential clinical problem characterized by functionally impairing moral emotions, beliefs, and behaviors as well as adverse beliefs about personal or collective humanity and life's meaning and purpose. MI can arise from personal transgressive acts or from being a victim of or bearing witness to others' inhumanity. Despite widespread interest in MI, until recently, there was no reliable measure of MI as an outcome, and prior research has revealed little about its causes, consequences, and intervention approaches. This review provides background information on the history of MI, defines key terms, and critically reviews assessment tools. Additionally, we describe a social-functional theory of the etiology of MI and a social-functional rehabilitation approach to treatment. This treatment approach, which can be used by any clinician regardless of clinical context, employs cross-cutting change agents to promote lasting corrective and humanizing prosocial experiences, enhancing belonging through valued actions and relationships.

Implementation science aspires to equitably accelerate the uptake of clinical research into practice to improve population health. The focus of implementation science includes individual behavior change mechanisms that are similar to those that drive the field of clinical psychology. For this reason, clinical psychologists are well-suited to take up implementation science methods in pursuit of improving the quality of behavioral health care. To do so, clinical psychologists must expand beyond individual behavior change to include a focus on organizations and systems. In this review, we reflect on ways that clinical psychologists can lead in the integration of implementation science principles and approaches into clinical psychology research and practice. We discuss the role clinical psychologists play in closing know-do gaps in behavioral health and describe how clinical psychologists can build implementation science competencies. We end with current controversies and opportunities for innovation to further improve the quality of behavioral health care.

The personality disorders are said to be at the vanguard in the shift to a dimensional model of classification, as exemplified in the Alternative Model of Personality (AMPD) presented in Section III of the fifth edition of the (DSM-5) for emerging models and in the 11th edition of the (ICD-11). Considered herein are some limitations and challenges. For the DSM-5 AMPD trait model, these include problematic placements, inadequate coverage, perceived complexity, and lack of cutoff points. For the DSM-5 AMPD Level of Personality Functioning (LPF), they include the complexity, the questionable presumption that the LPF defines the core of personality disorder, the presumption that the LPF identifies what is unique to the personality disorders, and the premise that the LPF is distinct from the maladaptive traits. Limitations and challenges of the ICD-11 model are the absence of lower-order facet scales and the fact that only the level of severity is required. This review suggests that the trait of depressivity belongs with negative affectivity and suspicion belongs within antagonism, that maladaptive traits from all 10 poles of the five domains should be provided, and that cutoff points based on social-occupational impairment and/or distress should be provided. The review summarizes research that questions whether the LPF represents the core of personality disorder, identifies what is unique to the personality disorders, and is distinct from maladaptive traits. Finally, the review suggests that the ICD-11 should require the assessment of the traits and include facet scales.

Anxiety and anxiety-related disorders are, as a group, the most common mental health conditions and are more common among women compared with among men. It is now evident that these disorders affect one in five pregnant and postpartum people and are more common than depression. For some disorders (e.g., obsessive-compulsive disorder), there is also evidence of an elevated risk for their development and exacerbation during perinatal periods. In this article, we review the literature pertaining to anxiety and anxiety-related disorders during the perinatal period. We also provide information related to pregnancy-specific anxiety and fear of childbirth constructs that exist outside of diagnostic classification but are particularly important in the perinatal context. We review the scope, prevalence, and etiology of these disorders as well as comorbidity, screening, assessment, and treatment. We conclude with an overview of some of the key gaps in knowledge and recommendations for future research.

Personality traits involving negative affect, as well as mental disorders including depression, anxiety, and posttraumatic stress disorder, are cardiovascular risk factors. However, which of these confer risk independently is uncertain, and the implications of their overlap, combinations, and interactions are poorly understood. Potential explanatory mechanisms are being characterized with increasing detail and sophistication. Of particular interest are psychobiological processes initiated by stress. Other mechanisms involve stress-related health behaviors, and illness behaviors that delay or reduce the effectiveness of medical treatment. With some promising exceptions, findings of intervention trials are uncertain regarding the effectiveness of psychological treatments for modifying affective traits and mental disorders to reduce their impact on cardiovascular disease. Recent developments include novel conceptualizations of mental disorders; examination of the interplay between cognitive factors and emotion; and theoretical frameworks that integrate psychological stress processes with neuroscience, health behavior, and social cognition. Also promising is increased attention to the roles of gender identity and minority group membership.

This article provides an overview of the current state of assessment and clinical intervention approaches for youth with juvenile legal system (JLS) involvement. The review includes () a brief overview of characteristics of youth with JLS involvement; () current screening and assessment frameworks within the JLS that identify treatment needs; () an overview of effective clinical interventions for common behavioral health concerns among youth with JLS involvement, including information about tailoring interventions to address the multiple intersecting identities (e.g., race, ethnicity, gender identity, sexual orientation) of youth within the JLS; and () an overview of implementation models and scalability of interventions.

Individuals from minoritized racial/ethnic groups face a disproportionate burden of Alzheimer's disease and related dementias. This health inequality reflects structural racism, which creates and sustains racial differences in social determinants of health, including education access and quality, economic stability, social and community context, neighborhood and built environment, and health care access and quality. Thus, understanding pathways that lead to dementia inequalities requires addressing individual- and system-level factors. This article summarizes evidence linking each social determinant of health to racial/ethnic inequalities in dementia, emphasizing upstream factors and mechanisms as potential levels of intervention. The importance of resilience in marginalized groups as well as critical research considerations for dementia inequalities are also discussed. Future directions highlight the need to understand the common and unique mechanisms driving inequalities across minoritized groups, where research is lacking.

The United States has one of the highest rates of correctional supervision among all nations in the world, reflecting the disproportionate incarceration of racial minorities and economically disadvantaged groups. Scholars have emphasized the role of structural factors and governmental policies in long-term shifts in crime and incarceration. However, much of the psychological research on crime and antisocial behaviors has not deeply considered this broader context, focusing mostly on individual and proximal environmental risk factors. This article presents a novel synthesis of large cross-disciplinary literatures that have not been previously integrated. After a brief summary of dominant themes in psychological research on the topic, we review the strong evidence, primarily from fields outside of psychology, for structural forces that explain pathways into criminal justice involvement, independent of individual-level explanations. A broader ecological framework is outlined to help unconfound individual and structural influences, with the hope of motivating policy change that is evidence-based and equitable.

Research on the disparity in common mental health problems borne by sexual minority individuals has entered a stage of increasing theoretical complexity. Indeed, such a substantial disparity is likely not determined by a singular cause and therefore warrants diverse etiological perspectives tested with increasingly rigorous methodologies. The research landscape is made even more complex by the constant and rapid shift in the ways in which sexual minority people understand and characterize their own identities and experiences. This review introduces readers to this complexity by summarizing the historical legacy of research on the sexual orientation disparity in mental health, describing five contemporary theoretical explanations for this disparity and their supporting evidence, and suggesting theoretically informed interventions for reducing this disparity. Last, we offer an agenda for future research to accurately model the complexity of the pathways and solutions to the disproportionately poorer mental health of sexual minority populations.

Obsessive-compulsive disorder (OCD) and eating disorders (EDs) are highly comorbid. Despite the high comorbidity, there is little understanding of why these disorders coexist and even less research on how to best treat this co-occurrence. In this article, we review the literature on comorbid OCD-ED and discuss potential underlying shared mechanisms, including anxiety/avoidance, perfectionism, intolerance of uncertainty, habit formation, disgust, shame and guilt, rumination, metacognitive beliefs, and shared biological characteristics. We then discuss prior models of OCD-ED comorbidity and shift the perspective from latent or categorical models to dimensional symptom models (e.g., network models). We describe how dimensional symptom models could advance the conceptualization, treatment, and prevention of comorbid OCD-ED. Next, we discuss how idiographic (one-person) symptom models could advance personalized treatment and provide a treatment example. Finally, we discuss future research needed to advance the field and improve treatment outcomes.

The opioid crisis, driven by illicitly manufactured fentanyl, presents significant challenges in treating opioid use disorder (OUD) and opioid withdrawal syndrome. Fentanyl is uniquely lethal due to its rapid onset and respiratory depressant effects, driving the surge in overdose deaths. This review examines the limitations of traditional diagnostic criteria like those of the , Fifth Edition, Text Revision (DSM-5-TR) and explores the potential of dimensional models such as the Hierarchical Taxonomy of Psychopathology (HiTOP) for a more nuanced understanding of OUD. Current treatments, including medications for OUD, are evaluated for efficacy in managing fentanyl-related OUD. Innovations in drug formulations and alternative induction methods are discussed to address the unique challenges posed by fentanyl. Psychotherapeutic and behavioral interventions, such as cognitive behavioral therapy and contingency management, are highlighted as crucial complements to pharmacotherapy. The review underscores the need for increased precision, comprehensive phenotyping, and advanced diagnostics to develop personalized treatment plans, all with the aim of improving patient outcomes and mitigating the societal impact of the opioid crisis.

Alcohol's link with sexuality is long-standing and prominent. While research continues to document robust associations between drinking and sexual behavior, scientific attention now centers primarily on evaluating mechanisms and attendant theoretical frameworks to advance our understanding of how alcohol exerts a causal impact. We describe four domains with reliable evidence of alcohol effects: sexualized social perceptions, sexual arousal, sexual risk taking, and sexual assault. We consider three contextual frames: distal factors associated with encountering opportunities for alcohol-involved sex, proximal factors associated with alcohol's acute effects, and distal-proximal interactions. We then examine the empirical support for mechanisms embedded within four theoretical frameworks: alcohol disinhibition, alcohol expectancy, alcohol myopia, and emotion regulation. Support for disinhibition mechanisms is evident with sexual arousal only. Expectancy and myopia mechanisms enjoy support across domains and make up bases for integrative expectancy-myopia causal explanations. Emotion regulation mechanisms evidence preliminary support in risk taking and sexual assault. Implications and future directions are considered.

Evidence from epidemiological, clinical, and biological research resulted in the immune hypothesis: the hypothesis that immune system dysfunction is involved in the pathophysiology of schizophrenia spectrum disorders (SSD). The promising implication of this hypothesis is the potential to use existing immunomodulatory treatment for innovative interventions for SSD. Here, we provide a selective historical review of important discoveries that have shaped our understanding of immune dysfunction in SSD. We first explain the basic principles of immune dysfunction, after which we travel more than a century back in time. Starting our journey with neurosyphilis-associated psychosis in the nineteenth century, we continue by evaluating the role of infections and autoimmunity in SSD and findings from assessment of immune function using new techniques, such as cytokine levels, microglia density, neuroimaging, and gene expression. Drawing from these findings, we discuss anti-inflammatory interventions for SSD, and we conclude with a look into the future.

Group-based trajectory modeling (GBTM) identifies groups of individuals following similar trajectories of one or more repeated measures. The categorical nature of GBTM is particularly well suited to clinical psychology and medicine, where patients are often classified into discrete diagnostic categories. This review highlights recent advances in GBTM and key capabilities that remain underappreciated in clinical research. These include accounting for nonrandom subject attrition, joint trajectory and multitrajectory modeling, the addition of the beta distribution to modeling options, associating trajectories with future outcomes, and estimating the probability of future outcomes. Also discussed is an approach to selecting the number of trajectory groups.

Depression is an eminently treatable disorder that responds to psychotherapy or medications; the efficacy of each has been established in hundreds of controlled trials. Nonetheless, the prevalence of depression has increased in recent years despite the existence of efficacious treatments-a phenomenon known as the treatment-prevalence paradox. We consider several possible explanations for this paradox, which range from a misunderstanding of the very nature of depression, inflated efficacy of the established treatments, and a lack of access to efficacious delivery of treatments. We find support for each of these possible explanations but especially the notion that large segments of the population lack access to efficacious treatments that are implemented as intended. We conclude by describing the potential of using lay therapists and digital technologies to overcome this lack of access and to reach historically underserved populations and simultaneously guarantee the quality of the interventions delivered.