{"title":"Adverse Childhood Experiences (ACEs) in the Digital Era: An Urgent Call for Precision Assessment.","authors":"Jane Pei-Chen Chang, Kuan-Pin Su","doi":"10.1159/000550728","DOIUrl":"https://doi.org/10.1159/000550728","url":null,"abstract":"","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":" ","pages":"1-9"},"PeriodicalIF":17.4,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126170","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}
Jan Kalde,Ece Atik,Johannes Stricker,Magnus Schückes,Peter Neudeck,Pamela Abel,Johanna Hollank,Andre Pittig,Reinhard Pietrowsky
This study evaluates the effectiveness of blended cognitive behavioral therapy (bCBT) with a digital health application (elona therapy) compared to standard cognitive behavioral therapy (CBT) for unipolar depression in outpatient care. This multicenter, randomized, two-arm controlled trial recruited 283 adult patients with unipolar depression in Germany. Patients were randomized to receive either standard face-to-face CBT combined with the digital health application (bCBT group) or standard face-to-face CBT alone. Symptoms of depression and anxiety, along with other patient-related characteristics, were assessed at baseline (T0: week 0) and post-intervention (T1: week 12). Patients in the bCBT group showed greater improvements in depressive symptoms (primary outcome: d = .62, p < .001), anxiety (d = .61, p < .001), quality of life (d = .42, p < .001), perceived self-efficacy (d = .41, p = .003), depression literacy (d = .66, p < .001) and overall disease severity outcomes (d = .45-.60, ps < .005) compared with patients in the CBT group. In conclusion, this study provides evidence supporting the effectiveness of bCBT in patients diagnosed with unipolar depressive disorder across a broad range of clinically relevant outcomes. The discussion addresses important limitations of this trial.
本研究评估了混合认知行为疗法（bbct）与数字健康应用（elona疗法）在门诊治疗单相抑郁症的效果，并与标准认知行为疗法（CBT）进行了比较。这项多中心、随机、双臂对照试验在德国招募了283名患有单相抑郁症的成年患者。患者被随机分为两组，一组接受标准面对面CBT结合数字健康应用（bCBT组），另一组单独接受标准面对面CBT。在基线（T0：第0周）和干预后（T1：第12周）评估抑郁和焦虑症状以及其他患者相关特征。与CBT组相比，bCBT组患者在抑郁症状（主要结局：d = .62, p < .001）、焦虑（d = .61, p < .001）、生活质量（d = .42, p < .001）、自我效能感（d = .41, p = .003）、抑郁认知（d = .66, p < .001）和总体疾病严重程度结局（d = .45-.60, p < .005）方面均有较大改善。总之，本研究提供了证据，支持bbct在广泛的临床相关结果中对诊断为单相抑郁症的患者的有效性。本文讨论了该试验的重要局限性。
{"title":"Blended Cognitive Behavioral Therapy Versus Standard CBT for Unipolar Depression: A Multicenter Randomized Controlled Trial.","authors":"Jan Kalde,Ece Atik,Johannes Stricker,Magnus Schückes,Peter Neudeck,Pamela Abel,Johanna Hollank,Andre Pittig,Reinhard Pietrowsky","doi":"10.1159/000550820","DOIUrl":"https://doi.org/10.1159/000550820","url":null,"abstract":"This study evaluates the effectiveness of blended cognitive behavioral therapy (bCBT) with a digital health application (elona therapy) compared to standard cognitive behavioral therapy (CBT) for unipolar depression in outpatient care. This multicenter, randomized, two-arm controlled trial recruited 283 adult patients with unipolar depression in Germany. Patients were randomized to receive either standard face-to-face CBT combined with the digital health application (bCBT group) or standard face-to-face CBT alone. Symptoms of depression and anxiety, along with other patient-related characteristics, were assessed at baseline (T0: week 0) and post-intervention (T1: week 12). Patients in the bCBT group showed greater improvements in depressive symptoms (primary outcome: d = .62, p < .001), anxiety (d = .61, p < .001), quality of life (d = .42, p < .001), perceived self-efficacy (d = .41, p = .003), depression literacy (d = .66, p < .001) and overall disease severity outcomes (d = .45-.60, ps < .005) compared with patients in the CBT group. In conclusion, this study provides evidence supporting the effectiveness of bCBT in patients diagnosed with unipolar depressive disorder across a broad range of clinically relevant outcomes. The discussion addresses important limitations of this trial.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"38 1","pages":"1-20"},"PeriodicalIF":22.8,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095513","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}
Vanessa K Tassone,Qiaowei Lin,Gloria Li,Aarna Rao,Victoria Duscio,Tia Mathur,Harani Uthayakumar,Syeda Zauraiz Sohail,Soha Kar,Danika A Quesnel,Wendy Lou,David Wiljer,Catherine M Sabiston,Benoit Mulsant,Venkat Bhat
INTRODUCTIONNon-adherence is a barrier to the effectiveness of physical activity (PA) interventions for major depressive disorder (MDD). This systematic review and meta-analysis identified reported adherence-related outcomes, compared adherence rates of PA and non-PA interventions in MDD, and determined predictors of adherence.METHODSMEDLINE, APA PsycINFO, CINAHL Plus, and SPORTDiscus were searched until September 5th, 2024. Pooled estimated risk differences [RDs] and 95% confidence intervals [CIs] were calculated using fixed-effects or random-effects models. Meta-regression explored predictors of adherence.RESULTSNinety-seven studies were included in this review, and 91 studies in the meta-analysis. Adherence-related outcomes for analyses included rates of intervention receipt, retention, protocol adherence, and session attendance. Retention was the most commonly reported outcome, with no significant difference between PA and non-PA interventions. Similarly, there were no significant differences in intervention receipt and session attendance. However, PA interventions had significantly lower protocol adherence than non-PA interventions (RD = -0.15; 95% CI: -0.23, -0.08). Severe baseline depressive symptoms, longer intervention durations, and in-person delivery predicted retention rates. Longer PA sessions predicted intervention receipt and supervision of activities predicted attendance rates.CONCLUSIONParticipants with MDD demonstrate lower protocol adherence to PA interventions than to interventions without a PA component. This result was based on a paucity of studies. Rates of intervention receipt, retention, and attendance were comparable in PA and non-PA interventions. Studies could benefit from including individuals with greater depressive symptom severity and supervised activity. With replication, findings could improve the design of, and increase adherence to, PA interventions in MDD.
{"title":"Adherence to Physical Activity Interventions in Major Depressive Disorder: A Systematic Review and Meta-Analysis.","authors":"Vanessa K Tassone,Qiaowei Lin,Gloria Li,Aarna Rao,Victoria Duscio,Tia Mathur,Harani Uthayakumar,Syeda Zauraiz Sohail,Soha Kar,Danika A Quesnel,Wendy Lou,David Wiljer,Catherine M Sabiston,Benoit Mulsant,Venkat Bhat","doi":"10.1159/000550802","DOIUrl":"https://doi.org/10.1159/000550802","url":null,"abstract":"INTRODUCTIONNon-adherence is a barrier to the effectiveness of physical activity (PA) interventions for major depressive disorder (MDD). This systematic review and meta-analysis identified reported adherence-related outcomes, compared adherence rates of PA and non-PA interventions in MDD, and determined predictors of adherence.METHODSMEDLINE, APA PsycINFO, CINAHL Plus, and SPORTDiscus were searched until September 5th, 2024. Pooled estimated risk differences [RDs] and 95% confidence intervals [CIs] were calculated using fixed-effects or random-effects models. Meta-regression explored predictors of adherence.RESULTSNinety-seven studies were included in this review, and 91 studies in the meta-analysis. Adherence-related outcomes for analyses included rates of intervention receipt, retention, protocol adherence, and session attendance. Retention was the most commonly reported outcome, with no significant difference between PA and non-PA interventions. Similarly, there were no significant differences in intervention receipt and session attendance. However, PA interventions had significantly lower protocol adherence than non-PA interventions (RD = -0.15; 95% CI: -0.23, -0.08). Severe baseline depressive symptoms, longer intervention durations, and in-person delivery predicted retention rates. Longer PA sessions predicted intervention receipt and supervision of activities predicted attendance rates.CONCLUSIONParticipants with MDD demonstrate lower protocol adherence to PA interventions than to interventions without a PA component. This result was based on a paucity of studies. Rates of intervention receipt, retention, and attendance were comparable in PA and non-PA interventions. Studies could benefit from including individuals with greater depressive symptom severity and supervised activity. With replication, findings could improve the design of, and increase adherence to, PA interventions in MDD.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"17 1","pages":"1-25"},"PeriodicalIF":22.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146089182","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}
Matthew Tsz Ho Ho, Joe Kwun Nam Chan, Heidi Ka Ying Lo, Catherine Zhiqian Fang, Corine Sau Man Wong, Krystal Chi Kei Lee, Francisco Tsz Tsun Lai, Amy Pui Pui Ng, William Chi Wai Wong, Wing Chung Chang
Introduction: Depression and diabetes often co-occur and worsen clinical outcomes of both conditions. However, mortality risk among depression patients with diabetes exposed to antidepressant is under-studied. We investigated whether antidepressant would decrease mortality risk in people with depression and type-2 incident diabetes.
Methods: This population-based cohort study identified 11,137 depression patients with incident type-2 diabetes between 2002-2021 in Hong Kong who were exposed to antidepressants, using territory-wide electronic medical-record database. Association between antidepressant exposure and mortality risk was analyzed by Cox proportional-hazards models for any antidepressant, specific drug classes, and individual agents, with stratified-analysis by HbA1c level. A comprehensive array of covariates, including age, sex, calendar-year period, catchment-area, pre-existing physical-comorbidities, diabetic-complications, substance/alcohol use disorders, cardiovascular/antidiabetes medications, and presence of antidepressants other than the specified drug was adjusted. Three sets of sensitivity-analyses were conducted by restricting to patients (a) with cumulative drug exposure ≥90 days and ≥180 days, (b) with medication-possession-ratio ≥80% and (c) monotherapy.
Results: Lower risk of all-cause mortality was associated with exposure to any antidepressant (HR 0.79, 95%CI 0.70-0.90) compared with no antidepressant in depression patients with incident-diabetes. Lower mortality risk was associated with exposure to noradrenergic and specific-serotonergic antidepressants (0.77[0.66-0.90]) compared with no antidepressant, and to mirtazapine (0.76[0.65-0.88]) and trazodone (0.75[0.63-0.90]). Sensitivity-analyses affirmed that lower mortality risk was associated with mirtazapine.
Conclusion: Depression patients with comorbid type-2 diabetes with exposure to several antidepressant is at decreased mortality risk. Further research is warranted to confirm our findings and clarify the mortality-reducing mechanisms of antidepressant in this vulnerable population.
{"title":"Antidepressants and Risk of Mortality in People with Depressive Disorder and Co-occurring type 2 Diabetes Mellitus: a 20-year Population-based Cohort Study.","authors":"Matthew Tsz Ho Ho, Joe Kwun Nam Chan, Heidi Ka Ying Lo, Catherine Zhiqian Fang, Corine Sau Man Wong, Krystal Chi Kei Lee, Francisco Tsz Tsun Lai, Amy Pui Pui Ng, William Chi Wai Wong, Wing Chung Chang","doi":"10.1159/000550667","DOIUrl":"https://doi.org/10.1159/000550667","url":null,"abstract":"<p><strong>Introduction: </strong>Depression and diabetes often co-occur and worsen clinical outcomes of both conditions. However, mortality risk among depression patients with diabetes exposed to antidepressant is under-studied. We investigated whether antidepressant would decrease mortality risk in people with depression and type-2 incident diabetes.</p><p><strong>Methods: </strong>This population-based cohort study identified 11,137 depression patients with incident type-2 diabetes between 2002-2021 in Hong Kong who were exposed to antidepressants, using territory-wide electronic medical-record database. Association between antidepressant exposure and mortality risk was analyzed by Cox proportional-hazards models for any antidepressant, specific drug classes, and individual agents, with stratified-analysis by HbA1c level. A comprehensive array of covariates, including age, sex, calendar-year period, catchment-area, pre-existing physical-comorbidities, diabetic-complications, substance/alcohol use disorders, cardiovascular/antidiabetes medications, and presence of antidepressants other than the specified drug was adjusted. Three sets of sensitivity-analyses were conducted by restricting to patients (a) with cumulative drug exposure ≥90 days and ≥180 days, (b) with medication-possession-ratio ≥80% and (c) monotherapy.</p><p><strong>Results: </strong>Lower risk of all-cause mortality was associated with exposure to any antidepressant (HR 0.79, 95%CI 0.70-0.90) compared with no antidepressant in depression patients with incident-diabetes. Lower mortality risk was associated with exposure to noradrenergic and specific-serotonergic antidepressants (0.77[0.66-0.90]) compared with no antidepressant, and to mirtazapine (0.76[0.65-0.88]) and trazodone (0.75[0.63-0.90]). Sensitivity-analyses affirmed that lower mortality risk was associated with mirtazapine.</p><p><strong>Conclusion: </strong>Depression patients with comorbid type-2 diabetes with exposure to several antidepressant is at decreased mortality risk. Further research is warranted to confirm our findings and clarify the mortality-reducing mechanisms of antidepressant in this vulnerable population.</p>","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":" ","pages":"1-17"},"PeriodicalIF":17.4,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053331","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}
Marketa Ciharova,Eirini Karyotaki,Mathias Harrer,Erica Weitz,Clara Miguel,Arpana Amarnath,Toshi A Furukawa,Constantin Yves Plessen,Ellen Driessen,Claudia Buntrock,Lingyao Tong,David Hellerstein,Lisa W Samstag,Ying Chen,Sreevani Rentala,Curt Hemanny,Irismar Reis de Oliveira,Marc B J Blom,Yvonne Burnand,Antonio Andreoli,Andrea K Wittenborn,Kevin L Delucchi,Nusrat Husain,Robert J DeRubeis,Joel M Town,Frank Röhricht,Han Choi,Jack Dekker,David J A Dozois,Martin B Keller,Raymond W Lam,François Lespérance,Giuseppe Maina,Gianluca Rosso,Jeanette Milgrom,Arun Ravindran,Charles F Reynolds Iii,Nicola Wiles,Brandon A Gaudiano,Livia Hartmann de Souza,Atsuo Nakagawa,Beatriz Rodríguez Vega,Angela Palao,Jaime López Rodríguez,Valerio Villamil Salcedo,Ingo Zobel,Elisabeth Schramm,Steven D Hollon,Heleen Riper,Pim Cuijpers
INTRODUCTIONIt is not clear which individual-patient- and study-level variables modify the effects in the comparison of combined treatment versus pharmacotherapy alone for adult depression.METHODSRandomized trials comparing combined treatment with pharmacotherapy alone were identified on September 1st, 2024, and individual participant data (IPD) requested from the authors. One-stage IPD meta-analyses were conducted to estimate effects on depressive symptoms at post-treatment and follow-up, response, remission, and reliable improvement, and to assess effect modifiers.RESULTSOf 75 eligible studies, 31 (41.33%) provided their IPD (3703 participants). Combined treatment was more effective in reducing depressive symptoms at post-treatment (SMD = 0.45, 95%CI: 0.27 to 0.64), six- (SMD = 0.55, 95%CI: 0.25 to 0.85) and twelve-month follow-up (SMD = 0.22, 95%CI: 0.02 to 0.43). The effect size was smaller in studies that provided IPD than in those that did not. No patient-level effect modifiers were identified. No difference between the two arms was found in studies using SSRIs (as opposed to other antidepressants) and recruiting specific target groups (versus unselected adult populations), and the difference between combined treatment and pharmacotherapy alone was larger if pharmacotherapy was not administered adequately, but these findings were not confirmed in sensitivity analyses. Several patient-level characteristics predicted higher depressive symptoms at post-treatment, regardless of treatment condition.CONCLUSIONCombined treatment outperforms pharmacotherapy alone regardless of individual characteristics. Thus, its delivery does not have to be limited to specific patient subgroups. However, IPD were available for only 41% of eligible studies, thus limiting this sample's representativeness.
{"title":"Modifiers in Effects of Combined Pharmacotherapy and Psychotherapy versus Pharmacotherapy Alone for Adult Depression: An Individual Participant Data Meta-analysis.","authors":"Marketa Ciharova,Eirini Karyotaki,Mathias Harrer,Erica Weitz,Clara Miguel,Arpana Amarnath,Toshi A Furukawa,Constantin Yves Plessen,Ellen Driessen,Claudia Buntrock,Lingyao Tong,David Hellerstein,Lisa W Samstag,Ying Chen,Sreevani Rentala,Curt Hemanny,Irismar Reis de Oliveira,Marc B J Blom,Yvonne Burnand,Antonio Andreoli,Andrea K Wittenborn,Kevin L Delucchi,Nusrat Husain,Robert J DeRubeis,Joel M Town,Frank Röhricht,Han Choi,Jack Dekker,David J A Dozois,Martin B Keller,Raymond W Lam,François Lespérance,Giuseppe Maina,Gianluca Rosso,Jeanette Milgrom,Arun Ravindran,Charles F Reynolds Iii,Nicola Wiles,Brandon A Gaudiano,Livia Hartmann de Souza,Atsuo Nakagawa,Beatriz Rodríguez Vega,Angela Palao,Jaime López Rodríguez,Valerio Villamil Salcedo,Ingo Zobel,Elisabeth Schramm,Steven D Hollon,Heleen Riper,Pim Cuijpers","doi":"10.1159/000550633","DOIUrl":"https://doi.org/10.1159/000550633","url":null,"abstract":"INTRODUCTIONIt is not clear which individual-patient- and study-level variables modify the effects in the comparison of combined treatment versus pharmacotherapy alone for adult depression.METHODSRandomized trials comparing combined treatment with pharmacotherapy alone were identified on September 1st, 2024, and individual participant data (IPD) requested from the authors. One-stage IPD meta-analyses were conducted to estimate effects on depressive symptoms at post-treatment and follow-up, response, remission, and reliable improvement, and to assess effect modifiers.RESULTSOf 75 eligible studies, 31 (41.33%) provided their IPD (3703 participants). Combined treatment was more effective in reducing depressive symptoms at post-treatment (SMD = 0.45, 95%CI: 0.27 to 0.64), six- (SMD = 0.55, 95%CI: 0.25 to 0.85) and twelve-month follow-up (SMD = 0.22, 95%CI: 0.02 to 0.43). The effect size was smaller in studies that provided IPD than in those that did not. No patient-level effect modifiers were identified. No difference between the two arms was found in studies using SSRIs (as opposed to other antidepressants) and recruiting specific target groups (versus unselected adult populations), and the difference between combined treatment and pharmacotherapy alone was larger if pharmacotherapy was not administered adequately, but these findings were not confirmed in sensitivity analyses. Several patient-level characteristics predicted higher depressive symptoms at post-treatment, regardless of treatment condition.CONCLUSIONCombined treatment outperforms pharmacotherapy alone regardless of individual characteristics. Thus, its delivery does not have to be limited to specific patient subgroups. However, IPD were available for only 41% of eligible studies, thus limiting this sample's representativeness.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"95 1","pages":"1-23"},"PeriodicalIF":22.8,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015240","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}
BACKGROUNDObsessive-compulsive disorder (OCD) is a chronic and disabling mental disorder. Cognitive-behavioral therapy and serotonin-reuptake inhibitors and their combination are first-line treatments. However, about 50% of the patients do not achieve response or remission, although many patients received additional pharmacotherapy. These results highlight the need for additional evidence-based treatment options.METHODSIn a randomized controlled trial (RCT) a manual-guided method of short-term psychodynamic therapy (STPP) for OCD was tested against a waiting list condition. Thirty-seven unmedicated patients were randomly assigned to STPP, 30 to the waiting list. The Y-BOCS total score post-therapy assessed by trained and masked raters was the primary outcome. Secondary outcomes included response, remission, depression, interpersonal problems and obsessive beliefs.RESULTSIn the intention-to-treat sample, STPP achieved a significantly lower Y-BOCS score (p < 0.0001) than the waiting list condition, associated with a large between-group effect size (d=1.04). The mean difference of change in the Y-BOCS between baseline and post-therapy or waiting period assessment was -11.49 (95% CI -14.36, -8.63) for STPP and -1.10 (95% CI -4.29, 2.10) in the waiting-list. Remission rates were 55% vs 17% (p=0.0012), response rates 64% vs 17% (p=0.0003) in favor of STPP.CONCLUSIONIn a first RCT, manual-guided STPP proved to be efficacious in OCD, thereby broadening the spectrum of evidence-based interventions. Of note, our study is one of the few trials using psychotherapy as a monotherapy in OCD, showing effects of psychotherapy alone. Further research is needed to replicate these findings and to compare STPP with other established treatments.
背景：强迫症（OCD）是一种慢性致残性精神障碍。认知行为疗法和血清素再摄取抑制剂及其联合治疗是一线治疗。然而，尽管许多患者接受了额外的药物治疗，但约50%的患者没有达到缓解或缓解。这些结果强调需要更多的循证治疗方案。方法在一项随机对照试验（RCT）中，采用手工指导的短期心理动力疗法（STPP）治疗强迫症。37名未接受药物治疗的患者被随机分配到STPP， 30名进入等候名单。治疗后Y-BOCS总分由训练有素的蒙面评分者评估为主要结果。次要结果包括反应、缓解、抑郁、人际关系问题和强迫信念。结果意向治疗组的Y-BOCS评分显著低于等候名单组（p < 0.0001），组间效应量较大（d=1.04）。基线和治疗后或等待期评估之间Y-BOCS变化的平均差异STPP为-11.49 (95% CI -14.36, -8.63)，等待名单为-1.10 （95% CI -4.29, 2.10）。缓解率为55% vs 17% (p=0.0012)，缓解率为64% vs 17% （p=0.0003）。结论在第一项随机对照试验中，手册引导的STPP被证明对强迫症有效，从而拓宽了循证干预的范围。值得注意的是，我们的研究是少数使用心理疗法作为强迫症单一疗法的试验之一，显示了单独使用心理疗法的效果。需要进一步的研究来重复这些发现，并将STPP与其他已建立的治疗方法进行比较。
{"title":"Short-term psychodynamic therapy of obsessive-compulsive disorder - a randomized controlled trial of unmedicated patients.","authors":"Falk Leichsenring,Christiane Steinert,Joachim Biskup,Lila Alina Feix,Nikolas Heim,Britta Nimis,Reinhard Kreische,Fatima Nöske,Christian Ruckes,Heinz Weiss,Günther Reich,Annabelle Starck","doi":"10.1159/000550421","DOIUrl":"https://doi.org/10.1159/000550421","url":null,"abstract":"BACKGROUNDObsessive-compulsive disorder (OCD) is a chronic and disabling mental disorder. Cognitive-behavioral therapy and serotonin-reuptake inhibitors and their combination are first-line treatments. However, about 50% of the patients do not achieve response or remission, although many patients received additional pharmacotherapy. These results highlight the need for additional evidence-based treatment options.METHODSIn a randomized controlled trial (RCT) a manual-guided method of short-term psychodynamic therapy (STPP) for OCD was tested against a waiting list condition. Thirty-seven unmedicated patients were randomly assigned to STPP, 30 to the waiting list. The Y-BOCS total score post-therapy assessed by trained and masked raters was the primary outcome. Secondary outcomes included response, remission, depression, interpersonal problems and obsessive beliefs.RESULTSIn the intention-to-treat sample, STPP achieved a significantly lower Y-BOCS score (p < 0.0001) than the waiting list condition, associated with a large between-group effect size (d=1.04). The mean difference of change in the Y-BOCS between baseline and post-therapy or waiting period assessment was -11.49 (95% CI -14.36, -8.63) for STPP and -1.10 (95% CI -4.29, 2.10) in the waiting-list. Remission rates were 55% vs 17% (p=0.0012), response rates 64% vs 17% (p=0.0003) in favor of STPP.CONCLUSIONIn a first RCT, manual-guided STPP proved to be efficacious in OCD, thereby broadening the spectrum of evidence-based interventions. Of note, our study is one of the few trials using psychotherapy as a monotherapy in OCD, showing effects of psychotherapy alone. Further research is needed to replicate these findings and to compare STPP with other established treatments.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"244 1","pages":"1-26"},"PeriodicalIF":22.8,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937684","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}
Alexa Alica Kupferschmitt, Thilo Hinterberger, Christoph Herrmann, Michael Jöbges, Stefan Kelm, Gerhard Sütfels, Thomas H Loew, Volker Köllner
Background: Post-COVID-syndrome (PCS) can lead to severe restrictions in the ability to work and participate in society and can lead to the development of depressive symptoms. The aim of this study is to investigate how many PCS-patients suffer from clinically relevant depressive symptoms and to what extent PCS-rehabilitation can modulate psychological symptoms as well as limitations in functional health.
Methods: Prospective multicenter cohort study PoCoRe (N = 1028). Assessment of depressiveness (PHQ-9, PHQ-2), fatigue (FSMC) and functional health and disability (WHO-DAS2.0). Frequency analyses, mean comparisons.
Results: At the start of rehabilitation, 71.4% (n = 734) fulfilled the core symptoms of depressive disorders in general in the PHQ-2. In the screening-positive patients, the PHQ-9 total score was on average M = 23.74 (SD = 4.43). As expected the depressive symptom burden was reduced more in depressed PCS-patients (d = .50) than in non-depressed PCS-patients (d =.32). Fatigue symptoms did not change. Functional health (WHO-DAS) improved above all in coping with everyday life d = .71, or 1.04, and in the non-depressed patients also in mobility d = .27. In the socio-medical assessment, 24.7% of the total sample were assessed as having an impaired capacity for the reference occupation and 19.5% as having an impaired capacity for the general labor market. Depressive patients had the worse socio-medical outcome.
Conclusion: Depressiveness is common and can be well influenced by PCS-rehabilitation. Fatigue is less easily influenced, which indicates that they are independent symptoms. Patients with persistent depression and fatigue have a poorer socio-medical prognosis.
{"title":"Depression, but not fatigue, improves as part of multimodal post-COVID rehabilitation.","authors":"Alexa Alica Kupferschmitt, Thilo Hinterberger, Christoph Herrmann, Michael Jöbges, Stefan Kelm, Gerhard Sütfels, Thomas H Loew, Volker Köllner","doi":"10.1159/000549848","DOIUrl":"https://doi.org/10.1159/000549848","url":null,"abstract":"<p><strong>Background: </strong>Post-COVID-syndrome (PCS) can lead to severe restrictions in the ability to work and participate in society and can lead to the development of depressive symptoms. The aim of this study is to investigate how many PCS-patients suffer from clinically relevant depressive symptoms and to what extent PCS-rehabilitation can modulate psychological symptoms as well as limitations in functional health.</p><p><strong>Methods: </strong>Prospective multicenter cohort study PoCoRe (N = 1028). Assessment of depressiveness (PHQ-9, PHQ-2), fatigue (FSMC) and functional health and disability (WHO-DAS2.0). Frequency analyses, mean comparisons.</p><p><strong>Results: </strong>At the start of rehabilitation, 71.4% (n = 734) fulfilled the core symptoms of depressive disorders in general in the PHQ-2. In the screening-positive patients, the PHQ-9 total score was on average M = 23.74 (SD = 4.43). As expected the depressive symptom burden was reduced more in depressed PCS-patients (d = .50) than in non-depressed PCS-patients (d =.32). Fatigue symptoms did not change. Functional health (WHO-DAS) improved above all in coping with everyday life d = .71, or 1.04, and in the non-depressed patients also in mobility d = .27. In the socio-medical assessment, 24.7% of the total sample were assessed as having an impaired capacity for the reference occupation and 19.5% as having an impaired capacity for the general labor market. Depressive patients had the worse socio-medical outcome.</p><p><strong>Conclusion: </strong>Depressiveness is common and can be well influenced by PCS-rehabilitation. Fatigue is less easily influenced, which indicates that they are independent symptoms. Patients with persistent depression and fatigue have a poorer socio-medical prognosis.</p>","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":" ","pages":"1-23"},"PeriodicalIF":17.4,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934762","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}
Sabine C Herpertz,Corinne Neukel,Katharina Williams,Anna Georg,Judith von Schönfeld,Nikola Schoofs,Catherine Hindi Attar,Dorota Buczylowska,Katja Boedeker,Theresa Dankowski,Michael Kalab,Marc Wenigmann,Jaqueline Scharf,Tabea von der Lühe,Michael Kaess,Steffen Luntz,Astrid Dempfle,Felix Bermpohl,Svenja Taubner
INTRODUCTIONAlthough children of parents with mental illness (MI) are at increased risk of adverse childhood experiences and parental maltreatment, prevention trials targeting parents with MI are scarce. In addition, meta-analyses highlight significant methodological shortcomings in the current research.TRIAL DESIGNTo investigate real-world efficacy of a 12-hours mentalization-based parenting counselling program (MB-PC) compared to a psychoeducation workshop (SCC+) as supplements to standard clinical care (SCC).METHODSThis large-scale, cluster-randomized, open-label (partially observer-blind), active-controlled bicentre superiority trial was conducted at German psychiatric hospitals. It included 252 patients undergoing psychiatric treatment for various serious MIs. MB-PC subsumed five individual sessions including video feedback, five group sessions that guided parents to better understand and respond to their child's mental states, and two sessions of social counselling, all provided by an interprofessional hospital team of non-psychothera¬pists.RESULTSPatients in the MB-PC arm reported improved parenting practices - measured by the Alabama Parenting Questionnaire (APQ) total score as primary outcome - at post-intervention compared to those from the SSC+ arm (effect size (ES) = 0.43, 95% CI (0.13, 0.73), p=0.004), but group difference decreased at 3-months follow-up (ES = 0.25, 95% CI (-0.04, 0.53), p=0.085). All secondary outcomes were in favour of the MB-PC intervention, such as parental stress, child abuse potential, and child emotional well-being.CONCLUSIONImplementing a mentalisation-based parenting programme in routine psychiatric hospital care may represent an important step forward in reducing the risk of child maltreatment and neglect among offspring of parents affected by severe mental disorders.
虽然父母患有精神疾病（MI）的孩子在不良童年经历和父母虐待的风险增加，但针对MI父母的预防试验很少。此外，荟萃分析突出了当前研究中方法论上的重大缺陷。试验设计：研究作为标准临床护理（SCC）补充的12小时基于心理的育儿咨询项目（MB-PC）与心理教育研讨会（SCC+）的现实效果。方法在德国精神病院进行大规模、集群随机、开放标签（部分观察者盲）、主动对照的双中心优势试验。其中包括252名因各种严重MIs接受精神治疗的患者。MB-PC包括五个包括视频反馈的个人会议，五个指导父母更好地了解和应对孩子精神状态的小组会议，以及两个社会咨询会议，所有这些会议都由非心理治疗师组成的跨专业医院团队提供。结果与SSC+组相比，MB-PC组的患者在干预后报告了父母教养方式的改善（以阿拉巴马父母教养问卷（APQ）总分作为主要结果测量）(效应量（ES) = 0.43, 95% CI (0.13, 0.73), p=0.004），但在3个月的随访中，组间差异减小（ES = 0.25, 95% CI (-0.04, 0.53), p=0.085）。所有次要结果均支持MB-PC干预，如父母压力、儿童虐待潜力和儿童情绪健康。结论在精神病院的常规护理中实施以精神化为基础的养育方案，可能是降低父母患有严重精神障碍的子女遭受虐待和忽视的风险的重要一步。
{"title":"Breaking the Intergenerational Cycle of Abuse - a Randomized Controlled Prevention Trial in Parents with Serious Mental Illness.","authors":"Sabine C Herpertz,Corinne Neukel,Katharina Williams,Anna Georg,Judith von Schönfeld,Nikola Schoofs,Catherine Hindi Attar,Dorota Buczylowska,Katja Boedeker,Theresa Dankowski,Michael Kalab,Marc Wenigmann,Jaqueline Scharf,Tabea von der Lühe,Michael Kaess,Steffen Luntz,Astrid Dempfle,Felix Bermpohl,Svenja Taubner","doi":"10.1159/000549647","DOIUrl":"https://doi.org/10.1159/000549647","url":null,"abstract":"INTRODUCTIONAlthough children of parents with mental illness (MI) are at increased risk of adverse childhood experiences and parental maltreatment, prevention trials targeting parents with MI are scarce. In addition, meta-analyses highlight significant methodological shortcomings in the current research.TRIAL DESIGNTo investigate real-world efficacy of a 12-hours mentalization-based parenting counselling program (MB-PC) compared to a psychoeducation workshop (SCC+) as supplements to standard clinical care (SCC).METHODSThis large-scale, cluster-randomized, open-label (partially observer-blind), active-controlled bicentre superiority trial was conducted at German psychiatric hospitals. It included 252 patients undergoing psychiatric treatment for various serious MIs. MB-PC subsumed five individual sessions including video feedback, five group sessions that guided parents to better understand and respond to their child's mental states, and two sessions of social counselling, all provided by an interprofessional hospital team of non-psychothera¬pists.RESULTSPatients in the MB-PC arm reported improved parenting practices - measured by the Alabama Parenting Questionnaire (APQ) total score as primary outcome - at post-intervention compared to those from the SSC+ arm (effect size (ES) = 0.43, 95% CI (0.13, 0.73), p=0.004), but group difference decreased at 3-months follow-up (ES = 0.25, 95% CI (-0.04, 0.53), p=0.085). All secondary outcomes were in favour of the MB-PC intervention, such as parental stress, child abuse potential, and child emotional well-being.CONCLUSIONImplementing a mentalisation-based parenting programme in routine psychiatric hospital care may represent an important step forward in reducing the risk of child maltreatment and neglect among offspring of parents affected by severe mental disorders.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"155 1","pages":"1-20"},"PeriodicalIF":22.8,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145777419","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}
Craig J Bryan,James Lynch,AnnaBelle O Bryan,Sean Mulvaney,Noah Treangen,Kirsi Concelmo,Emily Rooney,Justin C Baker,Lauren Khazem,Ennio Ammendola,Christina Rose Bauder,Samantha E Daruwala,Jacek Kolacz,Ashley Arens,Darrin M Aase,Jose Moreno,Nagy A Youssef,Jaryd Hiser
INTRODUCTIONPosttraumatic stress disorder (PTSD) is common among military personnel and veterans and is associated with numerous psychological problems and negative outcomes. First-line cognitive-behavioral treatments like cognitive processing therapy (CPT) are effective in treating PTSD, especially when delivered in a massed (i.e., daily) format. However, many patients, especially military personnel and veterans, continue to struggle with PTSD symptoms after CPT, which warrants further research to augment CPT's effects. Stellate ganglion block (SGB), which is a long-acting anesthetic injection that is proposed to "reset" sympathetic arousal and physical reactivity, is a promising adjunctive intervention, with previous research demonstrating reduced PTSD symptoms. The effectiveness of CPT combined with SGB remains understudied.METHODSIn this open-label randomized wait-list trial, 86 military personnel and veterans were assigned to receive SGB before or after massed CPT. PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5).RESULTSRelative to baseline, PCL-5 scores decreased in both groups (SGB-before-CPT: F(12,724)=23.4, p<.001; SGB-after-CPT: F(12,724)=21.1, p<.001), but reductions in PTSD symptoms were faster in SGB-before-CPT. Among the SGB-after-CPT participants who had not yet reached good end-state functioning by week 8, PCL-5 scores significantly decreased after they received the SGB procedure in week 12.CONCLUSIONResults support SGB increasing CPT's effectiveness when received prior to CPT. Additionally, military personnel and veterans who do not benefit from an initial course of massed CPT have significant reductions in PTSD symptoms when SGB was performed after CPT. SGB before CPT appears especially useful for patients looking for faster treatment response.
{"title":"Effectiveness of combined cognitive processing therapy with stellate ganglion block: an open-label randomized wait-list clinical trial.","authors":"Craig J Bryan,James Lynch,AnnaBelle O Bryan,Sean Mulvaney,Noah Treangen,Kirsi Concelmo,Emily Rooney,Justin C Baker,Lauren Khazem,Ennio Ammendola,Christina Rose Bauder,Samantha E Daruwala,Jacek Kolacz,Ashley Arens,Darrin M Aase,Jose Moreno,Nagy A Youssef,Jaryd Hiser","doi":"10.1159/000550014","DOIUrl":"https://doi.org/10.1159/000550014","url":null,"abstract":"INTRODUCTIONPosttraumatic stress disorder (PTSD) is common among military personnel and veterans and is associated with numerous psychological problems and negative outcomes. First-line cognitive-behavioral treatments like cognitive processing therapy (CPT) are effective in treating PTSD, especially when delivered in a massed (i.e., daily) format. However, many patients, especially military personnel and veterans, continue to struggle with PTSD symptoms after CPT, which warrants further research to augment CPT's effects. Stellate ganglion block (SGB), which is a long-acting anesthetic injection that is proposed to \"reset\" sympathetic arousal and physical reactivity, is a promising adjunctive intervention, with previous research demonstrating reduced PTSD symptoms. The effectiveness of CPT combined with SGB remains understudied.METHODSIn this open-label randomized wait-list trial, 86 military personnel and veterans were assigned to receive SGB before or after massed CPT. PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5).RESULTSRelative to baseline, PCL-5 scores decreased in both groups (SGB-before-CPT: F(12,724)=23.4, p<.001; SGB-after-CPT: F(12,724)=21.1, p<.001), but reductions in PTSD symptoms were faster in SGB-before-CPT. Among the SGB-after-CPT participants who had not yet reached good end-state functioning by week 8, PCL-5 scores significantly decreased after they received the SGB procedure in week 12.CONCLUSIONResults support SGB increasing CPT's effectiveness when received prior to CPT. Additionally, military personnel and veterans who do not benefit from an initial course of massed CPT have significant reductions in PTSD symptoms when SGB was performed after CPT. SGB before CPT appears especially useful for patients looking for faster treatment response.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"66 1","pages":"1-21"},"PeriodicalIF":22.8,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145760085","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}
Introduction Common mental disorders (CMD) are often work-related, impact work ability and are undertreated. This trial investigates whether psychotherapeutic consultation at work (PT-A) is more effective than care as usual (CAU) in reducing days of sickness absence (DOSA) among affected employees. Methods A randomized controlled trial (RCT) in five German study centers included employees with CMD or global assessment of functioning (GAF) <81, working ≥15 hours/week, recruited via companies and media. After baseline, participants were randomized 1:1 to intervention (IG: up to 16 individual psychotherapy sessions over nine months) or control (CG: diagnostic session + follow-up call) group. The primary outcome was self-reported DOSA in the last six months at 15 months post-baseline (T2). Analyses used intention-to-treat. Results From 09/2021 to 01/2023, 550 participants, 246 male, 301 female, and 1 diverse, were randomized to IG (n=279) and CG (n=270). 403 participants (74%) were first-time users of mental health care. DOSA at T2 were 21 days (SD=39) in the IG (n=206) versus 22 days (SD=39) in the CG (n=161), no significant treatment effect was observed ([0.65; 1.32], p=0.679). Conclusion PT-A did not significantly reduce DOSA compared to CAU. However, secondary outcomes showed considerable improvement of clinical symptoms such as depression and anxiety and return-to-work self-efficacy. Therefore, longer observation periods may be needed to assess the effects on DOSA. Moreover, compared to clinical experiences, the high number of men and first-time users indicate an improved accessibility for underserved groups of employees.
{"title":"Effectiveness of psychotherapeutic consultation at work compared to care as usual for employees with common mental disorders or subthreshold symptoms: A randomized controlled multicenter trial in Germany.","authors":"Eva Rothermund-Nassir,Nicole Rosalinde Hander,Kristin Herrmann,Manuel Feißt,Alexandra Balzer,Yesim Erim,Regina Herold,Sinja Hondong,Christoph Kröger,Marieke Hansmann,Uta Wegewitz,Ute Beate Schröder,Tamara Waldmann,Nadine Mulfinger,Volker Köllner,Lorena Brenner,Fiona Kohl,Meike Heming,Harald Gündel,Jeannette Weber,Peter Angerer","doi":"10.1159/000549531","DOIUrl":"https://doi.org/10.1159/000549531","url":null,"abstract":"Introduction Common mental disorders (CMD) are often work-related, impact work ability and are undertreated. This trial investigates whether psychotherapeutic consultation at work (PT-A) is more effective than care as usual (CAU) in reducing days of sickness absence (DOSA) among affected employees. Methods A randomized controlled trial (RCT) in five German study centers included employees with CMD or global assessment of functioning (GAF) <81, working ≥15 hours/week, recruited via companies and media. After baseline, participants were randomized 1:1 to intervention (IG: up to 16 individual psychotherapy sessions over nine months) or control (CG: diagnostic session + follow-up call) group. The primary outcome was self-reported DOSA in the last six months at 15 months post-baseline (T2). Analyses used intention-to-treat. Results From 09/2021 to 01/2023, 550 participants, 246 male, 301 female, and 1 diverse, were randomized to IG (n=279) and CG (n=270). 403 participants (74%) were first-time users of mental health care. DOSA at T2 were 21 days (SD=39) in the IG (n=206) versus 22 days (SD=39) in the CG (n=161), no significant treatment effect was observed ([0.65; 1.32], p=0.679). Conclusion PT-A did not significantly reduce DOSA compared to CAU. However, secondary outcomes showed considerable improvement of clinical symptoms such as depression and anxiety and return-to-work self-efficacy. Therefore, longer observation periods may be needed to assess the effects on DOSA. Moreover, compared to clinical experiences, the high number of men and first-time users indicate an improved accessibility for underserved groups of employees.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"38 1","pages":"1-26"},"PeriodicalIF":22.8,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145728382","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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