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Introduction: Smartphone app interventions based on cognitive-behavioral therapy (CBT) are promising scalable alternatives for treating mental disorders, but the evidence of their efficacy for postpartum depression is limited. We assessed the efficacy of Motherly, a standalone CBT-based smartphone app, in reducing symptoms of postpartum depression. Methods: Women aged 18–40 with symptoms of postpartum depression were randomized either to intervention (Motherly app) or active control (COMVC app). The primary outcome was symptoms of depression measured by the Edinburgh Postnatal Depression Scale (EPDS) at post-treatment. Secondary outcomes were anxiety symptoms, parental stress, quality of sleep, behavioral activation, availability of response-contingent positive reinforcement, and clinical improvement at post-treatment and 1-month follow-up. Exploratory analyses were performed to investigate if app engagement was associated with treatment response. Results: From November 2021 to August 2022, 1,751 women volunteered, of which 264 were randomized, and 215 provided primary outcome data. No statistically significant differences were found between groups at post-treatment: intervention: mean (SD): 12.75 (5.52); active control: 13.28 (5.32); p = 0.604. There was a statistically significant effect of the intervention on some of the secondary outcomes. Exploratory analyses suggest a dose-response relationship between Motherly app engagement and outcomes. Conclusion: Our standalone app intervention did not significantly reduce postnatal depression symptoms when compared to active control. Exploratory findings suggest that negative findings might be associated with insufficient app engagement. Consistent with current literature, our findings suggest that standalone app interventions for postpartum depression are not ready to be implemented in clinical practice. [ABSTRACT FROM AUTHOR]

The treatment or the resocialization is the most important part of the prison sentence which methods can be individual and group. Motivated inmates and less resistance for the treatment are the main precondition for effective treatment. Appropriate behavior of personnel is the main factor for that result. Cognitive-behavioral therapy (CBT) as the most effective evidence based psychotherapy approach for offender population is a type for inmate treatment. CBT is a result of Aaron Beck pioneering work in the 1960s. CBT model is based on the triangle relationships between cognition, emotions and behavior. The cognition is defined as a product of the three levels: cognitive schemas, negative automatic thoughts and dysfunctional thinking or thinking errors. The inventory of risk, need and strengths (IORNS), an risk assessment instrument, based on Risk, need and responsivity (RNR) model, was used for selection of (N=27) inmates and CBT treatment pilot program final evaluation, in Macedonian prison Bitola. The evaluation was done by comparing pre and post test measures in (N=12) male inmates, as optimal number for group psychotherapy treatment. According to the RNR model the treatment program needs to be oriented to the inmates needs. Implementing CBT treatment program for group psychotherapy and IORNS as short screening tool in Macedonian prisons was the aim of the project supported by the Council of Europe in this work. The results showed significant lower Procriminal attitudes but higher Aggression because of higher Aggressive behavior in the post measures. Results and instrument can be used in next CBT programs evaluations for better rehabilitation of prison inmates and reducing recidivism.

The treatment or the resocialization is the most important part of the prison sentence which methods can be individual and group. Motivated inmates and less resistance for the treatment are the main precondition for effective treatment. Appropriate behavior of personnel is the main factor for that result. Cognitive-behavioral therapy (CBT) as the most effective evidence based psychotherapy approach for offender population is a type for inmate treatment. CBT is a result of Aaron Beck pioneering work in the 1960s. CBT model is based on the triangle relationships between cognition, emotions and behavior. The cognition is defined as a product of the three levels: cognitive schemas, negative automatic thoughts and dysfunctional thinking or thinking errors. The inventory of risk, need and strengths (IORNS), an risk assessment instrument, based on Risk, need and responsivity (RNR) model, was used for selection of (N=27) inmates and CBT treatment pilot program final evaluation, in Macedonian prison Bitola. The evaluation was done by comparing pre and post test measures in (N=12) male inmates, as optimal number for group psychotherapy treatment. According to the RNR model the treatment program needs to be oriented to the inmates needs. Implementing CBT treatment program for group psychotherapy and IORNS as short screening tool in Macedonian prisons was the aim of the project supported by the Council of Europe in this work. The results showed significant lower Procriminal attitudes but higher Aggression because of higher Aggressive behavior in the post measures. Results and instrument can be used in next CBT programs evaluations for better rehabilitation of prison inmates and reducing recidivism. [ABSTRACT FROM AUTHOR]

Suicidal ideation is a major concern in clinical practice. Yet, little is known about prevalence rates of suicidal ideation in patients undergoing outpatient psychotherapeutic treatment. Therefore, the aim of the current study is to assess the prevalence of suicidal ideation in a large sample of psychotherapy outpatients in Germany. The data analyzed in this study is taken from the KODAP-project on the coordination of data collection and analysis at German university-based research and training outpatient clinics for psychotherapy. A total of N = 10,357 adult outpatients (64.4 % female; age: M(SD) = 35.94 (13.54), range: 18–92 years of age) starting cognitive-behavioral therapy at one of 27 outpatient clinics in Germany were included in the current study. Prevalence of suicidal ideation was assessed with the Suicide Item (Item 9) of the Beck-Depression Inventory II. Suicidal ideation was reported by 36.7 % (n = 3795) of the participants. Borderline Personality Disorder, Posttraumatic Stress Disorder, and recurrent Major Depression were the diagnoses most strongly associated with the presence and severity of suicidal ideation. Suicide ideation was assessed only with the respective item of the Beck Depression Inventory II. Suicidal ideation is very common among adult patients who start psychotherapy in Germany. A well-founded knowledge of risk assessment in suicidal patients and suicide-specific treatment options is therefore highly relevant. • Suicidal ideation was assessed in N = 10,357 adult outpatients (starting cognitive-behavioral therapy in Germany • 36.7% reported heightened suicidal ideation • Suicidal ideation was most prevalent among young patients, singles and those receiving disability pension • Suicidal ideation was most prevalent among individuals suffering from BPS, PTSD, or recurrent Major Depression [ABSTRACT FROM AUTHOR]

Abstract:Background: The original developers of motivational interviewing (MI) describe the foundation of their therapeutic method in the person-centered tradition of Carl Rogers. Although MI is sometimes interpreted as a cognitive-behavior therapy (CBT), it did not derive from learning theory and has from the beginning been understood and expounded as a person-centered approach (PCA). Method: Narrative and conceptual review. Results: As with Rogers's original method, the development of MI has been guided by empirical science based on the close observation of clinical practice. It is a behavioral approach in the broad sense of behavioral science. The underlying attitude or spirit with which MI is practiced is unambiguously humanistic in emphasizing partnership, acceptance, compassion, and empowerment. MI focuses on specific observable elements of therapeutic relationship that predict better client outcomes. Various behavioral scientists have distinguished MI from CBT both conceptually and with distinct clinical procedures. The psychological content of MI overlaps substantially with PCA practices such as accurate empathy and also with therapist skills often described as common or nonspecific factors in psychotherapy. Its component processes are engaging, focusing, evoking, and planning. The evoking process of MI distinguishes it from both CBT and nondirective PCA, involving MI-specific technical skills focused on specific client language known as change talk and sustain talk. Conclusions: Like PCA more generally, MI has found broad applications in helping professions well beyond counseling and psychotherapy such as health care, education, pastoral care, conflict resolution, and leadership. Possible historic reasons for confusing MI with CBT are explored. [ABSTRACT FROM AUTHOR]

Abstract Background Cognitive-Behavior Therapy (CBT) is the validated non-pharmacological treatment for chronic pain in pediatric patients. While some suggested CBT were comparable to the usual care in reducing children’s functional abdominal pain. This meta-analysis was designed to systematically review the literature for RCTs that investigated the efficacy of CBT in children with functional abdominal pain (FAP). Methods PubMed, Embase, and the Cochrane library were searched for papers published up to October 2022. Studies applying different CBT delivery methods (in-person, web-based, phone-based) were included in this meta-analysis to evaluate the comprehensive effectiveness of CBT compared with usual care. Weighted and standardized mean difference with the 95% confidence intervals were used for the synthesis of the results. Primary outcome was the decrease of functional disability inventory (FDI) and the secondary outcomes were the decrease of severity in pain intensity, depression, anxiety, gastrointestinal symptoms, and improvement in physical quality of life (QoL). Results A total of 10 RCTs with 1187 children were included in the final analysis. The results showed that CBT resulted in better effect in reducing functional disability inventory (SMD=-2.282, 95%CI: -4.537 to -0.027, P = 0.047), pain intensity (SMD=-0.594, 95%CI: -1.147 to -0.040, P = 0.036), and improving QoL (SMD = 14.097, 95%CI: 0.901 to 27.292, P = 0.036) compared with the control groups. Comparable effects were observed in the severity of depression (SMD=-0.493, 95%CI: -1.594 to 0.608, P = 0.380), anxiety (SMD=-0.062, 95%CI: -0.640 to 0.517, P = 0.835), and gastrointestinal symptoms (SMD=-1.096 95%CI: -2.243 to 0.050, P = 0.061) between CBT and usual treatment. Conclusions We observed the differences in post-treatment FAP and pain intensity for children receiving CBT compared with children receiving treatment as usual. CBT in the setting of FAP demonstrates promising developments and highlights the need for future research.

Background: Cognitive-Behavior Therapy (CBT) is the validated non-pharmacological treatment for chronic pain in pediatric patients. While some suggested CBT were comparable to the usual care in reducing children's functional abdominal pain. This meta-analysis was designed to systematically review the literature for RCTs that investigated the efficacy of CBT in children with functional abdominal pain (FAP). Methods: PubMed, Embase, and the Cochrane library were searched for papers published up to October 2022. Studies applying different CBT delivery methods (in-person, web-based, phone-based) were included in this meta-analysis to evaluate the comprehensive effectiveness of CBT compared with usual care. Weighted and standardized mean difference with the 95% confidence intervals were used for the synthesis of the results. Primary outcome was the decrease of functional disability inventory (FDI) and the secondary outcomes were the decrease of severity in pain intensity, depression, anxiety, gastrointestinal symptoms, and improvement in physical quality of life (QoL). Results: A total of 10 RCTs with 1187 children were included in the final analysis. The results showed that CBT resulted in better effect in reducing functional disability inventory (SMD=-2.282, 95%CI: -4.537 to -0.027, P = 0.047), pain intensity (SMD=-0.594, 95%CI: -1.147 to -0.040, P = 0.036), and improving QoL (SMD = 14.097, 95%CI: 0.901 to 27.292, P = 0.036) compared with the control groups. Comparable effects were observed in the severity of depression (SMD=-0.493, 95%CI: -1.594 to 0.608, P = 0.380), anxiety (SMD=-0.062, 95%CI: -0.640 to 0.517, P = 0.835), and gastrointestinal symptoms (SMD=-1.096 95%CI: -2.243 to 0.050, P = 0.061) between CBT and usual treatment. Conclusions: We observed the differences in post-treatment FAP and pain intensity for children receiving CBT compared with children receiving treatment as usual. CBT in the setting of FAP demonstrates promising developments and highlights the need for future research. [ABSTRACT FROM AUTHOR]

Purpose: Body-focused repetitive behaviors (BFRBs), including skin picking and hair pulling, are common behavioral problems with a lifetime prevalence of up to 5.5%. Extant research indicates that the best treatment approach for BFRBs is Cognitive Behavioral Therapy (CBT), but many of those who struggle with BFRBs are either reluctant to seek treatment or lack access to a therapist with sufficient expertise and experience. Methods: This paper presents preliminary data on the efficacy of two internet-based, therapist-assisted programs designed to treat hair pulling (TrichStop) and skin picking (SkinPick). The programs consist of evidence-based CBT components, including psychoeducation, Habit Reversal Training (HRT) and Acceptance and Commitment Therapy (ACT). We examined changes in self-reported symptom severity of participants in the two programs between February 2019 and December 2022 who had completed at least two assessments (840 participants in SkinPick and 583 participants in TrichStop). Results: Both programs resulted in a considerable reduction in symptom severity, with large effect sizes according to the conventional interpretation of Cohen's d. Improvement in symptoms was progressive over time, and overall improvement correlated with the number of sessions each participant has completed. Conclusions: This preliminary study, which is based on a large sample of participants, indicates that the two programs significantly reduce the severity of skin picking and hair pulling. The study has several limitations, including the lack of a control group, reliance on self-report based on partial scales, and paucity of demographic data, which should be addressed in future controlled studies. [ABSTRACT FROM AUTHOR]

This review traces the development of motivational interviewing (MI) from its happenstance beginnings and the first description published in this journal in 1983, to its continuing evolution as a method that is now in widespread practice in many professions, nations and languages. The efficacy of MI has been documented in hundreds of controlled clinical trials, and extensive process research sheds light on why and how it works. Developing proficiency in MI is facilitated by feedback and coaching based on observed practice after initial training. The author reflects on parallels between MI core processes and the characteristics found in 70 years of psychotherapy research to distinguish more effective therapists. This suggests that MI offers an evidence-based therapeutic style for delivering other treatments more effectively. The most common use of MI now is indeed in combination with other treatment methods such as cognitive behaviour therapies. [ABSTRACT FROM AUTHOR]

Objective: How are collaborative interactions associated with clients' progress in therapy? This study addressed this question, by assessing the quality of therapeutic collaboration and comparing it passage by passage with the clients' assimilation of problematic experiences in two cases of major depression treated with Cognitive Behavioral Therapy, one recovered and one improved-but-not-recovered. Method: We used the Therapeutic Collaboration Coding System to code collaborative work and the Assimilation of Problematic Experiences Scale (APES) to rate clients' progress. In both cases, for the distribution of specific collaborative therapeutic exchanges, we tested for the difference of empirical means between lower and higher APES levels. Results: Both cases progress in APES, but in contrast with Annie (Improved-but-not-recovered), Kate (Recovered) achieved higher levels of change in last sessions. In addition, we found significant differences in the types of collaborative therapeutic exchanges associated with lower and higher APES levels. Conclusion: Ambivalent therapeutic exchanges distinguished the recovered case from the not recovered case highlighting a source of difficulties in facilitating therapeutic change in CBT. In addition, observations in these cases supported the theoretical suggestion that supporting interventions would be better accepted at lower APES levels, whereas challenging interventions would be better accepted at higher APES levels. [ABSTRACT FROM AUTHOR]

Objective: To test the efficacy of smartphone-assisted online brief cognitive behavioral therapy (b-CBT) to treat maternal depression compared to online brief CBT plus an active control app. Methods: A randomized controlled trial was conducted. Assessments were performed at baseline (T0), midpoint (T1, week 4-5), post-treatment (T2, week 8), and follow-up (T3, 2-month postnatal follow-up) by blinded interviewers. The primary outcome was depression measured by the Edinburgh Postnatal Depression Scale (EPDS) at T2. We also assessed anxiety, stress, sleep quality, well-being, physical activity, treatment response, and offspring child behavior problems. Results: Eighty-one participants were randomized to the intervention (n=37) or active control (n=44) groups. Seventy-one participants completed the post-treatment assessment or reported primary outcome data. No differences were found between the intervention and active control groups regarding maternal depression or other mental health outcomes. Overall, we found large within-group effect sizes, with 80% of the total sample responding to treatment. Conclusions: Our data showed no difference between the groups, suggesting that adding apps to psychotherapy treatment may not enhance treatment effects on prenatal depression. A within-groups analysis showed that most participants with depression responded to treatment; however, future studies are needed to confirm whether this effect is related to factors other than the intervention.

Objective: American Indian and Alaskan Natives (AIAN) are regenerating cultural knowledge and practices to adapt westernized evidence-based interventions to address health concerns such as substance use. This study describes the process of selecting, adapting, and implementing motivational interviewing plus cognitive behavior therapy (motivational interviewing + Skills Training; MIST) for use in a combined substance use intervention with a rural, Northwest tribal community. Methods: An established community and academic partnership worked together to make culturally mindful changes to MIST. The partnership incorporated community leaders/Elders (n = 7), providers (n = 9), and participants (n = 50) to implement an iterative process of adapting and implementing the adapted form of MIST. Results: Key adaptations included presenting concepts grounded in tribal values, providing examples from the community perspective, and incorporating cultural customs and traditions. Overall, the MIST adaptation was favorably received by participants, and the adaptation appeared feasible. Conclusions: Adapted MIST appeared to be an acceptable intervention for this Native American community. Future research should evaluate the interventions efficacy in reducing substance use among this and other Native American communities. Future clinical research should consider strategies outlined in this adaptation as a potential process for working with Native American communities to implement culturally appropriate interventions. [ABSTRACT FROM AUTHOR]

Background: The experience of infidelity is very painful and leads to serious negative consequence among couples. The aim of this study is to compare the effectiveness of emotionally focused couple therapy (EFT) and cognitive-behavioral couple therapy (CBT) on forgiveness and marital intimacy of women affected by infidelity. Methods: This was a quasi-experimental study with a pre-posttest design. The statistical population included all the infidelity-affected women referred to Andishe and Tafakor counseling center in the first quarter of 2020 in Mashhad city. The sample size was determined by Cochran formula as 15 participants for each group. From this statistical population, 45 people were selected by purposive method based on inclusion criteria and were randomly replaced in three groups of CBT (N=15), EFT (N=15), and the control group (N=15. They did not receive any intervention. All participants were assessed before, after, and two months after the intervention with the marital forgiveness and Walker and Thompson's (1983) and marital intimacy scale (MIS). The obtained data were analyzed in SPSS-20 by statistical methods of the repeated measure analysis of variance. Results: The mean age of participants was 33.11 ±5.03, and their marriage duration was 6.23±2.89. The results demonstrated forgiveness and marital intimacy were significantly increased in CBT and EFT groups compared to the control group (P

• A brief telemental health intervention (iCOPE with COVID-19) was developed for youth. • The intervention was delivered at the outset of the COVID-19 pandemic. • Child and adolescent anxiety decreased post-intervention compared to pre-intervention. • Results suggest acceptance of iCOPE with COVID-19 with children and adolescents. The COVID-19 pandemic has prompted extensive disruptions to the daily lives of children and adolescents worldwide, which has been associated with an increase in anxiety and depressive symptoms in youth. However, due to public health measures, in-person psychosocial care was initially reduced, causing barriers to mental health care access. This study investigated the feasibility, acceptability and preliminary effectiveness of iCOPE with COVID-19, a brief telemental health intervention for children and adolescents to address anxiety symptoms. Sessions were provided exclusively using videoconferencing technology. Feasibility and acceptability were measured with client satisfaction data. The main outcome measure for effectiveness was anxiety symptom severity measured using the Screen for Child Anxiety and Related Disorders (SCARED). Results indicated that the treatment was well accepted by participants. Significant reductions in anxiety were noted for social anxiety, and were observed to be trending towards a mean decrease for total anxiety. The findings suggest that this brief telemental health intervention focused on reducing anxiety related to COVID-19 is acceptable and feasible to children and adolescents. Future research using a large sample and with a longer follow-up period could inform whether symptom decreases are sustained over time. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the impact of Cognitive-Behavior Therapy (CBT) on resilience in old people with "empty nest syndrome." Three older adults with empty nest syndrome underwent CBT for 8 weeks in a single-case experimental design. Changes in resilience were tracked through measurements at baseline, intervention, and follow-up. Visual analysis as well as an effect size index of Percentage of Nonoverlapping Data (PND) were then analyzed. CBT resulted in a significant increase in psychological resilience for all three participants across the intervention phase. Follow-up data showed that all subjects were able to maintain their resiliency four weeks after the intervention. This single-case experimental study supports the hypothesis that CBT improves resiliency in old people with empty nest syndrome. Cognitive Behavior Therapy is effective in increasing resiliency in old people with empty nest syndrome. The culture dynamics is an important component in the emergence and persistence of empty nest syndrome. [ABSTRACT FROM AUTHOR]

Patients with Major Depressive Disorder (MDD) have been found to have restricted capacity for mentalization, and it is possible that this constitutes a vulnerability factor for developing depression. Due to its focus on linking depressive symptomatology to emotions and interpersonal relations, it was hypothesized that Interpersonal Psychotherapy (IPT) would improve mentalization more than Cognitive Behavioral Therapy (CBT). In a randomized controlled trial of 90 patients undergoing IPT and CBT for MDD, Reflective Functioning (RF) was rated from Adult Attachment and from Depression-Specific Reflective Functioning (DSRF) Interviews before and after therapy. Treatment outcome was assessed using the Beck Depression Inventory-II. The interaction between time and treatment approach was statistically significant, with RF improving significantly more in IPT than in CBT. Change in RF was not correlated with change in depression. The difference in DSRF ratings before and after therapy was not statistically significant for any of the treatments. IPT may improve mentalization more than CBT. However, although RF increased significantly in IPT, the mean level was still low after therapy. A limitation of the study is the large amount of post-treatment missing data. More research is needed to understand the potential role of mentalization in symptom reduction. [ABSTRACT FROM AUTHOR]

Background and Objectives: Poor sleep is prevalent among individuals with social anxiety disorder (SAD) and may affect treatment outcome. We examined whether: (1) individuals with SAD differed from healthy controls (HCs) in sleep quality, (2) baseline sleep quality moderated the effects of treatment (Cognitive-behavioral group therapy [CBGT] vs. mindfulness-based stress reduction [MBSR] vs. waitlist [WL]) on social anxiety, (3) sleep quality changed over treatment, and (4) changes in sleep quality predicted anxiety 12-months post-treatment. Design: Participants were 108 adults with SAD from a randomized controlled trial of CBGT vs. MBSR vs. WL and 38 HCs. Methods: SAD and sleep quality were assessed pre-treatment and post-treatment; SAD was assessed again 12-months post-treatment. Results: Participants with SAD reported poorer sleep quality than HCs. The effect of treatment condition on post-treatment social anxiety did not differ as a function of baseline sleep quality. Sleep quality improved in MBSR, significantly more than WL, but not CBGT. Sleep quality change from pre- to post-treatment in CBGT or MBSR did not predict later social anxiety. Conclusions: MBSR, and not CBGT, improved sleep quality among participants. Other results were inconsistent with prior research; possible explanations, limitations, and implications for future research are discussed. ClinicalTrials.gov identifier: NCT02036658.

Background: Patients with chronic diseases such as multiple sclerosis (MS) suffer more from psychiatric consequences than others, and their quality of life may be drastically affected, causing syndromes like depression and anxiety. Mindfulness-integrated cognitive behavioral therapy (Mi-CBT) seems to improve stress coping strategies in chronically ill patients, but its effectiveness has been little studied in MS. So, in this study, we aimed to assess its effectiveness on stress coping strategies in women suffering from MS in Mazandaran province, Iran. Methods: In this semi-experimental study, we selected 40 women with MS who had been referred to a neurologist in Mazandaran province, Iran during the year 2016 by convenient sampling and randomly assigned to the Mi-CBT and control group with a one-to-one ratio. Patients in the intervention group were under treatment for eight 120-minutes session, while the control group only stayed on the waiting list. After obtaining the ethics committee’s approval (IR.IAU.CHALUS.REC.1397.018) and patient’s informed consent, both groups underwent a pre-test assessment with a stress status questionnaire developed by Endler and Parker in 1988. The same assessment was done for both groups two times more, one after compilation of all sessions, and one 45 days later. Repeated measures analysis of variance was done using SPSS Version 24 software. Results: There was a difference between intervention and the control group for avoidance-oriented, and problem-oriented stress coping strategies (p

Objective: To test the efficacy of smartphone-assisted online brief cognitive behavioral therapy (b-CBT) to treat maternal depression compared to online brief CBT plus an active control app. Methods: A randomized controlled trial was conducted. Assessments were performed at baseline (T0), midpoint (T1, week 4-5), post-treatment (T2, week 8), and follow-up (T3, 2-month postnatal follow-up) by blinded interviewers. The primary outcome was depression measured by the Edinburgh Postnatal Depression Scale (EPDS) at T2. We also assessed anxiety, stress, sleep quality, well-being, physical activity, treatment response, and offspring child behavior problems. Results: Eighty-one participants were randomized to the intervention (n=37) or active control (n=44) groups. Seventy-one participants completed the post-treatment assessment or reported primary outcome data. No differences were found between the intervention and active control groups regarding maternal depression or other mental health outcomes. Overall, we found large within-group effect sizes, with 80% of the total sample responding to treatment. Conclusions: Our data showed no difference between the groups, suggesting that adding apps to psychotherapy treatment may not enhance treatment effects on prenatal depression. A within-groups analysis showed that most participants with depression responded to treatment; however, future studies are needed to confirm whether this effect is related to factors other than the intervention. [ABSTRACT FROM AUTHOR]

This study aimed to identify the effectiveness of CBT in reducing symptoms of anxiety in a sample of adolescents with learning disabilities. To achieve the objectives of the study, the tool was prepared, which was represented by the anxiety scale, and it was confirmed that the scale had validity and consistency indications appropriate for its application to the individuals of the study sample, and a training program based on CBT was built. Where the researcher applied the study tools to a sample consisting of (8) students, they were chosen intentionally. Data were statistically processed by extraction of mean and standard deviations, and the unscientific Wilcoxon Signed Ranks Test was used. The results showed that there were statistically significant differences on pre and post measurement in reducing symptoms in favor of post measurement, which indicates the effectiveness of the training program. In light of the results, I made some recommendations. [ABSTRACT FROM AUTHOR]

• One-size-fits-all treatment approaches are not sufficient and data-data driven approaches to personalize treatment are necessary. • Individual characteristics may predict better outcomes with one treatment rather than another. • Personalized skill sequencing influences treatment outcome. Clinicians in practice routinely make decisions that, in effect, tailor the care they provide to each individual patient. For example, clinicians must decide which treatment package to administer, or what specific skills to introduce. Providers also determine when to change approaches, the frequency of sessions, and when to terminate treatment. In this review, we describe the empirical literature for personalizing the delivery of psychological care that corresponds to the inflection points in treatment that clinicians face. In addition, we provide data-based recommendations to clinicians for personalizing patient care at each of these decision points and suggest areas for future study. [ABSTRACT FROM AUTHOR]

Delivering psychotherapy by videoconference has been studied in a number of clinical trials, but no large controlled trial has involved generalized anxiety disorder (GAD). This multicenter randomized controlled non-inferiority trial was conducted to test if cognitive-behavior psychotherapy delivered by videoconference (VCP) is as effective as cognitive-behavior psychotherapy delivered face-to-face, using a strict margin of tolerance for non-inferiority. A total of 148 adults received a 15-session weekly manualized program. The treatment was based on the intolerance of uncertainty model of GAD. The impact of treatment was assessed using primary (GAD severity), secondary (worry, anxiety, and intolerance of uncertainty) and tertiary (general functioning) variables measured before and after treatment and at 6-month and 12-month follow-ups. Results showed that: (a) the treatment was effective; (b) VCP for GAD was statistically non-inferior to face-to-face psychotherapy on primary, secondary and tertiary measures at all assessment points; (c) change in intolerance of uncertainty significantly predicted change in the primary outcome measure over and above important clinical factors common to all psychotherapies (motivation, working alliance, perceived therapist competence, and client satisfaction). These findings support the use of VCP as a promising treatment option for adults with GAD. Clinical trial registry: ISRCTN#12662027. [ABSTRACT FROM AUTHOR]

Body dysmorphic disorder (BDD) typically originates in adolescence and is associated with considerable adversity. Evidence-based treatments exist but research on clinical outcomes in naturalistic settings is extremely scarce. We evaluated the short- and long-term outcomes of a large cohort of adolescents with BDD receiving specialist multimodal treatment and examined predictors of symptom improvement. We followed 140 young people (age range 10-18) with a diagnosis of BDD treated at two national and specialist outpatient clinics in Stockholm, Sweden (n = 96) and London, England (n = 44), between January 2015 and April 2021. Participants received multimodal treatment consisting of cognitive behavior therapy and, in 72% of cases, medication (primarily selective serotonin reuptake inhibitors). Data were collected at baseline, posttreatment, and 3, 6, and 12 months after treatment.The primary outcome measure was the clinician-rated Yale-Brown Obsessive-Compulsive Scale Modified for BDD, Adolescent version (BDD-YBOCS-A). Secondary outcomes included self-reported measures of BDD symptoms, depressive symptoms, and global functioning. Mixed-effects regression models showed that BDD-YBOCS-A scores decreased significantly from baseline to posttreatment (coefficient [95% confidence interval] = -16.33 [-17.90 to -14.76], p<0.001; within-group effect size (Cohen's d) = 2.08 (95% confidence interval, 1.81 to 2.35). At the end of the treatment, 79% of the participants were classified as responders and 59% as full or partial remitters. BDD symptoms continued to improve throughout the follow-up. Improvement was also seen on all secondary outcome measures. Linear regression models identified baseline BDD symptom severity as a predictor of treatment outcome at posttreatment, but no consistent predictors were found at the 12-month follow-up. To conclude, multimodal treatment for adolescent BDD is effective in both the short- and long-term when provided flexibly within a specialist setting. Considering the high personal and societal costs of BDD, specialist care should be made more widely available. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the role of attachment insecurity in predicting a worse longitudinal trend of eating disorder (ED) psychopathology and body uneasiness in patients with Anorexia Nervosa (AN) or Bulimia Nervosa (BN) treated with Enhanced Cognitive Behavior Therapy, considering the longitudinal interplay between these dimensions. Method: In total, 185 patients with AN or BN performed the baseline assessment, and 123 were re‐evaluated after 1 year of treatment. Participants completed questionnaires evaluating ED psychopathology (Eating Disorders Examination Questionnaire) and body uneasiness (body uneasiness test). For the assessment of adult attachment, the Experiences in Close Relationships‐Revised was administered at baseline. Bivariate latent change score analysis within the structural equation modeling framework was performed to investigate the evolution of ED psychopathology and body uneasiness, their longitudinal interplay, and the role of attachment style as an outcome predictor. Results: After treatment, all psychopathological features showed an overall improvement. Higher baseline levels of body uneasiness predicted a worse course of ED psychopathology. The change in body uneasiness over time depended on changes over time in ED psychopathology, but not vice versa. Insecure attachment predicted a worse longitudinal trend of ED psychopathology, and, through this impairment, it indirectly maintained higher levels of body uneasiness, as confirmed by mediation analyses. Discussion: The role of attachment insecurity as a predictor of treatment outcome suggests the need for an integration of the cognitive‐behavioral conceptualization of EDs with a developmental perspective that considers attachment‐related issues. Public significance statement: Considering the burden of EDs in terms of public health and the unsatisfactory response to standard treatments, the identification of outcome predictors is of considerable clinical interest. This study demonstrated that attachment insecurity was associated with worse longitudinal trends of ED psychopathology and body uneasiness in patients with AN and BN treated with CBT‐E, highlighting the importance of personalizing treatment programs taking into account a developmental perspective on these disorders. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic diseases such as multiple sclerosis (MS) suffer more from psychiatric consequences than others, and their quality of life may be drastically affected, causing syndromes like depression and anxiety. Mindfulness-integrated cognitive behavioral therapy (Mi-CBT) seems to improve stress coping strategies in chronically ill patients, but its effectiveness has been little studied in MS. So, in this study, we aimed to assess its effectiveness on stress coping strategies in women suffering from MS in Mazandaran province, Iran. Methods: In this semi-experimental study, we selected 40 women with MS who had been referred to a neurologist in Mazandaran province, Iran during the year 2016 by convenient sampling and randomly assigned to the Mi-CBT and control group with a one-to-one ratio. Patients in the intervention group were under treatment for eight 120-minutes session, while the control group only stayed on the waiting list. After obtaining the ethics committee's approval (IR.IAU.CHALUS.REC.1397.018) and patient's informed consent, both groups underwent a pre-test assessment with a stress status questionnaire developed by Endler and Parker in 1988. The same assessment was done for both groups two times more, one after compilation of all sessions, and one 45 days later. Repeated measures analysis of variance was done using SPSS Version 24 software. Results: There was a difference between intervention and the control group for avoidanceoriented, and problem-oriented stress coping strategies (p<0.01), but there was not a significant difference for emotion-oriented strategy between groups (P=0.22). Conclusion: MiCBT is effective in improving stress coping strategies in women with MS, and overall mental health. [ABSTRACT FROM AUTHOR]

Although modestly effective treatments exist for alcohol use disorder (AUD), many individuals return to heavy drinking after treatment, suggesting the need for better understanding of factors that contribute to maintaining abstinence or drinking reductions. Whereas past studies identified what treatments work for AUD, recent studies focus more on why particular treatments work, and the mechanisms by which treatment leads to change. This focus on mechanisms of behavior change (MOBC) may inform the process by which treatment leads to better outcomes, and also may lead to new treatments or modifications of existing treatments that target empirically supported mechanisms known to lead to change. There is a paucity of studies examining MOBC from a neurocognitive perspective. To address this gap in knowledge, the study described here is examining emotional reactivity, alcohol cue reactivity, and cognitive control as potential MOBC at three levels of analysis - self-report, behavior, and neural. One hundred ten treatment-seeking individuals with an AUD are being randomized to receive 8 sessions of either Cognitive Behavioral Treatment (CBT) or Mindfulness Based Treatment (MBT) after up to 4 sessions of a platform treatment focused on enhancing motivation to change. To establish the temporal relationship between changes in drinking and changes in MOBC, patients are assessed at baseline, during and immediately after treatment, and 9- and 15-months post-baseline. Relationships between changes in drinking and changes in the proposed MOBC will be examined using advanced mixed modeling techniques. Results should advance AUD treatment by targeting treatments to neurocognitive MOBC. [ABSTRACT FROM AUTHOR]

Objective To evaluate effects of the MINDSTRONG© cognitive-behavioral skills building program versus an attention control program on mental health outcomes and lifestyle behaviors of graduate health professional students. Participants: 201 entering graduate students from seven health sciences colleges at a public land grant University in the U.S. Midwest. Methods: A randomized controlled trial was conducted with three-month follow-up. Valid and reliable instruments measured depression, anxiety, stress, healthy lifestyle beliefs and healthy lifestyle behaviors. Results: Students receiving MINDSTRONG© reported less depression/anxiety and healthier lifestyle behaviors than those receiving the control program. Students with elevated levels of depression/anxiety at baseline demonstrated greater benefits from the program. Conclusions: MINDSTRONG© can be used as a preventive and early intervention for improving mental health outcomes and lifestyle behaviors in graduate students. Because the program can be delivered by trained non-mental health professionals, it has the potential to be widely scaled on campuses throughout the U.S. [ABSTRACT FROM AUTHOR]

Objective: Just‐in‐time adaptive interventions (JITAIs), momentary interventions delivered at identified times of risk, may improve skill utilization during cognitive‐behavioral therapy (CBT‐E) for bulimia‐spectrum eating disorders (BN‐EDs). JITAIs may be especially helpful for individuals with self‐regulation deficits, including emotion regulation deficits and elevated impulsivity. Method: Participants (N = 55 with BN‐EDs) received 16 sessions of CBT‐E with electronic self‐monitoring and were randomized to receive JITAIs (JITAIs‐On) or not receive JITAIs (JITAIs‐Off). Baseline Difficulties in Emotion Regulation Scale (DERS) and UPPS‐P Impulsive Behavior Scale (UPPS‐P) total scores were examined as moderators of baseline to post‐treatment change in binge episodes, compensatory behaviors, and Eating Disorder Examination (EDE) global score using repeated measures ANOVAs. Results: Emotion regulation difficulties significantly moderated compensatory behavior change (F[1, 51] = 4.31, p =.04, ηp2 = 0.08) such that individuals with emotion regulation deficits demonstrated greater improvements in the JITAIs‐On condition. Impulsivity moderated change in binge episodes (F[1, 51] = 8.94, p =.004, ηp2 = 0.15) and compensatory behaviors (F[1, 51] = 7.83, p =.007, ηp2 = 0.13), such that individuals with high impulsivity showed greater improvement in the JITAIs‐On condition. Neither DERS nor UPPS‐P scores moderated EDE global score change. Discussion: JITAIs appear particularly beneficial for facilitating skill use during treatment for BN‐EDs for individuals with self‐regulation deficits, yielding improved treatment outcomes. Public Significance Statement: Reminders to use therapy skills that are delivered via smartphone as an individual goes about their daily life may improve treatment response among individuals with bulimia nervosa who have difficulty coping with emotions or who tend to act impulsively. Results from this study indicate that individuals with these difficulties benefitted more from cognitive‐behavioral therapy when it was accompanied by in‐the‐moment reminders to use therapeutic skills, which may facilitate long‐term recovery. Clinical Trials.gov Registration Number: NCT03673540. [ABSTRACT FROM AUTHOR]

Research on the psychosocial impact of COVID-19 has found significant levels of distress among the general population, and among those especially vulnerable due to chronic social or health challenges. Among these are individuals aging with HIV infection, who are encountering COVID-19 as a new infectious threat to their health and wellbeing. In a longitudinal observational study of the psychosocial impact of COVID-19 in middle-aged and older people living with HIV, we identified a subset of participants who expressed heightened levels of distress and were referred for clinical intervention. This paper describes the supportive and contemporary cognitive-behavioral interventions that were provided and presents data on changes in distress in this case series. This work provides a model for identifying people in at-risk groups in acute need of psychological intervention and for implementing an individualized clinical response that can be safely delivered in the context of COVID-19 and future crisis situations. [ABSTRACT FROM AUTHOR]

An individual with obsessive-compulsive disorder (OCD) and poor insight has a significant impact on the person, thinking clearly about his obsessive thought and compulsive behavior. Cognitive-behavior therapy is an evidence-based therapy for the treatment of OCD patients. However, the need felt to incorporate other therapeutic approaches such as supportive, mindfulness-based therapy to treat OCD. This case study tried to discuss the efficacy of a holistic intervention approach in an individual with OCD who had poor insight. The result showed that the holistic approach decreased distress, intrusive thought and reassurance-seeking behavior and improved his insight. At the end of the psychotherapy session, the Y-BOCS score decreased to 15.

Objective: The study aimed to investigate the complex relationship between eating disorder (ED) specific psychopathology, emotion dysregulation, and their longitudinal variations in patients with anorexia nervosa (AN) treated with a multidisciplinary approach including enhanced cognitive‐behavior therapy (CBT‐E), and to provide an integrated model which includes childhood trauma as a predictor of worse treatment outcomes. Method: In total, 120 female patients with AN were evaluated at admission (T0), and 105 were re‐evaluated after 1 year (T1) of treatment. At T0, patients underwent a clinical assessment and filled the Symptom Checklist 90‐Revised (SCL90‐R), the Eating Disorders Examination Questionnaire (EDE‐Q), the Difficulties in Emotion Regulation Scale (DERS), and the Childhood Trauma Questionnaire (CTQ). SCL‐90‐R, EDE‐Q, and DERS were readministered at T1. Variations between T0 and T1 were evaluated, and the proposed model was investigated using bivariate latent change score analysis in a structural equation modeling (SEM) framework. Results: An overall significant clinical amelioration was observed after treatment. A unidirectional effect of DERS scores on EDE‐Q variations was outlined by SEM: patients with higher baseline DERS scores achieved less EDE‐Q improvements, and EDE‐Q latent change score was significantly predicted by longitudinal variations of DERS—but not vice versa. Higher CTQ scores predicted reduced treatment efficacy for ED‐specific psychopathology through the mediating effect of higher baseline DERS scores. Discussion: The present study sheds light on the mechanism by which early trauma compromises treatment outcome in patients with AN, underlining the crucial role of emotional dysregulation. [ABSTRACT FROM AUTHOR]

We compare the relative efficacy of virtual reality therapy exposure (VRET) versus in vivo therapy exposure among individuals suffering from phobias. A systematic search was completed up to 03 April 2020, using the following databases: ACM Digital Library, ResearchGate, IEEE, Science Direct, MIT PressJournals, Center for Direct Scientific Communication (CCSD) and Mary Ann Liebert Publishers. Five authors searched the databases using the following terms: Virtual Reality, Phobia, Mental health, Computing, Therapy, HMD, CAVE, Virtual ambient, in virtuo, Avoidance, Exposure, VRET, in vivo, Anxiety, Agoraphobia, Social Phobia, Stimuli, Cognitive–behaviour. All studies that evaluate the effect of in virtuo exposure towards phobia rehabilitation were selected. By reviewing the article, each author then applied the inclusion and exclusion criteria, and 30 articles were selected. Data extracted included the number of samples, amount of sessions, study variables that may affect the final outcome, therapy technology. The data provided was synthesized using a meta-analysis based on the results. The results demonstrated a positive outcome of Virtual Reality Exposure Treatment in the treatment of most phobias. In contrast, some of these treatments did not work for a few specific phobias in which the standard procedures were more effective. The findings suggest that for some specific phobias treatment, Virtual Reality Exposure Treatment does not reach the in vivo exposure level of immersion and presence. Further research is needed to perform studies with higher-dimension samples, since many papers report a low sample size and that is probably why many of them have inconclusive results. [ABSTRACT FROM AUTHOR]

Introduction: Various studies have highlighted the high prevalence of psychological and psychiatric problems among students with Internet addiction (IA). This study aimed to determine the effect of GCBT on self-control, self-efficacy as well as the prevalence of IA amongst students of Qazvin University of Medical Sciences (QUMS). Methods: This randomized controlled trial was performed on 80 students addicted to the Internet. Participants were randomly divided into control (without intervention) and treatment group (GCBT). The experimental group participated in a GCBT program consisted of 10 two2-hour sessions based on psychosocial training, cognitive reconstruction, behavior modification, and improving emotion regulation. Data were collected using demographic information, Yang IA test, brief self-control scale, and compulsive iInternet usage scale before and 3 months after GCBT. Results: The Rfindings demonstrated significant improvements in general self-efficacy (21.90 ± 5.1-–27.31 ± 3.9, F = 46.131, df = 1, P < 0.001) and self-control (33.03 ± 4.7-–44.78 ± 6.1, F = 59.252, df = 1, P < 0.001), while compulsive Internet usage (41.41 ± 6.35-–25.13 ± 3.97, F = 163.359, df = 1, P < 0.001) and IA (60.83 ± 9.95-–36.10 ± 5.16, F = 183.302, df = 1, P < 0.001) were remarkably reduced in the experimental group after GCBT. Conclusion: This study suggests that GCBT can be an effective treatment for those college students struggling with IA, with improving the psychological variables affecting IA.

This commentary describes the transition to remote delivery of cognitive-behavioral therapy (CBT) for anxiety in children with autism spectrum disorder (ASD) who participates in a clinical trial during the COVID-19 pandemic. The effects of COVID-19 on children's anxiety and on the family functioning are discussed. Modifications to CBT necessitated by telehealth delivery were aimed at maximizing engagement of children and their parents while maintaining treatment fidelity and adhering to the research protocol. Treatment targets were updated to address new sources of anxiety and CBT exposure exercises were modified to accommodate the new reality of quarantine restrictions. If the COVID-19 pandemic continues to affect treatment delivery it may require a widespread utilization of telehealth for treating anxiety in children with ASD. [ABSTRACT FROM AUTHOR]

This study reports on the results of a pilot study designed to evaluate the Resilience Education Program (REP): a brief Tier 2 intervention that includes small‐group cognitive‐behavioral instruction, paired with a modified check‐in/check‐out procedure. Three elementary school students demonstrating early indicators of internalizing behavior concerns participated in the current intervention. A multiple‐baseline single‐case design was used to evaluate intervention effects. Outcome data corresponded to teacher‐collected direct behavior rating data, which were specific to each student's particular internalizing concerns (e.g., negative affect, withdrawal) and were collected on a daily basis during times when these behaviors were most problematic. Visual analysis and effect size estimates were used in evaluating intervention effects relative to baseline conditions for each student. Results indicated REP yielded a moderate intervention effect for two out of three students (Tau‐U = 0.72 and 0.68, respectively), each of whom exhibited an immediate reduction in internalizing behavior. Both students also demonstrated an absence of negative behaviors in the maintenance phase. Findings for the third student were obfuscated by low behavioral rates during baseline. Following the intervention, educators rated REP as a socially valid intervention. Limitations of this study and future directions for research and practice are discussed. [ABSTRACT FROM AUTHOR]

Objective: Cognitive‐behavioral therapy (CBT)—therapist‐led (CBTth) and guided‐self‐help (CBTgsh)—has efficacy for binge‐eating disorder (BED) but many patients do not benefit sufficiently. We examined predictors and moderators for these two CBT methods. Method: Data were aggregated from randomized controlled trials (RCTs) testing psychosocial treatments for BED in the U.S. Predictors and moderators of outcomes (treatment completion and binge‐eating remission) were examined in N = 457 participants who received either CBTgsh (N = 164) or CBTth (N = 293). Results: Analyses, adjusting for demographic/clinical variables, indicated CBTth was significantly superior to CBTgsh for treatment completion (odds ratio [OR] = 20.0) and remission (OR = 14.6). For remission, analyses revealed significant predictors (age, treatment length, Weight Concern), a moderator (weight concern [OR = 5.13]), and a significant interaction between CBT‐type and treatment length (OR = 2.66). For CBTgsh, longer treatment was associated with less remission, whereas for CBTth, longer treatment was associated with greater remission. For CBTgsh, 44.1% with low weight concern versus 56.3% with high weight concern achieved remission whereas for CBTth, 43.5% with high weight concern and 61.0% with low weight concern achieved remission. Discussion: Analyses of aggregated RCT BED data, adjusting for demographic/clinical characteristics, indicated superiority (large effect‐sizes) in treatment outcomes of CBTth over CBTgsh and that Weight Concern moderated outcomes. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate changes in the trajectory of youth anxiety following the introduction of specific cognitive-behavior therapy (CBT) components: relaxation training, cognitive restructuring, and exposure tasks.MethodFour hundred eighty-eight youths ages 7-17 years (50% female; 74% ≤ 12 years) were randomly assigned to receive either CBT, sertraline (SRT), their combination (COMB), or pill placebo (PBO) as part of their participation in the Child/Adolescent Anxiety Multimodal Study (CAMS). Youths in the CBT conditions were evaluated weekly by therapists using the Clinical Global Impression Scale-Severity (CGI-S; Guy, 1976) and the Children's Global Assessment Scale (CGAS; Shaffer et al., 1983) and every 4 weeks by blind independent evaluators (IEs) using the Pediatric Anxiety Ratings Scale (PARS; RUPP Anxiety Study Group, 2002). Youths in SRT and PBO were included as controls.ResultsLongitudinal discontinuity analyses indicated that the introduction of both cognitive restructuring (e.g., changing self-talk) and exposure tasks significantly accelerated the rate of progress on measures of symptom severity and global functioning moving forward in treatment; the introduction of relaxation training had limited impact. Counter to expectations, no strategy altered the rate of progress in the specific domain of anxiety that it was intended to target (i.e., somatic symptoms, anxious self-talk, avoidance behavior).ConclusionsFindings support CBT theory and suggest that cognitive restructuring and exposure tasks each make substantial contributions to improvement in youth anxiety. Implications for future research are discussed. (PsycINFO Database Record

Background: Dialectical Behavior Therapy (DBT) has shown evidence of its effectiveness in the treatment of borderline personality disorder (BPD) and eating disorders (EDs) separately, and there is preliminary evidence for co-occurrent BPD and EDs. However, the long-term effectiveness of DBT for this specific population is still unknown. The main goal of this study was to assess long-term treatment effectiveness in people diagnosed with BPD and ED. Methods: Participants (N = 109) had previously received a 6-month treatment during a clinical trial (DBT = 64 vs. Treatment as Usual, Cognitive Behavior Therapy; TAU CBT = 45). Outcome measures (emotional eating, depressive symptoms, anger, emotion regulation, impulsiveness, and resilience) were evaluated prospectively at 4- and 6-year follow-ups. Results: There was a statistically significant improvement in most study outcomes from pre-treatment to the follow-ups in the DBT condition, and in depression, resilience and trait anger in the TAU CBT. No statistically significant between-group differences were found. Nonetheless, a high percentage of participants showed a clinically significant improvement over time in the DBT condition. Conclusions: Findings of this study contribute to determinate the long-term treatment effectiveness of DBT for people with BPD and ED in routine psychotherapeutic practice. Longitudinal studies with larger sample sizes are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Self-esteem is one of the essential components that make up an individual's personality. The level of self-esteem possessed by an individual influences the development of self-concept, self-confidence, self-motivation, and personal resilience. Self-esteem develops since the individual realizes its function in the social environment. The case study in this study discusses the condition of one of the students currently studying at the Faculty of Medical of University X of Yogyakarta. The initial assessments used are the intelligence test, personality test, and self-esteem scale. It is concluded that the subject experienced low self-esteem which had an impact on self-confidence, motivation, and resilience ability in attending lectures. This condition also affects the academic achievement of the subject, which is unsatisfactory. This study purpose is to determine the effectiveness of counseling with cognitive-behavioral therapy approach on subjects who have low self-esteem. The techniques used in cognitive-behavioral counseling therapy are ABCDE techniques, Socratic questions, vertical arrows, and relaxation techniques. This study uses a single-case experimental design method. The result is that the subject found some negative beliefs that made him helpless with the situation, especially in academic activities. Then the subject was able to find another positive alternative belief so that the subject had a positive judgment on him. After the counselling process in several sessions, the subject has high self-esteem. The subject has a positive assessment of himself and does not see his weaknesses as a scourge that makes him helpless in carrying out daily activities, especially academic activities

Abstract Background Currently, there is limited evidence to guide intervention and service delivery coordination for youth who suffer a concussion and subsequently experience persistent post-concussive symptoms (PCS) (Lumba-Brown et al. JAMA Pediatr 172(11):e182853, 2018; Lumba-Brown A et al. JAMA Pediatr 172(11):e182847, 2018). We have developed a collaborative care intervention with embedded cognitive-behavioral therapy, care management, and stepped-up psychotropic medication consultation to address persistent PCS and related psychological comorbidities. The CARE4PCS-II study was designed to assess whether adolescents with persistent symptoms after sports-related concussion will demonstrate better outcomes when receiving this collaborative care intervention compared to a usual care (control) condition. Methods/design This investigation is a randomized comparative effectiveness trial to receive intervention (collaborative care) or control (usual care). Two hundred sports-injured male and female adolescents aged 11–18 years with three or more post-concussive symptoms that persist for at least 1 month but less than 9 months after injury will be recruited and randomized into the study. The trial focuses on the effects of the intervention on post-concussive, depressive, and anxiety symptoms measured 3, 6, and 12 months after baseline. Discussion The CARE4PCS II study is a large comparative effectiveness trial targeting symptomatic improvements in sports injured adolescents after concussion. The study is unique in its adaptation of the collaborative care model to a broad spectrum of primary care, sports medicine, and school settings. The investigation incorporates novel elements such as the delivery of CBT through HIPAA complaint video conferenceing technology and has excellent widespread dissemination potential should effectiveness be demonstrated. Trial registration ClinicalTrials.gov, NCT03034720. Registered on January 27, 2017.

Background: Addiction is one of the greatest problems of human societies, which not only causes social and behavioral disorders but also affects different aspects of health and imposes huge financial loss on individuals, families, and society. The purpose of this study was to determine the effect of resistance training and mindfulness on the sexual function of addicted people. Methods: The present study is an experimental research conducted using a pretest-posttest design with a control group. Participants of this study consisted of 50 married men aged 30-45; since their referral to addiction treatment centers in Shahrekord two weeks had passed. They were selected using convenience sampling method and matched based on the age range and history of addiction and divided into four groups of resistance training, mindfulness, combined (resistance training and mindfulness), and control. The resistance and combined training groups participated in resistance training for 8 weeks. The mindfulness and combined training groups participated in mindfulness therapy training for 8 weeks. During this period, the control group performed their daily activities. Before and after the intervention, data were collected using an erectile dysfunction questionnaire. Data were analyzed using covariance. Results: All three types of intervention, including resistance training (P≤0.001), mindfulness training (P≤0.006), and combined training (P≤0.001), lead to the improvement of sexual performance. Additionally, combined training was more effective compared to the other two methods (P≤0.001). Conclusion: In order to improve the sexual performance of addicts, physical exercise and mindfulness training can be used. The simultaneous use of both methods has a greater influence on the improvement of sexual performance due to the addicts benefitting from the effects of two types of intervention.

Background: Severe irritability is a common, impairing problem among youth referred for mental health services, but evidence to guide care is limited. Treatment research can be advanced by adopting a transdiagnostic perspective, leveraging existing evidence-based treatment (EBT) techniques, and situating irritability within the context of emotion dysregulation. Accordingly, this study examined treatment outcomes for youth with different levels of irritability and dysregulation who received cognitive-behavioral therapy (CBT) or behavioral parent training (BPT) in a modular EBT framework.Method: We analyzed data from a community-based implementation trial of a transdiagnostic youth psychotherapy. Two-hundred treatment-referred youths (7-15 years; 47% female; 33% White, 28% Black, 24% Latinx, 14% multiracial, 2% other) and their caregivers completed measures of clinical problems and emotion dysregulation at baseline, with repeated outcomes assessments over 18 months. First, latent profile analysis was applied to baseline irritability and emotion dysregulation data; then, latent growth curve models were used to examine outcome trajectories, controlling for covariates.Results: A two-class solution fit well, differentiating youth with high (n = 54) vs. low (n = 146) levels of dysregulation and irritability at baseline. Nearly all high-dysregulation youth received either BPT (n = 26) or CBT-Depression (n = 23). Across measures, both groups showed statistically and clinically significant improvements over time. High-dysregulation youth had greater baseline severity than low-dysregulation youth, but otherwise their longitudinal trajectories were mostly similar, with few between-group slope differences. There was virtually no evidence of differential effects for BPT vs. CBT on clinical outcomes.Conclusions: Youth with severe irritability and dysregulation, treated with a transdiagnostic, modular, EBT approach, showed significant within-person improvements over time. Their outcome trajectories did not differ according to whether they received BPT or CBT. Findings extend the literature on modular, transdiagnostic, and EBT approaches for irritability and dysregulation, suggesting comparable benefits associated with BPT and CBT when treatment selection is guided by comprehensive assessment.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03153904.