روانشناسی بالینی

In modern scholarly perspectives on grieving, being saddened has been associated with bodily experience. Numbness, shaking, a heavy heart, and other physical symptoms are caused by the intense pain of loss. Most Western philosophies have increasingly focused on psychological models based on the idea of how the self adjusts to the devastating experience of losing a loved one, and this has received a lot of attention. To connect death, embodiment, self-identification, and psychological well-being, this conceptual article develops a mourning process from an Indigenous psychological perspective. This article proposes a psychological paradigm grounded in Indigenous contemplative knowledge through an interpretive analysis of the teachings of the Ashtavakra Gita. Rather than treating the Ashtavakra Gita solely as a philosophical or spiritual text, this article interprets it as an Indigenous psychological knowledge system offering culturally grounded insights into selfhood, attachment, suffering, and psychological well-being. The proposed Ashtavakra Witnessing Consciousness Model conceptualises grief as a five-stage, non-linear process involving embodied grief, existential crisis, meaning reframing, mortality acceptance, and witnessing consciousness, culminating in psychological well-being. This model shows how a traumatic incident can be transformed into a meaningful experience and a path to psychological well-being. Advaita Vedanta’s foundational text, the Ashtavakra Gita, presents a nondual viewpoint in which suffering arises from attachment to the body, ego, and interpersonal attachments. It distinguishes between witnessing consciousness and the short-lived embodied self. This psychological Model of Witnessing Consciousness offers an alternative understanding of control, attachment, suffering, and embodied grief, grounded in the Ashtavakra Gita. It highlights the psychological implications of developing the art of witnessing consciousness. This indigenous model of traditional knowledge has implications for existential, contemplative, and meaning-centred mourning therapies and adds a cross-cultural, psychological and philosophically informed perspective to bereavement research. The article explains how the five stages were derived from the text, illustrates the model with a composite case vignette, outlines clinical cautions against encouraging detachment prematurely, and sets out the model’s limitations and directions for empirical validation.

In most societies, using more than one language or language variety is the norm, yet the reference data against which children’s speech is judged derive largely from monolingual speakers. Systematic cross-linguistic variation is therefore liable to be read as atypical development, placing multilingual children at risk of misdiagnosis of speech sound disorder (SSD). This risk is most acute for closely related, understudied varieties, where difference and disorder overlap and community-specific data are scarce. Acoustic measures (e.g., voice onset time, vowel formants, segment durations) quantify fine-grained, continuous properties of speech production that categorical, transcription-based description obscures. No existing review, however, has mapped which acoustic measures have been applied to multilingual children, across which language varieties, or against which reference baselines their productions are interpreted. The objective of this review is to provide that map, showing where acoustic evidence is concentrated and where it is absent, to support clinical assessment and to identify where community-specific reference data are most needed. The review will follow updated Joanna Briggs Institute scoping review methodology and will be reported per the PRISMA Extension for Scoping Reviews. Searches will be conducted in MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), Web of Science Core Collection, and Linguistics and Language Behavior Abstracts, with grey literature sought through ProQuest Dissertations and Theses Global and conference proceedings; no date limits will be applied. Children from birth to 18 years are eligible regardless of clinical status, and a preschool subset (≤ 5;11) will be reported separately. After pilot calibration, two reviewers will independently screen and chart sources, resolving disagreements by discussion or a third reviewer. Charted data will be mapped through an acoustic-measure taxonomy crossed with language variety and reference baseline. This protocol has been registered on the Open Science Framework (OSF https://doi.org/10.17605/OSF.IO/R2EX5 ).

Background Digital mental health platforms routinely deliver self-administered symptom scales on the assumption that users with more severe symptoms are more likely to enter professional care. That assumption is rarely tested with linked participant-level data, and almost never in the Arabic-speaking Gulf. Objective To examine whether symptom severity at a user’s first self-assessment predicts booking a professional session within 90 days, across four symptom domains, on a Saudi commercial digital mental health platform. Methods Retrospective cohort analysis of 10,100 first assessments — depression, generalized anxiety, panic, and obsessive-compulsive scales — contributed by 5,524 unique users of the Talbinah platform and linked to demographic and session-booking records through a pseudonymous (SHA-256 hashed) user identifier. The primary outcome was any session booked within 90 days after the assessment. Severity was banded by the established cut-offs for the PHQ-9 and GAD-7, and by percentage of scale maximum for the panic and obsessive-compulsive measures, for which no severity thresholds are established. Per-scale multivariable logistic regression estimated adjusted odds ratios (aOR) for severity band (reference None/Minimal), adjusting for age, sex, and device type. Pre-specified sensitivity analyses used 30- and 180-day windows, an attended-session outcome, percentage-of-maximum banding applied to all four scales, and a subset with no prior booking (incident help-seeking). Reporting followed STROBE. Results Users were young (mean age 26.7 years, SD 8.1) and predominantly female (78.1%); 16.6% of first assessments were followed by a booking within 90 days. No severity band on any of the four scales was associated with higher odds of booking (severe vs None/Minimal: depression aOR 0.71, 95% CI 0.51–1.01; generalized anxiety 0.76, 0.49–1.16; panic 0.83, 0.52–1.31; obsessive-compulsive 1.01, 0.59–1.74). One severity contrast was statistically significant, in the opposite direction: moderate depression was associated with lower odds of booking (0.66, 95% CI 0.45–0.97). Older age (aOR ~1.2 per decade) and iOS device use (1.4–2.0) were associated with booking across scales. This absence of a positive severity–booking association was consistent across 30-, 90-, and 180-day windows, the attended-session outcome, and percentage-of-maximum banding; a nominal association for moderate anxiety seen under percentage banding did not persist with validated GAD-7 cut-offs. Estimates for the panic and obsessive-compulsive scales, which lack established severity thresholds, are exploratory. Conclusions On a Saudi digital mental health platform, greater self-reported symptom severity at first assessment was not followed by higher subsequent booking of professional care, consistently across specifications, and for moderate depression was associated with lower odds of booking; demographic and access-related attributes showed stronger associations with booking than symptom load did. Self-screening on its own appears insufficient as a pathway into care.

Background Non-suicidal self-injury (NSSI) is common among adolescents and often remains concealed because of shame and stigma. Voluntary disclosure can provide access to support, but emotional and interpersonal concerns shape the decision to disclose. This review will synthesize disclosure experiences, barriers, and facilitators reported by adolescents who have voluntarily disclosed NSSI at least once. Methods Primary qualitative studies and separately extractable qualitative components of mixed-methods studies involving adolescents aged 10–19 years will be eligible. Searches will cover PubMed, Embase, APA PsycINFO, CINAHL, Scopus, and Web of Science Core Collection. China National Knowledge Infrastructure, Wanfang Data, and the Chinese Biomedical Literature Database will also be searched. Coverage will extend from inception through 31 March 2026, inclusive, without language restrictions; formal searches have not yet been executed. Gray literature, reference lists, and forward citations will also be searched. Two human reviewers will independently select studies, appraise them using the Joanna Briggs Institute (JBI) qualitative checklist, and extract findings. Findings will be synthesized using JBI meta-aggregation, with confidence assessed using ConQual. Discussion The synthesis will examine disclosure decisions, recipients' responses, and subsequent experiences from adolescents' perspectives. Findings may inform clinical, school, and family support for voluntary NSSI disclosure. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261355173 , identifier: CRD420261355173.

Introduction Research on associations between pornography viewing and sexual violence has been limited by the absence of validated instruments that differentiate exposure along a violence continuum within pornographic practices, with existing measures focused on consumption frequency or problematic patterns rather than on the specific content consumed. The Pornography Violence Exposure Scale (PVES) was developed to assess exposure to pornographic content graded across three violence levels: non-violent material and domination-without-pain (Level 1), coercive content (Level 2), and explicit physical aggression (Level 3). Methods A cross-sectional study with 2,181 Spanish young adults aged 18–35 years who reported viewing pornography examined factor structure, measurement invariance across sex and age, convergent, nomological, and incremental validity, and discriminative capacity for sexual violence outcomes via Receiver Operating Characteristic (ROC) analysis. Results A bifactor model demonstrated good fit (CFI = 0.978, TLI = 0.957, RMSEA = 0.076), with a dominant general factor (ωH = 0.84, ECV = 0.81) capturing graded exposure to violent content. Strict measurement invariance was supported across sex and age groups. Convergent correlations with sexual violence outcomes (mean | r | = 0.24) substantially exceeded near-zero nomological associations with sexual function and partner-evaluation indicators (mean |r| = 0.03), and the general factor produced significant incremental validity for both victimization (Δ R 2 = 0.088) and perpetration (Δ R 2 = 0.200), with acceptable discrimination for perpetration (AUC = 0.753). Discussion The PVES is the first psychometrically validated instrument for measuring differentiated exposure to violent pornographic content, enabling more precise investigation of content-specific associations with sexual violence outcomes.

Modified dance for people with traumatic brain injury (TBI) is an emerging adjunct neurorehabilitation technique. The aim of this review is to describe the characteristics of dance programs developed for people with TBI, and to examine how stakeholders perceive these programs. Eight databases (MEDLINE, Scopus, Embase, CINAHL, Web of Science, SPORTDiscus, PsycINFO, and ProQuest Dissertations and Theses) were searched for studies on dance and TBI. Seven eligible articles were identified, involving a total of 22 dance participants with TBI and a further three people with TBI in a control group. The most common dance techniques used were dance movement therapy, improvisation, meditative movement, and mirroring. Modifications to programs included one-on-one delivery, individual tailoring with strategies to assist with cognitive or mobility barriers, and support from clinicians or assistants. Overall, the dance programs were feasible to deliver and acceptable to participants. Three studies revealed mixed evidence of efficacy in terms of motor fitness outcomes (e.g., balance and mobility), and there was insufficient evidence for efficacy in terms of cognition, neuroplasticity, and psychosocial outcomes. The review makes recommendations to enhance the safety and sustainability of dance for the neurorehabilitation population and to improve the standardized reporting of program design and execution to advance the field.

Applied behavior analysis (ABA) has developed an effective technology of reinforcement delivery, including Discrete Trial Training, Natural Environment Teaching, and token economies, largely on functional-behavioral grounds. Computational neuroscience has independently produced formal accounts of reinforcement learning centered on prediction errors and credit assignment. I propose a testable hypothesis connecting the two: the effectiveness of a reinforcement procedure depends on the quality of the learning signal that its delivery produces on each occasion, a property I term Reward Prediction-Error Fidelity (RPE Fidelity). The property is decomposed into four dimensions, temporal credit, contingency, prediction, and outcome value, each corresponding to a construct long studied in behavior analysis. Formalized within an actor-critic model with eligibility traces, the four dimensions enter the learning update multiplicatively, which implies that they cannot compensate for one another and that the effect of each depends on the others and on the learner’s history. The combination rule distinguishes the hypothesis from the separate behavioral constructs it draws on, and its dependence on learning history distinguishes it from steady-state quantitative models of reinforcement. I situate the hypothesis within an integrative framework, discuss its application to autistic learners, including differences in reward processing and volatility estimation and the role of learner assent, and compare it with procedural fidelity, quantitative behavioral theory, and alternative learning models, including attentional, timescale-invariant, successor-representation, and Bayesian accounts. I derive nine predictions, specifying for each the result that would favor the hypothesis and the result that would favor its strongest competitor, and outline a staged research programme compatible with single-case experimental designs.

The involvement of oxytocin in social behavior is well established, yet its interaction with neuromodulatory systems, such as serotonin and dopamine, remains incompletely understood. Here, we utilized immunohistochemistry, anatomical tracing, chemogenetic, and ex vivo electrophysiological approaches primarily in male mice, with female mice used only for an additional anatomical tracing control experiment, investigate how oxytocin modulates serotonergic and dopaminergic neuronal populations. Employing the dual-eGRASP tool, we visualized oxytocinergic projections from the paraventricular nucleus (PVN) to the serotonergic and dopaminergic neurons in dorsal raphe nucleus (DRN). Blocking oxytocin receptors in the DRN attenuated social interaction behavior. Additionally, analysis of c-Fos levels and neuronal excitability revealed that oxytocin inhibits serotonergic neurons while activating dopaminergic neurons in the DRN. Our findings suggest a bidirectional regulatory role of oxytocin signaling in the DRN serotonergic and dopaminergic neurons. Significance Statement Social behavior relies on interactions among neuromodulatory systems, yet how oxytocin communicates with serotonin and dopamine circuits remains unclear. We identify the DRN as a functionally relevant target of hypothalamic oxytocin neurons during social approach. Using dual-eGRASP, we visualize contacts from PVN oxytocin neurons onto both serotonergic and dopaminergic DRN. Blocking oxytocin receptors in the DRN reduces social interaction without affecting locomotion. Moreover, oxytocin suppresses serotonergic neuronal activity while increasing dopaminergic neuronal activation, revealing opposing control of two prosocial neuromodulatory populations within the same region. These findings provide a circuit framework for how oxytocin coordinates social behavior through bidirectional modulation of dorsal raphe neuromodulators.

نقش اکسی‌توسین در رفتار اجتماعی به‌خوبی اثبات شده است، اما تعامل آن با سیستم‌های نوروماژولاتوری مانند سروتونین و دوپامین هنوز به‌طور کامل درک نشده است. در این پژوهش، با استفاده از روش‌های ایمنوهیستوشیمی، ردیابی آناتومیکی، شیمی‌ژنتیک و الکتروفیزیولوژی خارج‌زنده عمدتاً در موش‌های نر و استفاده از موش‌های ماده صرفاً برای آزمایش کنترل ردیابی آناتومیکی اضافی، بررسی کردیم که اکسی‌توسین چگونه جمعیت‌های نورونی سروتونرژیک و دوپامینرژیک را تعدیل می‌کند. با به‌کارگیری ابزار dual-eGRASP، پروجکشن‌های اکسی‌توسینرژیک از هسته پاراونتریکولار (PVN) به نورون‌های سروتونرژیک و دوپامینرژیک در هسته رافه پشتی (DRN) را مشاهده کردیم. مسدودسازی گیرنده‌های اکسی‌توسین در DRN رفتار تعامل اجتماعی را کاهش داد. همچنین، تحلیل سطوح c-Fos و تحریک‌پذیری نورونی نشان داد که اکسی‌توسین نورون‌های سروتونرژیک را مهار و نورون‌های دوپامینرژیک را در DRN فعال می‌کند. یافته‌های ما نقش تنظیمی دوسویه سیگنال‌دهی اکسی‌توسین در نورون‌های سروتونرژیک و دوپامینرژیک DRN را پیشنهاد می‌کند. بیان اهمیت: رفتار اجتماعی مبتنی بر تعامل میان سیستم‌های نوروماژولاتوری است، اما نحوه ارتباط اکسی‌توسین با مدارهای سروتونین و دوپامین همچنان نامشخص است. ما DRN را به‌عنوان هدف عملکردی نورون‌های اکسی‌توسین هیپوتالاموس در رویکرد اجتماعی شناسایی کردیم. با استفاده از dual-eGRASP، تماس‌های نورون‌های اکسی‌توسین PVN با هر دو جمعیت سروتونرژیک و دوپامینرژیک DRN را مشاهده کردیم. مسدودسازی گیرنده‌های اکسی‌توسین در DRN تعامل اجتماعی را بدون تأثیر بر حرکت کاهش می‌دهد. افزون بر این، اکسی‌توسین فعالیت نورون‌های سروتونرژیک را سرکوب و فعالیت نورون‌های دوپامینرژیک را افزایش می‌دهد و کنترل متضاد دو جمعیت نوروماژولاتوری طرفدار اجتماع را در یک ناحیه نشان می‌دهد. این یافته‌ها چارچوبی مداری برای چگونگی هماهنگی رفتار اجتماعی توسط اکسی‌توسین از طریق تعدیل دوسویه نوروماژولاتورهای هسته رافه پشتی ارائه می‌کند.