A Dyadic Analysis of the Relationships Between Antisocial and Borderline Personality and Intimate Partner Violence Perpetration

Cluster B personality disorders of antisocial personality disorder (ASPD) and borderline personality disorder (BPD) have been implicated in predicting intimate partner violence (IPV) perpetration. However, most studies include only male perpetrators and ignore the dyadic interactions among couples. The current study examines the interactive role of both partners' ASPD and BPD features to predict IPV perpetration with a dyadic perspective. Seventy-seven married heterosexual couples reporting recent partner violence participated in the study. Each partner completed the Revised Conflict Tactics Scales and the Millon Clinical Multiaxial Inventory-II. A considerable number of participants (53.25% of the men and 46.75% of the women for ASPD and 41.56% of the men and 42.86% of the women for BPD) scored higher than the diagnostic cutoff point. Actor-partner interdependence modeling examined the reciprocal influence of men's and women's personality disorder features on IPV perpetration in two separate actor-partner interdependence models. Results of the first model revealed that the IPV perpetration of both wives and husbands was predicted by their own ASPD scores. In the second model, men's IPV perpetration was predicted both by his own and his partner's BPD features, but this was not true of women's IPV perpetration. While ASPD was a consistent risk factor for IPV perpetration, there were gender differences in the influence of BPD on IPV perpetration. Women's BPD symptoms appear to put her at risk for victimization of IPV. Therefore, in couples experiencing IPV and having BPD symptoms, both partners may benefit from interventions to address emotional instability to prevent future IPV.

From the lab to the clinic: Advancing pain exposure using principles of functional analysis

In this article, we use the example of pain exposure therapy to illustrate how behavioral pain treatments can be systematically personalized following the principles of functional analysis. Based on the fear-avoidance model, pain exposure therapy has evolved as a mechanistically-based treatment to modify the mechanism of avoidance learning with the aim to reduce disability levels. We first present experimental evidence on avoidance learning from a general psychological perspective. We then illustrate how functional analysis can help therapists understand and address individual drivers of pain avoidance behavior. Finally, we explore how the network theory can translate the principles of functional analysis into statistical parameters using intensive longitudinal data, potentially making exposure experiments more relevant to the daily lives of individuals.

Biased attention allocation in major depressive disorder: A replication and exploration of the potential effects of depression history

BACKGROUND

Increased attention allocation to negative-valenced information and decreased attention allocation to positive-valenced information have been implicated in the etiology and maintenance of depression. The Matrix task, a free-viewing eye-tracking attention assessment task, has shown corroborating results, coupled with adequate reliability. Yet, replication efforts are still needed. Therefore, we replicated a previously published study in depression, using the same task and attention measures. We also explored the potential added effect of depression history on attention allocation.

METHODS

Participants diagnosed with major depressive disorder (n = 65) and a matched control group of healthy participants (n = 37) freely viewed 60 different face matrices, each presented for six seconds and comprised of eight sad and eight happy faces. Attention allocation to corresponding areas of interest (AOIs) was compared, and the internal consistency of attention allocation measures was assessed. We then compared the attention allocation of participants amidst their first episode (n = 33) to that of participants with a recurrent depressive episode (n = 32).

RESULTS

A significant group-by-stimulus type (happy vs. sad faces) interaction emerged for total dwell time, replicating the findings of the original study. Groups differed on attention allocation to both the sad and happy faces. No findings emerged for first fixation measures. Internal consistency of the total dwell time measure was high. Depression history had no effect on attention allocation.

LIMITATIONS

Due to ethical constraints (delay of treatment), test-retest reliability was not assessed.

CONCLUSIONS

The Matrix task provides a reliable and replicable measure of attention allocation in MDD, showing no effects for depression history.

Risky sexual behavior and associated factors among people with severe mental illness in Africa: A systematic review and meta-analysis

BACKGROUND

Individuals, who suffer from severe mental illnesses (SMI), such as bipolar disorder (BD), schizophrenia (SCZ), and major depressive disorder (MDD), are more likely to engage in risky sexual behavior. A severe mental illness can lead to a decrease in impulse control, a reduction in cognitive function and memory, and a psychosocial impairment that increases risky sexual behavior. Risky sexual behavior (RSB) can lead to health problems such as sexually transmitted infections, including HIV/AIDS, early pregnancy, and unplanned pregnancies. The purpose of this systematic review and meta-analysis was to determine the pooled prevalence of risky sexual behavior and factors among individuals with severe mental illness in Africa.

METHOD

A systematic review of observational studies: cross-sectional and prospective cohort studies published between 2009 and 2022 that reported relative risks (RR) and odd ratios (OR) that had explicit the prevalence of RSB. We conducted primary article searches in PubMed/MEDLINE, Scopus, African Journal Online, PsycINFO, EMBASE, Psychiatry Online, CINAHL, Science Direct, and the Cochrane Library. This review's included studies were critically appraised, and those with scores >5 were included in the meta-analysis. Meta-regression was used to investigate other reasons for heterogeneity in the dataset.

RESULTS

This systematic review and meta-analysis includes twelve main studies with a total of 3625 participants, of whom 1605 were male and 2020 were female. The pooled prevalence of RSB among people with severe mental illness in Africa was 43.4 % (95 % CI 34.56-52.23). Being male OR = 2.83 (95 % CI 1.96-4.08), having active mania symptoms OR = 2.07(95 % CI 1.35-3.18), young adults OR = 2.79 (95 % CI 1.27-6.16), and current use of alcohol OR = 2.55 (95 % CI 1.71-3.79) were significantly associated with risky sexual behavior in this review.

CONCLUSION

This systematic review and meta-analysis revealed a high prevalence of risky sexual behavior (RSB) among individuals with severe mental illness in Africa, highlighting a critical public health concern. Several important factors were significantly associated with RSB in this population: being male, having active mania symptoms, young adults, and current alcohol use. These findings emphasize the need for targeted interventions and comprehensive support systems to address the behavioral and environmental risk factors that contribute to RSB in individuals with severe mental illness. Preventive strategies, including gender-sensitive approaches, integrated mental health and substance use services, and age-specific interventions, are essential to mitigate the risks associated with RSB and improve overall well-being in this vulnerable population.

Validity Evidence for an Observational Fidelity Measure to Inform Scale-Up of Evidence-Based Interventions

As evidence-based interventions are scaled, fidelity of implementation, and thus effectiveness, often wanes. Validated fidelity measures can improve researchers' ability to attribute outcomes to the intervention and help practitioners feel more confident in implementing the intervention as intended. We aim to provide a model for the validation of fidelity observation protocols to guide future research studying evidence-based interventions scaled-up under real-world conditions. We describe a process to build evidence of validity for items within the Session Review Form, an observational tool measuring fidelity to interactive drug prevention programs such as the Botvin LifeSkills Training program. Following Kane's (2006) assumptions framework requiring that validity evidence be built across four areas (scoring, generalizability, extrapolation, and decision), confirmatory factor analysis supported the hypothesized two-factor structure measuring quality of delivery (seven items assessing how well the material is implemented) and participant responsiveness (three items evaluating how well the intervention is received), and measurement invariance tests suggested the structure held across grade level and schools serving different student populations. These findings provide some evidence supporting the extrapolation assumption, though additional research is warranted since a more complete overall depiction of the validity argument is needed to evaluate fidelity measures.

Beyond Surviving: A Glimpse Into Jewish-Israeli Women's Recovery Trajectories After Experiencing Intimate Partner Violence

The present study identifies and articulates the recovery trajectories of 12 Jewish-Israeli women who experienced intimate partner violence. An interpretative phenomenological analysis of the Clinical Ethnographic Narrative interviews revealed three central themes. The first theme dealt with the chronology of the violence and its escalation. The second theme described the turning points that facilitated the termination of the violent relationship. The third theme reflects these women's attempts to regain control and fulfil their needs for competence, autonomy, and relatedness. The findings are discussed through the lens of Jewish-Israeli culture, which is child-oriented and underscores the centrality of motherhood.

Measuring fidelity of brief cognitive behavior therapy for insomnia: Development, reliability and validity

PURPOSE

Measuring fidelity is critical in program evaluations to assess how implementation influences outcomes. Implementer fidelity is comprised of adherence to the treatment content and competence of treatment delivery. Cognitive behavioral therapy for insomnia (CBT-I) is well-established and empirically supported with variants such as brief CBTi (bCBTi) showing promise in reducing both insomnia and depression. The impact of therapist fidelity on treatment outcomes is unknown in part because reliable measures have not been available. We developed measures of therapist fidelity for bCBT-i and assessed the impact of fidelity in the context of a pilot study with veterans in primary care.

METHODS/RESULTS

Audio recordings from 23 participants (78 % male) were coded. Therapist adherence measures were created for each session along with a single measure of therapist competence. Inter-rater reliability was established and predictive validity was determined. For total adherence, inter-rater reliability was excellent across sessions (ICC =.73 -.80). The competence measure showed good reliability across all sessions (ICC =.57) and was internally consistent (Cronbach's alpha =.75). There was only 10 % of shared variance between adherence and competence. All of the fidelity measures demonstrated associations with outcomes in the predicted direction; therapist adherence was significantly associated with decreased depression.

SPLASH Into Fitness: A Swimming-Based Pilot Intervention to Promote Healthful Identities and Behaviors Among Preadolescent Girls

BACKGROUND

Girls' physical activity and healthful eating behaviors decline throughout adolescence. These trajectories may be linked to the underdevelopment of exercise and healthful eater identities. Youth programs might consider prioritizing identity development as an innovative health promotion strategy, especially during the formative preadolescent life stage.

OBJECTIVES

This study examines healthful identities and behaviors among a sample of preadolescent girls who participated in SPLASH, a multicomponent youth program consisting of identity development ("I am an exerciser"; "I am a healthy eater"), physical activity, and healthful eating.

METHODS

SPLASH was piloted in a community-based recreational facility in the Midwest United States. Participants had differing levels of program access: all girls (N = 32, age = 10.6 ± 0.8) attended a 1-week summer day camp, and a subset (n = 16) received supplementary access to a 10-week eHealth program. Using a feasibility framework, we examined SPLASH's (1) preliminary efficacy, (2) implementation, and (3) acceptability.

RESULTS

Girls' exercise identities and behaviors improved following camp participation. At follow-up, those in the camp-plus-eHealth group reported greater improvements in physical activity enjoyment relative to girls in the camp-only group.

CONCLUSIONS

SPLASH is a promising identity-focused health promotion program for preadolescent girls. Community support and family engagement facilitated this pilot study. Programmatic impact should be assessed in additional communities.

Telehealth Lifestyle Pilot Study for Improving Occupational Performance in Older Adults

Occupation-centered lifestyle interventions improve health and delay age-related declines in older adults; however, little is known about the impact of a brief telehealth lifestyle program delivered individually. This pilot investigated the Holistic Occupational Performance Empowerment (HOPE) program on occupational performance and health-related quality of life. Twelve community-dwelling older adults completed six weekly lifestyle sessions to enhance behavior change toward individualized health goals. Goal Attainment Scaling (GAS) and the Short Form 20-Item Survey (SF-20) were administered preintervention and postintervention to measure program outcomes. Among 36 health-related goals, 69.4% achieved or exceeded the expected level of attainment. A paired samples t-test revealed statistically higher posttest GAS scores compared with pretest scores, indicating significant improvements in occupational performance. SF-20 mental health scores increased postintervention, although not significantly. Preliminary findings suggest that HOPE could positively impact occupational performance in community-dwelling older adults warranting a future large-scale randomized controlled trial.

Recent advances in the treatment of chronic pain and substance use disorders

Among people with substance use disorders (SUDs), chronic pain is among the most common comorbid chronic health conditions. Chronic pain increases risk for poor SUD treatment outcomes, including risk for overdose. Given rising overdose rates across North America, a renewed research focus has emerged to better understand the contribution and treatment of chronic pain in the context of an SUD. A significant portion of this research has focused on behavioral interventions given their safety and efficacy in treating both conditions separately. Therefore, this article will describe the recent advances in the treatment of chronic pain and SUD, including promising care delivery models and behavioral treatments. Areas for further study will also be reviewed.

Treatment for substance use disorder in mothers of young children: A systematic review of maternal substance use and child mental health outcomes

Substance use disorders (SUD) in mothers of young children can negatively impact the family unit and promote the intergenerational cycle of mental health disorders. This systematic review aims to: 1) provide an overview of substance use treatments for mothers of young children (from birth to 5 years old); 2) synthesize findings on maternal substance use and child/maternal mental health outcomes; and 3) identify key treatment components. Database searches in Medline, PsycINFO, PubMED, and PsycARTICLES were conducted on May 7th, 2024. A total of 14, 916 articles were identified following duplicate removal. Articles were screened following PRISMA guidelines. Eight articles (n = 900) met inclusion criteria. Outcomes of interest included maternal substance use, child/maternal mental health, and treatment components. All studies indicated maternal substance use treatments were at least as, or more, effective in improving maternal substance use and child/maternal mental health outcomes compared to controls. Treatment components included: mother/family mental health, basic needs, parenting skills, occupation/education, operant conditioning, crisis management, and medical education. Operant conditioning was the only treatment component which appeared to positively impact maternal substance use outcomes; no other treatment components were associated with outcomes of interest. This review provides preliminary evidence highlighting the benefits of substance use treatments for mothers of young children on substance use and mental health outcomes. Future randomized controlled trials with harmonized outcome measures and qualitative data that identifies treatment needs of mothers with lived experience are crucial to evaluate maternal substance use treatments and improve treatment development.

Concordance of Mother and Father Reports of Intimate Partner Violence and Observed Interactions in Unmarried Black Coparents Expecting Their First Child

Concordance between partner reports of Intimate Partner Violence (IPV) is generally low, but self-reporting of IPV and concordance between partners among expectant parents in marginalized communities has not been explored, nor have associations among each partner's reports of IPV and their behaviors in observed conflict discussions. This study will examine these gaps. One hundred and thirty-eight low-income, unmarried, Black, coparenting dyads expecting their first child together (136 mothers and 136 fathers) completed the Revised-Conflict Tactics Scale and a video recorded and coded conflict discussion. There was low concordance between parent's reports of IPV overall with moderate levels of concordance for coparents who were living together and had more harmonious relationships. Linear regression analyses indicated only mothers' reports of fathers' psychological and physical IPV but not fathers' reports of IPV were significantly associated with observed negative communication. Neither coparents' reports of psychological or physical IPV were associated with positive communication during a conflict discussion. These findings suggest that at the time of parenthood transitions, mothers' reports of fathers' IPV behaviors may be more robust in their association with negative/unhealthy couple communication patterns than fathers' reports and should be used when making safety determinations with families.

Implementing a group-based online mental well-being program for women living with and beyond breast cancer - A mixed methods study

PURPOSE

There is a gap in available mental well-being services in Australia for women diagnosed with breast cancer. This pilot mixed-methods uncontrolled study aimed to assess the feasibility of an online mental health and well-being intervention, the Be Well Plan (BWP), which enables participants to create a personalized, flexible well-being strategy.

METHODS

Women diagnosed with stages I-IV breast cancer were recruited into 4 asynchronous groups to participate in the BWP, a 5-week facilitator-led group-based mental health and well-being program. Psychological measures used at baseline and post-intervention included: the Warwick Edinburgh Mental Well-Being Scale, Brief Resilience Scale, Self-compassion Scale, 9-item Patient Health Questionnaire, 7-item General Anxiety Disorder scale, and EORC QLQ-C30. Multivariate analysis of variance and effect sizes were calculated on pre- and post-psychological measures, followed by qualitative content analysis on post-completion interviews with participants.

RESULTS

Nineteen women (mean age 45.7, standard deviation = 7.74) were included in the study. Large effect sizes were reported for mental well-being, depressive symptoms, and anxiety (partial ω2 = 0.28, 0.21, and 0.20, respectively). Self-compassion, resilience, and quality of life results were not statistically significant. Qualitative content analysis provided insight into experiences with Program Delivery Experience, Application of the BWP, Mental Health Improvements, Supporter Involvement, Adopted Interventions, and Recruitment. Participants reported benefits in mindfulness, grounding techniques, and physical activities.

CONCLUSION

The BWP has the potential to be an effective intervention to support the mental health and well-being of breast cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

This study highlights flexible interventions that accommodate the diverse needs of breast cancer survivors to improve mental well-being and alleviate psychological distress.

Associations between cannabis use and same-day health and substance use behaviors

OBJECTIVE

Cannabis use has increased in the United States as states have legalized/decriminalized recreational and/or medicinal use. The primary aim of this study was to examine daily associations between cannabis use and health (physical activity [PA]) and substance use (alcohol consumption, cigarette use) behaviors.

METHOD

Data from a 28-day nationwide study that prompted daily ecological momentary assessments (EMAs) were used to assess daily cannabis use, moderate-to-vigorous PA (MVPA), alcohol containing drinks consumed, and cigarettes smoked. Only participants who reported cannabis use on at least one day during the study period were included in the analysis (N = 98). Generalized linear mixed models were used to examine associations between cannabis use and same-day health and substance use behaviors while adjusting for race, biological sex, and age.

RESULTS

Daily cannabis use was positively associated with daily PA (p = 0.04, 3.31-minute higher PA duration on use vs. non-use days), number of alcohol containing drinks consumed (p = 0.01, 0.45 more drinks on use vs. non-use days), and number of cigarettes smoked (p = 0.01, 0.63 more cigarettes on use vs. non-use days).

CONCLUSIONS

This study was among the first to use EMAs to examine associations between daily cannabis use and same-day PA, alcohol consumption, and cigarette use. Overall, findings indicated that daily cannabis use is associated with higher engagement in these daily health and substance use behaviors. Further research is needed to understand mechanisms linking cannabis use with these and other behaviors.

Brief interventions for chronic pain: Approaches and evidence

Various countries have published national guidance supporting the integration of behavioral approaches into chronic pain treatment. Yet multiple barriers prevent broad patient access. Brief treatment formats may address universal shortcomings of therapists and resources and offer patients expanded access to care through lower costs and treatment burdens. This article summarizes published evidence for eight identified therapist delivered brief behavioral pain interventions (operationalized as 1-4 treatment sessions or ≤8 h total treatment time) for adults with chronic pain (≥18 years of age) including a description of the treatment approach, implementation features, evidence to date, and salient points. The discussion includes current clinical dissemination and future directions that leverage technology to enhance patient access to behavioral pain care.

In Coping with Intimate Partner Violence, Women's Beliefs About Forgiveness Matter

Women who experience intimate partner violence (IPV) often feel pressured to forgive their abusers and remain in dangerous relationships. However, forgiveness does not have to include reconciliation and it may be conceptualized in different ways. This quantitative study surveyed 110 women who experienced IPV from men and separated from their abusers. It then examined (a) the prevalence of 20 different beliefs about forgiveness and (b) the relationship between those beliefs, the women's self-reported practices of forgiveness, and the women's intent to return to their abusers. The study asked whether different beliefs about forgiveness were-in combination with different levels of forgiveness-associated with intent to return to abusers. It found that women's beliefs about forgiveness varied widely, but only 4.6% of the women believed that forgiveness involved reconciliation. In contrast, 80% of the women believed it was simultaneously possible to forgive and to avoid the men who hurt them. When interaction analyses were conducted, significant interactions were found between three beliefs and women's self-reported practices of forgiveness. For two beliefs, the interactions were positively associated with intent to return to abusers (i.e., a belief that forgiveness involves reconciliation, and a belief that forgiveness involves treating a person better than before). For one belief, the interaction was negatively associated with intent to return (i.e., the belief that it is possible both to forgive and to avoid a person). Results suggest that women's beliefs about forgiveness matter. Women are more likely to return to abusers if they believe forgiveness involves reconciliation or treating their abusers better than before. They are less likely to return, if they believe it is possible to forgive their abusers and still avoid them. Interventions targeting women's beliefs about forgiveness may increase their safety.

Adoption and social identity loss: Insights from adults adopted through Ireland's mother and baby homes

A central issue in adoption research is understanding why some individuals adapt to their adoption experience while others face considerable difficulties. The social identity approach (SIA) offers a valuable framework for examining this. Recent research has increasingly shown that identifying with social groups can protect and promote well-being. However, in the context of adoption, certain groups may also present challenges or become sources of strain. The present study seeks to understand how social identities shape individuals' adoption experiences. Semi-structured interviews (N = 16) with adults who were adopted through Mother and Baby Homes in Ireland were analysed using reflexive thematic analysis. The analysis produced two interrelated themes: (1) 'Adopted' as a social identity, which explores how participants' 'adopted' status itself constitutes a significant social identity, leading to experiences of marginalization and exclusion and (2) Adoption as social identity loss, which describes how participants face contested membership and compromised belonging within important social groups. Both themes illustrate how the process of adoption can result in social identity loss. Discussion of this analysis considers the consequences of social identity change for adoption adjustment. These findings expand the theoretical application of the SIA, in the context of adoption.

The acculturation challenge: A longitudinal investigation of acculturative stress and mental health of Chinese international students in Australia

The Australian university sector had almost one million international students in 2024. This population faces significant mental health challenges that affect their wellbeing and academic success, but these issues have received minimal empirical attention. Past research reports that international students experience acculturative stress due to language barriers, lack of social support, and discrimination, which contribute to poor mental health. Current evidence lacks insight into the progression of acculturative stress over time. To address this gap, this study conducted a longitudinal investigation of the mental health profiles of 140 Chinese international tertiary students in Australia and 84 Chinese tertiary students in China (Mage = 22.4, SD = 2.7). Participants in Australia were assessed in 2023 after their arrival (T1) and then five months later (T2). Contrary to expectations, the groups did not differ on standardised measures of distress, loneliness, wellbeing, social support, and resilience. However, Chinese students reported greater acculturative stress, as measured by the Acculturative Stress Scale for International Students (ASSIS), at T2 than at T1. Participants reported that the most significant challenge in adapting to life in Australia were language barriers and communication difficulties (84.3 %), which were rated more frequently than the academic demands of university (55.0 %). Potential methodological limitations aside, the results suggest that Chinese students may benefit from resources, supports, and interventions that target specific areas of acculturative stress, particularly in relation to language proficiency, to optimise their health and study.

How therapist effects shape pain-related outcome improvement in psychological treatments for chronic pain

Psychological chronic pain treatments have variable efficacy across individual patients, and on average tend to produce modest effects. In order to improve treatment outcomes, the past decade has seen a rapid increase in research focused on determining the mechanisms underlying treatment-related gains. The near exclusive focus of this research has been on uncovering patient-related mediators and moderators. However, treatment is delivered within the context of a patient-therapist dyad, and the dynamic contribution of therapist-related factors in influencing this dyad and patient outcomes has remained largely unexamined. The purpose of the current paper is to consider the unique contributions of therapist-related factors within our proposed "Top 3" dynamic, candidate contextual mechanisms: therapeutic working alliance, group climate/cohesion (i.e., in group therapy), and therapist quality. We define these process variables, identify validated measures, and review research documenting their effects on outcomes, drawing from the pain and broader psychotherapy literature. It is well established that some therapists are more effective than others, with so-called exceptional (i.e., not merely competent) therapists shown to produce effect sizes twice as large and demonstrate up to ten times better patient response rates. We focus on identifying the behaviors that such exceptional therapists engage in to harness the working alliance, build and maintain group cohesion and skilfully deliver and train patients in various therapeutic techniques. Future pain treatment outcome research evaluating the role of therapists in these "Top 3" process variables has the potential to provide novel insights into treatment mechanisms, inform therapist training, and to advance precision medicine.

An Examination of predictors of prospective changes in self-reported drinker identity and changes in drinker identity as a predictor of changes in alcohol use and associated consequences

PURPOSE

Self-reported drinker identity, the extent to which one views oneself as a drinker, is associated with alcohol consumption and related harms in young adults. The current study examined changes in self-reported drinker identity, theoretically relevant factors associated with drinker identity development, and drinker identity's association with changes in drinking and alcohol-related consequences. We hypothesized that drinker identity would increase over time; theoretically relevant factors would be significantly and positively associated with that increase, and increases in drinking identity would be associated with elevated drinking and related consequences.

METHOD

Participants were 588 heavy-drinking college students (63 % female, 50.5 % White, Meanage = 19.87, from two universities) reporting recent heavy episodic drinking and experiencing alcohol-related consequences in the previous month. Students completed baseline and follow-up assessments at 1-, 3-, and 6-months related to theoretically relevant factors, drinker identity, and drinking/related consequences.

RESULTS

Using parallel process latent growth curve modeling, we examined changes in drinker identity as a function of initial levels and changes in theoretically relevant factors. We also examined changes in alcohol use and related consequences as a function of changes in drinker identity. Results indicated that a more favorable initial attitude toward heavy drinking and an increase in favorable attitude toward heavy drinking were associated with an increase in drinker identity. Overall, alcohol use and associated consequences diminished over time, but increases in drinker identity were associated with smaller reductions in alcohol outcomes.

CONCLUSIONS

The study highlights the importance of attitudes as a potential contributing factor to drinker identity development, particularly among college students who drink heavily. This work further demonstrates a link between changes in drinker identity and changes in drinking and associated consequences. This work can inform future interventions aimed at targeting drinking identity.

Lived experiences of mothers: A longitudinal study of impacts and adjustment following adolescent psychiatric hospitalization for suicide attempts or other reasons

INTRODUCTION

Parents play crucial roles in monitoring and supporting youth who have been hospitalized after suicide attempts, but their adjustment in the period following hospitalization has been understudied. This study assessed the adjustment and impacts on mothers during the year following hospitalization.

METHOD

Participants included 135 mothers of suicidal adolescents and 117 mothers of adolescents hospitalized for other reasons. The Structured Clinical Interview for DSM (SCID) and the Child and Adolescent Impact Assessment were used to assess psychiatric diagnoses of Major Depressive Disorder [MDD], Generalized Anxiety Disorder [GAD], and Post-Traumatic Stress Disorder [PTSD], and impacts on caregivers at one, three, six, and 12 months after hospitalization.

RESULTS

Higher rates of MDD, GAD, and PTSD, and greater impacts were evidenced closer in time to the hospitalization. There were few overall differences between mothers of youth with and without suicidal behavior. However, family history of suicidal behavior was related to higher rates of MDD and PTSD, and greater severity of youth suicidal thoughts and behavior over the follow-up was related to greater impact upon mothers of suicidal youth.

CONCLUSIONS

This study highlights the mental health struggles of mothers of suicidal and other hospitalized youth and underscores the importance of support for caregivers.

A Mixed Methods Effectiveness Study of a Peer Support Intervention for Older Adults During the COVID-19 Pandemic: Results of a Randomized Clinical Trial

OBJECTIVE

Low-income white older adults and those of color are at greater risk for depression but less likely to receive care. We evaluated the impact of a one-to-one peer support intervention compared to active control delivered by nonpeers for this population.

DESIGN

Mixed methods, single-blind randomized controlled trial.

SETTING

Community-based social service and aging organizations and geriatric primary care.

PARTICIPANTS

Low-income white older adults and those of color 50+ with depression.

INTERVENTIONS

Peer Enhanced Depression Care and nonpeer, social interaction control.

MEASUREMENTS

Primary outcome was depression (PHQ-9). Data were collected at baseline, postinterventions, 3, 6, 9, and 12 months. Poststudy interviews were conducted with both groups.

RESULTS

Among 149 randomized participants, the mean age was 70, 84% were women, 52% Black and 41% White. Both groups experienced an average decrease of 3.7 (SE: 0.55, 95% CI: [-4.77, -2.63]) points in depression from baseline to postintervention and 2.56 (SE: 0.71, 95% CI: [-3.95, -1.17]) points from baseline to 12 months. Effect sizes at postintervention (Cohen's d = 0.81) and at 12-months (Cohen's d = 0.52) indicate large and medium effects, respectively. Both groups experienced decreases in loneliness and increases in adaptive coping and self-efficacy. Qualitative findings suggest the intervention group learned coping skills and experienced behavior change, whereas control group described a general positive experience.

CONCLUSIONS

Peer support intervention was not superior to social interactions delivered by nonpeers. Divergent quantitative and qualitative results suggest the need for additional effectiveness trials of peer support interventions outside of pandemic conditions. Trial Registration ClinicalTrials.gov Identifier: NCT04319094.

Enhancing psychological assessment and treatment of chronic pain: A research agenda for personalized and process-based approaches

The heterogeneity of chronic pain and stagnating improvements in treatment effectiveness have prompted calls for a shift toward personalized and process-based approaches to the assessment and treatment of chronic pain. As this opens a new line of research, several fundamental questions arise. We begin by defining key terms and reviewing attempts to personalize treatment to date. Despite progress in personalization, long-term effects remain unclear. Existing studies are limited by group-based approaches that overlook individual variability. Future research should use idiographic methods and process-based therapy to tailor interventions to individual needs. A person- and process-oriented research agenda is needed that combines ambulatory assessment, network modeling, and single-case designs to advance personalized treatments for chronic pain and improve clinical decision-making.

Psychological treatments for comorbid chronic pain and opioid use disorder: Current research and future directions

Chronic pain and opioid use disorder cause significant social, physical, and economic burdens on individuals and society. Historically, chronic pain and opioid use disorder have been treated individually, yet they often are comorbid conditions and treatment targeting both concurrently might improve outcomes. This article reviewed psychological treatment approaches for comorbid chronic pain and opioid use disorder. Treatments were classified as cognitive behavioral therapy-based, mindfulness-based, or integrated treatments. Treatments were primarily delivered in-person other than a cognitive behavioral digital health approach. Mindfulness-based and integrated interventions demonstrated the best outcomes. Given the significant public health burden from comorbid chronic pain and opioid use disorder, there is an urgent need for increased research and implementation of psychological treatments for these conditions.

Optimizing the Prediction of Depression Remission: A Longitudinal Machine Learning Approach

Decisions about when to change antidepressant treatment are complex and benefit from accurate prediction of treatment outcome. Prognostic accuracy can be enhanced by incorporating repeated assessments of symptom severity collected during treatment. Participants (n = 714) from the Genome-Based Therapeutic Drugs for Depression study received escitalopram or nortriptyline over 12 weeks. Remission was defined as scoring ≤ 7 on the Hamilton Rating Scale. Predictors included demographic, clinical, and genetic variables (at 0 weeks) and measures of symptom severity (at 0, 2, 4, and 6 weeks). Longitudinal descriptors extracted with growth curves and topological data analysis were used to inform prediction of remission. Repeated assessments produced gradual and drug-specific improvements in predictive performance. By Week 4, models' discrimination in all samples reached levels that might usefully inform treatment decisions (area under the receiver operating curve (AUC) = 0.777 for nortriptyline; AUC = 0.807 for escitalopram; AUC = 0.794 for combined sample). Decisions around switching or modifying treatments for depression can be informed by repeated symptom assessments collected during treatment, but not until 4 weeks after the start of treatment.

Prediction of electroconvulsive therapy outcome: A network analysis approach

OBJECTIVE

While electroconvulsive therapy (ECT) for the treatment of major depressive disorder is effective, individual response is variable and difficult to predict. These difficulties may in part result from heterogeneity at the symptom level. We aim to predict remission using baseline depression symptoms, taking the associations among symptoms into account, by using a network analysis approach.

METHOD

We combined individual patient data from two randomized controlled trials (total N = 161) and estimated a Mixed Graphical Model to estimate which baseline depression symptoms (corresponding to HRSD-17 items) uniquely predicted remission (defined as either HRSD≤7 or MADRS<10). We included study as moderator to evaluate study heterogeneity. For symptoms directly predictive of remission we computed odds ratios.

RESULTS

Three baseline symptoms were uniquely predictive of remission: suicidality negatively predicted remission (OR = 0.75; bootstrapped confidence interval (bCI) = 0.44-1.00) whereas retardation (OR = 1.21; bCI = 1.00-2.02) and hypochondriasis (OR = 1.31; bCI = 1.00-2.25) positively predicted remission. The estimated effects did not differ across trials as no moderation effects were found.

CONCLUSION

By using a network analysis approach this study identified that the presence of suicidal ideation predicts an overall worse treatment outcome. Psychomotor retardation and hypochondriasis, on the other hand, seem to be associated with a better outcome.

When less is more: Short-Term efficacy of a gamified personalized normative feedback intervention for college students

Despite various intervention efforts, college drinking remains a concern, and while personalized normative feedback (PNF) has proven effective, attempts to deliver it in a way that minimizes reactance and maximizes student engagement have been slow to emerge. This study examined the short-term effects of CampusGandr, a mobile gamified PNF intervention for college students. The game took place over 16 weeks (1 round per week) during the fall semester and included weekly PNF on various topics related to college life, including alcohol. Participants (N = 1,143) were recruited from universities in Texas and California and randomized into one of three conditions: no alcohol feedback (NAF), less alcohol feedback (LAF; delivered in 3 rounds), and more alcohol feedback (MAF; delivered in 6 rounds). Number of alcohol and non-alcohol feedback participants viewed was objectively tracked in CampusGandr. Relative to NAF, there were no significant effects for LAF or MAF on descriptive drinking norms or on drinking (any drinks consumed and typical number of drinks per week consumed) one-month post-intervention. However, a significant quadratic effect emerged between the number of alcohol feedbacks viewed and having consumed any drinks, indicating decreased odds of having consumed any alcohol at the follow-up with up to three alcohol feedbacks. Number of alcohol feedbacks viewed was also related to decreases in norms. Thus, despite a lack of evidence for differences in drinking between conditions, findings suggest future research is needed to explore the optimal dosage and timing of alcohol feedback within gamified interventions like CampusGandr.

The road to Aha: A recipe for mental breakthroughs

We present a novel framework for understanding the diverse spectrum of mental breakthrough events, ranging from problem-solving insights to profound personal transformations. We propose that these events, while varied in expression and impact, share common underlying mechanisms of representational change. We also hypothesise that the differences in phenomenological intensity can be conceptualized along a continuum. Central to our model are three core components - tension, altered salience, and enhanced flexibility - which we identify as essential prerequisites for significant cognitive restructuring. These components interact within an iterative cycle, influencing both the emergence and nature of insight experiences. Drawing on examples from different fields, we explore how a conflict between existing models can trigger this cycle, wherein mechanisms of attention allocation and relaxation of constraints work in tandem to facilitate the emergence of insights. Furthermore, we propose that the intensity of the "aha-moment" and the breadth of its impact are contingent on how central the conflict is within one's conceptual landscape and the extent to which existing mental models are challenged. Thus, the model accounts for both the subtle, momentary insights in problem-solving and the transformative realizations that reshape core beliefs and self-perception. By synthesising insights from various domains, including psychotherapy, contemplative science, and psychedelic research, we present a theoretical account with broad scope, aiming to shed light on the complex processes that can lead to a wide array of mental breakthroughs, thereby contributing to the understanding of insight phenomena across disciplines.

The Dialectical Relationship Between Burnout and Work Engagement: A Network Approach

Based on previous empirical evidence, scholars have argued for a dialectical relationship between burnout and work engagement. However, these conclusions largely rely on latent variable models, which have inherent limitations due to strong hierarchical assumptions about data. As a result, previous findings should be considered preliminary indications rather than conclusive evidence. In this study, we introduce network analysis to investigate the relationship between burnout and work engagement. We demonstrate its utility by comparing the fit indices of the network model and three factor models in a cross-national sample with 2469 employees from Norway and 879 employees from the US and UK. Based on theory and fit indices, we conclude that the network model was preferred in both samples. Using this model, we uncovered positive relationships between two work engagement variables and the exhaustion component of burnout. Theoretically, this study broadens our understanding and show support for the dialectical relationship between burnout and work engagement. Furthermore, by introducing the network model to empirical research, we provide a novel approach that contribute to nuance and ideas for research on burnout and work engagement. Practically, our results offer insightful data on possible points for intervention between burnout and work engagement variables.

A Conditional Process Analysis of Microaffirmations, Microaggressions, and Mental Health Among Thai Sexual Minorities

Sexual orientation (SO) microaggressions contribute to mental health issues among sexual minorities. Microaffirmations may mitigate these effects, with internalized heterosexism and SO concealment proposed as mediators. A community sample of 307 Thai sexual minorities completed measures assessing SO microaggressions, microaffirmations, internalized heterosexism, SO concealment, and mental health concerns. Serial mediation analysis using Hayes' PROCESS macro model 6 tested indirect effects through proposed mediators. Conditional process analysis using PROCESS model 85 examined the moderating role of microaffirmations. These models tested hypothesized moderated serial mediation relationships among study variables. SO microaggressions had a total effect on mental health concerns, directly and indirectly through increased SO concealment. The internalized heterosexism → SO concealment sequence mediated this relationship. Microaffirmations moderated the direct microaggressions-mental health link, reducing this association at higher levels of microaffirmations. The full model accounted for 31.6% of the variance (R2 = 0.316) in mental health concerns. The Johnson-Neyman technique identified 0.613 as the microaffirmations value above which the effect of SO microaggressions on mental health was no longer significant. Findings elucidate mechanisms linking SO microaggressions to mental health issues and microaffirmations' protective role among Thai sexual minorities. These results could inform efforts to mitigate minority stress impacts.

Effects of family cognitive therapy on aggressive behavior, family functioning, and marital quality in patients with major depression

BACKGROUND

Depression is a prevalent mental health disorder with significant impacts on individuals and families. We hypothesize that combining family cognitive therapy (FCT) with pharmacotherapy will be more effective in managing depression and improving family dynamics than pharmacotherapy alone.

AIM

To investigate the effects of FCT combined with sertraline on depression, aggressive behavior, and family functioning in patients with major depressive disorder (MDD).

METHODS

This study involved 178 patients diagnosed with MDD at the Shaoxing 7th People's Hospital from January 2022 to April 2024. Patients were divided into two groups according to whether they received FCT. FCT included both patient-focused cognitive therapy and family-focused psychological guidance over a 12-week period.

RESULTS

The observation group receiving combined treatment showed significantly greater reductions in depressive symptoms (Beck Depression Inventory scores: 27.4 ± 4.7 to 18.6 ± 5.2) compared to the control group (28.1 ± 5.5 to 20.9 ± 4.9), with P = 0.031 for the difference between groups. Improvements in family functioning and marital quality were also observed, with P < 0.001 for key dimensions on the Family Assessment Device and Enrich Marital Scale.

CONCLUSION

The combination of FCT with sertraline effectively reduces depressive symptoms and improves family dynamics in patients with MDD.

Divergent changes in social stress-induced motivation in male and female mice

Exposure to stressors has been shown to dysregulate motivated behaviors in a bidirectional manner over time. The relationship between stress and motivation is relevant to psychological disorders, including depression, binge eating, and substance use disorder; however, this relationship is not well characterized, especially in females, despite their increased risk of these disorders. Social defeat stress is a common model to study stress-induced motivation changes, however, historically this model excluded females due to lack of female-to-female aggression and unreliable male-to-female aggression. Additionally, changes in motivation are often assessed well after stress exposure ends, potentially missing or occluding changes to motivation during stress. Recently, the chronic non-discriminatory social defeat stress (CNSDS) model has demonstrated social defeat of male and female C57BL/6J mice by simultaneously exposing both mice to an aggressive male CD-1 mouse. Here we use this model to directly compare changes in the motivated behavior of male and female mice during and following chronic stress. We hypothesized that motivated behavioral responses would be dysregulated during stress and that the effects would worsen as the stress exposure continued. To monitor motivated behavior, mice had access to a Feeding Experimental Device.3 (FED3), a home cage device for operant responding. Operant responding was monitored prior to, during, and after stress by measuring nose pokes for sucrose pellets on a modified progressive ratio schedule of reinforcement. Our results demonstrated divergent behavioral outcomes between males and female mice in response to stress; where male mice increased motivated behavior during stress only, whereas female mice exhibited a decrease in motivation during and after stress. This study highlights the need to investigate the effects of stress-induced motivation over time, as well as the increased need to understand differences in the stress response in females.

Psychosocial and cognitive determinants of 10-year depressive symptom trajectories in patients with cardiovascular disease: The SMART-Medea Study

BACKGROUND

Middle-aged and older adults presenting clinically relevant depressive symptoms are often undiagnosed. Understanding the determinants of late-life depressive symptoms could improve prognosis. Further, individuals with manifest cardiovascular disease (CVD) are at an increased risk of depression. This study investigated if psychosocial and cognitive factors are associated with depressive symptom trajectories in individuals with CVD.

METHODS

Longitudinal data from the SMART-Medea study of 752 participants (median age 62 years, women 18 %) with a history of CVD was used. Psychosocial determinants (i.e., history of depression, anxiety, neuroticism, locus of control, adverse childhood events, recent adverse events, social support, and somatization) and cognition (i.e., memory functioning, working memory, executive functioning, and processing speed) were assessed via multinomial logistic regressions with depressive symptoms trajectories as outcome (i.e., "never depressed" (reference), "energy/sleep difficulties", "mild depressive symptoms" and "fluctuating severe depression"). Depressive symptom trajectories were based off of longitudinal PHQ-9 scores and created using latent class analysis. Analyses were adjusted for age, sex/gender, and education.

RESULTS

All psychosocial factors were associated with depressive symptom trajectories, except for social support, with increasing associations from the "energy/sleep difficulties" to the "fluctuating severe depression". For cognitive factors, only memory functioning was associated with decreased odds of "fluctuating severe depression" (OR = 0.63, 95 % CI = 0.47-0.85).

LIMITATIONS

The study population consisted of mostly white male participants with CVD; thus, the generalizability to other populations is low.

CONCLUSIONS

Our findings emphasize that a wide range of psychosocial factors are associated with mild as well as severe trajectories of depressive symptoms in patients with manifest CVD. Focusing on psychosocial factors could improve one's prognosis of depressive symptomology.

Six-week engagement in after-school activities involving chemosensory education does not affect olfactory abilities and personal significance of olfaction in 9-11-year-olds: Preliminary evidence

Chemosensory learning is a lifelong process of acquiring perceptual expertise and semantic knowledge about chemical stimuli within the everyday environment. In the research context, it is usually simulated using olfactory training, which typically involves repeated exposure to a set of odors over a period of time. Following olfactory training, enhanced olfactory performance has been observed in adults, and similar evidence is beginning to emerge in children. However, the literature is scant concerning the effects of interventions that more closely resemble how chemosensory experience is acquired in daily life. Since children's chemosensory ecology appears to play a crucial role in olfactory development, we investigated whether engaging in activities that stimulate the chemical senses enhances olfactory performance and metacognition. To this end, we invited 20 children aged 9-11 years to participate in teacher-assisted after-school activities for 30-60 minutes a day for six weeks. During the odd weeks, the children appraised herbal and spice blends and used them to prepare dishes and make beauty products. During the even ones, they explored the city by smellwalking and created smellscape maps. The educational outcomes were evaluated using the Sniffin' Sticks test for odor identification and discrimination and the Children's Personal Significance of Olfaction. Bayesian analyses did not reveal any compelling evidence in support of the alternative hypothesis that children in the chemosensory education group outperform those in the comparison group at the post-test. Rates of reliable increase but also decrease in performance on the Sniffin' Sticks identification and discrimination tests were similar in both groups. We corroborated the previous findings regarding girls' and older children's greater proficiency at identifying odors and the female keener interest in the sense of smell. We offer several practical suggestions researchers may want to consider to tailor their research protocols to reflect more closely the broader context in which chemosensory learning takes place and better capture the nuanced outcomes of such interventions.

Atomoxetine Reduces Decisional Impulsivity in Human Cocaine Addiction

BACKGROUND

Impulsivity is a well-known determinant of maladaptive behavior in cocaine use disorder (CUD), but there are currently no effective strategies for managing excessive impulsivity. Growing evidence from preclinical and clinical studies suggests that atomoxetine, a selective noradrenaline reuptake inhibitor, is effective in improving impulse control in both healthy individuals and individuals with neuropsychiatric conditions.

METHODS

We investigated the effects of atomoxetine on decisional impulsivity in patients with CUD. In a randomized, double-blind, placebo-controlled, crossover study, 28 patients diagnosed with moderate-to-severe CUD and 28 matched healthy control participants completed the Cambridge Gambling Task in 2 separate sessions, where they received either placebo or a single dose of 40 mg atomoxetine at each session. Computational modeling was used to break down decision making into 3 separable components: value, probability, and decisional impulsivity.

RESULTS

Our analyses revealed that patients with CUD were impaired in all components of decision making. Atomoxetine selectively reduced decisional impulsivity in patients with CUD by reducing their risk-seeking tendencies while enhancing their ability to tolerate delays. By contrast, atomoxetine did not affect impulsivity in control participants, but increased their sensitivity to prospective losses.

CONCLUSIONS

Taken together, our findings support the hypothesis of noradrenergic dysfunction in patients with CUD and provide novel translational evidence for the efficacy of atomoxetine in remediating decisional impulsivity in CUD.

Prevalence of depressive symptoms in people aged 50 years and older: A retrospective cross-sectional study

BACKGROUND

Depression is a serious health problem worldwide and is often associated with disability and reduced quality of life. In aging societies, early recognition of depression in older adults is highly relevant. Therefore, this study investigated the prevalence of depressive symptoms in individuals aged 50 and older with the aim to identify those at risk for major depression.

METHODS

We performed a retrospective cross-sectional study with data from 1000BRAINS to assess depressive symptoms in a sample of 1017 healthy adults aged 50 and older. The prevalence and dimension of depressive symptoms were measured by the Beck Depression Inventory II, and differences between demographic, clinical, and lifestyle-associated variables and the prevalence of depressive symptoms were analyzed.

RESULTS

Depressive symptoms were present in 21.3 % of the participants and were minimal in 14.2 %, mild in 4.5 %, moderate in 1.8 %, and severe in 0.8 %. The prevalence of depressive symptoms was highest in the age group 50 to 59 years, and the prevalence of severe depressive symptoms decreased with increasing age. A positive family history of depression, cognitive impairment, medication intake, and polyneuropathy were associated with significantly higher levels of depressive symptoms.

LIMITATIONS

The retrospective cross-sectional design and evaluation of depressive symptoms by a self-rating instrument may limit the generalizability of the results.

CONCLUSION

This study supports earlier findings of a higher prevalence of depressive symptoms among older adults. The group aged 50 to 59 appears to be particularly affected. Additionally, poor physical health, greater cognitive impairment, and sex-specific factors appear to contribute to depressive symptomatology.

Minimizing patient burden in outcome monitoring: The case for abbreviated versions of PHQ-9, GAD-7 and WSAS

BACKGROUND

The Improving Access to Psychological Therapies (IAPT) program uses the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), and the Work and Social Adjustment Scale (WSAS) as part of their unique outcome monitoring system. To reduce patient burden, this study explored whether abbreviated versions of these questionnaires can be used to derive relevant outcome statistics with minimal loss of information.

METHODS

Using two samples (training; n = 1530, validation; n = 766), we examined whether existing short-forms, PHQ-4 and GAD-R3, would provide enough information to calculate relevant outcomes with near perfect agreement with the outcomes based on the original scales. We also examined 1) whether additional items would further improve the agreement between the abbreviated and original scales, and 2) alternative short-forms based on the sample-derived item information curves. The latter was also used to derive an abbreviated version of WSAS.

RESULTS

The abbreviated version derived from the item information curves provided the closest match with the original scales. A 5-item version of PHQ, a 4-item version of GAD, and a 3-item version of WSAS were correlated 0.95 with their original counterpart. Agreement as expressed by Cohen's kappa also suggested near perfect agreement for the outcomes (reliable) recovery rate and reliable improvement rate (>0.80). The outcome point estimates also matched very well (<2 % difference). Results were replicated in the validation sample.

CONCLUSION

The derived abbreviated versions can be used for the purpose of routine outcome monitoring with minimal loss of information and reduce patient burden with nearly 50 %.

Psycho-biological mechanisms involved in suicidal risk, suicide attempts, and aggression: A replication and extension in bipolar disorder

BACKGROUND

Despite studies showing the individual roles of childhood maltreatment, alexithymia, impulsivity, and biological markers in suicide and aggression in bipolar disorder (BD), combined influence of these factors has not been studied yet.

METHODS

This study aimed to explore this issue in 353 individuals with BD completing self-report and clinician-rated measures. Blood samples were also taken to evaluate biological markers.

RESULTS

Higher C-reactive protein (CRP) and triglycerides (TG) and lower total cholesterol (TC) were observed in alexithymic people. Individuals with childhood maltreatment showed elevated CRP and lower TC and high-density lipoprotein cholesterol (HDLC). Those with both alexithymia and maltreatment displayed the most adverse profile regarding CRP and lipids. Depressive and manic symptoms, suicidal ideation, and low TC and HDL-C were associated with suicide attempts, while age, depressive and manic symptoms, childhood maltreatment, alexithymia, impulsivity, CRP, and low HDL-C accounted for suicidal risk. Aggression was linked to gender, impulsivity, and reduced low-density lipoprotein cholesterol (LDL-C).

LIMITATIONS

A cross-sectional design is a limitation of the study.

CONCLUSION

The study underscores the relationships between psychological and altered biomarkers, particularly elevated CRP and decreased lipid levels, and their roles in contributing to suicide and aggression, proposing a psychobiological model in BD.

Mindfulness interventions and quality of life in anxiety-related disorders: A systematic review and meta-analysis

Mindfulness-based interventions (MBIs) effectively treat anxiety symptoms across different anxiety and related disorders (ARDs), including panic disorder, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. In this systematic review and meta-analysis, we investigate whether MBIs also lead to improvements in the quality of life (QoL) of patients with ARDs. A systematic review was performed through electronic search in PUBMED, PsycINFO, Embase, Web of Science, and Clinical Trials databases. The inclusion criteria comprised randomized controlled trials (RCTs) investigating individuals diagnosed with ARDs who underwent MBIs with QoL as an outcome. The review included 15 RCTs, encompassing 1.465 participants. Broadly speaking, we found that MBIs were more effective than control groups in improving QoL for individuals with ARDs (Standardized Mean Difference, SDM = 0.175, 95 % CI 0.048 to 0.303). Upon classifying studies by control group types, MBIs demonstrated greater effectiveness than non-gold standard interventions (SDM = 0.213, 95 % CI 0.053 to 0.372). Notably, no significant difference was found between MBIs and gold standard interventions (SDM = 0.061, 95 % CI -0.175 to 0.297). MBIs may effectively improve QoL in individuals with ARDs. Further studies with larger samples are needed for more robust conclusions.

Onset and offset of nonsuicidal self-injury prospectively associates with emotion regulation and suicide ideation in adolescents

OBJECTIVE

Suicide ideation and attempts are increasing for individuals between the ages of 15 and 24. Emotion dysregulation is a common factor that has been linked to many risky behaviors including NSSI and suicidal ideation. The current study aimed to longitudinally examine how the onset and offset of NSSI associated with changes in emotion regulation domains and suicidal ideation in a community sample of adolescents.

METHOD

Participants between the ages of 14-17 were asked about NSSI, emotion regulation, and suicide ideation at baseline and 6-month follow-up. Most adolescents reported no NSSI at either timepoint (n = 316; 83 %); 5 % (n = 20) reported NSSI at both time points, 6 % (n = 23) had onset NSSI, and 6 % (n = 23) had offset NSSI. NSSI change groups were compared on emotion regulation domains and suicide ideation across time.

RESULTS

Adolescents who consistently did or did not engage in NSSI across time did not report any changes in emotion dysregulation or suicide ideation. Adolescents who reported an onset of NSSI during the follow-up also reported an increase in lack of impulse control and suicide ideation severity. Adolescents who stopped engaging in NSSI during the follow-up reported significantly better impulse control, better access to emotion regulation strategies, and increased use of reappraisal.

CONCLUSIONS

These results hold potential for interventions that help adolescents find alternative coping/emotion regulation strategies outside of NSSI use.

Stress reactivity moderates the association between stressful life events and depressive symptoms in adolescents: Results from a population-based study

BACKGROUND

A large body of evidence links stressful life events with depression. However, little is understood about the role of perceived impact in this association.

METHODS

We performed regression analysis to investigate whether self-reported stress reactivity (derived by regressing the impact-weighted life event score on the unweighted score) moderated the association between stressful life events and depressive symptoms in adolescents from the Avon Longitudinal Study of Parents and Children cohort (n = 4791), controlling for age at outcome, sex, ethnicity, and maternal education. Depressive symptoms were assessed using the self-report Short Mood and Feelings Questionnaire (score range 0-26) at 16 years of age. Adolescents also reported on their exposure to 23 possible stressful life events since age 12 and their impact, which were used to define stress reactivity groups using a residual regression approach.

RESULTS

We identified a moderating effect of stress reactivity. Adolescents with high stress reactivity showed a stronger association between the number of stressful life events and depressive symptoms than adolescents with low (b = 0.32, 95 % CI = 0.13, 0.50, p < 0.001) or typical (b = 0.44, 95 % CI = 0.28, 0.60, p < 0.001) stress reactivity.

LIMITATIONS

Limitations include the use of retrospective life event measures and limited generalisability of findings to other population-based, high-risk, or clinical samples.

CONCLUSIONS

When resources are limited, interventions should prioritise individuals with high stress reactivity who have experienced multiple stressful life events, as these individuals may be at greater risk for depression.

Treating anxiety comorbidity: Lessons from exposure generalization studies

Comorbidity is a characteristic hallmark of anxiety disorders. Presence of comorbid anxiety and depression is challenging to the diagnosis and treatment. Conventional and transdiagnostic treatment options for anxiety disorders strongly depend on the use of exposure. Recent compelling evidence suggests that the beneficial effects of exposure therapy are transferable across different fear- and anxiety provoking situations and might even affect depressive symptomatology. We provide an overview of findings on existing studies on generalization of exposure effects to untreated stimuli and depression. Potential mechanisms which contribute to generalization of beneficial exposure therapy effects, such as extinction generalization, mastery-related increases in self-efficacy and underlying neural changes are presented and discussed. Understanding and promoting mechanisms related to exposure therapy efficacy and generalization can expedite and enhance the development of more effective transdiagnostic therapy approaches for comorbid anxiety disorders.

The gain-of-function variant in the NLRP3 gene predicts the effectiveness of brief psychotherapy but not the risk of major depression

Major depressive disorder (MDD) is a highly prevalent psychiatric condition whose pathophysiology has been linked to neuroinflammatory processes involving the NLRP3 inflammasome. To address this point, the study investigated the association of the NLRP3 rs10754558 polymorphism with MDD diagnosis in a young adults population based study and the effectiveness of brief psychotherapies in a randomized clinical trial. A cross-sectional, population-based study was conducted with 1100 individuals aged 18-35 years, including 615 controls and 485 patients with MDD. Diagnosis was determined using the Mini International Neuropsychiatric Interview (M.I.N.I.) based on DSM-IV criteria. Our clinical trial included 227 participants with MDD aged 18-60 years from a randomized clinical trial evaluating the effectiveness of two brief psychotherapies for MDD. Depressive and anxiety symptoms were assessed at baseline, post-treatment (16-18 weeks), and 6-month follow-up using the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). Statistical analyses included logistic regression and generalized estimating equation (GEE) model adjusted for demographic and clinical variables. The results showed no significant association between rs10754558 genotypes and MDD diagnosis. However, when evaluating the efficacy of brief psychotherapies, the GG genotype was associated with poorer treatment outcomes for both depressive and anxiety symptoms compared to the GC/CC genotypes (p < 0.05). Longitudinal analysis revealed significant differences over time, with GG individuals demonstrating less symptom improvement (BDI-II: baseline 36.61 to follow-up 21.75; BAI: baseline 26.32 to follow-up 19.55) compared to GC/CC genotypes (BDI-II: baseline 32.05 to follow-up 20.29; BAI: baseline 22.05 to follow-up 17.96). These findings suggest that the GG genotype, previously characterized as a gain-of-function variant, may contribute to genetic heterogeneity influencing psychotherapy outcomes. This highlights the potential for genetic markers, such as rs10754558, to inform personalized psychiatric treatments and improve therapeutic strategies.

High intensity approaches to exposure and response prevention for obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric condition with multidetermined etiological and maintaining mechanisms. Cognitive behavioral therapy (CBT), specifically exposure and response prevention (ERP), is the first line behavioral intervention to treat OCD. ERP directly targets threat learning that characterizes OCD through processes of habituation (fear extinction) and inhibitory learning, in addition to eliciting neuronal changes implicated in OCD. Although ERP has a strong evidence base, not all OCD patients respond fully to standard, weekly or twice-weekly outpatient ERP. High intensity ERP-treatment delivered through more and/or longer sessions in a condensed manner-is a potential alternative approach that has also demonstrated efficacy for adults and youth with OCD. The goal of this review article is to describe the nature, rationale, and evidence for high intensity ERP for OCD treatment. We describe the foundations of ERP for OCD, various formats of intensive ERP, clinical research on the efficacy of this approach including neuronal changes, and potential pharmacological and neurosurgical augmentation strategies. We conclude with limitations of the current literature on intensive approaches and recommendations for future directions. While additional research is needed, high intensity ERP may be a promising approach for patients who have not responded to standard ERP or for patients requiring rapid symptom improvement.

Effects of repetitive transcranial magnetic stimulation combined with cognitive training for improving response inhibition: A proof-of-concept, single-blind randomised controlled study

BACKGROUND

Impaired response inhibition is a common characteristic of various psychiatric disorders. Cognitive training (CT) can improve cognitive function, but the benefits may be limited. Repetitive transcranial magnetic stimulation (rTMS) is a promising tool to enhance neuroplasticity, and thereby augment the effects of CT. We aimed to investigate the augmentation effects of rTMS on CT for response inhibition in healthy participants.

METHODS

Sixty healthy participants were randomly assigned to two experimental groups: one with prolonged intermittent theta burst stimulation (iTBS) + CT and the other with sham iTBS + CT over four experimental sessions. Prolonged iTBS (1800 pulses) was used to stimulate the right inferior frontal cortex (rIFC) and pre-supplementary motor area (pre-SMA) in a counterbalanced order. Participants completed a Stop Signal training task following iTBS over one brain region, followed by the Go/No-Go training task after iTBS over the other brain region. The Stroop task with concomitant electroencephalography was conducted before and immediately after the intervention.

RESULTS

There were no significant differences between groups in behavioural outcomes on the Stop Signal task, Go/No-Go task, Stroop task or Behavior Rating Inventory of Executive Functioning for Adults. Similarly, analysis of event-related potentials (ERPs) from the Stroop task (N200 and N400) and exploratory cluster-based permutation analysis did not reveal any significant differences between groups. Subgroup analyses revealed that individuals with higher baseline impulsivity exhibited better learning effects in the active group.

CONCLUSIONS

This first proof of concept study did not find evidence that four sessions of active rTMS + CT could induce cognitive or neurophysiological effects on response inhibition in healthy participants. However, subgroup analyses suggests that rTMS combined with CT could be useful in improving response inhibition in individuals with high impulsivity. It is recommended that future proof of concept studies examine its potential in this clinical population.

The Role of Parental Temperament and Parent-Child Fit in Two Stuttering Therapy Programs for Preschool-Aged Children Who Stutter: A Preliminary Study

PURPOSE

To understand factors contributing to therapy success, this study investigated the role of parents' temperament and the fit between parents' temperament and parent-reported child behavior problems in therapy outcomes across two therapy types.

METHOD

A total of 177 children who stutter and their parents were included in this study. Data from 149 children were present at the follow-up. Children received either Lidcombe Program (LP) or Rotterdam Evaluation Study of Stuttering Therapy randomized trial-Demands and Capacities Model (RESTART-DCM) therapy. Parents' temperaments and children's behaviors were measured at baseline. At 18 months of therapy postonset (T4) and 5 years later (T5), the children's remittance or persistence in stuttering was assessed.

RESULTS

High parental novelty seeking and high harm avoidance were associated with transient stuttering at T4 in the entire sample. Looking across therapies, novelty seeking remained significant in the RESTART-DCM group at T4, whereas in the LP group, significant associations were observed for reward dependence (at T4 and T5) and persistence (at T4). Meanwhile, none of the parent-child fits were associated with therapy outcome.

CONCLUSIONS

The results suggest that for preschoolers receiving treatment, parents who tend to seek novelty and exploration, as well as those with greater vigilance toward harm, have a positive impact on therapy success. In contrast, socially dependent parents might have a negative impact on therapy success in children receiving LP treatment, whereas diligent parents could serve as a protective factor in this therapy. These exploratory results should be interpreted with caution, and future research will be crucial to confirm and further interpret these results.

Effects of Recruitment Messaging on Ethnic/Racial Minority Screening in a RCT for Prenatal Insomnia: An Experimental Approach

OBJECTIVE

Using data from a nationwide recruitment campaign for an RCT evaluating digital cognitive behavioral therapy for prenatal insomnia, we tested whether a recruitment message that identified a racial/ethnic disparity in sleep quality (sleep disparities message) would increase the proportion of participants who engaged in study screening compared to a recruitment message without identified ethnic/racial disparities (standard message). We also tested whether the magnitude of the association of message type with completed eligibility screening varied by race/ethnicity.

METHOD

Pregnant people (n = 203,664) were randomly assigned to receive a sleep disparities or standard recruitment e-mail. A total of 1,782 pregnant people opened the recruitment e-mails. We used chi-square tests to compare the proportions of e-mails that led to study screening outcomes between the two e-mail message conditions.

RESULTS

The chi-square tests revealed that a smaller proportion of prospective participants who received a sleep disparities message visited the screening website X2 = 8.83, p = .003 and completed a study screener X2 = 4.92, p = .026 compared to those who received a standard message. Results of a logistic regression detected no statistically significant interactions between race/ethnicity and message type on the probability of a completing a study screener.

CONCLUSION

Manipulating and measuring the effects of recruitment messages can identify effective strategies for diversifying the participant pools in CBT-I trials.

Association of health locus of control with anxiety and depression and mediating roles of health risk behaviors among college students

We aimed to assess the association of health locus of control with anxiety and depression, and explore the mediating effects of health risk behaviors. A multi-stage cluster random sampling method was used among Chinese college students. Logistic regression models were used to explore the associations of health locus of control with anxiety and depression. Structural equation models were used to explore the mediation roles of health risk behaviors in the associations of health locus of control with anxiety and depression. A total of 3,951 college students were included in this study. Internality was associated with lower prevalence of depression (OR = 0.94, 95% CI, 0.91-0.97), powerful others externality was also associated with lower prevalence of anxiety and depression (0.92, 0.88-0.96; 0.93, 0.89-0.96), while chance externality was associated with higher risk of anxiety and depression (1.13, 1.08-1.18; 1.24, 1.20-1.28). The mediated proportion of health risk behaviors in associations of internality, powerful others externality, chance externality with anxiety was 7.55%, 2.37% and 2.18%, respectively. The mediated proportion of health risk behaviors in associations of powerful others externality, chance externality with depression was 10.48% and 2.14%, respectively. Health locus of control is associated with anxiety and depression that are mediated by health risk behaviors.

A pilot study protocol of a relational coordination training intervention among healthcare professionals in an Army medical center

BACKGROUND

As patient care becomes more complex, high-quality communication and relationships among healthcare professionals are critical to coordinating care. Relational coordination (RC), a process of high-quality communication supported by shared goals, shared knowledge, and mutual respect, is positively associated with better patient (e.g., quality of care) and staff (e.g., job satisfaction, and retention) outcomes. A few researchers have found that communication skills training improves RC in civilian hospitals. However, researchers have not tested the feasibility of conducting communication skills training based on the RC framework among healthcare professionals in military hospitals. To address this gap, we propose conducting an RC training intervention in a military hospital. The primary aim of the proposed pilot study is to determine the feasibility (e.g., recruitment, retention, and completion rates) of conducting an RC training intervention in an Army medical center. The secondary aim is to explore the acceptability and usability of the RC training intervention. We will also explore changes in RC, quality of care, job satisfaction, and intent to stay among participants following the RC training intervention.

METHODS

A single-group feasibility study will be conducted among nurses and physicians from three units (intensive care unit, medical-surgical, and labor and delivery unit). A convenience sample of licensed practical nurses (LPNs), registered nurses (RNs), resident physicians, and physicians from the participating units will be invited to complete a 1-h RC training intervention once a month for 3 months. Participants will complete RC, quality of care, job satisfaction, and intent to stay measures at baseline and 2 weeks after each RC training intervention session. To assess the feasibility of conducting an RC training intervention, we will examine recruitment/retention rates, intervention session completion rates, and survey measure completion rates. Acceptability will be assessed qualitatively through focus group interviews, and results will be used to refine the intervention and determine if the selected measures align with participant experiences. For our secondary aim, we will explore the acceptability of the RC training intervention through focus group interviews. We will also explore changes in outcome measures using descriptive statistics with 95% confidence intervals.

DISCUSSION

Findings will establish the feasibility and acceptability of conducting an RC intervention in a military hospital and inform refinement of the intervention and study procedures prior to conducting a larger randomized controlled trial to establish efficacy.

Negative Affectivity and Suicide Risk: The Buffering Role of Gratitude and Optimism in Spanish Adolescents

The role of optimism and gratitude in the link between negative affectivity and suicide risk (viz., depressive symptoms and suicidal ideation) was examined in a sample of 1401 Spanish adolescents. Overall, the results of a set of hierarchical regression analyses supported the prediction of optimism and gratitude as predictors of suicide risk. Moreover, we analyzed whether the negative affectivity optimism/gratitude interaction term explains the unique variance in depressive symptoms and suicidal ideation. The results show that optimism and gratitude buffered the association between negative affectivity and depressive symptoms/ suicidal ideation, indicating that among adolescents experiencing negative affectivity, those who presented a high level of optimism and gratitude reported a lower risk of suicide. Finally, the practical implications of these novel findings regarding the role of optimism and gratitude in preventing suicide risk among adolescents are discussed.