Family processShuang Lu, Christine T Y Ng, Renhui Lyu, Eddie S K Chong, Hui Hu, Xiaolu Dai, Kirk Warren Brown, Siu-Man Ng, Qiaobing Wu
Parent and child sociocultural adaptation is essential to migrant family well-being, and community-based mindfulness training may support this process. However, evidence on mindfulness interventions for migrant families remains scarce, particularly those engaging parent and child simultaneously. This study evaluates a parallel parent-child mindfulness intervention targeting sociocultural adaptation, psychological adjustment, and family relationships among Chinese new-arrival families in Hong Kong. In a randomized controlled trial, 116 parent-child dyads were assigned to an 8-week mindfulness intervention or routine community services. Outcomes were assessed at baseline, post-intervention, and 6-month follow-up. Compared with controls, the intervention significantly improved parents' sociocultural adaptation, with attenuated effects at follow-up. It also increased parent life satisfaction and reduced parenting stress at posttest. Child outcomes were largely nonsignificant, except for short-term improvements in social interaction and life satisfaction at posttest. Indirect effects of the intervention through parent sociocultural adaptation were nonsignificant, with estimates in the hypothesized direction for parent life satisfaction (B = 0.94, 95% CI [-0.02, 1.90]) and psychological distress (B = -1.42, 95% CI [-2.89, 0.04]). No mediation effects were observed among children. Subgroup analyses indicated that effects on parent adaptation and life satisfaction varied by child sex and family length of residence, with sustained effects observed only among parents of boys and families residing in Hong Kong for less than 2 years. Findings suggest that parallel parent-child mindfulness interventions may support specific aspects of migrant families' adaptation, with more consistent and sustained effects for parents than for children.
Journal of research on adolescence : the official journal of the Society for Research on AdolescenceLixian Cui, Xiwen Li, Doris Yuxuan Zhang, Morui Yu
Studies of identity-based discrimination among Chinese youth attending vocational schools and working in urban areas are scarce. To contribute to the global understanding, we adopted an explanatory sequential mixed-methods design with 204 Chinese internal migrant youth (Aged 16-24, 68.1% male, Mage = 20.17 years, SD = 1.57) to examine the associations between perceived discrimination and psychological adjustment, and the moderating roles of coping and perceived social support. In the first phase, participants completed self-report measures, and in the second phase, we interviewed a subsample of 47 youth to contextualize our quantitative trends. Quantitative findings showed that perceived discrimination was negatively linked to self-esteem and positively to depressive symptoms, whereas active-approach coping and social support were positively related to self-esteem and negatively with depressive symptoms. Expressive-evading coping covaried positively with depressive symptoms. We also found that passive-avoidant coping exacerbated the associations between discrimination and depressive symptoms. The roles of active coping and social support in relation to self-esteem varied by age. Qualitative data showed that migration status, rural origin, and regional dialects were the most cited reasons for experiencing discrimination, occurring most frequently in immediate neighborhoods and schools by locals and classmates. Most youth turned to close friends for emotional support, rather than parents, teachers, or classmates. Many would ignore or distract themselves from the experiences, and sometimes would actively cope with the stress. Both quantitative and qualitative findings reveal the unique challenges Chinese migrant youth encounter and distinct pathways of resilience in adapting to urban settings.
AIMS: Although combining long-acting injectable antipsychotics (LAIs) with psychosocial treatments for schizophrenia is important, psychiatrists' attitudes toward this approach remain underexplored. We investigated Japanese psychiatrists' perceptions of combining atypical LAIs with psychosocial interventions. METHODS: An anonymous cross-sectional web-based survey was administered to 1038 mid-career Japanese psychiatrists, of whom 69 provided complete responses. Participants' general attitude toward recommending atypical LAIs was dichotomized as positive or negative/neutral, and they rated on a 4-point scale the usefulness of combining atypical LAIs with five psychosocial interventions: (1) psychosocial treatment (e.g., psychoeducation), (2) day/night care, (3) community care, (4) financial/employment support, and (5) housing support. RESULTS: Thirty-nine respondents held a positive attitude toward recommending atypical LAIs, whereas 30 held a negative/neutral attitude. A positive attitude was significantly associated with perceiving the combination as useful for psychosocial treatment (p = 0.038), financial/employment support (p = 0.015), and housing support (p = 0.041), but not for day/night care (p = 0.090) or community care (p = 0.079). Free-text rationales most commonly cited improved adherence and relapse prevention, enhanced illness insight, and synergistic effects as reasons for valuing the combination. CONCLUSIONS: This exploratory study suggests that mid-career Japanese psychiatrists, particularly those with a favorable attitude toward atypical LAIs, perceive the combination of LAIs with psychosocial support not merely as an adherence tool but as a synergistic strategy promoting broader functional recovery. Because respondents represent a small, predominantly male, self-selected sample, the generalizability of the findings is limited.
Australian health review : a publication of the Australian Hospital AssociationNicole Black, Danusha Jayawardana, David W Johnston, Trong-Anh Trinh
OBJECTIVE: Within Australia, evidence is limited regarding how access to mental health care varies across geographical regions, and which areas experience the lowest levels of service use. This study aimed to provide new population-level evidence on the geographic variation in the use of Medicare-subsidised psychotherapy over the past decade and identify regions with the lowest service use. METHODS: We used administrative data from the Medicare Benefits Schedule to identify 2.7 million adults aged 25-54 years across mainland Australian states with a new mental health treatment plan from a general practitioner between 2014 and 2023. State-level trends were examined by calculating the proportion of individuals who accessed Medicare-subsidised psychotherapy within 3 months of receiving their mental health treatment plan in each state per year. We then examined variation in the use of psychotherapy across regions in 2023 (Statistical Area Level 4), and assessed how this psychotherapy use was associated with area-level socioeconomic disadvantage. RESULTS: Between 2014 and 2023, psychotherapy use among adults with a mental health treatment plan declined substantially across all states, from approximately 60% of adults in 2014 to <50% in 2023. Psychotherapy use also varied markedly across sub-state regions (Statistical Area Level 4s) in 2023, with uptake ranging from 36% in Sydney's Outer South West to 60% in Perth's inner suburbs. Access was generally lower in non-metropolitan regions and in areas with higher socioeconomic disadvantage. CONCLUSIONS: The results highlight the need for system supports that make psychological services more accessible, particularly in socioeconomically disadvantaged areas. Addressing access gaps will require coordinated efforts across general practice, service delivery and policy settings. Prioritising support and policies towards regions with the poorest access can assist with designing a more equitable mental health system.
Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, IncMd Nazmul Huda, Teresa Winata, Weng Tong Wu, Thomas Nguyen, Michael Bowden, Valsamma Eapen, Rajeev Jairam
BACKGROUND: Presentations of children and young people (CYP) to Emergency Departments (ED) for acute mental health (MH) issues have increased globally and in Australia. The Safeguards Teams Program (STP) was implemented to provide acute, rapid response, recovery-focused, trauma-informed brief intervention. This study aims to explore clinicians' perspectives and experiences implementing the STP, including barriers, facilitators and suggestions for programme improvement. METHODS AND MATERIALS: This study used a qualitative approach by employing in-depth interviews. Participants were recruited using purposive sampling. The interview transcripts were coded and analysed thematically. RESULTS: Key themes included perceived barriers to implementation, programme enablers and suggestions for improvement. Enablers of successful implementation included structures that supported clinicians' outreach and service accessibility, a centralised and flexible referral model that clinicians perceived facilitated timely care, and opportunities for clinicians' capacity building and collaboration. Clinicians also perceived that the STP supported children and young people experiencing MH crises who may not meet the intake criteria for other services, thereby addressing an important service gap. Perceived barriers included high demand, which increased workload, and challenges associated with the model of care (MoC) in its early stages of implementation. Suggestions for programme improvement emphasised the need for greater contextualisation of services through co-design, a more flexible MoC as part of STP service delivery, and a structured and formalised referral process. Participants also recommended including clinicians with specific skills and cultural awareness, enhancing community awareness, and strengthening integration efforts. CONCLUSIONS: Clinicians perceived the STP as a valuable crisis-response service with the potential to address an important service gap for CYP who need rapid outreach specialist MH crisis response. Findings relating to clinicians' experiences and perceptions of implementing the STP may inform the development, refinement and implementation of similar crisis-response models. Further quantitative research is needed to evaluate clinical outcomes, service utilisation and consumer perspectives associated with the STP.
Nursing in critical careAbdullah Avcı, Mükaddes Avcı
BACKGROUND: Nurses working in intensive care units (ICU) are at high risk for stress and anxiety. Aromatherapy stands out as a non-pharmacological and easily implementable complementary approach for alleviating these symptoms. To our knowledge, this is the first systematic review specifically examining the effects of aromatherapy on stress and anxiety among ICU nurses. AIMS: This systematic review aimed to evaluate the effects of aromatherapy on stress and anxiety among ICU nurses and to assess the methodological quality of the evidence. STUDY DESIGN: In this systematic review, a literature search was conducted in the Scopus, PubMed, Web of Science and Cochrane Library databases without any time restrictions. The review includes randomised controlled, experimental and quasi-experimental studies evaluating the effects of aromatherapy interventions on stress and/or anxiety among ICU nurses. The selection of studies, data extraction and assessment of methodological quality were conducted independently by two researchers. RESULTS: This systematic review included five studies involving a total of 254 participants. Two of these studies are randomised controlled trials, and three are quasi-experimental studies. The studies included in the review demonstrate that aromatherapy is administered using various essential oils and application methods (inhalation, topical application, etc.). The findings suggest that aromatherapy interventions may reduce stress among ICU nurses, whereas evidence regarding anxiety reduction is mixed and less consistent across studies. CONCLUSION: Aromatherapy may have potential benefits for reducing stress among ICU nurses, whereas evidence for anxiety reduction remains limited and inconsistent. Further high-quality studies are needed before firm conclusions or routine clinical implementation can be recommended. RELEVANCE TO CLINICAL PRACTICE: Aromatherapy may be considered as an optional supportive intervention within staff well-being programs, provided that safety, scent sensitivity, infection-control procedures and individual preferences are taken into account. However, standardised protocols and further high-quality evidence are required to support its routine clinical use.
Infant mental health journalJade Pryor, Alyssa Sawyer, Clemence Due, Sally Watson, Anne Sved Williams
Motherhood is inherently demanding, and some of these demands may be amplified for women with borderline personality disorder (BPD). The exacerbation of BPD symptoms from parenting-related stressors can have adverse impacts on mother-infant relationships and infant development. This qualitative study explores Australian mothers' views of the impacts of mother-infant dialectical therapy plus (MI-DBT+). MI-DBT+ is an innovative therapeutic intervention which integrates mother-infant dialectical behavior Therapy (MI-DBT), a known effective intervention for the mental health of mothers with BPD, with attachment and biobehavioral catch-up (ABC) therapy. Specifically, eight mothers completed semi-structured interviews about their experiences of intervention following completion of the MI-DBT+ program. A thematic analysis of this interview data found that mothers appreciated learning more skills to enhance their understanding of their infants' needs, behaviors and emotions. Mothers also reported improved reflective functioning and better control of their emotional responses. These skills assisted in managing emotional distress at both the individual and dyadic level. The study was limited due to available demographic data, with only maternal and child age available. Discussion also focuses on the fit between DBT and ABC, longer term developmental concerns and sustainability.
NMR in biomedicineZhiyan Wang, Savanna Babu, Nina Beck, Sebastian M Frank
Neurofeedback training is a procedure in which participants learn to modulate brain activity through their own efforts. Here, we designed a real-time neurofeedback training using functional magnetic resonance spectroscopy (fMRS) to modulate the concentration of glutamate, a major excitatory neurotransmitter, and its precursor glutamine (collectively referred to as Glx) in a volume-of-interest (VOI) located in the occipital lobes. During an induction phase participants employed a self-selected strategy to increase or decrease Glx concentration relative to a reference concentration measured prior to neurofeedback training. Participants were informed about their performance after the induction phase by displaying a disk in green for success or red for failure. The disk size indicated the magnitude of success or failure. The procedure was repeated over the course of 30 trials. Participants were randomly assigned to experimental and control groups (15 participants per group). The experimental group received veridical feedback about their success or failure in the induction phase. The control group received random feedback. Glx concentration in the VOI was measured using 2-s-long consecutive Point RESolved Spectroscopy (PRESS) scans in a 3-Tesla MRI scanner. The results showed that depending on group assignment, participants in the experimental group learned to increase or decrease Glx concentration over the course of training. No significant changes in Glx concentration were observed in the control group. These findings suggest that, with the help of veridical performance feedback, participants learned to modulate Glx concentration in the VOI in the desired direction over a relatively short period of time. fMRS-based neurofeedback training may complement existing neurofeedback approaches by targeting neurotransmitter-related processes.
Drug and alcohol reviewLouise MacGregor, Timothy Weaver, John Strang, Stephen Pilling, Nicola Metrebian, Kimberley Goldsmith
INTRODUCTION: Contingency Management (CM) involves the systematic application of positive reinforcement (financial incentives) to promote behaviour change, to improve treatment outcomes for individuals with opioid use disorder (OUD). To better understand patient heterogeneity, this study sought to identify meaningful subgroups/classes underlying the population based on characteristic groupings, followed by determining whether CM effectiveness varied between these subgroups. METHODS: Baseline characteristics (evidenced/theorised to impact CM effectiveness) of participants with OUD from the PRAISe trial (N = 552) were empirically examined using latent class analysis. Model selection was based on fit statistics and interpretability. Class was then evaluated as a potential moderator of CM effectiveness on abstinence from heroin using a mixed effects model (consistent with the PRAISe trial analysis). RESULTS: A four-class solution best described the population: (1) Less clinically complex/low alcohol dependence/high motivation to quit heroin (N = 115); (2) More clinically complex/low alcohol/high motivation (N = 287); (3) More clinically complex/high alcohol/high motivation (N = 73); and (4) More clinically complex/moderate alcohol/low motivation (N = 77). CM for Attendance, previously shown to increase heroin abstinence in the overall study sample, was more effective than no CM for participants in class (1) and (2) exclusively (OR = 5.21; 95% CI 1.25, 21.78 and OR = 1.87; 95% CI 1.03, 3.40, respectively). CM targeted at abstinence, previously shown to not be effective compared to no CM overall, was not effective in any class. DISCUSSION AND CONCLUSIONS: CM targeted at attendance is more effective for two subgroups of the OUD population characterised by either less complex clinical presentation and/or low dependence on alcohol. Individual differences may therefore inform a targeted CM treatment approach.
BACKGROUND: Emotional intelligence (EI) is critical in intensive care unit (ICU) nursing, where nurses face high stress, clinical instability and emotionally demanding situations. EI helps nurses manage emotions, improve communication and support clinical performance. It has also been linked to lower burnout and more adaptive coping among ICU nurses. AIM: This scoping review aimed to map the available evidence on emotional intelligence among nurses working in ICUs, including its key dimensions, associated professional outcomes and current knowledge gaps. STUDY DESIGN: A scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A structured search was conducted in MEDLINE, CINAHL, PubMed and Scopus for studies published in the past 10 years in Portuguese, English or Spanish. RESULTS: In total, this review included nine studies. The evidence highlights the crucial role of EI in emotional regulation, communication and clinical performance among ICU nurses. Key dimensions of emotional intelligence, including empathy, emotional clarity and self-regulation, were consistently identified as important. Training programmes demonstrated significant improvements in EI and reduced burnout symptoms, and EI was also associated with more adaptive coping strategies and improved professional performance. CONCLUSIONS: Emotional intelligence is an important competency in ICU nursing and has been linked to improved communication, clinical decision-making and lower burnout among nurses. Despite these benefits, research still shows gaps, particularly in standardising EI assessment tools and in the need for longitudinal studies. Targeted emotional intelligence training programmes may strengthen ICU nurses' emotional resilience and enhance care quality. RELEVANCE TO CLINICAL PRACTICE: Integrating EI development into ICU nursing education and institutional policies can help reduce burnout, improve communication with patients and families, and enhance overall clinical performance, thereby supporting a healthier work environment and strengthening nurses' communication and professional performance in intensive care settings.
A recent review of 11 international clinical guidelines for borderline personality disorder (BPD) and its features in adolescents, found broad agreement on core recommendations: structured assessment, psychotherapy as first-line treatment and family involvement. This is a meaningful step forward. But it raises a question the guidelines themselves do not answer: If clear recommendations exist, why are so many adolescents still not receiving a timely diagnosis? This commentary focuses on that gap. Clinicians frequently hesitate to diagnose BPD in young people, often out of concern about stigma or a belief that the diagnosis is premature or harmful. The evidence does not support these concerns. BPD features in adolescence are stable, clinically significant and respond to targeted treatment. When clinicians avoid the diagnosis, adolescents tend to receive fragmented, symptom-focused care that misses the underlying presentation. There is a real paradox here: The attempt to protect young people from a label ends up denying them access to the treatment that label would unlock. This commentary argues that future guideline development must go beyond describing what good care looks like and start addressing why clinicians struggle to provide it.
European journal of psychotraumatologyMarg Rogers, Victoria Williamson, Einar B Thorsteinsson, Neil Greenberg, Michelle Gossner, Amy Johnson, Yonggang Ren, Margaret Sims, Philip Siebler, Michèle L …
Background: Children living with a parent with complex post-traumatic stress disorder (CPTSD) may struggle to understand and respond to parental behaviours, increasing their risk of distress and mental health difficulties. Despite this, few evidence-informed narrative resources exist to support these children.Method: A free bibliotherapy e-storybook was co-created with over 30 participants from the affected communities and partners, including individuals with lived experience, service providers, clinicians, and an international interdisciplinary research team. Public feedback on a draft version informed further refinement. A cross-sectional online survey of additional community members and partners assessed the e-storybook. Twenty-two additional participants completed closed-ended and six open-ended survey questions.Results: Findings indicated that the co-creation approach was effective in developing a targeted and relevant resource for children.Conclusion: The e-storybook was perceived as a useful bibliotherapy tool to support child and family outcomes and to facilitate meaningful conversations about family experiences.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in CancerHazal Ozdemir Koyu, Cigdem Sari Öztürk
PURPOSE: Adolescent and young adult (AYA) survivors of childhood cancer remain at risk of psychological distress and reduced quality of life (QoL). We evaluated the efficacy of technology-based psychosocial interventions on QoL and psychological outcomes in this population. METHODS: PubMed, CINAHL, Cochrane Library, PsycINFO, Embase, Scopus, and Web of Science were searched for randomized controlled trials (RCTs) published between 2015 and 2025. Outcomes were QoL, anxiety, depression, distress, and emotional well-being. Risk of bias was assessed with RoB 2. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled with random-effects models (RevMan Web); heterogeneity (I2), subgroup analyses by assessment timing and leave-one-out sensitivity analyses were performed (PROSPERO: CRD420251248328). RESULTS: Ten RCTs (747 participants) were included. Technology-based interventions were associated with a small but statistically significant improvement in overall QoL (SMD = 0.24, 95% CI 0.09 to 0.39, p = 0.001); the effect was not significant post-intervention but was small-to-moderate at 6-24-month follow-up (SMD = 0.36, 95% CI 0.11 to 0.60, p = 0.004). A small-to-moderate reduction in anxiety was observed (SMD = - 0.35, 95% CI - 0.65 to - 0.05, p = 0.02), whereas effects on depression (SMD = - 0.31), distress (SMD = - 0.04), and emotional well-being (SMD = 0.20) were not statistically significant. CONCLUSION: Technology-based psychosocial interventions were associated with modest but statistically significant improvements in QoL and anxiety among AYA survivors of childhood cancer, with evidence of sustained benefits over time. Effects on broader psychological domains were more variable; larger, theory-driven trials with standardized outcomes are needed.
OBJECTIVES: Family caregivers of terminal cancer patients often experience substantial emotional burden. This study assessed depression, anxiety, stress, and coping-distress associations among caregivers in Eastern India to inform culturally sensitive interventions. METHODS: A cross-sectional survey was conducted among 100 adult caregivers of terminal cancer patients at a tertiary care hospital in Kolkata. Participants were recruited via systematic random sampling and interviewed using a structured proforma, the 21-item Depression, Anxiety and Stress Scale (DASS-21) and the Brief-COPE inventory. Descriptive statistics summarized demographics and caregiving characteristics. Spearman's rank correlation was used to assess associations between psychological distress and coping domains, with p < 0.05 considered statistically significant. RESULTS: Caregivers (median age 43 years; 70% male) were predominantly the patient's children (67%). Median DASS-21 scores indicated moderate depression (16), anxiety (14), and stress (16). Coping scores indicated low-to-moderate use of problem-focused (1.875 ± 0.321), emotional (1.871 ± 0.269), and avoidant coping (1.865 ± 0.266). Emotional coping correlated significantly with anxiety (ρ = 0.301, p = 0.002), depression (ρ = 0.317, p = 0.001), and stress (ρ = 0.293, p = 0.003). Depression also correlated with stress and problem-focused coping, while stress correlated with avoidant coping. SIGNIFICANCE OF RESULTS: Caregivers experienced considerable psychological burden, with emotional coping consistently linked to distress. These associations likely reflect reactive adaptation rather than inherent maladaptiveness. Results highlight an urgent need to recognize caregiver distress within oncology settings and to develop culturally informed psychosocial interventions in palliative care, particularly in low-resource environments. Such efforts could enhance both caregiver well-being and quality of end-of-life care.
BMJ mental healthEvelina Kontio, Victoria Sennerstam, Frank Svärdman, Conrad Samuelsson, Janina Hettman, Nathalie Broman, Ludwig Franke Föyen, Kersti Ejeby, Elin Lindsäter, Eri…
BACKGROUND: Stress-related mental ill health is highly prevalent, and most individuals first seek help in primary care where access to psychological support is often limited. OBJECTIVE: To test whether nurse-led collaborative care (CC) is non-inferior to cognitive behavioural therapy delivered as psychologist-guided self-help (GSH-CBT) in reducing stress for adult primary care patients with stress-related mental ill health. METHODS: A randomised controlled non-inferiority trial where 172 adult primary care patients with mild to moderate stress-related mental ill health were allocated to nurse-led CC or GSH-CBT (1:1). The primary outcome was the Perceived Stress Scale-10 administered every 3 weeks during the 12-week treatment phase. The a priori non-inferiority margin was 0.3 d, requiring the one-sided 95% CI of the effect size to fall within this bound. Secondary outcomes were symptoms of exhaustion, sleep problems, depressive symptoms, general anxiety and quality of life. FINDINGS: In both conditions, participants showed large, significant within-group improvements on the primary outcome and all secondary outcomes. The primary outcome showed a small between-group difference (d=0.22), favouring GSH-CBT, with the CI upper bound (0.52) exceeding the non-inferiority margin. For secondary outcomes, GSH-CBT led to a greater reduction in exhaustion (d=0.28; 95% CI 0.64 to 0.002). No other between-group differences were observed. CONCLUSIONS: Nurse-led CC was not non-inferior to GSH-CBT. Effect differences were small, but improvements were slightly larger in GSH-CBT. CLINICAL IMPLICATIONS: Given that nurse-led CC is safe, easy to administer, and that significant within-group improvements were observed across all measures, this intervention could be a viable option in primary care settings where psychologist-delivered treatment is limited.
PloS oneZuzanna Gurzyńska, Karolina Kucka, Marcin Trzciński, Katarzyna Topolska, Katarzyna Nowicka-Sauer, Krzysztof Sobczak
The period of university studies is associated with numerous stressors that can negatively affect the psychological functioning of young adults. This study aimed to investigate the relationship between perceived stress levels, preferred coping strategies, and psychological resilience. The analysis focused on resilience as a potential moderator of the relationship between coping strategies and stress intensity. The study included 607 Polish students. A significant part of the group was medical students (61.72%). The study employed the Perceived Stress Scale (PSS-10), the Coping Inventory (Mini-COPE), the Resilience Scale (SPP-25), and used an author-developed questionnaire to collect sociodemographic information. The respondents exhibited moderate stress intensity (M = 22.54; SD = 7.04) and a moderately high level of general resilience (M = 59.39; SD = 15.37). Among coping strategies, acceptance (M = 1.94) and active coping (M = 1.85) were chosen most frequently, while turning to religion and helplessness were chosen least frequently. Analysis of personal resources showed the highest scores in openness to experience and sense of humor. Interaction effects rarely reached statistical significance. The study group showed a profile of students who were stressed but had functional coping resources. The moderation analysis results indicate the complex nature of the relationships among the variables studied-although psychological resilience is a key resource, its role as a moderator of the relationship between coping strategies and stress is not universal and emerges only in specific areas of functioning. The data obtained suggest that psychological interventions should focus on strengthening existing resources (such as active coping) and developing resilience, which may serve as a buffer against the negative effects of academic stress.
JMIR research protocolsQiaosi Cai, Yihan Zeng, Noelia Jiménez-Orenga, Clara Miguel, Mathias Harrer, Pim Cuijpers, Amanda Díaz-García, Qun Ye
BACKGROUND: Emotional disorders-primarily anxiety and unipolar depressive disorders-are highly prevalent, disabling, and frequently comorbid. Disorder‑specific cognitive behavioral therapy (DS‑CBT) is considered a gold standard treatment, yet it can be inefficient in the context of high comorbidity and service constraints. Transdiagnostic psychotherapies that target shared maintaining mechanisms (eg, emotion dysregulation and neuroticism) have been developed, including the Unified Protocol, transdiagnostic behavior therapy, emotion regulation therapy, and various transdiagnostic internet-delivered cognitive behavioral therapy protocols. Recent meta-analyses suggest that transdiagnostic interventions are effective or likely effective, but a comprehensive comparative evaluation across different transdiagnostic protocols, DS‑CBT, other evidence‑based psychotherapies, and control conditions is lacking. OBJECTIVE: This study aims to conduct a network meta-analysis (NMA) to compare the efficacy and acceptability of various transdiagnostic therapies (eg, the Unified Protocol, transdiagnostic behavior therapy, and emotion regulation therapy), DS-CBT, other evidence-based active therapies (eg, acceptance and commitment therapy, behavioral activation, and mindfulness-based cognitive therapy), and control conditions (waitlist or care as usual) in improving symptoms in adults with anxiety and/or depressive disorders and generate a probabilistic ranking of their efficacy. METHODS: This meta-analysis will include randomized controlled trials from PubMed, Embase, PsycInfo, and the Cochrane Library, complemented by existing meta‑analytic research domain databases for depression and anxiety. Eligible participants are adults (≥18 years) with a principal diagnosis of anxiety and/or unipolar depressive disorder according to established diagnostic classification systems (eg, any version of the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases, 10th or 11th revisions) or scoring above a validated cutoff on anxiety or depression scales. Primary outcomes are continuous measures of anxiety and depressive symptom severity at the posttreatment time point; secondary outcomes include study dropout (acceptability) and response or remission where available. We will perform random-effects network meta-analyses within a frequentist framework using the netmeta package in R to estimate relative treatment effects and P scores for treatment rankings and examine transitivity and consistency. We will conduct additional Bayesian NMAs as sensitivity analyses using the surface under the cumulative ranking curve for ranking. RESULTS: As of September 2026, the literature search has been completed, and title and abstract screening is ongoing. Data analysis will be conducted in late 2026. We expect the meta-analysis to be completed and submitted for publication by the end of 2026, with results expected to be published in early 2027. CONCLUSIONS: This NMA will provide comprehensive comparative evidence on the efficacy and acceptability of transdiagnostic psychotherapies for emotional disorders, which can inform clinical decision-making and guideline development. TRIAL REGISTRATION: OSF Registries osf.io/p8957; https://osf.io/p8957/overview. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/104791.
JMIR research protocolsDayenne Jeneffer Souza da Silva, Vitor Leandro da Cunha, Luanna Barbara de Araújo Farias, Lara Cecília de Araújo Carlos, Candice Simões Pimenta de Medeiros, Ed…
BACKGROUND: Upper limb impairment is a common consequence of stroke, affecting independence and quality of life. Virtual reality (VR) interventions, including serious games designed for therapeutic purposes and commercial games developed primarily for entertainment, have been increasingly used for poststroke upper limb rehabilitation. Evidence comparing the effectiveness of these game types on functional outcomes remains unclear. OBJECTIVE: This systematic review protocol aims to determine whether serious and commercial VR games differentially impact upper limb function, measured by the Action Research Arm Test, in adults after stroke. Secondary outcomes will include upper limb motor function assessed using the Fugl-Meyer Assessment-Upper Extremity, Box and Block Test, Motor Activity Log, Jebsen-Taylor Hand Function Test, and Wolf Motor Function Test; functional independence assessed using the Functional Independence Measure and Barthel index; and adherence indicators, including dropout rates and session completion. Secondary objectives include evaluating pooled VR effects vs conventional therapy (CT) and exploring potential moderators, such as VR immersion level and stroke chronicity. METHODS: Parallel randomized controlled trials involving adults (aged ≥18 years) with ischemic or hemorrhagic stroke in the acute, subacute, or chronic phases will be included. Interventions using serious or commercial VR games (nonimmersive, semi-immersive, or fully immersive) delivered alone or combined with CT will be considered. Studies using nongamified VR, digital technologies without VR, or augmented reality not integrated into VR will be excluded. Eligible comparators include conventional physiotherapy, occupational therapy, usual care, educational interventions, or no therapy. This protocol was developed in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols) guidelines. Systematic searches will be conducted in the PubMed (MEDLINE), Web of Science, Embase, Scopus, Virtual Health Library, ScienceDirect, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Brazilian Clinical Trials Registry, World Health Organization (WHO) International Clinical Trial Registry Platform, and ISRCTN Registry databases from inception to February 2026. Data extraction will be performed independently by 2 reviewers, and risk of bias will be assessed using the Cochrane risk of bias 2.0 tool. Meta-analyses will be conducted when clinical and methodological homogeneity permits. A random-effects model is planned; however, the final choice of model will be based on the level of heterogeneity observed at the time of analysis. Subgroup analyses will explore stroke phase, immersion level, intervention dosage, and concomitant therapy. RESULTS: Data collection is planned from inception to February 2026. Study screening and data extraction are ongoing, with synthesis and meta-analysis expected by November 2026 and final publication anticipated in winter 2026. CONCLUSIONS: This systematic review will clarify whether different VR game formats produce distinct effects on upper limb rehabilitation after stroke, providing evidence to inform the design and implementation of VR-based neurorehabilitation interventions. TRIAL REGISTRATION: PROSPERO CRD42024595266; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024595266. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/95135.
BACKGROUND: This study evaluated the effect of structured grief counseling on grief responses in family caregivers of advanced cancer patients from the terminal phase through early bereavement, and may inform bereavement care in oncology and hospice settings. METHODS: We conducted a randomized controlled trial from October 2024 to November 2025 among family caregivers of patients with advanced cancer. Participants were assigned to structured grief counseling (intervention group, n = 55) or only psychological materials (control group, n = 56). Counseling began before the death and continued for 3 months after the death. Outcomes were assessed at enrollment, at the end of the intervention, and at 1 and 3 months after the death. Measures included grief, guilt, anxiety, depression, post-traumatic growth, and health-related quality of life. Linear mixed-effects models estimated group differences over time. RESULTS: Compared with control, the intervention produced lower Anticipatory Grief Scale scores over time (estimates = -9.31, P < 0.001). The intervention also yielded higher Post-traumatic Growth Inventory scores and Short-Form 36 Health Survey scores (estimates = 6.02 and 5.97, respectively; P < 0.001). Between-group differences for Bereavement Guilt Scale scores, Self-Rating Anxiety Scale scores, and Self-Rating Depression Scale scores were not significant. CONCLUSION: Structured grief counseling provided to family caregivers from the patient's terminal phase through the early bereavement period effectively improves grief status, post-traumatic growth, and health-related quality of life. These findings support the integration of standardized, family-centered bereavement support systems into oncology and hospice care services.
PloS oneYan Tang, Junjun Zhou, Wan Ying Gan, Kim Geok Soh, Kim Lam Soh
BACKGROUND: Fear of hypoglycaemia (FoH) can interfere with diabetes self-management in adults with type 2 diabetes mellitus (T2DM). Educational and behavioural interventions may address hypoglycaemia-related worry and avoidance, but evidence focused on adults with T2DM remains limited. This systematic review and meta-analysis examined the effects of structured educational and behavioural interventions on FoH in this population. METHODS: Nine databases were searched from inception to 31 December 2025 for randomised controlled trials of educational and behavioural interventions addressing FoH or FoH-related outcomes in adults with T2DM. Data were pooled using random-effects models, estimating standardised mean differences (SMDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using Tau² and I², and a 95% prediction interval was estimated. Small-study effects and additional sensitivity analyses were examined. Risk of bias was assessed using Cochrane RoB 2, and certainty of evidence was assessed using GRADE. The review was registered with PROSPERO (CRD42025630957). RESULTS: Eleven RCTs involving 1,096 participants were included. The exploratory pooled average effect favoured educational and behavioural interventions for reducing FoH (SMD = -1.89; 95% CI -2.54 to -1.25; p < 0.00001). Heterogeneity was substantial (Tau² = 1.10; I² = 95%), and the 95% prediction interval crossed the line of no effect (95% PI -4.34 to 0.56), suggesting that effects may differ across future similar studies. Funnel plot asymmetry and Egger's regression test suggested possible small-study effects. Trim-and-fill findings were estimator-dependent and suggested possible attenuation of the pooled estimate in exploratory analysis. The certainty of evidence was very low because of risk of bias, substantial heterogeneity, indirectness, and possible small-study effects. CONCLUSION: Very low-certainty evidence suggests that structured educational and behavioural interventions may reduce FoH in adults with T2DM; however, the magnitude and generalisability of this effect remain uncertain. Further RCTs with standardised FoH measures, longer follow-up, and clearer reporting of intervention components and fidelity are needed.
Journal of medical Internet researchYujin Ko, Junhyung Kim, Sunyoung Park, Hyunkyu Kim, June-Ho Seo, Il Ho Park, Jeemin Lee, Jae-Jin Kim
BACKGROUND: Although pharmacotherapy is the primary treatment for patients with acute-phase panic disorder, its incomplete efficacy causes them to experience frequent panic attacks and severe anticipatory anxiety for a considerable period. A prescription-based mobile digital therapeutic (DTx) that integrates self-guided cognitive behavioral therapy (CBT), real-time symptom management, and lifestyle tracking can be used as an adjunct to pharmacotherapy for these patients, helping them achieve rapid symptom recovery. OBJECTIVE: This study aimed to evaluate the efficacy of this adjunctive DTx in alleviating symptoms in patients with acute-phase panic disorder. METHODS: In total, 66 acute-phase patients experiencing frequent panic attacks were recruited from 6 institutions and randomly divided into a group receiving pharmacotherapy combined with DTx or pharmacotherapy alone, participating in an 8-week multicenter single-blind trial. The DTx app included 3 major services: training service consisting of structured CBT modules, companion service of just-in-time modules for coping with panic attacks, and care service providing daily self-management tracking tools. The self-report scales used as efficacy indicators were administered via paper questionnaires during a total of 4 visits at baseline, week 2, week 4, and week 8. The primary end point, the change in the Panic Disorder Severity Scale-Self Report (PDSS-SR) score, and the secondary end points, such as changes in overall anxiety, depression, panic-related catastrophic cognitions, and fear of bodily sensations, were compared between the 2 groups. Adherence to the DTx was objectively assessed using device use metrics. RESULTS: As 5 enrolled patients were excluded due to insufficient safety analysis or efficacy evaluation, the final analysis included 32 in the DTx group and 29 in the control group. The DTx group showed a significantly greater reduction in PDSS-SR scores at week 8 compared to the control group (mean 40.29%, SD 26.68% vs mean 17.61%, SD 30.37%; P=.007). This therapeutic benefit appeared rapidly by week 2 (mean 26.66%, SD 22.03% vs mean 11.05%, SD 21.73%; P=.02). The responder (≥40% PDSS-SR reduction) rate was also significantly higher in the DTx group (17/32, 53.12% vs 5/29, 17.24%; P=.007). While changes in depression and somatic fears were transient or similar between groups, the DTx group showed significantly greater sustained improvements in overall anxiety and catastrophic cognitions. The overall mean adherence rate was 78.12%, with no significant difference between responders and nonresponders. CONCLUSIONS: The adjunctive use of our prescription-based DTx resulted in early and sustained symptom reductions across panic severity, overall anxiety, and catastrophic cognitions, suggesting that this multifunctional and self-guided DTx including just-in-time management and lifestyle tracking can serve as a practical complement to routine psychiatric care for acute-phase patients experiencing frequent panic attacks. This app is expected to present a new framework for the treatment of acute-phase panic disorder by enabling the incorporation of various symptomatic aspects in patients' daily life into clinicians' evaluations and guidance in the clinic.
European journal of psychotraumatologyShamini Satkunam, Irene Dimitriou, Madiha Shaikh
Background: Psychological morbidity is common following admission to adult intensive care units (ICUs), with many patients experiencing post-traumatic stress disorder (PTSD), anxiety, and depression as part of post-intensive care syndrome. Eye Movement Desensitisation and Reprocessing (EMDR) is an established trauma-focused psychological therapy; however, its evidence base within critical care populations remains emerging.Objectives: This scoping review aimed to map the extent, characteristics, and findings of the available literature on the use of EMDR for ICU-related psychological distress.Methods: A scoping review was conducted in accordance with Joanna Briggs Institute methodology and reported following the PRISMA-ScR guidelines. The review aimed to systematically identify and synthesise evidence relating to the application and reported outcomes of EMDR in ICU survivors.Results: Seven publications representing six independent study populations were included. Participants included adult ICU patients experiencing PTSD symptoms, delirium-related psychological disturbances, and COVID-19-related distress. EMDR was delivered using either standard protocols or the Recent Traumatic Episode Protocol (R-TEP). Across the evidence base, EMDR was associated with reductions in trauma-related distress, although evidence for improvements in anxiety and depression was less consistent. Where qualitative data were available, participants additionally reported improved integration and processing of ICU experiences. Overall, methodological heterogeneity, overlapping samples, small sample sizes, and limited controlled evidence restrict the strength of conclusions that can be drawn.Conclusions: This review highlights growing but preliminary evidence supporting the feasibility and potential utility of EMDR, including R-TEP, for ICU-related psychological distress. While findings are promising, the current evidence base remains insufficient to determine effectiveness. Future research should prioritise adequately powered controlled studies, standardised outcome measures, longer-term follow-up, and more diverse ICU populations to strengthen the evidence base and inform clinical implementation.
BMJ openAmara Anyanwu, Dima Suki, Annelise Huynh, Giulio Draetta, Kyle Noll, J Jack Lee, Frederick F Lang, Mei Rui
INTRODUCTION: Neurosurgical patients commonly experience significant preoperative anxiety, which can negatively impact surgical outcomes and recovery trajectories. Music, as a powerful neurophysiological modulator of the human stress response, offers a non-pharmacological, non-invasive and cost-effective approach to anxiolysis by stabilising the hypothalamic-pituitary-adrenal axis and autonomic nervous system. The goal of this study is to evaluate the effects of live and recorded music on preoperative stress, serum-level and plasma-level biomarkers, perceived pain, anxiety and mood states in neurosurgical cancer patients. METHODS AND ANALYSIS: Enrolled neurosurgical patients (n=132) will be equally randomised to one of three groups: (1) simulated live music intervention using a Steinway Spirio M recording/player piano, (2) recorded music played through ambient speakers, or (3) control (no music). The musical selections will all incorporate 16 validated Compositional Elements of Relaxation (CERs). The intervention period will last 30 min.Endpoints will be assessed using validated pre-intervention and post-intervention questionnaires, including the State-Trait Anxiety Inventory-State subscale (STAI-S), the Profile of Mood States-Short Form (POMS-SF), and the Visual Analogue Scale for Pain (VASP), as well as serum biomarkers (eg, interleukin-6, cortisol and epinephrine) analysed using broad-spectrum proteomic and metabolomic approaches.The study will be conducted from January 2025 to January 2028. ETHICS AND DISSEMINATION: This study protocol was approved by the review board at MD Anderson Cancer Center on 12 May 2025. The results of this study will be disseminated through peer-reviewed journals and presented at relevant scientific conferences. TRIAL REGISTRATION NUMBER: NCT06536504.
BMJ openIoannis Angelakis, Sarah Donegan, Karen Hughes, Laura Goodwin, Ffion Curtis, Alison Bryant, David Sparks, Michelle Maden, Anum Nisar, Thomas Spain, Ahmed Waqas…
INTRODUCTION: Post-traumatic stress disorder (PTSD) is a serious mental health condition. It may develop following exposure to an extremely threatening event. Military personnel face an increased likelihood of developing PTSD because they sometimes bring experiences of difficult events from before they joined the military and because they have higher odds of being exposed to potentially traumatic events during service. To support the mental health of military personnel, several psychological interventions have been developed to help them manage PTSD symptoms. Although there is a lot of research demonstrating how well these interventions work, we do not know how the different interventions (eg, trauma-informed therapy, cognitive-behavioural therapy) compare. Because many of these interventions include more than one type of treatment (eg, behavioural activation), we do not know which specific component works best. METHODS AND ANALYSIS: To explore these questions, we will identify previous studies that have examined interventions for PTSD in military personnel. We will then use network meta-analysis methods to make comparisons between all interventions, including some that have never been compared against each other in previous studies, to identify the best treatments. We also aim to identify which individual components are effective, even when delivered in combination. We will work with people with lived experiences, researchers, and mental health professionals to guide the project stages. Overall, this project aims to improve outcomes for military and ex-military personnel with PTSD by (1) identifying effective treatments, (2) establishing the relevance and transferability of the findings to a wider audience and (3) offering suggestions that will have immediate implications for clinical practice. ETHICS AND DISSEMINATION: No ethics approval is required as this study only involves a systematic review of published literature. The findings will be published in peer-reviewed journals and presented at relevant conferences. PROSPERO REGISTRATION NUMBER: CRD420251081519.
European journal of psychotraumatologyIrada Meoon, Aungsana Khlaisuk, Siriyupa Nansunanon, Teerapon Dhippayom
Background: Post-traumatic stress disorder (PTSD) is prevalent among children and adolescents, with cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) widely used treatment options. This study compared the effects of CBT and EMDR in children and adolescents using a meta-analysis approach.Methods: PubMed, EMBASE, CENTRAL, CINAHL, ProQuest Dissertations & Theses, and PsycInfo were searched in March 2025. Randomized controlled trials that compared the effectiveness of CBT and EMDR on PTSD symptoms in children and adolescents aged 6-18 years who had been exposed to traumatic events were included. The Cochrane Risk of Bias version 2 was used to assess the methodological quality of the included studies. A random-effects model was applied to calculate the standardized mean difference (SMD) along with 95% confidence interval (CI), and the I2 statistic was used to quantify statistical heterogeneity.Results: Five trials (248 participants) were included. There was no statistically significant difference in PTSD symptoms between the CBT and EMDR groups, whether reported by children (SMD: 0.18; 95% CI: -0.07-0.43; I2 = 0%) or by parents (SMD: 0.23; 95% CI: -0.02-0.48; I2 = 0%). For anxiety, the pooled estimate did not reach statistical significance (SMD: 0.44; 95% CI: -0.19-1.07; I2 = 69%). Depression symptoms were higher in the CBT group than in the EMDR group (SMD: 0.44; 95% CI: 0.13-0.76; I2 = 0%).Conclusion: The comparative effects of CBT and EMDR in reducing PTSD and anxiety symptoms remain inconclusive. Although CBT was associated with higher depression symptoms compared with EMDR, the current evidence is based on a small number of trials, and the pooled estimates should be interpreted with caution.
MedicineJoy Nneka Uchenye Ejikeme, John Nwabueze Igabari, Daphney Mawila-Chauke, Moses Onyemaechi Ede, Glory Mmachukwu Nwakpadolu, Joy Oluchukwu Okoro, Blessing Ijeoma…
BACKGROUND: Cooperative efforts and the courage to withstand difficult times among workers in an organization enhance productivity. However, some employees become discouraged by hard times and unusual tasks in the organization, which leads to low resilience among workers. Empirical evidence shows that restaurant and hotel workers demonstrate low work resilience in the workplace. For this reason, this study investigated the impact of acceptance and commitment therapy (ACT) on work resilience among restaurant and hotel workers in tourism zones in Nigeria. METHODS: Of the 189 restaurant and hotel workers who were recruited and assessed at the pretest stage, 122 participated in a 12-session ACT intervention and were assessed twice immediately after the intervention was implemented. Multivariate analysis was used to precisely examine how the intervention affected the dependent variable. RESULTS: The findings showed that the ACT treatment group was more successful in improving workers' resilience in the restaurant and hotel industries. The difference in mean stress scores between the pretest and posttest for male and female workers indicates a reduction in mean resilience scores for both groups. Male workers showed a smaller decrease in mean resilience scores compared with their female counterparts at the posttest stage. CONCLUSION: ACT intervention is an effective strategy for improving the resilience skills of restaurant and hotel workers with low resilience. Therefore, researchers and practitioners are encouraged to advance the practice and implementation of ACT tenets and principles in the workplace.
Stress and health : journal of the International Society for the Investigation of StressRinat Avziz, Tal Litvak-Hirsch
The literature has extensively examined the outcomes of forced displacement worldwide. However, relatively few studies have explored its effect on divorced mothers. This qualitative longitudinal study examined the coping and home perceptions of 25 divorced mothers evacuated during the Israel-Gaza war (2023-2025). Based on two rounds of interviews approximately 1 year apart, it explored how divorced mothers navigated intersecting emotional, economic, and social stressors while managing family life under prolonged uncertainty. Using a hybrid thematic analysis informed by Lazarus and Folkman's stress and coping theory, dynamic coping patterns were identified that combined emotion- and problem-focused strategies. The findings indicate that mothers employed both problem-focused and emotion-focused coping strategies while reconstructing the meaning of home throughout divorce, evacuation, and return. Before evacuation, the home symbolised autonomy and post-divorce recovery; during displacement, it became an unstable symbolic and emotional space, yet one that mothers were able to recreate within temporary housing. Upon returning, home was redefined as a space of healing, belonging, and renewed growth. These findings deepen our theoretical understanding of coping by divorced mothers under intersecting stressors and underscore the importance of gendered and family-centred perspectives in research on emergency displacement. Practically, the study offers insights for developing tailored intervention models, stage-specific evacuation policies, and community support systems to strengthen the resilience of divorced mothers in contexts characterised by multiple intersecting stressors.
Journal of marital and family therapyNanna Fensman Lassen, Hanne Nørr Fentz, Klaus Nielsen, Tea Trillingsgaard
Online couple interventions are increasingly used to support couples experiencing relationship distress. However, little is known about how couples integrate intervention elements into their everyday lives. This longitudinal qualitative study examined how distressed parenting couples integrate change agreements developed in the online OurRelationship program. Six couples (12 participants) were included in the study. Data consisted of one coach session, as well as two rounds of individual interviews conducted 3-6 weeks and 6-7 months after program completion. Using longitudinal interpretative phenomenological analysis, we identified three main ways couples experienced, interpreted, and used the change agreements: (1) as instrumental contracts, (2) as expressions of mutual understanding, and (3) as making relational responsibility visible, including potential gendered asymmetries. Findings suggest that change agreements do not transfer directly into couples' everyday lives and that consequences evolve over time. Implications for practitioners, intervention design, and theories of relational change are discussed.
Hu li za zhi The journal of nursingLi-Hung Lee, Cheng-I Yang
In Taiwan, the number of male nursing professionals has increased steadily over the years, with the continued preparation of male entrants through the nursing education system serving as an important foundation for this growth. Accordingly, the professional development and clinical learning experiences of male nursing students warrant attention from both nursing education and clinical practice. Nursing has long been regarded as a predominantly female profession. During their education, male nursing students may encounter a lack of male role models, traditional gender-role expectations, and rejection by patients or family members when providing intimate care. These experiences may affect their clinical learning, professional confidence, and professional identity as well as frame the gender-related differences and challenges faced as a nursing professional. As the number of male nursing students continues to grow, this article provides an overview of the current development of men in nursing, explores the gendered challenges male nursing students may encounter during clinical learning, examines their coping and adjustment strategies, and offers recommendations from several perspectives. These recommendations include strengthening students' professional competence and role positioning as well as the provision by nursing educators, clinical instructors, and clinical placement settings of role models, supportive relationships, and inclusive learning environments. This article was written to help male students interested in nursing or newly enrolled in nursing education anticipate potential difficulties in their learning journey and develop appropriate coping strategies. The findings may also serve as a reference for nursing educators, clinical instructors, and clinical placement settings in planning teaching activities, making clinical placements, and providing student guidance and support.
PloS oneFrancisco J Ruiz, Douglas M Bastidas-Suárez, Camilo A Vargas
Psychological flexibility and inflexibility are core processes in the Acceptance and Commitment Therapy (ACT) model and are consistently associated with well-being and emotional distress. However, the validity of widely used measures, particularly the Acceptance and Action Questionnaire - II (AAQ-II), has been questioned due to potential overlap with indicators of distress and neuroticism. This study examined the psychometric properties of the Acceptance and Action Questionnaire - III (AAQ-III) and the PsyFlex in a general population sample from Colombia (N = 785) using network psychometrics. We estimated the dimensionality of each scale via Exploratory Graph Analysis (EGA) and evaluated replicability via bootstrap EGA (bootEGA). Discriminant validity was examined using a joint EGA that included the AAQ-III, PsyFlex, and measures of emotional distress (DASS-21) and neuroticism (BFI-2-Neuroticism). Convergent validity was assessed through correlations with the Multidimensional Psychological Flexibility Inventory - Short Form. EGA identified unidimensional structures for both instruments, and bootEGA confirmed perfect structural consistency and item stability. The joint EGA yielded five distinct communities, with the AAQ-III and PsyFlex forming separate communities from emotional symptoms and neuroticism, providing structural evidence consistent with the discriminant validity of both measures. Both instruments showed the expected patterns of correlations with flexibility and inflexibility processes. These findings provide initial validation evidence that the Spanish versions of the AAQ-III and PsyFlex are psychometrically sound measures of psychological inflexibility and flexibility.
OBJECTIVE: This exploratory pilot study aimed to examine the potential effects of a shortened, individually delivered dialectical behavior therapy (DBT)-based intervention added to pharmacotherapy on suicide-related outcomes among Chinese outpatients with affective disorders. METHODS: Twenty-one participants recruited from the psychiatric outpatient clinics of the First Affiliated Hospital, School of Medicine, Zhejiang University, were randomly assigned to two groups. Participants in the research group received pharmacotherapy plus a shortened, individually delivered DBT-based intervention, whereas those in the control group received pharmacotherapy alone. Participants completed baseline assessments, 12 weeks of treatment, and 12 weeks of follow-up, with assessments performed every 4 weeks. Outcomes included suicide risk or severity, depression, anxiety, and hopelessness assessed using self-report scales. RESULTS: After adjustment for baseline values using repeated-measures analysis of covariance (RM-ANCOVA), the between-group effect on suicide risk showed a marginal trend favoring the DBT-based psychotherapy group, but did not reach conventional statistical significance (F = 4.26, p = 0.054). The time effect (F = 0.234, p = 0.965) and time-by-group interaction (F = 1.306, p = 0.261) for suicide risk were not statistically significant. Depressive symptoms showed a significant time effect across the follow-up period, whereas most suicide-related and hopelessness outcomes were not statistically significant. These findings should be interpreted as preliminary because of the small sample size and baseline imbalance. CONCLUSION: The results provided preliminary pilot evidence that a shortened DBT-based intervention may be feasible and potentially beneficial as an adjunct to pharmacotherapy in this clinical population. However, the primary suicide-risk outcome did not show a statistically significant between-group effect. Larger adequately powered trials with baseline-adjusted analyses and more comprehensive outcome assessment are needed before firm conclusions can be drawn.
Clinical and experimental dental researchDavid C Johnsen, Lauren A G Erickson, Derek Smith, Carlos Garaicoa-Pazmino
BACKGROUND: Scarce scientific evidence is available on the association of cumulative coping challenges and periodontitis. The present retrospective cross-sectional exploratory study explored a new method to depict the association between periodontal disease (extent/severity/rate of progression) and cumulative coping challenges. METHODS: A population sample was identified with an array of periodontal disease levels and coping challenges within an academic setting. In January 2026, a total of 39 student-led patient presentations were recorded using an ordinal scale based on the 2017 American Academy of Periodontology/European Federation of Periodontology framework of staging/grading and a cumulative coping challenges score, including biologic, sociologic, behavioral, demographic, and oral disability-related factors. Spearman's correlation analysis was used to correlate periodontal disease level and cumulative coping challenges. RESULTS: A distinct and significant association was found between level of periodontal disease and cumulative coping challenges (Spearman's ρ = 0.77, 95% CI, p < 0.01). Clusters of patients depicted that those with mild forms of periodontal disease (Stages I-II) had few coping challenges and another group with severe forms of periodontal disease (Stages III-IV) harbored higher cumulative coping challenges. No person appeared with high disease and low cumulative coping challenges, and only one person appeared with low disease and high coping challenges. CONCLUSIONS: This retrospective cross-sectional exploratory study quantified risk factors from a series of cumulative coping challenges resulting in a single metric to be correlated with disease level based on the current staging/grading system for periodontal diseases. Periodontitis was observed among individuals with minimal disease and few coping challenges, and another group with severe stages and extensive coping challenges. Despite the theoretical limitation of the proposed scale, the present model has a practical use in an educational setting as an exploratory composite index.
Journal of marital and family therapyDania Andrade-Urbina, Martiño Rodríguez-González, María A Cueli-Naranjo, Alfonso Osorio, Jonathan G Sandberg
This study evaluated changes in attachment behaviors among Spanish-speaking couples participating in emotionally focused couple therapy (EFCT), using data from a randomized clinical trial of EFCT in this population. The study examined perceived secure attachment behaviors -accessibility, responsiveness, and engagement- measured by the Brief Accessibility, Responsiveness, and Engagement (BARE) scale, and their association with dyadic adjustment measured by the Dyadic Adjustment Scale (DAS). Seventy couples were randomly assigned to EFCT or a waiting list; two withdrew before beginning the intervention, resulting in a final analyzed sample of 68 couples. Results showed some changes in attachment behaviors, with significant effects observed only in women's perceptions of their partners. Increases in both self- and partner-perceived secure attachment behaviors significantly predicted improvements in dyadic adjustment. These findings highlight the clinical relevance of targeting secure attachment behaviors as mechanisms of therapeutic change related to relationship satisfaction.
PediatricsAlexandra D Monzon, Jeffrey C Hoover, Jessica S Pierce, Rachel Wasserman, Shedeline Ulysse, Susana R Patton
CONTEXT: The last meta-analysis of behavioral interventions regarding pediatric type 1 diabetes (T1D) management was conducted over a decade ago. OBJECTIVE: This meta-analysis aimed to (1) provide an updated review of adherence-promoting behavioral interventions and their effect on youths' hemoglobin A1C (HbA1C) and (2) evaluate whether multicomponent interventions targeting both direct and indirect processes of T1D management continue to yield greater HbA1C improvements. DATA SOURCES: We conducted a systematic search in PubMed and Scopus for articles published between April 2009 and February 2025. STUDY SELECTION: Included studies were randomized controlled trials (RCTs) evaluating behavioral interventions targeting T1D self-management in youth and young adults up to age 25 years. DATA EXTRACTION: Extracted data included study characteristics, intervention content and duration, and glycemic outcomes for intervention and comparison groups. RESULTS: Of the 62 RCTs identified, 46 reported sufficient data for quantitative analysis. The pooled effect size demonstrated a small benefit of adherence-promoting interventions on HbA1C (g = 0.12). Pilot RCTs showed larger effects (g = 0.36) than full RCTs (g = 0.07). Multicomponent interventions yielded greater improvements (g = 0.19) than direct (g = 0.08) or indirect (g = 0.15) interventions. Family-focused interventions demonstrated stronger effects (g = 0.29) than youth- (g = 0.05) or parent-focused (g = 0.04) interventions. LIMITATIONS: Findings are limited to published RCTs. CONCLUSIONS: Despite significant advancements in diabetes technology over the last decade, behavioral interventions continue to modestly improve HbA1C in youth with T1D. Multicomponent, family-focused strategies appear to be most effective. Findings highlight the need for rigorous trial designs to advance care for youth living with T1D. ARTICLE SUMMARY: Updated meta-analysis shows behavioral interventions modestly improve HbA1C in youth with T1D, with multicomponent, family-focused approaches outperforming single-component, youth- or parent-focused strategies overall.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyAlice Jugand, Maxi Miciak, Parker Lay, Michael H Bernstein, Leo Druart
BACKGROUND AND PURPOSE: Therapeutic alliance (TA) refers to mutuality and congruence concerning the bonds, goals, and tasks shared between the physiotherapist and patient. It relies on positive connections through partnership, communication, empathy, and mutual respect. TA is recognized as a central factor in the success of rehabilitation; however, most research remains rooted in psychological frameworks. In physiotherapy, the use of touch or physical activity creates unique relational dynamics that have not been studied in the French healthcare context. Thus, this study aims to identify and describe the characteristics of the TA in French physiotherapy. METHODS: A qualitative interpretive description design was chosen for its flexible, practice-oriented approach suitable for exploring complex clinical phenomena. Inductive analysis allowed themes to emerge from participants' experiences without a preconceived framework. Individual semi-structured interviews were conducted with private practice musculoskeletal physiotherapists and rehabilitation patients. Interview transcripts were analyzed using inductive thematic analysis to identify key themes. Rigor was enhanced through reflexive journaling, peer debriefing, and an audit trail. RESULTS: Thirteen interviews were completed. Three main themes were identified-"foster trust," "find meaning and collaborate," and "weigh going the extra mile and boundaries"-all encompassed by an overarching theme of creating a climate of safety. In addition to common TA qualities, physiotherapy-specific factors emerged: centrality of the body in care, frequent appointments, informal interactions, and social support. French contextual factors were also noted, such as extended patient contact time and the physician's influential role. DISCUSSION: The resulting framework supports reflection on relational practices and deepens understanding of the TA in physiotherapy in relation to other disciplines such as psychotherapy or cultural contexts.
Journal of marital and family therapyEllen T Welsh, Zoe C G Cloud, James H Boyd, Jennifer E McIntosh
Access to family and systemic therapies remains limited. Digital mental health interventions offer potential to extend access; however, most are designed for individual users, presenting challenges when engaging multiple members of a family. This study used a participatory co-design approach to inform the development of the Family e-Hub, a systemic, self-guided digital resource grounded in family-specific design principles. Drawing on the perspectives of consumers with lived experience of family therapy and family therapists, the study aimed to co-design recommendations for Family e-Hub content and strategies for design and implementation that may enable engagement by families. Findings identified systemic techniques that may be translated to a self-paced environment, recommendations for maintaining individual and relational safety, and strategies to support accessibility for diverse families. The paper summarizes these recommendations and discusses future directions for the Family e-Hub and the broader development of systemic digital mental health interventions.
Stress and health : journal of the International Society for the Investigation of StressMonique F Crane, Marjorie G Li, Eyal Karin, Daniel Gucciardi, Raffael Kalisch, Hester Xiao, Penny Van Bergen, Maria Kangas
The Systematic Self-Reflection Model of Resilience Strengthening (Crane, Searle, et al., 2019) proposes that coping self-reflection on everyday stressors can generate coping-related insights that refine modifiable capacities for resilience (e.g., coping beliefs, coping adjustment, and coping-enabling resources), thereby increasing the likelihood of resilience. However, reflective engagement and insight generation may be constrained by individual and contextual factors, raising the possibility that externally modeled coping insights could scaffold subsequent self-reflection and strengthen downstream adaptation. This preregistered study tests whether narrative exposure that explicitly models coping-related insights enhances the effects of structured self-reflection among emerging adults (18-25 years). Participants (target final N = 400; recruited from Australia and the United Kingdom) will be randomly assigned to one of three conditions: (1) high-insight priming story + reflection, in which short video stories explicitly convey a coping-related insight; (2) low-insight priming story + reflection, in which the same stories omit explicit meaning-making; or (3) reflection-only. Participants complete five weekly tasks, with assessments at baseline (T1), post-intervention (T2), and 3-month follow-up (T3). Primary outcomes include coping-related insight (self-report and blind-coded written insights), resilient capacities (coping self-efficacy, coping adjustment, support-seeking intentions, perceived social support), and mental ill-health symptoms (depression and anxiety). Resilience is operationalized as stressor reactivity, symptom levels relative to stressor exposure, calculated as residualised symptoms after accounting for adversity and daily hassles, at each time point. We hypothesize that high-insight priming narratives will increase insight and resilient capacities and reduce stressor reactivity over time. Mediation analyses will test underlying mechanisms.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyLaura Hoffmann, Carole Geimer, Gudrun Diermayr, Markus Reindl, Mike C Horton, Barbara Seebacher
BACKGROUND AND PURPOSE: Therapeutic alliance (TA)-the collaborative therapist-client partnership-is pivotal to outcomes, yet TA tools tailored to telerehabilitation are limited. We developed and preliminarily validated a therapist-reported measure for physiotherapists (PTs), occupational therapists (OTs), and speech and language therapists (SLTs): the Working Alliance Inventory-Telerehabilitation (WAI-Tele-Reha-G). METHODS: Items drew on expert interviews, adaptation guidelines, and the German WAI-Short Revised (therapist version) and were refined via cognitive interviews (n = 9) and pilot testing (n = 34). Validation involved German-speaking PTs, OTs, and SLTs (test: n = 128; retest: n = 84). Rasch partial credit modelling assessed model fit, unidimensionality, local independence, threshold ordering, and differential item functioning (DIF). Reliability (Cronbach's alpha, Person Separation Index [PSI]), test-retest reliability (Lin's concordance correlation coefficient [CCC]), convergent validity (with the Unified Theory of Acceptance and Use of Technology-2 Questionnaire [UTAUT-2], Technology Commitment-Short Scale, 5-item Revised Vocational Self-Efficacy Scale), known-groups validity, and targeting were evaluated. RESULTS: Goal, task and bond scales generally fit the Rasch model and were unidimensional with ordered thresholds; no DIF was detected in this sample. Minor local dependence in the task scale was handled via a superitem during Rasch estimation; scoring remained at the item level. Internal consistency was good (alpha = 0.80-0.81) and PSI modest (0.72-0.74). Test-retest reliability was excellent (CCC = 0.81-0.93). Correlations among goal, task, and bond were moderate-to-strong; correlations with technology acceptance/commitment and vocational self-efficacy were low-to-moderate, as hypothesised. Ceiling effects were < 15%, with targeting skewed towards higher TA levels. DISCUSSION: The WAI-Tele-Reha-G shows preliminary evidence of satisfactory psychometric properties for a therapist-reported assessment of TA in telerehabilitation. Interpretation should consider the modest sample, therapist-only perspective, targeting skew, and Rasch adjustments. Future work should add more challenging items to improve discrimination at high TA levels and develop a patient-reported version to capture the dyadic nature of TA.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in CancerKouthar Sulaiman Al-Alawi, Hana Harib Al Sumri, Amal Sulaiman Al Fahdi, Moon Fai Chan, Zayana Talib Al Kayoumi, Mohammed Al-Azri
PURPOSE: Mothers diagnosed with breast cancer in collectivist, faith-oriented societies face dilemmas regarding the timing, manner, and extent of disclosure of their illness to their children and extended family members. However, evidence addressing this issue within Arab contexts remains limited. This phenomenological qualitative study explored how Omani mothers with breast cancer navigate disclosure, interpret familial and communal responses, and employ coping strategies within sociocultural and religious frameworks. METHODS: In-depth semistructured interviews were conducted in Arabic with 18 Omani mothers diagnosed with stage I-III breast cancer, parenting at least one child aged 6-18 years. Participants were recruited from a national cancer care center in Muscat. The interviews were audio-recorded, transcribed verbatim, translated into English, and analyzed using the framework method, supported by NVivo. RESULTS: Three themes emerged: (1) illness disclosure and communication strategies; (2) family and community responses to the diagnosis; and (3) coping strategies grounded in faith, patience, and behavioral adjustment. Women's experiences were shaped by maternal roles, anticipated stigma, and faith-informed interpretations of illness. Disclosure decisions influenced the mobilization of support within kinship networks. Furthermore, coping mechanisms integrated religious meaning-making with efforts to maintain normalcy. CONCLUSION: These findings underscore the need for culturally responsive, family-centered psychosocial care in cancer services.
Journal of marital and family therapyRicardo S S Durães, Zila Elizabeth Pulache Vargas, Ana Cristina Garcia Dias, Francisco Lotufo-Neto, Renato T Ramos, Antonio de Pádua Serafim
Psychosocial distress can exacerbate marital conflict, maladjustment, and mental health vulnerability. This pilot randomized clinical trial examined cognitive-behavioral couple therapy (CBCT) integrated with mindfulness in low-income Brazilian couples (per-capita household income up to one minimum wage). Thirty-four participants (17 heterosexual couples) were randomized (independent computer-generated sequence) to an experimental (n = 16) or waitlist control group (n = 18). We assessed dyadic adjustment, mindful attention, marital social skills, and depressive symptoms (R-DAS, MAAS, IHSC, BDI-II) at baseline, post-treatment, and 3-month follow-up. The intervention was eight 80-min conjoint sessions plus daily home exercises. Time × group effects favored the experimental group for dyadic adjustment, mindful attention, and depressive symptoms (all p < 0.001, η p 2 = 0.20-0.37), but not marital social skills (p = 0.14). Because two outcomes differed at baseline, effects were confirmed with baseline- and dependence-adjusted sensitivity analyses. These findings provide preliminary evidence that CBCT with mindfulness may benefit disadvantaged couples.