The psychological impacts of content moderation on content moderators: a qualitative study

Article

Spence, R., Bifulco, A., Bradbury, P., Martellozzo, E. and DeMarco, J. 2023. The psychological impacts of content moderation on content moderators: a qualitative study. Cyberpsychology: Journal of Psychosocial Research on Cyberspace. 17 (4). https://doi.org/10.5817/cp2023-4-8
TypeArticle
TitleThe psychological impacts of content moderation on content moderators: a qualitative study
AuthorsSpence, R., Bifulco, A., Bradbury, P., Martellozzo, E. and DeMarco, J.
Abstract

Content moderation generally refers to the practice of monitoring user generated content and applying a set of rules defining what is acceptable. As a result, Content Moderators (CMs) are responsible for reviewing and removing harmful online material, which has the potential to cause psychological harm. However, little is known about the perceived impacts of the job. Semi-structured interviews were conducted with 11 commercial CMs who were exposed to child sexual abuse material (CSAM) as part of their job. Interviews were analysed using framework analysis to investigate any psychological impacts. Results demonstrated that CMs manifested with a range of symptoms consistent with experiencing repeated trauma. This included experiencing intrusive thoughts of CSAM, triggered by situations with similar contexts to those encountered at work, avoidance of children and negative cognitive and emotional effects such as cynicism, anxiety and detachment. These symptoms fit into a framework of post traumatic and secondary traumatic stress and suggest CMs wellbeing and exposure to stressful stimuli may be comparable to professionals working in the emergency services or caring professions, such as social workers. These personnel are at heightened risk of various problems including compassion fatigue, vicarious trauma and burnout. Companies which employ moderators should learn from these comparable professions and provide psychoeducation and trauma-informed care to CMs which have been demonstrated to help mitigate these challenges.

Keywordschild sexual abuse material; content moderation; trauma; post-traumatic stress disorder; work stress
Sustainable Development Goals3 Good health and well-being
Middlesex University ThemeHealth & Wellbeing
Research GroupCentre for Abuse and Trauma Studies (CATS)
PublisherMasaryk University
JournalCyberpsychology: Journal of Psychosocial Research on Cyberspace
ISSN
Electronic1802-7962
Publication dates
Online18 Sep 2023
Print18 Sep 2023
Publication process dates
Deposited14 Sep 2023
Submitted27 Nov 2022
Accepted07 Aug 2023
Output statusPublished
Publisher's version
License
Copyright Statement

Copyright © 2023 Ruth Spence, Antonia Bifulco, Paula Bradbury, Elena Martellozzo, Jeffrey DeMarco
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License https://creativecommons.org/licenses/by-sa/4.0/

Digital Object Identifier (DOI)https://doi.org/10.5817/cp2023-4-8
Web of Science identifierWOS:001097407300006
LanguageEnglish
Permalink -

https://repository.mdx.ac.uk/item/9y745

Log in to edit

Download files

Publisher's version
33166-Full article-60055-1-10-20230913.pdf
License: CC BY-SA 4.0

  • 1680
    total views
  • 621
    total downloads
  • 122
    views this month
  • 6
    downloads this month

Export as

Related outputs

Content moderator mental health and associations with coping styles: replication and extension of previous studies
Spence, R. and DeMarco, J. 2025. Content moderator mental health and associations with coping styles: replication and extension of previous studies. https://doi.org/10.20944/preprints202502.0160.v1
Exploring the use of Virtual Reality to enhance rapid decompression from occupational stress during short wellness breaks for content moderators
Spence, R., Campbell, N., Woofenden, T. and DeMarco, J. 2025. Exploring the use of Virtual Reality to enhance rapid decompression from occupational stress during short wellness breaks for content moderators. https://doi.org/10.21203/rs.3.rs-5684444/v1
'Understanding domestic violence and abuse: victim, suspect and crime predictors of police outcomes'
Barbin, A., Crivatu, I., Davies, K., Horvath, M.A.H. and Spence, R. 2025. 'Understanding domestic violence and abuse: victim, suspect and crime predictors of police outcomes'. Journal of Family Violence. https://doi.org/10.1007/s10896-024-00802-z
Issues with using police data to investigate offending: a research perspective
Spence, R. and Crivatu, I 2025. Issues with using police data to investigate offending: a research perspective. Police Journal: Theory, Practice and Principles. https://doi.org/10.1177/0032258x251313944
How does news coverage of suicide affect suicidal behaviour at a high-frequency location? A 7-year time series analysis
Marzano, L., Spence, R., Marsh, I, Barbin, A and Kruger, I 2024. How does news coverage of suicide affect suicidal behaviour at a high-frequency location? A 7-year time series analysis. BMJ Public Health. 3 (1). https://doi.org/10.1136/bmjph-2024-002136
‘I had no choice’: adult neutralisation of online sexual engagement with children
Bradbury, P., Bleakley, P. and Martellozzo, E. 2024. ‘I had no choice’: adult neutralisation of online sexual engagement with children. Journal of Police and Criminal Psychology. https://doi.org/10.1007/s11896-024-09645-2
Content moderator coping strategies: associations with psychological distress, secondary trauma and wellbeing
Spence, R., Martellozzo, E. and DeMarco, J. 2024. Content moderator coping strategies: associations with psychological distress, secondary trauma and wellbeing. Journal of Media Psychology: Theories, Methods, and Applications. https://doi.org/10.1027/1864-1105/a000454
Limerence, hidden obsession, fixation, and rumination: a scoping review of human behaviour
Bradbury, P., Short, E. and Bleakley, P. 2024. Limerence, hidden obsession, fixation, and rumination: a scoping review of human behaviour. Journal of Police and Criminal Psychology. https://doi.org/10.1007/s11896-024-09674-x
Content moderator mental health, secondary trauma, and well-being: a cross-sectional study
Spence, R., Bifulco, A., Bradbury, P., Martellozzo, E. and DeMarco, J. 2024. Content moderator mental health, secondary trauma, and well-being: a cross-sectional study. Cyberpsychology, Behavior, and Social Networking. 27 (2), pp. 149-155. https://doi.org/10.1089/cyber.2023.0298
Supporting digital key workers: Addressing the challenges faced by content moderators during and after the COVID-19 pandemic
Martellozzo, E., Bleakley, P., Bradbury, P., Spence, R. and DeMarco, J. 2024. Supporting digital key workers: Addressing the challenges faced by content moderators during and after the COVID-19 pandemic. International Journal of Technology, Policy and Management. 24 (2), pp. 212-228. https://doi.org/10.1504/IJTPM.2024.137818
Identity awoken in second-generation British Poles in the UK—personal journeys
Bifulco, A. and Smojkis, M. 2023. Identity awoken in second-generation British Poles in the UK—personal journeys. Genealogy. 7 (3). https://doi.org/10.3390/genealogy7030059
Moderating online child sexual abuse material (CSAM): Does self-regulation work, or is greater state regulation needed?
Bleakley, P., Martellozzo, E., Spence, R. and DeMarco, J. 2023. Moderating online child sexual abuse material (CSAM): Does self-regulation work, or is greater state regulation needed? European Journal of Criminology. 21 (2), pp. 231-250. https://doi.org/10.1177/14773708231181361
Content moderators’ strategies for coping with the stress of moderating content online
Spence, R., Harrison, A., Bradbury, P., Bleakley, P., Martellozzo, E. and DeMarco, J. 2023. Content moderators’ strategies for coping with the stress of moderating content online. Journal of Online Trust and Safety. 1 (5), pp. 1-18. https://doi.org/10.54501/jots.v1i5.91
The right tool for the job: evaluating police experiences of a pilot tool for responding to stalking
Bleakley, P., Frost, S., Bradbury, P., Short, E. and Martellozzo, E. 2023. The right tool for the job: evaluating police experiences of a pilot tool for responding to stalking. Policing: a Journal of Policy and Practice. 17. https://doi.org/10.1093/police/paac022
Understanding sexual violence and factors related to police outcomes
Davies, K., Spence, R., Cummings, E., Cross, M. and Horvath, M. 2022. Understanding sexual violence and factors related to police outcomes. Frontiers in Psychology. 13, pp. 1-13. https://doi.org/10.3389/fpsyg.2022.977318
Police responses to cyberstalking during the Covid-19 pandemic in the UK
Martellozzo, E., Bleakley, P., Bradbury, P., Frost, S. and Short, E. 2022. Police responses to cyberstalking during the Covid-19 pandemic in the UK. Police Journal: Theory, Practice and Principles. https://doi.org/10.1177/0032258X221113452
Impacts of the COVID-19 pandemic on reporting of rape, serious sexual offences, and domestic abuse in one English police force
Spence, R., Horvath, M., Dalton, C. and Davies, K. 2022. Impacts of the COVID-19 pandemic on reporting of rape, serious sexual offences, and domestic abuse in one English police force. Journal of Gender-Based Violence. 6 (2), pp. 242-260. https://doi.org/10.1332/239868021X16425806897258
Criminal court sentencing: the case for specialist ‘young adult’ courts
Ward, J. and Spence, R. 2022. Criminal court sentencing: the case for specialist ‘young adult’ courts. The British Journal of Criminology: An International Review of Crime and Society. 63 (4), pp. 1041-1057. https://doi.org/10.1093/bjc/azac076
Frontline response: exploring the impact of COVID‐19 on stalking behaviours
Short, E., Bradbury, P., Martellozzo, E., Frost, S. and Bleakley, P. 2022. Frontline response: exploring the impact of COVID‐19 on stalking behaviours. Journal of Police and Criminal Psychology. 37 (3), pp. 540-548. https://doi.org/10.1007/s11896-022-09514-w
The moderation effect of secure attachment on the relationship between positive events and wellbeing
Spence, R., Kagan, L., Nunn, S., Bailey-Rodriguez, D., Fisher, H., Hosang, G. and Bifulco, A. 2022. The moderation effect of secure attachment on the relationship between positive events and wellbeing. PsyCh Journal. 11 (4), pp. 541-549. https://doi.org/10.1002/pchj.546
Life events, depression and supportive relationships affect academic achievement in university students
Spence, R., Kagan, L., Nunn, S., Bailey-Rodriguez, D., Fisher, H., Hosang, G. and Bifulco, A. 2022. Life events, depression and supportive relationships affect academic achievement in university students. Journal of American College Health. 70 (7), pp. 1931-1935. https://doi.org/10.1080/07448481.2020.1841776
“Lucky Boy!”; Public perceptions of child sexual offending committed by women
Bradbury, P. and Martellozzo, E. 2021. “Lucky Boy!”; Public perceptions of child sexual offending committed by women. Journal of Victimology and Victim Justice. 4 (2), pp. 160-178. https://doi.org/10.1177/25166069211060091
Family history and searching for hidden trauma—a personal commentary
Bifulco, A. 2021. Family history and searching for hidden trauma—a personal commentary. Genealogy. 5 (2). https://doi.org/10.3390/genealogy5020046
Understanding trauma in children and young people in the school setting
Spence, R., Kagan, L., Kljakovic, M. and Bifulco, A. 2021. Understanding trauma in children and young people in the school setting. Educational and Child Psychology. 38 (1), pp. 87-98.
The child attachment style interview (Child-ASI) and depression: preliminary findings
Bifulco, A., Jacobs, C., Oskis, A., Bunn, A. and Spence, R. 2021. The child attachment style interview (Child-ASI) and depression: preliminary findings. Educational and Child Psychology. 38 (1), pp. 62-74.
Shared practice, learning, and goals between police and young people: a qualitative analysis of the National Volunteer Police Cadets
DeMarco, J. and Bifulco, A. 2021. Shared practice, learning, and goals between police and young people: a qualitative analysis of the National Volunteer Police Cadets. Policing: a Journal of Policy and Practice. 15 (4), pp. 2095-2110. https://doi.org/10.1093/police/paaa010
Life events and emotional disorder revisited: research and clinical applications
Bifulco, A., Spence, R. and Kagan, L. 2020. Life events and emotional disorder revisited: research and clinical applications. London, UK Routledge.
Exploring the removal of online child sexual abuse material in the United Kingdom: processes and practice
Martellozzo, E. and DeMarco, J. 2020. Exploring the removal of online child sexual abuse material in the United Kingdom: processes and practice. Crime Prevention & Community Safety. 22 (4), pp. 331-350. https://doi.org/10.1057/s41300-020-00099-2
Racial differences in Police experiences: investigation into the factors influencing citizen-police co-operation
DeMarco, J. 2016. Racial differences in Police experiences: investigation into the factors influencing citizen-police co-operation. International Journal of Research in Social Sciences and Humanities. 6 (2), pp. 42-63.
Author's reply to: Comment on "Web-based measure of life events using Computerized Life Events and Assessment Record (CLEAR): preliminary cross-sectional study of reliability, validity, and association with depression": validity and methodological issues
Bifulco, A. 2020. Author's reply to: Comment on "Web-based measure of life events using Computerized Life Events and Assessment Record (CLEAR): preliminary cross-sectional study of reliability, validity, and association with depression": validity and methodological issues. JMIR Mental Health. 7 (5). https://doi.org/10.2196/15434
Exploring policing and industry practice in the prevention of online child sexual abuse
Davidson, J., Schimmenti, A., Caretti, V., Puccia, A., Corbari, E., Bogaerts, S., Schilder, J., Scally, M., Bifulco, A. and DeMarco, J. 2020. Exploring policing and industry practice in the prevention of online child sexual abuse. in: Bryce, I. and Petherick, W. (ed.) Child Sexual Abuse: Forensic Issues in Evidence, Impact, and Management Academic Press. pp. 657-678
Researching the affects that on online pornography has on U.K. adolescents aged 11 to 16
Martellozzo, E., Monaghan, A., Davidson, J. and Adler, J. 2020. Researching the affects that on online pornography has on U.K. adolescents aged 11 to 16. SAGE Open. 10 (1), pp. 1-11. https://doi.org/10.1177/2158244019899462
Assessing attachment style in traumatized adolescents in residential care: A case approach
Jacobs, C., Boyce, N., Ilan-Clarke, Y. and Bifulco, A. 2019. Assessing attachment style in traumatized adolescents in residential care: A case approach. Maltrattamento E Abuso All’infanzia: Rivista Interdisciplinare. 21 (1), pp. 39-54. https://doi.org/10.3280/MAL2019-001004
Partner violence in women - associations with childhood maltreatment, attachment style and major depression
Bifulco, A., Damiani, R., Jacobs, C., Bunn, A. and Spence, R. 2019. Partner violence in women - associations with childhood maltreatment, attachment style and major depression. Maltrattamento E Abuso All’infanzia: Rivista Interdisciplinare. 21 (2), pp. 13-28. https://doi.org/10.3280/MAL2019-002002
Impacts of maltreatment in adolescence
Bifulco, A. and Frost, N. 2019. Impacts of maltreatment in adolescence. Maltrattamento E Abuso All’infanzia: Rivista Interdisciplinare. 21 (1), pp. 7-10. https://doi.org/10.3280/MAL2019-001001
Impacts of childhood maltreatment in adulthood
Bifulco, A. and Frost, N. 2019. Impacts of childhood maltreatment in adulthood. Maltrattamento E Abuso All’infanzia: Rivista Interdisciplinare. 21 (2), pp. 7-11. https://doi.org/10.3280/MAL2019-002001
Online sexual grooming: children as victims of online abuse
Martellozzo, E. 2017. Online sexual grooming: children as victims of online abuse. in: Martellozzo, E. and Jane, E. (ed.) Cybercrime and its victims Routledge, Taylor & Francis. pp. 108-128
Assessing child abuse: "We need to talk!"
Bifulco, A. and Schimmenti, A. 2019. Assessing child abuse: "We need to talk!". Child Abuse and Neglect. 98. https://doi.org/10.1016/j.chiabu.2019.104236
An adapted REA exploring online child sexual abuse victimisation across the EU
Scally, M. and DeMarco, J. 2016. An adapted REA exploring online child sexual abuse victimisation across the EU. British Psychological Society Annual Conference. Nottingham 26 - 28 Apr 2016
ISEC illegal use of the Internet: policing, collaboration and victimisation—A review of the literature. Document prepared for the European Commission initiative in dealing with cybercrime and cybersecurity
DeMarco, J., Davidson, J., Scally, M. and Long, E. 2015. ISEC illegal use of the Internet: policing, collaboration and victimisation—A review of the literature. Document prepared for the European Commission initiative in dealing with cybercrime and cybersecurity. Middlesex University.
Lifetime trauma, adversity and emotional disorder in older age women
Bifulco, A., Jacobs, C., Oskis, A., Cavana, F. and Spence, R. 2019. Lifetime trauma, adversity and emotional disorder in older age women. Maltrattamento E Abuso All’infanzia: Rivista Interdisciplinare. 21 (2), pp. 29-43. https://doi.org/10.3280/mal2019-002003
A contextual approach to trauma experience: lessons from life events research
Spence, R., Kagan, L. and Bifulco, A. 2019. A contextual approach to trauma experience: lessons from life events research. Psychological Medicine. 49 (9), pp. 1409-1413. https://doi.org/10.1017/s0033291719000850
The long-term effects of childhood financial hardship mediated by physical abuse, shame, and stigma on depression in women
Spence, R., Nunn, S. and Bifulco, A. 2019. The long-term effects of childhood financial hardship mediated by physical abuse, shame, and stigma on depression in women. Maltrattamento E Abuso All’infanzia: Rivista Interdisciplinare. 21 (1), pp. 55-72. https://doi.org/10.3280/MAL2019-001005
The long-term effects of childhood neglect or abuse. Implications for child and family services in the UK
Bifulco, A. 2019. The long-term effects of childhood neglect or abuse. Implications for child and family services in the UK. Papers of Social Pedagogy. 12 (2), pp. 57-78. https://doi.org/10.5604/01.3001.0013.5890
Online child sexual abuse
Martellozzo, E. 2019. Online child sexual abuse. in: Bryce, I., Robinson, Y. and Petherick, W. (ed.) Child Abuse and Neglect: Forensic Issues in Evidence, Impact, and Management Academic Press. pp. 63-77
Characteristics of severe life events, attachment style, and depression – Using a new online approach
Bifulco, A., Kagan, L., Spence, R., Nunn, S., Bailey-Rodriguez, D., Hosang, G., Taylor, M. and Fisher, H. 2019. Characteristics of severe life events, attachment style, and depression – Using a new online approach. British Journal of Clinical Psychology. 58 (4), pp. 427-439. https://doi.org/10.1111/bjc.12221
Web-based measure of life events using Computerized Life Events and Assessment Record (CLEAR): preliminary cross-sectional study of reliability, validity, and association with depression
Bifulco, A., Spence, R., Nunn, S., Kagan, L., Bailey-Rodriguez, D., Hosang, G., Taylor, M. and Fisher, H. 2019. Web-based measure of life events using Computerized Life Events and Assessment Record (CLEAR): preliminary cross-sectional study of reliability, validity, and association with depression. JMIR Mental Health. 6 (1). https://doi.org/10.2196/10675
Factors associated with variation in hospital use at the end of life in England
Bardsley, M., Georghiou, T., Spence, R. and Billings, J. 2019. Factors associated with variation in hospital use at the end of life in England. BMJ Supportive & Palliative Care. 9 (2), pp. 167-174. https://doi.org/10.1136/bmjspcare-2015-000936
Attachment style, loneliness and depression in older age women
Spence, R., Jacobs, C. and Bifulco, A. 2020. Attachment style, loneliness and depression in older age women. Aging and Mental Health. 24 (5), pp. 837-839. https://doi.org/10.1080/13607863.2018.1553141
Digital dangers and cyber-victimisation: a study of European adolescent online risky behaviour for sexual exploitation
DeMarco, J., Cheevers, C., Davidson, J., Bogaerts, S., Pace, U., Aiken, M., Caretti, V., Schimmenti, A. and Bifulco, A. 2017. Digital dangers and cyber-victimisation: a study of European adolescent online risky behaviour for sexual exploitation. Clinical Neuropsychiatry. 14 (1), pp. 104-112.
Child abuse and protection: contemporary issues in research, policy and practice
Davidson, J. and Bifulco, A. 2018. Child abuse and protection: contemporary issues in research, policy and practice. Routledge.
Social, family and trauma risk factors for common disorders in Israeli youth
Lawrence, S. and Bifulco, A. 2018. Social, family and trauma risk factors for common disorders in Israeli youth. Children and Youth Services Review. 86, pp. 264-270. https://doi.org/10.1016/j.childyouth.2018.01.041
Organised and Terrorist Networks: Empirical Research Report
Ruggiero, V., DeMarco, J., Monaghan, A., Huber, F., Jäger, B., Musotto, R., Wall, D., Bonfanti, M. and Meyer- Daetsch, L. 2017. Organised and Terrorist Networks: Empirical Research Report. European Commission.
Identity, attachment and resilience: Exploring three generations of a Polish family
Bifulco, A. 2017. Identity, attachment and resilience: Exploring three generations of a Polish family. London and New York Routledge.
Exploring disorganized attachment style among Malay mothers in Malaysia: a study using the Attachment Style Interview
Abdul Kadir, N. and Bifulco, A. 2017. Exploring disorganized attachment style among Malay mothers in Malaysia: a study using the Attachment Style Interview. Social Work in Mental Health. 15 (4), pp. 397-418. https://doi.org/10.1080/15332985.2016.1224796
Child online protection in the MENA region
Patrick, B., Monica, B., Davidson, J., Ali, M., Davison, P., Day, E., DeMarco, J., Rasul, M., Razai, S., Scally, M. and Wex, B. 2016. Child online protection in the MENA region. Centre for Justice and Crime Prevention.
EU online child safety: what does the literature say?
DeMarco, J., Davidson, J., Bifulco, A., Scally, M., Cheevers, C., Schimmenti, A., Caretti, V., Puccia, A., Corbari, E., Schilder, J. and Bogaerts, S. 2016. EU online child safety: what does the literature say? Crimen et Delictum: International Journal of Criminological and Investigative Sciences. 11 (1), pp. 1-19.
Adolescent attachment style in residential care: the attachment style interview and vulnerable attachment style questionnaire
Bifulco, A., Jacobs, C., Ilan-Clarke, Y., Spence, R. and Oskis, A. 2017. Adolescent attachment style in residential care: the attachment style interview and vulnerable attachment style questionnaire. The British Journal of Social Work. 47 (7), pp. 1870-1883. https://doi.org/10.1093/bjsw/bcw117
Help-seeking in emerging adults with and without a history of mental health referral: a qualitative study
Spence, R., Owens-Solari, M. and Goodyer, I. 2016. Help-seeking in emerging adults with and without a history of mental health referral: a qualitative study. BMC Research Notes. 9 (1). https://doi.org/10.1186/s13104-016-2227-8
"I wasn’t sure it was normal to watch it…”A quantitative and qualitative examination of the impact of online pornography on the values, attitudes, beliefs and behaviours of children and young people
Martellozzo, E., Monaghan, A., Adler, J., Davidson, J., Leyva, R. and Horvath, M. 2016. "I wasn’t sure it was normal to watch it…”A quantitative and qualitative examination of the impact of online pornography on the values, attitudes, beliefs and behaviours of children and young people. Middlesex University, NSPCC, OCC. https://doi.org/10.6084/m9.figshare.3382393
Interview investigation of insecure attachment styles as mediators between poor childhood care and schizophrenia-spectrum phenomenology
Sheinbaum, T., Bifulco, A., Ballespí, S., Mitjavila, M., Kwapil, T. and Barrantes-Vidal, N. 2015. Interview investigation of insecure attachment styles as mediators between poor childhood care and schizophrenia-spectrum phenomenology. PLoS ONE. 10 (8), pp. 1-12. https://doi.org/10.1371/journal.pone.0135150
Associations between depression and specific childhood experiences of abuse and neglect: a meta-analysis
Infurna, M., Reichl, C., Parzer, P., Schimmenti, A., Bifulco, A. and Kaess, M. 2016. Associations between depression and specific childhood experiences of abuse and neglect: a meta-analysis. Journal of Affective Disorders. 190, pp. 47-55. https://doi.org/10.1016/j.jad.2015.09.006
Enhancing police and industry practice
Davidson, J., DeMarco, J., Bifulco, A., Bogaerts, S., Caretti, V., Aiken, M., Chevers, C., Corbari, E., Scally, M., Schimmenti, A. and Puccia, A. 2016. Enhancing police and industry practice. Middlesex University.
Policing online child sexual abuse - the British experience
Martellozzo, E. 2015. Policing online child sexual abuse - the British experience. European Journal of policing Studies. 3 (1), pp. 32-52.
Measuring life events and their association with clinical disorder: a protocol for development of an online approach
Spence, R., Bunn, A., Nunn, S., Hosang, G., Kagan, L., Fisher, H., Taylor, M. and Bifulco, A. 2015. Measuring life events and their association with clinical disorder: a protocol for development of an online approach. JMIR Research Protocols. 4 (3), p. e83. https://doi.org/10.2196/resprot.4085
Focus on: antidepressant prescribing trends in the prescribing of antidepressants in primary care
Spence, R., Roberts, A., Ariti, C. and Bardsley, M. 2014. Focus on: antidepressant prescribing trends in the prescribing of antidepressants in primary care. Nuffield Trust.
Exploring young people's use of social networking sites and digital media in the internet safety context: a comparison of the UK and Bahrain
Davidson, J. and Martellozzo, E. 2013. Exploring young people's use of social networking sites and digital media in the internet safety context: a comparison of the UK and Bahrain. Information, Communication and Society. 16 (9), pp. 1456-1476. https://doi.org/10.1080/1369118X.2012.701655
Insecure attachment style as a vulnerability factor for depression: recent findings in a community-based study of Malay single and married mothers.
Abdul Kadir, N. and Bifulco, A. 2013. Insecure attachment style as a vulnerability factor for depression: recent findings in a community-based study of Malay single and married mothers. Psychiatry Research. 210 (3), pp. 919-924. https://doi.org/10.1016/j.psychres.2013.08.034
Anxiety and hospitalization in adolescence: relations to attachment style and parental support
Vulliez-Coady, L., Vidal, C., Vivot, A., Monnin, J., Nezelof, S. and Bifulco, A. 2013. Anxiety and hospitalization in adolescence: relations to attachment style and parental support. Psychiatria Danubina. 25 (Supp 2), pp. 135-142.
Linking lack of care in childhood to anxiety disorders in emerging adulthood: the role of attachment styles
Schimmenti, A. and Bifulco, A. 2015. Linking lack of care in childhood to anxiety disorders in emerging adulthood: the role of attachment styles. Child and Adolescent Mental Health. 20 (1), pp. 41-48. https://doi.org/10.1111/camh.12051
Problem parental care and teenage deliberate self-harm in young community adults
Bifulco, A., Schimmenti, A., Moran, P., Jacobs, C., Bunn, A. and Rusu, A. 2014. Problem parental care and teenage deliberate self-harm in young community adults. Bulletin of the Menninger Clinic. 78 (2), pp. 95-114. https://doi.org/10.1521/bumc.2014.78.2.95
Psychiatrie infantojuvénile en Europe – Grande-Bretagne
Bifulco, A. and Thomas, G. 2012. Psychiatrie infantojuvénile en Europe – Grande-Bretagne. in: Ferrari, P. and Bonot, O. (ed.) Traité européen de psychiatries et de psychoatologie de l’inefant et de l’adolescent Paris Lavoisier. pp. 691-697
Psychosocial models and issues in major depression
Bifulco, A. 2013. Psychosocial models and issues in major depression. in: Power, M. (ed.) The Wiley Blackwell Handbook of mood disorders WileyBlackwell. pp. 87-106
Assessing risk for perinatal depression with the Attachment Style Interview
Bifulco, A. Assessing risk for perinatal depression with the Attachment Style Interview. in: Carretti, V., Ragonese, N. and Crisafi, C. (ed.) Perinatal Depression Astrolabia, Roma.
The Attachment Style Interview (ASI)
Bifulco, A. 2014. The Attachment Style Interview (ASI). in: Farnfield, S. and Holmes, P. (ed.) The Routledge Handbook of Attachment: Assessment London and New York Routledge. pp. 178-191
Online offending behaviour and child victimisation: new findings and policy
Webster, S., Davidson, J. and Bifulco, A. 2014. Online offending behaviour and child victimisation: new findings and policy. Palgrave Macmillan.
Exploring young people's use of social networking sites and digital media in the Internet safety context: a comparison of the UK and Bahrain
Davidson, J. and Martellozzo, E. 2013. Exploring young people's use of social networking sites and digital media in the Internet safety context: a comparison of the UK and Bahrain. Information, Communication and Society. 16 (9), pp. 1456-1476. https://doi.org/10.1080/1369118X.2012.701655
Protecting vulnerable young people in cyberspace from sexual abuse: raising awareness and responding globally
Davidson, J. and Martellozzo, E. 2008. Protecting vulnerable young people in cyberspace from sexual abuse: raising awareness and responding globally. Police Practice and Research. 9 (4), pp. 277-289. https://doi.org/10.1080/15614260802349965
Risk factors and psychological outcomes of bullying victimization: a community-based study
Bifulco, A., Schimmenti, A., Jacobs, C., Bunn, A. and Rusu, A. 2014. Risk factors and psychological outcomes of bullying victimization: a community-based study. Child Indicators Research. https://doi.org/10.1007/s12187-014-9236-8
Adverse childhood experiences and their impact on frequency, severity, and the individual function of nonsuicidal self-injury in youth
Kaess, M., Parzer, P., Mattern, M., Plener, P., Bifulco, A., Resch, F. and Brunner, R. 2013. Adverse childhood experiences and their impact on frequency, severity, and the individual function of nonsuicidal self-injury in youth. Psychiatry Research. 206 (2-3), pp. 265-272. https://doi.org/10.1016/j.psychres.2012.10.012
Life events
Bifulco, A. 2013. Life events. in: Gabe, J. and Monaghan, L. (ed.) Key concepts in medical sociology London, UK SAGE Publications. pp. 45-50
Setting up a youth violence prevention project in a London hospital emergency department
Ilan-Clarke, Y., Bunn, A., DeMarco, J., Bifulco, A., Criddle, J. and Holdsworth, G. 2013. Setting up a youth violence prevention project in a London hospital emergency department. Journal of Public Mental Health. 12 (2), pp. 80-92. https://doi.org/10.1108/JPMH-09-2012-0005
Understanding alexithymia in female adolescents: the role of attachment style
Oskis, A., Clow, A., Hucklebridge, F., Bifulco, A., Jacobs, C. and Loveday, C. 2013. Understanding alexithymia in female adolescents: the role of attachment style. Personality and Individual Differences. 54 (1), pp. 97-102. https://doi.org/10.1016/j.paid.2012.08.023
Psychiatrie infantojuvénile en Europe: 68 Grande-Bretagne
Bifulco, A. and Thomas, G. 2012. Psychiatrie infantojuvénile en Europe: 68 Grande-Bretagne. in: Ferrari, P. and Bonnot, O. (ed.) Traité européen de psychiatrie et de psychopathologie de l'enfant et de l'adolescent Paris Lavoisier. pp. 691-697
Caring about attachment in young people in residential care: the use of the attachment style interview. Report of a voluntary sector and university partnership
Jacobs, C., Ilan-Clarke, Y. and Bifulco, A. 2012. Caring about attachment in young people in residential care: the use of the attachment style interview. Report of a voluntary sector and university partnership. Community Care Inform.
Vulnerability, life events and depression amongst Moslem Malaysian women: comparing those married and those divorced or separated
Abdul Kadir, N. and Bifulco, A. 2011. Vulnerability, life events and depression amongst Moslem Malaysian women: comparing those married and those divorced or separated. Social Psychiatry and Psychiatric Epidemiology. 46 (9), pp. 853-862. https://doi.org/10.1007/s00127-010-0249-4
Attachment style and psychological adjustment in couples
Conde, A., Figueirido, B. and Bifulco, A. 2011. Attachment style and psychological adjustment in couples. Attachment & Human Development. 13 (3), pp. 271-291. https://doi.org/10.1080/14616734.2011.562417
Condividere e condividere allo stesso modo.Il maltrattamento è un’esperienza condivisa dai fratelli? [= To share and share alike: is maltreatment an experience shared by siblings?]
Bifulco, A., Ilan-Clarke, Y., Hannan, L. and Schimmenti, A. 2008. Condividere e condividere allo stesso modo.Il maltrattamento è un’esperienza condivisa dai fratelli? [= To share and share alike: is maltreatment an experience shared by siblings?]. Noos – Aggiornamenti in Psichiatria. 3, pp. 253-274.
Quando i genitori maltrattano i figli. Le radici psicopatologiche dello sviluppo affettivo (When the parents maltreat their young: the developmental roots of psychopathology)
Schimmenti, A. and Bifulco, A. 2008. Quando i genitori maltrattano i figli. Le radici psicopatologiche dello sviluppo affettivo (When the parents maltreat their young: the developmental roots of psychopathology). in: Caretti, V. and Creparo, G. (ed.) Trauma e psicopatologia. Un approccio evolutivo-relazionale Rome Astrolabi. pp. 94-131
Le esperienze di maltrattamento vissute dai fratelli: tra ambiente condiviso e non condiviso
Schimmenti, A. and Bifulco, A. 2010. Le esperienze di maltrattamento vissute dai fratelli: tra ambiente condiviso e non condiviso. in: Schimmenti, V. (ed.) Oltre la madre: relazioni familiari e sviluppo psicologico Milan, Italy FrancoAngeli. pp. 114-129
Loss trauma
Bifulco, A. 2007. Loss trauma. in: Encyclopedia of Stress Academic Press. pp. 612-615
Il bambino maltrattato: le radici della depressione nel trauma e nell'abuso infantile
Bifulco, A. and Moran, P. 2007. Il bambino maltrattato: le radici della depressione nel trauma e nell'abuso infantile. Rome Astrolabio Ubaldini.
Familial patterns of stress
Bifulco, A. 2007. Familial patterns of stress. in: Fink, G. (ed.) Encyclopedia of Stress Academic Press. pp. 1-6
Wednesday's child: research into women's experience of neglect and abuse in childhood and adult depression
Bifulco, A. and Moran, P. 1998. Wednesday's child: research into women's experience of neglect and abuse in childhood and adult depression. London, U.K. Routledge.
Risk and resilience in young Londoners
Bifulco, A. 2009. Risk and resilience in young Londoners. in: Brom, D., Pat-Horenczyk, R. and Ford, J. (ed.) Treating traumatized children: risk, resilience and recovery Hove, U.K. Routledge. pp. 117-130
Depressed mothers and their children: attachment issues
Bifulco, A. 2010. Depressed mothers and their children: attachment issues. in: Kohen, D. (ed.) Oxford Textbook of Women and Mental Health Oxford, U.K. Oxford University Press (OUP). pp. 271-277
History of childhood abuse in Portuguese parents
Figuieredo, B., Bifulco, A., Paivia, C., Maia, A., Fernandes, E. and Matos, R. 2004. History of childhood abuse in Portuguese parents. Child Abuse and Neglect. 28 (6), pp. 669-682. https://doi.org/10.1016/j.chiabu.2003.11.021
Maternal attachment style and depression associated with childbirth ; preliminary results from a European and US cross-cultural study
Bifulco, A., Figueiredo, B., Guedeney, N., Gorman, L., Hayes, S., Muzik, M., Glatigny-Dallay, E., Valoriani, V., Kammerer, M. and Henshaw, C. 2004. Maternal attachment style and depression associated with childbirth ; preliminary results from a European and US cross-cultural study. The British Journal of Psychiatry. 184, pp. s31-s37.
Attachment style measurement: a clinical and epidemiological perspective
Bifulco, A. 2002. Attachment style measurement: a clinical and epidemiological perspective. Attachment & Human Development. 4 (2), pp. 180-188. https://doi.org/10.1080/14616730210157501
Lifetime stressors and recurrent depression: preliminary findings of the Adult Life Phase Interview (ALPHI)
Bifulco, A., Bernazzani, O., Moran, P. and Ball, C. 2000. Lifetime stressors and recurrent depression: preliminary findings of the Adult Life Phase Interview (ALPHI). Social Psychiatry and Psychiatric Epidemiology. 35 (6), pp. 264-275. https://doi.org/10.1007/s001270050238
Motherhood as a vulnerability factor in major depression: the role of negative pregnancy experiences
Bernazzani, O. and Bifulco, A. 2003. Motherhood as a vulnerability factor in major depression: the role of negative pregnancy experiences. Social Science & Medicine. 56 (6), pp. 1249-1260. https://doi.org/10.1016/S0277-9536(02)00123-5
Malaysian moslem mothers' experience of depression and service use
Abdul Kadir, N. and Bifulco, A. 2010. Malaysian moslem mothers' experience of depression and service use. Culture, Medicine, and Psychiatry. 34 (3), pp. 443-467. https://doi.org/10.1007/s11013-010-9183-x
Exploring psychological abuse in childhood. I: developing a new interview scale
Moran, P., Bifulco, A., Ball, C., Jacobs, C. and Benaim, K. 2002. Exploring psychological abuse in childhood. I: developing a new interview scale. Bulletin of the Menninger Clinic. 66 (Summer), pp. 213-240.
Childhood experiences of care and abuse (CECA): validierung der Deutschen version des fragebogenund korrespondierenden Interview sowie Ergebnisse einer Untersuchung von Zusammenhangen belastenader Kindheitserlebnisse mit suizdalen Verhaltensweisen
Kaess, M., Parzer, P., Mattern, M., Resch, F., Bifulco, A. and Brunner, R. 2011. Childhood experiences of care and abuse (CECA): validierung der Deutschen version des fragebogenund korrespondierenden Interview sowie Ergebnisse einer Untersuchung von Zusammenhangen belastenader Kindheitserlebnisse mit suizdalen Verhaltensweisen. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie. 39 (4), pp. 243-252. https://doi.org/10.1024/1422-4917/a000115
Investigating police practice in the UK: achieving best evidence in work with young victims of abuse
Davidson, J. and Bifulco, A. 2009. Investigating police practice in the UK: achieving best evidence in work with young victims of abuse. Pakistan Journal of Criminology. 1 (3), pp. 19-46.
Childhood experience and sexual offending: the use of the Childhood Experience of Care and Abuse (CECA) interview in forensic psychology research and practice
Bifulco, A. 2006. Childhood experience and sexual offending: the use of the Childhood Experience of Care and Abuse (CECA) interview in forensic psychology research and practice. in: Pham, T. (ed.) L'évaluation diagnostique des agresseurs sexuels Belgium Mardaga Pierre.
Early adversity and depression
Bifulco, A. 2009. Early adversity and depression. in: Ingram, R. (ed.) The International Encyclopedia of Depression New York Springer Publishing Company.
Multi-agency working: Implications for an early-intervention social work team
Moran, P., Jacobs, C., Bunn, A. and Bifulco, A. 2007. Multi-agency working: Implications for an early-intervention social work team. Child & Family Social Work. 12 (2), pp. 143-151. https://doi.org/10.1111/j.1365-2206.2006.00452.x
Teenage pregnancy, attachment style, and depression: a comparison of teenage and adult pregnant women in a Portuguese series
Figueiredo, B., Bifulco, A., Pacheco, A., Costa, R. and Magarinho, R. 2006. Teenage pregnancy, attachment style, and depression: a comparison of teenage and adult pregnant women in a Portuguese series. Attachment & Human Development. 8 (2), pp. 123-138. https://doi.org/10.1080/14616730600785686
Solutions on Stress (SOS): programmes, packages and products for helping teenagers
Bunn, A., Bifulco, A., Lorenc, A. and Robinson, N. 2007. Solutions on Stress (SOS): programmes, packages and products for helping teenagers. Young Consumers: Insight and Ideas for Responsible Marketers. 8 (1), pp. 29-35. https://doi.org/10.1108/17473610710733758
Exploring psychological abuse in childhood: II. Association with other abuse and adult clinical depression
Bifulco, A., Moran, P., Baines, R., Bunn, A. and Stanford, K. 2002. Exploring psychological abuse in childhood: II. Association with other abuse and adult clinical depression. Bulletin of the Menninger Clinic. 66 (3), pp. 241-258.
The Vulnerable Attachment Style Questionnaire (VASQ): an interview-based measure of attachment styles that predict depressive disorder
Bifulco, A., Mahon, J., Kwon, J., Moran, P. and Jacobs, C. 2003. The Vulnerable Attachment Style Questionnaire (VASQ): an interview-based measure of attachment styles that predict depressive disorder. Psychological Medicine. 33 (6), pp. 1099-1110. https://doi.org/10.1017/S0033291703008237
Problem partners and parenting: exploring linkages with maternal insecure attachment style and adolescent offspring internalizing disorder
Bifulco, A., Moran, P., Jacobs, C. and Bunn, A. 2009. Problem partners and parenting: exploring linkages with maternal insecure attachment style and adolescent offspring internalizing disorder. Attachment & Human Development. 11 (1), pp. 69-85. https://doi.org/10.1080/14616730802500826
Child victims of sexual abuse: children's experience of the investigative process in the criminal justice system
Davidson, J., Bifulco, A., Thomas, G. and Ramsay, M. 2006. Child victims of sexual abuse: children's experience of the investigative process in the criminal justice system. Practice: Social Work in Action. 18 (4), pp. 247-263. https://doi.org/10.1080/09503150601025253
Adult attachment style as mediator between childhood neglect/abuse and adult depression and anxiety
Bifulco, A., Kwon, J., Jacobs, C., Moran, P., Bunn, A. and Beer, N. 2006. Adult attachment style as mediator between childhood neglect/abuse and adult depression and anxiety. Social Psychiatry and Psychiatric Epidemiology. 41 (10), pp. 796-805. https://doi.org/10.1007/s00127-006-0101-z
Adult Attachment Style. II: Its relationship to psychosocial depressive-vulnerability
Bifulco, A., Moran, P., Ball, C. and Lillie, A. 2002. Adult Attachment Style. II: Its relationship to psychosocial depressive-vulnerability. Social Psychiatry and Psychiatric Epidemiology. 37 (2), pp. 60-67. https://doi.org/10.1007/s127-002-8216-x
Adult attachment style. I: Its relationship to clinical depression
Bifulco, A., Moran, P., Ball, C. and Bernazzani, O. 2002. Adult attachment style. I: Its relationship to clinical depression. Social Psychiatry and Psychiatric Epidemiology. 37 (2), pp. 50-59. https://doi.org/10.1007/s127-002-8215-0
Assessing psychosocial risk in pregnant/postpartum women using the Contextual Assessment of Maternity Experience (CAME)
Bernazzani, O., Marks, M., Bifulco, A., Siddle, K., Asten, P. and Conroy, S. 2005. Assessing psychosocial risk in pregnant/postpartum women using the Contextual Assessment of Maternity Experience (CAME). Social Psychiatry and Psychiatric Epidemiology. 40 (6), pp. 497-508. https://doi.org/10.1007/s00127-005-0917-y
Problem partners and parenting: exploring linkages with maternal insecure attachment style and adolescent offspring internalizing disorder
Bifulco, A., Moran, P., Jacobs, C. and Bunn, A. 2009. Problem partners and parenting: exploring linkages with maternal insecure attachment style and adolescent offspring internalizing disorder. Attachment & Human Development. 11 (1), pp. 69-85. https://doi.org/10.1080/14616730802500826
Concordance between mother and offspring retrospective reports of childhood adversity
Fisher, H., Bunn, A., Jacobs, C., Moran, P. and Bifulco, A. 2011. Concordance between mother and offspring retrospective reports of childhood adversity. Child Abuse and Neglect. 35 (2), pp. 117-122. https://doi.org/10.1016/j.chiabu.2010.10.003
The longitudinal psychometric properties of the EAS temperament survey in adolescence
Spence, R., Owens, M. and Goodyer, I. 2013. The longitudinal psychometric properties of the EAS temperament survey in adolescence. Journal of Personality Assessment. 95 (6), pp. 633-639. https://doi.org/10.1080/00223891.2013.819513
Cuidado y protección de menores contra el abuso sexual on line
Martellozzo, E. 2009. Cuidado y protección de menores contra el abuso sexual on line. Cuadernos de Seguridad. 11, pp. 151-181.
Online child sexual abuse by female offenders: an exploratory study
Martellozzo, E., Nehring, D. and Taylor, H. 2010. Online child sexual abuse by female offenders: an exploratory study. International Journal of Cyber Criminology. 4 (1&2), pp. 592-609.
Protecting children online: towards a safer internet
Davidson, J. and Martellozzo, E. 2008. Protecting children online: towards a safer internet. in: Wetherby, G., Williams, K., Birch, P. and Cain, M. (ed.) Sex as crime? Willan. pp. 338-355
Internet sex offenders: individual autonomy, ‘folk devils’ and state control
Martellozzo, E., Davidson, J. and Cambridge Socio-Legal Group 2009. Internet sex offenders: individual autonomy, ‘folk devils’ and state control. in: Sclater, S., Ebtehaj, F., Jackson, E. and Richards, M. (ed.) Regulating autonomy: sex, reproduction and family Oxford, UK Hart Publishing. pp. 129-146
Understanding the perpetrators' online behaviour
Martellozzo, E. 2010. Understanding the perpetrators' online behaviour. in: Davidson, J. and Gottschalk, P. (ed.) Internet child abuse: current research and policy Abingdon, UK Routledge-Cavendish. pp. 104-125
Online child sexual abuse: grooming, policing and child protection in a multi-media world
Martellozzo, E. 2012. Online child sexual abuse: grooming, policing and child protection in a multi-media world. London, UK Routledge.
Item response theory and validity of the NEO-FFI in adolescents
Spence, R., Owens, M. and Goodyer, I. 2012. Item response theory and validity of the NEO-FFI in adolescents. Personality and Individual Differences. 53 (6), pp. 801-807. https://doi.org/10.1016/j.paid.2012.06.002
Understanding adult attachment in family relationships: assessment and intervention
Bifulco, A. and Thomas, G. 2012. Understanding adult attachment in family relationships: assessment and intervention. Routledge.
Globalization, urbanization & security
Davidson, J. and Martellozzo, E. 2009. Globalization, urbanization & security. in: Cordner, G., Cordner, A. and Das, D. (ed.) Urbanization, policing & security: global perspectives CRC Press.
Clinical and economic outcomes from the UK pilot psychiatric services for personality-disordered offenders
Fortune, Z., Barrett, B., Armstrong, D., Coid, J., Crawford, M., Mudd, D., Rose, D., Slade, M., Spence, R., Tyrer, P. and Moran, P. 2011. Clinical and economic outcomes from the UK pilot psychiatric services for personality-disordered offenders. International Review of Psychiatry. 23 (1), pp. 61-69. https://doi.org/10.3109/09540261.2010.545989
Urbanization and security: moving forward, key themes, and challenges
Davidson, J. and Martellozzo, E. 2009. Urbanization and security: moving forward, key themes, and challenges. in: Cordner, G., Das, D. and Cordner, A. (ed.) Urbanization, policing, and security: global perspectives. CRC Press. pp. 435-440
Sex offenders' use of the Internet.
Martellozzo, E. 2010. Sex offenders' use of the Internet. in: Davidson, J. and Gottschalk, P. (ed.) Internet child abuse: current research and policy. Routledge-Cavendish. pp. 104-125
Evaluation of CEOP ThinkUKnow internet safety programme and exploration of young people's internet safety knowledge.
Davidson, J., Martellozzo, E. and Lorenz, M. 2009. Evaluation of CEOP ThinkUKnow internet safety programme and exploration of young people's internet safety knowledge. Centre for Abuse & Trauma Studies and Kingston University.
Cycle of abuse
Martellozzo, E. and Taylor, H. 2009. Cycle of abuse. Index on Censorship. 38 (1), pp. 117-122. https://doi.org/10.1080/03064220902761106
An evaluation of new services for personality-disordered offenders: staff and service user perspectives
Fortune, Z., Rose, D., Crawford, M., Slade, M., Spence, R., Mudd, D., Barrett, B., Coid, J., Tyrer, P. and Moran, P. 2010. An evaluation of new services for personality-disordered offenders: staff and service user perspectives. International Journal of Social Psychiatry. 56 (2), pp. 186-195. https://doi.org/10.1177/0020764009105281
The Attachment Style Interview (ASI): a support-based adult assessment tool for adoption and fostering practice
Bifulco, A., Jacobs, C., Bunn, A., Thomas, G. and Irving, K. 2008. The Attachment Style Interview (ASI): a support-based adult assessment tool for adoption and fostering practice. Adoption and Fostering. 32 (3), pp. 33-45. https://doi.org/10.1177/030857590803200306
The childhood experience of care and abuse questionnaire (CECA.Q): validation in a community series
Bifulco, A., Bernazzani, O., Moran, P. and Jacobs, C. 2005. The childhood experience of care and abuse questionnaire (CECA.Q): validation in a community series. British Journal of Clinical Psychology. 44 (4), pp. 563-581. https://doi.org/10.1348/014466505X35344
Childhood adversity, parental vulnerability and disorder: examining intergenerational transmission of risk
Bifulco, A., Moran, P., Ball, C., Jacobs, C., Baines, R., Bunn, A. and Cavagin, J. 2002. Childhood adversity, parental vulnerability and disorder: examining intergenerational transmission of risk. Journal of Child Psychology and Psychiatry. 43 (8), pp. 1075-1086. https://doi.org/10.1111/1469-7610.00234
Predicting onset of depression: the vulnerability to depression questionnaire
Moran, P., Bifulco, A., Ball, C. and Campbell, C. 2001. Predicting onset of depression: the vulnerability to depression questionnaire. British Journal of Clinical Psychology. 40 (4), pp. 411-427. https://doi.org/10.1348/014466501163896