Search Results (3,032)

Background/Objectives: Social rejection during the latency stage is a significant risk factor for children’s emotional and social development. Whereas earlier research focused primarily on individual characteristics of rejected children, contemporary perspectives emphasize peer-group processes, including norm formation, hierarchies, and social status structures. Although autonomy has been widely examined as an individual developmental construct, less attention has been given to its possible collective expression within the classroom peer group. This study aimed to explore how children understand and experience group autonomy and to clarify its role in social status and peer rejection. Methods: Twelve classroom-based focus groups were conducted with 140 fifth-grade children from five public elementary schools in Israel. Discussions were initiated using a projective narrative describing ambiguous peer exclusion. Data were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Coding was conducted independently by two researchers and refined through iterative comparison and reflexive procedures. Results: Three themes emerged: (1) a shared longing for classroom-based group autonomy and collective decision-making; (2) group autonomy as an implicit hierarchical criterion shaping social status, whereby reduced reliance on adults and alignment with peer norms were associated with higher status, while adult dependence was linked to marginalization; and (3) an ambivalent structure of autonomy, as children valued peer independence yet expressed fear of adult punishment and responsibility. Conclusions: Findings suggest that during the latency stage autonomy shifts toward a collectively organized peer-group process. Recognizing group autonomy as a developmental dimension may deepen understanding of social status and peer rejection within classroom contexts. Full article

Background/Objectives: This article is a narrative review that examines the development of attachment from intrauterine life to the first thousand days of a child’s life, integrating psychoanalytic, neuroscientific, genetic, and cross-cultural perspectives. Biological, relational, neurological, and cultural factors interact and shape individual differences in socio-emotional functioning. This paper aims to propose a reinterpretation of early attachment, describing it as both a clinical and relational phenomenon and an adaptive process inscribed in human evolutionary history, according to the Four-Domain Integrative Framework described herein. Methods: The review examined three main areas of evidence: early attachment characteristics, cross-cultural caregiving variations, and genetic and epigenetic mechanisms underlying environmental sensitivity. Results: The review first identified seven characteristics of early attachment (proximity seeking, emotional attunement, intrauterine experiences, maternal holding, security patterns, brain plasticity, and maternal stress) which represent developmental mechanisms that generate individual differences in trust, self-regulation, resilience, and psychopathological vulnerability. Second, cross-cultural variations in six distinct caregiving contexts were examined, demonstrating that secure attachment emerges through culturally specific pathways, differentially influencing motor development, sleep patterns, hypothalamic–pituitary–adrenal axis maturation, and social skills. Finally, the differential susceptibility model was provided through the analysis of five genetic and epigenetic systems (oxytocin receptor gene, serotonin transporter gene, dopamine receptor gene, glucocorticoid receptor methylation, and fetal programming) that modulate environmental sensitivity. Conclusions: Biological, relational, neurological, and cultural factors interact and shape individual differences in socio-emotional functioning. Full article

Background: Refugees arriving from conflict zones often continue to experience trauma and are at increased risk of anxiety and depression. Those seeking asylum form a group at higher risk of suffering adverse mental health outcomes, with higher needs for psychosocial and therapeutic care. This study aimed to determine metabolic changes potentially associated with psychological distress in refugees from Syria, using a saliva-based metabolomics approach via proton nuclear magnetic resonance (1H NMR) spectroscopy. Methods: Participants were recruited from Lethbridge Family Services and categorized into high and low stress burden groups using questionnaires assessing depression (PHQ-9) and generalized anxiety (GAD-7). Salivary metabolomic profiles from 26 female and 32 male participants were analyzed using supervised and unsupervised multivariate statistical methods to identify metabolic differences linked to composite stress, depression, and anxiety. Results: Salivary metabolic profiles showed the most prominent differences associated with anxiety in female participants and depression in male participants. Multivariate statistical analyses identified 31 metabolites and 13 biological pathways that were significantly altered according to mental health status, with the greatest changes observed in glycolysis/gluconeogenesis, sphingolipid metabolism, and taurine/hypotaurine metabolism. Conclusions: These findings indicate that salivary 1H NMR metabolomic profiling can identify a quantifiable “metabolic fingerprint” related to impaired mental health and psychological distress in a cost-effective, objective, and non-invasive way. This analytical strategy shows potential as a screening tool to support effective decision-making, enabling early identification of individuals at highest risk who require timely emotional and medical support. Full article

This review examines what constitutes heart rate variability (HRV), the relationship between HRV and the autonomic nervous system, and the physiology driving HRV. HRV is correlated with vagal nerve activity and parasympathetic nervous activation. Higher HRV is correlated with youth, active lifestyle, adaptive capacity, and good health. Next, the review examines the medical significance of HRV, especially the correlation between lower HRV and the presence of medical and psychological disorders. In general, HRV serves as a biomarker for health and disease, an index of autonomic nervous system dysregulation, an index of prefrontal cortical functionality, and a marker for psychopathology across diagnoses. Higher HRV is associated with several characteristics associated with successful psychotherapy and hypnotherapy: social engagement, compassion, emotional regulation, and cognitive flexibility. Given this association, somatic regulation should be regarded as integral to treatment alongside psychotherapy and hypnosis. Understanding HRV can enable the psychotherapist and hypnotherapist to optimize treatment. In effect, the therapist can harness the power of the brain and nervous system to better prepare the patient for therapy and to enhance the process of therapy. This review encourages therapists to utilize several strategies and interventions to increase patients’ HRV levels prior to and during therapy. The review will be most applicable for those hypnotherapists who integrate hypnosis into counseling and psychotherapy. The review describes the process by which HRV biofeedback training guides the individual to voluntarily increase HRV. It also identifies a number of lifestyle parameters and self-care practices (including self-hypnosis) that increase HRV. Encouraging lifestyle and self-care practices to increase HRV can support a greater response to hypnotherapy and psychotherapy. With additional training, hypnotherapists can integrate HRV biofeedback into a hypnosis practice. Further, several simple interventions already within the scope of most hypnosis practitioners can be utilized to enhance HRV at the beginning of a hypnotherapy process, and again during the process of therapy. Full article

This article is about the concept of external psychological control (having a sense of psychological control over the environment). This article examines the construct of external psychological control and differentiates it from similar concepts, showing its unique attributes and how it can help understand a diverse array of psychological phenomena. Of note, external psychological control differs from internal psychological control, which is about maintaining internal psychological equilibrium or being grounded. The term psychological control is similar to terms, but we show that it differs from them and is unique in how it is presently defined. Some of these terms include distress tolerance, self-efficacy, and many variations in terms of control as part of the terminology. Another term examined is related to psychological reserve, the depletion of which affects psychological control. The article presents an original questionnaire that could be used to research external psychological control. The article concludes with a formal mathematical representation of the interaction between psychological control and psychological reserve, and with simulation research that serves as a proof of concept of the constructs proposed. The concepts of psychological control and psychological reserve can help in understanding psychotherapeutic change mechanisms. The concepts of psychological control and psychological reserve are relatively novel terms that can help understand reactions to stress and consequent stress management. Full article

Background/Objectives: Dietary behavior in eating disorders (EDs) is often framed through either nutritional or psychological perspectives, yet emerging evidence suggests that eating may involve a transdiagnostic, emotionally embedded, and relationally negotiated process. While research highlights the role of emotion regulation difficulties, perfectionism, control, and overvaluation of weight and shape in ED maintenance, less is known about how these processes are interpreted and managed in clinical practice across different cultural contexts. This study explored psychotherapists’ perspectives on dietary behavior, nutritional assessment, and interdisciplinary collaboration in ED treatment in Greece and the United Kingdom. Methods: Eighteen psychotherapists (9 Greek and 9 British) with experience in treating individuals with EDs participated in in-depth semi-structured interviews. Data were analyzed using reflexive thematic analysis. Results: Three themes were developed. First, therapists conceptualized dietary behavior as reflecting broader transdiagnostic psychological processes, particularly perfectionism, control, emotion regulation difficulties, and body image concerns. Second, nutritional assessment and intervention (e.g., food diaries and meal plans) were experienced as emotionally significant practices that required negotiation of timing, meaning, and clients’ readiness for change. Third, interdisciplinary collaboration was described as involving ongoing negotiation of nutritional authority, with therapists balancing nutritional considerations and psychological safety, influenced by contextual differences between UK and Greek mental health systems. Conclusions: Findings suggest that dietary behavior in ED treatment may benefit from approaches that integrate psychological and nutritional perspectives. Clinicians may consider attending to clients’ emotional readiness, the symbolic meanings of food, and the dynamics of multidisciplinary collaboration, offering insights that can inform clinical practice and future research. Full article

Pharmacological antidepressant treatments alter the molecular and functional reactivity of stress-sensitive neural networks. However, how classical versus rapid-acting antidepressants differentially modulate acute stress-induced transcriptional responses across brain regions remains unclear. Here, we compared imipramine and ketamine in mice exposed to acute swim stress, assessing transcriptional adaptations across the frontal cortex, hippocampus, and striatum. Swim stress induced significant widespread activation of cFOS, which led to drug-specific modulations: imipramine primarily significantly dampened cortical and striatal cFOS expression, whereas ketamine preserved stress-evoked neuronal activation. In contrast, hippocampal activation was significantly robust but largely unaffected, indicating that acute antidepressant drug effects during stress coping preferentially target cortical and striatal plasticity mechanisms. In contrast, BDNF expression was altered only within the striatal region, where imipramine attenuated the stress-related increase in BDNF expression. Statistical analysis of behavioral outcomes during the swim stress confirmed a shared facilitation of active coping, yet these similar outcomes emerged from distinct molecular programs. Together, the data demonstrate that the treatment effects of the two substances diverge mechanistically, revealing cortical and striatal transcriptional signatures of classical versus rapid-acting antidepressant action. While these findings suggest potential translational relevance for understanding distinct mechanisms, further studies in humans are required to validate these signatures and their clinical implications. Full article

Background/Objectives: Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood and it tends to remain during adulthood. It not only affects cognitive abilities and behavior but also often presents emotional disturbances and alterations in the perceived quality of life. These symptoms are primarily related to dysfunctions in the ventromedial and dorsolateral prefrontal network. The main objective was to evaluate the feasibility and explore the initial outcomes of an integrated protocol combining neuropsychological treatment and transcranial direct current stimulation (tDCS). Methods: This study presents a single-case experimental A-B design of a 21-year-old woman, diagnosed with predominantly inattentive ADHD, treated at the University Psychology Clinic of Loyola Andalucía University. The treatment was carried out twice a week for 5 weeks (10 sessions in total), with 20 min of anodal tDCS at F3 and cathodal tDCS at F4 (2 mA), while digital neurorehabilitation exercises and psychotherapeutic support were provided. Results: An overall significant improvement was observed in cognitive functions (p = 0.008), with clinically significant gains in cognitive flexibility, visual working memory, and planning. Mixed results were found in inhibition, with improvement in interference control but no change in response inhibition. No significant changes were observed in sustained attention, auditory working memory, or processing speed. In terms of emotional state, an overall improvement was noted (p = 0.046), particularly in depression symptoms and perceived quality of life related to physical and psychological health. However, no significant changes were observed in anxiety symptoms or in areas related to the environment and social relationships. These findings reflect pilot-level evidence of clinical change within a feasibility framework. Conclusions: The combined treatment was found to be safe and feasible, showing promising preliminary improvements in cognitive and emotional domains. As a single-case study, these results serve as hypothesis-generating evidence for future controlled trials. Full article

Sex differences remain largely underexplored in metabolic disorders, particularly in the context of genetic predisposition to type 2 diabetes, the impact of aging, and environmental factors such as exposure to high-caloric diets. Previous studies using serotonin transporter (SERT)-knockout (SERT-KO) mice, which recapitulate metabolic conditions related to the lowered function of this transporter in humans, revealed an aggravated negative response of these mutants to housing on a high-fat/sugar ‘Western diet’ (WD). However, the role of sex in SERT-KO mice has not yet been studied. Available human and animal data suggest the differential regulation of insulin receptor-mediated signaling in males and females, which can be altered with aging. This study aimed to compare fat accumulation, blood biochemical changes, glucose tolerance, and insulin receptor (IR)-related signaling in the liver and various brain structures of 12-month-old male and female SERT-KO mice fed WD for 21 days. Relative to the dietary-unchallenged group and their wild-type (WT) littermates, WD-fed mutants of both sexes displayed markedly increased fat accumulation and impaired glucose and insulin tolerance. Body mass increase was more prominent in females than in males. The two sexes revealed a similar suppression of the gene expression of isoforms A and B of IR but distinct expression of IR-related factors. IR-related genes such as Cd36, Enpp, Ptpn1, Cyp4a14, Acsl1, and Pten showed differential expression between male and female SERT-KO mice fed WD. Several differences in gene expression were also found between the WT groups of the two sexes. Overall, the manifestations of hepatic steatosis, insulin resistance, and glucose tolerance were similar between the age groups of animals, whereas the gene expression of IR-related regulation differed between the groups. We conclude that aging and genetic absence of the serotonin transporter likely override sex differences in the end effects of WD challenge, while molecular mechanisms of adaptation of IR-mediated signaling are distinct between male and female SERT-KO mice fed WD. Full article

Human health and well-being are dependent on natural environments, which is the core foundation of the growing discipline of outdoor therapies. However, as with psychotherapy research in general, the field of outdoor therapies lacks descriptive process-oriented theoretical frameworks that precisely reflect this multi-faceted practice. Therapeutic work, whether this takes place indoors or outdoors, comprises numerous implicit relational and environmental dimensions. Implicit aspects are largely sensed, embodied and intuitive, and therefore hard to pin down and describe accurately. In this exploratory study, a survey mapped implicit guiding frameworks amongst outdoor therapy practitioners (n = 68) representing 18 nations. A constructivist grounded theory analysis resulted in the proposition of a practice theory, called the implicit ecosystem of outdoor therapies, made up of eight interrelated components: (1) joint engagement and co-creating agendas; (2) a foundation of safety and trust; (3) being in parallel and not fix; (4) awareness and attunement here-now; (5) the dynamic of outer and inner landscapes; (6) a constantly moving and meaning-making endeavor; (7) creativity, play, and whole-body activation; and (8) working through natural barriers and rewriting narratives. This grounded theory offers a preliminary blueprint of a practice-guiding framework developed from within the outdoor therapy discipline intended to advance theory, training, and research. Full article

Introduction: Over 100 studies demonstrate the efficacy of Emotional Freedom Techniques (EFT), an evidence-based therapeutic method. However, most research is on in-person delivery of EFT. Only a few studies examine EFT delivered virtually, and to date no research has provided a direct comparison of group virtual EFT to group in-person delivery. Objectives: Delivery of EFT shifted to online platforms in the wake of the 2020 COVID-19 pandemic. This makes a comparison of virtual delivery to in-person delivery timely. The research question of whether online group delivery is as effective as in-person group delivery is of high clinical relevance, given the increased access and convenience offered by virtual treatment options. Methods: Participants in the online group were a convenience sample of 172 participants drawn from four four-day virtual EFT training sessions. Changes in psychological and physiological symptoms were measured pre, post, and at six-month follow-up using the Patient Health Questionnaire (PHQ-4). The two-item Post Traumatic Stress Disorder (PTSD) Checklist (PCL), the Happiness Scale, and the QuickDASH pain scale. These results were then compared to those of a previously published study of in-person group EFT (n = 203) that used an identical training curriculum delivered face-to-face. Due to COVID restrictions, the physiological measures used in the face-to-face delivery could not be replicated in the virtual group. Results: Online group EFT demonstrated significant improvements in PTSD, anxiety, depression, pain, and happiness (all p < 0.001) pre to post EFT. These improvements were maintained at six-month follow-up for PTSD (p < 0.001), depression (p = 0.048), pain (p = 0.002), and happiness (p < 0.001). Although there was a reduction in anxiety in the online group at six-month follow-up, this did not reach significance (p = 0.102). When compared to the in-person group (pre-COVID), the percent change in symptoms, while still clinically and statistically significant, was for most conditions smaller in the virtual group (post COVID) at both post and follow-up time points. Conclusions: EFT is associated with significant improvements in psychological and physiological conditions including PTSD, anxiety, depression, pain, and happiness, whether delivered virtually in groups or in-person in groups. The psychological and physiological benefits identified in online treatment are similar to those found during in-person delivery, though not as large or clinically significant. This finding is consistent with the literature demonstrating that online treatment is an effective method of delivering psychological therapies. The results reinforce other studies showing COVID produced a significant increase in mental health symptoms. Published treatment guidelines already recommend in-person EFT as an efficient and potentially cost-effective first-line intervention in primary care; virtual group EFT can be similarly recommended. Full article

Recent revisions of personality disorder (PD) classifications have moved from categorical diagnoses toward dimensional models, raising renewed questions about the nosological status and clinical utility of borderline personality disorder (BPD). This narrative review traces the development of the borderline construct from early descriptions of patients positioned between neurosis and psychosis, through its theoretical consolidation within the concept of borderline personality organization, to the operationalization of BPD in DSM-III and subsequent diagnostic revisions. A central section summarizes contemporary controversies regarding the validity and utility of BPD features. Arguments for abandoning the diagnosis emphasize the absence of a distinct borderline factor in factor analytic studies, the tendency of the construct to capture fluctuating symptoms and patterns of behaviour rather than stable maladaptive personality traits, the stigmatizing and non-selective use of the label, and the lack of disorder-specific treatment approaches. In contrast, converging evidence supports the view that core borderline symptoms frequently function as markers of general PD pathology and of the severity of impairments in self and interpersonal functioning. The paper integrates the concept of the borderline level of personality functioning, conceptualizing borderline pathology as a dynamic dimension of dysfunction with potential transient regressions, and links this concept to the Level of Personality Functioning (LPF, Criterion A) within the DSM 5 Alternative Model for Personality Disorders (AMPD). Retaining borderline pathology as a dimension may support contemporary PD assessment by offering a clinically recognizable marker of overall dysfunction, a guide for rating severity, an indicator of personality structure and need for psychotherapy, without disrupting continuity with an extensive clinical and research tradition. Full article

Background: Interpersonal emotion regulation (iER) is the process of managing others’ emotions and is critical during early adolescence, when social awareness and peer dependence increase. Little is known about how sex and gender role orientation shape adolescents’ iER. This study examined whether early adolescents differ in their use of person-focused (acceptance) versus problem-focused (positive engagement) strategies and whether these differences depend on context and measurement method. Methods: Data were collected from 322 adolescents (141 girls, 181 boys; aged 10–14 years, M = 12.47, SD = 1.55). The cross-sectional online study used a multi-method design comprising open-ended visual vignettes, a standardised questionnaire, and a serious game task. Participants also completed a validated gender-role self-concept measure assessing femininity and masculinity. Analyses were conducted using Poisson and logistic regressions with sex, femininity, and masculinity as predictors. Results: Across tasks, adolescents preferred problem-focused over person-focused strategies. Girls and those higher in femininity reported or generated more acceptance-based strategies, whereas boys and those higher in masculinity favoured positive engagement. These effects were evident in reflective measures (vignettes and questionnaire) but not in the interactive game, where sex and gender differences were absent. Conclusions: Findings suggest that gendered socialisation processes shape how adolescents regulate others’ emotions, particularly when behaviour is consciously reported. However, in ecologically valid contexts, these differences diminish, indicating shared capacities for adaptive interpersonal regulation across genders. Full article

Whether the risk of gastric neoplasm is modified by newer glucose-lowering therapies—dipeptidyl peptidase-4 inhibitors (DPP4is), glucagon-like peptide-1 receptor agonists (GLP1RAs), and sodium–glucose cotransporter 2 inhibitors (SGLT2is)—remains uncertain. Given their global uptake and long-term use in populations already predisposed to malignancy, decision-grade comparative safety evidence is needed. We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) in adults without baseline gastric neoplasms. PubMed, Embase, Cochrane CENTRAL, Web of Science, ClinicalTrials.gov, ClinicalKey, ProQuest, and ScienceDirect were searched from inception to 10 January 2026, without language restrictions. The primary outcome was incident gastric neoplasms (benign or malignant). Random-effects frequentist NMA estimated risk ratios (RRs) with 95% confidence intervals (CIs); Bayesian NMA served as sensitivity analysis. Certainty of evidence was assessed using GRADE adapted for NMA (PROSPERO CRD420261282728). Fifty-two RCTs (171,165 participants; mean age 63.6 years; 36.9% women; mean follow-up 141.8 weeks) were included. At the class level, GLP1RAs were associated with lower gastric neoplasm risk versus controls (RR = 0.51, 95% CI = 0.28–0.92), whereas DPP4is were associated with higher risk (RR = 1.77, 95% CI = 1.09–2.85). These signals persisted in prespecified subgroup analyses among participants with diabetes mellitus, in trials with duration ≥52 weeks (GLP1RA: RR = 0.52, 95% CI = 0.28–0.95; DPP4i: RR = 2.05, 95% CI = 1.19–3.55), and in older populations (age ≥60 years; DPP4i: RR = 2.08, 95% CI = 1.15–3.77). No class showed a significant association in younger participants (<60 years) or shorter trials (<52 weeks). Across available RCT evidence, GLP1RA prescription generally had a relatively lower gastric neoplasm risk than controls. In contrast, among patients with diabetes mellitus receiving longer-term therapy, GLP1RAs may be the preferable option from the perspective of gastric neoplasm risk, while DPP4is warrant heightened vigilance and mechanistic clarification. These findings support improved neoplasms ascertainment in future trials rather than immediate prescribing changes. Full article

Background/Objectives: One of the most relevant risk factors for suicide is the terminal stage of oncological disease. However, it remains unclear whether palliative care affects suicide rates in this population. This study aimed to compare suicide rates in oncological patients receiving palliative care to a general oncological cohort. Methods: The rate of suicide among all patients admitted to the palliative care ward at the Medical University of Vienna for oncological diagnoses from November 2012 to March 2022 was compared to that of a diagnosis-matched control group retrieved from the Austrian Cancer Registry. Competing risk models in SAS (SAS Institute Inc., Cary, NC, USA) were used to test for significant differences in cumulative incidences of death by suicide. Cumulative incidences were also compared for sex and the most common diagnostic groups separately. Results: 1524 patients with oncological diagnoses receiving palliative care and 794,986 patients in the control group were included in the analysis. No excess suicide mortality was revealed (p = 0.117) in the group of patients receiving palliative care. Importantly, this remained true, after also including any potential cases of suicide within the palliative care sample in the analysis (p = 0.467). Only for patients with pancreatic cancer, a higher cumulative suicide incidence in the palliative care sample was found (p = 0.008). Conclusions: Palliative care for oncological patients may be able to alleviate the excess suicide mortality that is otherwise expected in terminally ill patients. This study underscores the importance of comprehensive multidisciplinary end-of-life care that addresses not only physical but also psychosocial aspects. Full article