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Objective: Adjuvant endocrine therapy (AET) is increasingly being prescribed for up to 10 years to people diagnosed with hormone receptor‐positive breast cancer. AET intake is often accompanied by side effects that significantly impact the well‐being of people. The way individuals cope with medication‐related side effects might play a pivotal role in their emotional adaption. Methods: This intensive‐longitudinal study investigated the association between self‐reported coping strategies (Brief COPE) and psychological well‐being (Patient Health Questionnaire‐4) among women undergoing AET. A multilevel factor analysis resulted in the identification of four coping factors, namely, problem‐focused, support‐focused, meaning‐focused, and avoidance‐focused coping. Daily coping efforts and experienced side effects were analyzed as predictors of psychological well‐being using multilevel modeling. Results: A total of 215 women (Mage = 56.5 ± 10.9 years) participated, resulting in a total of n = 2080 daily surveys (M = 9.67 ± 1.08). On average, women reported 3.7 ± 2.2 different side effects per day. Days characterized by an elevated frequency of side effects and increased burden were associated with diminished well‐being. Using more problem‐ and meaning‐focused strategies than usual to cope with side effects correlated positively with well‐being. Conversely, employing more support‐ and avoidance‐focused coping strategies than usual was linked to reduced psychological well‐being. Exploratory analyses focusing on individual coping strategies provided nuanced insights into coping behaviors. Conclusion: The present findings underscore the relationship between women's coping efforts concerning medication‐related side effects during AET and their daily well‐being. Psychosocial education (e.g., cognitive behavioral therapy) may offer valuable benefits for patients by helping them develop adaptive coping strategies to manage side effects. [ABSTRACT FROM AUTHOR]

Objective: Breast cancer has a strong impact on the mental state of those affected. Cognitive behavioral therapy (CBT) is one effective approach to reduce disease burden. This randomized controlled pilot trial aimed to assess the effect of the digital CBT‐based application Living Well on psychological outcomes in a German female breast cancer population. Methods: Female breast cancer patients (n = 70) with ongoing or finished oncological treatment that is who were receiving or had received any type of oncological treatment were included in the study and randomized to an intervention group (IG, n = 32) receiving Living Well in addition to care as usual, and a control group (CG, n = 38) receiving care as usual only. Participants completed standardized questionnaires at baseline and after 2, 4, 8, and 12 weeks to assess anxiety and depression (HADS) as primary outcomes, distress (DT), health‐related quality of life (HRQoL, AQoL‐8D), and illness perception (B‐IPQ) as secondary outcomes. Results: After 12 weeks, significant (p < 0.05) higher improvements in the IG could be observed in anxiety levels, HRQoL, and illness perception, when compared to the CG. Age and time since diagnosis were found to be relevant covariates for anxiety levels. In distress levels, the IG showed a clinically relevant and nearly significant reduction compared to the CG (p = 0.057). No effects could be observed in depression levels. Conclusions: The results demonstrate the potential of Living Well to improve psychological outcomes of female breast cancer patients and encourage further studies evaluating the effectiveness of the digital application. Trial Registration: The trial has been registered in the German Clinical Trials Register (DRKS00029918) [ABSTRACT FROM AUTHOR]

Introduction Tinnitus can be distressing, and it affects the quality of life (QoL) through psychological and cognitive impairments. Cognitive behavioral therapy (CBT) and notched sound therapy (NST) are tinnitus management approaches aiming to reduce symptoms and improve QoL via two different mechanisms. The CBT attains the cognitive principle, whereas the NST initiates tinnitus habituation. Objective To evaluate the effect of CBT and NST and compare their results in the management of chronic subjective tinnitus. Methods The present prospective study involved 64 adults with normal hearing and chronic subjective tinnitus. They were subjected to history taking, basic audiological evaluation, and extended high-frequency audiometry at 10 and 12.5 kHz. The participants were divided into two equal groups, the first treated with CBT and the second treated with NST. The psychoacoustic measures of tinnitus and the Arabic Questionnaire for Tinnitus Reaction (Arabic-QTR) were used to monitor the outcomes of both therapies. Results Both groups showed significant reduction in tinnitus severity according to the Arabic-QTR and tinnitus loudness matching. Improvement in the Arabic-QTR was better in the CBT group, while tinnitus loudness improvement was better in the NST group. Conclusion Both CBT and NST are effective in the management of chronic subjective tinnitus. In a comparison of the effect of the two therapies, CBT was found to be more effective in decreasing tinnitus-related distress, whereas SNT was found to be more helpful in reducing tinnitus loudness. [ABSTRACT FROM AUTHOR]

This study investigates the efficacy of a short-term integrative psychotherapeutic intervention designed to reduce suicidal behavior and ideation in depressed patients admitted to a psychiatric ward. Suicidal risk, influenced by mental health disorders, personal crises, social isolation, substance abuse, and trauma, is typically treated with pharmacotherapy and psychotherapy. The study focuses on combining various psychotherapeutic techniques including Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Mindfulness-Based Cognitive Therapy (MBCT) into a cohesive intervention program. The intervention, delivered over four weeks, included six modules encompassing psychoeducation, behavioral activation, cognitive restructuring, mindfulness practices, and personal development strategies. Participants were divided into an experimental group receiving both the psychotherapeutic intervention and medication and a control group receiving only medication. The study measured changes in hopelessness and depression using the Beck Hopelessness Scale (BHS), Montgomery-Åsberg Depression Rating Scale (MADRS), and the DASS-21R depression scale. The study concludes that integrative psychotherapeutic intervention significantly improves psychological outcomes for depressed patients at risk of suicide, offering a viable complement to pharmacological treatments. These findings support the potential of combining cognitive-behavioral and mindfulness techniques for the holistic management of depression and suicidal ideation in clinical settings. Results indicated significant reductions in hopelessness and depression among the experimental group. Specifically, the BHS and MADRS scores showed substantial decreases post-intervention, highlighting the immediate efficacy of the integrated psychotherapeutic approach. However, the DASS-21R results did not demonstrate statistically significant differences. [ABSTRACT FROM AUTHOR]

Brain-Computer Interface (BCI) neurorehabilitation offers the potential to improve recovery and quality of life for stroke survivors. It aims to restore lost physical and mental abilities through motor and cognitive therapies. Magnetoencephalography (MEG) signals are a major advancement in BCI technology as they provide accurate and consistent assessments of brain activity for control and interaction applications. MEG is indispensable for recording the magnetic fields produced in the brain during motor imagery tasks due to its capability to evaluate cerebral activity with remarkable temporal resolution. However, one of the major challenges associated with MEG recording is the loss of signal quality due to physiological artifacts and ambient noise. Additionally, the head movement of the individual during the recording process can result in the introduction of artifacts into the recorded data, which can distort the spatial mapping of brain activity. This, in turn, can jeopardize the reliability and accuracy of the results obtained. This study aims to identify the most effective technique for removing artifacts from MEG signals by conducting a comparative performance analysis of prominent denoising algorithms, such as Infomax, FastICA, SOBI, and SWT. The findings conclude that Infomax is the most effective algorithm for removing physiological artifacts from a signal while maintaining the integrity and essential features of the original data. FastICA was found to be the second most effective algorithm. Infomax outperformed FastICA in Power Spectral Density (PSD) and Percentage Root mean square error Difference (PRD) measurements. [ABSTRACT FROM AUTHOR]

Introduction: Children’s anxiety is associated with decreased cognitive performance. One well-established behavioral intervention to transiently improve cognitive performance in children is acute aerobic exercise (AAE). Thus far, however, it is unclear whether the benefits of AAE on cognition vary based on individual differences in children’s anxiety level. Therefore, we investigated whether trait anxiety levels mediate the effects of AAE on cognitive outcomes in preadolescent children. Methods: Ninety-five preadolescent children (9 to 11 yr, 41 females) underwent two experimental interventions in a random, crossover, and counterbalanced design: an exercise protocol (20 min of walking at 65% to 75% of HRpeak) and a nonexercise control (seated rest). Behavioral indices of cognitive performance (accuracy, reaction times, response time (RT) variability) were assessed before and after each intervention using a modified flanker task. The effects of each intervention on cognitive performance were calculated as pre- to postintervention differences (effect scores). These scores were first correlated with children’s personal characteristics: anxiety (STAIC), sex, age, body mass index, intelligence quotient, and aerobic fitness. Significant correlations guided subsequent hierarchical regression models, which specifically tested for associations between the effects scores and anxiety levels while controlling for remaining relevant covariates. Results: Regression analysis revealed that anxiety was a significant predictor of the effects that AAE and rest had on cognitive performance. Specifically, higher anxiety scores were associated with greater exercise-induced cognitive benefits (increased accuracy, decreased RT variability; all P < 0.05) and greater rest-induced cognitive impairments (decreased accuracy, increased RT variability; all P < 0.01). Conclusions: These findings suggest that children reporting higher trait anxiety might experience greater cognitive benefits from a single bout of AAE. [ABSTRACT FROM AUTHOR]

Background: First responders (i.e. police and ambulance staff) have increasingly become part of the mental health care system, often being the first port of call for those experiencing a crisis. Despite their frequent involvement in supporting those with mental health problems, there is evidence that mental health stigma is high amongst first responders. Aims: The aim of the present study was to evaluate a brief training video aimed at reducing mental health stigma amongst first responders. Methods: First responders watched a training video based on the cognitive behavioural model of mental health stigma, and involved contributions from people with lived experience, and first responders. Measures of mental health stigma were collected before and after viewing the training. Results: The training video produced small but significant improvements in mental health stigma, and these effects did not differ between police and ambulance staff. We were unable to determine what psychological constructs mediated this change in stigma. The feedback on the training video was generally positive, but also indicated some key areas for future development. Conclusions: The present study provides encouraging evidence that levels of mental health stigma can be improved using a resource-light training intervention. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to explore the presentation of symptoms in patients suffering from treatment-resistant mood disorder (TRMD), and associated clinical features, including age, gender, and comorbid conditions, that lead towards the development of treatment-resistant mood disorder. Furthermore, the study analyses the available psychotherapeutic treatment modalities and evidence-based non-medical treatment approaches for TRMD. Method: The current study utilized a systematic review approach where 37 articles were studied and three articles were theoretically sampled to authenticate and signify the findings. PRISMA guidelines were followed and the review was conducted by searching social sciences databases and electronic libraries including Google Scholar, Sage Journal, and Science Direct (1990-2020). Results: The results suggested that psychotherapeutic interventions including cognitive behavior therapy, mindfulbased cognitive therapy; and interpersonal and social rhythm therapeutic interventions are efficacious modalities for treatment when in augmentation with psychopharmacological treatment. Bipolar diathesis and comorbid conditions of anxiety and personality disorders are possible causal factors in developing the condition of treatment resistance in mood disorders. The prevalence rate of TRMD is more common in females and in late adulthood. The analysis also suggests that there are numerous risk factors contributing to making a mood disorder treatment-resistant over a period of time; the most observed conditions were physical and psychological comorbidity, inaccurate diagnosis, lack of proper medical treatment, illness severity, and late age diagnosis. In evidence-based non-medical treatment approaches aerobics demonstrated promising results in improving the condition of complex mood disorders. Conclusion: It was concluded that psychotherapeutic interventions in augmentation with pharmacological modalities enhance the efficacy of treatment. [ABSTRACT FROM AUTHOR]

Summary: Insomnia is a highly prevalent mental disorder, and is often co‐occurring with depression and anxiety disorders. Cognitive behavioural therapy for insomnia as treatment of choice for insomnia can also be applied digitally (digital cognitive behavioural therapy for insomnia), making it more accessible. This is a secondary data analysis of a two‐armed parallel randomized–controlled trial. In the primary publication, N = 238 participants meeting criteria for the 5th edition of Diagnostic and Statistical Manual of Mental Disorders chronic insomnia disorder were randomly assigned to either 8 weeks of digital cognitive behavioural therapy for insomnia + treatment‐as‐usual, or waitlist + treatment‐as‐usual. To determine the clinical effects of digital cognitive behavioural therapy for insomnia in populations with comorbid anxiety and depression symptoms, this secondary analysis focused on two subgroups: (1) participants with high initial depressive symptoms; and (2) participants with high initial anxiety symptoms. Symptoms of insomnia, depression and anxiety as primary outcome measures were obtained at baseline, 8 weeks post‐randomization and, in the intervention group only, at 6‐ and 12‐months follow‐up. At 8 weeks post‐randomization, the use of digital cognitive behavioural therapy for insomnia in both subgroups was associated with large reductions in insomnia severity in comparison to control (depression subgroup: d = 2.37; anxiety subgroup: d = 2.13). Between‐group treatment effects were also observed for symptoms of depression in the depression subgroup (d = 1.59), and for symptoms of anxiety in the anxiety subgroup (d = 1.28). Within‐group effects were stable over time (d = 0.64–1.63). This secondary analysis shows that digital cognitive behavioural therapy for insomnia reduces insomnia and comorbid symptoms in participants with high initial symptoms of either depression or anxiety with sustained long‐term effects. [ABSTRACT FROM AUTHOR]

Summary: The current study determined the extent to which sleep–wake state discrepancy impairs the efficacy of cognitive behavioural therapy for insomnia in a real‐world clinical sample. Sleep–wake state discrepancy occurs when there is an inconsistency between a person's subjective and objective sleep, and is a common phenomenon amongst patients with insomnia. Limited information is available on the effectiveness of cognitive behavioural therapy for insomnia in treating patients who experience significant sleep–wake state discrepancy in "real‐world" samples. In the present study, all patients with insomnia received cognitive behavioural therapy for insomnia through an outpatient insomnia program (N = 386; mean age = 51.96 years, SD = 15.62; 65.97% [N = 254] female). Prior to treatment, participants completed a polysomnography sleep study and sleep diary, which was used to calculate sleep–wake state discrepancy. At pre‐treatment, post‐treatment and 3‐month follow‐up, participants completed the Insomnia Severity Index and other questionnaires, and 1 week of sleep diaries from which sleep‐onset latency, wake after sleep onset and other sleep variables were calculated. There were no differences in self‐reported sleep‐onset latency, wake after sleep onset or Insomnia Severity Index scores at post‐treatment or 3‐month follow‐up between quintiles of sleep–wake state discrepancy. These results indicate that sleep–wake state discrepancy at pre‐treatment does not predict treatment response to cognitive behavioural therapy for insomnia. Future research could examine multi‐night assessments of sleep–wake state discrepancy to determine whether variations in discrepancy may relate to pre‐treatment insomnia severity and cognitive behavioural therapy for insomnia outcomes. [ABSTRACT FROM AUTHOR]

Summary: Insomnia and pain disorders are among the most common conditions affecting United States adults and veterans, and their comorbidity can cause detrimental effects to quality of life among other factors. Cognitive behavioural therapy for insomnia and related behavioural therapies are recommended treatments for insomnia, but chronic pain may hinder treatment benefit. Prior research has not addressed how pain impacts the effects of behavioural insomnia treatment in United States women veterans. Using data from a comparative effectiveness clinical trial of two insomnia behavioural treatments (both including sleep restriction, stimulus control, and sleep hygiene education), we examined the impact of pain severity and pain interference on sleep improvements from baseline to post‐treatment and 3‐month follow‐up. We found no significant moderation effects of pain severity or interference in the relationship between treatment phase and sleep outcomes. Findings highlight opportunities for using behavioural sleep interventions in patients, particularly women veterans, with comorbid pain and insomnia, and highlight areas for future research. [ABSTRACT FROM AUTHOR]

Objective: Cognitive Behavioral Therapy (CBT) for youth with Disorders of Gut‐Brain Interaction (DGBIs) is effective; however, there are calls in the field to strengthen the evidence base and identify specific mechanisms of treatment that yield the most benefit for this patient population. A unique, systematic treatment approach of CBT with initial evidence for success for pediatric patients with DGBIs was evaluated to further demonstrate its clinical utility in this population. Methods: This was a retrospective study of 42 pediatric patients aged 11–17 years with DGBIs, who were diagnosed and referred for CBT by pediatric gastroenterology providers. Providers also completed a survey rating acceptability and effectiveness of CBT. The systematic CBT approach included 10 sessions delivered by a psychologist at an integrated Pediatric GI Clinic. Results: Review of 42 pediatric charts showed significant decreases in self‐reported functional disability, abdominal pain, as well as depression and anxiety symptoms pre‐ to post‐CBT completion. A moderation effect was observed where patients reporting higher levels of depressive symptoms and primary symptom of abdominal pain reported smaller reductions in functional impairment compared to those with lower levels of depression and primary symptom of nausea or vomiting. Pediatric Gastroenterology providers were satisfied with this psychological treatment approach. Conclusions: This study provides evidence for acceptability and effectiveness of implementation of a systematic CBT approach for pediatric DGBIs in an integrated GI clinic, as well as areas worthy of future research, including identifying the most important mechanisms of treatment and factors that influence treatment response. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to investigate the efficacy of behavioral activation (BA), a novel psychological intervention, in ameliorating psychological distress and anxiety symptoms among patients diagnosed with esophageal and gastric cancer, as well as the mediating role of self‐efficacy between BA and psychological distress. Methods: A total of 139 patients diagnosed with esophageal and gastric cancer were recruited in China from March 2023 to October 2023 and randomly assigned to either the BA plus care as usual group (BA+CAU group) or the care as usual group (CAU group). Pre‐ and post‐intervention questionnaires, including the Psychological Distress Thermometer (DT), Generalized anxiety disorder 7‐item (GAD‐7) Scale, General Self‐Efficacy Scale (GSES) and the activation subscale of Behavioral Activation for Depression Scale (BADS‐A), were administered. Results: Generalized estimating equation analyses revealed that, compared to usual care alone, combining BA with usual care significantly ameliorated psychological distress, anxiety as well as improved self‐efficacy and activation. The mediation analysis revealed that self‐efficacy served as a mediator in the relationship between activation and psychological distress. Conclusions: BA primarily based on telephone or WeChat can not only directly ameliorates psychological distress and anxiety symptoms in patients with esophageal cancer and gastric cancer but also indirectly alleviates psychological distress by enhancing self‐efficacy. The study also demonstrates the potential of BA in cancer patients, a skill that can be effectively acquired by primary care workers without specialized training and implemented more flexible. Trial Registration: NCT06348940 [ABSTRACT FROM AUTHOR]

Background: Anxiety is one of the causes and consequences of a heart attack, and its therapy is critical in lowering the risk of recurrence and improving patients' quality of life. The current study aims to examine the effectiveness of behavioral therapy (BT) and cognitive behavioral therapy (CBT) on the anxiety levels of patients with heart attack. Methods: In the current experimental study, the statistical population included 387 patients with heart attack who visited Al Budoor Hospital in Baghdad, Iraq, in 2022. A random sample of 150 individuals was selected via simple random sampling. Using a multiple-group pre-test-post-test design, two intervention groups and one control group were examined by the Beck Anxiety Inventory (BAI) (50 people in each group). To analyze the data obtained from the pre-test and post-test for each group, the analysis of covariance (ANCOVA) was used to examine the significance of the results between groups. The SPSS software was used for analyses, and the statistical significance level of the results was deemed to be 0.05. Results: The one-way analysis of variance (ANOVA) test showed a significant difference between at least two groups (F = 14.90, P < 0.001). Furthermore, Tukey's post hoc test findings revealed that the post-test anxiety scores of both intervention groups were significantly different from the control group (P < 0.001). Moreover, the cognitive behavioral intervention group had lower mean anxiety scores than the behavioral intervention group, but this difference was not significant (P > 0.05). Conclusion: The findings indicated that BT and CBT methods significantly reduced anxiety in patients with heart attack, with cognitive-behavioral methods being more effective. [ABSTRACT FROM AUTHOR]

Background: Depression and anxiety are among the underlying factors and effects of heart attack. Reducing these patients' levels of depression and anxiety is crucial for reducing recurrent strokes and enhancing their quality of life (QOL). The current study was conducted to examine the effect of cognitive behavioral therapy (CBT) on depression and anxiety in heart attack patients. Methods: The current experimental study was conducted on a community of heart attack patients in 2021. The statistical population consisted of 197 patients admitted to the CCU of Yarmouk Teaching Hospital and Baghdad Teaching Hospital, Iraq. Using a simple random sampling method, 84 patients were chosen and divided into experimental and control groups (42 patients in each group). For data collection, the Symptom Checklist-90-Revised (SCL-90-R) was utilized. The data were analyzed using the analysis of covariance (ANCOVA) in SPSS software. The significance level was considered to be equal to 0.05. Results: The mean depression score in the control group (1.27 ± 0.52) was significantly higher after the intervention compared to the experimental group (0.68 ± 0.29) (P < 0.001). In addition, the experimental group's depression score in the posttest stage was significantly lower than in the pretest stage (P < 0.001). ANCOVA showed a statistically significant difference in the mean posttest score of the dependent variables of depression (F = 129.48; P < 0.001) and anxiety (F = 123.99; P < 0.001) in heart attack patients who received the intervention. Conclusion: CBT intervention was impressive in the treatment of anxiety and depression in heart attack patients, resulting in a significant decrease in anxiety and depression and a reduction in the likelihood of future heart attacks. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) refers to an enduring disorder associated with a high prevalence of comorbid depression, which negatively impacts patients' quality of life (QoL). The effectiveness of cognitive behavioral therapy (CBT) in tackling psychological well-being has been well-documented, with positive outcomes observed in various populations. This research aimed to evaluate the efficacy of CBT in reducing depressive symptoms and improving QoL among HF patients with comorbid depression. Methods: Researchers conducted a randomized controlled trial at the Nasiriyah Heart Center in Iraq. A total of 160 patients presenting with HF and comorbid depressive symptoms were randomly allocated to either a 12-week CBT intervention or a control group receiving usual care. To assess the patients' depressive symptoms and QoL, the investigators used the Arabic versions of the Beck Depression Inventory-ll (BDI-II) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) at baseline and post-intervention. Mixed-model ANOVA and ANCOVA were employed for data analysis. Results: The CBT group demonstrated significantly greater reductions in depressive symptoms (F(1,158) = 72.6, P < 0.001, qp2 = 0.32) and improvements in QoL (F(1,158) = 45.8, P < 0.001, qp2 = 0.23) in comparison with the control group. The significance of the results was not diminished by adjusting for potential confounders (age, gender, and NYHA functional class) in the ANCOVA analyses. Conclusion: CBT is an effective intervention for reducing depressive symptoms and improving QoL among HF patients with comorbid depression. Integrating psychological interventions, such as CBT, into the comprehensive care of HF patients may enhance patient outcomes and reduce the healthcare burden associated with comorbid depression. [ABSTRACT FROM AUTHOR]

Mild cognitive impairment (MCI) marks a critical phase in the progression to dementia. In our study, social workers utilized the Multicomponent Nonpharmacological Intervention Approach (MCNIA) to aid MCI participants (N = 52) and their caregivers, dividing into intervention and control groups. The intervention group underwent an additional regimen of non-pharmacological therapies besides pharmacological treatment. Our findings highlighted that: 1) MCNIA significantly enhanced cognitive and daily living abilities in the intervention group; 2) Caregivers experienced reduced burdens and improved social support; 3) Correlation analyses involving biomarkers indicated that MCNIA was particularly effective in alleviating depression in those with slightly more severe cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Anxiety is one of the most frequent disorders during the perinatal stage that is associated with adverse health effects in women and their babies. In spite of this, preventive interventions during this stage are scarce. A long-distance intervention carried out during pregnancy can be an effective and accessible resource to help improve women's emotional state. The objective of this study is to present and assess the effectiveness of a telepsychology cognitive–behavioral preventive intervention during pregnancy to manage anxiety. Methods: A random clinical trial will be carried out among pregnant women in Spain. The psychological intervention will take place via videoconference in seven weekly sessions, lasting one hour each, with groups of 6–8 pregnant women. Study outcomes will be collected via online questionnaires at five points in time: pre-intervention (baseline: t0), post-intervention (baseline: t1), follow-up at 1 month (t2), follow-up at 3 months (t3) and follow-up at 6 months (t4). The control group will receive usual pregnancy care (attendance at pregnancy follow-up consultations and information and answers to frequently asked questions provided by the midwife). Our primary hypothesis is that the intervention will decrease the frequency of women who present anxious symptomatology during pregnancy. The second objective is to analyze the effectiveness of this intervention to prevent depressive symptomatology during pregnancy, as well as postpartum anxiety and depressive symptomatology. The primary outcome measure is the difference in the mean anxiety score between the intervention and control groups assessed by the Edinburgh Depression Scale-Anxiety Subscale (EDS-3A), the State–Trait Anxiety Inventory (STAI) and Generalized Anxiety Disorder Screener (GAD-7) at the end of the intervention and at 1, 3 and 6 months postpartum. Generalized anxiety disorder (GAD) will be evaluated with the SCID clinical interview at the same time points. The secondary outcome will be determined by using the EPDS at the same time points. Conclusions: The results will determine whether a cognitive behavioral therapy applied via videoconference is well accepted by pregnant women, and if it is effective in preventing anxiety and emotional symptoms during the perinatal stage. If this intervention is an effective and useful resource among pregnant women, it can be implemented as a tool in Spanish healthcare. [ABSTRACT FROM AUTHOR]

Simple Summary: This review explores the role of physiotherapy in early and traditional palliative care (PC) for cancer patients, focusing on its effects on patient-reported outcomes (PROMs) such as fatigue, pain, and quality of life (QoL). The findings suggest that certain physiotherapy interventions, like cognitive behavioral therapy (CBT) and massage, can improve these outcomes, while others show limited or no significant benefits. However, the overall quality of the studies reviewed was low, highlighting the need for more rigorous research in this area to better understand how physiotherapy can support patients in PC. Background: This review aims to explore the role of physiotherapy in early and traditional palliative care (PC) for oncology patients, focusing on its impact on six patient-reported outcomes (PROMs), namely fatigue, pain, cachexia, quality of life (QoL), physical functioning (PHF), and psychosocial functioning (PSF). The purpose is to assess the effectiveness of various physiotherapy interventions and identify gaps in the current research to understand their potential benefits in PC better. Methods: A systematic literature search was conducted across PubMed, Embase, and Web of Science, concluding on 21 December 2023. Two independent reviewers screened the articles for inclusion. The Cochrane Risk of Bias Tool 2 was employed to assess the risk of bias, while the GRADE approach was used to evaluate the certainty of the evidence. Results: Nine randomized controlled trials (RCTs) were included, with most showing a high risk of bias, particularly in outcome measurement and missing data. Cognitive behavioral therapy (CBT) was the only intervention that significantly reduced fatigue, enhanced PHF, and improved QoL and emotional functioning. Graded exercise therapy (GET) did not yield significant results. Combined interventions, such as education with problem-solving or nutritional counseling with physical activity, showed no significant effects. Massage significantly improved QoL and reduced pain, while physical application therapies were effective in pain reduction. Mindful breathing exercises (MBE) improved QoL but had a non-significant impact on appetite. The overall certainty of the evidence was low. Conclusions: Physiotherapy can positively influence PROMs in oncology PC; however, the low quality and high risk of bias in existing studies highlight the need for more rigorous research to confirm these findings and guide clinical practice. [ABSTRACT FROM AUTHOR]

Les troubles somatiques fonctionnels (TSF) sont fréquents et entraînent une détérioration significative de la qualité de vie. Leur origine est multifactorielle et mal comprise, mais leur prise en charge est relativement codifiée. Les traitements médicamenteux sont généralement peu efficaces tandis que les approches psychocorporelles jouent un rôle central, avec trois grands principes : une relation médecin–patient empathique, respectueuse et sincère, une activité physique régulière et graduelle, et une psychothérapie de type thérapie cognitive et comportementale (TCC). L'établissement d'une alliance thérapeutique repose sur la reconnaissance de la véracité et de la pénibilité des symptômes et la délivrance d'un diagnostic positif associé à un modèle explicatif rationnel. Les facteurs d'entretien cognitifs – focalisation attentionnelle et catastrophisme – et comportementaux doivent être recherchés et constituent des cibles thérapeutiques privilégiées. Les patients ont fréquemment des conduites d'évitement, notamment de l'effort physique. Il faut alors les inciter à reprendre une activité physique graduelle, en s'adaptant à leurs possibilités. Celle-ci a fait ses preuves dans l'amélioration de la fatigue, la douleur et la qualité de vie physique et mentale des patients. Parmi les approches psychothérapeutiques, le bénéfice d'une TCC est modeste mais bien démontré. L'association d'une activité physique graduelle et d'une TCC semble complémentaire. D'autres approches comme la méditation de pleine conscience ont un niveau de preuve plus faible. Étant donnée la fréquence des TSF dans la population générale, il semble nécessaire que l'ensemble des médecins soit formé à leur prise en charge. Functional somatic disorders (FSD) are common conditions that result in a significant deterioration of the quality of life. Their origin is multifactorial and poorly understood, and their management is often inadequately defined. Medications typically show limited effectiveness, while mind–body approaches play a central role, guided by three key principles: establishing an empathetic, respectful, and sincere doctor–patient relationship; promoting regular and gradual physical activity; and implementing cognitive behavioral therapy (CBT). Special attention must be devoted to establishing a trustworthy relationship between the physician and the patient. Recognizing the reality and severity of symptoms and providing a positive diagnosis as well as an explanatory model to account for them rationally are fundamental aspects of patient management. Cognitive and behavioral maintenance factors should be investigated and constitute therapeutic targets. Cognitive factors include focused attention on body functioning and catastrophizing. Patients frequently display avoidance behaviors, particularly in relation to physical exertion, and it is crucial to motivate them to reintroduce gradual physical activity customized to their abilities. This approach has demonstrated efficacy in improving fatigue, pain, and the physical and mental quality of life for patients with FSD. Among psychotherapeutic approaches, the benefit of CBT is well-established. The combination of gradual physical activity and CBT appears to be complementary. Other mind-body approaches such as mindfulness meditation might help although their level of evidence is weaker. Given the prevalence of FSD in the general population, it seems necessary for all physicians to be trained in managing this condition. [ABSTRACT FROM AUTHOR]

Higher Education Institutes (HEIs) have been met with an unprecedented demand on their student counselling and wellbeing services in recent years with the impacts of COVID‐19 and high rates of mental health concerns amongst student populations. Online mental health programs offer one solution by providing students with quick and easy access to effective therapeutic content. The Focused Minds Program is an evidence‐based eight‐module online self‐guided cognitive behavioural intervention that targets the transdiagnostic risk factor of perfectionism and has been shown to decrease depression, anxiety, and disordered eating. The program was implemented at a UK university between 2021 and 2023. Recruitment occurred via departmental emails, academic staff, and the university's counselling staff and website. Participants were provided with access to the intervention for 6‐weeks and completed weekly surveys of psychosocial measures. The trial's implementation was assessed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework: reach (uptake via the recruitment channels), effectiveness (outcomes on psychometric measures of mental wellbeing), adoption (staff and organisational support), implementation (intervention engagement and attrition), and maintenance (continued implementation across the trial period). Key barriers to successful implementation, as well as proposed solutions, are discussed to guide future online mental health interventions provided in HEIs. [ABSTRACT FROM AUTHOR]

Internet‐based interventions have proven to be effective for the treatment of depression in different samples, but evidence from the Middle East and North Africa (MENA) region is scarce. The aim of this study was to investigate the acceptance and efficacy of an internet‐based cognitive behavioural writing intervention for Arabic‐speaking participants with depression living in the MENA region. A total of 259 participants (167 female, age in years: M = 25.58, SD = 6.39) with depressive symptoms indicative of clinical relevance were randomly allocated to a treatment group (TG; nTG = 128) or a waitlist control group (WG; nWG = 131). The TG received an internet‐based intervention over a 6‐week period. The primary outcome was depressive symptoms, and secondary outcomes were anxiety and quality of life (QoL). T‐tests with change scores from pre‐ to post‐treatment were used for data analyses. Intention‐to‐treat (ITT) as well as completer analyses were calculated. The ITT analysis revealed significant differences between the TG and WG in depression (T257 = −4.89, p < 0.001, d = 0.70) and QoL (T257 = 3.39, p < 0.001, d = 0.47). Significant differences regarding anxiety symptoms (T257 = 3.25, p < 0.05, d = 0.53) were identified for the completer sample. The general dropout rate was 39.9%. The results indicate the feasibility and efficacy of an internet‐based cognitive behavioural writing intervention in adults from Arabic‐speaking countries. The development and implementation of such interventions can be used to improve access to psychological help and adequate treatment. [ABSTRACT FROM AUTHOR]

Background: Black and Latino youth are disproportionately affected by trauma from community violence, but to date, few data support the benefit of evidence-based treatments for these youth or of including peer support to engage these youth in mental health services. Objective: From 2018 until 2020, a hospital and community-based violence intervention program in Philadelphia pilot tested the integration of home and community-based Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) with peer services and case management for youth impacted by community violence. This study describes the implementation of this intervention. Method: Data was gathered by querying the program's database. The Child Post Traumatic Stress Symptom Severity Scale (CPSS-SR-5) and the Short Mood and Feelings Questionnaire (SMFQ) were utilized to evaluate the participants' pre- and post-intervention assessment of PTSD and depression. The sample (N = 50) consisted of Black and Latino youth, mean age 14. Results: Twenty-nine (58%) completed TF-CBT, and 82% met peer and case management goals. Youth who completed therapy showed significant improvement in both PTSD and depression symptoms at post-test. Conclusion: To our knowledge, this is the first study describing the implementation of home and community-based TF-CBT with peer support and case management. The study's limitations and need for further research are discussed. Plain language summary: Black and Latino youth are disproportionally affected by violence across US cities. Mental health research is needed to evaluate how to engage these youth in mental health services and provide effective and culturally relevant trauma treatment. This research describes the experiences of 50 children and adolescents (ages 8–18) who participated in this pilot tested health services intervention using their electronic health records to access de-identified information and present youths' demographics, services received, and clinical outcomes. Specifically, we describe ways in which the intervention was culturally relevant to the participants' lived experiences. Services delivered consisted of the integration of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) with peer services and case management for youth impacted by community violence. Services were provided by licensed social workers and certified peer specialists at a hospital and community-based (i.e., youth's home, school) violence intervention program (HVIP). Our results indicate that this intervention shows preliminary efficacy for decreasing post-traumatic stress disorder (PTSD) and depression symptoms for Black & Latino youth impacted by ongoing violence. This real-world study lays out a blueprint for implementing similar programs. The study has several limitations, and we discuss the need for additional research. [ABSTRACT FROM AUTHOR]

Background: Cognitive Behavioural Therapy (CBT) has been proven to be effective for anxiety and depression in children and young people (CYP). Over the past 20 years there have been several attempts at delivering CBT through apps, online software, videogames, but also with a therapist via phone or videoconferencing platforms, with promising results for the "technology-assisted" versions. However, most research, have compared online CBT to waiting lists, and not many studies looked at the effectiveness of face-to-face (f2f) CBT versus technology-assisted CBT. Methods: Adopting the PRISMA guidelines, we evaluated 1849 citations and identified 10 eligible studies. Studies were identified through the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, PubMed/MEDLINE, Web of Science, and Scopus. Results: Ten studies met our inclusion criteria. The studies included a variety of technology-assisted forms of CBT, including videoconferencing and online CBT. Of these, seven looked at the effectiveness of technology-assisted CBT for anxiety in CYP, and seven looked at depression. The meta-analyses had low heterogeneity and showed that technology-assisted CBT was non-inferior to f2f CBT for anxiety and depression in CYP (d = 0.06 and 0.12 respectively). Conclusions: Technology-assisted CBT may be a valid alternative for the treatment of anxiety and depression in CYP. Future studies should consider what specific delivery modalities are most cost-effective. Plain Language Summary: Cognitive Behavioural Therapy (CBT) has been proven to be effective for anxiety and depression in children and young people (CYP). Over the past 20 years there have been several attempts at delivering CBT through apps, online software, videogames, but also with a therapist via phone or videoconferencing platforms, with promising results for the "technology-assisted" versions. However, most research, have compared online CBT to waiting lists, and not many studies looked at the effectiveness of face-to-face (f2f) CBT vs technology-assisted CBT. Adopting the PRISMA guidelines, we evaluated 1849 citations and identified 10 eligible studies. Studies were identified through Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, PubMed/MEDLINE, Web of Science, and Scopus. Ten studies met our inclusion criteria. The studies included a variety of technology-assisted forms of CBT, including videoconferencing and online CBT. Of these, seven looked at the effectiveness of technology-assisted CBT for anxiety in CYP, and seven looked at depression. The meta-analyses had low heterogeneity and showed that technology-assisted CBT was non-inferior to f2f CBT for anxiety and depression in CYP. Technology-assisted CBT is a valid alternative for the treatment of anxiety and depression in CYP. Future studies should consider what specific delivery modalities are most cost-effective. [ABSTRACT FROM AUTHOR]

Emerging evidence indicates that perceptions of self-harm behaviours and self-harm scars may thwart recovery from depression, yet limited research has explored adolescent accounts of their self-harm and scars during therapy. This study sought to explore how adolescents describe their self-harm behaviours and scars during Cognitive Behavioural Therapy (CBT) and explore the sociocultural discourses that may influence these descriptions. The participants were six female adolescents (aged 14-17 years old) with clinical depression, who were engaging in self-harm. All participants accessed CBT as part of clinical trial evaluating three psychological treatments for major depressive disorder in Child and Adolescent Mental Health Services. Audio-taped CBT sessions were analyzed using discourse analysis. Within CBT sessions, adolescents drew upon stigma discourses in talking about their self-harm. Adolescent also described their self-harm scars as shameful and stigmatizing, and as "proof" of the legitimacy of their depression. It is important for CBT practitioners to understand the context of sociocultural discourses around self-harm behaviours and self-harm scars, which are reflected in how adolescents with depression describe these within therapy and may serve to maintain distress. The study indicates that awareness of use of language and intersecting sociocultural discourses can inform CBT practice. Plain language summary: We know that when teenagers are in treatment for depression, perceptions of their self-harming behaviours and self-harm scars can impact recovery. We also know that wider sociocultural beliefs around self-harm tend to be negative and stigmatizing, which might impact how teenagers perceive their self-harm and scars. This study aimed to explore how depressed adolescents talk about their self-harm behaviours and their self-harm scars during therapy for depression. The participants in this study were six female teenagers (aged 14-17 years old) with depression, who were engaging in self-harm. These teenagers participated in a type of therapy called Cognitive-Behavioural Therapy as a part of a larger study evaluating treatments for teenage depression in Child and Adolescent Mental Health Services in the UK. The therapy sessions were recorded, transcribed, and analyzed with a focus on the language used by the teenagers to describe their self-harm and scars. Within the therapy sessions, the teenagers talked about their self-harm in stigmatizing ways, which reflected prominent societal-held beliefs about self-harm. The teenagers in the study also believed that while their self-harm scars were shameful and stigmatizing, the scars also provided a sense of validation that their depression was legitimate. The findings of this study suggest that it could be helpful for therapists to consider how wider sociocultural beliefs around self-harm may impact how teenagers talk about their self-harm and scars in treatment for depression. [ABSTRACT FROM AUTHOR]

Purpose: Cognitive behaviour therapy based on the Clark and Wells (1995) model is a first-line treatment for neurotypical people seeking support for social anxiety. While autistic people frequently report high social anxiety, it is unclear how appropriate the model is for this population. Methods: Over 300 autistic and non-autistic adults completed an online survey measuring key variables of the Clark and Wells model (socially-related negative thoughts, safety behaviours, self-focused attention). Using multiple regression and structural equation modelling, we assessed whether these variables accounted for the link between autism and social fears. Results: In multiple regression, autistic people experienced greater social fears than expected based on Clark and Wells variables, and safety behaviours were less predictive of social fears in autistic people. In structural equation modelling, Clark and Wells variables only mediated half the link between autistic traits and social fears. In exploratory analysis, we found that distress relating to uncertainty was an additional variable that needed to be taken into consideration in the relationship between autistic traits and social fears. Conclusion: The Clark and Wells variables were relevant in autism, but did not fully explain elevated social fears in autistic people, which suggests that other factors are also important in accounting for social anxiety in autistic people. This means that therapy informed by the model may not be optimal for autistic people. We recommend further research developing adapted therapy for social anxiety in autistic people. [ABSTRACT FROM AUTHOR]

Purpose: Active engagement in one's therapy is a key contributor to successful outcomes. Research on child engagement in cognitive behaviour therapy (CBT) has largely focused on youth without autism. This longitudinal study examined multiple indicators of child engagement in relation to outcomes for autistic children who took part in CBT for emotion regulation. Method: Data were collected from 60 autistic children who were between 8 and 13 years of age (86.7% male; Mage = 9.58 years, SD = 1.44 years; 75% White). Indicators of child engagement included independent observer ratings of in-session involvement, as measured by the Child Involvement Rating Scale, and therapist ratings of the therapeutic relationship and homework completion using single-item measures. Indicators of engagement were measured at early (i.e., first third), middle (i.e., mid third), and late (i.e., final third) stages of treatment. Parent-reported emotion regulation was the primary treatment outcome, as measured by the Emotion Regulation Checklist. Results: After controlling for pre-treatment scores, in-session involvement significantly predicted some aspects of post-treatment emotion regulation, whereas therapeutic relationship and homework completion did not. Conclusions: Child in-session involvement throughout therapy may be particularly relevant for treatment change. Addressing issues related to in-session involvement early in treatment may help to promote therapeutic success for autistic children. [ABSTRACT FROM AUTHOR]

Background: Tracheostomy patients commonly develop anxiety and depression. This study investigates the efficacy of cognitive-behavioral interventions in improving mental health and quality of life (QOL) in tracheostomy patients. The focus is on assessing the effectiveness of structured psychological support as part of holistic tracheostomy recovery protocols. Methods: In this randomized controlled trial (RCT) conducted at Baghdad Teaching Hospital, Iraq, in the second half of 2022, we included 100 tracheostomy patients. The sampling method was convenience sampling, and the study population comprised tracheostomy patients referred for treatment. Participants were randomly allocated into two groups: an intervention group receiving tracheostomy education and cognitivebehavioral training (n = 50) and a control group receiving conventional care (n = 50). We used the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI) to measure anxiety and depression, and the 36-ltem Short Form Survey (SF-36) to assess QOL. The Statistical analysis was performed using SPSS software, employing chi-square test and Mann-Whitney U-test. Results: This study showed significant improvements in anxiety and depression among tracheostomy patients receiving cognitive-behavioral interventions. Anxiety scores in the intervention group decreased from 23.66 ± 14.73 to 14.44 ± 10.36, while the control group saw negligible change. Depression scores similarly improved in the intervention group, dropping from 16.82 ± 9.31 to 12.30 ± 8.10, with the control group remaining stable. QOL, measured via the SF-36, also improved, with notable increases in physical health and mental health scores for the intervention group, affirming the effectiveness of the cognitive-behavioral approach in enhancing mental health outcomes for tracheostomy patients. Conclusion: Cognitive-behavioral therapy (CBT) coupled with tracheostomy self-care education demonstrated meaningful improvements in mental health and QOL compared to conventional care over a 6-month follow-up. These findings support integrating structured psychosocial guidance within holistic post-tracheostomy recovery protocols. [ABSTRACT FROM AUTHOR]

Background: Physical and psychological problems are common among individuals with multiple sclerosis (MS), thus emphasizing the need for the evaluation of the effectiveness of different psychological therapies for these patients. Thus, this study aimed to compare the efficacy of group cognitive behavioral therapy (GCBT) with group acceptance and commitment therapy (GACT) in the treatment of fear beliefs related to panic disorder in MS patients, focusing on the revised sensitivity theory of brainbehavioral systems. Methods: This experimental study was conducted employing a pretest-posttest design with a control group. The statistical population consisted of MS patients with panic disorder who sought treatment at the Khorasan MS Association in Mashhad, Iran. Through the convenience sampling method, 36 women who met the inclusion criteria were selected from among 3200 patients. The participants were randomly divided into 3 groups: GCBT (N = 12), GACT (N = 12), and the control group (N = 12). Pretest and posttest intervention assessments were conducted using Jackson's five-factor questionnaire and the Panic Belief Inventory (PBI). Descriptive methods and repeated measures analysis of variance were utilized for data analysis. Results: The results revealed a significant reduction in fear beliefs among participants in the intervention groups compared to the control group (P < 0.05). Furthermore, significant changes were observed in the behavioral-brain systems of the participants in the intervention group compared to the control group (P < 0.05). Comparing the intervention groups revealed that the impact of GACT is higher than GCBT on the behavioral activation system (BAS) and panic beliefs (P = 0.04). Conclusion: It can be concluded that GCBT and GACT were effective in improving the fear beliefs of patient and changing their brain-behavioral systems. Comparing two interventions showed higher efficacy of GACT. [ABSTRACT FROM AUTHOR]

This commentary on a case describes how social determinants of health also contribute to insomnia and then suggests how to balance risks and benefits of different strategies for managing chronic insomnia. Behaviorally induced insufficient sleep syndrome can exacerbate morning side effects of prescription sleep aids, and there are potentially serious long-term risks (eg, dementia, falls, death) associated with chronic benzodiazepine use. Before trying sleeping pills, chronic insomnia should be treated with cognitive behavioral therapy. [ABSTRACT FROM AUTHOR]

Background: Low-intensity psychological interventions may be a cost-effective, accessible solution for treating depression and anxiety in patients with long-term conditions, but evidence from real-world service settings is lacking. This study examined the effectiveness of low-intensity psychological interventions provided in the Improving Access to Psychological Therapies programme in England for patients with and without long-term conditions. Methods: A retrospective analysis was conducted on patients (total N = 21,051, long-term conditions n = 4024) enrolled in three low-intensity psychological interventions, i.e. Internet-delivered cognitive behavioural therapy (iCBT), guided self-help (GSH), and psychoeducational group therapy (PGT) within a Talking Therapies service from 2016 to 2020. Primary outcomes included pre–post-treatment changes in depression (Patient Health Questionnaire-9) and anxiety (Generalised Anxiety Disorder-7). Results: Overall, both cohorts significantly improved on all outcomes post-treatment, with large effect sizes. Patients with long-term conditions experienced a greater reduction in depression while those without experienced a greater reduction in anxiety, but these differences were marginal (< 1 score difference on both measures). No difference between the cohorts was shown when comparing the differential effectiveness across interventions, but those engaging in iCBT showed greater reduction in depression and anxiety than those in GSH and PGT, while those in GSH improved more than PGT. Conclusions: Low-intensity psychological interventions, particularly iCBT, were effective in treating depression and anxiety in patients with long-term conditions in a real-world service setting. Our large-scale study supports the continued and increased implementation of low-intensity psychological interventions for this subpopulation via integrated care. [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome is a common, chronic disorder of gut-brain interaction with complex pathophysiology. It is characterized by abdominal pain and alterations in bowel movements, currently diagnosed based on the Rome IV criteria. If alarm symptoms are present, objective workup may be required to exclude organic etiologies. Irritable bowel syndrome remains a frequent reason to visit primary care physicians and gastroenterologists. It puts a significant burden on patients' quality of life and has high economic costs. Given limited access to gastroenterology consultation, initiating treatment promptly in the primary care setting should be the standard of care to minimize patients' pain and suffering. Treatment requires a patient-centred approach and often multiple treatment options, including dietary management, pharmacotherapy, and psychological approaches, such as cognitive-behavioral therapy and gut-directed hypnotherapy. [ABSTRACT FROM AUTHOR]

Background: Compulsive exercise is common in eating disorders (EDs), but a systematic treatment model is lacking. The CompuLsive Exercise Activity TheraPy (LEAP) is a cognitive behavioral therapy treatment for compulsive exercise in EDs, delivered by trained therapists in groups over four consecutive weeks (8 groupsessions and 1 individual session), aiming to promote healthy physical activity. LEAP is currently evaluated in a randomized efficacy trial. In parallel, it is crucial to learn more about how it is perceived by qualitatively investigating participants' subjective experiences. Methods: Nine patients with various EDs participating in the LEAP trial were interviewed about their experiences of taking part in LEAP and about compulsive exercise as an ED symptom using a semi-structured interview guide. The interview transcripts were analyzed according to thematic analysis. Results: The informants expressed that compulsive exercise had not been addressed in their standard ED treatment and that LEAP as such provided an important complement, spurring reflection, awareness, and changed feelings and behaviors in relation to compulsive exercise. Initially, increased PA was triggered for some, but this side effect was transitory. A wish for more treatment time, in terms of longer or additional sessions, was expressed. Conclusions: Overall, LEAP seemed to fill an important treatment need and seemed both acceptable and feasible to patients. However, treatment time and the initial increase in PA may need further investigation and attention in order to optimize this treatment. Trial registration: The trial is registered with the ISRCTN registry (registration date 20200325), trial ID ISRCTN80711391. Plain English summary: Compulsive exercise (CE) is very common in individuals with eating disorders (EDs) often tightly connected with the eating pathology. Even so, most standard treatments do not specifically target CE, leaving patients without strategies to normalize their exercise. The CompuLsive Exercise Activity TheraPy (LEAP) is delivered as an adjunctive treatment to standard ED treatment (targeting CE in patients with EDs. In this study, nine former LEAP patients were interviewed about their experiences of taking part in LEAP and about CE as an ED symptom. The informants were in general satisfied with LEAP and indicated that participation had positive effects on their exercise-related thoughts and attitudes, as well as actual exercise behaviors. They all experienced that CE was not addressed in their standard treatment, although they were motivated to work towards changing it. LEAP was therefore viewed as an important complement. Participating in LEAP initially triggered some informants to exercise more, which fortunately ceased over time and is similar to the temporal negative effect (increased food occupation) often observed initially in cognitive behavioral therapy for eating disorders. The content of LEAP was experienced as valid, informative, and eye-opening, and being able to discuss CE-related topics in a group setting was for many a positive experience. The experiences expressed in this study are very useful for continued development of LEAP. Although preliminary, the results also suggest that LEAP may be a valuable add-on treatment within ED care. [ABSTRACT FROM AUTHOR]

Youth mental health is a major public health concern. Adolescents experiencing mental health crises are increasingly presenting to high-intensity settings such as inpatient and partial hospitalization programs. These services offer a multimodal approach involving medication management, cognitive-behavioral therapy (CBT), and dialectical behavior therapy (DBT).1 Treating these distressed youth in intense settings is challenging due to their high acuity, limited lengths of stay, and frequent lack of resources. However, CBT/DBT are typically evaluated in outpatient settings, leaving clinicians in high-intensity programs to adapt models with limited guidance.2 While traditional CBT/DBT interventions are not new or unfamiliar, and various literature reviews report their effectiveness, few reports offer specific guidance and practical tips for implementing these procedures.1-6 This Clinical Perspectives article highlights the necessary adaptations of traditional CBT/DBT for these intense settings in which high acuity, shorter stays, limited resource allocation, and a lack of staff involvement/training are limiting factors. [ABSTRACT FROM AUTHOR]

Rationale: Motivational dysfunctions related to effort exertion are common in psychiatric disorders. Dopamine systems regulate exertion of effort and effort-based choice in humans and rodents. Objectives: Previous rodent studies mainly employed male rats, and it is imperative to conduct studies in male and female rats. Methods: The present studies compared the effort-related effects of IP injections of the dopamine antagonists ecopipam and haloperidol, and the vesicular monoamine transport-2 inhibitor tetrabenazine (TBZ), in male and female rats using the fixed ratio 5/chow feeding choice task. Results: Ecopipam (0.05–0.2 mg/kg) and haloperidol (0.05–0.15 mg/kg) induced a low-effort bias, decreasing lever pressing and increasing chow intake in males and females in the same dose range. With lever pressing, there was a modest but significant dose x sex interaction after ecopipam injection, but there was no significant interaction after administration of haloperidol. In the first study with TBZ (0.25-1.0 mg/kg), there was a robust sex difference. TBZ shifted choice from lever pressing to chow intake in male rats, but was ineffective in females. In a second experiment, 2.0 mg/kg affected choice behavior in both males and females. TBZ increased accumbens c-Fos immunoreactivity in a sex-dependent manner, with males significantly increasing at 1.0 mg/kg, while females showed augmented immunoreactivity at 2.0 mg/kg. Conclusions: The neural and behavioral effects of TBZ differed across sexes, emphasizing the importance of conducting studies in male and female rats. This research has implications for understanding the effort-related motivational dysfunctions seen in psychopathology. [ABSTRACT FROM AUTHOR]

Introduction: Functional neurological disorder challenges conventional medical understanding, presenting neurological symptoms without organic explanations. This report delves into the intricate interplay between psychological and physical manifestations, emphasizing the importance of timely diagnosis and intervention and its impact on a patient's mental health and quality of life. Case presentation: A 40-year-old single Iranian man was admitted for the third time owing to exacerbation of mood symptoms, including depression, irritability, aggression, suicidal ideation, and movement and sensory problems. The patient's symptoms began with psychological stressors and family conflict, leading to muscle weakness and tremors in the left hand. Over a year, muscle weakness escalated, leading to slow movement, motor impairment in the lower limbs, and reliance on a cane for walking. The patient still exhibited symptoms, such as a mask-like face, stooped walking posture, and a relative improvement of symptoms periodically. At first, the patient was suspected of Parkinson's disease and was placed on levodopa and amantadine. However, the medication was discontinued owing to an unsatisfactory response and the lack of strong evidence in favor of neurological problems on frequent examinations and reviews. Despite multiple hospitalizations, the patient's symptoms remained unresolved. Finally, after years of investigations, based on specialists' recommendations, he was admitted to the psychosomatic ward for diagnostic evaluationele, and he was diagnosed with functional neurological disorder (psychogenic parkinsonism). He underwent pharmacotherapy, electroconvulsive therapy, and psychotherapy. He was discharged with partial improvement of symptoms, but showed periods of relapse and remission during the following years. Conclusion: This case study illuminates functional neurological disorder complexities, emphasizing the need for a holistic diagnostic approach. Timely interventions, including psychological support, can alleviate symptoms, reduce healthcare costs, and improve the overall prognosis. The report contributes to evolving functional neurological disorder understanding in psychiatry and neurology. The report underscores early recognition, advocating for comprehensive interventions involving psychiatric support, cognitive-behavioral therapy, and patient psychoeducation. [ABSTRACT FROM AUTHOR]

Purpose: This qualitative evidence synthesis aimed to identify and integrate findings where adults with fibromyalgia discussed how they managed their pain, and their perceptions of prescribed treatments from healthcare professionals. Materials and Methods: A comprehensive search strategy was implemented in PubMed, Scopus, ISI Web of Science, and Cinahl Plus databases. The GRADE-CERQual framework was used to evaluate the findings confidence. The findings were analyzed using an inductive thematic analysis approach. Results: A total of 35 studies (N = 728) were included. The confidence in the findings ranged from high to low confidence. Patients with fibromyalgia often do not benefit from seeking medical attention due to provider stigma, and have varying views on medication effectiveness commonly reporting feeling like "walking chemists." They find mixed effects from exercise, and consider psychological support essential, although the benefits of cognitive-behavioral therapy were controversial. Combining cognitive-behavioral therapy with physical exercise appears more effective, while natural and complementary therapies have short-term benefits and high costs. Conclusions: Pain management is a source for frustration and an unmet need for patients with fibromyalgia. The current findings provide crucial insight for providers and researchers; and support the need for fibromyalgia phenotyping and precision medicine approaches to pain management. Implications for Rehabilitation: Chronic widespread pain is the defining feature of fibromyalgia, yet pain reduction is often an unmet need for these individuals. The lack of effective treatments resulting in long-term relief proves frustrating for patients and healthcare providers. Rehabilitation professional should consider the unique insight into this complex, heterogeneous condition that this qualitative synthesis provides to better understand their patient's perspective on pain management. Given the differing perspectives on pain treatment approaches individuals with fibromyalgia report, providers should discuss with each patient their current strategies and take a patient-centered, individualized approach to form an effective treatment plan. [ABSTRACT FROM AUTHOR]

Introduction: Transdiagnostic self-help cognitive behavioral therapy (CBT) approaches may help ease the burden of untreated symptoms of internalizing distress, especially in geographic areas with relatively small numbers of mental health providers. Methods: Over the course of 12 months, we conducted a six-week randomized controlled trial (N = 275) across Indiana, a state with high unmet need for mental health care. All participants were given immediate access to a single-session intervention (SSI) followed by randomization to either guided or unguided CBT-based bibliotherapy. We used mixed models to model change over time in distress, well-being, and emotion regulation as a piecewise function of study week. Results: The sample was in their early 30s (M = 34.10, SD = 11.68), mostly female (75.64%, n = 208) and, consistent with the demographics of the state, mostly Non-Hispanic White (80.36%, n = 221). Less than half of participants accessed the SSI (39.27%, n = 108). There was no evidence that completing the SSI was associated with improved outcomes, though it improved study engagement. Participants randomized to the guided (vs. unguided) condition experienced greater overall improvements in internalizing distress (SMD=-0.44, 95% CI: -0.74, -0.13) and cognitive reappraisal (SMD = 0.32, 95% CI: 0.06, 0.58). The differences between groups in improvements in well-being (SMD = 0.25, 95% CI: -0.13, 0.63) and expressive suppression (SMD=-0.24, 95% CI: -0.55, 0.07) were smaller and not statistically significant. Virtually all participants expressed some interest in more therapy via telehealth (89.74%, n = 140). Findings were sensitive to multiple imputation using random forests as well as propensity score matching. Discussion: Self-help approaches are scalable interventions for individuals in under-served states. As in previous work, guided self-help was more effective than unguided self-help. More work should focus on adding additional treatment steps past self-help. [ABSTRACT FROM AUTHOR]

Background: Intrusive re-experiencing of trauma is a core symptom of posttraumatic stress disorder. Intrusive re-experiencing could potentially be reduced by 'rewinding', a new treatment approach assumed to take advantage of reconsolidation-updating by mentally replaying trauma fast-backward. Methods: The present analogue study was the first to investigate 'rewinding' in a controlled laboratory setting. First, 115 healthy women watched a highly aversive film and were instructed to report film-related intrusions during the following week. Twenty-four hours after film-viewing, participants reporting at least one intrusion (N = 81) were randomly allocated to an intervention (fast-backward, or fast-forward as active control condition) or a passive control condition. Intervention groups reactivated their trauma memory, followed by mentally replaying the aversive film either fast-backward or fast-forward repeatedly. Results: Results indicate that replaying trauma fast-backward reduced intrusion load (intrusion frequency weighted for intrusion distress) compared to the passive group, whereas replaying fast-forward did not. No above-threshold differences between fast-backward and fast-forward emerged. Conclusion: Present findings strengthen the view that 'rewinding' could be a promising intervention to reduce intrusions. [ABSTRACT FROM AUTHOR]

Purpose: Chronic pain is a highly prevalent and distressing condition with limited treatment efficacy. Prior research reports associations between the experience of mental imagery about chronic pain and pain itself, particularly in those with anxiety and depression. However, many aspects of these associations remain unexplored. A better understanding could help improve cognitive-behavioural therapies for chronic pain. This study aimed to describe the prevalence of intrusive pain-related mental imagery in a sample of people with chronic pain, examine the extent to which this imagery explained variation in pain intensity and disability, and examine the association between negative interpretations of imagery and pain. Method: A cross-sectional online survey was conducted. Participants with chronic pain (n = 151) completed standardised measures of anxiety, depression, health anxiety, general imagery use, and an adapted questionnaire about intrusive pain-related imagery. Results: Intrusive pain-related imagery was present in 52.3% of the sample. Demographic variables, anxiety, depression, and health anxiety significantly explained 19% (p <.001) of the variation in pain intensity and 20.2% (p <.001) in pain disability. The presence/absence of intrusive pain-related imagery did not significantly explain any additional variance for either outcome. However negative interpretations of imagery explained additional variance in pain disability. Intrusive imagery was interpreted negatively, experienced as moderately distressing, and was associated with higher rates of anxiety, depression and health anxiety. Conclusions: Experiencing intrusive imagery about pain is common, but its presence or absence appears to have no direct relationship on pain intensity or disability. The relationship is likely to be more complex, warranting further investigation. Negative interpretations of imagery represent a potential treatment target amenable to intervention. [ABSTRACT FROM AUTHOR]

Objectives. Cognitive-Behaviorally Based Interventions (CBIs) are evidence-based treatments for alcohol and other drug (AOD) use with potential variable effectiveness by population sub-groups. This study used evidence synthesis to examine treatment effect by demographic and study context factors in clinical trials of CBI for AOD. Methods. Studies were systematically identified, and their characteristics and outcome data were extracted and summarized. Standardized mean differences were calculated for within- and between-condition effects on substance use outcomes. Demographic and study context moderators were identified during data acquisition and several sensitivity analyses were conducted. Results. The sample included K = 29 trials and a total of 15 study-level moderators were examined. Information on participants' age, biological sex, and race were reported in at least 26 trials, but information on gender identity, sexual orientation, and ethnicity were reported infrequently or in non-inclusive ways. The mean between-condition effect size was small and moderately heterogenous (d = 0.158, 95% CI = 0.079, 0.238, I2 = 46%) and the mean within-condition effect size was large and showed high heterogeneity (dz = 1.147, 95% CI = 0.811, 1.482, - I2 = 96%). The specific drug targeted in the study and whether biological assay-based outcomes were used moderated between-condition CBI efficacy and the inclusion of co-occurring mental health conditions and study publication date moderated within-condition CBI effects. Conclusions. Results provide preliminary data on study context factors associated with effect estimates in United States based clinical trials of CBI for AOD. [ABSTRACT FROM AUTHOR]

The management and treatment of harmful sexual behaviors (HSBs) in autistic adolescents is a complex area of research and clinical practice. Autistic adolescents face unique challenges in understanding social and sexual interactions, putting them at a higher risk of engaging in HSBs. Existing research on interventions for HSBs among autistic adults is growing, but evidence for adolescents is not well understood. Thus, understanding the effectiveness of interventions targeting HSBs in autistic adolescents is crucial. We conducted a rapid evidence assessment to review peer-reviewed research on the effectiveness of interventions for autistic adolescents at risk of or engaging in HSBs. In all, 12 studies met the criteria for review. Inclusion criteria required articles to be published in a peer-reviewed journal, be related to HSB prevention and intervention in adolescents aged 12 to 18 with autism spectrum disorder, be written in English, and include original data. Six databases were used, and we screened the titles and abstracts of 34 studies. The reviewed studies described cognitive-behavioral therapy, pharmacological interventions, family involvement, and multidisciplinary team approaches in addressing HSBs. However, the literature has significant limitations and we suggest that the literature is not robust enough to indicate a promising evidence-based approach for interventions for autistic adolescents who are at risk of or who display and engage in HSBs, and the findings are not transferable to practice. Additional research is required to better prepare healthcare professionals for addressing HSBs in autistic adolescents. [ABSTRACT FROM AUTHOR]

This article aimed to provide a systematic narrative synthesis of existing studies on the mediators of change in psychotherapy with adolescents (10–19 years) and transition age youth (TAY) (20–29 years) who have experienced trauma-related symptoms or posttraumatic disorder. Additionally, we were interested in identifying psychotherapy-, trauma type-, and clients' age- and gender-specific mediators of treatment outcome. Following the preferred reporting items for systematic reviews and meta-analyses, a total of 3,723 studies published in PubMed and PsycINFO databases were screened against inclusion criteria, revealing 15 eligible studies. No studies with only TAY were found; therefore, all results were limited to therapy with adolescents. Cognitive mediators were tested in 66% of selected studies, followed by parents/family-related, mental-health-related, therapy-related, and behavioral mediators. Moderate evidence was found for posttraumatic cognitions, whereas therapeutic alliance seemed to be a promising candidate for future research. Striking absence of non-cognitive-behavioral therapy interventions, emotional and adolescent-specific mediators, as well as studies with males and in non-Western societies was evident. Future original studies would benefit from applying methodological rigor in respect to mediation testing. [ABSTRACT FROM AUTHOR]

Current studies suggest an ongoing rise in anxiety, affecting lives, families, and society. While many empirically supported treatments for anxiety exist, counselors would benefit from a creative and comprehensive approach that is easily recalled for application in evidence-based practices and consultation. The BREAK FREE model, rooted in Cognitive Behavioral Therapy and empirical knowledge, was developed as a practical and memorable mnemonic for counselors to use when working with various anxiety disorders and symptoms. The BREAK FREE approach highlights the relevant aspects of CBT to innovatively treat anxiety, with applications for anxiety prevention and treatment across settings, populations, and severity of needs. In this article, the BREAK FREE model is shared, and counseling implications and suggestions for future research are explored. [ABSTRACT FROM AUTHOR]

Purpose: This study explores the feasibility, acceptability, and treatment outcomes of Empower@Home, a digital cognitive behavioral therapy intervention for geriatric depression. Method: Participants with depressive symptoms (PHQ-9 ≥ 5) underwent a nine-session remote intervention supported by a lay coach (N = 103). Results: Most participants (91%) completed all nine sessions (mean = 8.5). According to the Treatment Evaluation Inventory, participant attitudes toward the program were largely positive. A medium effect in depression reduction was observed following the intervention (Cohen's d = 0.75) and at a 10-week follow-up (Cohen's d = 0.60). This reduction was large (Cohen's d = 1.31 at posttest and Cohen's d = 1.18 at 10-week follow-up) among those who presented with moderate depression at baseline (PHQ-9 ≥ 10). Significant improvements were also reported in anxiety, social isolation, loneliness, and behavioral activation. Discussion: Empower@Home is a promising, acceptable digital mental health intervention for treating depression in older adults. [ABSTRACT FROM AUTHOR]

Introduction: In-person cognitive behavioral therapy (CBT) can reduce self-reported anxiety in older adults. However, studies are limited for remote CBT. We assessed the effectiveness of remote CBT in mitigating self-reported anxiety in older adults. Methods: We conducted a systematic review and meta-analysis based on a literature search of PubMed, Embase, PsycInfo, and Cochrane databases up to March 31, 2021, for randomized controlled clinical trials comparing the effectiveness of remote CBT versus non-CBT controls on mitigating self-reported anxiety in older adults. We calculated within-group pre-to-post-treatment standardized mean difference using Cohen's d, obtained the difference between a remote CBT group and a non-CBT control group as our effect size for cross-study comparison, and conducted a random-effects meta-analysis. Changes in scores on self-reported anxiety symptoms (Generalized Anxiety Disorder-7 item Scale, Penn State Worry Questionnaire, or Penn State Worry Questionnaire – Abbreviated), and self-reported depressive symptoms (Patient Health Questionnaire-9 item Scale or Beck Depression Inventory) were primary and secondary outcomes, respectively. Results: Six eligible studies, containing 633 participants with a pooled mean age of 66.6 years, were included in the systematic review and meta-analysis. There was a significant mitigating effect of intervention on self-reported anxiety, favoring remote CBT over non-CBT controls (between-group effect size: −0.63; 95% CI: −0.99 to −0.28). We also found a significant mitigating effect of intervention on self-reported depressive symptoms (between-group effect size: −0.74; 95% CI: −1.24 to −0.25). Discussion: Remote CBT is more effective in reducing self-reported anxiety and depressive symptoms than non-CBT control in older adults. [ABSTRACT FROM AUTHOR]

Anxiety and depression are among the most common mental health concerns in youth, with rates of these internalizing problems continuing to rise. Universal school-based interventions have shown promising results in improving poor mental health outcomes; however, more research is needed across different cultural contexts. This study is part of an ongoing evaluation of A Lust for Life Schools Programme, a universal process-based cognitive behavioral therapy intervention for Irish primary school children. This study investigated the efficacy of the program through a cluster randomized controlled trial. Nine schools were randomly allocated to the intervention or control groups. Four hundred and seventy participants completed measures at three timepoints (baseline, post-intervention, and 6-week follow-up) assessing internalizing problems, anxiety, and depressive symptoms (primary outcomes) and avoidance, problem-solving, seeking social support, academic self-efficacy, social self-efficacy, and emotional self-efficacy (secondary outcomes). Although participants reported that they were mostly satisfied with the intervention, results revealed that the intervention did not have a significant effect on the outcome variables compared to the control group. Implications of the findings and recommendations for future research are discussed. [ABSTRACT FROM AUTHOR]

Substance use disorders (SUDs) are associated with profound sleep disturbances, including insomnia, sleep fragmentation, and circadian rhythm dysfunction resulting in serious mental and physical consequences. This minireview presents an overview of the neurocircuitry underlying sleep disturbances in SUDs and elaborates on treatment options with emphasis on alcohol use disorder (AUD) and opioid use disorder (OUD). A PubMed, Embase, CINAHL Plus, Cochrane, and Scopus search were conducted using sleep- and AUD/OUD related keywords from January 1st, 2000, to January 31st, 2023, with preferences for recent publications and randomized-controlled trials. A bidirectional relationship exists between insomnia and addiction with the status of each condition impacting the other in dictating clinical outcome. Existing evidence points to a resurgence of insomnia during detoxification, and unless treated satisfactorily, insomnia may lead to relapse. The discussion summarizes the strengths and limitations of cognitive behavioral therapy and pharmacological treatment for insomnia in SUDs covering evidence from both animal and clinical studies. The assumption of reestablishing normal sleep patterns by attaining and maintaining sobriety is misguided. Comorbid insomnia in patients with SUDs should be approached as an independent condition that requires its own treatment. Future clinical trials are needed with the aim of providing a resource for guiding clinical management of the many patients with insomnia and SUD. [ABSTRACT FROM AUTHOR]

Background Digital health interventions show potential to increase caregivers' access to psychosocial care; however, it is unclear to what extent existing interventions may need to be tailored to meet caregivers' unique needs. Purpose This study aimed to determine whether—and if so, how—an efficacious Internet-delivered insomnia program should be modified for caregivers. The generalizability of these findings beyond the tested program was also examined. Methods Higher-intensity family caregivers (N = 100; age M = 52.82 [ SD = 13.10], 75% non-Hispanic White, 66% ≥college degree) received access to an Internet-based cognitive-behavioral therapy for insomnia (CBT-I) program. Participants who completed one or more intervention "Cores" provided open-ended feedback on their experience; nonusers (completed no Cores) shared their barriers. Results Most caregivers who used the program (n = 82, 82%) found it feasible, citing its user-friendly, fully automated online format. Many reported that CBT-I strategies were helpful, although some faced challenges in implementing these strategies due to the unpredictability of their caregiving responsibilities. Opinions were divided on the utility of tailoring the program for caregivers. Nonusers (n = 18, 18%) primarily cited concerns about time burden and lifestyle compatibility as usage barriers. Conclusions Delivering fully automated behavioral interventions through the Internet appears suitable for many caregivers. Extensive tailoring may not be required for most caregivers to benefit from an existing online CBT-I program, although additional guidance on integrating CBT-I strategies in the context of challenging sleep schedules and environments may help a subset of caregivers. Future research should explore how such tailoring may enhance digital health intervention uptake and effectiveness for caregivers. [ABSTRACT FROM AUTHOR]

Background Delivering insomnia treatment by the Internet holds promise for increasing care access to family caregivers, but their ability to adhere to and benefit from such fully-automated programs has not been rigorously tested. Purpose This fully-powered, single-group trial tested whether characteristics of the caregiving context influence high-intensity caregivers' engagement with and benefit from an empirically validated Internet intervention for insomnia. Methods At baseline, caregivers providing unpaid time- and responsibility-intensive care who reported insomnia (N = 100; age M = 52.82 [ SD = 13.10], 75% non-Hispanic white, 66% ≥college degree) completed questionnaires about caregiving context and sleep, then 10 prospectively-collected online daily sleep diaries. Caregivers then received access to SHUTi (Sleep Healthy Using the Internet), which has no caregiver-specific content, for 9 weeks, followed by post-assessment (questionnaires, diaries). Engagement was tracked by the SHUTi delivery system. Results Sixty caregivers completed SHUTi, 22 initiated but did not complete SHUTi, and 18 did not initiate SHUTi. Caregivers were more likely to use SHUTi (than not use SHUTi) when their care recipient (CR) had worse functioning, and were more likely to complete SHUTi when supporting more CR activities of daily living (ADL; p s < .03). Higher caregiver guilt, more CR problem behaviors, and being bedpartners with the CR related to more improved sleep outcomes, whereas supporting more CR instrumental ADL related to less improvement (p s < .05). Conclusions Factors associated with greater caregiving burden, including greater CR impairment and caregiving guilt, were generally associated with better engagement and outcomes. Caregivers with substantial burdens can adhere to and benefit from a fully automated insomnia program without caregiver-specific tailoring. [ABSTRACT FROM AUTHOR]