Dr. Andrew Allen

Physical activity (PA) provides many significant mental health benefits. Though psychologists frequently promote PA in psychotherapy, there is a lack of structured guidance for psychologists on how to promote PA whilst navigating ethical guidelines and professional standards. This commentary discusses three ethical considerations relevant to psychologists’ PA promotion: PA promotion as a psychological intervention, safe practice, and the scope of practice of a psychologist. We provide detailed discussion using examples from research and case scenarios on PA promotion. We recommend that psychologists utilise their expertise in behaviour change when promoting PA, utilise physical health screening tools to assess for risk and refer to health professionals when specialised exercise support is required. In doing so, we aim to provide a structured resource that increases psychologists’ confidence and competence to safely integrate PA promotion into psychological treatment.

Objective: Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder associated with executive functioning difficulties. ADHD individuals are at a higher risk of persistent criticism, potentially leading to the development of early maladaptive schemas (EMS). Yet, little is known about the link between ADHD and EMS. The purpose of this scoping review was to examine the existing literature regarding ADHD and EMS, synthesising and evaluating relevant research.

Method: A comprehensive search of seven electronic databases was undertaken to identify literature regarding ADHD and EMS. Reference lists of articles were also searched.
Results: Six studies were included in the review. Several EMS—most prominently social isolation/alienation, defectiveness/shame, failure, and insufficient self-control/self-discipline—were consistently found to be correlated with ADHD symptoms and elevated in ADHD populations when compared to healthy controls. However, limitations of the evidence include insufficient sample-size justification, inconsistent analysis of EMS individually, reliance on cross-sectional designs, and limited studies investigating specific subpopulations of ADHD.

Conclusion: Based on the results, a theoretical schema therapy formulation for ADHD is proposed. Evidence suggests a link between ADHD and EMS, but further research is required to understand the directionality and variance among subpopulations, and to support relationships between ADHD and other aspects of schema therapy.

KEY POINTS
What is already known about this topic:
(1) Individuals with ADHD often face persistent criticism from caregivers, educators, and peers in early life, increasing the risk of developing co-occurring mental disorders.
(2) EMS, a core construct of Schema Therapy, develop in early childhood and have been recognised as a transdiagnostic factor across several mental disorders.
(3) Limited research has associated ADHD symptoms and diagnoses with various EMS.

What this topic adds:
(1) The results of six included studies indicated that several EMS were consistently elevated in ADHD populations and positively correlated with ADHD symptoms.
(2) The most prominent EMS included social isolation/alienation, defectiveness/shame, failure to achieve, insufficient self-control/self-discipline, and emotional inhibition, which align with common symptoms and difficulties associated with ADHD.
(3) Based on these findings, it is suggested that individuals with ADHD form EMS based on negative early experiences and criticism, which may be activated later in life

Anxiety disorders are highly prevalent, yet access to effective psychological treatments remains limited. Artificial intelligence (AI)-enabled mental health applications offer a scalable and accessible means to bridge treatment gaps. This study qualitatively explored the experiences of adults with anxiety symptoms using PATH, an AI-enabled mental health intervention. Participants (N = 100) with moderate-to-severe anxiety were recruited via Prolific and engaged with PATH before providing feedback. A total of 67 participants completed the qualitative questions at the 2-week timepoint, and 51 participants completed a further questionnaire at the 8-week timepoint. Participants had a mean age of 39.84 (SD = 11.19). Most were born in the UK (89.6%), and reported their ethnicity as White (92.5%), Asian (3.0%), mixed (3.0%) and Black (1.5%). Many worked full-time (53.7%) or part-time (20.9%), and a minority (14.9%) were students. Data were analysed using Qualitative Descriptive Analysis. Four overarching themes emerged: (1) Key Reasons for Use; (2) Usability and Functionality; (3) Preferred In-App Interventions; and (4) Facilitators and Barriers to Sustained Engagement. Findings underscore the value of empathetic, personalised and readily available AI-enabled interventions for anxiety management, while also highlighting design challenges requiring refinement.

Peer-to-peer bullying is a widespread, persistent form of harm among young people with profound and lasting impacts on their development and wellbeing. Anonymous harm reporting tools, like Stymie, offer a valuable response to known help-seeking barriers, enabling earlier identification and intervention to prevent or limit these harms. This paper reports on findings from a foundational study exploring educators' (n = 14) experiences of Stymie in Australian schools. Semantic thematic analysis identified five overarching themes, demonstrating the utility and positive impact of Stymie in creating safer school environments. Specifically, the results showed that Stymie addressed an identified need and pathway for reporting concerns within schools, with anonymity a core feature. Educators suggested Stymie had helped to facilitate early intervention and deterrence, while creating positive shifts in school safety culture. However, the results also suggested that scaffolded implementation and integration is essential to ensure active engagement with the tool and to maxi-mise outcomes.

Objectives
Risky sexual behaviors (RSB; e.g., condomless sex with strangers) contribute to global health epidemics by facilitating the transmission of STIs and increasing exposure to sexual violence, particularly in younger populations. Therefore, understanding the etiological factors influencing RSB is crucial for informing tailored prevention and intervention approaches. Early Maladaptive Schemas (EMS) offer a potential etiological explanation with associated intervention through Schema Therapy. This study extends previous research regarding EMS and RSB by investigating the influence of schema-driven coping responses.

Methods
An anonymous, cross-sectional online survey recruited 238 participants (135 women, 101 men, 2 non-binary) with a mean age of 29.45 (SD = 6.75). Data were analyzed using bivariate correlations and hierarchical regression models.

Results
EMS domains of Impaired Limits and Other-Directedness were significantly associated with RSB engagement, as were overcompensation and avoidance coping responses. These associations were observed among younger participants.

Conclusions
The findings support the role of EMS as an etiological factor for RSB engagement while identifying behavioral patterns that may be targeted with Schema Therapy to protect sexual health and promote wellbeing.

Non-consensual condom removal (NCCR) is a form of sexual violence involving the removal of a condom before or during sexual intercourse without a partner's knowledge or consent. There is evidence linking the perpetration of non-consensual condom removal to personality characteristics associated with condom use resistance (CUR) tactics and broader categories of sexual violence. The current study aimed to expand on this research by examining NCCR in relation to early maladaptive schemas (EMS) and Schema Theory in an Australian sample. A national cross-sectional survey of people with a penis (N = 106) measured NCCR through modifiable behavioural precursors: sexual arousal and intent to engage in the act. The results identified significant positive associations between certain EMS, CUR, and NCCR arousal but not NCCR intent. Logistic regression analyses indicated that stronger entitlement-related beliefs (e.g. expecting to get one's own way) and other-directed punitiveness (e.g. believing others should be punished for mistakes) were associated with higher odds of NCCR arousal; entitlement-related beliefs were also associated with higher odds of NCCR intent. These findings contribute to understanding the relationship between patterns of dysfunctional cognitions and the perpetration of sexual violence. Intervention efforts may benefit from targeting dysfunctional entitlement and punitive beliefs alongside condom negotiation.

Objective
Definitions of recovery from eating disorders (EDs) have traditionally emphasised symptom reduction and functional restoration. However, growing research highlights the importance of integrating personal recovery, defined by self-acceptance, autonomy, and psychological wellbeing. This study explored the relationship between partial clinical remission and personal recovery in individuals with lived experience of an ED.

Method
A total of 234 participants (N = 234; Mage = 28.10; 89.3% female; 49.6% non-heterosexual) were recruited online and completed measures assessing ED symptom severity, quality of life, and personal recovery. Criteria for partial clinical remission were based on established cut-offs for measures of ED symptomology. Personal recovery was defined by self-endorsement of a validated recovery framework.

Results
Chi-square tests revealed that rates of personal recovery (52.1%) were significantly higher than rates of partial clinical remission (22.6%). While clinical remission increased the likelihood of personal recovery (OR = 6.46), many participants endorsed personal recovery despite not meeting clinical criteria. No significant differences in personal recovery were found between ED types or between heterosexual and non-heterosexual participants as an exploratory analysis.

Conclusions
These findings underscore the importance of incorporating personal recovery constructs into ED assessment, treatment, and outcome monitoring.

Generalized Anxiety Disorder (GAD) is prevalent and often co-occurs with depression, contributing to significant disability and healthcare burden. Although treatments such as CBT and SSRIs are effective, access remains limited. This exploratory, randomized controlled trial evaluated the effectiveness of an AI-powered mental health app (PATH) in reducing symptoms of anxiety and depression. A total of 316 UK-based participants (aged 19-70) were randomized to either the intervention group (PATH) or a control group (NHS self-help website). The intervention provided evidence-based strategies including CBT-informed chat therapy and interactive tools. Anxiety (GAD-7) and depression (PHQ-9) scores were measured at baseline, two, eight, and twelve weeks. Of the 316 randomized participants, 235 completed the post-intervention assessment (33.0% attrition in the intervention group vs. 18.5% in the control group). Retention at 8-week and 12-week follow-ups was 77.4% and 54.0%, respectively. At two weeks, the intervention group showed significantly lower GAD-7 and PHQ-9 scores compared to control, with medium effect sizes. At eight weeks, those who continued using the app showed significant reductions in both anxiety and depression, while those who discontinued still showed medium improvements in anxiety. Effects were maintained at twelve weeks, with moderate to large effect sizes. Findings suggest that PATH significantly reduces anxiety and depressive symptoms, particularly with continued use. These results support the app's potential as a scalable, accessible digital intervention to address mental health treatment gaps.

Physical activity is a well-established intervention for improving mental health outcomes, yet its integration into psychological practice remains under-researched. Psychologists, as mental health professionals, are well-positioned to promote physical activity. This Short Communication describes the case for physical activity promotion within psychological practice. We explore both clinical and ethical considerations for incorporating physical activity promotion into psychological practice, practical strategies using the '5As model' and a case study to guide psychologists, addressing barriers to change and enhancing client motivation. Importantly, we discuss the need for further training and development for psychologists to ensure safe, impactful physical activity promotion is implemented in practice. By providing actionable recommendations, we aim to support psychologists in integrating physical activity promotion into their clinical practice, ultimately enhancing mental health care.

Objectives
Research consistently reports an association between auditory hallucinations and traumatic experiences, yet the psychological mechanisms underpinning this relationship remain poorly understood. Empirical evidence suggests that enduring dispositions, including early maladaptive schemas, interact with immediate stressors to elicit auditory hallucinations. The inner critic represents the activation of such enduring dispositions and concurs with common themes in auditory hallucinations. This study aimed to investigate the effect of the inner critic on speech illusions and the emotional valence of perceived words.

Design
A quasi-experimental design was utilised.

Methods
Forty-two non-clinical participants (67.40% female, Mage = 29.63) completed self-report questionnaires measuring predisposition to hallucination-like experiences, self-criticism and demanding and punitive parent schema modes. Participants then completed an auditory perception task, the Babble Task, inducing speech illusions before and after an inner critic imagery manipulation.

Results
A mixed factorial analysis of variance revealed a significant main effect of the inner critic manipulation on speech illusions, with participants reporting more speech illusions after the manipulation. Participants scoring high on the demanding parent mode reported more speech illusions overall. Linguistic analysis of speech illusions demonstrated an increase in negative tone across groups following the inner critic manipulation.

Conclusions
While acknowledging concerns regarding the convergent validity of the Babble Task, these findings add nuance to existing theories by suggesting that an activated inner critic impairs source monitoring and shapes the content of ensuing auditory intrusions. Additionally, the findings indicate the inner critic as a potential target for treatment in distressing auditory hallucinations.