INTRODUCTIONAccess to effective post-traumatic stress disorder (PTSD) treatment is limited in low-resource regions (LRRs).METHODSWe conducted a randomized controlled trial to evaluate the efficacy of Guided Written Exposure (GWE), an online therapy developed for LRRs, in reducing PTSD, depression, and insomnia symptoms compared to minimal contact control (MCC). Adults (N=95) meeting DSM-5 criteria for PTSD or subthreshold PTSD were randomly assigned to GWE (N=65) or MCC (N=30) in China from June 27, 2022, to August 11, 2023, with a final follow-up on April 16, 2024. Assessments were conducted at pre-treatment, post-treatment, and 1-month follow-up for both groups, and at 3- and 6-month follow-ups for the GWE group. The primary outcome was the PTSD Symptom Scale Interview-DSM5 (PSSI-5, assessed by blinded evaluators) and PTSD CheckList-5 (PCL-5).RESULTSGWE had significantly lower PSSI-5 (1-month: d=-0·74, 95% CI [-0·98, -0·51], p<·001) and lower PCL-5 (1-month: d=-0·79, 95% CI [-1·03, -0·54], p<·001) than MCC. Reliable change in PTSD symptoms at 1-month: GWE 65% (42/65) vs. MCC 37% (11/30), p=·01. GWE also had significantly lower depression and insomnia severity than MCC at post-treatment and 1-month follow-up. Effects maintained through 6 months for PTSD, depression, and insomnia in the GWE group.CONCLUSIONSGWE may be an efficacious intervention for individuals with PTSD in LRRs.
{"title":"An Online Guided Written Exposure Therapy for Symptoms of Posttraumatic Stress Disorder: A Randomized Controlled Trial.","authors":"Muyang Li,Ye Zhao,David Rosenfield,Zeyu Guo,Mingcen Wei,Shijia Fan,Yu Li,Yinyin Zang","doi":"10.1159/000549609","DOIUrl":"https://doi.org/10.1159/000549609","url":null,"abstract":"INTRODUCTIONAccess to effective post-traumatic stress disorder (PTSD) treatment is limited in low-resource regions (LRRs).METHODSWe conducted a randomized controlled trial to evaluate the efficacy of Guided Written Exposure (GWE), an online therapy developed for LRRs, in reducing PTSD, depression, and insomnia symptoms compared to minimal contact control (MCC). Adults (N=95) meeting DSM-5 criteria for PTSD or subthreshold PTSD were randomly assigned to GWE (N=65) or MCC (N=30) in China from June 27, 2022, to August 11, 2023, with a final follow-up on April 16, 2024. Assessments were conducted at pre-treatment, post-treatment, and 1-month follow-up for both groups, and at 3- and 6-month follow-ups for the GWE group. The primary outcome was the PTSD Symptom Scale Interview-DSM5 (PSSI-5, assessed by blinded evaluators) and PTSD CheckList-5 (PCL-5).RESULTSGWE had significantly lower PSSI-5 (1-month: d=-0·74, 95% CI [-0·98, -0·51], p<·001) and lower PCL-5 (1-month: d=-0·79, 95% CI [-1·03, -0·54], p<·001) than MCC. Reliable change in PTSD symptoms at 1-month: GWE 65% (42/65) vs. MCC 37% (11/30), p=·01. GWE also had significantly lower depression and insomnia severity than MCC at post-treatment and 1-month follow-up. Effects maintained through 6 months for PTSD, depression, and insomnia in the GWE group.CONCLUSIONSGWE may be an efficacious intervention for individuals with PTSD in LRRs.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"103 1","pages":"1-21"},"PeriodicalIF":22.8,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145554714","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}
Mechanisms of change are widely assumed to be activated by the onset of treatment. This foundational premise underlies decades of psychotherapy research and guides the timing of measurement and intervention in clinical science. The present study challenges this assumption by demonstrating that one of the most well-established predictors of treatment outcome-the therapeutic alliance-not only changes before therapy begins, but that these early, pre-treatment changes predict both alliance development and symptom reduction throughout treatment. In a randomized controlled trial for depression (N=100), the therapeutic alliance was assessed twice before patients met their therapist, and weekly thereafter. The pre-treatment change in alliance significantly predicted subsequent alliance dynamics and clinical improvement, above and beyond baseline levels. The findings remained robust even after controlling for pre-treatment outcome expectations and previous treatment experience. These findings suggest that mechanisms traditionally viewed as the result of treatment targeting may, in fact, be antecedents. By revealing pre-treatment shifts in a mechanism once thought to be non-existent prior to patient-therapist contact, this work may challenge fundamental assumptions in clinical psychology and highlights the need to reconceptualize therapeutic change as a dynamic, temporally extended process that may begin before any intervention has occurred. Such a shift has implications for how we define, measure, and intervene on core mechanisms of human change.
{"title":"Therapeutic change may begin before the therapist and patient ever meet: Pre-treatment alliance changes predict clinical outcomes.","authors":"Sigal Zilcha-Mano","doi":"10.1159/000548510","DOIUrl":"https://doi.org/10.1159/000548510","url":null,"abstract":"Mechanisms of change are widely assumed to be activated by the onset of treatment. This foundational premise underlies decades of psychotherapy research and guides the timing of measurement and intervention in clinical science. The present study challenges this assumption by demonstrating that one of the most well-established predictors of treatment outcome-the therapeutic alliance-not only changes before therapy begins, but that these early, pre-treatment changes predict both alliance development and symptom reduction throughout treatment. In a randomized controlled trial for depression (N=100), the therapeutic alliance was assessed twice before patients met their therapist, and weekly thereafter. The pre-treatment change in alliance significantly predicted subsequent alliance dynamics and clinical improvement, above and beyond baseline levels. The findings remained robust even after controlling for pre-treatment outcome expectations and previous treatment experience. These findings suggest that mechanisms traditionally viewed as the result of treatment targeting may, in fact, be antecedents. By revealing pre-treatment shifts in a mechanism once thought to be non-existent prior to patient-therapist contact, this work may challenge fundamental assumptions in clinical psychology and highlights the need to reconceptualize therapeutic change as a dynamic, temporally extended process that may begin before any intervention has occurred. Such a shift has implications for how we define, measure, and intervene on core mechanisms of human change.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"29 1","pages":"1-11"},"PeriodicalIF":22.8,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145545294","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}
Sara Romanazzo,Francesca Monti,Sara Ceccatelli,Francesco De Cesaris,Alberto Chiarugi,Fiammetta Cosci
INTRODUCTIONVerbal instructions modulate the expectation concerning a given drug. Knowing that the prescribing clinician is positive and enthusiastic toward the prescribed treatment may lead to positive expectations. We tested whether administering strongly positive verbal instructions together with a pharmacological prescription might trigger a placebo effect in migraine patients.METHODSOutpatients (n = 102) were randomly assigned to: (a) an experimental condition: the pharmacological prescription was coupled to strongly positive verbal instructions; (b) a control condition: the prescription was coupled to positive verbal instructions. Subjects were assessed before the prescription (T0), 7-day (T1), 15-day (T2), 1-month (T3), 2-month (T4), and 3-month after it (T5). At each assessment point, Headache Impact Test (HIT-6) and two Numeric Rating Scales (NRSs) were proposed. Kellner's scale of change was administered at T1-T5.RESULTSPatients who received strongly positive instructions had no HIT decrease (p = 0.177; η2 = 0.034). Patients who received positive instructions had HIT decrease (p = 0.006; η2 = 0.770). No difference was found between the groups. No significant across timepoints change of expectations was observed in the group who received strongly positive instructions (p = 0.433; η2 = 0.021) or in the group who received positive instructions (p = 0.151; η2 = 0.037). Since the first group had a decrease across timepoints of the score while the second group had a peak at T2, difference between them was statistically significant (p = 0.029; η2 = 0.049).CONCLUSIONStrongly positive verbal instructions did not produce placebo effect.
{"title":"Placebo effect of verbal instructions coupled with pharmacological treatment: results from a randomized controlled trial in migraine patients.","authors":"Sara Romanazzo,Francesca Monti,Sara Ceccatelli,Francesco De Cesaris,Alberto Chiarugi,Fiammetta Cosci","doi":"10.1159/000548932","DOIUrl":"https://doi.org/10.1159/000548932","url":null,"abstract":"INTRODUCTIONVerbal instructions modulate the expectation concerning a given drug. Knowing that the prescribing clinician is positive and enthusiastic toward the prescribed treatment may lead to positive expectations. We tested whether administering strongly positive verbal instructions together with a pharmacological prescription might trigger a placebo effect in migraine patients.METHODSOutpatients (n = 102) were randomly assigned to: (a) an experimental condition: the pharmacological prescription was coupled to strongly positive verbal instructions; (b) a control condition: the prescription was coupled to positive verbal instructions. Subjects were assessed before the prescription (T0), 7-day (T1), 15-day (T2), 1-month (T3), 2-month (T4), and 3-month after it (T5). At each assessment point, Headache Impact Test (HIT-6) and two Numeric Rating Scales (NRSs) were proposed. Kellner's scale of change was administered at T1-T5.RESULTSPatients who received strongly positive instructions had no HIT decrease (p = 0.177; η2 = 0.034). Patients who received positive instructions had HIT decrease (p = 0.006; η2 = 0.770). No difference was found between the groups. No significant across timepoints change of expectations was observed in the group who received strongly positive instructions (p = 0.433; η2 = 0.021) or in the group who received positive instructions (p = 0.151; η2 = 0.037). Since the first group had a decrease across timepoints of the score while the second group had a peak at T2, difference between them was statistically significant (p = 0.029; η2 = 0.049).CONCLUSIONStrongly positive verbal instructions did not produce placebo effect.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"14 1","pages":"1-17"},"PeriodicalIF":22.8,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145545295","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}
Serge A Steenen, Roos van Westrhenen, Camilo C Steenen, L Thomas Klausch, Ad De Jongh
Introduction: Psychotropic medications are frequently prescribed alongside trauma-focused psychotherapy for post-traumatic stress disorder (PTSD), yet their impact on treatment response remains uncertain. This study emulated target trials to examine the association between psychotropic co-medication at treatment onset and psychotherapy outcomes in a real-world PTSD cohort.
Methods: A prospective cohort of 6,125 adults with chronic or delayed-onset PTSD received a standardized 2-8 day trauma-focused psychotherapy program, including daily prolonged exposure and eye movement desensitization and reprocessing (EMDR) therapy, at a Dutch psychotrauma center (2021-2024). Target trial emulation with double machine learning with inverse probability of treatment weighting estimated the effects of specific psychotropic co-medications versus non-use on changes in Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) scores (range, 0-80) from pre-to post-treatment.
Results: Mean CAPS-5 scores improved by 25.7 points (Cohen's d = -2.30). Psychotropic co-medication (n = 1,382) was associated with reduced symptom improvement compared with non-use (model-estimated difference = -2.52 points; relative reduction = -9.4%, 95% CI = -10.0 to -8.9; d = -1.11, E = 10.0). This effect persisted at 6-month follow-up (d = -0.42). Antidepressants overall (d = -0.28; follow-up d = -0.56), amitriptyline (d = -0.51), and mirtazapine (d = -0.29) were consistently associated with poorer outcomes across sensitivity analyses. Similar patterns were observed for anticonvulsants, mood-stabilizing anticonvulsants, antipsychotics, fluoxetine, zolpidem, and zopiclone. Sensitivity analyses and E-values indicated robustness to unmeasured confounding.
Conclusion: Several psychotropic co-medications were associated with reduced outcomes of evidence-based trauma-focused psychotherapy for PTSD. By identifying this as a potentially modifiable factor, psychotherapy outcomes may be optimized. Trials are warranted to evaluate whether tapering or substituting these agents improves outcomes.
精神药物通常与创伤性心理治疗一起用于治疗创伤后应激障碍（PTSD），但它们对治疗反应的影响尚不确定。本研究模拟目标试验，以检验现实世界PTSD队列中治疗开始时精神药物联合用药与心理治疗结果之间的关系。方法：在荷兰精神创伤中心（2021-2024），6125名患有慢性或延迟性PTSD的成年人接受了标准化的2-8天创伤心理治疗项目，包括每天延长暴露时间、眼动脱敏和再加工。使用治疗加权逆概率的双机器学习模拟目标试验，估计特定精神药物联合用药与不使用对临床给药的PTSD量表DSM-5 （CAPS-5）评分（范围，0-80）从治疗前到治疗后的影响。结果：CAPS-5平均评分提高25.7分（Cohen’s d=-2.30）。与未使用精神药物相比，联合使用精神药物（n=1,382）与症状改善程度降低相关（模型估计差异= -2.52点；相对降低= -9.4%,95% CI = -10.0至-8.9;d=-1.11， E=10.0）。这种效果在6个月的随访中持续存在（d=-0.42）。抗抑郁药物总体（d=-0.28；随访d=-0.56）、阿米替林（d=-0.51）和米氮平（d=-0.29）在敏感性分析中一致与较差的结果相关。在抗惊厥药、情绪稳定抗惊厥药、抗精神病药、氟西汀、唑吡坦和唑匹克隆中也观察到类似的模式。敏感性分析和e值表明对未测量的混杂具有稳健性。结论：几种精神药物联合用药与循证创伤心理治疗PTSD的预后降低有关。通过确定这是一个潜在的可改变的因素，心理治疗的结果可能会得到优化。有必要进行试验来评估逐渐减少或替代这些药物是否能改善结果。
{"title":"Concomitant Psychotropic Medication Is Associated with Reduced Outcomes of Trauma-Focused Psychotherapy for Post-Traumatic Stress Disorder.","authors":"Serge A Steenen, Roos van Westrhenen, Camilo C Steenen, L Thomas Klausch, Ad De Jongh","doi":"10.1159/000549259","DOIUrl":"10.1159/000549259","url":null,"abstract":"<p><strong>Introduction: </strong>Psychotropic medications are frequently prescribed alongside trauma-focused psychotherapy for post-traumatic stress disorder (PTSD), yet their impact on treatment response remains uncertain. This study emulated target trials to examine the association between psychotropic co-medication at treatment onset and psychotherapy outcomes in a real-world PTSD cohort.</p><p><strong>Methods: </strong>A prospective cohort of 6,125 adults with chronic or delayed-onset PTSD received a standardized 2-8 day trauma-focused psychotherapy program, including daily prolonged exposure and eye movement desensitization and reprocessing (EMDR) therapy, at a Dutch psychotrauma center (2021-2024). Target trial emulation with double machine learning with inverse probability of treatment weighting estimated the effects of specific psychotropic co-medications versus non-use on changes in Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) scores (range, 0-80) from pre-to post-treatment.</p><p><strong>Results: </strong>Mean CAPS-5 scores improved by 25.7 points (Cohen's d = -2.30). Psychotropic co-medication (n = 1,382) was associated with reduced symptom improvement compared with non-use (model-estimated difference = -2.52 points; relative reduction = -9.4%, 95% CI = -10.0 to -8.9; d = -1.11, E = 10.0). This effect persisted at 6-month follow-up (d = -0.42). Antidepressants overall (d = -0.28; follow-up d = -0.56), amitriptyline (d = -0.51), and mirtazapine (d = -0.29) were consistently associated with poorer outcomes across sensitivity analyses. Similar patterns were observed for anticonvulsants, mood-stabilizing anticonvulsants, antipsychotics, fluoxetine, zolpidem, and zopiclone. Sensitivity analyses and E-values indicated robustness to unmeasured confounding.</p><p><strong>Conclusion: </strong>Several psychotropic co-medications were associated with reduced outcomes of evidence-based trauma-focused psychotherapy for PTSD. By identifying this as a potentially modifiable factor, psychotherapy outcomes may be optimized. Trials are warranted to evaluate whether tapering or substituting these agents improves outcomes.</p>","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":" ","pages":"1-19"},"PeriodicalIF":17.4,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12707873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVEVisceral adipose tissue (VAT) is a metabolically active fat depot linked to cardiometabolic disease, but its relationship with depression independent of general and central adiposity remains unclear. We investigated the association of MRI-quantified VAT with incidence of depression and evaluated whether it predicts depression risk beyond body mass index (BMI) and waist-to-height ratio (WHtR).METHODSWe analyzed 50,729 UK Biobank participants who underwent abdominal MRI between 2014 and 2020. Baseline VAT volume, BMI, and WHtR were measured, and incidence of depression was ascertained. Cox proportional hazards models estimated hazard ratios (HRs) for depression, and restricted cubic splines assessed potential non-linear associations. Mediation analyses quantified the extent to which VAT accounted for associations of BMI and WHtR with depression.RESULTSOver a median follow-up of 15.4 years, each 1-SD higher VAT was associated with a 29% increased risk of depression (HR, 1.29; 95% CI, 1.19-1.39), independent of sociodemographic, behavioral, and clinical factors. Participants in the highest VAT quartile had nearly double the risk compared with the lowest quartile. BMI and WHtR showed non-linear associations but were not independently associated with depression after adjusting for VAT. VAT provided superior predictive value compared with BMI and WHtR, and mediation analyses indicated that it accounted for most of their observed associations.CONCLUSIONSVisceral adiposity, rather than general (BMI-defined) or central (WHtR-defined) adiposity, is the principal adipose-related predictor of depression risk. These findings highlight VAT as the principal adiposity measure for risk assessment and a potential target for prevention.
{"title":"Visceral Adiposity and Risk of Depression Independent of General and Central Adiposity: A Prospective Cohort Study.","authors":"Dengke Wu,Wenbin Nan,Zhenhua Xing","doi":"10.1159/000549345","DOIUrl":"https://doi.org/10.1159/000549345","url":null,"abstract":"OBJECTIVEVisceral adipose tissue (VAT) is a metabolically active fat depot linked to cardiometabolic disease, but its relationship with depression independent of general and central adiposity remains unclear. We investigated the association of MRI-quantified VAT with incidence of depression and evaluated whether it predicts depression risk beyond body mass index (BMI) and waist-to-height ratio (WHtR).METHODSWe analyzed 50,729 UK Biobank participants who underwent abdominal MRI between 2014 and 2020. Baseline VAT volume, BMI, and WHtR were measured, and incidence of depression was ascertained. Cox proportional hazards models estimated hazard ratios (HRs) for depression, and restricted cubic splines assessed potential non-linear associations. Mediation analyses quantified the extent to which VAT accounted for associations of BMI and WHtR with depression.RESULTSOver a median follow-up of 15.4 years, each 1-SD higher VAT was associated with a 29% increased risk of depression (HR, 1.29; 95% CI, 1.19-1.39), independent of sociodemographic, behavioral, and clinical factors. Participants in the highest VAT quartile had nearly double the risk compared with the lowest quartile. BMI and WHtR showed non-linear associations but were not independently associated with depression after adjusting for VAT. VAT provided superior predictive value compared with BMI and WHtR, and mediation analyses indicated that it accounted for most of their observed associations.CONCLUSIONSVisceral adiposity, rather than general (BMI-defined) or central (WHtR-defined) adiposity, is the principal adipose-related predictor of depression risk. These findings highlight VAT as the principal adiposity measure for risk assessment and a potential target for prevention.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"129 5 1","pages":"1-18"},"PeriodicalIF":22.8,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145403870","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}
David Wedema,Johanna H M Hovenkamp-Hermelink,Eliza L Korevaar,Klaas J Wardenaar,Robert A Schoevers
INTRODUCTIONDepression is a common mental disorder with often persistent consequences. Even after adequate treatment, recovery may be far from optimal. To enhance outcomes, we aimed to identify and synthesize factors that depressed adults themselves perceived as facilitating or hindering recovery.METHODSWe searched PubMed, PsycINFO, and SocINDEX (last search: February 2, 2025), screened reference lists and consulted experts. Eligible studies used a qualitative design, published in English or Dutch since 1980, and explored recovery factors in adults (≥18 years) with depression.RESULTSFrom 4,872 records, 3,394 were screened on title and abstract, and 122 on full text. Twenty-seven articles were eligible and included in the qualitative evidence synthesis. These articles described the experiences with recovery from depression of 939 individuals. Most studies were conducted in Europe (N=11), followed by North America (N=7), Asia (N=6), Australia (N=5), and South America (N=2). Eight overarching themes emerged: (1) Social connections, (2) Reconstructing the self, (3) Autonomy, (4) Professional support, (5) Self-management strategies, (6) Physical health, (7) Instrumental facilitators/barriers, and (8) Temporal dimensions. We present an overview of the relative importance of factors and propose a conceptual model illustrating the interconnectedness of themes.CONCLUSIONRecovery from depression involves a diverse range of interconnected factors. While professional treatment is considered valuable, various other factors also influence individuals' recovery. Our findings underscore the need for an integrated and person-centered approach that combines therapeutic support with personal capacities, self-management strategies, and contextual aspects, emphasizing relational quality, self-reflection, and open dialogue, to optimize subjectively experienced recovery.
{"title":"What helps and hinders recovery from depression? A systematic review and qualitative evidence synthesis of patient-identified recovery factors.","authors":"David Wedema,Johanna H M Hovenkamp-Hermelink,Eliza L Korevaar,Klaas J Wardenaar,Robert A Schoevers","doi":"10.1159/000548808","DOIUrl":"https://doi.org/10.1159/000548808","url":null,"abstract":"INTRODUCTIONDepression is a common mental disorder with often persistent consequences. Even after adequate treatment, recovery may be far from optimal. To enhance outcomes, we aimed to identify and synthesize factors that depressed adults themselves perceived as facilitating or hindering recovery.METHODSWe searched PubMed, PsycINFO, and SocINDEX (last search: February 2, 2025), screened reference lists and consulted experts. Eligible studies used a qualitative design, published in English or Dutch since 1980, and explored recovery factors in adults (≥18 years) with depression.RESULTSFrom 4,872 records, 3,394 were screened on title and abstract, and 122 on full text. Twenty-seven articles were eligible and included in the qualitative evidence synthesis. These articles described the experiences with recovery from depression of 939 individuals. Most studies were conducted in Europe (N=11), followed by North America (N=7), Asia (N=6), Australia (N=5), and South America (N=2). Eight overarching themes emerged: (1) Social connections, (2) Reconstructing the self, (3) Autonomy, (4) Professional support, (5) Self-management strategies, (6) Physical health, (7) Instrumental facilitators/barriers, and (8) Temporal dimensions. We present an overview of the relative importance of factors and propose a conceptual model illustrating the interconnectedness of themes.CONCLUSIONRecovery from depression involves a diverse range of interconnected factors. While professional treatment is considered valuable, various other factors also influence individuals' recovery. Our findings underscore the need for an integrated and person-centered approach that combines therapeutic support with personal capacities, self-management strategies, and contextual aspects, emphasizing relational quality, self-reflection, and open dialogue, to optimize subjectively experienced recovery.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"27 1","pages":"1-26"},"PeriodicalIF":22.8,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145403871","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}
Johanne Pereira Ribeiro,Jutta Stoffers-Winterling,Mie Sedoc Jørgensen,Sophie Juul,Minoo Matbouriahi,David Fisher,Wouter van Ballegooijen,Mickey T Kongerslev,Erik Simonsen,Eirini Karyotaki,Pim Cuijpers,Anthony Bateman,Jan Philipp Klein,Federico Amianto,Peter Fonagy,Richard Porter,Katherine Dixon-Gordon,Alexander L Chapman,Kathleen Thomaes,Gitta A Jacob,Ueli Kramer,Björn Philips,Johan Franck,Elahe Majdara,Stefan Priebe,Andrew Chanen,Katie Nicol,Kim T Mueser,David Carlyle,Mary C Zanarini,Donald W Black,Shelley McMain,Jack Dekker,Ole Jakob Storebø
BACKGROUNDBorderline personality disorder (BPD) is a complex and heterogeneous condition. Psychotherapy reduces symptom severity; however, characteristics of the individual may influence treatment outcomes. This systematic review examined whether specific baseline variables moderate the effect of psychotherapy on BPD severity through individual participant data meta-analysis (IPD-MA).METHODSA literature search up to 12 May 2025 across 10 databases (including PubMed, Medline, Embase, PsychINFO, CINAHL, Web of Science, and Cochrane CENTRAL) identified randomised clinical trials (RCTs) comparing psychotherapy to treatment as usual (TAU) or clinical management control interventions (CM) for BPD. Authors of included trials were contacted to retrieve IPD. IPD-MAs employed a one-stage random-effects approach to estimate treatment effects and potential moderators in bivariate linear mixed-effects models. The study was registered with PROSPERO (CRD42021210688).RESULTSOut of 33696 records identified, 42 RCTs (3848 participants) were eligible. IPD was obtained from 19 trials (1482 participants). All trials had an overall high risk of bias. There was a high rate of missing data across trials (378/1482, 25.1%). IPD-MA showed that psychotherapy significantly reduced BPD severity compared to TAU/CM (β: -.25, 95% CI: -.43 to -.07, SE: .09, p = .0065; 19 trials, 1104 participants). Significant negative moderators were co-occurring depressive disorder(s) (β: .31, 95% CI: .03 to .59) and exposure to sexual trauma (β: .60, 95% CI: .16 to 1.04). While positive moderators were co-occurring anxiety disorder(s) (β -.34, 95% CI: -.64 to -.03) and alcohol-use disorder(s) (AUD) (β -.34, 95% CI: -.67 to -.01).CONCLUSIONPsychotherapy may be especially beneficial for BPD with co-occurring anxiety. Patients with co-occurring AUD should not be excluded from treatment; rather, treatment motivation should be emphasised. Further, clinicians should prioritise trauma-informed care.
{"title":"Treatment moderators of symptom severity in psychotherapy for people with borderline personality disorder: Systematic review with meta-analyses of individual participant data.","authors":"Johanne Pereira Ribeiro,Jutta Stoffers-Winterling,Mie Sedoc Jørgensen,Sophie Juul,Minoo Matbouriahi,David Fisher,Wouter van Ballegooijen,Mickey T Kongerslev,Erik Simonsen,Eirini Karyotaki,Pim Cuijpers,Anthony Bateman,Jan Philipp Klein,Federico Amianto,Peter Fonagy,Richard Porter,Katherine Dixon-Gordon,Alexander L Chapman,Kathleen Thomaes,Gitta A Jacob,Ueli Kramer,Björn Philips,Johan Franck,Elahe Majdara,Stefan Priebe,Andrew Chanen,Katie Nicol,Kim T Mueser,David Carlyle,Mary C Zanarini,Donald W Black,Shelley McMain,Jack Dekker,Ole Jakob Storebø","doi":"10.1159/000548417","DOIUrl":"https://doi.org/10.1159/000548417","url":null,"abstract":"BACKGROUNDBorderline personality disorder (BPD) is a complex and heterogeneous condition. Psychotherapy reduces symptom severity; however, characteristics of the individual may influence treatment outcomes. This systematic review examined whether specific baseline variables moderate the effect of psychotherapy on BPD severity through individual participant data meta-analysis (IPD-MA).METHODSA literature search up to 12 May 2025 across 10 databases (including PubMed, Medline, Embase, PsychINFO, CINAHL, Web of Science, and Cochrane CENTRAL) identified randomised clinical trials (RCTs) comparing psychotherapy to treatment as usual (TAU) or clinical management control interventions (CM) for BPD. Authors of included trials were contacted to retrieve IPD. IPD-MAs employed a one-stage random-effects approach to estimate treatment effects and potential moderators in bivariate linear mixed-effects models. The study was registered with PROSPERO (CRD42021210688).RESULTSOut of 33696 records identified, 42 RCTs (3848 participants) were eligible. IPD was obtained from 19 trials (1482 participants). All trials had an overall high risk of bias. There was a high rate of missing data across trials (378/1482, 25.1%). IPD-MA showed that psychotherapy significantly reduced BPD severity compared to TAU/CM (β: -.25, 95% CI: -.43 to -.07, SE: .09, p = .0065; 19 trials, 1104 participants). Significant negative moderators were co-occurring depressive disorder(s) (β: .31, 95% CI: .03 to .59) and exposure to sexual trauma (β: .60, 95% CI: .16 to 1.04). While positive moderators were co-occurring anxiety disorder(s) (β -.34, 95% CI: -.64 to -.03) and alcohol-use disorder(s) (AUD) (β -.34, 95% CI: -.67 to -.01).CONCLUSIONPsychotherapy may be especially beneficial for BPD with co-occurring anxiety. Patients with co-occurring AUD should not be excluded from treatment; rather, treatment motivation should be emphasised. Further, clinicians should prioritise trauma-informed care.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"44 1","pages":"1-32"},"PeriodicalIF":22.8,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357918","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}
Maria Serra-Blasco,Neus Miquel-Giner,Muriel Vicent-Gil,Daniel Porta-Casteràs,Ignacio Martínez-Zalacaín,Marta Cano,Víctor De la Peña-Arteaga,Lorea Mar-Barrutia,Maria Alemany-Navarro,Carles Soriano-Mas,Marina López-Solà,Jessica R Andrews-Hanna,Maria J Portella,Joaquim Soler,Narcís Cardoner,Pino Alonso,Clara López-Solà
INTRODUCTIONObsessive-compulsive disorder (OCD) is a chronic condition where many patients remain symptomatic despite first-line treatments such as Cognitive Behavioural Therapy and selective serotonin reuptake inhibitors. This randomised controlled trial evaluated Mindfulness-Based Cognitive Therapy (MBCT) efficacy as an augmentation strategy and its impact on brain functional connectivity.METHODSSixty-eight participants with moderately symptomatic OCD were randomised into MBCT or Treatment as Usual (TAU). Clinical outcomes were evaluated using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Obsessive-Compulsive Inventory, alongside other relevant secondary outcomes. Data were analysed using repeated measures ANOVA to assess time * group effects. Neuroimaging functional measures (resting-state network-connectivity), were collected before and after the intervention and analysed using independent component analysis.RESULTSPrimary outcome: MBCT significantly reduced OCD symptoms compared to TAU (31.73% vs. 8.07% Y-BOCS reduction).SECONDARY OUTCOMESMBCT group also experienced reductions in depressive symptoms, rumination, perceived stress and quality of life. No significant post-treatment changes were observed in resting-state connectivity. However, baseline connectivity demonstrated significant predictive value, with lower connectivity in pre-selected networks of interest, including the fronto-striatal, salience, and default-mode networks, associated with greater reductions in Y-BOCS scores.CONCLUSIONMBCT is an effective strategy for individuals with moderately symptomatic OCD who continue to experience symptoms despite prior gold-standard treatments. While no post-treatment changes in brain functional connectivity were observed, baseline connectivity patterns predicted symptom reduction, suggesting a neural basis for MBCT response. Trial name: Mindfulness-Based Cognitive Therapy: Efficacy and fMRI-based Response Predictors in a Group of OCD Patients. ID number: NCT03128749.
{"title":"Clinical and Neuroimaging Effects of Mindfulness-Based Cognitive Therapy for Symptomatic OCD Patients after First-Line Treatments: A Randomised Controlled Trial.","authors":"Maria Serra-Blasco,Neus Miquel-Giner,Muriel Vicent-Gil,Daniel Porta-Casteràs,Ignacio Martínez-Zalacaín,Marta Cano,Víctor De la Peña-Arteaga,Lorea Mar-Barrutia,Maria Alemany-Navarro,Carles Soriano-Mas,Marina López-Solà,Jessica R Andrews-Hanna,Maria J Portella,Joaquim Soler,Narcís Cardoner,Pino Alonso,Clara López-Solà","doi":"10.1159/000548961","DOIUrl":"https://doi.org/10.1159/000548961","url":null,"abstract":"INTRODUCTIONObsessive-compulsive disorder (OCD) is a chronic condition where many patients remain symptomatic despite first-line treatments such as Cognitive Behavioural Therapy and selective serotonin reuptake inhibitors. This randomised controlled trial evaluated Mindfulness-Based Cognitive Therapy (MBCT) efficacy as an augmentation strategy and its impact on brain functional connectivity.METHODSSixty-eight participants with moderately symptomatic OCD were randomised into MBCT or Treatment as Usual (TAU). Clinical outcomes were evaluated using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Obsessive-Compulsive Inventory, alongside other relevant secondary outcomes. Data were analysed using repeated measures ANOVA to assess time * group effects. Neuroimaging functional measures (resting-state network-connectivity), were collected before and after the intervention and analysed using independent component analysis.RESULTSPrimary outcome: MBCT significantly reduced OCD symptoms compared to TAU (31.73% vs. 8.07% Y-BOCS reduction).SECONDARY OUTCOMESMBCT group also experienced reductions in depressive symptoms, rumination, perceived stress and quality of life. No significant post-treatment changes were observed in resting-state connectivity. However, baseline connectivity demonstrated significant predictive value, with lower connectivity in pre-selected networks of interest, including the fronto-striatal, salience, and default-mode networks, associated with greater reductions in Y-BOCS scores.CONCLUSIONMBCT is an effective strategy for individuals with moderately symptomatic OCD who continue to experience symptoms despite prior gold-standard treatments. While no post-treatment changes in brain functional connectivity were observed, baseline connectivity patterns predicted symptom reduction, suggesting a neural basis for MBCT response. Trial name: Mindfulness-Based Cognitive Therapy: Efficacy and fMRI-based Response Predictors in a Group of OCD Patients. ID number: NCT03128749.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"101 1","pages":"1-32"},"PeriodicalIF":22.8,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145332012","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}
David C Saunders,Shosuke Suzuki,Nilofar Vafaie,Michael H Bloch,Hedy Kober
INTRODUCTIONMindfulness has been shown to benefit children and adolescents. However, predictors of treatment effects of mindfulness-based interventions (MBIs) are less well-known.OBJECTIVETest the treatment effect of MBIs in children/adolescents; test for moderation by meditation practice history (MPH) of the investigator(s); compare moderation by MPH to other study- and participant-level variables.METHODSStudies were identified in PubMed and Google Scholar. English-language reports of clinical trials testing an MBI in youth were included. Investigator MPH was collected via online survey distributed to the first, last, and/or corresponding authors of included studies. Data were analyzed using random-effects models. We preformed omnibus, moderator, and multiple publication bias analyses. Treatment efficacy (Hedge's g and r) was the primary outcome. Secondary analyses included tests for moderation by study- and participant-level characteristics, and investigator MPH.RESULTSData were included from 107 studies, including 1,393 statistics and 8,510 participants. We observed a small-to-moderate significant omnibus effect size (g = 0.33, CI: 0.27-0.39). MBI effects were significantly associated with minutes investigators meditated in the past 24 hours (p=0.05) and number of times investigators meditated in the past 7 days (p<0.01), with those meditating >30 minutes (g=0.51 [0.35-0.66]) and more than 7 times (g=0.52 [0.39-0.65]), respectively, displaying the highest effect sizes.CONCLUSIONThese findings confirm the benefit of MBIs in youth. We provide novel evidence that greater investigator MPH is significantly associated with better treatment outcomes. The results may invite a new way of thinking about and evaluating the mental health treatment literature and may motivate similar studies in other populations or interventions.
{"title":"Investigator Meditation Practice Predicts Efficacy of Child/Adolescent Mindfulness-Based Interventions: A Meta-Analysis.","authors":"David C Saunders,Shosuke Suzuki,Nilofar Vafaie,Michael H Bloch,Hedy Kober","doi":"10.1159/000548530","DOIUrl":"https://doi.org/10.1159/000548530","url":null,"abstract":"INTRODUCTIONMindfulness has been shown to benefit children and adolescents. However, predictors of treatment effects of mindfulness-based interventions (MBIs) are less well-known.OBJECTIVETest the treatment effect of MBIs in children/adolescents; test for moderation by meditation practice history (MPH) of the investigator(s); compare moderation by MPH to other study- and participant-level variables.METHODSStudies were identified in PubMed and Google Scholar. English-language reports of clinical trials testing an MBI in youth were included. Investigator MPH was collected via online survey distributed to the first, last, and/or corresponding authors of included studies. Data were analyzed using random-effects models. We preformed omnibus, moderator, and multiple publication bias analyses. Treatment efficacy (Hedge's g and r) was the primary outcome. Secondary analyses included tests for moderation by study- and participant-level characteristics, and investigator MPH.RESULTSData were included from 107 studies, including 1,393 statistics and 8,510 participants. We observed a small-to-moderate significant omnibus effect size (g = 0.33, CI: 0.27-0.39). MBI effects were significantly associated with minutes investigators meditated in the past 24 hours (p=0.05) and number of times investigators meditated in the past 7 days (p<0.01), with those meditating >30 minutes (g=0.51 [0.35-0.66]) and more than 7 times (g=0.52 [0.39-0.65]), respectively, displaying the highest effect sizes.CONCLUSIONThese findings confirm the benefit of MBIs in youth. We provide novel evidence that greater investigator MPH is significantly associated with better treatment outcomes. The results may invite a new way of thinking about and evaluating the mental health treatment literature and may motivate similar studies in other populations or interventions.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"24 1","pages":"1-19"},"PeriodicalIF":22.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145241037","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：