Gratitude and hope are established predictors of mental and physical health and well-being. Scarce literature investigates relevant mediators of these relationships in a single model and during the COVID-19 pandemic. The current study investigated the mediating role of health anxiety (measured three months after baseline) in the relationship of gratitude and hope at baseline with alcohol use, fatigue, pain, and well-being six months later. The sample was composed of 788 mostly male (58.1%), White (70.3%), middle-aged adults ( = 38.0,  = 11.8). Structural equation models (SEM) were used to analyze the data. Gratitude at baseline's indirect effect of health anxiety three months later was both small and negative for alcohol use ( = ‒.06, 95% CI [-.10, -.03]) and pain ( = ‒3.01, 95% CI [-4.34, -1.68]). Health anxiety appears to be a robust mediator of the relationship between gratitude and mental and physical health outcomes. Hope was a stronger and more direct predictor of well-being compared to gratitude. The findings of this study may provide evidence for examining health anxiety levels as a risk factor when trying to promote resilience factors in individuals who report health issues, particularly during times of environmental contagion.

A systematic review and meta-analysis was conducted of different types of CBTs for ID in adults treated in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for studies published until January 2025. The effectiveness of CBT, methodological quality, and moderators of treatment outcomes were examined and benchmarked by meta-analytically comparing them with efficacy studies for ID. Thirty-two studies were included, comprising 5231 participants. Very large within-group effect sizes (ES; Hedges' g) were obtained for ID-severity at post-treatment (1.87), and follow-up (1.68), on average 12 months post-treatment. Remission rates were 45% post-treatment and 51% at follow-up. Attrition rate was 13.9%. Risk of bias was considerable in the majority of studies. The benchmarking analysis showed that effectiveness studies (1.83) had almost exactly the same ES as efficacy studies (1.82) at post-treatment. Furthermore, there was no significant difference between effectiveness and efficacy studies on sleep diary measures, remission rates, and self-ratings of depression and anxiety. CBTs for ID are effective when delivered in routine clinical care, with ESs comparable to those found in efficacy studies. However, the evidence needs to be interpreted with caution because of the risk of bias in a high proportion of studies.: CRD420251032141.

Previous research has demonstrated that post-traumatic stress disorder (PTSD) symptoms and exposure to potentially morally injurious events (PMIEs) frequently co-occur in military veterans and share similar adverse mental and behavioral health outcomes. While studies have established a robust association between PTSD and dissociative symptoms in veterans, evidence supporting a direct link between exposure to PMIEs and dissociative symptoms has largely been anecdotal. In this cross-sectional study, a volunteer sample of 189 Israeli male combat veterans completed validated self-report questionnaires assessing PTSD symptoms, exposure to PMIEs, and dissociative symptoms. The results show cooccurrence of PTSD symptoms and depersonalization and/or derealization symptoms, hereby suggesting the existence of a dissociative subtype of PTSD, characterized by elevated PTSD symptoms alongside persistent or recurrent symptoms of depersonalization and/or derealization. Moreover, PTSD symptoms were found to mediate the relationship between PMIE exposure and dissociative symptoms. Notably, one of the facets of exposure to PMIEs, the commission of moral transgressions, was significantly associated with depersonalization/derealization symptoms, suggesting a dissociative subtype of PMIE exposure. These findings provide empirical support for the trauma model, which conceptualizes dissociative symptoms as resulting from severe trauma, and underscore the importance of offering specialized treatments for veterans who report having committed moral transgressions.

Blended cognitive behavioral therapy (bCBT) combines the use of traditional in-clinic, face-to-face therapy sessions with online therapy platforms. The blended aspect can either be supplementary to face-to-face sessions, or a partial replacement of face-to-face sessions. While bCBT has been available for two decades, there is no statistically synthesized overview of its effectiveness in treating internalizing disorders, including anxiety and depression. In this study, we examined effectiveness in two meta-analyses: 1) comparing bCBT to treatment as usual; 2) comparing bCBT change scores from pre- to post-treatment. We tested the influence of moderators on effectiveness: blended method, online therapist contact, and diagnosis. In line with expectations, results from meta-analysis one (k = 19 studies,  = 2749) showed that supplementary bCBT leads to a significantly superior treatment effect over treatment as usual ( = 0.41, 95% CI [0.24, 0.59]) while replacement bCBT is on par with treatment as usual ( = -0.01, 95% CI [-0.18, 0.17]). Meta-analysis two included 32 studies ( = 1895) and showed significant improvement with bCBT ( = 1.12, 95% CI [0.92, 1.33]), irrespective of blended method or therapist contact. Findings suggest that bCBT is a worthwhile form of treatment for both anxiety and depression.

Homework is a potential contributor to treatment response in cognitive-behavioral therapy (CBT) for anxiety, but less is known regarding the importance of yoga homework for generalized anxiety disorder (GAD). This study examined the impact of homework engagement on treatment response within a randomized controlled trial (RCT) of 12 weeks of group CBT, Kundalini Yoga (KY), or stress education (SE) in a subsample of 190 adults with GAD (71% female, Mean age = 33 ± 13) who attended ≥2 sessions and submitted ≥1 homework log. Participants in CBT and KY showed greater overall homework engagement than those in SE (s < .05). Across treatment arms, staff-rated homework compliance ( = .002,  = 1.74), but not participant-reported days per week engaged in homework ( = .108), predicted clinical response at post-treatment ("response"). Greater staff-rated homework compliance was related to a greater response for those in CBT ( = .005,  = 2.49) and KY ( = .049,  = 1.66), but not SE. Greater participant-reported homework days per week was only marginally related to response to CBT ( = .054,  = 1.71), and was not related to response to KY or SE. These findings highlight the importance of homework engagement in CBT for GAD. More research is needed to further elucidate the role of homework engagement in yoga for GAD.TRIAL REGISTRATION: clinicaltrials.gov: NCT01912287; https://clinicaltrials.gov/ct2/show/NCT01912287.

The metacognitive model of psychological disorders emphasises common causal factors across psychopathologies and assigns a central role to maladaptation in metacognition. Metacognitions concerning the uncontrollability of thoughts are considered central, occurring in most disorders, whilst other more specific metacognitions, make additional contributions to particular disorders. The Meta-cognitions about Health Anxiety questionnaire (MCQ-HA) was developed to assess metacognitive beliefs relevant to health anxiety and includes three subdomains: beliefs that thoughts cause illness; beliefs about biased thinking; and beliefs that thoughts are uncontrollable. As these metacognitive domains may improve our understanding of health anxiety, the aim of the current study was to assess the psychometric properties of the MCQ-HA in a Norwegian sample and test the fit of the metacognitive model applied to health anxiety symptoms. Eight-hundred and thirty-nine participants completed a battery of self-report questionnaires. Confirmatory factor analysis supported the a-priori three-factor solution of the MCQ-HA, with acceptable internal consistency and demonstrable convergent- and incremental validity. A test of the goodness of fit of a pre-specified metacognitive model of health anxiety based on associations indicated a good model fit. Our findings support the use of the MCQ-HA and support the metacognitive conceptualisation of health anxiety symptoms.

Caregivers of individuals with rare neurogenetic conditions often experience mental health challenges, often alongside substantial experiences of resilience. Unfortunately, caregiving burden can make accessing mental health support difficult, and restricted resources during the COVID-19 pandemic further exasperated these challenges. The present study leveraged a community-academic partnership to pilot three virtual telemental health therapies-Acceptance and Commitment Therapy, Dialectical and Behavioral Therapy, and Integrated Couples' Behavioral Therapy-in a sample of 80 caregivers of individuals with Prader Willi syndrome and Williams syndrome. Across 12 weeks of treatment, caregivers completed clinical assessment forms and daily ecological momentary assessments to monitor well-being and mental health. Results provide preliminary evidence that each treatment was feasible, acceptable, and potentially effective in addressing the mental health needs of most caregivers. Virtual community-academic partnerships may provide a useful model for supporting caregivers, while also training the next generation of providers ready to meet the unique, persistent needs of this population. Randomized controlled trials are a necessary next step to determining efficacy. Given that mental health challenges for caregivers pre-dated the pandemic and continue to persist, identifying suitable treatment options remains high priority.

Routine outcome monitoring and feedback (ROM) systems have been established to enhance therapeutic outcomes, prevent drop-outs and facilitate data-driven personalization in psychotherapy. However, the underlying mechanisms of ROM systems remain unknown, although the therapeutic alliance has been discussed as a potential mechanism. In this pre-registered (https://osf.io/jkmct) single case experimental design study with multiple (3) baselines and  = 34 outpatients in routine care, a potential causal effect of the structured discussion of feedback on the therapeutic alliance over the first 20 sessions is investigated. The single case effects were aggregated using a random effects meta-analysis to estimate the group-level effect and its heterogeneity. As potential moderators, baseline impairment and level of personality functioning were tested. The meta-analysis resulted in a significant effect size of Ruscio's  = 0.92 with a 95% CI [0.88, 0.95] ( < .001) and Hedges'  = 1.33 with a 95% CI [1.04, 1.62] ( < .001). The potential moderators were not significant. These results establish causality between the structured feedback discussions and the improvement of the therapeutic alliance with large, robust effect sizes regardless of case complexity and open up the possibility of using ROM systems as a specific intervention to increase the therapeutic alliance.

Generalized anxiety disorder (GAD) is a severe and prevalent disorder among older adults. Cognitive behaviour therapy (CBT) is recommended treatment for GAD, but older adults benefit less than younger peers. Physical exercise has been suggested to improve treatment efficacy. We aimed to determine the efficacy of augmenting CBT with physical exercise for older adults with GAD. This randomised controlled trial included 50 participants (mean [SD] age 66.52 [4.09] years; 39 [78%] female) with GAD. Participants received individual CBT and were randomised to either physical exercise or telephone attention placebo. The main outcome measure was self-reported worry on the Penn State Worry Questionnaire (PSWQ). Secondary outcome measures were clinician-rated remission and self-reported symptoms of anxiety, depression, and quality of life. Although the interaction between time and condition was statistically nonsignificant, moderation analysis revealed that this interaction was significant for participants with low treatment credibility to CBT at baseline. Participants randomised to physical exercise were five times more likely to achieve reliable long-term worry-reduction than placebo control. We found significant differences in favour of physical exercise for secondary measures of depression and anxiety. Participants with better cognitive inhibition at baseline were more likely to achieve clinician-rated remission. Findings suggest that physical exercise augments CBT for older adults with GAD.

People with type 1 diabetes mellitus (T1DM) may benefit from cognitive behavioural therapy (CBT) interventions; self-guided digital tools are a potentially scalable solution. Two promising components for T1DM from CBT are problem-solving and exposure. Our aim was to preliminarily explore whether two digital tools, namely a problem-solving tool and an exposure tool, could be helpful for people with T1DM, and to investigate types of problems reported. We recruited nine participants from a specialised diabetes unit. Following one drop-out, eight participants used the tools for 4 weeks and answered questionnaires on usability, mental health, and diabetes distress. Comments and ratings showed that there were two distinct types of users that can be matched to the types of digital tools: those with general problem areas in diabetes and those of an avoidant type, driven by fear of hypoglycaemia. All participants used problem-solving to some degree, typically solving one or two problems. Three participants used exposure, registering at least one exercise. Both exposure and problem-solving may be useful in future interventions for people with T1DM. A digital self-guided CBT intervention for T1DM could include problem-solving with exposure as an option and be evaluated as a full digital self-care programme.

Idiographic networks offer a transdiagnostic approach to case conceptualization and may aid in selecting the treatment focus. We provide a practical manual for constructing idiographic paper-pencil networks. These networks focus on a single main problem, delineate the maladaptive processes that perpetuate it, and thereby inform treatment recommendations. We tested the feasibility and clinical utility of the network construction. Eight therapists applied a manual to construct idiographic paper-pencil networks with twelve patients. Both therapists and patients assessed the feasibility of the manual, the clarity of the network visualization, and the perceived clinical utility of the networks. Additionally, they evaluated changes in common therapeutic factors due to network construction. Therapists and patients rated the manual as highly feasible, viewed the network visualizations favorably, and assessed the clinical utility of the networks positively. Both therapists and patients reported improvements in treatment expectations, therapeutic alliance, and therapy motivation due to network construction. This study provides a manual for developing idiographic process-based networks during the initial psychotherapy session. Both therapists and patients evaluated the manual and the resulting networks positively, suggesting their potential to enhance case conceptualization and treatment selections in psychotherapy.

Whilst there is evidence supporting the effectiveness of Dialectical Behavior Therapy (DBT) for the treatment of Binge Eating Disorder (BED), it remains unclear whether this can be delivered virtually without loss of clinical effect. This study aims to explore the acceptability and preliminary clinical effectiveness of a virtual therapist-led DBT group for BED. Of 108 adults with BED who were offered a virtual 10-week DBT group between 2020 and 2022, 51 commenced treatment; 8 groups were conducted. Patients completed measures of eating disorder pathology, mood and anxiety at start, end of treatment, and 1-month follow-up. Binge abstinence rates were recorded weekly. Forty-seven percent of those offered the group began treatment; of that group 71% completed treatment. Binge abstinence rates of 64.71% were achieved by end of treatment. Generalized Linear Mixed Models showed significant reductions in eating and mood pathology, with generally strong effect sizes. All changes were maintained at 1-month follow-up. Preliminary findings suggest that a virtual 10-week DBT group for BED is clinically effective. Further research is required to replicate these findings in an appropriately powered sample. The significant number of patients not opting-in suggests barriers to treatment uptake that would be helpful to explore to further inform treatment acceptability.

Among those with borderline personality disorder (BPD), dialectical behavior therapy (DBT) is considered a frontline treatment for reducing impulsivity and suicidality and improving emotion regulation. DBT has been proven effective when delivered within Veterans Health Administration. Much of the research supporting the use of DBT was conducted on patients with relatively clean diagnostic profiles (e.g. excluding bipolar disorder). However, Veterans are diagnostically complex and are especially likely to have comorbid posttraumatic stress disorder (PTSD). We sought to understand how a PTSD diagnosis affected treatment outcomes among Veterans who presented for full-model DBT treatment. In a sample of 62 Veterans, half of whom had probable ( = 24) or confirmed ( = 7) PTSD, we tested whether comorbid PTSD and BPD affected baseline severity, treatment engagement, or treatment outcomes. Compared to those without PTSD, BPD-PTSD did not hamper treatment engagement and was unrelated to BPD symptom severity at baseline. BPD-PTSD was associated with noninferior and indeed sharper reductions in BPD symptoms throughout treatment. That is, relative to Veterans without PTSD, Veterans with co-occurring PTSD and BPD symptoms reported steeper symptom reductions. Altogether, our findings support the use of DBT in Veterans who present with both BPD symptoms and PTSD.

Anxiety and depressive disorders are the most prevalent disorders worldwide and significantly impair quality of life (QoL). Transdiagnostic cognitive behavioural therapy (TD-CBT) is effective in treating these disorders and improving QoL, but its long-term mechanisms of change are poorly understood. Rumination and worry are key processes addressed by TD-CBT. In this study, we analysed the sequential effect of TD-CBT on post-treatment rumination and worry, anxiety/depression symptoms at 6-months and psychological and physical QoL at 12-months. We use data from PsicAP, a randomised clinical trial in the Primary Care (PC) setting, with 1061 participants randomised to TAU (treatment as usual) or TD-CBT+TAU. Path analyses using SEM were employed to test serial mediation models. Analyses indicated that TD-CBT exerts its long-term beneficial effects on QoL through a cascade of effects, whereby first the maladaptive cognitive processes of rumination and worry are reduced (post-treatment), then anxiety and depressive symptoms (6-months) and finally QoL is improved (12-months). This study provides longitudinal evidence on the mechanisms of change of TD-CBT in patients with anxiety and depression. It also highlights the importance of targeting transdiagnostic interventions towards early modification of negative repetitive thought processes as a critical pathway to long-term symptomatic and functional recovery.

Despite a wealth of research demonstrating the efficacy of exposure therapy for the anxiety and related disorders, research shows that few therapists use this technique in clinical practice. Negative beliefs about exposure therapy have been shown to be the most significant barrier to use or optimal use. A richer and more nuanced understanding of the relationship between negative beliefs and exposure use, and its implications for training and practice, is warranted. This research aimed to identify the specific negative beliefs about exposure held by Australian psychologists, and the association of these beliefs with the use of therapist-assisted and self-guided exposure (i.e. between-session exposure homework) of exposure therapy for anxiety, obsessive-compulsive, and post-traumatic stress disorders. One hundred registered psychologists participated in an online study. Results suggest that the most frequently endorsed negative belief is the need for arousal reduction techniques to tolerate distress associated with exposure therapy. Negative beliefs about exposure were negatively correlated with both therapist-supported and self-guided exposure of exposure therapy across all disorders, though largest correlations were found for therapist-supported techniques. Training implications of these findings are discussed.

Sudden gains are rapid, substantial, and lasting symptom reductions between sessions which have been associated with better treatment outcomes. Frequent symptom measurements in treatment change research can be burdensome; ultra-brief scales can reduce this burden, increase completion rates, and enable the examination of a broader range of constructs. This study compared the timing, prevalence, and treatment outcomes associated with sudden gains during an internet-delivered treatment using standard and ultra-brief self-report measures of depression and anxiety. Existing data ( = 937) from a five-week internet-delivered treatment for depression and anxiety in university students was analysed. Anxiety symptoms were measured using the Generalized Anxiety Disorder 7-item Scale (GAD-7) and its brief version the GAD-2, and depression symptoms were measured using the Patient Health Questionnaire 9-item Scale (PHQ-9) and its brief version the PHQ-2. More sudden gains were identified by the PHQ-9 than the PHQ-2, and more by the GAD-2 than the GAD-7. Critically, the standard and ultra-brief measures identified different individuals as having experienced a sudden gain. Sudden gains were associated with higher baseline symptom severity. These results seem to raise important questions about the detection of sudden gains, and the comparability of findings across studies using different measures.

Cognitive-Behavioral Therapy (CBT) and Mindfulness-Based Therapy (MBT) are efficacious treatments for Sexual Interest/Arousal Disorder (SIAD) in women. Many women with SIAD have a history of sexual assault (SA), but the degree to which SA history predicts engagement in treatment of SIAD, or its efficacy, is generally unknown. It is also possible that treatment of SIAD may improve Posttraumatic Stress Disorder (PTSD) symptoms related to SA. We engaged in secondary analysis of a trial assessing an online intervention for SIAD (called ) to explore whether SA history predicted treatment engagement or outcomes, and whether PTSD symptoms improved. Women with SIAD were randomized to online CBT ( = 43), online MBT ( = 43), or a waitlist control ( = 43). Participants completed self-report measures of engagement, SIAD symptoms, and PTSD symptoms at baseline, mid-treatment, posttreatment, and 6-month posttreatment. SA history did not predict treatment engagement or changes in SIAD symptoms. Overall PTSD symptoms decreased in MBT over and above waitlist. Exploratory analyses including follow-up assessment suggested that, among SA survivors, PTSD symptoms improved most in CBT whereas, for those without SA history, improvement was greater in MBT. SA survivors can use and benefit from evidence-based online therapies, like , for SIAD.

Little is known about which transdiagnostic cognitive behavioural processes (precipitating or maintaining factors across different psychiatric disorders) are most critical to target to improve the outcomes of interventions for eating disorders (EDs). As a first step toward developing a better understanding of this issue, we conducted a modified Delphi study to reach consensus on processes for early intervention and augmenting evidence-based treatment. Across three rounds, four panels were included: people with lived experience ( = 38), significant others ( = 27), clinicians specialising in the treatment of EDs ( = 44), and ED researchers ( = 29). For early intervention, nine processes were endorsed: basing self-worth on one or two aspects of oneself; persistent and excessively high standards; poor distress tolerance skills; being self-critical; negative body image; difficulty coping with developmental life transitions; low self-compassion; low self-worth and self-acceptance; and negative social media use. For augmenting treatment, nine similar processes were endorsed, except life transitions and social media use, which were replaced by social isolation and unhelpful thinking habits. This information can inform a future research agenda for improving interventions for EDs. However, consensus only occurred for approximately one fifth of the 49 processes, with a disconnect between the lived experience and researcher panels that requires attention.

Chronic musculoskeletal pain (MSKP) is a common and challenging condition often occurring with generalized anxiety disorder (GAD). Cognitive behavior therapy (CBT) is a first-line treatment for GAD, but limitations on the potential availability or engagement in CBT have encouraged consideration of remote and autonomous treatment options. Yet, little is known about preferences for different modalities of CBT. This study evaluated relative preferences for in-person, telehealth, or digital CBT among individuals with comorbid MSKP and anxiety. Using local and national online advertising, we recruited a sample of 85 individuals with MSKP and self-reported clinical levels of anxiety (mean age: 40.3, 74.4% female, 67.1% White). Results indicated a significant preference for in-person therapy over digital treatment. Nonetheless, multiple indices of higher pain-related fear and distress were linked to a greater relative preference for digital therapy. Dissemination of scalable digital treatment for anxiety for adults with MSKP may find the best reception among individuals with these characteristics.

Internet-based interventions (IBIs) are effective for treating depression, but they can also lead to negative effects in some participants. There is no consensus on which specific characteristics of negative effects clinicians and researchers should focus on. Studies often combine distinct (sub)categories of negative effects, complicating interpretation. This study aimed to identify specific (sub)categories of negative effects related to depression and adherence and explore their predictors. In a sample of participants undergoing an IBI for depression ( = 1610; 61% female), 113 participants (7%) reported experiencing at least one negative effect. 110 participants qualitatively reported negative effects and were categorized into a framework consisting of two main categories (treatment-related vs. patient-related) of negative effects, divided into five subcategories (format, contact, implementation, symptoms, and insight). No differences in adherence were observed between any (sub)categories of negative effects; however, participants who reported treatment-related negative effects showed significantly lower symptom improvement than those reporting patient-related negative effects. No patient demographic characteristics predicted any negative effects. Differentiating treatment- and patient-related negative effects could enhance future research and intervention efforts.