INTRODUCTIONMental pain-a pain not primarily felt in the body-is a predictor of suicide and is often described as one of the most distressing aspects of depression. However, the absence of a clear definition hampers both research and clinical practice. This metasynthesis aims to characterize the lived experience of mental pain to inform the future development of a definition.METHODSWe conducted a systematic search in MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science to identify qualitative studies reporting first-person accounts of mental pain. Thematic synthesis was used to generate descriptive and analytical themes, drawing on semantic, clinical, and phenomenological insights. The quality of the primary studies was assessed using the Critical Appraisal Skills Programme (CASP), and the Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach was applied to evaluate the findings.RESULTSThe metasynthesis included 49 qualitative studies with 1,467 participants and led to the development of 22 themes and 85 subthemes. Mental pain was defined by five phenomenal features: unpleasant, immediate, identity-disrupting, invisible, and often perceived as worse than physical pain. It is also accompanied by unspecific psychological and physical manifestations. The emergence of mental pain can be conceptualized as a signal of a threatened sense of self in response to bodily, psychological, existential, or social adversity. Confidence in the findings was moderate due to methodological and reporting limitations.CONCLUSIONA clearer understanding of mental pain may enhance clinical practice by helping clinicians better identify, understand, and respond to this form of suffering.
精神上的痛苦——一种主要不是在身体上感受到的痛苦——是自杀的前兆，通常被描述为抑郁症最令人痛苦的方面之一。然而，缺乏明确的定义阻碍了研究和临床实践。这种元合成的目的是表征精神痛苦的生活经验，以告知未来发展的定义。方法我们在MEDLINE， EMBASE, PsycINFO， CINAHL和Web of Science中进行了系统的检索，以确定报告第一人称精神疼痛的定性研究。主题综合用于生成描述性和分析性主题，利用语义，临床和现象学的见解。使用关键评估技能计划（CASP）评估初步研究的质量，并使用定性研究综述证据的置信度（GRADE-CERQual）方法评估研究结果。结果荟萃共纳入49项定性研究，共1467名受试者，共开发了22个主题和85个副主题。精神上的痛苦被定义为五个显著特征：令人不快的、即时的、扰乱身份的、无形的，并且通常被认为比身体上的痛苦更糟糕。它还伴有非特异性的心理和生理表现。精神疼痛的出现可以被概念化为对身体、心理、存在或社会逆境的自我威胁感的反应。由于方法和报告的限制，研究结果的可信度不高。结论对精神疼痛的认识可以帮助临床医生更好地识别、理解和应对这种形式的痛苦，从而提高临床实践水平。
{"title":"What is mental pain? A systematic review and metasynthesis of qualitative research on the lived experience of mental pain.","authors":"Samy Kozlowitz,Alexandre Ribeiro,Jordan Sibeoni,Baptiste Brossard,Astrid Chevance","doi":"10.1159/000548567","DOIUrl":"https://doi.org/10.1159/000548567","url":null,"abstract":"INTRODUCTIONMental pain-a pain not primarily felt in the body-is a predictor of suicide and is often described as one of the most distressing aspects of depression. However, the absence of a clear definition hampers both research and clinical practice. This metasynthesis aims to characterize the lived experience of mental pain to inform the future development of a definition.METHODSWe conducted a systematic search in MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science to identify qualitative studies reporting first-person accounts of mental pain. Thematic synthesis was used to generate descriptive and analytical themes, drawing on semantic, clinical, and phenomenological insights. The quality of the primary studies was assessed using the Critical Appraisal Skills Programme (CASP), and the Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach was applied to evaluate the findings.RESULTSThe metasynthesis included 49 qualitative studies with 1,467 participants and led to the development of 22 themes and 85 subthemes. Mental pain was defined by five phenomenal features: unpleasant, immediate, identity-disrupting, invisible, and often perceived as worse than physical pain. It is also accompanied by unspecific psychological and physical manifestations. The emergence of mental pain can be conceptualized as a signal of a threatened sense of self in response to bodily, psychological, existential, or social adversity. Confidence in the findings was moderate due to methodological and reporting limitations.CONCLUSIONA clearer understanding of mental pain may enhance clinical practice by helping clinicians better identify, understand, and respond to this form of suffering.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"103 1","pages":"1-20"},"PeriodicalIF":22.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189492","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":"Menstrual Cycle Dynamics in Mental Health Demand new Approaches in Psychotherapy and Digital Health.","authors":"Sibel Nayman,Inga Niedtfeld,Bernd Lenz,Alexander Karabatsiakis,Christian Schmahl,Christine Kuehner","doi":"10.1159/000548508","DOIUrl":"https://doi.org/10.1159/000548508","url":null,"abstract":"","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"56 1","pages":"1-5"},"PeriodicalIF":22.8,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083512","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}
Tao Zhang,Bryant Pui Hung Hui,Ducasse Ducasse,Ying Li,Yongyi Wang,Jiawei Hu,Willie Tang Chung Tang,Yingzi Ke
INTRODUCTIONSelf-injurious thoughts and behaviors (SITBs) are major public health issues worldwide. In recent years, there has been a growing body of research investigating the application of acceptance and commitment therapy (ACT) for SITBs. This study systematically reviews and meta-analyzes the effectiveness of ACT in reducing SITBs.METHODSWe systematically searched six databases and examined the reference lists of relevant studies. Studies that explored the effectiveness of ACT versus control conditions for reducing SITBs were included. Effect sizes were calculated using Hedges' g with the random effect model. Subgroup analyses and meta-regression were also performed.RESULTSA total of 48 studies (N = 4,719) were included in this review. The results indicated that ACT outperformed control conditions in alleviating suicide ideation (g = -0.64), suicide attempt (g = -0.66), self-harm (g = -1.53), non-suicidal self-injury (g = -0.59), and overall SITBs (g = -0.99) at post-treatment. Also, ACT was effective in reducing suicide ideation (g = -2.15), non-suicidal self-injury (g = -1.18), and overall SITBs (g = -1.52) at follow-up. Moderator analyses revealed that ACT was more successful in mitigating suicide ideation when delivered in a group format or in Eastern countries. Similarly, studies conducted in Eastern countries, or those employing direct interventions, reported greater efficacy in addressing overall SITBs.CONCLUSIONThis review highlights the effectiveness of ACT in reducing SITBs and suggests that it may serve as a promising alternative strategy to standard treatment for SITBs. More high-quality and large-scale randomized controlled trials are required to substantiate our findings.
{"title":"Efficacy of Acceptance and Commitment Therapy for Suicide and Self-harm: A Systematic Review and Meta-analysis.","authors":"Tao Zhang,Bryant Pui Hung Hui,Ducasse Ducasse,Ying Li,Yongyi Wang,Jiawei Hu,Willie Tang Chung Tang,Yingzi Ke","doi":"10.1159/000548398","DOIUrl":"https://doi.org/10.1159/000548398","url":null,"abstract":"INTRODUCTIONSelf-injurious thoughts and behaviors (SITBs) are major public health issues worldwide. In recent years, there has been a growing body of research investigating the application of acceptance and commitment therapy (ACT) for SITBs. This study systematically reviews and meta-analyzes the effectiveness of ACT in reducing SITBs.METHODSWe systematically searched six databases and examined the reference lists of relevant studies. Studies that explored the effectiveness of ACT versus control conditions for reducing SITBs were included. Effect sizes were calculated using Hedges' g with the random effect model. Subgroup analyses and meta-regression were also performed.RESULTSA total of 48 studies (N = 4,719) were included in this review. The results indicated that ACT outperformed control conditions in alleviating suicide ideation (g = -0.64), suicide attempt (g = -0.66), self-harm (g = -1.53), non-suicidal self-injury (g = -0.59), and overall SITBs (g = -0.99) at post-treatment. Also, ACT was effective in reducing suicide ideation (g = -2.15), non-suicidal self-injury (g = -1.18), and overall SITBs (g = -1.52) at follow-up. Moderator analyses revealed that ACT was more successful in mitigating suicide ideation when delivered in a group format or in Eastern countries. Similarly, studies conducted in Eastern countries, or those employing direct interventions, reported greater efficacy in addressing overall SITBs.CONCLUSIONThis review highlights the effectiveness of ACT in reducing SITBs and suggests that it may serve as a promising alternative strategy to standard treatment for SITBs. More high-quality and large-scale randomized controlled trials are required to substantiate our findings.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"68 1","pages":"1-28"},"PeriodicalIF":22.8,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058951","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}
Miriam A Schiele,Harry A Fagan,David S Baldwin,Katharina Domschke
Treatment resistance in anxiety disorders (TR-AD) constitutes a major clinical challenge conferring a considerable burden regarding quality of life and societal health costs. This systematic review provides an overview of pharmacological, psychotherapeutic and neurostimulatory treatment options in adults with treatment-resistant generalized anxiety disorder (TR-GAD), panic disorder (TR-PD) / agoraphobia and social anxiety disorder (TR-SAD). A total of 26 randomised controlled trials (RCTs) and 36 open label studies were identified, with, however, mostly small sample sizes and several methodological limitations. According to RCTs, selective serotonin reuptake inhibitors (SSRI) or clomipramine are effective in TR-PD after failure to respond to cognitive behavioral therapy (CBT). In pharmacological TR-SAD, switching from one SSRI to another or to venlafaxine was found helpful in open label trials. RCTs further suggest augmentation with quetiapine, risperidone, olanzapine or pregabalin in TR-GAD, pindolol in TR-PD and clonazepam in TR-SAD. Open label studies in TR-AD provide preliminary evidence for ketamine or augmentation with nefazodone, reboxetine, buspirone, aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone, divalproex sodium, levetiracetam, zonisamide, flumazenil, pregabalin, cannabidiol and acamprosate. For pharmacological TR, CBT was effective in several RCTs. Following non-response to CBT, first evidence suggests effectiveness of Acceptance and Commitment Therapy and Mindfulness-Based Cognitive Therapy. Only inconclusive support was identified for repetitive transcranial magnetic stimulation (rTMS) in TR-AD. In summary, this integrative review may provide an evidence base for expert recommendations, inform clinical guidelines, and inspire further research into innovative, personalized treatment of TR-AD increasing response rates and lowering the considerable individual and public health burden of anxiety disorders.
{"title":"INTEGRATIVE SYSTEMATIC REVIEW ON PHARMACOLOGICAL, PSYCHOTHERAPEUTIC AND NEUROSTIMULATORY TREATMENT OPTIONS IN TREATMENT-RESISTANT ANXIETY DISORDERS.","authors":"Miriam A Schiele,Harry A Fagan,David S Baldwin,Katharina Domschke","doi":"10.1159/000547926","DOIUrl":"https://doi.org/10.1159/000547926","url":null,"abstract":"Treatment resistance in anxiety disorders (TR-AD) constitutes a major clinical challenge conferring a considerable burden regarding quality of life and societal health costs. This systematic review provides an overview of pharmacological, psychotherapeutic and neurostimulatory treatment options in adults with treatment-resistant generalized anxiety disorder (TR-GAD), panic disorder (TR-PD) / agoraphobia and social anxiety disorder (TR-SAD). A total of 26 randomised controlled trials (RCTs) and 36 open label studies were identified, with, however, mostly small sample sizes and several methodological limitations. According to RCTs, selective serotonin reuptake inhibitors (SSRI) or clomipramine are effective in TR-PD after failure to respond to cognitive behavioral therapy (CBT). In pharmacological TR-SAD, switching from one SSRI to another or to venlafaxine was found helpful in open label trials. RCTs further suggest augmentation with quetiapine, risperidone, olanzapine or pregabalin in TR-GAD, pindolol in TR-PD and clonazepam in TR-SAD. Open label studies in TR-AD provide preliminary evidence for ketamine or augmentation with nefazodone, reboxetine, buspirone, aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone, divalproex sodium, levetiracetam, zonisamide, flumazenil, pregabalin, cannabidiol and acamprosate. For pharmacological TR, CBT was effective in several RCTs. Following non-response to CBT, first evidence suggests effectiveness of Acceptance and Commitment Therapy and Mindfulness-Based Cognitive Therapy. Only inconclusive support was identified for repetitive transcranial magnetic stimulation (rTMS) in TR-AD. In summary, this integrative review may provide an evidence base for expert recommendations, inform clinical guidelines, and inspire further research into innovative, personalized treatment of TR-AD increasing response rates and lowering the considerable individual and public health burden of anxiety disorders.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"16 1","pages":"1-43"},"PeriodicalIF":22.8,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058952","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}
Christian Fazekas,Nandu Goswami,Franziska Matzer,Alexander Avian,Julia Lodron,Marc Rijksen,Barbara Hanfstingl,Voyko Kavcic,Andrea Groselj-Strele,Harald Sourij,Harald H Kessler,Evelyn Stelzl,Clarissa Daniela Voegel,Tina Maria Binz,Karin Schmid-Zalaudek,Alexander Wittmann,Stefan Pilz
INTRODUCTIONUnderstanding chronic stress as a potential risk factor for COVID-19 progression could inform public health measures and personalized preventive interventions. Therefore, we investigated the influence of chronic stress prior to SARS-CoV-2 infection on symptom persistence 1 month after COVID-19 onset.METHODSThe participants of this prospective cohort study named "StressLoC" were adults with COVID-19 who had tested positive for SARS-CoV-2 infection within the last 7 days. Pre-existing perceived chronic stress assessed by the Perceived Stress Scale (PSS-10) was the primary predictor. The number of stressful life events and hair cortisol concentration served as additional measures of pre-existing chronic stress. The main outcome was examined using the Long COVID Symptom and Impact Tool. It was defined as the presence of any new and impactful COVID-19-related symptom at month 1 after inclusion. Accordingly, participants were assigned to either the ongoing symptomatic COVID-19 group (OSC-G) or control group.RESULTSThe study cohort comprised 288 participants (73.3% female), with a median age of 46 years (IQR 35-56). A total of 210 participants (72.9%) were categorized as OSC-G. Multivariate logistic regression showed that allocation to OSC-G was predicted by perceived chronic stress in the month prior to COVID-19 (OR: 1.08, 95% CI: 1.03-1.14; p = 0.002) and the number of pre-existing symptoms (OR: 1.08, 95% CI: 1.03-1.13; p = 0.001). The number of stressful life events and hair cortisol concentration did not predict OSC-G allocation.CONCLUSIONSResults suggest that higher levels of pre-existing perceived chronic stress increase the odds of developing ongoing symptomatic COVID-19.
了解慢性压力是COVID-19进展的潜在危险因素可以为公共卫生措施和个性化预防干预提供信息。因此，我们研究了SARS-CoV-2感染前的慢性应激对COVID-19发病后1个月症状持续性的影响。方法本前瞻性队列研究“StressLoC”的参与者是在过去7天内检测出SARS-CoV-2感染阳性的COVID-19成年人。以感知压力量表（PSS-10）评估的预先存在的感知慢性压力是主要预测因子。压力生活事件的数量和头发皮质醇浓度作为预先存在的慢性压力的额外测量。使用长COVID症状和影响工具检查主要结果。定义为在纳入后第1个月出现任何新的和有影响的covid -19相关症状。因此，参与者被分配到持续症状的COVID-19组（OSC-G）或对照组。结果研究队列包括288名参与者（73.3%为女性），中位年龄为46岁（IQR 35-56岁）。共有210名参与者（72.9%）被归类为OSC-G。多因素logistic回归显示，COVID-19前一个月的慢性应激感知（OR: 1.08, 95% CI: 1.03-1.14; p = 0.002）和先前存在的症状数量（OR: 1.08, 95% CI: 1.03-1.13; p = 0.001）预测了OSC-G的分配。压力生活事件的数量和毛发皮质醇浓度不能预测OSC-G分配。结论：研究结果表明，较高水平的既往感知慢性压力会增加发生持续症状性COVID-19的几率。
{"title":"Perceived Chronic Stress prior to SARS-CoV-2 Infection Predicts Ongoing Symptomatic COVID-19: A Prospective Cohort Study.","authors":"Christian Fazekas,Nandu Goswami,Franziska Matzer,Alexander Avian,Julia Lodron,Marc Rijksen,Barbara Hanfstingl,Voyko Kavcic,Andrea Groselj-Strele,Harald Sourij,Harald H Kessler,Evelyn Stelzl,Clarissa Daniela Voegel,Tina Maria Binz,Karin Schmid-Zalaudek,Alexander Wittmann,Stefan Pilz","doi":"10.1159/000547858","DOIUrl":"https://doi.org/10.1159/000547858","url":null,"abstract":"INTRODUCTIONUnderstanding chronic stress as a potential risk factor for COVID-19 progression could inform public health measures and personalized preventive interventions. Therefore, we investigated the influence of chronic stress prior to SARS-CoV-2 infection on symptom persistence 1 month after COVID-19 onset.METHODSThe participants of this prospective cohort study named \"StressLoC\" were adults with COVID-19 who had tested positive for SARS-CoV-2 infection within the last 7 days. Pre-existing perceived chronic stress assessed by the Perceived Stress Scale (PSS-10) was the primary predictor. The number of stressful life events and hair cortisol concentration served as additional measures of pre-existing chronic stress. The main outcome was examined using the Long COVID Symptom and Impact Tool. It was defined as the presence of any new and impactful COVID-19-related symptom at month 1 after inclusion. Accordingly, participants were assigned to either the ongoing symptomatic COVID-19 group (OSC-G) or control group.RESULTSThe study cohort comprised 288 participants (73.3% female), with a median age of 46 years (IQR 35-56). A total of 210 participants (72.9%) were categorized as OSC-G. Multivariate logistic regression showed that allocation to OSC-G was predicted by perceived chronic stress in the month prior to COVID-19 (OR: 1.08, 95% CI: 1.03-1.14; p = 0.002) and the number of pre-existing symptoms (OR: 1.08, 95% CI: 1.03-1.13; p = 0.001). The number of stressful life events and hair cortisol concentration did not predict OSC-G allocation.CONCLUSIONSResults suggest that higher levels of pre-existing perceived chronic stress increase the odds of developing ongoing symptomatic COVID-19.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"138 1","pages":"1-12"},"PeriodicalIF":22.8,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025281","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}
Sarah Maguire,Francisco J Schneuer,Kelly M Dann,Sarah Barakat,Jane Miskovic-Wheatley,Moin Ahmed,Morgan Sidari,Grant Sara,Kristi Griffiths,Ian B Hickie,Janice Russell,Stephen Touyz,Sloane Madden,Claire Diffey,Michelle Roberton,Warren Ward,Amy Hannigan,Michelle Cunich,Natasha Nassar
BACKGROUNDMost previous mortality research in eating disorders involves individuals attending specialist treatment services. Data linkage across jurisdictional health databases at a population level improves the generalisability of findings.AIMSTo investigate mortality risk and causes of death for people with an eating disorder across a large geographic region using administrative health datasets.METHODUsing linked hospital, mental health and death records, a retrospective cohort study was conducted including individuals aged 10-59 years who received an eating disorder diagnosis during hospital-based encounters in Australia, over a 10-year period between 2010 and 2019. A contemporary cohort of people accessing community care only were also evaluated. Mortality rates and standardised morality ratios (SMR) compared to the general population were calculated for each state, and by sex and age groups. Cox regression models were used to assess the risk of sociodemographic characteristics on mortality.RESULTSMortality in people hospitalised with an eating disorder (N=19,697) was more than four times higher than the general population (SMR: 4.54), and highest in people aged 30-39 years (SMR: 13.32). Men hospitalised for eating disorders had a higher risk of death. Mortality rates in anorexia nervosa were not higher than other eating disorder diagnoses. Almost three-quarters of deaths were caused by suicide/self-harm or cardio/respiratory illness.CONCLUSIONSPeople accessing hospital care with eating disorders in Australia have a higher risk of premature death regardless of age, sex or eating disorder diagnosis. Gender and age group disparities can inform policy and resource allocation and support the development of targeted interventions.
{"title":"Mortality in people with eating disorders presenting to the health system: A national population-based record linkage study.","authors":"Sarah Maguire,Francisco J Schneuer,Kelly M Dann,Sarah Barakat,Jane Miskovic-Wheatley,Moin Ahmed,Morgan Sidari,Grant Sara,Kristi Griffiths,Ian B Hickie,Janice Russell,Stephen Touyz,Sloane Madden,Claire Diffey,Michelle Roberton,Warren Ward,Amy Hannigan,Michelle Cunich,Natasha Nassar","doi":"10.1159/000547950","DOIUrl":"https://doi.org/10.1159/000547950","url":null,"abstract":"BACKGROUNDMost previous mortality research in eating disorders involves individuals attending specialist treatment services. Data linkage across jurisdictional health databases at a population level improves the generalisability of findings.AIMSTo investigate mortality risk and causes of death for people with an eating disorder across a large geographic region using administrative health datasets.METHODUsing linked hospital, mental health and death records, a retrospective cohort study was conducted including individuals aged 10-59 years who received an eating disorder diagnosis during hospital-based encounters in Australia, over a 10-year period between 2010 and 2019. A contemporary cohort of people accessing community care only were also evaluated. Mortality rates and standardised morality ratios (SMR) compared to the general population were calculated for each state, and by sex and age groups. Cox regression models were used to assess the risk of sociodemographic characteristics on mortality.RESULTSMortality in people hospitalised with an eating disorder (N=19,697) was more than four times higher than the general population (SMR: 4.54), and highest in people aged 30-39 years (SMR: 13.32). Men hospitalised for eating disorders had a higher risk of death. Mortality rates in anorexia nervosa were not higher than other eating disorder diagnoses. Almost three-quarters of deaths were caused by suicide/self-harm or cardio/respiratory illness.CONCLUSIONSPeople accessing hospital care with eating disorders in Australia have a higher risk of premature death regardless of age, sex or eating disorder diagnosis. Gender and age group disparities can inform policy and resource allocation and support the development of targeted interventions.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"24 1","pages":"1-20"},"PeriodicalIF":22.8,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995893","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":"Enhancing Yoga Interventions in Oncology: Addressing Heterogeneity and Long-Term Sustainability.","authors":"Jianing Miao, Jun Li, Yaling Li","doi":"10.1159/000548052","DOIUrl":"10.1159/000548052","url":null,"abstract":"","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":" ","pages":"1-2"},"PeriodicalIF":17.4,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966334","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}
Psychotherapy is the primary treatment for adolescent Borderline Personality Pathology (BPP), yet its mechanisms remain unclear. Given potential self-report biases due to alexithymia and impaired interoception, this study examined cortisol responses as a physiological stress marker alongside session ratings from adolescent BPP patients and their therapists to assess its potential as a complementary measure in psychotherapy process research. N = 56 adolescents (94.6% female) with BPP (≥ 3 DSM-IV BPD criteria) receiving Adolescent Identity Treatment or Dialectical Behavioral Therapy and their therapists provided pre- and post-session salivary cortisol samples and completed the Session Evaluation Questionnaire. Residual Dynamic Structural Equation Modelling examined associations between cortisol responses and session ratings, with moderation by age, depression, BPP severity, identity diffusion, and trauma. Cortisol responses did not correlate with session ratings in patients. In therapists, higher cortisol responses were associated with lower session smoothness (r = -.164; p < .001) and deepness (r = -.086; p = .004), as well as with lower positivity (r = -.145; p < .001) and higher arousal (r = .072; p = .012) post-session. Higher depression levels moderated the association between cortisol responses and session deepness in patients (β = -.009, p = .007). While session ratings and cortisol responses correlated in therapists, no such correlation was found in patients. Possible mechanisms include altered interoceptive abilities, dysregulated hypothalamic-pituitary-adrenal (HPA) axis function, or increased variability in self-ratings or cortisol due to BPP. While physiological markers and self-reports offer complementary insights into psychotherapy processes, future studies should include healthy and clinical controls and baseline investigation of HPA axis function (i.e. stress reactivity) in both groups, along with additional hormonal markers.
心理治疗是青少年边缘性人格病理学（BPP）的主要治疗方法，但其机制尚不清楚。鉴于述情障碍和内感受受损可能导致的自我报告偏差，本研究将皮质醇反应与青少年BPP患者及其治疗师的会话评分一起作为生理应激标记，以评估其作为心理治疗过程研究补充措施的潜力。N = 56名接受青少年认同治疗或辩证行为治疗的BPP（≥3项DSM-IV BPD标准）青少年（94.6%为女性），治疗师提供治疗前和治疗后唾液皮质醇样本，并填写治疗评估问卷。剩余动态结构方程模型检验了皮质醇反应与会话评分之间的关系，并通过年龄、抑郁、BPP严重程度、身份扩散和创伤来调节。皮质醇反应与患者的疗程评分无关。在治疗师中，较高的皮质醇反应与较低的会话平滑度（r = - 0.164; p < 0.001）和深度（r = - 0.086; p = 0.004）以及较低的积极性（r = - 0.145; p < 0.001）和较高的唤醒（r = 0.072; p = 0.012）相关。较高的抑郁水平调节了患者皮质醇反应和会话深度之间的关联（β = - 0.009, p = 0.007）。虽然疗程评分和皮质醇反应在治疗师中有相关性，但在患者中没有发现这种相关性。可能的机制包括内感受能力改变，下丘脑-垂体-肾上腺（HPA）轴功能失调，或由于BPP导致的自我评分或皮质醇变异性增加。虽然生理标记和自我报告为心理治疗过程提供了补充见解，但未来的研究应包括健康和临床对照以及两组中HPA轴功能（即应激反应）的基线调查，以及其他激素标记。
{"title":"Beyond Self-Reports: Integrating Cortisol Measurement in Psychotherapy Process Research among Adolescents with Borderline Personality Pathology.","authors":"Yasmine Blaha,Marialuisa Cavelti,Silvano Sele,Julian Koenig,Ronan Zimmermann,Klaus Schmeck,Michael Kaess","doi":"10.1159/000547941","DOIUrl":"https://doi.org/10.1159/000547941","url":null,"abstract":"Psychotherapy is the primary treatment for adolescent Borderline Personality Pathology (BPP), yet its mechanisms remain unclear. Given potential self-report biases due to alexithymia and impaired interoception, this study examined cortisol responses as a physiological stress marker alongside session ratings from adolescent BPP patients and their therapists to assess its potential as a complementary measure in psychotherapy process research. N = 56 adolescents (94.6% female) with BPP (≥ 3 DSM-IV BPD criteria) receiving Adolescent Identity Treatment or Dialectical Behavioral Therapy and their therapists provided pre- and post-session salivary cortisol samples and completed the Session Evaluation Questionnaire. Residual Dynamic Structural Equation Modelling examined associations between cortisol responses and session ratings, with moderation by age, depression, BPP severity, identity diffusion, and trauma. Cortisol responses did not correlate with session ratings in patients. In therapists, higher cortisol responses were associated with lower session smoothness (r = -.164; p < .001) and deepness (r = -.086; p = .004), as well as with lower positivity (r = -.145; p < .001) and higher arousal (r = .072; p = .012) post-session. Higher depression levels moderated the association between cortisol responses and session deepness in patients (β = -.009, p = .007). While session ratings and cortisol responses correlated in therapists, no such correlation was found in patients. Possible mechanisms include altered interoceptive abilities, dysregulated hypothalamic-pituitary-adrenal (HPA) axis function, or increased variability in self-ratings or cortisol due to BPP. While physiological markers and self-reports offer complementary insights into psychotherapy processes, future studies should include healthy and clinical controls and baseline investigation of HPA axis function (i.e. stress reactivity) in both groups, along with additional hormonal markers.","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":"11 1","pages":"1-25"},"PeriodicalIF":22.8,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959921","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}
Yasmine Blaha, Marialuisa Cavelti, Silvano Sele, Julian Koenig, Ronan Zimmermann, Klaus Schmeck, Michael Kaess
Introduction: Psychotherapy is the primary treatment for adolescent borderline personality pathology (BPP), yet its mechanisms remain unclear. Given potential self-report biases due to alexithymia and impaired interoception, this study examined cortisol responses as a physiological stress marker alongside session ratings from adolescent BPP patients and their therapists to assess its potential as a complementary measure in psychotherapy process research.
Methods: N = 56 adolescents (94.6% female) with BPP (≥3 DSM-IV BPD criteria) receiving Adolescent Identity Treatment or Dialectical Behavioral Therapy and their therapists provided pre- and post-session salivary cortisol samples and completed the Session Evaluation Questionnaire. Residual Dynamic Structural Equation Modeling examined associations between cortisol responses and session ratings, with moderation by age, depression, BPP severity, identity diffusion, and trauma.
Results: Cortisol responses did not correlate with session ratings in patients. In therapists, higher cortisol responses were associated with lower session smoothness (r = -0.164; p < 0.001) and deepness (r = -0.086; p = 0.004), as well as with lower positivity (r = -0.145; p < 0.001) and higher arousal (r = 0.072; p = 0.012) post-session. Higher depression levels moderated the association between cortisol responses and session deepness in patients (β = -0.009, p = 0.007).
Conclusion: While session ratings and cortisol responses correlated in therapists, no such correlation was found in patients. Possible mechanisms include altered interoceptive abilities, dysregulated hypothalamic-pituitary-adrenal (HPA) axis function, or increased variability in self-ratings or cortisol due to BPP. While physiological markers and self-reports offer complementary insights into psychotherapy processes, future studies should include healthy and clinical controls and baseline investigation of HPA axis function (i.e., stress reactivity) in both groups, along with additional hormonal markers.
心理治疗是青少年边缘性人格病理学（BPP）的主要治疗方法，但其机制尚不清楚。鉴于述情障碍和内感受受损可能导致的自我报告偏差，本研究将皮质醇反应与青少年BPP患者及其治疗师的会话评分一起作为生理应激标记，以评估其作为心理治疗过程研究补充措施的潜力。N = 56名接受青少年认同治疗或辩证行为治疗的BPP（≥3项DSM-IV BPD标准）青少年（94.6%为女性），治疗师提供治疗前和治疗后唾液皮质醇样本，并填写治疗评估问卷。剩余动态结构方程模型检验了皮质醇反应与会话评分之间的关系，并通过年龄、抑郁、BPP严重程度、身份扩散和创伤来调节。皮质醇反应与患者的疗程评分无关。在治疗师中，较高的皮质醇反应与较低的会话平滑度（r = - 0.164; p < 0.001）和深度（r = - 0.086; p = 0.004）以及较低的积极性（r = - 0.145; p < 0.001）和较高的唤醒（r = 0.072; p = 0.012）相关。较高的抑郁水平调节了患者皮质醇反应和会话深度之间的关联（β = - 0.009, p = 0.007）。虽然疗程评分和皮质醇反应在治疗师中有相关性，但在患者中没有发现这种相关性。可能的机制包括内感受能力改变，下丘脑-垂体-肾上腺（HPA）轴功能失调，或由于BPP导致的自我评分或皮质醇变异性增加。虽然生理标记和自我报告为心理治疗过程提供了补充见解，但未来的研究应包括健康和临床对照以及两组中HPA轴功能（即应激反应）的基线调查，以及其他激素标记。
{"title":"Beyond Self-Reports: Integrating Cortisol Measurement in Psychotherapy Process Research among Adolescents with Borderline Personality Pathology.","authors":"Yasmine Blaha, Marialuisa Cavelti, Silvano Sele, Julian Koenig, Ronan Zimmermann, Klaus Schmeck, Michael Kaess","doi":"10.1159/000547941","DOIUrl":"10.1159/000547941","url":null,"abstract":"<p><strong>Introduction: </strong>Psychotherapy is the primary treatment for adolescent borderline personality pathology (BPP), yet its mechanisms remain unclear. Given potential self-report biases due to alexithymia and impaired interoception, this study examined cortisol responses as a physiological stress marker alongside session ratings from adolescent BPP patients and their therapists to assess its potential as a complementary measure in psychotherapy process research.</p><p><strong>Methods: </strong>N = 56 adolescents (94.6% female) with BPP (≥3 DSM-IV BPD criteria) receiving Adolescent Identity Treatment or Dialectical Behavioral Therapy and their therapists provided pre- and post-session salivary cortisol samples and completed the Session Evaluation Questionnaire. Residual Dynamic Structural Equation Modeling examined associations between cortisol responses and session ratings, with moderation by age, depression, BPP severity, identity diffusion, and trauma.</p><p><strong>Results: </strong>Cortisol responses did not correlate with session ratings in patients. In therapists, higher cortisol responses were associated with lower session smoothness (r = -0.164; p < 0.001) and deepness (r = -0.086; p = 0.004), as well as with lower positivity (r = -0.145; p < 0.001) and higher arousal (r = 0.072; p = 0.012) post-session. Higher depression levels moderated the association between cortisol responses and session deepness in patients (β = -0.009, p = 0.007).</p><p><strong>Conclusion: </strong>While session ratings and cortisol responses correlated in therapists, no such correlation was found in patients. Possible mechanisms include altered interoceptive abilities, dysregulated hypothalamic-pituitary-adrenal (HPA) axis function, or increased variability in self-ratings or cortisol due to BPP. While physiological markers and self-reports offer complementary insights into psychotherapy processes, future studies should include healthy and clinical controls and baseline investigation of HPA axis function (i.e., stress reactivity) in both groups, along with additional hormonal markers.</p>","PeriodicalId":20744,"journal":{"name":"Psychotherapy and Psychosomatics","volume":" ","pages":"1-13"},"PeriodicalIF":17.4,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966297","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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