Search Results (902)

Background: Anxiety disorders are common in childhood, yet access to cognitive behavioral therapy (CBT) is often limited. Internet-delivered CBT (iCBT) can help overcome these barriers, but evidence in younger children remains scarce. This pilot study describes the development and preliminary evaluation of an Italian iCBT platform for children with mild to moderate anxiety. Methods: Five children aged 8–12 years and their caregivers were recruited through pediatricians. Eligibility was assessed using the MASC-2 and a psychiatrist interview. Each child completed a supervised session with the WebApp, which delivers CBT modules combining psychoeducation, cognitive restructuring, relaxation, and gamified activities. Usability was evaluated using the ita-MAUQ, observation, and interviews. Results: All participants completed the session without dropouts. Mean ita-MAUQ scores were consistently above the midpoint, with the highest ratings for interface design and satisfaction. Children appreciated the interactive, game-like features, while caregivers valued the clarity and practicality of content. Qualitative feedback indicated good comprehensibility and engagement, with suggestions for improving navigation flow and language adaptation. No adverse events occurred. Conclusions: This pilot study supports the feasibility, safety, and acceptability of the new iCBT platform and provides essential insights for its refinement and future large-scale clinical trials. Full article

Social anxiety disorder (SAD) is defined as a pathological fear of social interactions in which an individual may be negatively evaluated by others. The crucial component of assessing the state as clinical is the ‘context-insensitivity’ of the fear—i.e., the negative evaluation does not have any tangible repercussions, or the evaluation is not as detrimentally negative, as the patient presumes. However, this model excludes the role of self-conscious emotions, specifically shame, in aggravating social fears. This article models shame as an emotion that is highly aversive, unpredictable, and resistant to metacognitive regulation, which entails a perspective that SAD is the product of high shame-proneness and the inability to voluntarily mitigate it. The evidence of mutual correlates, such as socially prescribed perfectionism and treatment outcomes of cognitive and behavioral therapeutic modalities, is used to justify the argument. The article suggests the possibility of implementing humor as a supplement to a standard SAD-treatment self-regulation strategy that would allow subjects to control the emergence of their shame more efficiently. Finally, a potential randomized control trial study design is proposed to test the perspective outlined. Full article

Shift workers face a heightened risk of insomnia. Recent research has yielded promising insights, but further progress is necessary to better treat insomnia in this group. The present pilot study evaluates how different characteristics impact sleep in shift workers to develop an innovative therapeutic approach. An online survey was administered to an ad hoc sample of N = 225 (112 shift workers), and correlations were calculated between sleep variables and specific characteristics (e.g., psychological impairment, personality traits, sleep-related behavior, attitudes towards sleep and shift work). Group differences between good/poor sleepers and day/shift work were determined using Mann–Whitney U-tests and Kruskal–Wallis H-tests. Regression was used to identify appropriate predictors. All factors (except perfectionism, chronotype, and importance of sleep) yielded significant results in both correlations and group differences (good/poor sleepers). The two groups of day/shift workers showed only minor differences. Dysfunctional beliefs about sleep, pre-sleep arousal, and depression were identified as predictors of poorer sleep. We conclude that interventions on psychological constraints (anxiety and depression), personality traits (anxiety, concern, emotional instability, and tension), social integration, sleep-related factors (dysfunctional beliefs, especially cognitive pre-sleep-arousal, sleep hygiene) and the attitude toward shiftwork, can replace those on regularity and will build an innovative therapy for shift workers on this basis. Once the newly developed treatment manual is finalized, its efficacy will be assessed through a randomized controlled trial. Full article

Background: Serotonin (5-HT) is a neurotransmitter and a hormone that regulates various functions. Serotonin receptors have been studied in animal experiments in the vestibular system, beginning from the inner ear and vestibular nuclei. However, the role of serotonin in the vestibular system and disorders remains to be clarified. Methods: A review of the literature was performed on different databases according to the PRISMA guidelines. Only publications published on humans and in English have been included. A total of 41 articles were included in this review. Results: There are many publications regarding the use of SSRI/SNRI in vestibular disorders. Regarding persistent postural perceptual dizziness (PPPD) and chronic subjective dizziness (CSD) the available evidence supports multimodality treatment incorporating vestibular rehabilitation, serotonergic medications, and cognitive behavior therapy, although most studies have not included a placebo control group. As for vestibular migraine (VM), SNRI and SSRIs were proposed as preventive therapy and demonstrated a reduction in vertigo attacks in patients with Menière’s Disease (MD), especially when symptoms of anxiety disorder were present. Conclusions: Although SSRIs/SNRIs are considered an off-label therapy for vertigo, several studies have assessed their efficacy in vestibular disorders, as indicated in the data published on PPPD, MD, and VM above all. As some studies report that serotonin receptors are also present in the inner ear and vestibular nuclei, it can be postulated that in cases where the natural levels of serotonin are altered, such as in depression and anxiety, the change in serotonin levels may affect vestibular function and play a role in vestibular disorders. Full article

Novice therapists often experience a complex interplay of self-doubt, emotional strain, and professional uncertainty as they transition from training to independent clinical practice. This study explored the lived experiences of novice cognitive behavioral therapy (CBT) therapists, focusing on the challenges of early practice and the strategies employed to support regulation and growth. Seven early-career CBT therapists participated in semi-structured interviews, and data were analyzed using Interpretative Phenomenological Analysis (IPA). Two overarching themes were identified: professional identity challenges and self-beliefs, and strategies for emotional regulation and continuous development. Participants reported difficulties managing anxiety, boundary-setting, and integrating their professional and personal selves, particularly when working with complex presentations such as grief, self-harm, and personality disorders. At the same time, supervision, personal therapy, peer and family support, and ongoing professional development were seen as crucial in building resilience and sustaining competence. The findings suggest that training and professional structures should place greater emphasis on reflective practice, boundary management, and preparation for emotionally charged cases, while framing supervision as both a clinical and emotional resource. By highlighting the perspectives of novice therapists, the study underscores the importance of supportive systems in fostering resilience and sustainable professional growth. Full article

Major depressive disorder (MDD) affects approximately $4.4\%$ of the global population. Its prevalence is increasing among adolescents and has led to the psychosocial condition known as hikikomori. MDD is typically assessed by self-report questionnaires, which, although informative, are subject to evaluator bias and subjectivity. To address these limitations, recent studies have explored machine learning (ML) for automated MDD detection. Among the input data used, speech signals stand out due to their low cost and minimal intrusiveness. However, many speech-based approaches lack integration with cognitive behavioral therapy (CBT) and adherence to evidence-based, patient-centered care—often aiming to replace rather than support clinical monitoring. In this context, we propose ML models to assess MDD in hikikomori patients using speech data from a real-world clinical trial. The trial is conducted in Italy, supervised by physicians, and comprises an eight-session CBT plan that is clinical evidence-based and follows patient-centered practices. Patients’ speech is recorded during therapy, and the Mel-Frequency Cepstral Coefficients (MFCCs) and wav2vec 2.0 embedding are extracted to train the models. The results show that the Multi-Layer Perceptron (MLP) predicted depression outcomes with a Root Mean Squared Error (RMSE) of $0.064$ using only MFCCs from the first session, suggesting that early-session speech may be valuable for outcome prediction. When considering the entire CBT treatment (i.e., all sessions), the MLP achieved an RMSE of $0.063$ using MFCCs and a lower RMSE of $0.057$ with wav2vec 2.0, indicating approximately a $9.5\%$ performance improvement. To aid the interpretability of the treatment outcomes, a binary task was conducted, where Logistic Regression (LR) achieved $70\%$ recall in predicting depression improvement among young adults using wav2vec 2.0. These findings position speech as a valuable predictive tool in clinical informatics, potentially supporting clinicians in anticipating treatment response. Full article

Background: Difficulties in emotion regulation (ER) are commonly described in eating disorders (ED), but few studies report its impact on ED treatment outcome. The main goal of this study was to investigate the patterns of change in difficulties in ER among ED-diagnosed female patients who received a Cognitive Behavioral Therapy (CBT) treatment. Methods: Participants (N = 74; Mage = 29.2; SD = 11.5) completed pre- and post-treatment questionnaires to assess difficulties in ER, disordered eating symptoms, general psychopathology, and personality traits. Results: Considering ED treatment outcome status, 24.3% of patients displayed a poor outcome, while 28.4% achieved partial remission, and 47.3% achieved full remission. Most of the patients who achieved full remission (80%) reported decreases in difficulties in ER, while only 55.6% of the participants displaying poor outcomes reported improvements in ER. The results from the structural equation modeling (SEM) suggest that the risk of poor outcome was directly related to increased post-treatment difficulties in ER, while improvements in the severity index of global psychopathology was related to increased pre-treatment difficulties in ER. Conclusions: Better ED treatment outcomes are associated with higher levels of ER improvements. Future prospective studies are warranted to establish which ER components may positively influence the recovery of ED-diagnosed patients. Full article

Background: Diabetes and mental health conditions frequently co-occur, with depression and anxiety affecting up to 20–30% of people with diabetes. These comorbidities worsen glycemic control, adherence, and quality of life, yet mental health is often neglected in diabetes care. Integrating mental health services into diabetes management is recommended by international organizations to improve patient outcomes. Objectives: To systematically review the evidence on integrated mental health interventions in diabetes care, compared to usual diabetes care, in improving patient outcomes (glycemic control, mental health, adherence, quality of life). Methods: We searched PubMed/MEDLINE, Embase, PsycINFO, and Scopus (2000 through July 2024) for studies of diabetes care integrating mental health support (e.g., collaborative care, co-location, stepped care, or digital interventions). Inclusion criteria were controlled trials or cohort studies involving individuals with type 1 or type 2 diabetes receiving an integrated mental health intervention, with outcomes on glycemic control and/or mental health. Two reviewers independently screened titles/abstracts and full texts, with disagreements resolved by consensus. Data on study design, population, intervention components, and outcomes were extracted. Risk of bias was assessed using Cochrane or appropriate tools. Results: Out of records identified, 64 studies met inclusion criteria (primarily randomized controlled trials). Integrated care models consistently improved depression and anxiety outcomes and diabetes-specific distress, and yielded modest but significant reductions in glycated hemoglobin (HbA1c) compared to usual care. Many interventions also enhanced treatment adherence and self-management behaviors. For example, collaborative care trials showed greater depression remission rates and small HbA1c improvements (~0.3–0.5% absolute reduction) relative to standard care. Co-located care in diabetes clinics was associated with reduced diabetes distress, depression scores, and HbA1c over 12 months. Digital health integrations (telepsychiatry, online cognitive-behavioral therapy) improved psychological outcomes and adherence, with some reporting slight improvements in glycemic control. Integrated approaches often increased uptake of mental health services (e.g., higher referral completion rates) and showed high patient satisfaction. A subset of studies reported fewer emergency visits and hospitalizations with integrated care, and one economic analysis found collaborative care cost-effective in primary care settings. Conclusions: Integrating mental health into diabetes care leads to better mental health outcomes and modest improvements in glycemic control, without adverse effects. Heterogeneity across studies is noted, but the overall evidence supports multidisciplinary, patient-centered care models to address the psychosocial needs of people with diabetes. Healthcare systems should prioritize implementing and scaling integrated care, accompanied by provider training and policy support, to improve outcomes and bridge the persistent treatment gap. Future research should focus on long-term effectiveness, cost-effectiveness, and strategies to reach diverse populations. Full article

Adolescents diagnosed with pediatric-onset multiple sclerosis (POMS) face a distinct set of challenges as they cope with a chronic neuroinflammatory disease during a formative stage of life. This review examines the growing body of literature on the psychosocial and cognitive consequences of POMS, from the trauma of diagnosis to disruptions in identity development, academic difficulties, and increased vulnerability to mental health issues. Many young people with MS experience fatigue, cognitive decline, depression, and anxiety, all of which can significantly interfere with their daily lives and overall well-being, even if physical symptoms of the disease remain limited. Yet, current care systems often fall short in addressing their needs, and interventions tailored to adolescents remain scarce. There is a pressing need for developmentally sensitive, family-centered, and integrated models of care. Targeted research and policy action are essential to better support this underserved group. This review builds on prior research by integrating recent findings with adolescent-development frameworks and by proposing a multicomponent health-promotion intervention model specific to POMS. The review describes relevant evidence-based approaches including cognitive behavioral therapy, mindfulness, peer-based interventions, and cognitive rehabilitation that were validated in adults with MS and chronically ill adolescents. The objective is to synthesize evidence and translate it into actionable recommendations for clinical care and research. Full article

Restless legs syndrome (RLS) is a sensorimotor disorder with evening-predominant symptoms; convergent models implicate brain iron dysregulation and alter dopaminergic/glutamatergic signaling. Because EEG provides millisecond-scale access to cortical dynamics, we synthesized waking EEG/ERP findings in RLS (sleep EEG excluded). A structured search across major databases (1980–July 2025) identified clinical EEG studies meeting prespecified criteria. Across small, mostly mid- to late-adult cohorts, four reproducible signatures emerged: (i) cortical hyperarousal at rest (fronto-central beta elevation with a dissociated vigilance profile); (ii) attentional/working memory ERPs with attenuated and delayed P300 (and reduced frontal P2), pointing to fronto-parietal dysfunction; (iii) network inefficiency (reduced theta/gamma synchrony and lower clustering/longer path length) that scales with symptom burden; and (iv) motor system abnormalities with exaggerated post-movement beta rebound and peri-movement cortical–autonomic co-activation, together with evening-vulnerable early visual processing during cognitive control. Dopamine agonist therapy partially normalizes behavior and ERP amplitudes. These converging EEG features provide candidate biomarkers for disease burden and treatment response and are consistent with models linking brain iron deficiency to thalamo-cortical timing failures. This mechanistic review did not adhere to PRISMA or PICO frameworks and did not include a formal risk-of-bias or quantitative meta-analysis; samples were small, heterogeneous, and English-only. Full article

Background/Objectives: The antiseizure effects of cannabidiol (CBD) were extensively studied when used as a monotherapy. However, there is conflicting evidence regarding its use in combination with levetiracetam (LEV). Methods: This study explored the effects of chronic co-administration of CBD and LEV in a pentylenetetrazole-kindling rat model to evaluate potential antiseizure and neuropsychiatric interactions. Male and female Wistar rats (n = 48) were divided into four treatment groups: one control and three treated by receiving LEV 300 mg/kg and LEV + CBD at 10 and 60 mg/kg, respectively. Seizure parameters were assessed using the Racine scale, and behavior was evaluated using the open field (OF), novel object recognition (NOR), and social interaction (SI) tests. Results: While both combinations, LEV + CBD 10 mg/kg and 60 mg/kg, significantly reduced maximal seizure intensity, the LEV + CBD 10 mg/kg attenuated LEV’s anti-kindling effect. Additionally, only LEV + CBD 60 mg/kg reduced seizure duration compared to LEV alone (p = 0.0002). In behavioral assessments, LEV + CBD 10 mg/kg showed anxiolytic effects in the OF test by increasing central activity (p = 0.0141). In contrast, the LEV + CBD 60 mg/kg impaired social behavior in both sexes (p = 0.0019). LEV improved the cognitive performance of female rats in the NOR test (p = 0.0301), but this improvement was not observed in LEV + CBD groups. Conclusions: CBD exhibited dose-dependent effects when combined with LEV: low doses might offer anxiolytic effects but promote kindling, and high doses enhance seizure control but potentially worsen social interaction. The results support the therapeutic potential of LEV-CBD co-treatment, while highlighting the need for careful dose optimization when considering CBD as an adjunctive therapy. Full article

The identification of brain clearance failure as a precursor to a large variety of neurodegenerative diseases has shifted fluid dynamics from a secondary to a tertiary target of brain health. The identification of the glymphatic system, detailing cerebrospinal fluid entry along perivascular spaces and exit via perivenous and meningeal lymphatic pathways, provided a challenge to previous diffusion models and established aquaporin-4–dependent astroglial polarity as a governing principle of solute transport. Multiple lines of evidence now support a coupled glymphatic–venous axis, wherein vasomotion, venous outflow, and lymphatic drainage are functionally interrelated. Failure of any axis will cascade and affect the entire axis, linking venous congestion, aquaporin-4 disassembly, and meningeal lymphatic failure to protein aggregation, neuroinflammation, edema, and intracranial hypertension. Specific lines of evidence from diffusion tensor imaging along vascular spaces, clearance MRI, and multi-omic biomarkers can provide a measure of transport. Therapeutic strategies are rapidly advancing from experimental strategies to translational approval, including behavioral optimization, closed-loop sleep stimulation, vascular and lymphatic therapies, focused ultrasound, pharmacological polarity recoupling, and regenerative bioengineering. Novel computational approaches, such as digital twin dynamic modeling and adaptive trial designs, suggest that clearance measures may serve as endpoints to be approved by the FDA. This review is intended to bridge relevant mechanistic and translational reviews, focusing on impaired clearance as an exploitable systems defect rather than an incapacitating secondary effect. Improving our understanding of the glymphatic-venous axis Injury may lead to future target strategies that advance cognitive resilience, alleviate disease burden, and improve quality of life. By clarifying the glymphatic–venous axis, we provide a mechanistic link between impaired interstitial clearance and the pathological accumulation of amyloid-β, tau, and α-synuclein in neurodegenerative diseases. The repair of aquaporin-4 polarity, venous compliance, and lymphatic drainage might therefore open new avenues for the diagnosis and treatment of Alzheimer’s and Parkinson’s disease, supplying both biomarkers of disease progression and new targets for early intervention. These translational implications not only locate clearance failure as an epiphenomenon of neurodegeneration but, more importantly, as a modifiable driver of the course of neurodegeneration. Full article

Background/Objectives: Eating disorders (EDs) frequently emerge during critical stages of childhood and adolescence, when identity development and emotional regulation are still maturing. Disturbances in self-concept clarity and identity integration may transform the body into a symbolic battlefield for autonomy, belonging, and self-worth. This review synthesizes developmental, psychosocial, neurocognitive, and therapeutic perspectives on the role of identity disturbance in EDs. Methods: A narrative review was conducted (2010–2025) using combinations of terms related to identity, self-concept clarity, self-discrepancy, objectification, interoception, and eating disorders (anorexia nervosa, bulimia nervosa, and binge-eating disorder). Results: Findings indicate that identity vulnerability (expressed as low self-concept clarity, heightened self-discrepancies, and self-objectification) mediates the association between early adversity, sociocultural pressures, and ED symptoms. Neurocognitive studies reveal altered self-referential processing, default mode network connectivity, and interoceptive signaling. Clinically, comorbid borderline personality features further exacerbate identity disturbance and complicate recovery. Evidence-based treatments such as enhanced cognitive-behavioral therapy (CBT-E) effectively target core maintaining mechanisms, while adjunctive interventions (mentalization-based therapy, schema therapy, narrative approaches, and compassion- or acceptance-based methods) show promise in addressing identity-related processes and improving outcomes. Conclusions: Identity disturbance provides a unifying framework for understanding why ED symptoms become entrenched despite adverse consequences. Integrating identity-focused approaches with nutritional and medical care may enhance recovery and reduce chronicity in youth. Future research should adopt longitudinal and mechanistic designs to clarify pathways linking identity change to clinical improvement and test identity-specific augmentations to standard ED treatments. Full article

Background: Displaced individuals endure challenges, including conflict, forced migration, family separation, human rights violations, limited access to essential services, and increased exposure to violence and abuse. These hardships significantly impact their mental health, often leading to heightened trauma-related symptoms. Methods: We used a cross-sectional correlational design in refugee camps, homes, and centers across Jordan and Spain. 200 refugees with confirmed status in the past ten years were recruited. Demographic data were collected via a demographic form, the PTSD-8 Inventory assessed traumatic symptoms, and data analysis included descriptive statistics, independent t-tests, one-way ANOVA, and Chi-square tests. Results: Most participants had a secondary education, were unemployed, and had low incomes. PTSD symptoms were prevalent, with rates of recurrent thoughts (63.5%), re-experiencing events (57.5%), nightmares (50.5%), sudden reactions (56.5%), activity avoidance (53.5%), avoidance of specific thoughts or feelings (56.5%), jumpiness (53.5%), hypervigilance (53.5%), feeling on guard (41.5%), and general avoidance (43.5%) rated from rarely to most of the time. All symptoms were significantly more frequent among refugees in Jordan than in Spain. Conclusions and Recommendations: Intrusive thoughts were more frequent among females, urban residents, and unemployed individuals. Avoidance behaviors were higher in married and unemployed individuals. Hypervigilance was more prevalent among females, married individuals, and those with lower incomes. Regionally, females and married individuals in Jordan exhibited more intrusive thoughts and avoidance. In Spain, intrusive thoughts and hypervigilance were more common among females and the unemployed. The findings highlight the urgent need for targeted mental health interventions, particularly in refugee camps like those in Jordan, where PTSD symptom rates were significantly higher. Programs should prioritize trauma-focused therapies, such as Cognitive Behavioral Therapy, while adopting gender-sensitive approaches to address the heightened vulnerability of women and unemployed individuals. Given the strong link between unemployment and symptom severity, livelihood support and vocational training should be integrated into psychosocial care. Policymakers in host countries like Jordan could benefit from adopting integration strategies similar to Spain’s, which may contribute to lower PTSD prevalence. Additionally, community-based awareness initiatives could improve early symptom recognition and access to care. Future research should explore longitudinal outcomes to assess the long-term impact of displacement and resettlement conditions on mental health. Full article

Global estimates show a 17.9% prevalence of neuropsychiatric disorders in individuals recently hospitalized with COVID-19. Cognitive behavioral therapy (CBT) has been proposed as a nonpharmacological strategy to mitigate these effects. This study examined the potential effects of CBT on anxiety, depression, post-traumatic stress disorder (PTSD), and quality of life (QoL) in post-COVID-19 patients. This prospective, nonrandomized, single-center clinical trial involved 15 patients (mean age 53.4 years) who underwent weekly CBT sessions for six weeks. Between-group differences in anxiety and depression scores were non-significant (p > 0.05); however, significant intragroup improvements were observed in anxiety (p = 0.01), depression (p = 0.01), and PTSD (p = 0.01) after the intervention. Thus, CBT was associated with reduced anxiety, depression, and PTSD as well as improved quality of life in post-COVID-19 patients. Improvements in QoL were noted mainly in the domains of functional capacity, vitality, emotional aspects, and mental health. While these findings suggest that CBT may be beneficial for post-COVID-19 patients, the small sample size, absence of a control group, and short follow-up period limit the strength of our conclusions. Therefore, the results should be considered preliminary, and further randomized controlled trials with larger sample sizes are warranted. Full article