Line Caes,Aikaterini Christogianni,Tim G Hales,Lesley A Colvin
{"title":"The need for flexible, co-developed Adverse Childhood Experiences (ACEs) assessment: response to Chang & Su, Adverse Childhood Experiences (ACEs) in the Digital Era: An Urgent Call for Precision Assessment.","authors":"Line Caes,Aikaterini Christogianni,Tim G Hales,Lesley A Colvin","doi":"10.1159/000551662","DOIUrl":"https://doi.org/10.1159/000551662","url":null,"abstract":"","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"13 1","pages":"1-6"},"PeriodicalIF":22.8,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147490058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTIONThis study evaluated the effectiveness of a stepped-care approach - a staged model that escalates from lower- to higher-intensity treatments according to clinical response - for the treatment of adolescents and adults with ADHD, taking into account symptom severity and prior treatment response.METHODSIn a multicenter study, adolescents and adults with ADHD (16-45y) participated in a two-step treatment program including randomized controlled trials. Step1: Patients were (block-)randomized to 3 months of Psychoeducation (PE), Telephone-assisted self-help (TASH), or waiting control (WC). Step2: Based on Step1-response (full, partial, none), patients received either counseling or were randomized to counseling with/without neurofeedback (NF) or pharmacological treatment (with/without NF) for 6 months. The primary outcome was change in clinician-rated ADHD symptoms, analyzed using linear (mixed-)effects models for repeated measures to account for correlations within participants over time.RESULTSBetween 01/2015-09/2020, N=299 (mean age=28y, 55.2% male) patients were randomized in Step1. The primary outcome showed no significant between-group differences (PE vs. TASH: d=-0.12, 95%-CI [-3.18,1.19], p=0.64; PE vs. Control: d=-0.26, 95%-CI [-4.25,0.05], p=0.13; TASH vs. Control: d=-0.14, 95%-CI [-3.24,1.04], p=0.57). However, significant within-group effects emerged (PE: d=-0.60; TASH: d=-0.48; WC: d=-0.34; p<0.001). Step2 also showed no between-group differences but significant within-group effects (MPH: d=-0.59; MPH+NF: d=-0.76; counseling: d=-0.57/-1.35, p=0.01/p<0.001). Mixed-models revealed symptom reduction in all Step1 responders and Step1 non-responders in Step2.CONCLUSIONThe lack of Step1-RCT differences questions the specific effects of PE/TASH. Similar patterns emerged in Step2, but intensified treatment for Step1 non-responders improved outcomes in MPH groups. Step1 response influenced later treatment success. Some stepped-care combinations did not further reduce symptoms, but no rebound effects occurred. The main limitations of this study are the two-step design complexity, limited information on certain (additional) psychosocial components, and the need to make assumptions about missing data. Nevertheless, findings support the feasibility and partial effectiveness of a stepped-care approach.
本研究评估了阶梯式治疗方法的有效性，该方法是一种根据临床反应从低强度到高强度治疗的分阶段模型，考虑到症状严重程度和先前的治疗反应，用于治疗青少年和成人多动症。方法在一项多中心研究中，16-45岁的青少年和成人ADHD患者参与了包括随机对照试验在内的两步治疗方案。步骤1：患者被随机分为3个月的心理教育（PE）、电话辅助自助（TASH）或等待控制（WC）。Step2：根据Step1-response（完全，部分，无反应），患者接受咨询或随机分为有/没有神经反馈（NF）或药物治疗（有/没有NF）组，为期6个月。主要结果是临床评定的ADHD症状的变化，使用线性（混合）效应模型对重复测量进行分析，以解释参与者之间随时间的相关性。结果2015年1月- 2020年9月，Step1随机纳入N=299例患者（平均年龄28岁，男性55.2%）。主要终点组间无显著差异（PE vs. TASH: d=-0.12, 95% ci [-3.18,1.19], p=0.64; PE vs.对照组：d=-0.26, 95% ci [-4.25,0.05], p=0.13; TASH vs.对照组：d=-0.14, 95% ci [-3.24,1.04], p=0.57）。然而，出现了显著的组内效应（PE: d=-0.60; TASH: d=-0.48; WC: d=-0.34; p<0.001）。Step2也没有组间差异，但组内效应显著（MPH: d=-0.59; MPH+NF: d=-0.76；咨询：d=-0.57/-1.35, p=0.01/p<0.001）。混合模型显示所有Step1应答者和Step1无应答者在Step2中症状减轻。结论缺乏Step1-RCT差异对PE/TASH的特异性效果提出质疑。Step2中也出现了类似的模式，但Step1无应答者的强化治疗改善了MPH组的结果。Step1反应影响后期治疗成功。一些阶梯护理组合没有进一步减轻症状，但没有出现反弹效应。本研究的主要局限性是两步设计的复杂性，关于某些（额外的）社会心理成分的有限信息，以及需要对缺失的数据做出假设。然而，研究结果支持了分步治疗方法的可行性和部分有效性。
{"title":"Efficacy of a Stepped Care Approach for Adolescents and Adults with Attention-Deficit/Hyperactivity Disorder (ADHD): An Adaptive Intervention Study Including Randomized Controlled Trials (ESCAlate).","authors":"Toivo Zinnow,Wolfgang Retz,Anna Kaiser,Esther Sobanski,Daniel Brandeis,Roberto D Amelio,Sergyi Davydenko,Thomas Ethofer,Ann-Christine Ehlis,Andreas J Fallgatter,Samira Groß,Beate Krecklow,Petra Retz-Junginger,Peter Praus,Marcel Schulze,Johannes Thome,Sabina Millenet,Tobias Banaschewski,Alexandra Philipsen,Michael Rösler","doi":"10.1159/000551307","DOIUrl":"https://doi.org/10.1159/000551307","url":null,"abstract":"INTRODUCTIONThis study evaluated the effectiveness of a stepped-care approach - a staged model that escalates from lower- to higher-intensity treatments according to clinical response - for the treatment of adolescents and adults with ADHD, taking into account symptom severity and prior treatment response.METHODSIn a multicenter study, adolescents and adults with ADHD (16-45y) participated in a two-step treatment program including randomized controlled trials. Step1: Patients were (block-)randomized to 3 months of Psychoeducation (PE), Telephone-assisted self-help (TASH), or waiting control (WC). Step2: Based on Step1-response (full, partial, none), patients received either counseling or were randomized to counseling with/without neurofeedback (NF) or pharmacological treatment (with/without NF) for 6 months. The primary outcome was change in clinician-rated ADHD symptoms, analyzed using linear (mixed-)effects models for repeated measures to account for correlations within participants over time.RESULTSBetween 01/2015-09/2020, N=299 (mean age=28y, 55.2% male) patients were randomized in Step1. The primary outcome showed no significant between-group differences (PE vs. TASH: d=-0.12, 95%-CI [-3.18,1.19], p=0.64; PE vs. Control: d=-0.26, 95%-CI [-4.25,0.05], p=0.13; TASH vs. Control: d=-0.14, 95%-CI [-3.24,1.04], p=0.57). However, significant within-group effects emerged (PE: d=-0.60; TASH: d=-0.48; WC: d=-0.34; p<0.001). Step2 also showed no between-group differences but significant within-group effects (MPH: d=-0.59; MPH+NF: d=-0.76; counseling: d=-0.57/-1.35, p=0.01/p<0.001). Mixed-models revealed symptom reduction in all Step1 responders and Step1 non-responders in Step2.CONCLUSIONThe lack of Step1-RCT differences questions the specific effects of PE/TASH. Similar patterns emerged in Step2, but intensified treatment for Step1 non-responders improved outcomes in MPH groups. Step1 response influenced later treatment success. Some stepped-care combinations did not further reduce symptoms, but no rebound effects occurred. The main limitations of this study are the two-step design complexity, limited information on certain (additional) psychosocial components, and the need to make assumptions about missing data. Nevertheless, findings support the feasibility and partial effectiveness of a stepped-care approach.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"1 1","pages":"1-32"},"PeriodicalIF":22.8,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147490052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Methodological considerations, clinical implications, and future directions in individual participant data meta-analyses of psychotherapy for borderline personality disorder.","authors":"Johanne Pereira Ribeiro,Ole Jakob Storebø","doi":"10.1159/000551562","DOIUrl":"https://doi.org/10.1159/000551562","url":null,"abstract":"","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"85 1","pages":"1-7"},"PeriodicalIF":22.8,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147490057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joe Kwun Nam Chan,Ryan Cheuk Yin Li,Corine Sau Man Wong,Vanessa Ramesh Mahboobani,Kam Ming Ku,Wing Chung Chang
INTRODUCTIONBorderline-personality-disorder (BPD) research is scarce. This study quantified risks of physical-diseases and assessed mortality patterns in individuals with BPD.METHODSThis retrospective population-based cohort study investigated individuals with a first-recorded diagnosis of BPD in 2006-2021, utilizing a medical-record database of public-healthcare services in Hong-Kong. Individuals without mental-disorders attending primary-care-clinics in the study-period served as unexposed-comparison (i.e., PCC cohort). We estimated risks of physical-diseases and all-cause and cause-specific mortality using Cox-proportional hazards-regression models, and calculated excess life-years lost (LYLs).RESULTSThis analysis included 3092 patients with BPD and 902927 individuals in the PCC cohort. BPD was associated with increased risks of a wide-spectrum of physical-diseases, with the highest hazards-ratio (HR) for epilepsy (7.58 [95% confidence-intervals:5.33-10.79]). HRs for other physical-diseases ranged from 1- to 3-fold higher than the PCC cohort. Individuals with BPD experienced elevated risk of all-cause (5.65 [4.83-6.61]), natural-cause (2.02 [1.56-2.62]) and external-cause mortality (30.35 [23.52-39.17]), with suicide and cardiovascular-diseases as the leading-contributors. External-causes accounted for 40.4% of deaths in BPD, while natural-causes explained 37.3%. The excess-LYL for BPD was 13.01 years (9.35-15.52). The association between BPD and physical-diseases generally became statistically non-significant among males but remained significantly elevated among females. BPD-associated all-cause mortality risk was higher in females than males. Statistically-significant associations between BPD and physical-diseases were predominantly-observed in individuals with BPD-diagnoses at younger-ages.CONCLUSIONBPD is associated with increased risk of physical-diseases, excess-mortality and reduced life-expectancy. Suicide-prevention strategies and physical-health monitoring are urgently-warranted to reduce physical-health disparities and premature-mortality in BPD.
{"title":"Association of borderline personality disorder with physical diseases and mortality: a 16-year population-based electronic health-record cohort study in Hong Kong.","authors":"Joe Kwun Nam Chan,Ryan Cheuk Yin Li,Corine Sau Man Wong,Vanessa Ramesh Mahboobani,Kam Ming Ku,Wing Chung Chang","doi":"10.1159/000551534","DOIUrl":"https://doi.org/10.1159/000551534","url":null,"abstract":"INTRODUCTIONBorderline-personality-disorder (BPD) research is scarce. This study quantified risks of physical-diseases and assessed mortality patterns in individuals with BPD.METHODSThis retrospective population-based cohort study investigated individuals with a first-recorded diagnosis of BPD in 2006-2021, utilizing a medical-record database of public-healthcare services in Hong-Kong. Individuals without mental-disorders attending primary-care-clinics in the study-period served as unexposed-comparison (i.e., PCC cohort). We estimated risks of physical-diseases and all-cause and cause-specific mortality using Cox-proportional hazards-regression models, and calculated excess life-years lost (LYLs).RESULTSThis analysis included 3092 patients with BPD and 902927 individuals in the PCC cohort. BPD was associated with increased risks of a wide-spectrum of physical-diseases, with the highest hazards-ratio (HR) for epilepsy (7.58 [95% confidence-intervals:5.33-10.79]). HRs for other physical-diseases ranged from 1- to 3-fold higher than the PCC cohort. Individuals with BPD experienced elevated risk of all-cause (5.65 [4.83-6.61]), natural-cause (2.02 [1.56-2.62]) and external-cause mortality (30.35 [23.52-39.17]), with suicide and cardiovascular-diseases as the leading-contributors. External-causes accounted for 40.4% of deaths in BPD, while natural-causes explained 37.3%. The excess-LYL for BPD was 13.01 years (9.35-15.52). The association between BPD and physical-diseases generally became statistically non-significant among males but remained significantly elevated among females. BPD-associated all-cause mortality risk was higher in females than males. Statistically-significant associations between BPD and physical-diseases were predominantly-observed in individuals with BPD-diagnoses at younger-ages.CONCLUSIONBPD is associated with increased risk of physical-diseases, excess-mortality and reduced life-expectancy. Suicide-prevention strategies and physical-health monitoring are urgently-warranted to reduce physical-health disparities and premature-mortality in BPD.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"12 1","pages":"1-18"},"PeriodicalIF":22.8,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147471742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Future of Psychotherapy and Psychosomatics.","authors":"Stephan Zipfel","doi":"10.1159/000550766","DOIUrl":"https://doi.org/10.1159/000550766","url":null,"abstract":"","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"192 1","pages":"1-7"},"PeriodicalIF":22.8,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Before treatment begins: The dynamic landscape of interacting therapeutic mechanisms.","authors":"Sigal Zilcha-Mano","doi":"10.1159/000551420","DOIUrl":"https://doi.org/10.1159/000551420","url":null,"abstract":"","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"61 1","pages":"1-4"},"PeriodicalIF":22.8,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147393997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDBeck's cognitive theory posits that maladaptive beliefs causally drive depressive symptoms. Yet empirical support for the cognition-to-symptoms pathway is mixed, often due to sparse sampling, conflation of within- and between-person variance, and limited temporal modeling. We therefore aimed to address these limitations by testing reciprocal cognition-symptom dynamics in routine care using a more robust within-person longitudinal approach drawing on session-to-session assessments.METHODSAdults in Norwegian primary care receiving CBT-oriented treatment (baseline N=1,564; PHQ-9≥10) completed eight assessments across ≈16 weeks (PHQ-9; three-item negative self-beliefs measure). Primary analyses were observation-level Dynamic Panel Models (DPMs); residual-level models served as corroboration. We modeled nonlinearity and time trends, tested equality-over-time and varying intervals, and reported model-implied long-run effects.RESULTSSymptoms and negative self-beliefs declined nonlinearly. Time-lagged models supported reciprocity: lower negative self-beliefs predicted later symptom reductions, and lower symptoms predicted later belief change. In DPMs, a one-point improvement in negative self-beliefs forecast a long-run .46-point PHQ-9 reduction (95%CI .22-.70); a one-point PHQ-9 improvement forecast a .16-point belief change (95%CI .09-.22). Standardized long-run effects were .36 (cognition→symptoms; 95%CI .13-.42) and .21 (symptoms→cognition; 95%CI .12-.26); magnitudes did not differ (χ²(1)=1.77, p=.18). Findings were robust across specifications.CONCLUSIONSThis study provides credible longitudinal, within-person evidence in line with Beck's model: improvements in negative self-beliefs precede and accumulate into subsequent symptom relief, while symptoms also feed back on beliefs. As such, it fills an important empirical gap by demonstrating a robust cognition-to-symptoms pathway under rigorous temporal modeling.
{"title":"Dynamics of cognitions and symptoms during treatment: A prospective test of Beck's cognitive theory of depression.","authors":"Otto Robert Smith,Marit Knapstad,Leif Edvard Aarø","doi":"10.1159/000551172","DOIUrl":"https://doi.org/10.1159/000551172","url":null,"abstract":"BACKGROUNDBeck's cognitive theory posits that maladaptive beliefs causally drive depressive symptoms. Yet empirical support for the cognition-to-symptoms pathway is mixed, often due to sparse sampling, conflation of within- and between-person variance, and limited temporal modeling. We therefore aimed to address these limitations by testing reciprocal cognition-symptom dynamics in routine care using a more robust within-person longitudinal approach drawing on session-to-session assessments.METHODSAdults in Norwegian primary care receiving CBT-oriented treatment (baseline N=1,564; PHQ-9≥10) completed eight assessments across ≈16 weeks (PHQ-9; three-item negative self-beliefs measure). Primary analyses were observation-level Dynamic Panel Models (DPMs); residual-level models served as corroboration. We modeled nonlinearity and time trends, tested equality-over-time and varying intervals, and reported model-implied long-run effects.RESULTSSymptoms and negative self-beliefs declined nonlinearly. Time-lagged models supported reciprocity: lower negative self-beliefs predicted later symptom reductions, and lower symptoms predicted later belief change. In DPMs, a one-point improvement in negative self-beliefs forecast a long-run .46-point PHQ-9 reduction (95%CI .22-.70); a one-point PHQ-9 improvement forecast a .16-point belief change (95%CI .09-.22). Standardized long-run effects were .36 (cognition→symptoms; 95%CI .13-.42) and .21 (symptoms→cognition; 95%CI .12-.26); magnitudes did not differ (χ²(1)=1.77, p=.18). Findings were robust across specifications.CONCLUSIONSThis study provides credible longitudinal, within-person evidence in line with Beck's model: improvements in negative self-beliefs precede and accumulate into subsequent symptom relief, while symptoms also feed back on beliefs. As such, it fills an important empirical gap by demonstrating a robust cognition-to-symptoms pathway under rigorous temporal modeling.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"7 1","pages":"1-20"},"PeriodicalIF":22.8,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147381389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peter Lilliengren,Malin Ljungdahl,Mattias Rööst,Fredrik Falkenström,Joel M Town,Daniel Maroti
BACKGROUNDSomatic symptom disorder (SSD) is associated with substantial impairment and high healthcare use, particularly among patients with chronic symptoms, psychiatric comorbidity, and poor response to standard interventions. Intensive Short-Term Dynamic Psychotherapy (ISTDP) is a promising emotion-focused approach, but evidence in treatment-resistant SSD remains limited.METHODSIn this interrupted time-series study, 25 SSD patients who showed no improvement across two empirically supported online interventions in the preceding project year received up to 16 sessions (M = 14.1) of online ISTDP. Piecewise multilevel modeling compared PHQ-15 trajectories across 60 weeks before and 21 weeks after start of ISTDP. Secondary measures (PHQ-9, GAD-7, PCL-5, DERS-16) were administered pre-, post-, and at 12-week follow-up.RESULTSPHQ-15 trajectories were stable or slightly worsening during the pre-treatment year but declined significantly after ISTDP began, corresponding to a large estimated slope difference (d = 1.08) at the end of the treatment phase. Among completers (n = 22), 59% achieved minimal clinically meaningful improvement (≥3 PHQ-15 points), 27% showed ≥30% reduction, and 14% met recovery criteria. Secondary outcomes showed significant pre-post improvements in depression (d = 0.68) and anxiety (d = 0.42), while trauma symptoms and emotion regulation showed small, non-significant changes (d ≤ 0.30). Gains were largely maintained at 12-week follow-up. Emotional responses to treatment were common, but serious adverse events rare and dropout low.CONCLUSIONSOnline ISTDP appears feasible and effective for SSD patients who do not benefit from lower-intensity interventions and may represent a useful next step in stepped-care pathways for complex, treatment-resistant presentations.
{"title":"Online Intensive Short-Term Dynamic Psychotherapy (ISTDP) for Treatment-Resistant Somatic Symptom Disorder: An Interrupted Time-Series Study.","authors":"Peter Lilliengren,Malin Ljungdahl,Mattias Rööst,Fredrik Falkenström,Joel M Town,Daniel Maroti","doi":"10.1159/000550629","DOIUrl":"https://doi.org/10.1159/000550629","url":null,"abstract":"BACKGROUNDSomatic symptom disorder (SSD) is associated with substantial impairment and high healthcare use, particularly among patients with chronic symptoms, psychiatric comorbidity, and poor response to standard interventions. Intensive Short-Term Dynamic Psychotherapy (ISTDP) is a promising emotion-focused approach, but evidence in treatment-resistant SSD remains limited.METHODSIn this interrupted time-series study, 25 SSD patients who showed no improvement across two empirically supported online interventions in the preceding project year received up to 16 sessions (M = 14.1) of online ISTDP. Piecewise multilevel modeling compared PHQ-15 trajectories across 60 weeks before and 21 weeks after start of ISTDP. Secondary measures (PHQ-9, GAD-7, PCL-5, DERS-16) were administered pre-, post-, and at 12-week follow-up.RESULTSPHQ-15 trajectories were stable or slightly worsening during the pre-treatment year but declined significantly after ISTDP began, corresponding to a large estimated slope difference (d = 1.08) at the end of the treatment phase. Among completers (n = 22), 59% achieved minimal clinically meaningful improvement (≥3 PHQ-15 points), 27% showed ≥30% reduction, and 14% met recovery criteria. Secondary outcomes showed significant pre-post improvements in depression (d = 0.68) and anxiety (d = 0.42), while trauma symptoms and emotion regulation showed small, non-significant changes (d ≤ 0.30). Gains were largely maintained at 12-week follow-up. Emotional responses to treatment were common, but serious adverse events rare and dropout low.CONCLUSIONSOnline ISTDP appears feasible and effective for SSD patients who do not benefit from lower-intensity interventions and may represent a useful next step in stepped-care pathways for complex, treatment-resistant presentations.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"14 1","pages":"1-10"},"PeriodicalIF":22.8,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147329332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nana Xiong, Qingtian Mi, Qiqing Sun, Qi Liu, Tengteng Fan
Introduction: Psychosocial stress plays a critical role in symptom exacerbation in irritable bowel syndrome (IBS), yet neural mechanisms linking social rejection to visceral pain remain poorly understood. This study examined the behavioral and neural responses to social rejection in patients with IBS, focusing on prefrontal regulation.
Methods: Using functional magnetic resonance imaging (fMRI) and a validated social exclusion paradigm, we compared the behavioral and neural responses of 35 patients with IBS (Rome IV criteria, without comorbid depression or anxiety disorders) and 36 matched healthy controls (HCs). Participants experienced phases of inclusion, exclusion, and re-inclusion while reporting emotional distress and abdominal pain severity.
Results: Compared to HCs, patients with IBS reported a greater increase in abdominal pain during exclusion and showed a pattern suggesting prolonged emotional distress upon re-inclusion. At the neural level, patients with IBS exhibited reduced activation in the dorsomedial prefrontal cortex (dmPFC) during exclusion and in the left inferior frontal gyrus (LIFG) during re-inclusion. Functional connectivity analyses further revealed altered interactions within prefrontal regions (LIFG-dmPFC) and between prefrontal and limbic areas (dmPFC-amygdala) in IBS. Moreover, greater dmPFC-amygdala coupling was associated with heightened emotional distress during social exclusion and was related to greater abdominal pain even at one-year follow-up.
Conclusions: These findings indicate altered engagement and coordination of prefrontal regulatory networks during social rejection in IBS, offering insights into neural mechanisms linking psychosocial stress to pain chronicity in IBS.
{"title":"Disrupted Prefrontal Regulation of Social Rejection in Irritable Bowel Syndrome.","authors":"Nana Xiong, Qingtian Mi, Qiqing Sun, Qi Liu, Tengteng Fan","doi":"10.1159/000551116","DOIUrl":"https://doi.org/10.1159/000551116","url":null,"abstract":"<p><strong>Introduction: </strong>Psychosocial stress plays a critical role in symptom exacerbation in irritable bowel syndrome (IBS), yet neural mechanisms linking social rejection to visceral pain remain poorly understood. This study examined the behavioral and neural responses to social rejection in patients with IBS, focusing on prefrontal regulation.</p><p><strong>Methods: </strong>Using functional magnetic resonance imaging (fMRI) and a validated social exclusion paradigm, we compared the behavioral and neural responses of 35 patients with IBS (Rome IV criteria, without comorbid depression or anxiety disorders) and 36 matched healthy controls (HCs). Participants experienced phases of inclusion, exclusion, and re-inclusion while reporting emotional distress and abdominal pain severity.</p><p><strong>Results: </strong>Compared to HCs, patients with IBS reported a greater increase in abdominal pain during exclusion and showed a pattern suggesting prolonged emotional distress upon re-inclusion. At the neural level, patients with IBS exhibited reduced activation in the dorsomedial prefrontal cortex (dmPFC) during exclusion and in the left inferior frontal gyrus (LIFG) during re-inclusion. Functional connectivity analyses further revealed altered interactions within prefrontal regions (LIFG-dmPFC) and between prefrontal and limbic areas (dmPFC-amygdala) in IBS. Moreover, greater dmPFC-amygdala coupling was associated with heightened emotional distress during social exclusion and was related to greater abdominal pain even at one-year follow-up.</p><p><strong>Conclusions: </strong>These findings indicate altered engagement and coordination of prefrontal regulatory networks during social rejection in IBS, offering insights into neural mechanisms linking psychosocial stress to pain chronicity in IBS.</p>","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":" ","pages":"1-26"},"PeriodicalIF":17.4,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147309478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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