Objective: This study examined predictors of dropout during the active phase of outpatient CBT, distinguishing between quality-related and quality-neutral dropouts. The focus was on patient, process, and therapist variables, including the therapeutic alliance and early treatment courses. Method: Routine data from 590 outpatient psychotherapy patients were analyzed. Dropouts were classified as quality-related (dissatisfaction or lack of progress) or quality-neutral (external reasons). Logistic regression models identified predictors of quality-related dropout. Symptom improvement differences between dropout and regular completion were calculated using t-tests. Results: 24.2% of patients discontinued therapy for quality-related reasons, while 10.8% dropped out for quality-neutral reasons. Significant predictors were lower treatment satisfaction (OR = 1.07) and a weaker therapeutic alliance (OR = 0.86). Quality-related dropouts occurred between the 10th and 15th sessions, while quality-neutral dropouts were between the 20th and 25th sessions. Early deterioration was a marginal predictor of quality-related dropout, while 58.6% of early responders in the quality-related dropout group showed significant improvement before discontinuing therapy. Conclusion: Lower treatment satisfaction and a weaker therapeutic alliance predicted quality-related dropout. Some early dropouts still showed improvement, suggesting that discontinuation does not always reflect treatment failure. Differentiating between quality-related and quality-neutral dropouts clarifies dropout patterns and improves interpretation of treatment outcomes.

Longitudinal Investigation of Psychotherapy Outcomes (LIPO): What are the clinical and neurobiological changes in a 6-month follow-up?

Abstract: The Multidimensional Emotional Disorder Inventory (MEDI) is a brief, transdiagnostic measure assessing nine dimensions of emotional disorders. This study evaluated the psychometric and clinical properties of the German version of the MEDI in a large sample ( N = 1,129) including healthy individuals and patients from two outpatient psychotherapy clinics. The results showed high internal consistency (Cronbach's α = .73–.92) and acceptable test–retest reliability ( r tt = .58–.78) over a 7-month interval. Exploratory structural equation modeling confirmed the original nine-factor model, although with reduced consistency for the Avoidance scale. Correlations with established symptom and personality measures, as well as clinical diagnoses, indicated good convergent and discriminant validity. Overall, the MEDI – German version demonstrated good psychometric properties, making it suitable for evaluating therapeutic interventions for emotional disorders in clinical practice and research.

ABSTRACT Introduction: In Germany, there is a lack of recent population-based data regarding the prevalence of multiple personality disorder (MPD; ICD-10: F44.81) and the treatment of individuals with this diagnosis. This study aimed to assess the prevalence, psychiatric comorbidities, and treatment of MPD in Germany. Materials and Methods: Based on nationwide claims data, an observational trend study was conducted. For each year from 2012 to 2021, the proportion of persons with at least one coded MPD diagnosis was determined, stratified by sex, age and region. Additionally, psychiatric comorbidity, psychopharmacotherapy, hospital treatment, and outpatient psychotherapy among persons diagnosed with MPD in 2021 were assessed. Results: From 2012 to 2021, the administrative prevalence of MPD increased by 58.5% (from 4.1/100,000 to 6.5/100,000), with a prevalence peak in 17- to 24-year-olds and a female/male ratio of 6:1. In 2021, 86.4% of individuals with a MPD diagnosis had at least one co-occurring psychiatric diagnosis, with 23.9% having five or more. Top comorbidities were anxiety disorders (73.7%), depressive disorders (60.5%), other personality disorders (38.9%), substance use disorders (18.4%), and eating disorders (15.4%). Regarding pharmacotherapy, antidepressants (47.4%), tranquilisers (31.5%), antipsychotics (28.0%), and opioid analgesics (12.8%) were most frequently prescribed. 44.4% of individuals with MPD received psychotherapy, and 14.2% underwent psychiatric hospitalisation (median duration: 7 weeks). Discussion: In this study, we found an administrative prevalence of MPD of 4.1/100,000 in 2012 and 6.5/100,000 in 2021. These figures are considerably lower than those found in epidemiological studies, indicating underdiagnosis of MPD in Germany. The increase in MPD diagnoses was mainly due to a surge in outpatient diagnoses. Individuals with MPD diagnoses had high psychiatric comorbidity, especially depression, anxiety, and personality disorders. Therapeutic measures were in line with current guidelines, with the exception of above-average opioid analgesics prescriptions, which may be related to the high BPD comorbidity.

Introduction Although personality functioning has a long psychodynamic tradition and has received renewed interest in psychotherapy research with the DSM-5 and ICD-11, little is known about its course and influencing factors following psychotherapy. Methods In a sample of 1208 completed outpatient psychodynamic psychotherapies, we examined changes in personality functioning in the 1-year follow-up. Machine learning was used to filter out potential predictors from all 227 possible predictors for changes in personality functioning following psychotherapy. Results For most patients, improvement in personality functioning remained stable following psychotherapy. Fourteen potential predictors were identified, including the length of psychotherapy, adverse childhood experiences, diagnosis of PTSD or recurrent depressive disorder, the improvement in interpersonal problems and symptoms as well as the stability of the bond between psychotherapist and patient. Furthermore, it was found that strong improvements can be considered a potential indicator for subsequent loss of personality functioning following psychotherapy. Discussion Our results suggest that in most cases improvement in personality functioning achieved during psychotherapy remains stable. In addition, the change in personality functioning following psychotherapy appears to be influenced by a multitude of small effects. It is then discussed that most of the identified predictors are associated with interpersonal relationships and experiences.

The early response effect, defined as a reliable symptomatic improvement during the initial phase of treatment, is the most robust predictor of recovery following eating disorder treatment. This study aimed to investigate which symptom domains mostly influence the early response effect. Data from N=232 adult patients (90.8% females; mean age=29.97, SD=10.67) treated in an outpatient eating disorder psychotherapy service were randomly partitioned into training (N=161) and test (N=71) samples. A Bayesian network model was developed in the training sample, modelling early changes (sessions 1-4) and interactions among symptoms measured by the Eating Disorder Examination Questionnaire (EDE-Q). A variable selection approach was applied to include only the most important variables in the model (i.e., reliable predictors of recovery). The trained model was externally validated by applying it to predict post-treatment recovery status in the test sample. Prediction accuracy was evaluated using the AUC statistic. The model identified a network of six interrelated eating disorder symptoms which were the most important predictors of recovery. The model was reliable in predicting recovery status and showed good generalisability to a test sample (training AUC=0.81 vs. test AUC = 0.77). Early changes in six areas (ranked by importance) reliably predict recovery after therapy: [1] avoidance of body exposure; [2] feelings of 'fatness'; [3] preoccupation with food, eating or calories; [4] fear of losing control over eating; [5] dissatisfaction with body shape; [6] dietary rules. The identification of early response domains associated with eventual recovery could help to inform targeted interventions strategies for patients with eating disorders. Future replication is warranted in more diverse and larger samples, including the applicability of these findings to different diagnostic groups.

Complex Regional Pain Syndrome (CRPS) is a significantly impairing pain condition that can co-occur with other disorders, including Functional Neurological Symptom Disorder (FNSD). Interdisciplinary interventions augmented with peripheral nerve catheters (PNCs) are gaining attention as effective treatments for CRPS, but their utility in treating comorbid conditions like FNSD remains unclear. This case study presents a 15-year-old female who completed a PNC-augmented interdisciplinary pain program followed by outpatient psychotherapy, providing the first description of this approach for a patient with comorbid CRPS and FNSD and examining its short- and long-term impact. The PNC-augmented CRPS program resulted in resolution of CRPS symptoms and initial improvement in FNSD symptoms. However, functional symptoms returned post-discharge with a different presentation. A subsequent course of psychotherapy was associated with reduced FNSD episode frequency and improved overall functioning. Brief interdisciplinary treatment augmented by PNCs may be beneficial for CRPS; however, it does not appear effective for the long-term treatment of FNSD, which may require psychotherapy and intervention. For patients with comorbid CRPS and FNSD, longer-term interdisciplinary or psychological treatment appears essential to support sustained recovery and functional restoration.

BackgroundEye movement desensitization and reprocessing (EMDR)-centered psychotherapy is an evidence-based treatment for post-traumatic stress disorder (PTSD), yet symptom trajectories during routine outpatient care vary considerably. Process factors such as therapeutic alliance and treatment intensity may influence outcomes, but their independent and combined contributions in real-world clinical settings remain unclear. This study examined the relationships among therapeutic alliance, treatment intensity, and PTSD symptom change in a naturalistic outpatient context.MethodsThis single-center retrospective cohort study analyzed routinely collected clinical data from adults with a clinician-confirmed chart diagnosis of PTSD based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria who completed EMDR-centered psychotherapy at a single outpatient psychological clinic in the Philippines between 2022 and 2025. PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5) at baseline, mid-therapy, and post-treatment. Therapeutic alliance was measured at mid-therapy using the five-item Agnew Relationship Measure-5 (ARM-5). Treatment intensity was defined as the total number of completed psychotherapy sessions. Linear regression and moderation analyses examined associations between alliance, treatment intensity, and symptom change, adjusting for age, sex, trauma type, and therapy type.ResultsThe sample included 138 patients. Mean PTSD symptom scores decreased from 43.7 at baseline to 37.8 at mid-therapy and 30.0 at post-treatment. Therapeutic alliance did not predict early symptom change (baseline to mid-therapy; β = −0.01, p = 0.878) but significantly predicted overall symptom reduction (baseline to post-treatment; β = 0.61, p < 0.001; R² = 0.245) and late-phase improvement (mid-therapy to post-treatment; β = 0.62, p < 0.001; R² = 0.207). Treatment intensity significantly predicted symptom reduction from baseline to post-treatment (β = −0.21, p < 0.001; adjusted R² = 0.251) and from mid-therapy to post-treatment (β = −0.26, p < 0.001). Moderation analyses showed no significant interaction between therapeutic alliance and treatment intensity across treatment phases (all p > 0.10), indicating independent effects.ConclusionsIn routine outpatient EMDR-centered psychotherapy, therapeutic alliance and treatment intensity independently predict PTSD symptom improvement. Alliance appears most consequential after initial treatment engagement, while greater session completion supports sustained symptom reduction. These findings underscore the importance of fostering a strong working alliance beyond early sessions and promoting adequate treatment exposure to optimize outcomes in real-world trauma-focused care.

The authors sought to examine how psychotherapy use by U.S. adults changed beyond increases during the acute phase of the COVID-19 pandemic. A nationally representative sample of U.S. noninstitutionalized, civilian adults (N=147,448) was drawn from the 2019-2023 National Health Interview Survey to describe psychotherapy use trends and compare patients' sociodemographic, insurance, and mental health characteristics between 2019-2020 and 2021-2023. Between 2019 and 2023, psychotherapy use increased from 9.5% to 13.4%, whereas reports of delaying or not receiving psychotherapy because of cost increased from 5.2% to 6.6%. Among respondents who reported using psychotherapy, no significant differences were found in telehealth use and reports of delaying or not receiving psychotherapy because of cost. The increase in adult psychotherapy use was sustained after the acute phase of the pandemic. With the increased demand for services, monitoring trends in psychotherapy access is vital.

Digital mental health interventions (DMHI) have the potential to provide patients awaiting outpatient psychotherapy with a valuable and immediate treatment option to bridge long waiting periods. However, randomized controlled trials concerning these interventions are marred by high attrition rates and low adherence, and research on the implementation of these interventions in real-world settings is scarce. The present study aims to provide real-world data on the uptake and use of prescribed DMHI, as well as the effect of DMHI use on psychological well-being. 150 patients with various mental disorders awaiting face-to-face psychotherapy were included in this preregistered study. All patients received a prescription for a diagnosis-specific DMHI to bridge the waiting period. Structured telephone interviews were conducted to assess uptake of the prescription, use of the DMHI, and psychological well-being four and 12weeks after inclusion. 56% of the patients reported an uptake of the DMHI prescription. The percentage of patients who actually used the DMHI was lower than for uptake (29%). Patients who expressed interest in the use of DMHI, higher treatment expectations, and lower psychological well-being were more likely to use the DMHI. A linear mixed model indicated a significant improvement in psychological well-being among DMHI users. The findings of the present study underscore that the implementation of DMHI in real-world settings is hindered by low uptake rates and even lower utilization. To improve DMHI use, it is essential to incorporate potential mediating factors, such as treatment expectations, into future research.

Background and aimThe Systemic Therapy Inventory of Change (STIC) is designed to measure changes in family, couple, and individual therapy from a multisystemic and multidimensional perspective. The aim of the present study was to translate the English version of the STIC into German and to evaluate the psychometric properties of the German version in a clinical sample of 309 patients starting outpatient psychotherapy covered by the German Statutory Health Insurance.MethodsPatients were recruited between July 2023 and November 2024 at Heidelberg Institute for Psychotherapy (HIP) of the University Hospital Heidelberg. In addition to the STIC, several other questionnaires were completed by the participants, including the Patient Health Questionnaire (PHQ-9), Childhood Trauma Questionnaire (CTQ), Experience in Close Relationships (ECR-RD-8), and the Systemic Clinical Outcome and Routine Evaluation (SCORE-15). Pearson correlation coefficients were calculated between the STIC subscales and the corresponding criterion measures.ResultsSignificant correlations with various outcome measures between 0.26 and 0.81 demonstrated the construct validity of the German version of the STIC. Multiple linear regression analyses showed that higher scores on the subscale IPS (Individual Problems and Strengths) and RWP (Relationship with Partner) were significantly associated with higher quality of life.ConclusionThe questionnaire could be used in psychotherapy settings for routine outcome monitoring and psychotherapy research.

IntroductionIndividuals with spinal cord injury (SCI) have a higher prevalence of mental health problems than the general population but face significant barriers to accessing outpatient psychotherapy. Understanding the factors that influence therapists' willingness to treat this population is critical for improving mental healthcare equity.MethodsWe conducted a cross-sectional online survey among licensed outpatient psychotherapists in Southern Germany. All therapists registered with the Association of Statutory Health Insurance Physicians who had an email address or an online contact form were invited to participate. In total, 677 complete datasets were analyzed in this study. Using logistic regression, we examined the associations between therapists' self-reported willingness to accept a hypothetical therapy request from an individual with SCI and nine potential influencing factors, including personal, emotional, and organizational variables.ResultsSix variables were significantly associated with the therapists' willingness. Therapists who agreed to provide home-based therapy had higher odds of being in the willing group [OR = 2.28, 95% CI [1.50, 3.46], p < 0.001], as did those who reported a stronger feeling of preparedness [OR = 1.83, 95% CI [1.51, 2.21], p < 0.001] and greater field experience [OR = 1.34, 95% CI [1.11, 1.61], p = 0.002]. In contrast, older age [OR = 0.83, 95% CI [0.74, 0.92], p < 0.001], higher levels of emotional response [OR = 0.82, 95% CI [0.68, 0.99], p = 0.040], and workload concerns [OR = 0.73, 95% CI [0.55, 0.95], p = 0.020] were associated with lower odds of being in the willing group.ConclusionWillingness to provide psychotherapy for individuals with SCI is associated with both modifiable (e.g., training, preparedness, home visit policies) and non-modifiable (e.g., age) factors. These findings highlight the importance of disability-specific education and structural adjustments to reduce access barriers. Although the present study was limited to Southern Germany, reports from other countries, such as Australia and Switzerland, document a low uptake of psychotherapy among individuals with SCI, suggesting that this may represent a broader challenge across healthcare systems. Our results thus contribute to a better understanding of provider-side barriers in Germany and may stimulate further international research into disability-inclusive mental healthcare provision.

The goal of this study was to characterize mental health care utilization, including variables associated with initiation of a posttraumatic stress disorder (PTSD) evidence-based psychotherapy (EBP), among veterans with PTSD in the year following a suicide attempt. In a national survey of veterans with a recent suicide attempt, 431 had a diagnosis of PTSD and were included in the present study. Patients completed self-report measures of PTSD symptom severity, stigma, and logistic barriers to care. Mental health utilization data were extracted from the electronic health record. Descriptive statistics were used to characterize mental health care utilization in the year after a suicide attempt, and regression analyses were used to identify patient- and health service-related factors associated with PTSD EBP initiation. The majority of the sample received eight or more outpatient mental health visits in the year following the index suicide attempt (95.8%); however, only 10.4% initiated a PTSD EBP, and even fewer (4.2%) received a minimally adequate treatment dose (e.g., eight or more sessions). PTSD severity, stigma, and logistic barriers to care did not account for significant variance in PTSD EBP initiation. In addition to outpatient psychotherapy, the majority of patients received an antidepressant-related medication (90.7%), and a substantial portion experienced subsequent psychiatric hospitalization (46.2%). Although the majority of patients received eight or more outpatient mental health visits, few engaged in a PTSD EBP, suggesting that additional work is needed to determine how best to time PTSD treatment in the context of a recent suicide attempt. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

BackgroundIn recent years, routine outcome monitoring has been increasingly complemented by routine process monitoring in psychotherapy and other health care settings. Various approaches to therapy feedback exist, differing in assessment frequency, integration into the therapeutic process, and degree of personalization. In this study, we will use a procedure of high-frequency assessment through daily self-ratings, a standard process questionnaire, alongside a personalized questionnaire derived from case formulation, and frequent feedback interviews using visual diagrams to mirror the ongoing therapeutic processes.ObjectiveThis study aims to investigate the effectiveness of combining routine process monitoring with hypno-psychotherapy (autosystemic hypnotherapy) by comparing it to autosystemic hypnotherapy without process feedback in the outpatient treatment of mood disorders. It also seeks to examine process-outcome relationships and mechanisms of change through high-frequency self-assessments and session-based feedback.MethodsThis study is a randomized controlled trial with 2 arms, using within-therapist randomization (ABAB design) in outpatient psychotherapy. Participants are recruited offline via routine intake procedures. A total of 100 patients will be randomly assigned to one of the two conditions following a waiting period. The inclusion criterion is the existence of any mood disorder (major depressive disorder or anxiety disorder), assessed via a clinical interview. Each therapist treats patients in both conditions. Outcomes will be measured at 4 time points: after diagnosis confirmation, postwaiting period, posttreatment, and a 6-month follow-up. Primary and secondary outcomes, including symptom severity, will be assessed using questionnaires. Data collection also includes patient and therapist session evaluations using the Bern Patient and Therapist Session Questionnaire. In the feedback condition, therapists conduct frequent interviews using time-series data generated from daily self-assessments using the synergetic navigation system, including the Therapy Process Questionnaire and an individualized measure based on case conceptualization.ResultsWhile this study is ongoing, the primary aim is to assess the effects of the feedback condition on therapeutic outcomes, including symptom reduction and patient motivation. This study will also explore how dynamic monitoring and feedback influence the therapeutic alliance and session-level improvements. It is expected that the feedback condition will lead to improvements in symptom severity and therapeutic engagement compared to the nonfeedback condition. Recruitment is ongoing, with 22 participants enrolled. The training of therapists and the data collection began in 2022. Data collection will end and study findings will be published in 2027. The German Society for Auto-Systemic Hypnotherapy is funding these training courses.ConclusionsThis study combines effect and process measures within a feedback condition, compared to a nonfeedback condition. It incorporates dynamic process assessment to explore change mechanisms by analyzing patterns of time-series data and session ratings by patients and therapists. The approach provides insights into how continuous feedback and tailored monitoring influence therapeutic progress and outcomes.Trial RegistrationOSF Registries osf.io/z2efy; https://doi.org/10.17605/OSF.IO/Z2EFYInternational Registered Report Identifier (IRRID)DERR1-10.2196/78166

Managing Behavioral Health Concerns in Early Childhood: The Role of Child Psychiatry Access Programs.

Blended care (BC), the integration of Internet-based interventions into psychotherapy (PT), is thought of as a promising approach to enhance PT's effectiveness and efficiency. This randomized controlled trial aimed to investigate the effectiveness as well as the implementation and usage of BC with transdiagnostic online modules compared to PT in routine care in Germany. Routine outpatient PT is delivered by licensed psychotherapists across different therapeutic orientations (cognitive behavioral therapy, psychodynamic, systemic), with variable treatment lengths and procedures. Psychotherapists in routine outpatient care recruited 1,159 patients who were randomized to BC or PT. The primary outcome was self-reported mental distress (the composite of anxiety and depression); secondary outcomes included self-reported satisfaction with life, level of functioning, eating pathology, and drug and alcohol use, as well as therapist-rated severity and changes. Outcomes were measured at baseline, 6 weeks, 12 weeks, 6 months, and 12 months. We examined whether BC and PT groups changed differently over time using linear mixed models. We also investigated differences in sessions and terminations and report usage metrics of the BC platform. Contrary to our hypotheses, we did not find differences between BC and PT in outcomes, including anxiety, depression, satisfaction with life, level of functioning, eating pathology, alcohol and drug use, therapist-rated severity, and satisfaction with treatment at 6 months postrandomization (all p > .05). BC and PT did not differ in the number of sessions or terminations. Regarding usage of the BC platform, 534 patients (91.6%) received at least one online chapter, with M = 7.26 (SD = 7.01) of a total of 39 online chapters assigned on average, and patients logged in M = 19.73 (SD = 24.66) times and spent M = 367.14 (SD = 338.27) minutes on the platform. In this real-world application of BC, therapists had considerable flexibility in implementing BC and integrating Internet-based interventions with sessions. Our findings suggest that the benefits observed in more structured BC setups may not fully translate to a flexible and transdiagnostic BC setup in routine care, potentially due to variations in implementation and adherence. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Skills-based psychotherapy is an evidence-based treatment for functional neurological disorder (FND). However, evidence supporting its real-world efficacy is limited, and no consensus exists on optimal treatment duration. The authors examined how baseline neuropsychiatric characteristics are related to outcomes among patients with FND who were receiving psychotherapy. This retrospective cohort included 97 patients with FND who received outpatient skills-based psychotherapy between 2019 and 2023. FND symptoms included motor (79%), seizure (32%), and speech (24%) presentations. Baseline characteristics and clinician-estimated outcomes were extracted from medical records. Univariate screenings were followed by multivariate regression analyses to identify predictors of improvement. At the end of treatment (mean±SD number of sessions=20.0 ± 17.1), 64 patients (66%) had chart-documented evidence of improvement; 20 had complete or near-complete symptom resolution. In a logistic regression, improvement was positively associated with full-time employment and negatively associated with being in a concurrent psychotherapy. After adjustment of analyses for baseline demographic factors and FND subtypes, the number of sessions attended positively correlated with improvement. Of 43 patients who received >16 sessions, 56% showed additional improvement with more treatment. Factors associated with continued improvement in univariate screenings were longer illness duration, cognitive symptoms at baseline, and not being in concurrent psychotherapy, the latter independently predicting continued improvement in prolonged treatment. These findings indicate that skills-based psychotherapy is effective for some patients with FND in real-world outpatient settings. Prolonged treatment benefits a subgroup of patients with FND, highlighting the need for prospective studies to refine and individualize psychotherapy protocols.

Previous studies have shown that patients with depression recall fewer specific autobiographical memories, a phenomenon known as overgeneral autobiographical memory (OGM). OGM refers to the retrieval of categorical memories (repeated events) and extended memories (events lasting more than 24h), rather than specific, single-event recollections. This pattern has been linked to dysfunctional emotion regulation and childhood trauma. While most research has used the Autobiographical Memory Test (AMT) to assess OGM, such standardized cue-word paradigms are limited in capturing how autobiographical memories unfold in real-life psychotherapeutic settings. This study introduces a novel methodology to assess autobiographical memories as they naturally emerge during videotaped psychodynamic psychotherapy sessions. We analyzed videotapes of the first and 40th psychodynamic psychotherapy sessions of 55 patients with major depression. Therapist questions served as prompts for autobiographical narratives, which were rated for specificity and overgeneralization (extended, categorical). We also examined the role of adverse childhood experiences (ACEs) in changes to memory specificity during therapy. Linear regression analysis showed a significant time × memory-type × ACE interaction. No significant changes were observed for categorical or extended memories. In contrast, for specific memories, higher ACE scores predicted fewer specific memories at baseline but greater increases in specificity from session 1 to 40. This study demonstrates the feasibility of assessing autobiographical memory specificity directly within psychodynamic psychotherapy sessions. The proposed methodology provides an ecologically valid alternative to traditional lab-based assessments of autobiographical memory and can be applied in the naturalistic context of real-life therapeutic interactions. Our findings suggest a potential improvement in autobiographical memory specificity during psychodynamic psychotherapy - particularly among individuals with higher ACE scores - that may be reliably assessed using this novel approach. Not applicable.

Sleep disturbances are highly prevalent among individuals with alcohol use disorder (AUD). Although sleep often improves during AUD treatment, associations with treatment outcomes have been inconsistent and have focused primarily on mean sleep parameters rather than daily within-person variability. Sleep variability is an emerging marker of physiological dysregulation and is linked to negative symptoms that may sustain alcohol use. Adults with AUD (N = 80) completed a 7-day daily sleep diary and clinical assessments before and after a 12-session outpatient psychotherapy treatment for AUD. Multilevel models examined pre- to post-treatment changes in sleep variability. Multiple regression models tested whether changes in sleep variability predicted changes in alcohol use and psychosocial outcomes. All analyses used Bayesian estimation. Variability in sleep onset latency (SOL; estimate = -4.43, 95% CI [-7.12, -1.40]), sleep midpoint (estimate = -18.77, 95% CI [-31.29, -4.13]), sleep efficiency (estimate = -1.87, 95% CI [-3.01, -0.61]), and number of awakenings (estimate = -0.17, 95% CI [-0.29, -0.04]) decreased across treatment. Variability in SOL emerged as the most robust predictor, with greater reductions in variability in SOL being associated with greater reductions in percentage drinking days (estimate = 0.01, 95% CI [0.001, 0.02]), drinks per drinking day (estimate = 0.10, 95% CI [0.001, 0.20]), and negative consequences from alcohol use (estimate = 0.51, 95% CI [0.24, 0.79]). Notably, improvements in mean-level sleep parameters were not associated with improvements in any treatment outcomes. These results suggest that sleep variability, particularly in SOL, may be an important marker of treatment response and a potential target for future intervention above and beyond mean-value sleep parameters. Future research would benefit from further examination into what drives changes in sleep variability as well as potential added benefits of adapting AUD treatments to include components that target sleep consistency.

ObjectiveInternational treatment guidelines recommend psychotherapy as the first-line treatment for anorexia nervosa (AN). Adaptation of Western evidence-based treatments to different cultures through personalization has become increasingly important, but evidence remains limited. This study examined the feasibility and effectiveness of AN outpatient psychotherapies in Korea.MethodsA total of 160 adult patients diagnosed with AN (mean age = 25.3 years) were recruited from an eating disorder (ED) clinic in Korea. They received one of the following psychotherapy programs motivational enhancement therapy with nutrition (MET with nutrition) (n = 47); Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) augmented by New Maudsley Model for Collaborative Care (NMCC) (n = 20); or Specialist Supportive Clinical Management (SSCM) (n = 93). Treatments were administered face-to-face by trained therapists, following protocols tailored to each individual. Demographic and ED‐related clinical data were collected through standardized interviews and questionnaires at baseline and at the end of treatment.ResultsOverall dropout rate was 40.3%, with a lower rate observed in MANTRA augmented by NMCC and SSCM than MET with nutrition. All three psychotherapies increased body mass index (BMI), with minimal group differences. Individuals with lower baseline BMI and those who attended more sessions experienced greater BMI increases across all psychotherapies.ConclusionPsychotherapies for AN were feasible and showed promise in terms of effectiveness among Korean patients. Despite comparable BMI increases, the therapies led by experienced therapists and with greater personalization had lower dropout rates. Further studies using randomized controlled trials are needed while controlling for variables outside treatments.