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Psychotherapy may contribute to the experience of meaning in life. This study investigated meaning in life among patients with personality disorders during inpatient or day-hospital psychotherapy. Meaning in life was approached from two conceptual perspectives: personality functioning with an emphasis on self-direction and existential psychology. We investigated changes in the sense of meaning in life and accounted for changes in depressive symptoms and identity and interpersonal pathology. Using pre-post measures, Livesley's General Assessment of Personality Disorder, especially, the Lack-of-Meaning-Purpose-and-Direction subscale and Steger's Meaning-in-Life Presence subscale were administered to 75 patients with personality disorders during inpatient or day-hospital psychotherapy for 8-12 months. Regression models showed that levels of the lack and presence of meaning decreased and increased during treatment, respectively, controlled for changes in depressive symptoms. Decreased identity pathology was significantly associated with changes in the lack or presence of meaning. Meaning in life may act as an outcome variable in intensive psychotherapy for personality disorders. The development of identity and self-direction may restore or create the ability to give life meaning., (© 2025 The Author(s) Personality and Mental Health Published by John Wiley & Sons Ltd.)

Background: Prevalences of mental disorders are increasing worldwide. However, many people with mental health problems do not receive adequate treatment. An important factor preventing individuals from seeking professional help is negative attitudes toward psychotherapeutic treatment. Although a positive shift in attitudes has been observed in recent years, there is still substantial stigma surrounding psychotherapeutic treatment. First studies have linked higher health literacy with more positive attitudes toward psychotherapy, but more research is needed in this area., Objective: This study aimed to examine how general and mental health literacy are associated with attitudes toward psychotherapeutic treatment in Germany. Additionally, associations between sociodemographic factors, experience with psychotherapy, and attitudes toward psychotherapy were explored., Methods: A random sample was drawn from a panel representative of the German-speaking population with internet access in Germany and invited to participate in the study via email. Overall, 2000 individuals aged ≥16 years completed the web-based survey with standardized questionnaires in September and October 2022. Attitudes toward psychotherapy and both general and mental health literacy were assessed using the Questionnaire on Attitudes Towards Psychotherapeutic Treatment (QAPT) with 2 subscales ("positive attitudes" and "non-acceptance of society"), the European Health Literacy Survey instrument (HLS-EU-Q16) and the Mental Health Literacy Tool for the Workplace (MHL-W-G). Associations between the questionnaire scales were assessed with Pearson correlations. Additionally, basic sociodemographic information and information on personal and family experiences with psychotherapy were collected. Pearson correlations (age), ANOVAs (level of education and subjective social status), and t tests (experience with psychotherapy, gender, and migration background) were used to analyze how these relate to attitudes toward psychotherapy., Results: More favorable attitudes toward psychotherapy and lower perceived societal nonacceptance were found in those with higher general (r=0.14, P<.001; r=-0.32, P<.001, respectively) and mental health literacy (r=0.18, P<.001; r=-0.23, P<.001, respectively). Participants with treatment experience for mental health problems (t 1260.12 =-10.40, P<.001, Cohen d=-0.49; t 1050.95 =3.06, P=.002, Cohen d=0.16) and who have relatives with treatment experience (t 1912.06 =-5.66, P<.001, Cohen d=-0.26; t 1926 =4.77, P<.001, Cohen d=0.22) reported more positive attitudes and higher perceived societal acceptance than those without treatment experience. In terms of sociodemographic differences, being a woman (t 1992 =-3.60, P<.001, Cohen d=-0.16), younger age (r=-0.11, P<.001), higher subjective social status (F 2,1991 =5.25, P=.005, η 2 =.005), and higher levels of education (F 2,1983 =22.27, P<.001, η 2 =.021) were associated with more positive attitudes toward psychotherapeutic treatment. Being a man (t 1994 =5.29, P<.001, Cohen d=0.24), younger age (r=-0.08, P<.001), and lower subjective social status (F 2,1993 =7.71, P<.001, η 2 =.008) were associated with higher perceived nonacceptance of psychotherapy., Conclusions: Positive associations between attitudes toward psychotherapy and both general and mental health literacy were delineated. Future studies should investigate whether targeted health literacy interventions directed at individuals with lower general and mental health literacy might also help to improve attitudes toward psychotherapeutic treatment and help-seeking behavior., (©Rebekka Schröder, Tim Hamer, Ralf Suhr, Lars König. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 24.01.2025.)

The psychological symptoms of Parkinson's disease (PD) worsen the quality of life of patients and their partners. However, these non-motor symptoms (mainly anxiety and depression) remain undiagnosed and undertreated in PD. Here, we report the benefits of a 12-week intervention using talking therapy (psychotherapy and counselling). This work was conducted in a group of individuals (people living with PD, and partners) with mild-to-moderate anxiety and depression. We discuss our results in context and conclude that short-term talking therapy should be integrated into PD therapeutics., Competing Interests: Declarations. Conflict of interest: A.A.R. and P.P. were full-time employees of Imperial College London at the time the project was conducted. A.A.R. and P.P. report no competing interests. R.H. and C.M. report consultancies to Imperial College London and the receiving of honoraria from Imperial College London. At the time this manuscript was written, C.M. held an honorary teaching fellowship with Birkbeck and a professional affiliation at the Tavistock Relationships as a Senior Clinician., (© 2025. Crown.)

Many clinical sites shifted towards digital delivery of mental health services during the COVID-19 pandemic. There is still much to learn regarding tailoring digitally delivered interventions for trauma-affected populations. The current study examined the perceptions of Canadian mental health clinicians who provided digitally delivered psychotherapies utilized for trauma-affected populations. Specifically, we explored the shift to digital health use, what changed with this rapid shift, what needs, problems, and solutions arose, and important future considerations associated with delivering trauma-focused and adjunct treatments digitally. Survey data were collected from 12 Canadian mental health clinician participants. Surveys were adapted from the Alberta Quality Matrix of Health and Unified Theory of Acceptance and Use of Technology model. As a follow-up, the participants were invited to participate in either a semi-structured qualitative interview or focus group to further explore their perspectives on digitally delivered trauma-focused and adjunct therapies. Twenty-four clinician participants partook in an interview or focus group. The participants in this study supported the use of digitally delivered psychotherapies utilized for trauma-affected populations, sharing that these interventions appeared to offer similar quality of care to in-person delivery. Further research is required to address clinicians' concerns with digital delivery (e.g., patient safety) and identify other avenues in which digitally delivered psychotherapies utilized for trauma-affected populations can be engaged with and improved upon.

Despite sustained efforts among critically informed scholars to integrate thinking from disability studies into psychology, the psy disciplines continue to largely neglect the lived experience of disabled people and overlook disability as a form of social inequity and valued culture. In this article, I make a renewed case for integrating thinking from disability studies into psy, in particular within the psychotherapy professions and in the case of 'energy limiting conditions', a grass-roots concept that includes clinically and socially marginalised chronic illness such as Long COVID. Drawing on my experience as a disabled practitioner, and situating this within extant literature on disability and psy, I take an autoethnographic approach to exploring opportunities and challenges in bridging the interdisciplinary divide. I argue that unacknowledged institutional ableism within psy reproduces and is reinforced by physical and attitudinal barriers for disabled practitioners and service users, engendering under-representation of disability in psychotherapy professions and lacunae in disability-affirmative conceptual resources. Additionally, I propose that hermeneutical lacunae are bolstered by documented defensive clinical practices pertaining to disability. After discussing a wealth of opportunities for integration offered by disability studies, and noting the institutional failure within psy to embrace disability-related demographic and epistemic diversity, I question whether ongoing epistemic and social exclusions within the psy disciplines constitute a case of 'willful epistemic ableism'. Drawing on theorising vis-à-vis epistemic injustice and epistemologies of ignorance, I signal a form of systematic, actively maintained and structurally incentivised (motivated) non-knowing that results in collective failure among dominant groups to recognise established hermeneutical resources of the disabled community and allies. I conclude with suggestions of how this form of epistemic injustice might be mitigated., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ Group.)

The human-caused climate crisis is advancing relentlessly and poses a global threat. But to what extent is our psyche also in crisis due to climate change? This article explores the profound impacts of the climate crisis and environmental destruction on mental health, advocating for a comprehensive, ecologically-oriented approach to psychiatry and psychotherapy., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an Firma (Nicht-Sponsor der Veranstaltung): nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an Firma (Sponsor der Veranstaltung): nein Erklärung zu nichtfinanziellen Interessen ELB ist Präsidentin der Deutschen Gesellschaft für Psychologie (DGPs); ELB und SaS sind Mitglieder der Interessensgruppe „Mensch, Klima, Nachhaltigkeit“ der Deutschen Gesellschaft für Psychologie (DGPs). Zudem ist ELB Mitglied im Wissenschaftsrat. Sowohl ELB als auch SaS sind Mitglieder der Organisation „Psychologists/Psychotherapists for Future“. SK war Referent für Gesundheit beim Wissenschaftlichen Beirat der Bundesregierung Globale Umweltveränderungen (WBGU) und Mitautor des WBGU-Hauptgutachtens „Gesund leben auf einer gesunden Erde“. Sowohl SK als auch AML sind Mitglieder der Taskforce „Klima und Psyche“ der Deutschen Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN). AML ist Präsident der Deutschen Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) und Sprecher des Deutschen Zentrums für Psychische Gesundheit (DZPG)., (Thieme. All rights reserved.)

Objectives: In this paper, a novel approach is presented for selecting psychological treatment levels for older adults with borderline personality disorder (BPD). BPD tends to be a lifelong disorder persisting into old age, with a specific presentation of BPD symptoms in later life, which is illustrated by three different clinical cases., Methods: Recently, a clinical staging and health management model for BPD was presented to assist in selecting appropriate treatment approaches., Results: We combined this clinical staging model for BPD across the lifespan with psychotherapeutic treatment levels for older adults with personality disorders., Conclusions: This may allow for a more accurate treatment selection for older adults with BPD and was applied to the three clinical cases. Finally, implications for research and clinical practice are discussed.

Global change affects both individual life situations and social coexistence in a variety of ways. However, the effects of social events on mental illness and psychotherapy are only recorded and included in psychotherapy research in individual areas. The aim of this study is to explore current problems and concerns of patients in Germany on the basis of practical experience reports, to collect possible social causes and to bundle considerations for therapeutic treatment. To this end, psychotherapists (n=10) and psychotherapy patients (n=12) were interviewed in qualitative interviews and these were analyzed using grounded theory. After evaluating the collected perspectives, five main effects of current social events and the consequences of globalization were identified. From the perspectives of psychotherapists and patients, these include increasing anxiety about the future, decreasing social inclusion, increased questions about goals and identity as a concern for psychotherapy, increased psychological stress as a result of political divide and an increased demand for diversity-sensitive psychotherapy. In addition to expanding the scope of action, therapeutic approaches primarily include providing contact, guidance, orientation, emotional support and bonding experiences. The inclusion of knowledge from psychotherapists and patients as well as findings from social science can be helpful for identifying current problems and developing new therapeutic approaches or bundling, linking, and effectively using existing ones., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: Although evidence for benefits of psychotherapy is substantial, less is known about potential harm. Therefore, we systematically summarized randomized controlled trials (RCTs) to compile evidence-based data on the frequency and characteristics of adverse events (AEs) of psychotherapy. Method: This systematic review of result publications is based on a review of harm consideration in psychotherapy study protocols. Results: On the basis of 115 study protocols, 85 RCTs with 126 psychotherapy and 61 control conditions were eligible for inclusion. The sample consisted of 14,420 participants with the most common mental disorders. Harmful events, e.g., AEs, number of individuals with symptom deterioration, were explicitly reported in 60% of the studies. Conceptualization, recording, and reporting of AEs were heterogeneous. For most reported AEs, the association to study treatment remained unclear. Conclusions: Because the AE recording approaches of the individual studies differed substantially, results could only be compared to a limited extent. Consistent with other findings, this review demonstrates that AEs can be expected to affect more than one in ten participants. Serious AEs occurred more than in one in 21 participants in psychotherapy RCTs. To allow a balanced risk/benefit evaluation of psychotherapy, systematic harm monitoring and reporting should become standard in psychotherapy RCTs.

Background: Deprescribing of medication or psychotherapy represents a critical phase in treatment. The aim of the work is to systematically analyze recommendations for deprescribing medication and discontinuation of psychotherapy in the evidence- and consensus-based S3 guidelines of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) to identify potential research gaps., Methods: A systematic analysis of the DGPPN S3 guidelines to investigate and compare information and recommendations on deprescribing., Results: Regarding deprescribing of medication, our analysis showed that eight of the 20 included S3 guidelines contain information both in the form of recommendations and background information. Regarding psychotherapy, only two guidelines provided information on deprescribing., Conclusion: Our results highlight the need to expand guidelines to include evidence-based recommendations for deprescribing medication or discontinuation of psychotherapy. Future research should focus on the development of specific, generic, and evidence-based guidelines that support both medical staff and patients during these critical phases of therapy., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: A. Hasan erhielt Vortragshonorare von AbbVie, Advanz, Janssen, Otsuka, Rovi, Recordati und Lundbeck. Er war Mitglied in Advisory Boards für Boehringer Ingelheim, Janssen, Otsuka, Rovi, Recordati und Lundbeck. Einladungen zu Kongressen oder anderen Aktivitäten wurden nicht angenommen. Er ist Herausgeber der AWMF-S3-Leitlinie Schizophrenie. W. Strube erhielt Vortragshonorare von MAG & More (neurocare), Recordati und Rovi. Er war Mitglied in Advisory Boards von Recordati, Janssen und Boehringer Ingelheim. Einladungen zu Kongressen oder anderen Aktivitäten wurden nicht angenommen. E. Wagner war Mitglied in Advisory Boards von Recordati und Boehringer Ingelheim. S. Leucht erhielt Honorare für Beratung und/oder Vorträge und/oder Lehrmaterial von Angelini, Boehringer Ingelheim, Eisai, Ekademia, Gedeon Richter, Janssen, Karuna, Kynexis, Lundbeck, Medichem, Medscape, Mitsubishi, Neurotorium, Otsuka, Novo Nordisk, Recordati, Rovi, Teva. S. Seitz und T. Halms geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Objective: There is a growing interest in idiographic patient-reported outcome measures (I-PROMs) for routine outcome monitoring (ROM) and clinical feedback (CF) in psychotherapy, but to our knowledge, no systematic reviews of the empirical literature. Method: We conducted a systematic literature search for empirical papers investigating effects and experiences of I-PROMs for ROM/CF and found a total of 13 papers. There was only one experimental controlled effectiveness study. Results: We formulated a narrative summary of the data set as a whole. We conducted a secondary analysis of nine papers containing qualitative data on stakeholder experiences with I-PROMs and found three superordinate themes and eight subthemes, summarized as "I-PROMs can facilitate self-reflection for patients, assist in identifying and tracking therapeutic topics, and make patients more committed to therapy by giving them a greater sense of responsibility and empowerment. Formulating goals and problems can be difficult, and lack of progress can be demotivating. Time in therapy is precious and must be spent wisely. Effective use of I-PROMs is facilitated by flexibility and therapists' use of clinical skills." Conclusion: We discuss the limitations of the study and provide recommendations for future research and clinical practice.

Background: Psychotherapy is a key evidence-based method for the treatment of mental disorders. However, little research has been published on the negative effects of psychotherapies. Aims: We examined this issue through a systematic literature review of previous systematic reviews on randomized controlled trials (RCTs). Methods: We focused on previous reviews and meta-analyses on 1) RCTs examining the effectiveness of psychotherapies and 2) previous reviews and meta-analyses specifically focusing on the negative effects of psychotherapy. We included publications published in PubMed and the Cochrane Databases from the year 2000 or later. Results: Of the 1,430 relevant publications, only a small proportion (30%) mentioned negative outcomes, mostly withdrawal. Only 57 of the extracted original studies monitored potential negative effects, and only three small-scale studies indicated negative effects. Conclusions: The systematic monitoring of negative effects in psychotherapy has not been given the same attention as has been given to the benefits of therapy.

Objectives: The goals of this narrative review are to review the literature on psychotherapeutic interventions for older adults with histories of child maltreatment (CM) and to examine the unique considerations for assessing, diagnosing, and treating older adults with CM histories., Methods: Online database searches were conducted to identify the extant research into the efficacy of psychotherapeutic interventions for older adults with CM-related trauma., Results: Eight studies met inclusion criteria. The primary target diagnoses were post-traumatic stress disorder and depression. Psychotherapeutic interventions included Narrative Exposure Therapy, exposure-based treatments, Life Review Therapy, integrated treatments, and a spiritually-focused group therapy., Conclusions: While limited in number and generalizability due to study design and sample size and characteristics, the studies provide preliminary evidence of potentially effective psychotherapeutic treatments for older adults with CM histories. Further research is needed to determine the most effective psychotherapeutic interventions for this population., Clinical Implications: Many older adults suffer for decades with the repercussions of CM. Due to knowledge gaps regarding best practices for treating older adults with CM histories, many clinicians are poorly equipped to treat this population. Therefore, awareness of CM-related pathology and familiarity with effective psychotherapeutic interventions are essential for clinicians to meet the needs of this population.

Interest in the therapeutic potential of oxytocin for the treatment of mental health disorders, especially those involving social dysfunction, has increased considerably in recent years. To date, most studies have only evaluated oxytocin as monotherapy, with highly inconsistent results. A new line of research is exploring the effects of combining oxytocin with psychotherapy. The aim of the present review was to evaluate the therapeutic effects of intranasal oxytocin combined with psychotherapy in individuals with psychiatric disorders. Only randomized clinical trial design was eligible for inclusion. A search of relevant databases yielded 2480 articles published through April 30, 2024. Of these, 13 trials (518 participants) were included in this review and 4 of them in a meta-analysis. The trials evaluated a range of different psychotherapeutic interventions, oxytocin doses, and mental disorders. Overall, the trials suggested that combined treatment reduced negative mental representations, decreased stress, and increased therapeutic alliance. Meta-analysis showed that combined treatment significantly reduced depressive symptoms (d= -1.58, 95 % CI: -3.15 to -0.01). However, the treatment with oxytocin had no significant effects on psychiatric symptoms (d= 0.00, 95 % CI: -0.56-0.57) or social functioning (d = 0.21, 95 % CI: -0.07-0.49). Limitations included the heterogeneity and limited sample sizes of the trials. The findings suggest that the combination of intranasal oxytocin and psychotherapy may be an effective therapeutic approach to reduce depressive symptoms in individuals with mental disorders and may improve retention and therapeutic alliance., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing financial interests or personal relationships that may have influenced the work reported in this study., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: This qualitative study aimed to explore patients' experiences with a novel treatment approach for endometriosis-associated pain, termed 'sinosomatics'. Specifically, it sought to understand women's experiences of the treatment and its components, the effects of the treatment on biological, psychological, and social levels, and how the women interpreted the changes they experienced., Methods: We conducted ten semi-structured interviews with patients, who had undergone the complementary treatment for endometriosis-associated pain. These interview sessions were audio-recorded, transcribed, and analyzed using Mayring's content analysis method with the aid of MAXQDA software., Results: Three key categories emerged: 'treatment experience,' 'treatment effects,' and 'explanation for effects'. The treatment was described as a "turning point" in patients' lives, offering new insights into the involvement of psychosocial factors in endometriosis-associated pain and paving the way for overcoming adverse life events. The therapy strengthened women's empowerment, inspired hope, fostered coping strategies, and promoted personal growth. Both the holistic view of body and mind and the psychological approach to treatment led to a change in the way how women perceived the disease., Conclusions: Patients recognized the innovative combination of psychotherapy and acupuncture point stimulation as a significant advancement in managing their disease. The treatment has helped them to acquire a more holistic understanding of their bodily complaints and to cope more effectively with their symptoms. The findings highlight the importance of a patient-centered and empathetic treatment approach that empowers women to take an active role in managing their condition., Competing Interests: Declarations. Ethics approval and consent to participate: The qualitative study was conducted according to the Declaration of Helsinki, and the study protocol was approved by the Ethics Committee of Medical Faculty at LMU Munich (Project number 309 − 13). All participants gave written informed consent. Consent for publication: Not applicable. Competing interests: After the conduct of the study, one of the authors (F.B.) started to run a medical education center that provides advanced training in sinosomatics. The conduct of the study was partially supported by funds from the Schweizer-Arau Foundation to A.L., F.B., and K.M. All other authors do not have competing interest., (© 2024. The Author(s).)

Opinion is divided about the certainty of the evidence base for gender-affirming medical interventions in youth. Proponents claim that these treatments are well supported, while critics claim the poor-quality evidence base warrants extreme caution. Psychotherapy is one of the only available alternatives to the gender-affirming approach. Discussion of the treatment of gender dysphoria in young people is generally framed in terms of two binary approaches: affirmation or conversion. Psychotherapy/exploratory therapy offers a treatment option that lies outside this binary, although it is mistakenly conflated with conversion therapies. Psychotherapy does not impose restrictive gender stereotypes, as is sometimes claimed, but critically examines them. It empowers young people to develop creative solutions to their difficulties and promotes agency and autonomy. Importantly, an exploratory psychotherapeutic process can help to clarify whether gender dysphoria is a carrier for other psychological or social problems that may not be immediately apparent. Psychotherapy can therefore make a significant contribution to the optimal, ethical care of gender-dysphoric young people by ensuring that patients make appropriate, informed decisions about medical interventions which carry risks of harm and have a contested evidence base., Competing Interests: Competing interests: RD'A is a board member of the Society for Evidence-based Gender Medicine and a member of the advisory board for the Gender Exploratory Therapy Association., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

The phenomenon of neural plasticity pertains to the intrinsic capacity of neurons to undergo structural and functional reconfiguration through learning and experiential interaction with the environment. These changes could manifest themselves not only as a consequence of various life experiences but also following therapeutic interventions, including the application of noninvasive brain stimulation (NIBS) and psychotherapy. As standalone therapies, both NIBS and psychotherapy have demonstrated their efficacy in the amelioration of psychiatric disorders' symptoms, with a certain variability in terms of effect sizes and duration. Consequently, scholars suggested the convenience of integrating the two interventions into a multimodal treatment to boost and prolong the therapeutic outcomes. Such an approach is still in its infancy, and the physiological underpinnings substantiating the effectiveness and utility of combined interventions are still to be clarified. Therefore, this opinion paper aims to provide a theoretical framework consisting of compelling arguments as to why adding NIBS to psychotherapy can promote therapeutic change. Namely, we will discuss the physiological effects of the two interventions, thus providing a rationale to explain the potential advantages of a combined approach., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Daniele Saccenti et al.)

Background: Therapists and their patients increasingly discuss digital data from social media, smartphone sensors, and other online engagements within the context of psychotherapy., Objective: We examined patients' and mental health therapists' experiences and perceptions following a randomized controlled trial in which they both received regular summaries of patients' digital data (eg, dashboard) to review and discuss in session. The dashboard included data that patients consented to share from their social media posts, phone usage, and online searches., Methods: Following the randomized controlled trial, patient (n=56) and therapist (n=44) participants completed a debriefing survey after their study completion (from December 2021 to January 2022). Participants were asked about their experience receiving a digital data dashboard in psychotherapy via closed- and open-ended questions. We calculated descriptive statistics for closed-ended questions and conducted qualitative coding via NVivo (version 10; Lumivero) and natural language processing using the machine learning tool latent Dirichlet allocation to analyze open-ended questions., Results: Of 100 participants, nearly half (n=48, 49%) described their experience with the dashboard as "positive," while the other half noted a "neutral" experience. Responses to the open-ended questions resulted in three thematic areas (nine subcategories): (1) dashboard experience (positive, neutral or negative, and comfortable); (2) perception of the dashboard's impact on enhancing therapy (accountability, increased awareness over time, and objectivity); and (3) dashboard refinements (additional sources, tailored content, and privacy)., Conclusions: Patients reported that receiving their digital data helped them stay "accountable," while therapists indicated that the dashboard helped "tailor treatment plans." Patient and therapist surveys provided important feedback on their experience regularly discussing dashboards in psychotherapy., (© Lauren Southwick, Meghana Sharma, Sunny Rai, Rinad S Beidas, David S Mandell, David A Asch, Brenda Curtis, Sharath Chandra Guntuku, Raina M Merchant. Originally published in JMIR Mental Health (https://mental.jmir.org).)

Although integrative therapies are increasingly popular in clinical psychology, their dissemination in the psychiatric literature has been limited. To care for patients living with complex psychiatric problems, the authors formulated a flexible, pragmatic, problem-oriented integrative therapy (PIT). The aims of this article are to increase psychiatric attention to the value of integrative therapies, authorize their use, and present the authors' PIT approach. PIT combines common factors, theoretical synthesis, and technical eclecticism. After delineating patients' problems and goals, clinicians apply discrete therapeutic elements derived by unbundling numerous theories and practices. Clinicians improvise and pivot their practice in response to patients' shifting problems and goals, as well as to advances in the field. Practicing PIT requires familiarity with numerous therapeutic theories and models and a willingness to continually expand skill sets. PIT's effectiveness may be assessed by comparing results obtained with PIT with those obtained via conventional psychotherapeutic modalities., Competing Interests: Dr. Yager receives editorial fees from Wolters-Kluwer. Dr. Kay reports no financial relationships with commercial interests.

There is an inevitable limit to understanding the internal experience of patients with whom therapists work in psychotherapy. The farther their experience is from that of their therapist, the more challenging this endeavor can be. Accepting that therapists cannot exactly know a patient's internal experience invites them to explore novel ways of appreciating another person's way of perceiving relationships, deriving meaning from them, and using their experience to motivate behavior. The concept of umwelt can be used as a metaphor to help therapists imagine the internal world of their patients, as shaped by patients' developmental, interpersonal, and traumatic experiences. Umwelt refers to the unique worldview created by a species' idiosyncratic perceptual organs and survival strategies. This first Psychotherapy Musings describes the concept of umwelt , applies it to the case of a patient with difficult-to-treat mental health problems, and explicates the benefit of this novel perspective., Competing Interests: The author reports no financial relationships with commercial interests.

Patients' access to their psychotherapy records may be assumed to be well protected; however, the matter is intricately regulated. In fact, the statutes and rights pertaining to patient access to psychotherapy notes vary across states. Taken together, federal and state laws indirectly and inconsistently delineate lawful access-as well as clinical exceptions to providing access-to psychotherapy notes. Federal law defers to state laws when the latter afford individuals greater access to their notes. Both federal and individual state levels vary in providing for possible conditions under which access may be restricted. Right of access to psychotherapy notes is a matter of importance for all mental health clinicians in the United States. Awareness and integration of pertinent laws and regulations allow clinicians to manage such matters without a negative impact on their clinical care. Further consideration of how clinical practice interacts with other dimensions of health care administration (clinical, ethical, and legal) may serve to enhance the integrity of a clinician's work and the ability to adapt to difficult clinical circumstances with confidence., Competing Interests: The authors report no financial relationships with commercial interests.

Epigenetic modifications play a pivotal role in the regulation of gene expression and cell function, offering potential markers of disease states and therapeutic outcomes. Recent advancements in neuroscience have spurred interest in studying the epigenetic underpinnings of psychosomatic medicine. This review presents a new perspective on the role of epigenetic regulation in the realms of psychosomatics and psychotherapy. The authors first highlight epigenetic patterns associated with prevalent psychosomatic disorders, including irritable bowel syndrome, fibromyalgia, psoriasis, and lichen planus. For these conditions, psychotherapy serves as a treatment modality and can be conceptualized as an epigenetic intervention that beneficially affects the epigenome as part of the therapeutic process. Focusing on cognitive-behavioral and mindfulness-based therapies, the authors highlight evidence on psychotherapy-associated epigenetic signatures occurring at genes that are involved in stress response, inflammation, neurotransmission, neuroplasticity, and aging. Educating patients about the potential of psychotherapy to affect the epigenome may enhance patient engagement with and adherence to treatment, and psychotherapy-induced epigenetic changes have the potential to promote transgenerational disease prevention, underscoring the far-reaching implications of this therapeutic approach. Challenges persist in epigenetic studies, and this review aimed to catalyze further research in this burgeoning field, with the goal of enhancing patient care., Competing Interests: Work reported in this review was performed while Dr. Kroflin was a student at the University of Zagreb School of Medicine, Zagreb, Croatia.The authors report no financial relationships with commercial interests.

Depressive and anxiety symptoms are more prevalent in patients with cirrhosis compared to the general population. Between 2009 and 2019, the prevalence of depression in cirrhosis increased by 80%, while the prevalence of generalized anxiety disorder increased by over 400%. When present, anxiety and depression are linked to lower health-related quality of life, more severe symptoms (eg, fatigue), and poorer response to medical treatment. Screening instruments for depression and anxiety have shown acceptable validity in patients with cirrhosis. However, the diagnosis of depression and anxiety disorder remains challenging in this population and should follow the established criteria for general populations. Treatment interventions are numerous and include patient education and support around liver disease, pharmacological agents, and psychotherapy. Antidepressants are the treatment of choice for patients with depressive or anxiety disorder and cirrhosis. However, consideration must be given to dose adjustment and choice of agent due to changes in their metabolism in patients with liver disease. Psychotherapy may be used as a stand-alone therapy or concomitantly with pharmacotherapy. The high prevalence and complexity of depressive and anxiety symptoms in patients with cirrhosis support the integrated care approach in which patients are cared for by multidisciplinary teams., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases.)

Fear of cancer recurrence (FCR) is a common and distressing condition among adolescents and young adults (AYAs). This study aims to investigate the efficacy of digital interventions, including distress screening-based information provision and smartphone problem-solving therapy, on common psychological distress, especially FCR, in AYA patients with cancer. Participants will be 224 AYA outpatients with cancer aged 15-39 years who will be randomly assigned to either an 8-week smartphone-based intervention or a waitlist control group. This intervention includes smartphone-based distress screening, information provision, and psychotherapy (problem-solving therapy). The primary endpoint will be the Fear of Cancer Recurrence Inventory-Short Form score at week 8. This study will be conducted as a fully decentralized, randomized, and multicenter trial. The study protocol was approved by the Institutional Review Board of Nagoya City University on 19 April 2024 (ID: 46-23-0005). Trial registration: UMIN-CTR: UMIN000054583., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Complex Posttraumatic Stress Disorder (CPTSD) is a condition resulting from exposure to chronic, interpersonal traumatic events, in which some form of control or power dynamics existed. Its clinical picture includes the main symptom clusters of posttraumatic stress disorder, accompanied by dysregulated emotion, problems in interpersonal relationships, and difficulties in identity integration. In addition, both clinical work and research have shown CPTSD to include highly distressing and complicated psychological phenomena, such as identification with the aggressor, various forms of dissociation, self-harm and self-destructive behaviors, and more. Due to this highly complex and multilayered clinical picture, the treatment of CPTSD poses a significant clinical challenge to therapists. In this special issue of In Session, we present a series of case studies, each representing a different therapeutic approach to CPTSD (e.g., skills training for affective and interpersonal regulation, Eye Movement Desensitization and Reprocessing, psychodynamic, integrative psychotherapy). These cases also represent a wide variety of patient populations, as well as different types of underlying traumatic events. Together, they reveal the breadth of clinical possibilities currently available to trauma therapists encountering cases of CPTSD. They also highlight the challenges and dilemmas that clinicians often face when treating this condition, as well as ways to overcome those., (© 2024 Wiley Periodicals LLC.)

Objective: Therapists' interpersonal skills play a significant role in outcome differences between therapists. Similarly, the strength of the therapeutic alliance is influenced by therapist characteristics. Therefore, the aim of this study was to capture therapist differences in the alliance and to examine the effect of therapists' interpersonal skills on the therapeutic alliance., Methods: Interpersonal skills of 99 incoming therapists were measured in a group discussion using the Therapy-Related Interpersonal Behaviors (TRIB) scale. The therapists treated n =1031 psychotherapy outpatients as part of their clinical training. The alliance was assessed at the end of therapy using the Assessment for Signal Clients (ASC). Hierarchical linear models were used to predict the alliance from interpersonal skills, controlling for other patient and therapist variables. Initial impairment was examined as a moderator of the effect., Results: The therapist effect (TE) on the alliance was 7.3%. Interpersonal skills were a significant predictor of the alliance ( b =0.104, p <0.001) and could explain 1.8% of the total variance beyond all control variables. The TE was reduced to 5.7%, meaning that 23.0% of the therapist differences in the alliance could be attributed to interpersonal skills. Although the moderation effect of initial impairment was only marginally significant ( b =0.069, p =0.061), the association between interpersonal skills and alliance disappeared with low patient impairment., Discussion: The TRIB scale can measure interpersonal skills before the start of training. The prediction should be considered in the context of the several years' temporal distance between the measurements of interpersonal skills and the alliance, applicable to the selective sample of therapists chosen for the training., Conclusion: Interpersonal skills can predict the alliance. The influence of therapists' interpersonal skills on the alliance increases with the initial impairment of patients, while there is no significant relationship with low-impaired patients. Using video-based rating systems, interpersonal skills of individual therapists can be measured automatically, therapists with deficits can be identified, and targeted training can be provided., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

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., Competing Interests: Dr. Kelmendi is a Co-founder, consultant, and has equity in Transcend Therapeutics, and is also a consultant for Ceruvia Lifesciences. Dr. Alpert reports royalties from Cambridge University Press, Honoraria from Belvoir Publishing and MGH Psychiatry Academy. Dr. Carpenter discloses consulting income in the past three years from Neuronetics, Neurolief, Magnus Medical, Motif Neurotech, Sage Therapeutics, Otsuka, MAPS Public Benefit Corporation, and Change Healthcare. She has clinical trials contracts with Neuronetics, Neurolief, and Janssen and research device loans from Neuronetics and Nexstim. Her effort was supported in part by the National Institute of General Medical Sciences (P20GM130452) funded COBRE Center for Neuromodulation at Butler Hospital. Dr. Grzenda discloses income from consulting to the American Psychiatric Association. Dr. Kraguljac has served on an advisory board for Neurocrine Biosciences Inc. and is a member of the American Board of Psychiatry and Neurology Article Based Continuing Certification committee. Dr. McDonald is compensated as the chair of the DSMB for an NIA sponsored multicenter study. He is on the Board of Skyland Trail and 3Keys. He is a paid consultant for Signant and Sage Therapeutics. He receives a stipend as a deputy editor of the American Journal of Psychiatry. Dr. Rodriguez has, in the last three years, been a consultant for Biohaven Inc., Osmind, and Biogen; received research grant support from Biohaven Inc.; received royalties from American Psychiatric Association Publishing; and received a stipend from APA Publishing for her role as Deputy Editor at The American Journal of Psychiatry. Dr. Rodriguez’s effort was supported in part by the VA Office of Research and Development Clinical Science Research & Development Service, US, Department of Veterans Affairs (1I01CX001789-01A2). Dr. Widge discloses device donations from Medtronic, consulting income from Dandelion Science, and multiple unlicensed patents in the area of brain stimulation for psychiatric illness. Dr. Nemeroff serves as a paid consultant to AbbVie, ANeuroTech (division of Anima BV), Signant Health, Magstim, Inc., Intra-Cellular Therapies, Inc., EMA Wellness, Sage, Silo Pharma, Engrail Therapeutics, Pasithea Therapeutic Corp., EcoR1, GoodCap Pharmaceuticals, Inc., Senseye, Clexio, Ninnion Therapeutics, AncoraBio, and SynapseBio. Dr. Nemeroff is a stockholder with the following: Seattle Genetics, Antares, Inc., Corcept Therapeutics Pharmaceuticals Company, EMA Wellness, and Naki Health. He serves on the scientific advisory boards of ANeuroTech (division of Anima BV), Brain and Behavior Research Foundation (BBRF), Anxiety and Depression Association of America (ADAA), Skyland Trail, Signant Health, Laureate Institute for Brain Research (LIBR), Inc., Heading Health, Pasithea Therapeutic Corp., and Sage and on the board of directors for Gratitude America, ADAA, Lucy Scientific Discovery, Inc. His patents are as follows: “Method and devices for transdermal delivery of lithium (US 6,375,990B1)” and “Method of assessing antidepressant drug therapy via transport inhibition of monoamine neurotransmitters by ex vivo assay (US 7,148,027B2).” Dr. Holtzheimer receives royalties from Oxford University Press and UpToDate. Drs. Sippel, Hamblen, and Schnurr report no financial relationships with commercial interests.

Background: Due to its high impact on quality of life and mental health, close monitoring and often psychotherapy is recommended for patients with a ventricular assist device (VAD). This study investigates the psychological comorbidity and the corresponding psychotherapeutic treatment situation of VAD patients. Special attention is also given to the professional perspective VAD team (assistant and senior cardiologists and specialized nurses)., Methods: We conducted a cross-sectional observational study. Data from 50 VAD patients (mean age = 53.52, standard deviation = 13.82 years, 84.0% male) and their VAD team were analyzed. The presence of a psychological disorder was evaluated by structured clinical interviews for DSM-IV (SCID-I-Interviews). Patients answered a questionnaire regarding their current psychotherapeutic treatment status and their attitude towards psychotherapy. The VAD team answered a questionnaire about the patients' needs for psychotherapy and indicated whether they addressed this topic with the patient. Data were analyzed descriptively, by analysis of variance and t-test., Results: A total of 58% of VAD patients suffered from at least one significant psychological disorder, 79.3% of those were not in psychotherapy. The VAD team could not identify the patients who suffered from a psychological disorder (F = 1.90; p = 0.18). They perceived more need for psychotherapy than they addressed with their patients (T = 3.39; p < 0.001)., Conclusions: While there is a high psychological morbidity among VAD patients, only few receive psychotherapy. Psychological comorbidity is not easily detected by the VAD team. Standardized psychosocial care could be implemented by regular psychological assessments and further information of patients and their VAD teams., (© 2024 The Author(s). Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

This article explores the implications of epistemic trust within the mentalizing model of psychopathology and psychotherapy, emphasizing the role of the restoration of epistemic trust in therapeutic settings. At the core of this exploration is the developmental theory of mentalizing, which posits that an individual's ability to understand mental states-both their own and others'-is cultivated through early caregiver interactions. The article expands on this concept by reviewing and integrating evolutionary theories suggesting that humans have evolved a unique sensitivity to teaching and learning through ostensive cues, enhancing our capacity for cultural transmission and cooperation. However, adversities such as trauma or neglect can disrupt this developmental trajectory, leading to epistemic disruption, where individuals struggle to engage with or learn from social experiences effectively. This disruption can manifest in psychological disorders, where mentalizing failures are associated with difficulties in social functioning and in maintaining relationships. The article proposes that psychotherapeutic approaches can effectively address these disruptions, and it outlines three key aspects of communication that unfold in psychotherapeutic interventions. It discusses how the effectiveness of these interventions may hinge on the reestablishment of epistemic trust, enabling patients to reengage with their social environments constructively and adaptively.

Introduction: Suicide is a serious global public health issue, and a history of attempted suicide is the most critical indicator of suicide risk. There are limited studies on the effectiveness of psychotherapy in individuals who have attempted suicide, and other outcome measures related to suicide risk in suicide attempts have not been explored., Aim/question: This study aimed to systematically review and perform a meta-analysis of the effectiveness of psychotherapy on individuals who have attempted suicide., Methods: This study conducted a comprehensive literature search of five major databases (PubMed, EMBASE, Cochrane, Web of Science, and Ovid). The protocol for this study is registered with PROSPERO (CRD42023464401) and follows the PRISMA guidelines., Results: This meta-analysis included a total of 34 trials from 32 literature sources. The study involved a total of 6600 participants. The results showed that psychotherapy had a positive effect on reducing the suicidal tendencies of individuals who have attempted suicide and effectively reduced the number of repeated suicide attempts as well as the levels of suicidal ideation, depression, anxiety and hopelessness., Implications for Practice: This study concludes that psychotherapy is effective in reducing the suicidal tendencies of individuals who have attempted suicide. Psychological therapy for individuals who have attempted suicide are crucial in preventing future suicidal behaviours., (© 2024 John Wiley & Sons Ltd.)

Introduction: The study aims to examine psychologists' and psychiatrists' experiences of built environments, indoors and outdoors, in providing psychotherapy. The research explores how the environment matters in clinical practice from the perspective of psychologists and psychiatrists and seeks to comprehend the significance of the facilities where psychotherapy takes place., Methods: This study design is explorative and qualitative. Data is generated by eight in-depth interviews with six clinical psychologists and two psychiatrists and was analyzed using an interpretative phenomenological approach., Results: Our findings revealed that the built environment matters in clinical practice as it appears to be closely linked to fostering a more comprehensive approach and facilitating various associations and themes in psychotherapy. Three superordinate themes emerged from the data: Design as therapeutic tool, Nature as a co-therapist, and lastly, Expanding the therapeutic space, highlights the participants' perspective on the transformative potential of the built environment to become therapeutic., Conclusion: The findings reveal how built environments can be actively utilized as tools in psychotherapy. Environments are not to be considered merely as neutral and passive spaces for conducting and receiving psychotherapy rather than experienced as places that may regulate and impact both therapists and patients, the relationship between them.

Objective: Machine learning has a great potential for prospectively forecasting individual patient response to mental health care (MHC), thereby enabling treatment personalization. However, previous efforts have been limited to populations living in predominantly higher income, developed countries. This study aimed to extend the reach of precision MHC systems by developing and testing a feasible and readily implementable algorithm for identifying patients at risk of nonresponse to routinely delivered psychotherapy in Chile, a developing country in Latin America., Method: Data were derived from a community-based, randomized trial that tested the effects of progress feedback on naturalistically delivered psychotherapy outcome. Patients were 547 adults who were consecutively admitted to an outpatient clinic in Santiago, Chile. Treatment response was defined using norms for reliable improvement on the Outcome Questionnaire-30. Based on 10 sociodemographic and seven clinical predictors, we trained elastic net and random forest algorithms on a randomly selected training set (70%; n = 384). The best performing algorithm was tested on a hold-out sample (30%; n = 163)., Results: Reliable improvement was achieved in 42% of the cases. A random forest algorithm demonstrated moderate performance in the hold-out sample (area under the curve = .74, Brier score = .21), correctly identifying 73% of the patients who did not respond., Conclusion: This study developed a predictive algorithm that demonstrated moderate accuracy in identifying patients at risk of nonresponse to naturalistic psychotherapy in Chile, using routinely assessed and easy-to-collect sociodemographic and clinical information. Using such tools may represent one step toward reducing the multilayered outcome disparities faced by individuals receiving MHC in socioeconomically disadvantaged contexts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: There is considerable research focusing on the negative outcomes of psychotherapy, however, there remains an overlooked population: those who appear to show no response after treatment. This qualitative evidence synthesis aimed to review the available literature exploring client and therapist experiences of psychotherapy nonresponse., Method: Seven databases were searched for studies using qualitative approaches to explore nonresponse. Twenty-four studies met inclusion criteria and were analysed using Thematic Synthesis., Results: Six overarching client perspective themes and 18 subthemes were identified: Hopes and fears; A difficult task; A Disconnected relationship; Staying involved; Therapy was not worth the investment and, On a trajectory for improvement. Four overarching therapist perspective themes and 10 subthemes were identified: High expectations; Experiencing a disconnect; Feeling threatened and Holding onto hope., Discussion: A model of psychotherapy nonresponse is proposed. The experience of nonresponse appears to involve both clients and therapists finding therapy difficult, experiencing problems connecting and not being open in the therapeutic relationship. Importantly, nonresponse appears not to be an absence of effects, but a range of experiences that are potentially harmful, particularly to clients. However, there were varied experiences of nonresponse, which indicates the importance of qualitative outcome measurement., Competing Interests: Declaration of competing interest All authors declare that they hold no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Dissociation is a psychological process in reaction to threat which can be found in many psychiatric conditions. Dissociative symptoms can become very disabling, whether in daily life or in care. Nevertheless, few studies seem to have examined the efficacy of psychotherapy on the latter and its relevance as a therapeutic target., Method: A systematic review of the literature (PRISMA) on the efficacy of psychotherapy on dissociative symptoms in adults with mental disorders was conducted. Effectiveness was considered in terms of reduction in dissociative symptomatology. The search was conducted on Scopus, PubMed and PsycInfo. Overall, 50 full-text articles were evaluated., Results: Fourteen studies were included in the review. In all, 711 adult subjects with post-traumatic stress disorder, borderline personality disorder or dissociative disorder were included. Overall, this systematic review reports a reduction in dissociative symptoms associated with a variety of psychotherapeutic interventions, without allowing any conclusions to be drawn on the superiority of one psychotherapy over another., Discussion: The conclusions of this work highlight three possible therapeutic orientations for reducing dissociative symptoms: (i) by reintegrating the dynamic subsystems, (ii) by treating the cognitive processes underlying dissociation, and (iii) by acting on the processes identified as common to the effectiveness of psychotherapy., (Copyright © 2024 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Background: Oxytocin, popularly known as the "social hormone", has wide implications for the regulation of socially relevant cognitions, emotions and behaviors. Individual differences in oxytocin may be relevant to mental health treatment outcomes, given the centrality of the therapeutic relationship in psychotherapy., Methods: This systematic review aimed to synthesize findings from psychotherapy studies that examined oxytocin measurement and augmentation methods and their association with treatment outcomes. The methodology was preregistered in the Open Science Framework (https://osf.io/xtyvc/?view&#95;only=2bc37dc0b2cd41f8939e2964bd8b884f). Five databases were searched on 30th of March 2023 (PubMed, SCOPUS, Web of Science, Medline, PsycINFO). Eligible studies were assessed for risk of bias and findings were summarized using narrative synthesis and vote counting methods., Results: Overall, 24 studies (n=881 participants) including experimental and observational designs and covering various diagnostic groups were reviewed. Findings from 9 studies (n=406) indicate that oxytocin measures were associated with psychotherapy treatment outcomes for depression, and oxytocin-augmentation improved depression outcomes. Results regarding other mental disorders were mixed and inconclusive., Discussion: Current evidence indicates that oxytocin-augmented psychotherapy for depression warrants further research. Currently there is not sufficient evidence to draw firm conclusions regarding the clinical relevance of oxytocin in the context of other disorders. Key limitations are the lack of meta-analytic synthesis and small sample sizes for primary studies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Routine process and outcome monitoring interventions added to psychotherapy are known to improve treatment outcomes, although they vary in format and effectiveness., Objective: This study aimed to evaluate whether a therapist-independent, internet-based routine process monitoring and feedback system could significantly reduce psychological distress and enhance the quality of the therapeutic relationship compared with a treatment-as-usual control group among individuals already engaged in individual psychotherapy., Methods: We randomized 475 participants into either the intervention group, which received access to an internet-based routine process monitoring and feedback system in addition to psychotherapy, or the control group, which received only psychotherapy. The trial lasted for 10 weeks. Follow-up assessments at 5 weeks and 10 weeks used the Clinical Outcomes in Routine Evaluation-Outcome Measure as the primary outcome, with the Working Alliance Inventory-Short Revised and the Real Relationship Inventory-Client form as secondary outcomes., Results: Per-protocol analyses (n=166) showed that psychological distress decreased in both groups, but there was no significant advantage for the intervention group. The intervention group experienced a decline in the genuineness dimension score of the real relationship, with an effect size of d=-0.27, compared with d=0.01 in the control group. In the intervention group (but not in the control group), dropouts showed significantly lower real relationship levels (P=.002), working alliance quality (P=.051), and emotional disclosure (P=.01) compared with those who completed the study. Additionally, logistic regression revealed distinct predictors of dropout within the control group and intervention group., Conclusions: The findings do not provide conclusive evidence for the efficacy of the new internet-based intervention in enhancing self-monitoring and prompting reflection on patients' emotional responses to their therapists. However, the intervention appears to influence patients' perceptions of the genuineness dimension in the therapeutic relationship, warranting further investigation. We hypothesize that this alteration in the genuineness dimension could be attributed to the intervention facilitating a more realistic and accurate perception of the therapeutic relationship among participants., Trial Registration: ClinicalTrials.gov NCT06038747; https://clinicaltrials.gov/study/NCT06038747., International Registered Report Identifier (irrid): RR2-10.2196/55369., (©Alberto Stefana, Paolo Fusar-Poli, Eduard Vieta, Eric A Youngstrom. Originally published in JMIR Mental Health (https://mental.jmir.org), 27.11.2024.)

Background: The abandonment of psychotherapeutic treatments is influenced by various factors, including patient characteristics, therapist traits, and the therapeutic relationship. Despite the well-documented importance of these factors, limited empirical research has focused on the role of the therapeutic relationship and the characteristics of therapist-patient dyads in predicting treatment dropout. This study protocol outlines a longitudinal research project aimed at predicting dropout and non-response in psychotherapy for individuals with personality disorders. The research seeks to identify predictive factors related to psychotherapy outcomes, focusing on patient, therapist, and dyadic elements. Specifically, the study will examine the influence of therapist characteristics (e.g., personality traits, countertransference, responsiveness) on treatment outcomes, explore the impact of relational factors (e.g., treatment expectations, epistemic trust, therapeutic alliance) on therapy effectiveness, and assess how the therapeutic alliance within therapist-patient dyads affects the likelihood of dropout and non-response., Methods: The longitudinal study will include 100 therapist-patient dyads (200 participants) recruited from various Mental Health Services in Milan, Italy. Validated instruments will be administered to both patients and therapists at four-time points: T0 (baseline), T1 (3 months), T2 (6 months), and T3 (1 year). Data will be collected at baseline and at the one-year mark to evaluate the relationships between therapist, patient, and dyadic factors and treatment outcomes., Discussion: Identifying predictive variables associated with high dropout rates can help preempt treatment discontinuation, reducing the financial and operational burdens on mental health services. Understanding these factors will enable the development of targeted interventions to improve treatment engagement and reduce attrition. This approach could enhance outcomes for individuals with personality disorders and lead to more efficient resource allocation and sustainable delivery of mental health care., (© 2024. The Author(s).)

Introduction: While ample data demonstrate the effectiveness of inpatient psychosomatic treatment, clinical observation and empirical evidence demonstrate that not all patients benefit equally from established therapeutic methods. Especially patients with a comorbid personality disorder often show reduced therapeutic success compared to other patient groups. Due to the heterogeneous and categorical personality assessment, previous studies indicated no uniform direction of this influence. This complicates the derivation of therapeutic recommendations for mental disorders with comorbid personality pathology., Methods: Analyzing n = 2094 patients from German university hospitals enrolled in the prospective "MEPP" study, we tested the dynamic interaction between dimensionally assessed personality functioning and psychopathology of anxiety and depression., Results: Longitudinal structural equation modelling replicated the finding that the severity of symptoms at admission predicts symptom improvement within the same symptom domain. In addition, we here report a significant coupling parameter between the baseline level of personality function and the change in general psychopathology - and vice versa., Discussion and Conclusion: These results imply that personality pathology at admission hinders the therapeutic improvement in anxiety and depression, and that improvement of personality pathology is hindered by general psychopathology. Furthermore, the covariance between both domains supports the assumption that personality functioning and general psychopathology cannot be clearly distinguished and adversely influence each other. A dimensional assessment of the personality pathology is therefore recommendable for psychotherapy research and targeted therapeutic treatment., Competing Interests: Declaration of competing interest Christoph Herrmann-Lingen reports financial support was provided by Hogrefe Publishing. Christoph Herrmann-Lingen reports financial support was provided by Novartis AG. All authors, except for Stephan Doering, are working at one of the German university departments of psychosomatic medicine and psychotherapy. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Transgender youths are more likely than cisgender youths to need mental health care because of their high exposure to discrimination and victimization, including within health care systems. Accordingly, transgender youths have low care satisfaction and high rates of treatment dropout, further exacerbating existing mental health inequities. To reduce these inequities, mental health providers need knowledge and skills to enhance transgender youths' treatment engagement and benefits. However, a comprehensive set of practices addressing the needs of transgender youth patients and their providers does not exist. The authors developed gender-affirming psychotherapy (GAP), an evidence-informed set of skills and principles to augment mental health treatments for transgender youths., Methods: GAP was developed by using a human-centered design, a methodological approach for creating interventions that prioritize the needs of key stakeholders, which in this study included mental health providers and transgender youths and their parents (N=36). A scoping review of the literature and stakeholder focus groups were conducted to create GAP, which encompasses core principles and skills to enhance mental health services for transgender youths., Results: GAP encompasses 27 principles and 38 skills, organized within 10 domains. All principles and skills were designed to be relevant for various provider types (e.g., psychiatrists and social workers) and to be flexibly adapted to meet diverse patient needs., Conclusions: GAP offers a scalable and flexible approach to addressing the growing mental health care needs of transgender youths. The findings of this study suggest that a human-centered design is a feasible and efficient method for developing interventions to address health inequities., Competing Interests: Dr. Price is the founder and director of Affirm Solutions, L.L.C., which provides gender-affirming psychotherapy training online. Dr. Pachankis reports receiving royalties from Oxford University Press for books related to LGBTQ-affirmative mental health treatments. The other authors report no financial relationships with commercial interests.

3,4-Methylenedioxymetamphetamine(MDMA)-assisted psychotherapy (MDMA-AP) is a proposed treatment for posttraumatic stress disorder (PTSD) that may be approved for adults soon. PTSD is also common among trauma-exposed adolescents, and current treatments leave much room for improvement. We present a rationale for considering MDMA-AP for treating PTSD among adolescents. Evidence suggests that as an adjunct to therapy, MDMA may reduce avoidance and enable trauma processing, strengthen therapeutic alliance, enhance extinction learning and trauma-related reappraisal, and hold potential beyond PTSD symptoms. Drawing on existing trauma-focused treatments, we suggest possible adaptations to MDMA-AP for use with adolescents, focusing on (1) reinforcing motivation, (2) the development of a strong therapeutic alliance, (3) additional emotion and behavior management techniques, (4) more directive exposure-based methods during MDMA sessions, (5) more support for concomitant challenges and integrating treatment benefits, and (6) involving family in treatment. We then discuss potential risks particular to adolescents, including physical and psychological side effects, toxicity, misuse potential, and ethical issues. We argue that MDMA-AP holds potential for adolescents suffering from PTSD. Instead of off-label use or extrapolating from adult studies, clinical trials should be carried out to determine whether MDMA-AP is safe and effective for PTSD among adolescents., Competing Interests: Declarations. Conflict of interest: SK has received modest side income from organizing clinical training in narrative exposure therapy. JZ declares no competing interests. Ethical approval: Not applicable., (© 2023. The Author(s).)

In this study we introduce an innovative mathematical and statistical framework for the analysis of motion energy dynamics in psychotherapy sessions. Our method combines motion energy dynamics with coupled linear ordinary differential equations and a measurement error model, contributing new clinical parameters to enhance psychotherapy research. Our approach transforms raw motion energy data into an interpretable account of therapist-patient interactions, providing novel insights into the dynamics of these interactions. A key aspect of our framework is the development of a new measure of synchrony between the motion energies of therapists and patients, which holds significant clinical and theoretical value in psychotherapy. The practical applicability and effectiveness of our modelling and estimation framework are demonstrated through the analysis of real session data. This work advances the quantitative analysis of motion dynamics in psychotherapy, offering important implications for future research and therapeutic practice., (© 2024 The Authors. British Journal of Mathematical and Statistical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

This review aimed to develop a conceptual model of the therapeutic alliance in the context of psychotherapy and suicidal experiences from therapist and client perspectives. The protocol was pre-registered on PROSPERO (CRD42021268273). MEDLINE, PsycINFO, Web of Science, Embase and CINAHL were systematically searched from database inception to April 2024. Eligible studies were peer-reviewed, qualitative, and included client and/or therapist's perspectives of the therapeutic alliance in the context of psychotherapy and suicidal experiences. Studies were critically appraised and analysed using a meta-ethnography approach involving a reciprocal translation of studies and line of argument synthesis. Thirty-seven papers were included, generating two overarching themes; 'Working on the edge' and 'Being ready, willing, and able to build an alliance in the context of suicidal experiences'. Therapeutic alliance in the context of suicidal experiences is unique, fluid, potentially lifesaving, and influenced by multiple inter-connected internal and external processes and systems. Clinical implications emphasise the need to improve training, supervision, and support for therapists to equip them with the additional skills required in navigating the intricacies of the therapeutic alliance with clients who have suicidal experiences. Flexibly interweaving risk assessment into therapeutic conversation was beneficial to the alliance with suicidal clients and enhanced their safety., Competing Interests: Declaration of competing interest PG and DP are among other co-authors of a suicide-focussed CBT treatment manual for people with psychosis (Tarrier et al., 2013), which is published under copyright as a book. Cognitive Behavioural Suicide Prevention Therapy has been applied, adapted, and assessed in pilot and phase 2 trials for several high-risk populations. The authors of the review have been and/or are currently funded to work on these trials and have published work arising from these trials., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: The authors examined racial/ethnic and socioeconomic disparities in receiving treatment for alcohol use disorder (AUD)., Methods: A retrospective cohort study was conducted that included adults (≥18 years) with AUD from the All of Us Controlled Tier database v7. Outcomes were lifetime receipt of FDA-approved medications (disulfiram, acamprosate, and naltrexone), psychotherapy (individual, family, and group-based session), and combination treatment (medication and psychotherapy). The study examined treatment receipt by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, other), insurance (private, Medicare, Medicare and Medicaid, Medicaid, Veteran Affairs [VA], none), income (<$10K, $10-<$50K, $50-$100K, >$100K), and area deprivation index (ADI) quintiles. Multivariable logistic and multinomial logistic regressions were used to assess the association between patient characteristics and treatment receipt., Results: The cohort consisted of 18,692 patients (mean age=57.1 years; 60.7% were male; 47.1% were non-Hispanic White). Almost 70% received no treatment, 11.4% received medication, 24.0% received psychotherapy, and 4.9% received combination treatment. In adjusted analysis, non-Hispanic Black (aOR=0.78, 95% CI=0.69-0.89) and Hispanic (aOR=0.75, 95% CI=0.64-0.88) individuals were less likely to receive medication than non-Hispanic White counterparts. There was no association between race/ethnicity and receipt of psychotherapy or combination treatment. Compared with private insurance, dual eligibility was associated with less use of medication, Medicare and Medicaid with less use of medication and combination treatment, and VA and no insurance with more use of psychotherapy and combination treatment. Higher income and lower ADI were positively associated with all treatment types., Conclusions: There are disparities in AUD treatment by race/ethnicity, socioeconomic status, and insurance. Systematic approaches are required to improve equitable access to effective treatment., Competing Interests: Mr. Rich is a policy analyst at the Reason Foundation. Dr. Bernstein reports receiving funding support from an Institutional National Research Service Award (T32HP32715) and personal fees from Alosa. Dr. Glass facilitated a quality improvement pilot study for which Pear Therapeutics Inc provided digital therapeutic prescriptions at no cost to Kaiser Permanente Washington. Dr. Rothberg serves as a consultant for Blue Cross Blue Shield Association. The other authors report no financial relationships with commercial interests.

Purpose: Psychological distress, including anxiety and depression, is common among adults with CF, associating with poor quality of life, lung function, and healthcare utilization. This 3-year, multi-site, telehealth-delivered randomized trial sought to determine whether Acceptance and Commitment Therapy (ACT with CF) is superior to supportive psychotherapy (SP), in improving psychological functioning for adults with CF., Methods: One hundred twenty-four adults with CF and elevated anxiety and/or depressive symptoms were recruited coincident with the first COVID lockdown, from Thomas Jefferson University Hospitals, University of Virginia, Augusta University, Duke University Medical Center, and social media. Participants were randomized to 6 weeks of either ACT with CF or SP, delivered via Zoom. They completed measures of psychological functioning: depression (BDI-II), anxiety (BAI), cognitive fusion (CFQ-13), acceptance and committed action (AAQ-II); and barriers to adherence at baseline, post-treatment, and at 3-months follow-up. Biobehavioral outcomes, including CF severity and treatment burden, were gathered using EMR data., Results: Participants were young adults (mean age 25 years [SD = 12]), female (75 %), on CFTR modulators (67 %), psychotropic medication(s) (60 %), with previous psychotherapy engagement (72 %). Treatment effects were evaluated using analysis of covariance, controlling for baseline levels of respective outcomes, age, biological sex, and FEV 1 . ACT demonstrated greater improvements in psychological functioning at 6-weeks (mean score = 57.3 [51.6, 63.0]) relative to SP (mean score = 67.8 [62.2, 73.5], Cohen's d = 0.59, P = .017), with largest improvements in cognitive fusion (CFQ-13) and acceptance and committed action (AAQ-II). Treatment improvements in psychological functioning persisted at 3-months (ACT: 59.7 (53.5, 65.9) vs. SP: 69.0 [62.6, 75.4], Cohen's d = 0.40, P = .041), with ACT demonstrating continued improvements in the CFQ-13 and AAQ-II. Negative affect scores were not consistently improved on our mean-rank composite outcome variable (Cohen's d = 0.22, P = .170), despite post hoc reductions in BDI-II scores (ACT: -7.4 [-9.4, -5.4] vs. SP: -4.5 [-6.4, -2.6], P = .040). Improvements in psychological flexibility (CFQ-13 and AAQ-II) were also robustly associated with reductions in negative affect (B = -0.45, P < .001). Individuals in ACT with greater baseline barriers to medication adherence reported greater reductions in barriers after treatment (P = .026). Individuals with lower baseline FEV 1 /FVC ratios (e.g. ≤ 65 %) demonstrating greater improvements in ACT compared with SP (ACT: 7.3 [1.7, 12.8] vs. SP: 1.3 [-3.2, 5.8], P = .036 for interaction)., Conclusions: ACT with CF was superior to SP in improving psychological functioning among adults with CF and elevated psychological distress, with additional benefits in secondary biobehavioral outcomes in a subset of individuals with greater medical burden. Improvements in psychological flexibility strongly associated with reductions in negative affect., Clinicaltrials: gov ID #NCT04114227 Supported by the Boomer Esiason Foundation., Competing Interests: Declaration of competing interest None, (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

We verified the need for instruments that could assess the perceptions of patients, therapists, and psychotherapy supervisors about online Psychotherapy., Objectives: to Build a scale of advantages and disadvantages of online psychotherapy., Method: A pilot cross-sectional multicenter sample collected from 2020 to 2021 of 129 patients, 20 therapists, and 35 supervisors. We used several analyses. The final scale contained 22 items divided into two domains: advantages and disadvantages., Results: Cronbach's alpha showed good internal consistency (0.88 and 0.85). The scale showed discriminative ability. Convergent validity showed significant correlations between WAI-SR domains (p 〈0,001). The scale showed a good data fit in the confirmatory factor analysis (X 2  = 255,859; DF = 197; p = .003; CFI = 0.95; RMSEA = 0.047; GFI = 0.84 TLI = 0.94)., Conclusion: This pilot study showed that the instrument proved preliminary good psychometric properties but needs to be evaluated in a larger sample., Competing Interests: Declaration of competing interest The authors do not have any conflicts of interest to report., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Talking therapy for people with intellectual disabilities is often specifically adapted. One adaptation is the involvement of significant others in therapy, however, there is no systematic description of the use of this adaptation in routine clinical practice., Method: An online survey of UK psychologists regarding the inclusion of significant others in individual therapy with people with intellectual disabilities. Data were analysed using qualitative content analysis., Results: Ninety-five psychologists who work with people with intellectual disabilities provided responses to questions regarding the decision to include significant others in therapy, factors that make including significant others more or less likely and how the role of significant others is explained to them., Conclusions: Psychologists consider a range of factors in deciding the involvement of significant others. We discuss implications for training of therapists working with people with intellectual disabilities, issues of consent and how the roles of significant others are understood., (© 2024 The Author(s). Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Objective: Research has identified racial/ethnic disparities in mental health treatment engagement, and there have been recent calls to examine effects of mental health treatment engagement on clinical outcomes among youth of color. This study aimed to examine racial/ethnic differences in (a) behavioral and attitudinal engagement, (b) treatment effectiveness, and (c) the associations between engagement and treatment effectiveness., Method: N = 200 youth (ages 7-15; 33% White, 28% Black, 25% Hispanic/Latinx, and 14% multiracial; 52% male) and their N = 200 parents participated in a randomized controlled trial testing the effectiveness of a transdiagnostic psychotherapy for common youth emotional and behavioral problems. Youth and parents reported internalizing and externalizing symptoms and treatment engagement (e.g., behavioral and attitudinal). Multilevel regression models examined variations in youth symptom trajectories by racial/ethnic group., Results: While all racial/ethnic groups showed comparable attitudinal engagement scores, Black and Latinx youth attended significantly fewer sessions than White and multiracial youth (8-9 vs. 13). However, youth in all racial/ethnic groups showed significant and similar improvements in treatment outcomes., Conclusions: Black and Latinx youth attended fewer sessions than White youth, but their clinical outcomes were similar to those of White youth. Future research should examine the meaning and implications of session attendance in relation to outcomes in youth of color. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Context: The decolonial turn in psychology criticizes conventional Western psychotherapeutic frameworks and seeks to decolonize therapeutic practices by considering diverse cultural perspectives. Indigenous healing has been increasingly used in the psychotherapy of ethnic communities, but also in the psychotherapy of Western clients. The research questions of the present study were focused on how Western clients experience the therapies inspired by Indigenous healing., Objective: The study aimed to explore the motivations, experiences, and mental health outcomes of participants of therapies inspired by Indigenous healing with a focus on issues related to intercultural transfer of therapeutic practice., Design: Semi-structured qualitative interviews were used to gather narratives from 28 participants. Thematic analysis was used for data analysis., Results: Participants reported the following long-lasting outcomes of Indigenous therapies: increased well-being, calm, satisfaction with life, better emotion regulation, coping with stress, behavioral control, problem solving, decision making as well as a more sensitive and deeper experience of reality. Conventional Western psychotherapy was perceived as conversation-based, while Indigenous therapy was perceived as experience-based and more complex. The integration of experiences from Indigenous therapies was more difficult in the Western sociocultural environment compared to participation in the place of their origin, within the community of Indigenous people., Conclusion: Indigenous healing has beneficial outcomes for Western clients, but the integration of these experiences is quite difficult and requires systematic psychotherapeutic support in the Western cultural environment., (Copyright © 2024. Published by Elsevier Inc.)

Autistic adults experience disproportionate rates of co-occurring mental health problems. Psychotherapy has been recognized as an appropriate treatment approach, but evidence is limited. Researchers used a qualitative research paradigm to explore the experiences of mental health providers who provide psychotherapy to autistic adults. The Enhanced Critical Incident Technique was used to interview 13 mental health providers regarding perceptions of facilitating therapy with autistic adults. This research highlights challenges to providing psychotherapy to autistic adults while also illuminating ways that mental health providers have worked to ameliorate such challenges and create positive experiences in therapy. This research also contrasts therapy for autistic adults relative to the general population. Practice recommendations and suggestions for future research are offered., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: This retrospective claims analysis explored the treatment utilization and characteristics among patients with post-traumatic stress disorder (PTSD) of different severity., Methods: The index date was the first PTSD claim. The analysis observed 12 months pre- and 24 months post-index. Adults with insurance gaps, cancer, or acute PTSD during the observation were excluded. Patients were categorized into three severity cohorts based on treatment and healthcare services utilization for PTSD: 1. Baseline PTSD (BP) (no PTSD visits post-index, no FDA-approved medications/ psychotherapy, and no severe mental health comorbidities); 2. PTSD without Comorbidities (PwoC) (≥1 PTSD visits post-index and no severe mental health conditions); 3. PTSD with Comorbidities (PwC) (≥1 PTSD visits post-index and severe mental health comorbidities present). For the primary analysis, cohorts were propensity-score matched. A sub-analysis examined patients with PTSD and Substance or Alcohol Use Disorder (SUD/AUD)., Results: The primary analysis observed 1714 BP, 1681 PwoC, and 1681 PwC patients. Treatment utilization rates were highest among PwC vs. other cohorts (84.5% psychotherapy, 76.1% off-label medications, and 26.1% FDA-approved medications [p<0.001]). PwC cohort also had the highest number of psychotherapy sessions and medication prescriptions per patient (20.1 sessions, 12.6 off-label prescriptions, and 2.0 FDA-approved prescriptions [p<0.001]). The proportion of days covered (PDC) indicated low medication adherence (0.25-0.40) with adherent patient rates (PDC ≥0.80) between 8.0-17.5%. The SUD/AUD sub-analysis identified 85 BP, 537 PwoC, and 3154 PwC patients. Conclusions were similar, with PwC cohort having highest treatment utilization rates (87.1% psychotherapy, 85.0% off-label medications, 28.2% FDA-approved medications [p≤0.013] with 24.4 sessions, 16.1 off-label prescriptions, and 2.0 FDA-approved prescriptions per patient [p≤0.002]). Only 4.7-11.4% of patients were adherent., Conclusions: PwC patients received psychotherapy and pharmacotherapy more frequently than PwoC and BP patients. Medication adherence among treated patients was low. Patients with SUD/AUD had numerically higher treatment utilization and lower medication adherence., Competing Interests: The authors have read the journal’s policy and have the following competing interests: FS, VZ, and DG are employees of ZRx Outcomes Research Inc., which received funding from Lykos for this work. DDA is an employee of Lykos. WB was an employee of Lykos at the time of the study conduction and manuscript submission. Lykos is developing 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy, which has not been approved by any regulatory agency. The safety and efficacy of MDMA-assisted therapy have not been established for the treatment of PTSD. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no additional patents, products in development, or marketed products associated with this research to declare.", (Copyright: © 2024 Stanicic et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)