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Aims: There is considerable evidence that waiting list (WL) control groups overestimate the effect sizes of psychotherapies for depression. It is not clear, however, what are the exact causes for this overestimation. We decided to conduct a meta-analytic study to compare trials on psychotherapy for depression with a WL control group against trials with a care-as-usual (CAU) control group., Methods: We used an existing meta-analytic database of randomized trials comparing psychological treatments of adult depression with control groups and selected trials using a WL or a CAU control group. We used subgroup and meta-regression analyses to examine differences in effect sizes between WL and CAU controlled trials., Results: We included 333 randomized controlled trials (472 comparisons; total number participants: 41,480), 141 with a WL and 195 with a CAU control group (3 included both). We found several significant differences between WL and CAU controlled trials (in type of therapy examined, treatment format, recency, target group, recruitment strategy, number of treatment arms and number of depression outcome measures). The overall effect size indicating the difference between treatment and control at post-test for all comparisons was g = 0.77 (95% confidence interval [CI]: 0.71; 0.84) with high heterogeneity ( I 2 = 84; 95% CI: 82; 85). A highly significant difference was observed between studies with a CAU control group ( g = 0.63; 95% CI: 0.55; 0.71; I 2 = 85; 95% CI: 83; 86) and studies with a WL ( g = 0.95; 95% CI: 0.85; 1.04; I 2 = 80; 95% CI: 78; 82; p for difference < 0.001). This difference remained significant in all sensitivity analyses, including a meta-regression analysis in which we adjusted for all differences in characteristics of studies with a WL versus CAU control group. We also found that pre-post effect sizes in WL control conditions ( g = 0.37; 95% CI: 0.28; 0.46) were significantly smaller than change within CAU conditions ( g = 0.64; 95% CI: 0.50; 0.78). We found few indications that pre-post effect sizes within therapy conditions differed between WL and CAU controlled trials., Conclusions: WL control conditions considerably overestimate the effect sizes of psychological treatments, compared to trials using CAU control conditions. This overestimation is probably caused by a smaller improvement within the WL condition compared to the improvement in the CAU condition. WL control conditions should be avoided in randomized trials examining psychological treatments of adult depression.

Objective: In this study, it was aimed to examine the effects of problem solving therapy, which is a cognitive behavioral method, on adolescents diagnosed with alcohol and substance use disorder., Method: A semi-structured interview and intelligence test were administered to adolescents with diagnosis of substance use disorder to identify comorbidities. 46 adolescents who met the inclusion criteria were divided into two groups. Problem solving therapy was applied to the first group for 5 weeks, once a week, while the other group continued their routine controls in the center. Beck Depression Inventory, Screen for Child Anxiety Disorders, Revised Social Problem Solving Inventory, Addiction Profile Index and Treatment Motivation Questionnaire were administered to the groups at the beginning of the study and at the end of the 5th week and the results were analyzed., Results: Sociodemographic and substance use characteristics, comorbid psychopathologies and scale mean scores of the groups in the first evaluation were found to be similar to each other. Although the depression and anxiety scores decreased significantly in both groups, no significant difference was found between the groups. Problemsolving skills and treatment motivation increased in the therapy group and decreased in the control group. The difference between groups was found to be significant (p=0.045, 0.037 for problem solving and treatment motivation respectively). While the severity of addiction decreased in therapy group, it increased in control group, but the difference was not significant., Conclusion: This study is important in that it shows that psychosocial interventions strengthen the treatment of substance use disorder in adolescents. In our country, no other study was evaluating the effects of the intervention methods in addicted adolescents was found. Future studies with larger sample sizes and where the long-term results of substance use disorder are evaluated are needed.

Aims: Refugees are confronted with the task of adapting to the long-term erosion of psychosocial systems and institutions that in stable societies support psychological well-being and mental health. We provide an overview of the theoretical principles and practical steps taken to develop a novel psychotherapeutic approach, Integrative Adapt Therapy (IAT), which aims to assist refugees to adapt to these changes. This paper offers the background informing ongoing trials of IAT amongst refugees from Myanmar., Methods: A systematic process was followed in formulating the therapy and devising a treatment manual consistent with the principles of the Adaptation and Development After Persecution and Trauma (ADAPT) model. The process of development and refinement was based on qualitative research amongst 70 refugees (ten from West Papua and 60 Rohingya from Myanmar). The therapeutic process was then piloted by trained interventionists amongst a purposively selected sample of 20 Rohingya refugees in Malaysia., Results: The final formulation of IAT represented an integration of the principles of the ADAPT model and evidence-based techniques of modern therapies in the field, including a transdiagnostic approach and the selective use of cognitive behavioural treatment elements such as problem-solving and emotional regulation techniques. The steps outlined in refining the manual are outlined in relation to work amongst West Papuan refugees, and the process of cultural and contextual modifications described during early piloting with Rohingya refugees in Malaysia., Conclusions: IAT integrates universal principles of the ADAPT model with the particularities of the culture, history of conflict and living context of each refugee community; this synthesis of knowledge forms the basis for participants gaining insights into their personal patterns of psychosocial adaptation to the refugee experience. Participants then apply evidence-based techniques to improve their capacity to adapt to the serial psychosocial changes they have encountered in their lives as refugees. The overarching goal of IAT is to provide refugees with a coherent framework that assists in making sense of their experiences and their emotional and interpersonal reactions to the challenges they confront within the family and community context. As such, the principles of a general model (ADAPT) are used as a springboard for making concrete, manageable and meaningful life changes at the individual level, a potentially novel approach for psychosocial interventions in the field.

Background: Mood disorder after stroke is common but drug and psychosocial treatments have been assessed with disappointing results. Preventing mood disorder from developing in the first place could be a better approach and might reduce the need for pharmacotherapy in this predominantly older patient group. We used a brief problem-solving therapy and evaluated its effect in reducing mood disorder in the 12 months after stroke., Methods: A 3-group, parallel, randomised controlled trial. Four hundred fifty patients with stroke were randomised within 1 month of hospital admission to problem-solving therapy from a psychiatric nurse, non-specific support given by volunteers or treatment-as-usual. Follow up took place at 6 and 12 months after stroke. Standardised measures of mood (Present State Examination, GHQ-28), cognitive state (mini-mental state examination) and function (Barthel ADL index, Frenchay Activities Index) were taken at baseline, 6 and 12 months after randomisation. Satisfaction with care was recorded at follow up., Results: At 6 months, all psychological and activity measures favoured problem-solving therapy. At 12 months, patients in the problem-solving therapy group had significantly lower GHQ-28 scores and lower median Present State Examination symptom scores. There were no statistically significant differences in activity. The problem-solving therapy group were more satisfied with some aspects of care., Conclusions: The results are encouraging and suggest it is possible to prevent mood disorder in stroke patients using a psychological intervention. The differences between the groups at 12 months may indicate a sustained impact of psychological therapies, by comparison with non-specific support., Trial Registration: ISRCTN: ISRCTN33773710 Registered: 23/01/2004 (Retrospectively).

Background: Major depressive disorder (MDD) has a highly recurrent nature. After successful treatment, it is important to identify individuals who are at risk of an unfavorable long-term course. Despite extensive research, there is no consensus yet on the clinically relevant predictors of long-term outcome in MDD, and no prediction models are implemented in clinical practice. The aim of this study was to create a prognostic index (PI) to estimate long-term depression severity after successful and high quality acute treatment for MDD., Methods: Data come from responders to cognitive therapy (CT) and interpersonal psychotherapy (IPT) in a randomized clinical trial (n = 85; CT = 45, IPT = 40). Primary outcome was depression severity, assessed with the Beck Depression Inventory II, measured throughout a 17-month follow-up phase. We examined 29 variables as potential predictors, using a model-based recursive partitioning method and bootstrap resampling in conjunction with backwards elimination. The selected predictors were combined into a PI. Individual PI scores were estimated using a cross-validation approach., Results: A total of three post-treatment predictors were identified: depression severity, hopelessness, and self-esteem. Cross-validated PI scores evidenced a strong correlation (r = 0.60) with follow-up depression severity., Conclusion: Long-term predictions of MDD are multifactorial, involving a combination of variables that each has a small prognostic effect. If replicated and validated, the PI can be implemented to predict follow-up depression severity for each individual after acute treatment response, and to personalize long-term treatment strategies., (© 2018 The Authors. Depression and Anxiety published by Wiley Periodicals, Inc.)

Background: Headache disorder is not only a common complaint but also a global burden. Pharmacotherapeutic and non-pharmacotherapeutic approaches have been developed for its treatment and prophylaxis. The present study included a systematic review of psychological treatments for primary headache disorder accessible in Korea., Methods: We included English and Korean articles from EMBASE, MEDLINE, Cochrane library database, SCOPUS, ScienceDirect, Web of Science, CINAHL, PsycArticles and Korean database, KoreaMed and KMBASE which studied primary headache and medication-overuse headache. The primary efficacy measure was the number of headache days per month, while secondary efficacy measures were the number of headache attacks per week, headache index, treatment response rate, and migraine disability assessment. The meta-analysis was performed using R 3.5.1. to obtain pooled mean difference and pooled relative risk with 95% confidence interval (CI) for continuous data and dichotomous data, respectively., Results: From 12,773 identified articles, 27 randomized clinical trials were identified. Primary outcome showed significant superiority of psychological treatments (pooled mean difference = - 0.70, 95% CI [- 1.22, - 0.18]). For the secondary outcomes, the number of headache attacks (pooled mean difference = - 1.15, 95% CI [- 1.63, - 0.67]), the headache index (pooled mean difference = - 0.92, 95% CI [- 1.40 to - 0.44]) and the treatment response rate (pooled relative risk = 3.13, 95% CI [2.24, 4.37]) demonstrated significant improvements in the psychological treatment group over the control group., Conclusion: Psychological treatments for primary headache disorder reduced headache frequency and the headache index. Future research using standardized outcome measures and strategies for reducing bias is needed.

Background: Although psychotherapy is one of the most efficacious and effective treatments for depression, limited accessibility to trained providers markedly limits access to care. In an attempt to overcome this obstacle, several platforms seeking to provide these services using digital modalities (eg, video, text, and chat) have been developed. However, the use of these modalities individually poses barriers to intervention access and acceptability. Multimodal platforms, comprising those that allow users to select from a number of available modalities, may be able to provide a solution to these concerns., Objective: We aimed to investigate the preliminary effectiveness of providing psychotherapy through a multimodal digital psychotherapy platform. In addition, we aimed to examine differential responses to intervention by gender, self-reported physical health status, and self-reported financial status, as well as how prior exposure to traditional face-to-face psychotherapy affected the effectiveness of a multimodal digital psychotherapy intervention. Finally, we aimed to examine the dose-response effect., Methods: Data were collected from a total of 318 active users of BetterHelp, a multimodal digital psychotherapy platform. Data on physical health status, financial status, and prior exposure to psychotherapy were obtained using self-report measures. Effectiveness was determined by the extent of symptom severity change, which was measured using the Patient Health Questionnaire at Time 1 (time of enrollment) and Time 2 (3 months after enrollment). Intervention dosage was measured as the sum of individual therapist-user interactions across modalities., Results: Depression symptom severity was significantly reduced after the use of the multimodal digital psychotherapy intervention (P<.001). Individuals without prior traditional psychotherapy experience revealed increased improvement after intervention (P=.006). We found no significant dose-response effect of therapy, nor significant differences in outcomes across gender, self-reported financial status, and self-reported physical health status., Conclusions: Users of BetterHelp experienced significantly reduced depression symptom severity after engaging with the platform. Study findings suggest that this intervention is equally effective across gender, self-reported financial status, and self-reported physical health status and particularly effective for individuals without a history of psychotherapy. Overall, study results suggest that multimodal digital psychotherapy is a potentially effective treatment for adult depression; nevertheless, experimental trials are needed. We discuss directions for future research., (©Enitan T Marcelle, Laura Nolting, Stephen P Hinshaw, Adrian Aguilera. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 23.01.2019.)

Background: Self-guided internet-based cognitive behavioral therapies (iCBTs) for depressive symptoms may substantially increase accessibility to mental health treatment. Despite this, questions remain as to the generalizability of the research on self-guided iCBT., Objective: We sought to describe the clinical entry criteria used in studies of self-guided iCBT, explore the criteria's effects on study outcomes, and compare the frequency of use of these criteria with their use in studies of face-to-face psychotherapy and antidepressant medications. We hypothesized that self-guided iCBT studies would use more stringent criteria that would bias the sample toward those with a less complex clinical profile, thus inflating treatment outcomes., Methods: We updated a recently published meta-analysis by conducting a systematic literature search in PubMed, MEDLINE, PsycINFO, and EMBASE. We conducted a meta-regression analysis to test the effect of the different commonly used psychiatric entry criteria on the treatment-control differences. We also compared the frequency with which exclusion criteria were used in the self-guided iCBT studies versus studies of face-to-face psychotherapy and antidepressants from a recently published review., Results: Our search yielded 5 additional studies, which we added to the 16 studies identified by Karyotaki and colleagues in 2017. Few self-guided iCBT studies excluded patients with severe depressive symptoms (6/21, 29%), but self-guided iCBT studies were more likely than antidepressant (14/170, 8.2%) studies to use this criterion. However, self-guided iCBT studies did not use this criterion more frequently than face-to-face psychotherapy studies (6/16, 38%). Beyond this, we found no evidence that self-guided iCBTs used more stringent entry criteria. Strong evidence suggested that they were actually less likely to use most entry criteria, especially exclusions on the basis of substance use or personality pathology. None of the entry criteria used had an effect on outcomes., Conclusions: A conservative interpretation of our findings is that the patient population sampled in the literature on self-guided iCBT is relatively comparable with that of studies of antidepressants or face-to-face psychotherapy. Alternatively, studies of unguided cognitive behavioral therapy may sample from a more heterogeneous and representative patient population. Until evidence emerges to suggest otherwise, the patient population sampled in self-guided iCBT studies cannot be considered as less complex than the patient population from face-to-face psychotherapy or antidepressant studies., (©Lorenzo Lorenzo-Luaces, Emily Johns, John R Keefe. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 09.11.2018.)

Background: Anxious depression is an important subtype of Major Depressive Disorder (MDD) defined by both syndromal (anxiety disorders) and dimensional (anxiety symptoms) criteria. A debated question is how anxiety affects MDD treatment. This study examined the impact of comorbid anxiety disorders and symptoms on the effectiveness of and dropout during Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for MDD., Methods: Depressed individuals were randomized to CT (n = 76) or IPT (n = 75). Outcome was depression severity measured with the Beck Depression Inventory-II (BDI-II) at the start of each therapy session, post treatment, and monthly up to five months follow-up. Anxiety disorders were assessed with the Structured Clinical Interview for DSM-IV Axis I disorders, (phobic) anxiety symptoms were assessed with Brief Symptom Inventory subscales., Results: Approximately one third of participants had a comorbid anxiety disorder. Comorbid anxiety disorders and anxiety symptoms were associated with less favorable depression change during IPT as compared to CT in the treatment phase, but not in the trial follow-up phase. Individuals with a comorbid anxiety disorder had significantly higher treatment dropout during both treatments., Limitations: Not all therapists and participants were blind to the assessment of comorbid anxiety disorders and the assessments were performed by one rater., Conclusions: A preference for CT over IPT for MDD is justifiable when comorbid anxiety is present, although long-term differences are not established and replication of this finding is needed. Clinicians should be aware of the risk of dropout for depressed individuals with an anxiety disorder., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Despite extensive research, there is no consensus how Personality Disorders (PD) and PD features affect outcome for Major Depressive Disorder (MDD). The present study evaluated the effects of PD (features) on treatment continuation and effectiveness in Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for MDD., Methods: Depressed outpatients were randomized to CT (n=72) and IPT (n=74). Primary outcome was depression severity measured repeatedly with the Beck Depression Inventory-II (BDI-II) at baseline, three months, at the start of each therapy session, at post-treatment and monthly during five months follow-up., Results: Comorbid PD and PD features did not affect dropout. Multilevel and Cox regression models indicated no negative effect of PD on BDI-II change and remission rates during treatment and follow-up, irrespective of the treatment received. For both therapies, higher dependent PD features predicted overall lower BDI-II scores during treatment, however this effect did not sustain through follow-up. Cluster A PD features moderated treatment outcome during treatment and follow-up: individuals with high cluster A PD features had greater BDI-II reductions over time in CT as compared to IPT., Limitations: Not all therapists and participants were blind to the assessment of PD (features), and assessments were performed by one rater. Further research must investigate the state and trait dependent changes of PD and MDD over time., Conclusions: We found no negative impact of PD on the effectiveness and treatment retention of CT and IPT for MDD during treatment and follow-up. If replicated, cluster A PD features can be used to optimize treatment selection., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: Although a number of effective psychotherapies have been identified for cancer patients, little is known about therapy processes, as they unfold the course of treatment and the role of therapy processes in treatment outcome. We used growth curve modeling to evaluate the associations between therapy processes and outcomes among gynecological cancer patients participating in 2 types of therapy., Methods: Two hundred twenty five women newly diagnosed with gynecological cancer were randomly assigned to receive 8 sessions of a coping and communication intervention or a client-centered supportive therapy. Participants completed measures of preintervention and postintervention depression, working alliance after Session 2, and postsession progress and depressive symptoms after each session. Therapists completed measures of perceived patient progress., Results: Both patients and therapists reported a steady increase in session progress and patients reported a steady decrease in depressive symptoms over the course of both the coping and communication intervention and client-centered supportive sessions. Perceived progress in one session predicted progress in the subsequent session. Early working alliance predicted improved session progress and reductions in postsession depressive symptoms over sessions. Working alliance did not predict prepost treatment changes in depression. Patient-rated session progress predicted greater reductions in pretreatment to posttreatment depression, but therapist-rated progress did not., Conclusions: For 2 types of treatment delivered to women diagnosed with gynecological cancer, patient-rated session progress and depressive symptoms rated over therapy sessions may serve as a yardstick that can be useful to therapists to gauge patient's response to treatment., (Copyright © 2016 John Wiley & Sons, Ltd.)

Background: One of the major barriers to the dissemination and implementation of psychological treatments is the scarcity of suitably trained therapists. The currently accepted method of training is not scalable. Recently, a scalable form of training, Web-centered training, has been shown to have promise., Objective: The goal of our research was to conduct a randomized comparison of the relative effects of independent and supported Web-centered training on therapist competence and investigate the persistence of the effects., Methods: Eligible therapists were recruited from across the United States and Canada. They were randomly assigned to 1 of 2 forms of training in enhanced cognitive behavior therapy (CBT-E), a multicomponent evidence-based psychological treatment for any form of eating disorder. Independent training was undertaken autonomously, while supported training was accompanied by support from a nonspecialist worker. Therapist competence was assessed using a validated competence measure before training, after 20 weeks of training, and 6 months after the completion of training., Results: A total of 160 therapists expressed interest in the study, and 156 (97.5%) were randomized to the 2 forms of training (81 to supported training and 75 to independent training). Mixed effects analysis showed an increase in competence scores in both groups. There was no difference between the 2 forms of training, with mean difference for the supported versus independent group being -0.06 (95% Cl -1.29 to 1.16, P=.92). A total of 58 participants (58/114, 50.9%) scored above the competence threshold; three-quarters (43/58, 74%) had not met this threshold before training. There was no difference between the 2 groups in the odds of scoring over the competence threshold (odds ratio [OR] 1.02, 95% CI 0.52 to 1.99; P=.96). At follow-up, there was no significant difference between the 2 training groups (mean difference 0.19, 95% Cl -1.27 to 1.66, P=.80). Overall, change in competence score from end of training to follow-up was not significant (mean difference -0.70, 95% CI -1.52 to 0.11, P=.09). There was also no difference at follow-up between the training groups in the odds of scoring over the competence threshold (OR 0.95, 95% Cl 0.34 to 2.62; P=.92)., Conclusions: Web-centered training was equally effective whether undertaken independently or accompanied by support, and its effects were sustained. The independent form of Web-centered training is particularly attractive as it provides a means of training large numbers of geographically dispersed therapists at low cost, thereby overcoming several obstacles to the widespread dissemination of psychological treatments., (©Zafra Cooper, Suzanne Bailey-Straebler, Katy E Morgan, Marianne E O'Connor, Caroline Caddy, Layla Hamadi, Christopher G Fairburn. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 18.10.2017.)

Cognitive behavior group therapy (CBGT) is effective for social anxiety disorder (SAD), but a substantial proportion of patients do not typically achieve normative functioning. Cognitive behavioral models of SAD emphasize negative self-imagery as an important maintaining factor, and evidence suggests that imagery is a powerful cognitive mode for facilitating affective change. This study will compare two group CBGT interventions, one that predominantly uses verbally-based strategies (VB-CBGT) and another that predominantly uses imagery-enhanced strategies (IE-CBGT), in terms of (a) efficacy, (b) mechanisms of change, and (c) cost-effectiveness. This study is a parallel groups (two-arm) single-blind randomized controlled trial. A minimum of 96 patients with SAD will be recruited within a public outpatient community mental health clinic in Perth, Australia. The primary outcomes will be self-reported symptom severity, caseness (SAD present: yes/no) based on a structured diagnostic interview, and clinician-rated severity and life impact. Secondary outcomes and mechanism measures include blind observer-rated use of safety behaviors, physiological activity (heart rate variability and skin conductance level) during a standardized speech task, negative self-beliefs, imagery suppression, fear of negative and positive evaluation, repetitive negative thinking, anxiety, depression, self-consciousness, use of safety behaviors, and the EQ-5D-5L and TiC-P for the health economic analysis. Homework completion, group cohesion, and working alliance will also be monitored. The outcomes of this trial will inform clinicians as to whether integrating imagery-based strategies in cognitive behavior therapy for SAD is likely to improve outcomes. Common and distinct mechanisms of change might be identified, along with relative cost-effectiveness of each intervention., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The present study explored the temporal relationships between change in five candidate causal mechanisms and change in depressive symptoms in a randomized comparison of individual Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for adult depression. Furthermore, hypotheses concerning the mediation of change in these treatments were tested. Patients were 151 depressed adult outpatients treated with either CT (n = 76) or IPT (n = 75). Depression severity was assessed with the BDI-II. Candidate mediators included both therapy-specific as well as common factors. Measures were taken multiple times over the course of treatment (baseline, mid-, and post-treatment). Pearson's correlations and Latent-Difference-Score models were used to examine the direct and indirect relationships between (change in) the candidate mediators and (subsequent) (change in) depression. Patients showed improvement on all measures. No differential effects in pre- to post-treatment changes were observed between the two conditions. However, change in interpersonal functioning occurred more rapidly in IPT. Only little empirical support for the respective theoretical models of change in CT and IPT was found. Future studies should pay special attention to the timing of assessments and within-patient variance., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: The Behavioural and Cognitive Psychotherapy (BCP) Journal is the main academic publication of the British Association for Behavioural and Cognitive Psychotherapies. It publishes empirical studies, reviews and theoretical papers, brief reports and single cases., Aim: To describe the main areas of interest and focus in BCP papers., Method: All the papers published in BCP from 2000 to July 2016 were analysed. A categorization procedure was followed with 813 contributions in six main areas: main author country; main author gender; kind of contribution; kind of therapeutic approaches; kind of samples; kind of focus/topic., Results: Although the journal's scope is international, first authors tend to come from English-speaking countries. Since 2009, females contribute more than males. Empirical studies surpass theoretical studies and reviews, while the main therapy denomination is cognitive behavioural therapy. Variability of samples is wide, and ranges from analogues to main disorders. Finally, the main focus of papers is to study change and psychopathology, therapists' training and improvement of CBT., Conclusion: Given the total number of categorized papers, it can be tentatively assumed that they could exemplify some main areas of interest and evolvement in the cognitive and behavioural field.

In this article the guideline-adherent psychiatric psychotherapeutic treatment of patients with bipolar disorders is outlined and the required resources are estimated. Based on the core recommendations of the S3 guidelines for diagnostics and treatment of bipolar disorders published in 2012, inpatient treatment needs in hours per week and per patient are determined for both manic and bipolar depressive episodes. The resulting staffing requirements are estimated on this basis. In summary, for guideline-adherent inpatient psychiatric psychotherapeutic treatment the additional needs regarding the physician/psychotherapeutic domain add up to 44 min per patient and week during a manic episode and 88 min for patients with bipolar depression when compared to current psychiatry staffing regulations.

There is a pressing global need for trained and competent mental health clinicians to deliver evidence-based psychological therapies to millions of trauma survivors in need of care. Three model, large-scale training programs were initiated a decade ago, one in the United Kingdom (U.K.), and two in the United States (U.S.), to disseminate high-quality, evidence-based psychological care to traumatized children and adults in need of assistance. Milestone contributions to implementation science have been made by each of these training programs, although limitations and challenges remain to be considered. In contrast, culturally adapted and simplified PTSD interventions and therapy training programs have also been developed and tested during the past decade, three of which show particular promise for broader implementation. These simplified but evidence-based interventions have been developed for use by lay counsellors or health technicians with minimal or no prior mental health training. Finally, a growing range of technology-based and technology-assisted training models for PTSD providers have also been developed and disseminated in the past decade. This trend is expected to accelerate as more providers become accustomed to acquiring clinical training in this modality or format, although significant barriers to technology-based training will need to be overcome., (Copyright © 2016. Published by Elsevier Ltd.)

This article pays tribute to the seminal paper by Peter J. Lang (1977; this journal), "Imagery in Therapy: Information Processing Analysis of Fear." We review research and clinical practice developments in the past five decades with reference to key insights from Lang's theory and experimental work on emotional mental imagery. First, we summarize and recontextualize Lang's bio-informational theory of emotional mental imagery (1977, 1979) within contemporary theoretical developments on the function of mental imagery. Second, Lang's proposal that mental imagery can evoke emotional responses is evaluated by reviewing empirical evidence that mental imagery has a powerful impact on negative as well as positive emotions at neurophysiological and subjective levels. Third, we review contemporary cognitive and behavioral therapeutic practices that use mental imagery, and consider points of extension and departure from Lang's original investigation of mental imagery in fear-extinction behavior change. Fourth, Lang's experimental work on emotional imagery is revisited in light of contemporary research on emotional psychopathology-linked individual differences in mental imagery. Finally, key insights from Lang's experiments on training emotional response during imagery are discussed in relation to how specific techniques may be harnessed to enhance adaptive emotional mental imagery training in future research., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In the past several decades, increasing evidence supports the efficacy of psychotherapies for depression. The vast majority of findings from meta-analyses, randomized clinical trials (RCTs) and naturalistic studies have demonstrated that well-established psychotherapies (behavioural activation, problem-solving therapy, psychodynamic therapy, cognitive-behavioural therapy, interpersonal therapy and emotion-focused therapy) are superior to no-treatment and control conditions, and are in most cases equally effective in treating depression. However, despite this abundant support for psychotherapies, studies have also consistently shown high drop-out rates, high percentages of non-respondent patients who experience treatment failures, and mixed findings regarding the enduring effects of psychotherapy. Thus, there is a need to develop more personalised treatment models tailored to patients' needs. A new integrative sequential stepwise approach to the treatment of depression is suggested.

Objective: We examined the rates, baseline predictors and clinical impact of sudden gains in a randomized comparison of individual Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for adult depression., Method: 117 depressed outpatients received 16-20 sessions of either CT or IPT. Session-by-session symptom severity was assessed using the BDI-II. Sudden gains were examined using the original criteria as defined by Tang and DeRubeis (1999b). Furthermore, we examined whether the duration of the between-session interval at which sudden gains were recorded affected the results., Results: There were significantly more patients with sudden gains in CT (42.2%) as compared to IPT (24.5%). The difference appeared to be driven by the criterion representing the stability of the gain. No between-group differences were found with regard to the magnitude, timing and predictors of the gains. Those with sudden gains were less depressed at post-treatment and follow-up. After controlling for the duration of the between-session interval, the difference in rates between the two conditions became a non-significant trend. Other sudden gains characteristics were similar to those observed when allowing for longer intervals as well., Conclusions: The current study indicates differences in occurrence of sudden gains in two treatment modalities that overall showed similar results, which might reflect different mechanisms of change., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Although both cognitive therapy (CT) and interpersonal psychotherapy (IPT) have been shown to be effective treatments for major depressive disorder (MDD), it is not clear yet whether one therapy outperforms the other with regard to severity and course of the disorder. This study examined the clinical effectiveness of CT v. IPT in a large sample of depressed patients seeking treatment in a Dutch outpatient mental health clinic. We tested whether one of the treatments was superior to the other at post-treatment and at 5 months follow-up. Furthermore, we tested whether active treatment was superior to no treatment. We also assessed whether initial depression severity moderated the effect of time and condition and tested for therapist differences., Method: Depressed adults (n = 182) were randomized to either CT (n = 76), IPT (n = 75) or a 2-month waiting list control (WLC) condition (n = 31). Main outcome was depression severity, measured with the Beck Depression Inventory - II (BDI-II), assessed at baseline, 2, 3, and 7 months (treatment phase) and monthly up to 5 months follow-up (8-12 months)., Results: No differential effects between CT and IPT were found. Both treatments exceeded response in the WLC condition, and led to considerable improvement in depression severity that was sustained up to 1 year. Baseline depression severity did not moderate the effect of time and condition., Conclusions: Within our power and time ranges, CT and IPT appeared not to differ in the treatment of depression in the acute phase and beyond.

Background: Breast cancer survivors experience long-term physical and psychological sequelae after their primary treatment that negatively influence their quality of life (QOL) and increase depressive symptoms. Group-based cognitive-behavioral stress management (CBSM) delivered after surgery for early-stage breast cancer was previously associated with better QOL over a 12-month follow-up and with fewer depressive symptoms up to 5 years after study enrollment. This 8- to 15-year follow-up (median, 11 years) of a previously conducted trial (NCT01422551) evaluated whether women in this cohort receiving CBSM had fewer depressive symptoms and better QOL than controls at an 8- to 15-year follow-up., Methods: Women with stage 0 to IIIb breast cancer were initially recruited 2 to 10 weeks after surgery and randomized to a 10-week CBSM intervention or a 1-day psychoeducational control group. One hundred women (51 CBSM patients and 49 controls) were recontacted 8 to 15 years after study enrollment to participate in a follow-up assessment. The Center for Epidemiologic Studies-Depression (CES-D) scale and the Functional Assessment of Cancer Therapy-Breast (FACT-B) were self-administered. Multiple regression was employed to evaluate group differences on the CES-D scale and FACT-B over and above effects of confounding variables., Results: Participants assigned to CBSM reported significantly lower depressive symptoms (d, 0.63; 95% confidence interval [CI], 0.56-0.70) and better QOL (d, 0.58; 95% CI, 0.52-0.65) above the effects of the covariates., Conclusions: Women who received CBSM after surgery for early-stage breast cancer reported lower depressive symptoms and better QOL than the control group up to 15 years later. Early implementation of cognitive-behavioral interventions may influence long-term psychosocial functioning in breast cancer survivors., (© 2015 American Cancer Society.)

Background: In recent years, armed conflicts in the Middle East have resulted in high rates of exposure to traumatic events. Despite the increasing demand of mental health care provision, ongoing violence limits conventional approaches of mental health care provision. Internet-based interventions for posttraumatic stress disorder (PTSD) have proved feasible and effective in Western countries, but their applicability and efficacy in war and conflict regions remains unknown., Objective: This study investigated the efficacy of a cognitive behavioral Internet-based intervention for war-traumatized Arab patients, with focus on Iraq., Methods: A total of 159 individuals with PTSD participated in a parallel group randomized trial. Participants were randomly allocated by a computer-generated sequence to a treatment group (n=79) or a waiting list control group (n=80). The treatment group received 2 weekly 45-minute cognitive behavioral interventions via Internet over a 5-week period (10 sessions in total). The primary outcome was recovery from posttraumatic stress symptoms., Results: Posttraumatic stress symptoms were significantly reduced from baseline to posttreatment (intention-to-treat analysis) in the treatment group relative to the control group (F1,157=44.29, P<.001, d=0.92). Treatment effects were sustained at 3-month follow-up. Completer analysis indicated that 29 of 47 patients (62%) in the treatment group had recovered from posttraumatic stress symptoms at posttreatment (reliable change and Posttraumatic Stress Diagnostic Scale score <20) versus 1 patient (2%) in the control group (OR 74.19, 95% CI 9.93-585.8, P<.001) indicating that the chance of recovering was 74.19 times higher in the treatment than in the control group., Conclusions: The results indicate, even in unstable and insecure settings with ongoing exposure to human rights violations through war and dictatorships, people with posttraumatic stress symptoms benefit from a cognitive behavioral treatment provided entirely through the Internet. This method of delivery could improve patients' access to humanitarian aid in the form of e-mental health services., Trial Registration: Australian New Zealand Clinical Trial Registry, ACTRN12611001019998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347505 (Archived by WebCite at http://www.webcitation.org/6Wto4HCdH).

Background and Purpose: Dementia is associated with multiple daily life challenges that have a major impact for health outcome, affecting both the patients and their caregivers. In this review, the efficacy of physical, cognitive and psychosocial interventions in the treatment of dementia patients is evaluated, and how caregiver education and support may contribute to patient care is analysed., Results and Conclusions: Due to the complex nature of cognitive and psychosocial interventions, their efficacy depends strongly on local settings. Thus, active components of these interventions are not always obvious, even in controlled randomized trials. Successful patient management includes (i) the safekeeping of basic support, (ii) the provision of a stable external milieu that is adjusted to the patients' cognitive resources and (iii) the provision of multimodal therapeutic concepts that are closely adapted to the practical needs of the patients and caregivers., (© 2014 EAN.)

Purpose: We performed a systematic review of the currently available evidence on whether psychological treatments are effective for treating depressed primary care patients in comparison with usual care or placebo, taking the type of therapy and its delivery mode into account., Methods: Randomized controlled trials comparing a psychological treatment with a usual care or a placebo control in adult, depressed, primary care patients were identified by searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and PsycINFO up to December 2013. At least 2 reviewers extracted information from included studies and assessed the risk of bias. Random effects meta-analyses were performed using posttreatment depression scores as outcome., Results: A total of 30 studies with 5,159 patients met the inclusion criteria. Compared with control, the effect (standardized mean difference) at completion of treatment was -0.30 (95% CI, -0.48 to -0.13) for face-to-face cognitive behavioral therapy (CBT), -0.14 (-0.40 to 0.12) for face-to-face problem-solving therapy, -0.24 (-0.47 to -0.02) for face-to-face interpersonal psychotherapy, -0.28 (-0.44 to -0.12) for other face-to-face psychological interventions, -0.43 (-0.62 to -0.24) for remote therapist-led CBT, -0.56 (-1.57 to 0.45) for remote therapist-led problem-solving therapy, -0.40 (-0.69 to -0.11) for guided self-help CBT, and -0.27 (-0.44 to -0.10) for no or minimal contact CBT., Conclusions: There is evidence that psychological treatments are effective in depressed primary care patients. For CBT approaches, substantial evidence suggests that interventions that are less resource intensive might have effects similar to more intense treatments., (© 2015 Annals of Family Medicine, Inc.)

Objective: This article reviews neuroimaging studies that inform psychotherapy research. An introduction to neuroimaging methods is provided as background for the increasingly sophisticated breadth of methods and findings appearing in psychotherapy research., Method: We compiled and assessed a comprehensive list of neuroimaging studies of psychotherapy outcome, along with selected examples of other types of studies that also are relevant to psychotherapy research. We emphasized magnetic resonance imaging (MRI) since it is the dominant neuroimaging modality in psychological research., Results: We summarize findings from neuroimaging studies of psychotherapy outcome, including treatment for depression, obsessive compulsive disorder (OCD), and schizophrenia., Conclusions: The increasing use of neuroimaging methods in the study of psychotherapy continues to refine our understanding of both outcome and process. We suggest possible directions for future neuroimaging studies in psychotherapy research.

Background: Post-traumatic stress disorder (PTSD) is highly prevalent in children and adolescents who have experienced trauma and has high personal and health costs. Although a wide range of psychological therapies have been used in the treatment of PTSD there are no systematic reviews of these therapies in children and adolescents., Objectives: To examine the effectiveness of psychological therapies in treating children and adolescents who have been diagnosed with PTSD., Search Methods: We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to December 2011. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: CENTRAL (the Cochrane Central Register of Controlled Trials) (all years), EMBASE (1974 -), MEDLINE (1950 -) and PsycINFO (1967 -). We also checked reference lists of relevant studies and reviews. We applied no date or language restrictions., Selection Criteria: All randomised controlled trials of psychological therapies compared to a control, pharmacological therapy or other treatments in children or adolescents exposed to a traumatic event or diagnosed with PTSD., Data Collection and Analysis: Two members of the review group independently extracted data. If differences were identified, they were resolved by consensus, or referral to the review team. We calculated the odds ratio (OR) for binary outcomes, the standardised mean difference (SMD) for continuous outcomes, and 95% confidence intervals (CI) for both, using a fixed-effect model. If heterogeneity was found we used a random-effects model., Main Results: Fourteen studies including 758 participants were included in this review. The types of trauma participants had been exposed to included sexual abuse, civil violence, natural disaster, domestic violence and motor vehicle accidents. Most participants were clients of a trauma-related support service. The psychological therapies used in these studies were cognitive behavioural therapy (CBT), exposure-based, psychodynamic, narrative, supportive counselling, and eye movement desensitisation and reprocessing (EMDR). Most compared a psychological therapy to a control group. No study compared psychological therapies to pharmacological therapies alone or as an adjunct to a psychological therapy. Across all psychological therapies, improvement was significantly better (three studies, n = 80, OR 4.21, 95% CI 1.12 to 15.85) and symptoms of PTSD (seven studies, n = 271, SMD -0.90, 95% CI -1.24 to -0.42), anxiety (three studies, n = 91, SMD -0.57, 95% CI -1.00 to -0.13) and depression (five studies, n = 156, SMD -0.74, 95% CI -1.11 to -0.36) were significantly lower within a month of completing psychological therapy compared to a control group. The psychological therapy for which there was the best evidence of effectiveness was CBT. Improvement was significantly better for up to a year following treatment (up to one month: two studies, n = 49, OR 8.64, 95% CI 2.01 to 37.14; up to one year: one study, n = 25, OR 8.00, 95% CI 1.21 to 52.69). PTSD symptom scores were also significantly lower for up to one year (up to one month: three studies, n = 98, SMD -1.34, 95% CI -1.79 to -0.89; up to one year: one study, n = 36, SMD -0.73, 95% CI -1.44 to -0.01), and depression scores were lower for up to a month (three studies, n = 98, SMD -0.80, 95% CI -1.47 to -0.13) in the CBT group compared to a control. No adverse effects were identified. No study was rated as a high risk for selection or detection bias but a minority were rated as a high risk for attrition, reporting and other bias. Most included studies were rated as an unclear risk for selection, detection and attrition bias., Authors' Conclusions: There is evidence for the effectiveness of psychological therapies, particularly CBT, for treating PTSD in children and adolescents for up to a month following treatment. At this stage, there is no clear evidence for the effectiveness of one psychological therapy compared to others. There is also not enough evidence to conclude that children and adolescents with particular types of trauma are more or less likely to respond to psychological therapies than others. The findings of this review are limited by the potential for methodological biases, and the small number and generally small size of identified studies. In addition, there was evidence of substantial heterogeneity in some analyses which could not be explained by subgroup or sensitivity analyses. More evidence is required for the effectiveness of all psychological therapies more than one month after treatment. Much more evidence is needed to demonstrate the relative effectiveness of different psychological therapies or the effectiveness of psychological therapies compared to other treatments. More details are required in future trials in regards to the types of trauma that preceded the diagnosis of PTSD and whether the traumas are single event or ongoing. Future studies should also aim to identify the most valid and reliable measures of PTSD symptoms and ensure that all scores, total and sub-scores, are consistently reported., (Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Posttraumatic stress disorder (PTSD) is a highly prevalent psychiatric disorder that can become chronic and debilitating when left untreated. The most commonly recommended first-line treatments for PTSD among adults are individual trauma-focused psychotherapies. Other evidence-based treatments include specific antidepressant medications and non-trauma-focused psychotherapies. Despite the effectiveness of these available treatments, many patients' symptoms do not remit. This has led to the search for novel treatments for PTSD. In this review, the authors critically evaluate the data supporting several emerging pharmacological and other somatic interventions in the categories of medication-assisted psychotherapy, novel medication monotherapy strategies, and neuromodulation, selected because of the salience of their mechanisms of action to the pathophysiology of PTSD (e.g., MDMA-assisted psychotherapy, ketamine, cannabidiol, transcranial magnetic stimulation). The authors also evaluate the evidence for treatments that are the focus of increasing scientific or public interest (i.e., hyperbaric oxygen therapy, stellate ganglion block, neurofeedback). To date, the evidence supporting most novel pharmacological and somatic treatments for PTSD is preliminary and highly variable; however, the data for several specific treatments, such as transcranial magnetic stimulation, are encouraging. [ABSTRACT FROM AUTHOR]

It is known that economic problems can cause psychological stress, and that psychological stress causes physiological changes often linked to disease. Here we report a systematic review and meta-analysis of studies on physiological effects of psychological treatment for individuals with economic problems. Of 5071 papers in our initial PsycInfo search, we identified 16 papers on physiological effects for psychological treatment of the economically stressed. We found 11 controlled studies, among which we found a small to moderate significant effect size, Hedges' g = 0.319, p < 0.001. The largest effect sizes were found for heart rate variability and measures of inflammation, and the smallest for measures involving cortisol. The studies were all on chronically poor populations, thus restricting generalization to other financially stressed populations such as students, athletes in training, and those stressed by relative deprivation compared with neighbors or other reference groups. None of the studies examined effects of these psychophysiological changes on disease susceptibility, and none included elements of financial planning. The nascent field of financial psychophysiology calls for more research in these areas. Even so, results suggest that financially stressed people can benefit physiologically from psychological stress management methods. [ABSTRACT FROM AUTHOR]

Summary: Sleep restriction therapy is a behavioural component within cognitive behavioural therapy for insomnia and is an effective standalone treatment for insomnia, but its effect on depressive symptoms remains unclear. This review aimed to synthesise and evaluate the impact of single‐component sleep restriction therapy on depressive symptoms relative to a control intervention. We searched electronic databases and sleep‐related journals for randomised controlled trials and uncontrolled clinical trials, published from 1 January 1986 until 19 August 2023, that delivered sleep restriction therapy to adults with insomnia. Random‐effects meta‐analysis of standardised mean differences and Cochrane risk of bias assessment were performed on randomised controlled trials, while uncontrolled clinical trials were discussed narratively. The meta‐analysis was pre‐registered on PROSPERO (ID: CRD42020191803). We identified seven randomised controlled trials (N = 1102) and two uncontrolled clinical trials (N = 22). Findings suggest that sleep restriction therapy is associated with a medium effect for improvement in depressive symptoms at post‐treatment (Nc = 6, g = −0.45 [95% confidence interval = −0.70 to −0.21], p < 0.001) and a small effect at follow‐up (Nc = 4, g = −0.31 [95% confidence interval = −0.45 to −0.16], p < 0.001). Five of the seven included randomised controlled trials were judged to have a high risk of bias. Standalone sleep restriction therapy appears to be efficacious for improving depressive symptoms at post‐treatment and follow‐up. However, conclusions are tentative due to the small number of trials and because none of the trials was performed in a population with clinically defined depression. Large‐scale trials are needed to test the effect of sleep restriction therapy in patients experiencing depression and insomnia. Findings also highlight the need to improve the standardisation and reporting of sleep restriction therapy procedures, and to design studies with more rigorous control arms to reduce potential bias. [ABSTRACT FROM AUTHOR]

This paper explores the psychotherapy process in a short-term psychoanalytic treatment (STPP) with a depressed adolescent. The empirical case study draws on both quantitative and qualitative data to examine the development of the psychotherapy process over time. 15 of the 29 audio recorded therapy sessions with a 16-year-old boy were sampled at intervals across the treatment. Session transcripts were coded using the Adolescent Psychotherapy Q-Set (APQ) and data analysed descriptively to compare characteristics of the process across the three treatment phases – beginning, middle, and ending. Descriptive statistics are supported with session extracts. Analysis of the APQ data suggests change in the patient's presentation across the therapy. In the early stages, he appeared withdrawn and made minimal responses to the therapist's attempts to work together; in the middle phase, he became more engaged, more able to talk about feelings, and more active in the sessions; and this was reflected in a less depressed presentation in the final phase. The therapist maintained a consistent therapeutic approach across all phases: supportive, non-judgemental, and working to make sense of the young person's experiences, looking for patterns and inviting curiosity about how things might be understood differently. Despite increased engagement in the therapy, depressive symptoms remained in the clinical range. [ABSTRACT FROM AUTHOR]

Background and Purpose: Fatigue is a common and disabling symptom in multiple sclerosis (MS). Educational interventions have shown potential to reduce fatigue. The aim was to systematically review the current best evidence on patient education programmes for MS‐related fatigue. Methods: This was a systematic review and meta‐analysis following Cochrane methodology. A systematic search was conducted in eight databases (September 2023). Moreover, reference lists and trial registers were searched and experts in the field were contacted. Randomized controlled trials were included evaluating patient education programmes for people with MS with the primary aim of reducing fatigue. Results: In total, 1176 studies were identified and assessed by two independent reviewers; 15 studies (1473 participants) were included. All interventions provided information and education about different aspects of MS‐related fatigue with different forms of application, some with components of psychological interventions. Amongst those, the most frequently applied were cognitive behavioural therapy (n = 5) and energy‐conservation‐based approaches (n = 4). Studies differed considerably concerning mode of intervention delivery, number of participants and length of follow‐up. Interventions reduced fatigue severity (eight studies, n = 878, standardized mean difference −0.28; 95% confidence interval −0.53 to −0.03; low certainty) and fatigue impact (nine studies, n = 824, standardized mean difference −0.21; 95% confidence interval −0.42 to 0.00; moderate certainty) directly after the intervention. Mixed results were found for long‐term effects on fatigue, for secondary endpoints (depressive symptoms, quality of life, coping) and for subgroup analyses. Conclusion: Educational interventions for people with MS‐related fatigue may be effective in reducing fatigue in the short term. More research is needed on long‐term effects and the importance of specific intervention components, delivery and context. [ABSTRACT FROM AUTHOR]

Background: There is considerable interest in identifying factors that predict outcome from psychological treatment. This review examines the relationship between readiness / stage of change at entry to CBT treatment and treatment attendance or outcome in people with mental health problems other than addiction. Methods: Four databases: PsycINFO; MEDLINE; Embase and CINAHL were searched to identify relevant studies published in English from 1st January 1980 onwards. Following title and abstract screening, and full text review of potentially eligible studies, a total of 22 eligible studies were identified, of which 21 were included in the narrative synthesis. The review was registered on PROSPERO REF: CRD42020209173. Results: Nineteen studies explored the relationship between readiness and symptom outcome, with a majority (n = 13) identifying at least one statistically significant relationship between variables, either directly or in interaction with another measure. A number of these also tested other associations which were non-significant. In contrast, five studies explored the association between readiness and treatment attendance, and findings were inconclusive. Conclusions: The systematic review found some evidence suggesting that readiness is linked to symptom outcome in CBT, regardless of the type of clinical problem or readiness measure used. The studies adopting an RCT design identified no evidence of differences in the relationship between readiness and outcome when comparing CBT to other psychotherapeutic interventions. Study quality was variable, and a range of methodological limitations and potential avenues for future work are discussed. [ABSTRACT FROM AUTHOR]

Despite the high prevalence and severity of intimate partner violence (IPV) perpetration among men with mental health (MH) problems and substance use (SU), there is limited evidence on the most effective ways to reduce IPV within these groups. Hence, the present systematic review aims to evaluate the effectiveness of psychological interventions for male IPV perpetrators with MH issues and SU problems. Five databases (B-On, Pubmed PsycInfo, Science Direct, and Scopus) were searched for studies examining the effectiveness of IPV interventions. Twenty-three studies met the inclusion criteria, with 13 interventions described. Interventions were grouped into (1) specific interventions for SU among IPV perpetrators (k = 8), (2) nonspecific interventions for SU among IPV perpetrators (K = 3), and (3) specific interventions targeting MH among IPV perpetrators (k = 2). Cognitive behavioral therapy and motivational interviewing techniques were the most common approaches. Both specific and nonspecific programs addressing SU problems showed some positive effects on perpetrators' behavior and attitudes. However, data from the two intervention programs focusing on MH showed reduced symptoms and re-assaults but without significant differences between the conditions. Despite methodological shortcomings in the studies, the specific and nonspecific interventions targeting SU and IPV show promise, which hinders drawing firmer conclusions. Nonetheless, further research is necessary to deepen our understanding of the MH impact interventions on IPV perpetrators. [ABSTRACT FROM AUTHOR]

People with refugees and asylum seeker status (R/AS) have been forced to leave their home and resettle in new countries due to political unrest, conflict, and violence. This review aimed to describe the nature and extent of cultural adaptations to psychological interventions for adults with R/AS experiencing clinically significant psychological distress, and the acceptability and efficacy of these interventions. A search was conducted in October 2023 and February 2024 across five electronic databases: PsycINFO, Medline, Embase, PubMed, and Cochrane. Eligible studies were randomized controlled trials of psychological interventions conducted in any geographic context. Studies reporting on interventions with minimal adaptations only to facilitate treatment access, with no clear evidence for cultural adaptation, were excluded. Eighteen studies were identified, and cultural adaptations were described in line with the Ecological Validity Model. Studies investigating transdiagnostic interventions, cognitive behavioral therapy (CBT) interventions, and other psychotherapies were synthesized. Analysis and reporting of acceptability were limited across intervention groups, highlighting a need for more robust research in this area. CBT interventions and other psychological therapies were found to be most efficacious with moderate to large effects across validated psychological measures. Small to moderate effect sizes were observed across transdiagnostic interventions. The evidence quality was generally of some concerns. While the evidence requires further developments, the current review provides a timely synthesis of culturally adapted interventions for adults with R/AS to inform intervention development and clinical practice. Strengths, limitations, and recommendations for future research are discussed. [ABSTRACT FROM AUTHOR]

Objectives: Several contemporary models of psychotherapy demand psychotherapists and counsellors to navigate an intensely personal involvement with clients. This study considers how this personal involvement impacts the clinician as a person. Design: We interviewed practitioners about how working with clients in a one‐on‐one therapeutic setting changed them. Methods: A grounded theory analysis of interviews with behavioural and cognitive therapists (N = 14; 9 women, 5 men) was carried out. Results: Working with clients may improve practitioners' self‐regulation by generating a clearer view of themselves, providing strategies for effective living and facilitating self‐compassion. These changes are often either clinical work's unavoidable effects or gains from accidental exposure to clients' contents. Clinical work may also improve practitioners' relationships by demonstrating the value of and providing strategies for managing one's input in crucial relationships and non‐judgemental acceptance. Improved relational regulation often occurs as unavoidable learning or results from intentional emulation. Both self‐regulation and relational regulation may contribute to clinical competency. Professionals can also unintentionally reproduce client quirks and accidentally learn practical tips. Possible implications are discussed. Conclusion: Clients' influence on counsellors and psychotherapists deserves attention in psychotherapy research, training and supervision. [ABSTRACT FROM AUTHOR]

Objective: Previous qualitative studies have investigated the experiences of undergoing an evidence‐based psychotherapy for psychosis among individuals affected by such condition. However, the literature investigating the perspectives, experiences and needs of psychological practitioners providing the treatment remains considerably underrepresented. In the context of Asian cultures, where pervasive stigma towards psychosis and mental health services exists and interferes with proactive help‐seeking, such research appears even more pertinent. To address the gap in the existing literature, this study utilised qualitative methodology to investigate the experiences of practitioner psychologists working with clients with psychosis in a South‐East Asian city‐state. Method: Six fully qualified participants were recruited from the local mental health services via convenience sampling. Semi‐structured qualitative interviews were conducted. Transcribed verbatim data were then subjected to inductive thematic analysis. Results: Four superordinate themes emerged, as follows: therapeutic alliance, cognitive behavioural therapy for psychosis (CBTp) as primary approach, cultural influences and needs of practitioners. Conclusions: Results indicated that both practitioner psychologists and their clients contributed collaboratively to the establishment of therapeutic alliance. Although CBTp was utilised as a principal psychotherapeutic approach, acceptance and commitment therapy (ACT) was also valued. Necessary adaptations in the treatment were reflected on to address the specificity of local cultures, including the use of language and addressing pervasive public stigma. The necessity of multidisciplinary collaboration, localised training and supervision was also expressed. [ABSTRACT FROM AUTHOR]

Psychological interventions are important tools for addressing different mental disorders around the world, and considering cultural diversity during the implementation of psychological intervention may lead to improved outcomes. This scoping review updates on the knowledge about the cultural adaptation of cognitive behavioral therapy in the Arab world. This study included 21 studies about the cultural adaptation of cognitive behavioral therapy and other types of psychological interventions that have been implemented for Arab people. The sources of information were PUBMED, Web of Science Journal, CINHA, and search engine Google. For scoping review, the PRISMA-ScR framework was followed. The results showed that the process of cultural adaptation of CBT for Arab people focused on the following stages: (1) define the target group, (2) review the literature and select content, (3) feedback from stakeholders, (4) producing a guide for adaptation, (5) translation and adaptation process, (6) testing process for the adapted tools, and (7) final refinement. The process of cultural adaptation for CBT was superficial and focused on the content but not on the context. In addition, the cultural adaption process for CBT for Arab people focused on three major areas: (1) cultural awareness, (2) assessment and engagement, and (3) technique modification. [ABSTRACT FROM AUTHOR]

Purpose: An increasing number of individuals with stroke are having difficulties in returning to work, having a significant impact on both individuals and society. The aims of this meta-analysis were to summarize the interventions to support the return to work (RTW) for individuals with stroke and to quantitatively evaluate the efficacy of each type of intervention. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Embase, Cochrane Library, CINAHL, and PsycINFO were searched until 26 June 2023, and the list of references of the initially included articles was also searched. Two researchers independently performed the search, screening, selection, and data extraction. The primary outcome was RTW rate (the RTW rate was defined as the proportion of individuals who returned to work in each group (intervention and control) at the endpoint). Pooled risk ratio (RR) was estimated using a random-effects model with 95% confidence intervals (CIs). Results: A total of 13 studies representing 4,282 individuals with stroke were included in our study. Results showed that physiological interventions could improve the RTW rate of individuals with stroke (RR: 1.19, 95% CI: 1.01 to 1.42, I2 = 72%). And receiving intravenous thrombolytic therapy was beneficial in promoting the RTW in individuals with stroke. Subgroup analysis and meta-regression analysis showed that the individuals' functional status during hospitalization was the only source of heterogeneity. Psychological interventions had little or no effect on the RTW rate of individuals with stroke (RR: 1.20, 95% CI: 0.58 to 2.51, I2 = 30%). Work-related interventions had little or no effect on the RTW rate of the individuals with stroke (RR:1.36,95%CI: 0.99 to 1.88, I2 = 73%). The subgroup analysis showed that country, age, and follow-up method were the sources of heterogeneity. Conclusion: Physiological intervention promoted the RTW of individuals with stroke. But, the effect of psychological and work-related interventions in promoting the RTW of individuals with stroke was not significant. We anticipate that these findings may inform the design of future interventions. For future research, we recommend that more high-quality randomized controlled trials be conducted to further promote the RTW of individuals with stroke. Systematic Review Registration: PROSPERO Registration Number, CRD42023443668. [ABSTRACT FROM AUTHOR]

Objective: The current guidelines and canonical norms of diagnosis or treatment for Post-traumatic stress disorder (PTSD) with sleep disorder are still conflicting and have not yet reached a consensus. This study aimed to unravel the most effective countermeasures between two categories (psychotherapy and pharmacotherapy) put forward by the National Institute for Health and Clinical Excellence (NICE) and World Federation of Societies of Biological Psychiatry (WFSBP) respectively to treat PTSD individuals co-exist with sleep disorders. Methods: Four databases, including PubMed, EMBASE, Cochrane Library, and APA PsyNet, were searched from inception to February 02, 2023. Results: Twenty articles with 24 Randomized controlled trials (RCTs) and a total number of 1,647 participants were included. As demonstrated in the network meta-analysis comparison results, CBT-I (standardized mean differences (SMD) =-1.51,95% confidence interval (CI):-2.55 to -0.47), CBT-I plus IRT (SMD=-1.71, 95%CI:-3.39, -0.03), prazosin (SMD=-0.87, 95%CI:-1.59 to -0.16) and hydroxyzine (SMD=-1.06, 95%CI: -1.94 to -0.19) significantly reduced PTSD symptoms compared with placebo. In contrast to placebo, CBT-I (SMD=-5.61, 95%CI:-8.82 to -2.40) significantly improved sleep quality. For nightmare severity, IRT (SMD=-0.65, 95%CI:-1.00 to -0.31), prazosin (SMD=-1.20, 95%CI:-1.72 to -0.67) and hydroxyzine (SMD=-0.98,95%CI:-1.58 to -0.37) significantly reduced nightmare severity in comparison with placebo. Conclusions: This study suggested that under most circumstances, psychotherapy namely CBT-I had a favorable profile, but pharmacotherapy with prazosin was effective in managing nightmare severity. The sole avail of CBT-I was recommended to improving sleep quality while CBT-I and CBT-I plus IRT showed excellent management of PTSD symptom severity. Exposure to CBT-I is recommended for depression. The relevant clinical guidelines for the management of individuals with PTSD and sleep disorders may regard this as a reference. PROSPERO: CRD42023415240. [ABSTRACT FROM AUTHOR]

Objective: The authors compared the engagement, clinical outcomes, and adverse events of text or voice message–based psychotherapy (MBP) versus videoconferencing-based psychotherapy (VCP) among adults with depression. Methods: The study used a sequential multiple-assignment randomized trial design with data drawn from phase 1 of a two-phase small business innovation research study. In total, 215 adults (ages ≥18 years) with depression received care from Talkspace, a digital mental health care company. Participants were initially randomly assigned to receive either asynchronous MBP or weekly VCP. All therapists provided evidence-based treatments such as cognitive-behavioral therapy. After 6 weeks of treatment, participants whose condition did not show a response on the Patient Health Questionnaire–9 or was rated as having not improved on the Clinical Global Impressions scale were randomly reassigned to receive either weekly VCP plus MBP or monthly VCP plus MBP. Longitudinal mixed-effects models with piecewise linear time trends applied to multiple imputed data sets were used to address missingness of data. Results: Participants who were initially assigned to the MBP condition engaged with their therapists over more weeks than did participants in the VCP condition (7.8 weeks for MBP vs. 4.9 weeks for VCP; p<0.001). No meaningful differences were observed between the two groups in rates of change by 6 or 12 weeks for depression, anxiety, disability, or global ratings of improvement. Neither treatment resulted in any adverse events. Conclusions: MBP appears to be a viable alternative to VCP for treating adults with depression. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Method Results Discussion We aimed to compare use of, and outcomes from, programme‐led and focused interventions (guided self‐help and 10 session cognitive behavioral therapy for eating disorders [CBT‐T]) relative to other psychological therapies (including group and individual CBT for eating disorders [CBT‐ED]) in a national sample of emerging adults receiving early intervention for a non‐underweight binge/purge eating disorder.Data were drawn from 54 English eating disorder services using the First Episode Rapid Early Intervention for Eating Disorders (FREED) model. Participants (N = 1097) had a mean age of 18.95 years (SD 2.42) and diagnoses of bulimia nervosa (n = 506; 45%), binge eating disorder (n = 121; 11%), another specified feeding or eating disorder (n = 460; 42%), or an eating disorder, unspecified (n = 10, 1%). Linear mixed models were used to assess for effects of time and treatment on binge eating and purging, eating disorder psychopathology, depression/anxiety, and body mass index.11% (n = 117) of patients received guided self‐help and 24% (n = 268) received CBT‐T. Baseline eating disorder psychopathology and depressive/anxiety symptoms did not differ significantly across the guided self‐help, CBT‐T, group CBT‐ED, and individual CBT‐ED conditions. All treatments were associated with significant reductions in symptoms over time. GSH and CBT‐T performed comparably to longer CBT‐ED.We provide additional evidence for the effectiveness of GSH and CBT‐T in the treatment of non‐underweight binge/purge eating disorders. Programme‐led and focused interventions may be under‐utilized and future research should explore when they are offered, and when not, both within and outside of early intervention settings. [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome (IBS) is a complex disorder of gut–brain interaction (DGBI) that is thought to affect a significant proportion of the population. As a result of the nature of IBS, it is hard to predict treatment efficacy as all individuals respond differently, and thus multidisciplinary treatment has become increasingly of interest as it targets multiple aspects of IBS at the same time. Here, we aim to review the literature of both multidisciplinary and single‐discipline therapy for IBS. Ovid MEDLINE was utilised with a systematic search to find relevant randomised controlled trials. The population included adults with a Rome diagnosis of IBS and an intervention that was either multidisciplinary care, diet, psychotherapy, gut‐directed hypnotherapy (GDH) or physiotherapy. Multidisciplinary care studies found an overall significant improvement, while dietary treatment was varied. A low fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet was the only one to improve symptoms, while gluten‐free and fibre diets had mixed evidence for their efficacy. Novel diets, including a tritordeum‐based diet and low tryptophan diet, significantly improved symptoms. Cognitive behavioural therapy was found to be efficacious when compared to controls, as was psychoeducation. GDH was also found to be efficacious, but 83.3% of studies examined a refractory IBS population. There is a lack of literature looking at how multidisciplinary care and different combinations of disciplines work to treat those with IBS in secondary care. Further studies are required for a greater understanding of how multidisciplinary care may be utilised to better manage IBS. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment is common in Parkinson's disease (PD) but has limited treatment options. Medication has shown some benefits but accompanied by risk of adverse events. We aimed to investigate effectiveness and feasibility of nonpharmacological interventions for people with PD and cognitive impairment on patient‐centred outcomes. Methods: Systematic searches of five databases (MEDLINE, Embase, CINAHL, PsycINFO and Web of Science) were performed for studies evaluating nonpharmacological interventions for people with PD and cognitive impairment, reporting health‐related quality of life, function (activities of daily living) or wellbeing outcomes, published up to 15 May 2023. Two reviewers independently assessed full‐text articles and one reviewer extracted data, with a second reviewer reliability checking all data extraction. Randomised controlled trials (RCTs) were synthesised through meta‐analysis using a random‐effects meta‐analysis with restricted maximum likelihood method pooled estimate and observational studies through narrative synthesis. Results: Eleven RCTs and three noncontrolled studies were included, studying a range of interventions: cognitive training, cognitive stimulation, cognitive rehabilitation, physical and cognitive exercise, goal management training, psychoeducation with mindfulness, broader rehabilitation programs and a psychological intervention. Feasibility was demonstrated. The majority showed effectiveness for their primary outcome. Meta‐analysis showed no significant improvement in HrQoL (seven RCTs: pooled effect, standardised mean difference, −0.20 [−0.57−0.18]) or function (four RCTs: 0.08 [−0.36, 0.52]), and wellbeing measurement was infrequent and indirect. Quality of evidence was judged as very low, limiting the conclusions drawn. Conclusion: Whilst nonpharmacological trials for cognitive impairment in PD have shown promise, we found no evidence of effectiveness on HrQoL, function or wellbeing. However, this is based on very low‐quality evidence from a small number of diverse studies, not powered for these outcomes. Feasibility of a range of interventions has been demonstrated in both PD‐mild cognitive impairment and PD‐dementia. There is a need for more robust, adequately powered studies. [ABSTRACT FROM AUTHOR]

Simple Summary: Insomnia is prevalent in patients with cancer, with rates ranging from 30% to 60%. Addressing insomnia remains important in this population, as it can improve patient quality of life and reduce suffering. However, inconsistent methods of defining insomnia and evaluating potential interventions renders treatment difficult. Furthermore, many factors influence insomnia's presentation, requiring a specialized and individualized approach to its management for each patient. This review sought to use thorough and strict criteria to assess current psychological intervention for insomnia. To this end, we describe current psychological treatment options for insomnia, highlight gaps in the existing research, and offer suggestions for treating insomnia in patients with cancer. Background/Objectives: Insomnia is a frequent and distressing symptom with limited treatment in patients with cancer. Among the available treatments for insomnia, psychological interventions are some of the most assessed. While studies and reviews show promise of interventions improving insomnia in patients with cancer, inconsistent approaches to operationalizing and measuring insomnia combined with the heterogeneity of available treatments render comparisons and synthetization difficult. This review sought to rigorously synthesize psychological interventions for patients with cancer and insomnia by describing current therapies, identifying gaps in the literature, and offering supportive interventions. Methods: A comprehensive search of five databases—Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, EBSCO CINAHL Plus with Full Text, and Cochrane Library—was conducted through 1 August 2024. The review included randomized trials and non-inferiority trials evaluating psychological interventions for patients with various types of cancers. Twenty-one studies were included, and study quality ranged from good to excellent, according to the PEDro scale. Results: The current evidence supports the use of cognitive behavioral therapy (CBT) to treat insomnia over and above psychoeducation alone, mindfulness-based stress reduction, Brief Behavioral Therapy, the Benson Relaxation Technique, progressive muscle relaxation, mindfulness meditation, mind-body bridging, and home-based psychological nursing. Digital, minimal, and internet-based intervention modalities are effective, though professional-delivered CBT proved most effective. Conclusions: CBT remains the most effective psychological intervention for insomnia in this population. Challenges exist regarding the implementation of CBT, so further research is warranted to identify the best psychological interventions for specific settings and subsets of patients with cancer. [ABSTRACT FROM AUTHOR]

Social anxiety disorder (SAD) is a high-prevalence mental disorder among children and adolescents. The aim of this study is to compare and rank the effectiveness of several psychotherapies for SAD among children and adolescents. Only randomized controlled trials (RCTs) were utilized by searching PubMed, Embase, Cochrane Library, and Web of Science. We used network meta-analysis in the Bayesian framework to analyze the data. This study is registered with PROSPERO, number CRD42023476829. In total, 30 RCTs with 1547 individuals were included, and nine psychotherapies with three control conditions were compared and ranked in this study. The findings revealed that internet-delivered cognitive behavioural therapy (surface under the cumulative ranking curve [SUCRA: 71.2 %]), group cognitive behavioural therapy (SUCRA: 68.4 %), and individual cognitive behavioural therapy (SUCRA: 66.0 %) significantly reduced social anxiety symptoms; internet-delivered cognitive behavioural therapy also significantly decreased depression symptoms in these patients (SUCRA: 92.2 %). In addition, group cognitive behavioural therapy can enhance functioning in these patients (SUCRA: 89.6 %). These results suggest that internet-delivered cognitive behavioural therapy is the optimal type of psychotherapy for reducing social anxiety and depression symptoms in children and adolescents with SAD, internet-delivered parent-child interaction therapy and cognitive bias modification of interpretation have relatively poor treatment effects on social anxiety symptoms in children than other psychological interventions, and group cognitive behavioural therapy has better benefits in enhancing the functioning among children and adolescents with SAD. Further studies are needed to ascertain these results due to the limited number of included studies. • Network meta-analysis examines interventions for social anxiety disorder. • Internet-delivered CBT is an optimal psychotherapy for social anxiety disorder. • Group CBT has better benefits in enhancing the functioning. • Findings can provide recommendations for health care professionals and patients. [ABSTRACT FROM AUTHOR]