Search Results (199)

Background/Objectives: Incorporating parent training into cognitive-behavioral therapy for anxious youth has not been shown to significantly improve outcomes perhaps because these interventions have not addressed potential interfering psychological barriers to implementing parenting changes and rarely offer between-session support. There is growing evidence that Acceptance and Commitment Therapy (ACT) can target these psychological barriers and generate more flexible and adaptive behavioral repertoires in parents of children with a variety of presenting challenges. Methods: Following a pilot trial of “Acceptance and Commitment Therapy for Parents of Anxious Children (ACT-PAC)” a six-week group-based intervention focused on targeting psychological barriers to parenting change using mindfulness and acceptance approaches, we collected qualitative feedback from participants in two post-treatment phases by conducting individual interviews and a focus group with participants that completed the intervention. Results: Analysis of interview responses revealed that parents found ACT principles and processes to be helpful, and many also appreciated the ACT-PAC group setting that allowed parents to recognize their experiences were shared by others and to self-disclose in a non-judgmental space. Feedback from the focus group further provides preliminary evidence that ACT-PAC is acceptable to and feasible for parent participants and suggests modifications such as involving additional caregivers, making resources more readily available, and creative structural changes that may facilitate between-session practice. Conclusions: Results suggest that the group-based intervention can be both maintained and improved for future participants. Limitations to generalizability in light of possible selection bias and the small focus group sample size are addressed. Full article

Perioperative anxiety is a common psychophysiological stress response experienced by patients before and after surgery, with a global prevalence of approximately 48%. Its occurrence is influenced by multiple factors including age, sex, type of surgery, and psychosocial determinants. The underlying pathophysiological mechanisms are complex, involving multi-system interactions such as autonomic nervous system imbalance, dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, dysfunction of limbic system neural circuits, and neuroinflammation. Current assessment strategies are evolving from sole reliance on psychological scales toward multimodal approaches incorporating objective biomarkers including heart rate variability, cortisol, and electroencephalography. Management paradigms have shifted from traditional pharmacological premedication to integrated systems encompassing structured patient education, digital health tools, neuromodulation techniques, and cognitive behavioral therapy. However, significant gaps persist regarding standardized screening protocols, biomarker validation, and targeted intervention pathways for high-risk populations. Future management is likely to require more individualized risk assessment and intervention selection. Biomarker-based risk prediction, artificial intelligence-assisted intervention decision-making, and the deep integration of digital therapeutics such as virtual reality with existing enhanced recovery pathways will be key directions for improving patient outcomes and recovery quality. This structured narrative review summarizes current evidence on perioperative anxiety in adults, focusing on epidemiology, pathophysiological mechanisms, assessment tools, biomarkers, and multimodal management strategies. Full article

Background: Resistant arterial hypertension (RAH) is a heterogeneous cardiovascular condition influenced by biological, behavioral, psychosocial, and neuroendocrine mechanisms. Within emerging precision medicine frameworks, psychobehavioral assessment may contribute to a more individualized characterization of patients with RAH and help identify modifiable dimensions associated with therapeutic resistance. This study evaluated the feasibility and preliminary outcomes of a brief psychobehavioral intervention in patients with RAH. Methods: This feasibility-oriented exploratory pre–post pilot study included 20 adults with RAH recruited from a tertiary outpatient clinic specialized in resistant hypertension. Participants underwent psychobehavioral assessment using the Hospital Anxiety and Depression Scale (HADS). Individuals presenting clinically significant anxiety and/or depressive symptoms (scores ≥ 8) received an individualized semi-structured brief cognitive–behavioral therapy (CBT) intervention consisting of 8–9 weekly sessions. Feasibility indicators included intervention adherence, completion of the protocol, operational flexibility, and absence of symptom worsening. Pre- and post-intervention emotional symptoms were compared using nonparametric analyses. Results: High baseline emotional burden was observed, with 90% of participants presenting anxiety symptoms and 60% depressive symptoms. Following the intervention, reductions in anxiety [median 11 (IQR 8–13) vs. 6 (4–8); p < 0.001] and depressive symptoms [10 (8–11) vs. 5 (3–8); p < 0.001] were identified. No worsening of symptoms occurred. The intervention demonstrated satisfactory feasibility and acceptability, including flexibility for remote and in-person delivery. Conclusions: These preliminary findings suggest that psychobehavioral phenotyping combined with individualized brief CBT may represent a feasible complementary strategy within precision-oriented cardiovascular care for resistant hypertension. Although causal inference cannot be established due to the pilot design and absence of a control group, the findings support further investigation of psychobehavioral dimensions as potentially relevant components of personalized hypertension management. Full article

Background: People living with HIV (PLWH) are increasingly reaching older ages due to the success of antiretroviral therapy. However, aging with HIV is associated with increased risk of multimorbidity, neurocognitive impairment, frailty, psychosocial stress, and functional decline. Multidomain geriatric screening framed within an Age-Friendly 4Ms Framework (Mentation, Medication, Mobility, What Matters Most) and consideration of multi-complexity may help identify aging-related vulnerabilities and guide multidisciplinary care with greater impact on patient outcomes. However, real-world implementation of such programs within HIV clinical settings remains limited. Methods: We conducted a retrospective analysis of adults aged ≥50 years enrolled in a multidisciplinary Healthy Aging Program within a large, integrated HIV care system. Multidomain screening assessments included cognitive evaluation (Montreal Cognitive Assessment), mental health screening (PHQ-2, GAD-2), functional assessment (Katz ADL, Lawton IADL), frailty screening (Edmonton Frail Scale), and intrinsic capacity domains using the WHO Integrated Care for Older People (ICOPE) framework. Screening results, referrals, clinical interventions, and cardiometabolic risk management measures were extracted from clinical program databases and electronic medical records. Results: A total of 317 adults aged ≥50 years completed multidomain screening. Participants had well-controlled HIV infection, with viral suppression in 96.2% and a median CD4 count of 660 cells/mm³. Despite this, aging-related vulnerabilities were common. Overall, 78.4% of participants had at least one abnormal screening domain. Cognitive impairment was identified in nearly half of individuals screened, including mild impairment in 39.8% and moderate impairment in 8.7%. Functional limitations were identified in 10.1% of participants, while anxiety symptoms were present in 9.5%. Sensory impairments were common, including vision impairment in 36.5% of participants. Polypharmacy was prevalent, with 33.2% of participants prescribed five or more chronic medications. Screening frequently generated multidisciplinary referrals, including behavioral health services (42.3%), social work support (42.9%), and pharmacist-led cardiometabolic risk review (56.8%). Age-stratified analyses demonstrated similar prevalence of screening abnormalities across age groups, including individuals aged 50–59 years. Modest improvements in cardiometabolic preventive care were observed during follow-up. Statin utilization increased from 65.6% at baseline to 70.0% at 12 months, and LDL cholesterol declined modestly during the observation period. Conclusions: Multidomain screening integrated into routine HIV care identified a high prevalence of aging-related vulnerabilities among PLWH aged ≥50 years despite excellent virologic control. These findings suggest that aging-related risk in HIV is not adequately captured by chronological age alone and support early, universal implementation of multidomain screening within HIV care models. Full article

Objective: This study aimed to compare the effectiveness of online cognitive behavioral therapy (CBT) delivered by an AI chatbot versus human peer counselors (participants were told it was AI) in reducing anxiety symptoms in young adults. Methods: Ninety young adults with mild-to-severe anxiety were randomized to a 4-week intervention of AI-CBT (n = 30), peer-counselor-CBT (n = 30), or a no-intervention control (n = 30). The primary outcome, anxiety, was assessed at baseline, mid-point, and post-intervention. Secondary outcomes (the self-efficacy for exercise, sleep quality), psychotherapy benefit, and qualitative user experiences were also evaluated. Results: Both AI and human-delivered interventions led to significant within-group reductions in anxiety (p < 0.05). However, in the primary intention-to-treat analysis, neither intervention demonstrated a statistically significant advantage over the no-intervention control group at post-intervention. A secondary per-protocol analysis suggested a benefit for the human-delivered intervention among study completers. Notably, participants in the AI group reported significantly lower perceived treatment benefit than the human group (p < 0.001). Qualitative analyses indicated that while AI was valued for accessibility and consistency, human intervention was perceived as more flexible in guidance, individualized, emotionally supportive, and conducive to deeper exploration. Conclusions: In this exploratory trial, both AI- and peer-counselor-CBT showed within-group promise, but the evidence does not support their efficacy over a no-intervention control. The AI’s limitations in providing flexible, emotionally supportive, and personalized interaction likely explain the efficacy gap observed between the two interventions. While AI may serve as a scalable support tool, claims of clinical efficacy require significant caution. These preliminary findings warrant replication in a prospectively registered confirmatory trial. Full article

Background/Objectives: Burning mouth syndrome (BMS) is a chronic idiopathic orofacial pain disorder characterized by persistent intraoral burning in the absence of detectable mucosal alterations. Diagnosis is challenging due to the lack of specific biomarkers and the need to exclude numerous systemic and local conditions that can mimic oral burning. This literature review aims to summarize current and emerging therapeutic strategies for BMS. Methods: A structured and filtered search of PubMed, Scopus, and Web of Science identified studies evaluating pharmacological, phytotherapeutic, and non-pharmacological interventions. Results: Various antidepressants, anticonvulsants, benzodiazepines, H2 receptor antagonists, and low-dose naltrexone have demonstrated varying degrees of symptom reduction, while alpha lipoic acid (ALA) and phytomedicines such as capsaicin, Hypericum perforatum, Catuama, lycopene, crocin, and melatonin show mixed clinical benefits. Non-pharmacological approaches, including photobiomodulation (PBM), oral cryotherapy, neuromodulation techniques, and cognitive behavioral therapy, also provide meaningful symptom improvement in many patients. Conclusions: Across all modalities, therapeutic responses remain heterogeneous and generally incomplete, underscoring the absence of a universally effective treatment. Current evidence supports an individualized and multidisciplinary approach that integrates pharmacological, psychological, and adjunctive therapies to address the multifactorial nature of BMS. Full article

Background/Objectives: Intimate partner abuse (IPA) is common among university students, including nursing students, and is linked to posttraumatic stress symptoms. Accessible online psychosocial interventions are needed to reduce trauma-related symptoms and support posttraumatic growth (PTG). This study examined the effects of an online psychosocial intervention grounded in social learning theory and cognitive behavioral therapy on posttraumatic stress symptoms and PTG among nursing students who experienced IPA in Türkiye. Methods: A randomized controlled trial was conducted among nursing students in Türkiye reporting IPA exposure. Participants were randomly assigned to an intervention group (n = 17) or a control group (n = 18). The intervention group received an eight-session online psychosocial program delivered individually. Assessments were conducted at pre-intervention, post-intervention, and at 1-, 3-, and 6-month follow-ups. Repeated-measures ANOVA was used, and partial eta-squared (ηp²) values were calculated. Results: The intervention group showed significant reductions in posttraumatic stress symptoms compared with the control group, with large effect sizes (p < 0.001; ηp² = 0.402–0.676). Furthermore, significant increases were observed in posttraumatic growth, indicating large and sustained effects over time (p < 0.001; ηp² = 0.515–0.773). Conclusions: The online psychosocial intervention effectively reduced posttraumatic stress symptoms and enhanced posttraumatic growth among nursing students who experienced IPA. However, results should be interpreted with caution due to the small sample size, and future studies with larger samples are warranted. Full article

Hybrid cognitive behavioral therapy (CBT), combining group and individual sessions, for treating obsessive–compulsive disorder (OCD) has rarely been examined in routine clinical practice. This prospective observational study preliminarily evaluated the feasibility and acceptability of a hybrid CBT program implemented in Japan. The program consisted of one pre-treatment individual session, eight group sessions, and one post-treatment individual session. Feasibility and acceptability were assessed using dropout rates and written questionnaire feedback. Twenty-eight individuals (mean age = 36.1 ± 14.0 years) participated, with two dropouts. Seven participants reported that the program duration was too short, whereas the remaining participants considered it appropriate. Nineteen participants indicated their willingness to participate in a similar program. Open-ended feedback highlighted the importance of group composition and program content. Self-Rating Yale–Brown Obsessive Compulsive Scale scores decreased at Session 8 (estimate = −2.74, p = 0.002) and post-treatment (estimate = −4.16, p < 0.001) according to a linear mixed-effects model. Reductions were also observed in Sheehan Disability Scale, State–Trait Anxiety Inventory, and Clinical Global Impressions Scale scores, whereas Center for Epidemiologic Studies Depression Scale scores showed no significant change. These findings suggest the feasibility and acceptability of the program and may inform future program development. Full article

Substance use disorder (SUD) is a global problem with serious psychological, physiological, and social consequences. Seeking professional help is often delayed due to a lack of self-recognition of addiction, frequently sustained by self-deception. Although self-deception is a core feature of SUD, the mechanisms underlying it remain insufficiently studied. This research examines the role of impulsivity and self-efficacy in predicting self-deceptive behaviors—manipulation and mystification—in individuals undergoing addiction rehabilitation. The sample consisted of 122 Spanish participants from therapeutic communities (Mage = 44.99, SD = 10.58; 82.8% male) who completed the Self-Deception Questionnaire (SDQ-12), the Impulsive Control Scale Ramón y Cajal (ECIRyC), and the Drug Taking Confidence Questionnaire (DTCQ). Results showed that impulsivity significantly predicted both manipulation and mystification. Manipulation was also associated with self-efficacy in managing temptation and duration of addiction, highlighting its multifaceted nature. In contrast, mystification was predicted solely by impulsivity, suggesting a stronger dependence on internal psychological processes rather than contextual factors. These findings underscore the importance of targeting impulsivity and enhancing self-efficacy in addiction treatment. Interventions such as Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and mindfulness-based approaches may be particularly effective in reducing self-deceptive behaviors and supporting long-term recovery. Full article

Parkinson disease (PD) and mood disorders represent two substantial global health burdens that increasingly co-occur as both conditions rise in prevalence worldwide. Diagnosing Parkinson disease in patients with pre-existing mood disorders is clinically challenging due to overlapping symptoms, medication effects, and shared neurobiological mechanisms. Apathy, psychomotor slowing, and fatigue may mimic depressive symptoms, leading to delayed recognition of early parkinsonism. Development of an underlying neurodegenerative disorder could account for some treatment-resistant symptoms or treatment failures if not recognized. Therefore, the identification of PD will change the treatment and management plan significantly. Accurate diagnosis of PD requires a detailed neurologic examination focusing on bradykinesia, rigidity, and resting tremor, supported when appropriate by dopamine transporter imaging (DaT scan) or other emerging biomarkers. Understanding the temporal relationship between psychiatric and motor features helps differentiate prodromal PD from primary mood disorders. Management of patients with both mood disorders and PD integrates dopaminergic replacement therapy for motor symptoms with individualized treatment of psychiatric comorbidities. Levodopa remains the cornerstone for motor control, while dopamine agonists, MAO-B inhibitors, and COMT inhibitors can be added as needed. For depression and anxiety, SSRIs and SNRIs are first-line choices; quetiapine or clozapine are preferred when treatment for psychosis is necessary. Intentional, thoughtful polypharmacy is frequently required. Non-pharmacologic interventions—including cognitive behavioral therapy, structured exercise, and patient–caregiver education—enhance mood, function, and quality of life. Multidisciplinary collaboration between neurology, psychiatry, and allied health professionals is essential for optimal outcomes. This review offers guidance to healthcare providers as well as other interested parties involved in patients with mood disorders who may also be developing or have PD, especially to those who may have limited access to neurologic resources. Full article

Despite decades of research, suicide risk factors predict outcomes at chance levels, and there is a dearth of protective factor and resilience research, which limits the utility of risk-based approaches. Further, suicide prevention interventions primarily consist of individual psychotherapies and treating individuals after suicide-related outcomes occur. Unfortunately, there is a lack of upstream suicide prevention interventions targeting known suicide risk factors and aiming to increase well-being and resilience in the U.S. Thus, we discuss these problems in the field and the U.S. health care system and provide a possible solution. We propose using low-intensity, universal, and upstream prevention interventions, such as Stress Control. Stress Control is a classroom-style, Cognitive Behavior Therapy-based program shown to reduce “risk,” stress, anxiety, and depression and boost well-being and resilience as part of a stepped-care model. Although Stress Control’s suicide prevention effectiveness has not yet been directly assessed, we discuss how it could be a promising suicide prevention strategy with additional testing. A proposed mechanism for this reduction is building resilience to common risk factors and suicide ideation via evidence-based coping skills, thereby decreasing future suicide risk. We review current limitations and discuss how upstream, scalable, universal prevention interventions can help improve psychological resilience and reduce suicidal thoughts and behaviors, lowering the U.S. suicide rate. Implications and recommendations are discussed. Full article

The rise in ICU survival rates has introduced new challenges related to the long-term effects of intensive care, known as Post-Intensive Care Syndrome (PICS). Nurses play a key role in these clinics; however, the nature and outcomes of their interventions remain insufficiently understood. Objectives: This review aims to identify nursing interventions for PICS in follow-up clinics. Methods: Using the JBI scoping review methodology, we searched PubMed, Web of Science and CINAHL (via EBSCOhost) in March 2025, and examined grey literature in RCAAP and Open Dissertations (through B-ON). Inclusion criteria, based on JBI’s PCC (Population, Concept, Context), focused on nursing interventions for PICS for patients and families in follow-up. Studies involving children, adolescents, pregnant women, and those receiving end-of-life care were excluded. Results: Encompassing studies from 2005 to 2022 across multiple countries, this review highlights nursing interventions for post-ICU recovery. A total of 394 articles that met our search criteria were found, resulting from searches in the mentioned databases. These were initially exported to Rayyan, and 115 duplicates were removed. The 21 articles that met our inclusion criteria were fully analyzed, and those that effectively answered our questions and met our inclusion criteria were selected. In the end, 9 articles were selected, to which, after an individual analysis of their bibliographic references, 3 more were added, totaling 12 articles submitted to the final analysis. Conclusions: For patients, interventions ranged from debriefing, PICS symptom evaluation, ICU re-visits, health education, cognitive–behavioral therapy and support groups, complemented by home-based physical rehabilitation and virtual reality. Family-focused interventions centered on appointment involvement, educational sessions, patient diary review, and emotional support. These assessments and interventions address the consequences of ICU admission, with the goal of facilitating physical, mental, and emotional rehabilitation of ICU survivors. This review emphasizes the critical role of follow-up consultations in the recovery of both patients and families. A comprehensive assessment using PICS scales and the integration of families into care plans are crucial for optimizing intervention outcomes. Implications for Clinical Practice: The development of evidence-based guidelines for implementation of follow-up clinics for SPICI appointments is necessary. Full article

This narrative review integrates longitudinal cohort studies, neuroimaging and biomarker research, and major clinical trials to examine how depression and cognitive decline interact across the dementia continuum. Depression and cognitive impairment frequently co-occur in late life and exhibit substantial clinical and biological overlap. Meta-analytic and large population-based cohort studies consistently show that late-life depression increases the risk of mild cognitive impairment and dementia, with stronger associations observed for vascular dementia than for Alzheimer’s disease. Neurobiological studies implicate cerebrovascular pathology, neuroinflammation, hypothalamic–pituitary–adrenal axis dysregulation, and fronto-subcortical circuit dysfunction as key mechanisms linking depressive symptoms to later cognitive decline. In a subset of older adults, new-onset depression—particularly when accompanied by executive dysfunction, subjective cognitive decline, or high white-matter hyperintensity burden—are associated with an increased likelihood of near-term cognitive decline and dementia, although evidence for a definitive prodromal state remains limited. Depression is also highly prevalent as part of the behavioral and psychological symptoms of dementia, occurring in 30–50% of individuals with Alzheimer’s disease and even higher proportions in dementia with Lewy bodies or frontotemporal dementia. Comorbid depression in dementia accelerates cognitive and functional decline, increases neuropsychiatric burden, and worsens quality of life for patients and caregivers. Therapeutically, antidepressant treatment may confer modest benefits on mood and selected cognitive domains (e.g., processing speed and executive function) in non-demented older adults, whereas in established dementia, antidepressant efficacy is limited. In contrast, cholinesterase inhibitors, memantine, and multimodal non-pharmacological interventions yield small but measurable improvements in depressive or apathy-related symptoms. Emerging disease-modifying therapies for Alzheimer’s disease have demonstrated cognitive benefits, but current trial data provide insufficient evidence regarding effects on depressive symptoms, highlighting an important gap for future research. These findings underscore the need for stage-specific, integrative strategies to address the intertwined trajectories of mood and cognition in aging. Full article

Background/Objectives: Chemsex is defined as the intentional use of psychoactive substances to enhance or prolong sexual activity, predominantly observed among men who have sex with men. It has emerged as a notable behavioral and public health concern due to its association with high-risk sexual practices, psychiatric morbidity, and somatic complications. Despite increasing recognition, global prevalence estimates vary widely (3–52.5%) due to differences in study populations and methodology. Commonly used substances include synthetic cathinones, amphetamines/methamphetamines, MDMA, GHB/GBL, ketamine, alkyl nitrites, and PDE-5 inhibitors. Methods: A narrative review was conducted using PubMed through 11 December 2025. Search terms combined chemsex-related terminology, substance names, and health outcomes. Recent English-language publications (2020–2025) were prioritized. Evidence was synthesized thematically across epidemiology, health complications, motivations, and interventions. Results: Chemsex is strongly associated with unprotected sex, multipartner encounters, and prolonged intercourse, leading to significantly increased rates of HIV, syphilis, gonorrhoea, and chlamydia. Psychiatric complications include depression, anxiety, compulsive sexual behavior, and psychosis, with higher risks in individuals engaging in slamming or polysubstance use. Somatic complications vary by substance and include cardiovascular disease, hyponatremia, rhabdomyolysis, ulcerative cystitis, methemoglobinemia, and overdose. Motivational factors extend beyond sexual enhancement and include minority stress, internalized and externalized stigma, and maladaptive coping mechanisms. Integrated interventions combining harm reduction, cognitive–behavioral therapy, peer-led services, and pharmacotherapy, alongside digital health tools to support PrEP adherence and risk reduction, show promise in mitigating these harms. Conclusions: Chemsex represents a complex interplay of biological, psychological, and sociocultural factors that contribute to elevated STI risk and psychiatric and somatic morbidity. Addressing chemsex requires destigmatized, multidisciplinary approaches that integrate behavioral, pharmacological, and community-based interventions. Digital health innovations can further enhance engagement, risk reduction, and access to timely care. Full article

Background/Objectives: Tinnitus affects various aspects of health, yet its impact on occupational functioning remains less well explored. This study investigated the impact of tinnitus on work productivity, the role of comorbidities of anxiety, depression, and quality of life, and explored whether an evidence-based intervention may potentially influence workplace functioning. Methods: The study used cross-sectional and longitudinal data and employed mixed methods design to enable comparing work productivity before and after undertaking ICBT for tinnitus. Data were collected from 449 participants (64% employed; mean age of 54.4 years) who were seeking to enroll in an internet-based psychological intervention. Of these, 200 also completed an internet-based cognitive behavioral therapy intervention (ICBT). Data were analyzed using descriptive statistics, analysis of variance, qualitative content analysis and comparisons made between those whose work was unaffected due to tinnitus and those who worked less. Results: Pre-intervention, 81% reported no change in work patterns. Because of tinnitus 11% worked fewer hours, 7% had stopped working, and 1% received disability allowance. Participants were significantly less effective in their work capacity prior to undertaking the intervention compared to post-intervention and at follow-up; for the overall sample and post-intervention improvements were observed in tinnitus distress, anxiety, depression, and insomnia. There was significant time difference between group interactions for tinnitus, anxiety and insomnia but not for depression and quality of life when comparing those working and not working. Qualitative findings highlighted challenges related to attention, fatigue, and communication, as well as coping strategies and role modifications. Conclusions: Further studies are required to build on this exploratory research. The present findings underscore the need for workplace policies recognizing tinnitus as a potential disability and providing reasonable accommodation and options to access tinnitus interventions. Clinical interventions should also consider how to improve workplace functioning in individuals with bothersome tinnitus. Future research should explore ways to address cognitive load and enhance productivity. Full article