Search Results (166)

Depression, anxiety disorders and sleep disorders are becoming increasingly prevalent among college students. While psychotherapy and pharmacotherapy remain important interventions, their practical implementation in university settings may be constrained by factors including limited service accessibility, scheduling constraints, privacy concerns, stigma, and poor long-term adherence. As a low-threshold supportive intervention that can be readily integrated into campus environments, art healing offers a complementary approach to promoting college student mental health. This review includes 20 studies retrieved from the Web of Science and PubMed databases. These studies provide evidence for the mental health benefits of auditory art, visual art, and integrated art healing. The findings indicate that music-based interventions (the primary form of auditory art) have relatively robust supporting evidence for alleviating stress and anxiety; visual art and integrative art healing also yield measurable positive mental health outcomes. However, existing research is limited by heterogeneous intervention delivery protocols, small sample sizes, short follow-up periods, and substantial variation in methodological quality. Current evidence supports art healing as a complementary strategy for mental health promotion in higher education settings, rather than an alternative treatment modality. Future work should test standardized protocols in multi-site student samples. Long-term follow-up designs to further clarify its target populations, underlying mechanisms, and sustained efficacy. Full article

This article proposes a general integrative model focusing on psychological control and psychological reserve. The former refers to internal psychological control and external psychological control. Internal psychological control refers to the management of physiological processes associated with arousal and panics. Here, the concept of internal psychological control is differentiated into two components: cognitive control/executive function and self-control/emotional regulation. External psychological control refers to the sense the person has of being able to manage, have agency in, and otherwise not be overwhelmed by the external context in which one is adapting functionally. Here, the concept of external psychological control is differentiated into two major sub-components: managing reactivity to external events, such as to daily stressors or extreme events, e.g., natural disasters, and proactively taking steps to have agency in and using predictive processing to adjust to context by mitigating the probability of experiencing overwhelming events. Psychological reserve refers to the fluid state reservoir of mental, cognitive, emotional, motivational, and stress management/coping space that is available for use in confronting ongoing and new stressors, challenges, or difficulties. Here, this article differentiates psychological reserve into phases of depletion and recovery. This article examines prior work on psychological control and reserve, demonstrating how they can be understood or modified based on the present sub-component differentiation of the concepts involved. The revised model is applied to understanding psychotherapeutic change mechanisms, a biopsychosocial model of the mechanisms, an integrated functional adaptational model, posttraumatic stress disorder, a unified model for psychotherapy and psychology generally, and clinical recommendations. Full article

Background: Depression and anxiety disorders remain among the leading contributors to global disability and represent a major public health challenge. Although evidence-based psychotherapies are available, access to treatment remains limited due to structural, economic, geographical, and workforce-related barriers. Digital mental health interventions have emerged as scalable approaches to reducing this treatment gap, with artificial intelligence (AI)-guided cognitive behavioral therapy (CBT) representing a rapidly developing and clinically relevant extension of digital psychotherapy. Objective: This review aims to synthesize current evidence on digital and AI-guided CBT interventions for depression and anxiety, with a focus on clinical utility, scalability, mechanisms of change, safety considerations, and public health relevance. In addition, the review proposes a clinically oriented conceptual framework for understanding the role of AI-guided CBT within contemporary digital psychiatry. Methods: A focused narrative review was conducted using PubMed, Scopus, and Google Scholar databases, covering publications from 2010 to 2025. Relevant peer-reviewed studies, systematic reviews, meta-analyses, and conceptual papers addressing digital CBT, AI-assisted CBT, conversational agents, symptom monitoring, and digital mental health implementation were identified and analyzed qualitatively. Results: Existing evidence suggests that internet-delivered CBT, mobile applications, and AI-based conversational agents may reduce depressive and anxiety symptoms, particularly in individuals with mild to moderate conditions. However, the evidence base remains heterogeneous, with limitations including short follow-up periods, variability in intervention quality, reliance on self-reported outcomes, and insufficient data on long-term effectiveness, safety, and real-world implementation. Emerging concepts such as digital therapeutic alliance, continuous symptom monitoring, adaptive intervention delivery, and AI-driven personalization may represent key factors influencing engagement and clinical outcomes. Conclusions: AI-guided CBT represents a promising but still evolving component of modern mental health care. These technologies have the potential to improve accessibility, optimize resource allocation, and support stepped-care and hybrid models of treatment. Future research should prioritize rigorous clinical validation, long-term outcome evaluation, transparent safety protocols, ethical governance, and integration into real-world health systems. AI-guided CBT should not be understood as a replacement for clinicians, but as a complementary and scalable extension of evidence-based psychotherapy. Full article

Major depressive disorder (MDD) is a prevalent psychiatric disorder in which epigenetic mechanisms, particularly DNA methylation (DNAm), may contribute to disease vulnerability and treatment response. Epigenome-wide association studies (EWAS) have increasingly investigated longitudinal methylomic changes associated with therapeutic interventions in depression; however, methodological heterogeneity limits comparability across studies. This critical review examined the methodologies and findings of longitudinal EWAS evaluating DNAm changes related to treatment response in MDD and treatment-resistant depression (TRD). A literature search identified seven studies published up to 20 June 2026. Six studies investigated non-pharmacological interventions, including electroconvulsive therapy, trauma-focused psychotherapy, and cognitive interventions, and one study explored pharmacotherapy. Considerable heterogeneity was observed regarding sample size, biospecimen type, methylation platforms, preprocessing pipelines, covariate adjustment, statistical modeling, and longitudinal sampling schedules. Most studies used Illumina EPIC array-based workflows and mixed-model analytical approaches, while one study employed sequencing-based methylation profiling. Overall, treatment-related methylation changes were modest and often limited to specific CpG sites or differentially methylated regions associated with immune, inflammatory, stress-related, and neurobiological pathways. Current evidence supports the feasibility of longitudinal EWAS approaches in depression research but highlights the need for larger cohorts, methodological standardization, and integration with multi-omics and clinical data to improve reproducibility and biomarker discovery. Full article

Narrative psychotherapy focuses on jointly discussing life stories with patients to promote shifts in sense of self and narrative identity. Narrative approaches have roots in constructivism which requires various elements or cognitive processes necessary for meaning making, such as the discussion of thoughts and feelings, how thoughts and feeling change over time, and how the patient’s construction of meaning contributes to their sense of self and place in the world. Narrative psychotherapy may have unique elements that promote recovery for people with psychosis. For instance, narrative approaches may help to integrate narratives that are fragmented or focused on illness identity, though the research is limited. The current study is a narrative review that aims to (1) discuss current theoretical and research findings related to narratives and narrative identity in people with psychosis; (2) identify and describe psychotherapy approaches that focus on narratives. We summarize recent findings that highlight positive outcomes for people experiencing psychosis, and how people move towards more integrated and complex narratives. We found a range of therapeutic approaches that focus on narratives including metacognitive therapy (i.e., metacognitive reflection and insight therapy), trauma-based psychotherapy (i.e., trauma-focused cognitive-behavioral therapy for psychosis and narrative enhancement therapy), treatment focused on self-stigma or illness identity (i.e., narrative enhancement and cognitive therapy and self-concept and engagement and life), and art and creative therapies. We discuss interpretation of findings and their implication for mechanisms of change. Full article

Fear is a transdiagnostic construct implicated in multiple psychiatric disorders, reflecting a partial dissociation between clinical phenotypes and underlying neurobiological mechanisms. Converging evidence suggests that aberrant fear processing plays a central role in cognitive and psychopathological models of psychosis. In this narrative review, we synthesize evidence on the neurobiological mechanisms of aberrant fear modulation in schizophrenia from a translational perspective, integrating findings from neuroimaging, preclinical models, pharmacological interventions, and psychotherapy. Schizophrenia is characterized by aberrant emotional processing and inappropriate neural responses to stimuli with reduced or absent objective salience, reflecting impaired discrimination of relevant environmental information. At the system level, evidence implicates dysregulation of cortico-limbic and salience-processing networks in altered fear learning, threat appraisal, and emotional prediction. Neurochemical findings indicate that dopamine–glutamate dysregulation and associated intracellular signaling pathways act as upstream modulatory mechanisms contributing to these network-level abnormalities. Therapeutic interventions, including antipsychotic drugs and psychotherapeutic approaches, partially modulate these systems, although effects remain heterogeneous. Overall, the evidence supports a hierarchical model in which aberrant fear processing in schizophrenia arises from disrupted salience attribution and impaired integration across cognitive, affective, and neurobiological levels. This intermediate dysfunction links molecular alterations to large-scale network disturbances and clinical symptom expression, providing a framework for more mechanism-based therapeutic strategies. Full article

Background/Objectives: Survivors of sexual violence and domestic violence/intimate partner violence (IPV) often require support beyond the immediate emergency encounter; however, post-acute care remains inconsistently defined, unevenly organised or conceptualised, and fragmented across service systems. This scoping review mapped international post-acute follow-up, care, assistance, and support pathways, with particular attention to organisational models, continuity mechanisms, loss to follow-up after first access, and implications for the Italian context. Methods: We conducted an international health-services scoping review of post-acute follow-up, care, assistance, and support interventions for survivors of sexual violence and domestic violence/IPV. Searches were performed in PubMed/MEDLINE, Scopus, Web of Science Core Collection, Embase, APA PsycINFO via EBSCOhost, and CINAHL via EBSCOhost. Eligible studies were published from 2013 onward and had to describe an identifiable post-acute component beyond the initial emergency, forensic, or first-contact phase. The review followed a Population–Concept–Context framework and was reported in accordance with PRISMA-ScR. Results: Forty-four studies were included in the core synthesis, comprising 16 studies on sexual violence/sexual assault, 27 on domestic violence/IPV, and one mixed domestic, family, and sexual violence outreach model. The sexual violence literature clustered around early trauma-focused interventions, sexual assault care centre pathways, medical follow-up, follow-up attendance, and digital continuity tools. The IPV literature was broader and included psychotherapy, advocacy and case-management models, housing-first and trauma-informed stabilisation approaches, nurse-led and clinic-based services, outreach and safety-contact programmes, digital interventions, and programmes for system-involved survivors. Across both fields, the pathways most consistently described as supporting continuity combined structured re-contact, coordinated support, and multi-component responses over time. Conclusions: The mapped literature supports conceptualising post-acute responses to sexual violence and domestic violence/IPV as continuity pathways that extend beyond first contact and link healthcare, psychological, advocacy, and social supports. Systems may be better positioned to support continuity when they provide structured follow-up, warm handoffs, coordinated navigation, and context-sensitive recovery models. These findings point to provisional, evidence-informed organisational questions for strengthening post-acute pathways, including in Italy, particularly around structured re-contact, warm handoffs, survivor navigation, and integration between healthcare, anti-violence, psychological, and territorial social-support services. Full article

Extensive explorations in neuroscience, psychology, and psychotherapy increasingly recognized the embodied and relational foundations of selfhood, underscoring the need for an integrated framework spanning development, psychopathology, and therapeutic change. This narrative review synthesizes empirical and theoretical literature across neuroscience, embodiment research, predictive processing, developmental science, phenomenology, and psychodynamic theory, proposing a multidimensional neuropsychodynamic framework of embodied selfhood and its clinical implications. A central contribution is the positioning of Peripersonal Space (PPS) as an embodied action-oriented interface that functions as a primary developmental scaffold for bodily self-consciousness, self-other relations, affect regulation and temporal continuity. PPS is proposed as a dynamic matrix linking embodied predictive self-processes with relational experience, thereby shaping subjective temporality and autobiographical processes. Within this framework, subjective time emerges through bodily rhythms, interpersonal synchronization, and predictive engagement with environmental affordances. These embodied temporal processes gradually extend toward autobiographical continuity and mentalizing capacities, supported by coordinated interactions among large-scale brain networks. Psychodynamic concepts including holding, containment, dimensionality, and symbolic transformation are revisited in dialogue with contemporary embodied and relational neuroscience. Clinically, disturbances of selfhood across psychopathological conditions are discussed in relation to altered PPS organization, disturbances in self-evidencing, and embodied temporal continuity. Psychotherapeutic change is conceptualized as involving gradual reorganization across embodied, affective, and reflective dimensions through co-regulation, interpersonal attunement, and temporally extended relational engagement. Overall, this perspective advances a process-oriented and interdisciplinary framework linking embodiment, temporality, autobiographical integration, and psychotherapy, while highlighting directions for future interdisciplinary research at the interface of neuroscience, embodiment and psychodynamics. Full article

In this essay, hope is presented as a key driver of psychiatric and psychotherapy outcomes, helping clients move beyond symptom relief toward meaning, resilience, and flourishing. The text integrates goal-based models with relational, narrative, and cultural dimensions. Drawing on the “standard account,” the author proposes that hope is the interplay of wishing for a valued good, believing its attainment is possible (though difficult), and trusting internal and external resources, including the therapeutic alliance. A vignette of Susanne, a young woman with partial dissociative identity disorder, illustrates how psychoeducation and small wins increase belief, while a consistent therapeutic alliance builds trust that extends to self-trust and cooperation. Clinicians play a central role as “hope carriers,” shaping realistic goals, reinforcing progress, and avoiding false hope. Full article

Psychotherapy is an effective treatment for a wide range of mental disorders, yet treatment outcomes remain highly variable across patients. The emerging field of precision psychotherapy seeks to address this variability by tailoring interventions to the characteristics and needs of individual patients. Recent advances in artificial intelligence (AI) have accelerated this effort by enabling predictive models that identify patients at risk for treatment non-response and support personalized treatment selection. However, most current approaches to precision psychotherapy focus primarily on predicting outcomes or stratifying patients into subgroups, while offering limited tools for supporting clinical decision-making within the therapeutic process itself. This paper proposes that advancing precision psychotherapy may benefit from conceptual frameworks capable of representing therapeutic interactions as they unfold within clinical sessions. Psychotherapy is fundamentally a communicative process in which psychological change is understood to emerge through the evolving dialogue between therapist and patient. To help structure this process, we introduce a dimensional framework that conceptualizes mental activity as organized across five hierarchical dimensions: action, thought, emotion, experience, and being. These dimensions provide a structured representation of the forms in which psychological activity appears in therapeutic dialogue and may allow therapeutic interaction to be described as a sequence of dimensional transitions between therapist and patient. Such a representation could serve as a conceptual basis for the future development of computational tools aimed at analyzing therapeutic dialogue and identifying patterns that may be associated with therapeutic processes such as change, rupture, or shifts in interaction. Integrated with AI-based analysis of psychotherapy sessions, this framework may inform the design of systems intended to support the analysis of therapeutic processes, such as monitoring patterns of interaction or identifying potential shifts in patient experience, while preserving the central role of clinical judgment. By providing a formalized representation of therapeutic dialogue, this approach is intended as a conceptual and methodological step toward the development of more precise, process-informed approaches to psychotherapy. Full article

Background/Objectives: Limited data exist on care delivery, engagement, and clinical outcomes among rural populations accessing telehealth mental health services, particularly within integrated psychotherapy-and-psychiatry models. This retrospective observational 12-week cohort study aimed to examine access, engagement, and preliminary clinical outcomes for rural and non-rural patients receiving services through a national outpatient telehealth mental health program. Engagement and clinical outcomes were expected to be comparable among rural and non-rural patients. Methods: Descriptive and inferential analyses were conducted to examine access to care, engagement, and changes in depressive symptoms, anxiety symptoms, and suicidal ideation among rural and non-rural patients receiving telehealth mental health services over a 12-week treatment period. Clinical outcomes were evaluated using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7). The full sample included 8354 rural and 177,864 non-rural patients and was used to assess access and engagement in treatment. A clinical sample (rural n = 2096; non-rural n = 43,067) that included patients who completed 12 weeks of care was further examined to assess symptom improvement outcomes. Results: Rural patients demonstrated greater baseline symptom severity and medical complexity relative to non-rural patients. Mean time to first appointment was 5.2 days among rural patients and 5.5 days among non-rural patients, with comparable engagement across groups and rural patients averaging approximately 1–2 touch points per week in care. Patient satisfaction ratings averaged 4.9 out of 5. Within the clinical sample, rural patients demonstrated clinically meaningful symptom improvement across depression and anxiety outcomes. Mean PHQ-9 scores improved by 7.0 points (95% CI: 6.72–7.28), and mean GAD-7 scores improved by 6.1 points (95% CI: 5.83–6.37). Additionally, 70.5% of rural patients achieved a minimal clinically important difference in PHQ-9 or GAD-7 scores, and 66.7% of patients reporting suicidal ideation at baseline no longer endorsed suicidal ideation at endline. Conclusions: These findings support the feasibility and preliminary effectiveness of large-scale virtual mental health care models for rural populations. Rural patients demonstrated engagement and clinical outcomes comparable to non-rural patients despite greater baseline severity and medical complexity. Full article

Background/Objectives: Patients in palliative care frequently experience multidimensional suffering that extends beyond physical symptoms to include existential distress, demoralization, and loss of meaning. Psychedelic-assisted therapies (PAT), including ketamine-assisted psychotherapy (KAP), have re-emerged as promising interventions for these domains. This study aimed to provide a narrative overview and critical evaluation of the existing secondary literature on PAT in palliative care and serious illness and to examine the extent to which emerging best-practice recommendations are reflected in this literature. Methods: An overview of reviews with framework-based narrative synthesis was conducted, including narrative reviews, systematic reviews, scoping reviews, and meta-analyses addressing psychedelic-assisted interventions in patients with life-limiting illness. A comprehensive search of major databases was performed from inception to February 2026. Data extraction and narrative synthesis focused on clinical outcomes, safety, and the incorporation of key domains derived from recent interdisciplinary best-practice recommendations for PAT in palliative care. Results: Twenty-two reviews were included, synthesizing evidence primarily from early-phase clinical trials and observational studies, predominantly in oncology populations. Across reviews, PAT was consistently associated with reductions in depression, anxiety, and existential distress, along with improvements in quality of life and spiritual well-being. Safety profiles were generally favorable under controlled conditions. However, the incorporation of key therapeutic domains—such as preparation and integration, therapeutic setting, clinician training, and relational and biographical factors—was heterogeneous and often incomplete. Most reviews emphasized outcomes over process and context. Conclusions: The current body of secondary literature suggests potential application of PAT to address psychological and existential suffering in palliative care. However, the available evidence remains preliminary and is predominantly derived from small early-phase studies characterized by methodological heterogeneity, limited blinding, and highly selected populations. At the same time, the partial incorporation of emerging best-practice recommendations highlights a gap between evidence synthesis and normative clinical guidance. Full article

Background: Functional Neurological Disorder (FND) is a common and disabling condition at the interface of neurology and psychiatry, characterized by motor, sensory, seizure-like, or cognitive symptoms that are incongruent with recognized neurological disease but associated with substantial impairment. Despite its frequency and marked female predominance, FND remains underdiagnosed and often misunderstood. Methods: This narrative review synthesizes evidence from neurobiological, biomarker, and treatment studies, with attention to predictive coding, salience network dysfunction, impaired sense of agency, stress-related mechanisms, and sex- and gender-related vulnerability. Results: Current evidence supports a model of FND as a disorder of distributed brain network dysfunction involving abnormal interactions among salience, limbic, motor, and self-monitoring systems. Predictive coding and impaired agency models provide clinically useful frameworks for understanding symptom generation, although they remain mechanistic hypotheses rather than definitive causal explanations. Candidate biomarkers, including functional connectivity alterations, autonomic dysregulation, and HPA axis measures, offer pathophysiological insight but remain insufficiently validated for routine diagnosis. Female predominance likely reflects interacting biological, psychological, and sociocultural mechanisms rather than a single neuroendocrine pathway. Conclusions: This review contributes an integrated, clinically oriented framework linking neurobiology, biomarkers, sex/gender vulnerability, and treatment in FND. Current evidence supports multidisciplinary care combining diagnostic communication, specialized physiotherapy, psychotherapy, and coordinated follow-up, while future research should prioritize standardized phenotyping, longitudinal designs, and multimodal biomarker validation. Full article

This study conceptualizes the theological principle declared by the Apostle Paul in 2 Corinthians 12:9–10—“My power is made perfect in weakness” (ἡ γὰρ δύναμίς μου ἐν ἀσθενείᾳ τελεῖται)—as the Perfection in Weakness Paradox (PIW) and examines it through an integrative lens with contemporary third-wave psychotherapies. A Reformed theological exegesis of 2 Corinthians 12:9–10 identifies two foundational axes: sola gratia (grace alone) and the acknowledgment of weakness. The core mechanisms of Self-Compassion (Neff), Acceptance and Commitment Therapy (ACT; Hayes), Post-Traumatic Growth (PTG; Tedeschi and Calhoun), and Rumination-Focused Cognitive Behavioral Therapy (RFCBT; Watkins) are then analyzed for their systematic parallels with PIW’s theological structure—acceptance of weakness, dissolution of self-criticism, meaning-making through suffering, and transformation of rumination. The evidence-based framework of Spiritual Psychiatry is applied to examine the relationship between spiritual practices and mental health from neuroscientific and clinical perspectives. The central thesis is bidirectional: (1) the revelatory principle of 2 Corinthians provides theological foundations for the healing mechanisms of third-wave psychotherapies, and (2) the empirical evidence of these psychotherapeutic theories offers convergent support for and strengthens the theological interpretation of 2 Corinthians in a contemporary clinical context. This integrative framework proposes a new model for interdisciplinary dialogue between theology and psychiatry and discusses implications for clinical practice. Full article

Trauma-related autobiographical memories can manifest as involuntary, vivid, emotionally charged intrusions that perpetuate avoidance, negative emotions, and functional impairment. While these memories are central to post-traumatic stress disorder (PTSD), they also occur across diagnoses and are often reported in depressive disorders, including treatment-resistant depression (TRD). Although trauma-focused psychotherapies are effective, their routine implementation can be limited by dropout, residual symptoms, and difficulty engaging patients with severe depression, dissociation, or complex comorbidities. Intranasal esketamine is an approved rapid-acting treatment for TRD and has been hypothesized to create transient conditions that may facilitate psychotherapeutic work on traumatic memories. This narrative review synthesizes clinical and translational evidence on ketamine and esketamine for PTSD and trauma-related symptoms, with particular attention to the distinction between intravenous ketamine studies, intranasal esketamine data, and studies combining these compounds with psychotherapy. Currently, the most robust evidence in this area comes from three randomised trials of intravenous ketamine for PTSD. In contrast, data on intranasal esketamine and psychotherapy-combination approaches are mainly from pilot studies, retrospective analyses, or case reports. We additionally propose a pragmatic, feasibility-oriented protocol integrating intranasal esketamine with a structured traumatic-memory intervention for TRD patients with clinically relevant trauma-memory symptoms. The novelty of the proposal does not lie in claiming efficacy, but in specifying a standardised imagery rescripting module and predefining two timing hypotheses. The proposal targets patients with TRD with relevant trauma-memory symptoms, and it embeds the intervention within existing esketamine-care infrastructure. Overall, the available literature supports mechanistic plausibility and preliminary feasibility more than clinical efficacy. The evidence base remains small, heterogeneous, and largely uncontrolled, and controlled studies are needed before efficacy claims can be made. Full article