Cognitive Behavioral Therapy Research Articles

Effectiveness of Digital Mental Health Interventions in the Workplace: Umbrella Review of Systematic Reviews.

There is potential for digital mental health interventions to provide affordable, efficient, and scalable support to individuals. Digital interventions, including cognitive behavioral therapy, stress management, and mindfulness programs, have shown promise when applied in workplace settings. The aim of this study is to conduct an umbrella review of systematic reviews in order to critically evaluate, synthesize, and summarize evidence of various digital mental health interventions available within a workplace setting. A systematic search was conducted to identify systematic reviews relating to digital interventions for the workplace, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The review protocol was registered in the Open Science Framework. The following databases were searched: PubMed, Web of Science, MEDLINE, PsycINFO, and Cochrane Library. Data were extracted using a predefined extraction table. To assess the methodological quality of a study, the AMSTAR-2 tool was used to critically appraise systematic reviews of health care interventions. The literature search resulted in 11,875 records, which was reduced to 14 full-text systematic literature reviews with the use of Covidence to remove duplicates and screen titles and abstracts. The 14 included reviews were published between 2014 and 2023, comprising 9 systematic reviews and 5 systematic reviews and meta-analyses. AMSTAR-2 was used to complete a quality assessment of the reviews, and the results were critically low for 7 literature reviews and low for the other 7 literature reviews. The most common types of digital intervention studied were cognitive behavioral therapy, mindfulness/meditation, and stress management followed by other self-help interventions. Effectiveness of digital interventions was found for many mental health symptoms and conditions in employee populations, such as stress, anxiety, depression, burnout, and psychological well-being. Factors such as type of technology, guidance, recruitment, tailoring, and demographics were found to impact effectiveness. This umbrella review aimed to critically evaluate, synthesize, and summarize evidence of various digital mental health interventions available within a workplace setting. Despite the low quality of the reviews, best practice guidelines can be derived from factors that impact the effectiveness of digital interventions in the workplace. OSF Registries osf.io/rc6ds; https://doi.org/10.17605/OSF.IO/RC6DS.

Flexibility between immersion and distancing: Relationship with depressive symptoms and therapeutic alliance

Objectives High levels of change are linked to the flexibility between immersion and distancing, as well as to higher levels of therapeutic alliance. This study aims to explore the evolution of flexibility between immersion and distancing throughout the entire therapeutic process and its relationship with therapeutic alliance and depressive symptoms in a clinical case. Method We analyzed five sessions of a good outcome case of depression undergoing cognitive–behavioral therapy. We assessed the distancing/immersion of these sessions using the Measure of Immersed and Distanced Speech, and therapeutic alliance with the Working Alliance Inventory-Short Form. The depressive symptoms were assessed from the Beck Depression Inventory-II. Results Flexibility and therapeutic alliance from both client’s and therapist’s perspectives increased throughout the therapeutic process. A strong negative correlation was found between flexibility and depressive symptoms. Conclusions The increase in flexibility can be an adaptive pattern associated with the decrease in depressive symptoms, the increase in therapeutic alliance (from both the client's and the therapist's perspective), and therapeutic success.

Patients' reasons for declining a primary care trial online therapy: a mixed methods study.

Integrating therapist-led sessions and Cognitive Behavioural Therapy (CBT) materials within one online platform may be effective for people with depression. A trial evaluating this mode of delivering CBT is being conducted. To maximize future trial recruitment and understand patients' views of health interventions, it is important to explore reasons for declining to participate. To explore patients' reasons for declining to participate in a trial of integrated online CBT for depression. A mixed methods study collecting data from patients via questionnaires and telephone interviews at the three UK trial sites. Individuals completed a short questionnaire about their reasons for not taking part in the trial. Telephone interviews further explored these reasons with a sub-group. Quantitative data were summarized using descriptive statistics. Qualitative interviews were analysed thematically. Of 1799 patients who responded to an invitation to participate in the trial, 40.3% declined contact. The most common reasons were not wanting: to take part in research (n=387); therapy provided online (n=284); to receive CBT (n=262). Qualitative interviews with 15 'decliners' highlighted that decisions related to perceptions of eligibility, previous experiences of CBT and uncertainty about receiving CBT online. Personal circumstances, depressive symptoms or other mental health issues were also barriers to participation. Reasons given by primary care patients for not taking part in a trial of integrated online CBT suggest that, at the point of recruitment, it is important to discuss the patient's perceptions of their eligibility and whether they would accept the intervention being evaluated.

Shared or different pathways to change? Clients’ experiences of change in cognitive behavioral therapy and emotion-focused therapy for depression

Objective Cognitive behavioral therapy (CBT) and Emotion-focused therapy (EFT) are empirically supported models for treating depression. Comparisons of the models regarding outcome exist, but no comparison of the clients’ experiences of change. This study explored and compared experiences of change in CBT and EFT for major depression. Method We conducted a comparative thematic analysis of the experiences of 28 clients after 12–18 sessions of either CBT (n = 14) or EFT (n = 14). Results The analysis resulted in five themes reported across treatments: (1) Changing the understanding of my problems; (2) Finding a new way to relate to inner experiences; (3) Changing how I see myself; (4) Challenging problematic ways of being with others; (5) Bringing changes into everyday life. Across treatment modalities, the clients experienced the same types of changes. Compared to EFT clients, more CBT clients emphasized the importance of practicing new strategies when facing adversity in their change process. Reversely, more EFT clients emphasized getting in touch with, tolerating, and listening to their inner experiences. Conclusion Our findings suggest that clients undergoing CBT and EFT describe changes in the same domains but show differences in how they emphasize various pathways leading to their change.

Interventions to Prevent Relapse or Recurrence of Preconception Anxiety and/or Depression in Perinatal Women: A Systematic Review.

Women with preconception anxiety and/or depression experience high rates of relapse or recurrence of the disorders in the perinatal period. This review aimed to identify perinatal interventions that were designed to prevent relapse or recurrence in women with a history of anxiety and/or depression. The review was conducted based on the PRISMA guidelines. Six medical databases were searched with specific search strategies for each. The reference lists of literature reviews retrieved in this search were also screened, as well as the reference lists of reviews identified within these reviews. Additionally, the publications of the first authors of included studies were reviewed for relevant articles. There were 10 articles eligible for inclusion. These articles described pharmacological or dietary supplement interventions, as well as psychological and/or behavioural interventions. All identified studies focused on the prevention of recurrent depression, comprising four antenatal interventions and six postnatal interventions. No studies reporting interventions for the prevention of recurrent anxiety were identified. Several published studies provided evidence supporting the use of prophylactic antidepressants and progesterone to prevent relapse or recurrence of depression, although studies were limited by small sample sizes and the potential for study bias. More recent and higher quality evidence exists for the role of mindfulness and cognitive behavioural therapy in the prevention of depressive relapse. Further exploration of relapse prevention strategies for women with preconception anxiety and/or depression is required, particularly for recurrent anxiety.

Emotion regulation-based internet-delivered cognitive behavioural therapy for premenstrual dysphoric disorder: study protocol for a randomised controlled trial in Sweden

IntroductionPremenstrual dysphoric disorder (PMDD) is a cyclic mood disorder affecting around 2%–5% of women of reproductive age. Pharmacological interventions exist, but many patients with PMDD experience residual symptoms, discontinue medications...

University student experiences of digital mental health packages

ABSTRACT The number of UK university students reporting mental health problems is increasing. Cognitive-behavioural therapy (CBT) is evidence based for treating mental health problems, but waiting lists restrict access to this face-to-face intervention. Digital mental health packages (DMHP) increase access to evidence-based interventions and allow individuals to access support anonymously. Two common DMHP are computerised CBT (cCBT), CBT delivered with limited therapist involvement, and digital peer support, where individuals with shared lived experience support each other. These are increasingly available in universities despite a lack of research into students’ experience using them. This study explores university student’s experiences of using DMHP. Eleven participants from UK universities took part in semi-structured interviews, which explored their experiences using DMHP. Qualitative data was analysed using Reflexive thematic analysis. Five themes were generated: ‘Signposted to self-reliance’, ‘It’d be nice to talk to someone’, ‘It’s a community, but not a true community’, ‘Easy in, easy out’ and ‘It’s a safe space’. There was a wealth of information available to participants via DMHP, but some felt forced to use it, or did not feel staff support was sufficient. Reading similar experiences normalised some student’s distress but made others feel worse. Some students queried whether they should be supporting other students, considering they are seeking support themselves. Further research should explore how to best create online peer support communities for university students, and to explore which students would most benefit from DMHP, as they do not appear suitable for all.

A Systematic Review of Telemedicine Solutions to Provide Psychological Interventions for Women Receiving Fertility Treatments.

Introduction: Infertility and assisted reproduction treatment (ART) are frequently accompanied by the experience of emotional disorders. Psychological interventions are available for infertile populations, but the barriers of current face-to-face models of care difficult their dissemination. This systematic review (PROSPERO: CRD4202340179) aims to summarize how technologies are used in telemedicine psychological programs to manage emotional disorders in women undergoing fertility treatments. Methods: Searches were conducted in December 2023 in six different databases. Two independent researchers conducted the searches, extracted the information, and assessed the quality of the studies (NHLBItool). Results: Nineteen studies including 2,520 participants met eligibility criteria. Interventions were provided mostly to women who were undergoing in vitro fertilization/intracytoplasmic sperm injection (n = 11). Emotional disorders most frequently addressed were anxiety and depression (n = 11). The majority of the psychological programs were based on cognitive-behavioral therapy (n = 6), emotional writing (n = 3), acceptance and commitment therapy (n = 3), or positive reappraisal (n = 3). Many interventions were based on the use of internet (n = 5), diaries (n = 3), self-administered manuals (n = 2), short message service (n = 1), or face-to-face sessions (n = 5) supported by the inclusion of phone calls, emails, or audios. There is a lack of preventive interventions (n = 1). Conclusions: To the best of our knowledge, this is the first systematic review that explores the use of all kinds of technologies to provide psychological interventions to manage emotional disorders during ART. Results derived from this work may guide the development of future telemedicine services to provide psychological interventions.

Accepting your Body after Cancer (ABC), a group-based online intervention for women treated for breast cancer: study protocol for a feasibility randomised controlled trial

IntroductionBreast cancer is the most common cancer among women worldwide. While increasing numbers of women are living beyond breast cancer, treatment-related body image concerns are common and associated with adverse...

Unveiling the potential of 360° videos: Tailored interventions for test anxiety within cognitive behavioral therapies

Abstract This study aims to evaluate the effectiveness of 360° video technology in reducing test anxiety. The objective is to evaluate whether 360° exposure in individual psychological counseling, aligned with Cognitive Behavioral Therapies (CBT), is more effective than imagined exposure at reducing test anxiety. The study was conducted with a sample of 26 participants who met the research criteria. 14 participants who met the inclusion criteria were included in the 360° exposure (experimental) group, while the remaining 12 participants were placed in the imaginary exposure (control) group. Data were gathered from seven measurements (Pre-test, 360° video Before, 360° video After, Post-test, 1 month before Exam, 1 week before Exam, 1 month after Exam). The effectiveness of the intervention was assessed using the Westside Test Anxiety Scale, the State Anxiety Inventory, and the Five Factor Model Personality Scales. The data were analyzed using two-way ANOVA and ANCOVA. According to the results of these analyses, 360° video exposure was found to be significantly more effective than imaginary exposure (F(6,144) = 105.64; p ¡ .001; 2p = 0.81). Similarly, the inclusion of covariates (neuroticism, state anxiety, and gender) in the analysis did not change. The findings suggest that 360° videos may offer a potential therapeutic tool in the treatment of test anxiety, demonstrating superiority over imaginary exposure. Nevertheless, additional research on the efficacy of 360° video is warranted, considering that the effectiveness of 360° video may differ across demographic groups and various types of 360° video and virtual reality experiences.

Relapse prevention among Iranian people who smoke through cognitive behavioral intervention: application of Marlatt’s model

BackgroundRelapse is by far the most likely outcome of any smoking cessation attempt. The present study aimed to assess the effectiveness of cognitive-behavioral intervention based on Marlatt’s model on relapse prevention of people who smoke.MethodsThis interventional study was conducted among 265 people who smoke who referred to smoking cessation centers in Kurdistan province in Iran (intervention group = 129, control group = 136). The intervention group received cognitive behavioral therapy smoking cessation based on the Marlatt’s model for 8 sessions and each session was one hour weekly, and the control group received routine smoking cessation treatment trough 7 one-hour weekly sessions. The data were collected by using a researcher-made questionnaire. The follow-ups were performed immediately, 1 week and 3 months after the intervention.ResultsWe found that 42.6% of the intervention group consumed more than 20 cigarettes daily before the intervention, reaching to 13.7% immediately, 10.2% one week and 6.2% three months after the intervention. There was a significant difference in the mean scores of internal and external high-risk situations, internal and external self-efficacy, coping skills, positive and negative outcome expectations, and abstinence violation effect between the intervention and control groups at immediately, one week, and three months after the intervention (P < 0.0001). A significant difference between the lapse and relapse rate in the intervention group compared to the control group immediately, one week and three months after the intervention was observed (P < 0.001).ConclusionCognitive-behavioral intervention is effective in reducing cigarette smoking, high-risk situations of smoking, abstinence violation effect, positive outcome expectation of smoking lapse and relapse and increasing self-efficacy, coping skills, and quitting smoking.

Use of adjuvant treatment options in tobacco and nicotine counseling: results of an anonymous survey

Counseling and treatment of tobacco and nicotine users include classical behavioral therapy and cognitive-behavioral therapy methods. More than half of the quitters after an intervention relapsed into old behavior after 12 months. Discussions with experts have shown that evidence-based interventions are individually supplemented with treatment options without scientific evidence or with inconsistent efficacy. This study examined the use of adjuvant treatment options in the area of smoking cessation such as aromatherapy.The sample for our anonymous online survey (Sosci survey) consisted of 351 experts. All of them had registered with their contact data in a freely accessible database (https://www.anbieter-raucherberatung.de/anbieter.php). A total of 88 experts took part in the survey. Respondents were on average 53 years old, and 71% were female. They reported on average 14 years of experience in smoking cessation counseling. More than half of the participants (66.3%; n=57) had employed at least one adjuvant treatment option. Exercise (49.1%), hypnosis (34.5%) and acupuncture (27.3%) were mentioned most often.Adjuvant treatment options appear to be important in the counseling of tobacco and nicotine users and there should be more discussion on these options among experts. These should also considered in the development of curricula for counsellors on tobacco and nicotine cessation.

Assessing Anxiety, Depression, and PTSD in Women Experiencing Abuse: Implications for Mental Health Services

Domination over women is a social violence that harms the mental health of an individual, with over 736 million women worldwide facing physical, sexual, or emotional violence at some point in their lifetime. The purpose of this study is to identify ways of improving mental health services for women experiencing abuse by investigating the co-occurrence and cross-correlation of anxiety, depression, and Post-Traumatic Stress Disorder (PTSD) with the general population of abused women. Additionally, it seeks to increase awareness of the potential future impact of abuse and the need to work on the quality of health care for such victims. This is a desk-based approach study that reviewed data from only recent high-impact papers dealing with the mental health of abused women. Articles were retrieved from databases such as ScienceDirect, SAGE Journals, SpringerLink, PubMed, and Wolters Kluwer Online. Many data were derived according to prevalence, demographic features, kinds of abuse, and intervention effectiveness. PTSD and depression have been identified to be very common in abused women, and many of these cases present with comorbidities. Cognitive-behavioral therapy (CBT) and Interpersonal Psychotherapy have been endorsed as practices that can potentially be effective for traumatized clients. However, insurance, cost and prejudice put an obstacle for people to receive these. In conclusion, culturally tailored community-formulated and inviting favorable modification together with other nonpharmacological approaches may be beneficial to mental health and promote reversibility.

The availability of Cognitive Behaviour Therapy for psychosis (CBTp) inThe Netherlands

ABSTRACT Background Although Cognitive Behaviour Therapy for psychosis (CBTp) is a first-choice recommended evidence-based treatment, studies suggest that its availability falls short. This study aimed to assess the availability of CBTp in The Netherlands and to identify factors related to implementation. Method Online survey among 189 psychosis-specialized teams of 19 mental health organisations, together providing care to approximately 25% of all adults with a psychotic disorder in Dutch mental healthcare. Results CBTp was available for 19.2 to 26.4% of patients. About a third of the treatments were provided by psychologists untrained in CBTp. Availability was associated with how much the team psychologists were trained in CBTp (r(126) = .477, p < .001) and with the patient to therapist ratio (r(116) = -.757, p < .001). We explored psychologist time use and reflected on how their available hours may be matched to patients’ various treatment needs. Discussion Most Dutch patients with psychosis do not have access to CBTp. We recommend enhancing therapists’ CBTp skills, allocating protected CBTp time, and increasing the number of psychologists in psychosis teams. 0.37 FTE of psychologists per 100 patients are required solely for CBTp. Further research into comorbid disorder treatment need is recommended to establish staffing guidelines.

Impact and Mechanisms of Cognitive Behavioural Therapy for Insomnia on Fatigue among Cancer Survivors: A Secondary Analysis of a Randomized Controlled Trial.

Cancer-related fatigue is one of the most common symptoms in cancer survivors. Cognitive behavioural therapy for insomnia (CBT-I) can improve fatigue, but mechanisms are unclear. This secondary analysis of a randomized controlled trial evaluated whether CBT-I led to a significant improvement in fatigue, accounting for change in comorbid symptoms of insomnia, perceived cognitive impairment (PCI), anxiety, and depression. The parent study evaluated the impacts of CBT-I on PCI and insomnia. Cancer survivors with insomnia and PCI were randomized to CBT-I or a sleep-self monitoring waitlist control. Fatigue was measured using the Multidimensional Fatigue Symptom Inventory - Short Form at pre-, mid-, and post-treatment. Significant improvement in fatigue was defined as a reduction >10.79 points. Insomnia, PCI, anxiety and depression symptoms were assessed. A linear mixed model evaluated whether CBT-I improved fatigue after adjusting for comorbidities. Mediation analyses examined whether change in comorbidities accounted for the effect of CBT-I on fatigue. The sample consisted of 132 cancer survivors (77% female, Mage=60.12 years, 41% breast cancer). There was a significant group-by-time interaction on fatigue, p<.001, with the CBT-I group experiencing a 20.6-point reduction in fatigue compared to 3.7-points in the control. Improvements in fatigue were fully accounted for by improvements in the comorbidities with change in insomnia accounting for 45.3% of the effect observed in fatigue. CBT-I resulted in significant improvement in fatigue, and these effects were largely accounted for by change in insomnia. CBT-I is a robust intervention with efficacy for improving fatigue among cancer survivors.

A Tale of Two Treatments: A Randomised Controlled Trial of Mindfulness or Cognitive Behaviour Therapy Delivered Online for People with Rheumatoid Arthritis

Introduction: This study aimed to determine the relative efficacy of mindfulness-based stress reduction (MBSR) or cognitive behaviour therapy (CBT) in comparison to a waitlist control (WLC) for people with rheumatoid arthritis (RA). Participants completed assessments before and after treatment and at 6-month follow-up. Methods: Two hundred and sixty-nine participants with RA were recruited and randomised in a 2:2:1 ratio to MBSR:CBT:WLC. Participants completed a semi-structured clinical interview for depression and were stratified for history of recurrent depression. We measured the primary outcome of pain interference, as well as pain severity, depression, anxiety, functional ability, and fear of progression. We predicted that MBSR and CBT would result in improvements compared to WLC. We also predicted that those with a history of recurrent depression would benefit more from MBSR than CBT for depression. Results: MBSR and CBT were equally efficacious in reducing pain interference compared to WLC. Similar results were found for depression. MBSR demonstrated superior outcomes to CBT for fear of progression at post-treatment and functional ability at 6-month follow-up. CBT only was better than WLC for pain severity at 6-month follow-up. Depressive status did not moderate the efficacy of treatment. Conclusions: MBSR and CBT resulted in statistically and clinically significant changes in pain interference compared to WLC. MBSR was more efficacious than CBT for functional ability and fear of progression, while CBT showed superiority for pain severity. The effect sizes were comparable to those achieved with face-to-face interventions, confirming both online treatments are effective for people with RA.

The effectiveness of psychosocial interventions for reducing problematic substance use, mental ill health, and housing instability in people experiencing homelessness in high income countries: A systematic review and meta-analysis.

Adults experiencing homelessness in high income countries often also face issues of problematic substance use, mental ill health, in addition to housing instability, so it is important to understand what interventions might help address these issues. While there is growing evidence of the effectiveness of psychosocial interventions for the general population, limited evidence exists specifically for those experiencing homelessness. To summarise the existing evidence of whether psychosocial interventions work in reducing problematic substance use, mental ill health, and housing instability for adults experiencing homelessness in high income countries. We used searches undertaken for the Homelessness Effectiveness Evidence and Gap Map (EGM) 5th edition. These were supplemented with hand searches of key journals and a call for evidence. We included all Randomised Control Trials and non-randomised studies where a comparison group was used and which examined psychosocial interventiONS for adults experiencing homelessness. 'Psychosocial intervention' is a broad term and covers several interventions, including cognitive behavioural therapy (CBT), contingency management, and motivational interviewing. We focused on studies that measure at least one of three outcomes: reduction in problematic substance use (alcohol and/or drugs); reduction in mental ill-health; reduction in housing instability. For included studies sourced from the EGM, we used the risk of bias assessments reported in the EGM. For included studies sourced from our own searches, we used the same tools used in the EGM to undertake our own assessments. We carried out meta-analysis where possible, and where not possible, presented included studies narratively. We included 26 papers covering 23 individual intervention studies. All of the included studies were from the United States. Of the 26 papers, 14 were assessed as having medium or high risk of bias, with main issues being lack of masking/blinding, lack of power calculations, and high levels of drop-out. We found that psychosocial interventions overall were better than standard care (-0.25 SD, 95% confidence intervals [CI] [-0.36, -0.13]). This finding covered six different interventions and was subject to a high level of between-study differences (heterogeneity). We also found that psychosocial interventions were more effective than standard care in relation to all three of our outcomes of interest, although were statistically significant only for substance abuse and mental ill-health. For substance use, we found an average effect size of (-0.34 SD, 95% CI [-0.48, -0.21]); for mental ill health of (-0.18 SD, 95% CI [-0.34, -0.01]); and for housing instability of (-0.10 SD, 95% [-0.90, 0.70]). We were able to undertake five meta-analyses (statistical summaries) with respect to four types of intervention: CBT, Contingency Management, Motivational Interviewing, and Brief Motivational Interventions, in relation to specific outcomes. Of these five analyses, we found significant effects for the effectiveness of Contingency Management in reducing problematic substance use (-0.49 SD, 95% CI [-0.85, -0.14]), and of Motivational Interviewing in reducing mental ill-health (-0.19 SD, 95% CI [-0.26, -0.12]). We also found non-significant effects in relation to CBT and reducing mental ill health (-0.30 SD, 95% CI [-0.61, 0.002]), Motivational Interviewing and reducing problematic substance use (-0.27 SD, 95% CI [-0.56, 0.01]), and Brief Motivational Interventions and reducing problematic substance use (-0.24 SD, 95% CI [-0.61, 0.13]). Meta-analysis was not possible for any other interventions or outcomes. This systematic review sought to understand the effectiveness of psychosocial interventions for adults in high income countries experiencing homelessness, for reducing problematic substance use, reducing mental ill-health, and increasing housing stability. The review shows potential benefits of these interventions, with some encouraging results for some interventions and outcomes. Where we could calculate effect sizes, these were often small and, in many cases, crossed the line of no effect (i.e., there is a chance that they are equally or less effective than treatment as usual). Significant heterogeneity between studies and high rates of drop-out in many studies reduces the confidence in the interventions.There are some limitations with the evidence base. The included studies were entirely from the United States. There was a clear gender bias in the included studies, with nearly two-thirds of participants being men. (This is despite 4 of the 26 included studies focusing on women only.) We also found that the theoretical basis for the approach of interventions was not sufficiently considered, so it was difficult to understand why the intervention expected the outcomes they measured. Finally, many of the studies included were assessed as having high or medium risk of bias.

Mindfulness- and acceptance-based programmes for obsessive-compulsive disorder: A systematic review and meta-analysis.

Mindfulness- and acceptance-based programmes (MABPs) in the treatment of obsessive-compulsive disorder (OCD) are increasingly gaining research interest, yet a comprehensive systematic review and meta-analysis is missing. To fill this gap, we analysed 46 trials involving 2221 patients. Two independent reviewers screened records, extracted data, assessed risk of bias, and rated overall quality of evidence. MABPs were associated with large reductions in OCD-severity in between-group analysis in randomised controlled trials (k = 33; g =-.87; CI=-1.13,-.60) and within-group pre-post analysis in all MABPs (k = 49; g =-1.72; CI=-2.00,-1.44). Depressive symptoms decreased between- and within-group with a small to moderate effect, with maintained reductions at follow-up for both OCD and depression. Moderate to large pre-post improvements were also observed in anxiety, obsessive beliefs, and quality of life. MABPs did not differ from cognitive behavioural therapy and exposure and response prevention (k = 9; g=.02; CI=-.23,.26) but were superior to medication (k = 5; g =-.77; CI=-1.44,-.11) and waitlist (k = 16; g =-1.66; CI=-2.1,-1.24). Symptom reductions were observed across world regions, but to varying degrees. When combined, increases in mindfulness and psychological flexibility predicted reductions in OCD symptoms. Outcomes were not moderated by treatment duration, samples', and therapists' characteristics. MABPs can reduce OCD-severity, but further high-quality trials with long-term follow-ups are needed to confirm results.

Sleep disturbance and menopause.

Sleep problems are among the most prevalent and bothersome symptoms of menopause. This review characterizes menopausal sleep disturbances, describes biopsychosocial predictors, and summarizes the evidence supporting pharmacological and nonpharmacological treatment options. Recent studies found that sleep changes are early indicators of perimenopause and sought to disentangle the respective impacts of menopausal status, hot flashes (HFs), and changes in reproductive hormones on peri-/postmenopausal sleep problems. Both HFs and reproductive hormones predicted sleep problems, but neither solely accounted for the myriad changes in sleep, thus highlighting the contribution of additional biopsychosocial risk factors. Inconsistencies across studies were likely due to differences in study design and methodology, participants' menopausal stage, and the presence of sleep complaints. Recent studies support the use of psychological (cognitive-behavioral therapy for insomnia) and pharmacological (e.g., neurokinin B antagonists) treatments in addition to hormone therapy. Sleep problems are common and of critical import to women during the menopausal transition, significantly influencing treatment preferences and satisfaction. Thus, sleep problems should be routinely assessed from a biopsychosocial perspective and treated with evidence-based interventions throughout menopause. Treatment selection should be based on diagnosis and careful assessment.

Exploring the Potential of Psychedelics in the Treatment of Headache Disorders: Clinical Considerations and Exploratory Insights.

Exploration of the potential of serotonergic psychedelic drugs, such as psilocybin and LSD, as potential treatments for headache disorders. This review addresses the need for well-informed physician guidelines and discusses mechanisms, safety, and efficacy of these treatments. Further research, including the consideration of combination with psychotherapy, is needed. Psychedelics demonstrate promising outcomes as treatments for headache disorders. Recent findings indicated that some patients who underwent brief periods of treatment with psychedelics experienced a reduction in headache attack frequency, severity, or duration. When prescription medications are ineffective at treating headache disorders, or are habit-forming, patients often turn to alternative options. There is anecdotal evidence that psychedelic drugs like LSD and psilocybin can effectively treat and prevent pain in patients with headache disorders, such as migraine or cluster headache. It is vital that physicians treating patients who self-treat with psychedelics be well-informed about the mechanisms and their effects to best advise their patients and coordinate their care well. This is a review assessing the literature on the mechanisms, safety, and efficacy of psychedelic drugs as a headache management intervention. We believe there is evidence that may support further investigation into the clinical use of psychedelic medications to treat cluster headache and migraine, including the consideration of use in conjunction with other interventions like cognitive behavioral therapy or acceptance and commitment training.