Social anxiety disorder (SAD) is marked by intense fear of social situations and negative evaluation. This study investigated neural effects of SAD-specific imagery scripts and their relationships with Brief Fear of Negative Evaluation (BFNE).

Thirty-six SAD and 32 healthy controls underwent four five-minute fMRI runs: anxiety-provoking imagery, rest, relaxing imagery, and rest. The order of imageries was counterbalanced. Functional connectivity analysis and connectome-based predictive modeling with respect to BFNE were performed using six seed regions, including the bilateral amygdala, left hypothalamus, bilateral dorsomedial prefrontal cortex (DMPFC), left ventromedial PFC (VMPFC), and left posterior cingulate cortex (PCC).

Group × task interaction effects were found in connectivity of left amygdala-right cerebellum, left PCC-bilateral superior frontal gyrus, and left PCC-right posterior middle temporal gyrus, and group × engagement effects were discovered in left hypothalamus-bilateral DMPFC and left VMPFC-right DMPFC couplings. Group × task × engagement interactions highlighted aberrant functional connections of right amygdala-left VMPFC, DMPFC-left DLPFC, and left VMPFC-bilateral supplementary motor area in SAD. Patterns of connectivity predicted the BFNE scores in various segments of imagery conditions.

Patient's medication, physiological measures were not considered. Noisy nature of fMRI could have interfered participants from focusing.

Our results revealed disrupted functional connections associated with emotion dysregulation and overly self-referent thinking in SAD. Markedly, patients showed maladaptive responses related to relaxation-inducing blocks, challenging the expected relaxation response. Overall findings emphasized inappropriate engagements of various processes in relaxing circumstances that do not overtly involve social anxiety to be associated with symptomatology.

Intolerance of uncertainty (IU), the tendency to find uncertainty negative, is a fundamental transdiagnostic dimension across anxiety-related disorders. Over the past two decades, there has been an increase in both clinical and experimental research on the role of IU in the maintenance and treatment of anxiety-related disorders. However, there has been a lack of integration of research findings from a mechanistic perspective, which has slowed progress in translational research. This review seeks to fill this gap by synthesising the clinical (e.g. randomised controlled trials) and experimental (e.g. lab-based) literature on the psychological mechanisms that drive change in IU across anxiety-related disorders. The review highlighted that: (1) cognitive restructuring, supported by mechanisms such as cognitive appraisal, modify IU-related cognitions, (2) behavioural exposures, supported by mechanisms such as inhibitory learning, alter IU-related cognitions and physiological arousal, and (3) mindfulness techniques underpinned by mechanisms such as attentional monitoring, decentering, and acceptance, change IU-related cognitions. Across the different therapeutic techniques reviewed, there was a lack of evidence for how different mechanisms change IU-related emotions and behaviours. Directions for further research include directly comparing the effectiveness of different mechanisms that produce change in IU across anxiety disorders and other mental health disorders, and examining the specificity of change in IU over other anxious traits. Overall, the findings provide a foundation for future translational research efforts to build upon maximising existing treatment interventions and/or to develop novel treatment interventions to target dispositional IU and situational uncertainty-related distress in anxiety-related disorders and beyond.

Reward processes can reinforce extinction learning and aide cognitive processes involved with inhibitory learning. Anhedonia, characterized by deficits in reward incentivization, hedonic response, and learning, may therefore predict worse treatment outcomes. The current study examined associations between pretreatment self-reported anhedonia and several measures of anxiety symptom severity and treatment outcomes in a naturalistic exposure-based treatment setting. We used multilevel models to examine the relationship between pretreatment anhedonia with change in general treatment response and disorder-specific symptoms for obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic disorder (PD). Consistent with hypotheses, pretreatment anhedonia severity was associated with higher pretreatment anxiety symptom severity across all measures. However, inconsistent with hypotheses, higher anhedonia scores were associated with greater symptom improvement across treatment for OCD, GAD, and PD, and had no significant relationships with diagnosis-general outcome measures, PTSD symptoms, or SAD symptoms. In sensitivity analyses including number of sessions, higher anhedonia was associated with more sessions across treatment and anhedonia no longer significantly predicted OCD or GAD treatment outcomes when controlling for treatment dose. Together, findings suggest that individuals with higher pretreatment anhedonia still respond to exposure therapy for anxiety disorders, but may require more sessions. More broadly, results highlight challenges in translating laboratory research to naturalistic clinical settings and the need for intensive longitudinal studies that can assess the role of reward processes in exposure therapy.

Non-invasive brain stimulation (NIBS) has the potential to treat generalized anxiety disorder (GAD). To assess the efficacy (response/remission/post-treatment continuous anxiety severity scores) and acceptability (failure to complete treatment for any reason) of NIBS, we searched PubMed, Web of Science, and the Cochrane Library (as of April 2024) for articles on NIBS for GAD and conducted a network meta-analysis of eight randomized trials (20 treatment arms, 405 participants). Data were pooled using standardized mean difference (SMD) and odds ratio (OR) with 95 % confidence interval (CI). Repetitive transcranial magnetic stimulation (rTMS) was the most widely studied treatment for GAD. The right dorsolateral prefrontal cortex (DLPFC) was the most common treatment target for GAD. High-frequency rTMS showed higher response rates (OR 291.40, 95 % CI 13.08 to 6490.21) and remission rates (OR 182.14, 95 % CI 8.72 to 3805.76) compared with other active therapies. Continuous theta burst stimulation (cTBS) greatly improved continuous post-treatment anxiety severity scores (SMD -2.56, 95 % CI -3.16 to -1.96). No significant differences in acceptability were found between the treatment strategies and the sham stimulation group. These findings provide evidence to consider NIBS techniques as alternative or adjunctive treatments for GAD.

Extinction learning is central to behavioral therapies for post-traumatic stress disorder (PTSD), but relapse poses a major challenge to this approach. Recent work has revealed a critical role for the thalamic nucleus reuniens (RE) in the suppression of extinguished fear memories. Silencing the RE yields a relapse of extinguished fear (i.e., "circuit-induced relapse"). Considerable work suggests that RE may contribute to extinction by inhibiting the retrieval of hippocampal (HPC)-dependent fear memories. To test this hypothesis, we first examined whether undermining the formation of contextual fear memories in the HPC would prevent circuit-induced relapse. Intra-hippocampal infusions of the NMDA receptor antagonist, APV, prior to auditory fear conditioning eliminated contextual fear memory and prevented the subsequent relapse of extinguished fear to the auditory conditioned stimulus (CS). In a second experiment, we used an activity-dependent labeling system (AAV-cFos-tTA; AAV-TRE-hM3Dq-mCherry) to express excitatory DREADDs in HPC neurons during fear conditioning. Chemogenetic reactivation of these ensembles after extinction was sufficient to drive relapse of fear to the extinguished CS. Lastly, in a third experiment, we expressed excitatory DREADDs in HPC ensembles captured during extinction learning and found that chemogenetic reactivation of this ensemble was sufficient to inhibit circuit-induced relapse. These results reveal that HPC-dependent ensembles play a critical role in regulating the expression and relapse of extinguished fear.

Anxiety disorder is one of the most common and disabling neuropsychiatric syndromes in patients with Parkinson's disease (PD), seriously affecting the quality of life and prognosis of PD patients.

The objective of this study was to analyze the risk factors for anxiety in PD patients and to evaluate the effectiveness of cognitive behavioral therapy (CBT) in treating PD with anxiety disorder (PDAD).

Baseline data were recorded for 211 PD patients and 139 PDAD patients, and multi-factorial and independent risk factors for anxiety disorder in PD patients were analyzed. ​The 139 PDAD patients were divided into clinical testing (CMO) and CBT groups. Assessments were taken at baseline and after the end of the intervention. A 5-month follow-up survey was conducted after the intervention. The mouse PD model was induced by MPTP, and the anxiety state of mice was detected by rotarod test and open-field test. The expression of BDNF/PI3K/Akt protein in serum and mouse brain was detected by western blot.

PDAD patients had significantly higher HAMA scores than PD patients. PSQI, ESS, HAMD, SCOPA-AUT, UPDRS-III and Hoehn-Yahr were independent risk factors for anxiety disorder in PD patients. After the intervention, the psychological state, cognitive function and quality of life improved in both the CMO and CBT groups, with the CBT group showing better improvement Results from follow-up showed that the number and frequency of falls was lower in the CBT group than in the CMO group, and that patients were more satisfied with the CBT intervention than the CMO group. L-dopa treatment alleviated anxiety in PD mice. L-dopa treatment increased BDNF, p-PI3K, and p-Akt protein levels. Moreover, the combination of L-dopa and CBT enhanced the boosting effect of L-dopa on these proteins.

CBT is an effective treatment for anxiety in patients with Parkinson's disease. Medications combined with CBT have been shown to be effective in improving depression, anxiety and quality of life in PDAD patients.

To explore the effect of cognitive behavioral therapy combined with escitalopram in the treatment of senile depression.

A total of 230 elderly patients with depression admitted to our hospital from were selected as the observation objects. The control group (n = 115) was treated with escitalopram, and the observation group (n = 115) was combined with cognitive behavioral therapy on the basis of escitalopram. The levels of serum laboratory indexes (S100 protein, cortisol (Cor), homocysteine (Hcy), 5-hydroxytryptamine (5-HT), dopamine (DA), norepinephrine (NE)), daily living ability, depression status and cognitive function in 2 groups before and after treatment were observed.

After treatment, the levels of S100 protein, Cor and Hcy in the observation group were significantly lower than those in the control group, while the levels of 5-HT, DA and NE were significantly higher than those in the control group (P < 0.05). After treatment, the Barthel index and Montreal Cognitive Assessment (MoCA) score of the observation group were significantly higher than that of the control group, while the Hamilton Depression Scale (HAMD) was significantly lower than that of the control group (P < 0.05). The treatment efficiency (95.65 %) was significantly higher than that of the control group (85.22 %), and the total incidence of adverse reactions (6.09 %) during the treatment period was significantly lower than that of the control group(17.39 %) (P < 0.05).

For elderly patients with depression, combined cognitive behavioral therapy based on escitalopram help patients to further improve the ability of daily living, improve depression, and promote the recovery of cognitive function.

Excessive anxiety is a common and hazardous mental disorder, especially in medical education. Positive psychology has proposed an effective path to reduce anxiety among medical students through mindset change. This study tests whether a growth mindset curbs anxiety in Chinese medical students.

The online cross-sectional survey was conducted among medical students enrolled in medical schools in Northeast China, yielding 3,114 valid responses (valid response rate = 89.2%). Data were statistically analyzed using STATA 17.0. The questionnaire covered sociodemographic statistics, the Growth Mindset Scale, and the Generalized Anxiety Disorder scale. Propensity score matching was utilized to investigate the causal relationship between a growth mindset and anxiety, thereby controlling for potential confounding variables.

The detection rate of anxiety symptoms was 41.1%, and anxiety status significantly differed by scholarship, grades, parenting style, and academic stress. Propensity score matching showed a mean treatment effect of -0.096 in the one-to-one matching sample, and - 0.112 and - 0.126 for K-nearest-neighbor matching and kernel matching, respectively. All were significant at the 1% level.

Medical students have a high prevalence of anxiety symptoms influenced by scholarship, grades, parenting style, and academic pressure. Furthermore, their growth mindset may help alleviate their anxiety, and it continues to develop as educators emphasize their health status. Fostering a growth mindset among Chinese medical students may promote their mental health, alleviate anxiety, and improve overall well-being. Parents should support their children to overcome anxiety and encourage them to try new things, and Chinese medical students are encouraged to continually adjust their mindset to cope with challenges positively. Educators should foster the cultivation of growth mindset in medical students through multidimensional interventions involving cognitive scaffolding, behavioral reinforcement, and environmental structuring, which consequently enhances their psychological well-being.

Not applicable.

Social anxiety disorder (SAD) is a common and disabling psychiatric disorder. It is generally treated with medication and psychotherapy such as cognitive-behavioral therapy (CBT). Due to the involvement of cortical and subcortical areas in the pathophysiology of SAD, non-invasive brain stimulation techniques such as transcranial Direct Current Stimulation (tDCS) are potential adjunctive treatment options for SAD. This study aims to assess comparable efficacy of CBT, intensified tDCS, and combined CBT/tDCS on clinical symptoms and quality of life of patients with SAD and comorbid depression.

In this randomized controlled trial, 37 adults with SAD and comorbid depressive disorder were assigned into three groups: (1) CBT + active tDCS (n = 13), (2) active tDCS alone (n = 12), and (3) CBT + sham tDCS (n = 12). SAD symptoms, depressive states, quality of life and trait worry were assessed with the Liebowitz Social Anxiety Scale, Beck's Depression Inventory, QOL questionnaire (WHOQOL-BREF), and the Penn State Worry Questionnaire respectively. The active tDCS was an intensified stimulation protocol (20 min, twice-daily sessions with 20 min intervals, 5 consecutive days) and was applied over the left dorsolateral prefrontal cortex (F3) and medial prefrontal cortex (Fpz). The CBT was provided individually based on the exposure technique at 12-20 sessions, twice a week. All clinical measures were assessed at baseline, after the intervention, and at 3-month follow-up.

SAD symptoms significantly decreased after intervention and follow-up in all groups, with no significant differences between them. However, CBT + tDCS resulted in a numerically larger symptom reduction, significantly exceeding CBT + sham tDCS on the fear scale. Depressive states and trait worry significantly improved in all groups post-intervention and at the 3-month follow-up, with no between-group differences. Quality of life (total scores, physical, and psychological domains) significantly improved after the and at the 3-month follow-up only in the CBT + tDCS and tDCS-alone groups with no between-group differences.

Psychotherapeutic interventions​ with CBT, intensified tDCS targeting the prefrontal cortex, and the combined CBT-tDCS are effective for alleviating primary and secondary clinical symptoms in individuals with SAD. The combined CBT-tDCS intervention showed superior efficacy in reducing the primary symptoms of SAD.

IRCT20220421054607N1, registration date: 19/05/2022, available at: https://irct.behdasht.gov.ir/trial/63119 .

Many psychotherapy interventions have a large evidence base and can help a substantial number of people with symptoms of mental health conditions. However, we still have little understanding of why treatments work. Early advances in psychotherapy, such as the development of exposure therapy, built on theoretical and experimental evidence from Pavlovian and instrumental conditioning. More generally, all psychotherapy achieves change through learning. The past 25 years have seen substantial developments in computational models of learning, with increased computational precision and a focus on multiple learning mechanisms and their interaction. Now might be a good time to formalize psychotherapy interventions as computational models of learning to improve our understanding of mechanisms of change in psychotherapy. To advance research and help bring together a new joint field of theory-driven computational psychotherapy, we first review literature on cognitive behavioral therapy (exposure therapy and cognitive restructuring) and introduce computational models of reinforcement learning and representation learning. We then suggest a mapping of these learning algorithms on change processes presumably underlying the effects of exposure therapy and cognitive restructuring. Finally, we outline how the understanding of interventions through the lens of learning algorithms can inform intervention research.

Psychological distress is recognized as an independent risk factor for cardiovascular diseases (CVDs), contributing to increased morbidity and mortality. While eHealth is increasingly used to deliver psychological interventions, their effectiveness for patients with CVDs remains unclear.

This meta-analysis aimed to evaluate the effects of eHealth psychological interventions for patients with CVDs.

Eligible studies were retrieved from 5 databases (Embase, Medline, PubMed, CINAHL, and Cochrane Library), covering the period from database inception to December 2024. Randomized controlled trials (RCTs) investigating the effect of evidence-based psychological eHealth interventions to improve psychosocial well-being and cardiovascular outcomes for people with CVDs were included. The Cochrane Risk of Bias tool (version 2) was used to judge the methodological quality of reviewed studies. RevMan (version 5.3) was used for meta-analysis.

A total of 12 RCTs, comprising 2319 participants from 10 countries, were included in the review. The results demonstrated significant alleviation of depressive symptoms for patients receiving psychological eHealth intervention compared to controls (number of paper included in that particular analysis, n=7; standardized mean difference=-0.30, 95% CI -0.47 to -0.14; I2=57%; P<.001). More specifically, in 6 trials where internet-based cognitive behavioral therapy was delivered, a significant alleviation of depressive symptoms was achieved (standardized mean difference=-0.39, 95% CI -0.56 to -0.21; I2=53%; P<.001). There was no significant change in anxiety or quality of life. Synthesis without meta-analysis regarding stress, adverse events, and cardiovascular events showed inconclusive findings.

Psychological eHealth interventions, particularly internet-based cognitive behavioral therapy, can significantly reduce depressive symptoms among patients with CVDs. A multidisciplinary approach is crucial for comprehensively improving psychological and cardiovascular outcomes. Future studies should explore integrating persuasive design features into eHealth and involving mental health professionals for intervention delivery.

PROSPERO CRD42023452276; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023452276.

This study evaluated psychiatric diagnoses and race/ethnicity as predictors of both incident and long-term benzodiazepine use.

We implemented two designs using commercial healthcare claims from Optum's de-identified Clinformatics® Data Mart Database. We first conducted a case-control study and examined 1,904,608 individuals with a new benzodiazepine prescription (ages 13-64 from 2010 to 2019) and matched controls. We used conditional logistic regression to examine 21 potential indications and other psychiatric diagnoses and race/ethnicity as predictors of filling a benzodiazepine prescription. We then used Cox proportional hazards regression in a cohort study among those with a new benzodiazepine to examine the degree to which psychiatric diagnoses and race/ethnicity predicted transitioning to long-term treatment, defined as six months or more of continuous prescription fills.

All included psychiatric diagnoses were associated with incident benzodiazepine use, and most subsequently predicted long-term treatment. Among the most common and strongest predictors for incident use was having any anxiety disorder (Odds Ratio = 5.71; 95% Confidence Interval [CI], 5.67-5.76). Two years after the initial prescription, 8.0% of BZD recipients had met criteria for long-term treatment at least once. Among the strongest predictors of long-term treatment was severe mental illness [e.g., schizophrenia; (Hazard Ratio = 2.36; 95% CI, 2.27-2.47)]. Individuals from all racial/ethnic minoritized groups were less likely to have both incident and long-term benzodiazepine use compared with White individuals.

These findings highlight that transition to long-term treatment is occasionally occurring and notable among BZD recipients, particularly among those with severe mental illness.

Although the evidence-base for mental health and psychosocial support (MHPSS) interventions in humanitarian settings is growing rapidly, their mechanisms of change remain poorly understood despite the potential to improve the effectiveness and reach of interventions.

This study aimed to explore the mechanisms or factors that drive change in a modular transdiagnostic telephone-delivered mental health intervention, Common Elements Treatment Approach (t-CETA).

Participants were Syrian refugee children and adolescents living in tented settlements in Lebanon.

We used a multiple n = 1 design, drawing on secondary data from 9 children who completed t-CETA during a pilot randomized controlled trial.

Children with historical war-related trauma were more likely to show significant improvement across symptom clusters by the end of treatment compared to children presenting with depression related to daily living conditions. Children also showed fluctuating symptoms during the early stages of treatment (engagement and cognitive restructuring) but significant decline in symptoms after the trauma module (prolonged imaginal exposure) and depression module (behavioral activation). Salient external life events identified were starting or dropping out of school, working, change in living conditions, family conflict and the October Revolution; and interpersonal factors of parental engagement (with or without full attendance) and counsellor skills in building rapport were also identified as having an impact on treatment success.

Implications of our findings are discussed in terms of integrating active ingredients into MHPSS programming, and building on parental and multi-sector involvement in child and adolescent mental health care in humanitarian settings.

Cognitive-behavioral therapy (CBT) is an effective treatment for the range of anxiety disorders as demonstrated in many randomized controlled trials (RCTs) conducted over the past 30 years.

To examine the change of CBT effect sizes over time, we tested whether publication year was a significant moderator.

We pooled studies from three previously published meta-analyses and searched three electronic databases (PubMed, PsychINFO, Web of Science) to identify any additional studies published from February 1, 2022 to January 24, 2025. The final analysis included 49 studies comprising a total of 3645 participants.

We selected RCTs comparing CBT for anxiety disorders with psychological or pill control conditions.

Two independent raters used predefined data fields, including study quality indicators.

The mean effect size of all RCTs comparing CBT vs. controls revealed a Hedges' g of 0.51, 95 % CI [0.40, 0.62], with significant differences in effect sizes between the diagnostic groups. Uncontrolled pre-post effect size calculations revealed a large effect for CBT, Hedges' g = 1.18, 95 % CI [1.01, 1.34], and a medium effect for the control conditions, Hedges' g = 0.59, 95 % CI [0.47, 0.70]. A linear meta-regression of publication year on effect sizes (Hedges g) showed no significant change in effect sizes as compared to the control conditions over the span of the last 30 years (B = -0.008, SE = 0.006, t(47) = -1.18, p = 0.24).

Although CBT is an effective treatment for anxiety disorders, the effect sizes did not increase over the last 3 decades. This calls for studies on the processes of treatment change to improve the efficacy of CBT.

The study aims to investigate whether physical exercise is associated with psychological resilience, thereby significantly affecting adolescent social anxiety, and to analyze the longitudinal cross-temporal stability between these three interrelated factors.

The methodology involved a survey utilizing the International Physical Activity Questionnaire (IPAQ), the Connor-Davidson Resilience Scale (CD-RISC), and the Social Anxiety Scale (SAS) across various regions in China, including Sichuan, Guangdong, Shanxi Province, and Beijing. A total of 1259 participants were recruited from primary, middle, and high schools, with an average age of 13.7 years. The sample comprised 626 males and 633 females. A longitudinal tracking survey approach was implemented, commencing in June 2023, with follow-up rounds scheduled every three months, culminating in a total of four rounds.

The results are as follows: (1) Physical exercise was significantly positively correlated with psychological resilience (r = 0.35, p < 0.001) and significantly negatively correlated with social anxiety (r = - 0.26, p < 0.001); (2) Physical exercise could significantly negatively predict social anxiety in the next period (PET1 → SAT2: β = - 0.31, p < 0.001); (3) Psychological resilience played a mediating role in the association between physical exercise on social anxiety (PET1 → PRT2: β = 0.42, PRT2 → SAT3: β = - 0.38, p-values < 0.001).

Physical exercise, psychological resilience, and social anxiety exhibit cross-temporal stability, and physical exercise has a significant lagged effect on psychological resilience and social anxiety. Physical exercise may indirectly reduce social anxiety through its association with enhanced psychological resilience in adolescents.

Internet-based Cognitive Behavioral Therapy (ICBT) is effective in treating anxiety disorders, yet there is room for improvement in treatment response and reduction in dropout rates. This study proposes a personalized, modular ICBT intervention that leverages the extended evolutionary meta-model to provide a dynamic and adaptive treatment approach, aiming to enhance usability and efficacy.

The trial will be conducted in two phases. Phase I involves 182 participants who will undergo a 30-day ecological momentary assessment to record functional processes and anxiety levels three times a day. The data collected will help in identifying key functional predictors of anxiety for each participant through group iterative multiple model estimation. In Phase II, participants who complete Phase I will be randomized into three groups: personalized CBT, standard CBT, and a waiting list. Outcome measures will include Brief Symptom Inventory, specific measures of anxiety, usability metrics, and dropout rates. Assessments will be conducted at baseline, immediately post-treatment, and at 1- and 3-month follow-ups. A linear mixed model will be utilized to analyze the data and determine the intervention's efficacy.

Anticipated outcomes from this study include advancements in personalized CBT for anxiety disorders, contributing valuable insights into their potential benefits and addressing existing challenges in the field.

Social anxiety disorder (SAD) is one of the most common psychiatric disorders in adolescents. The heterogeneity of both symptoms and etiology is an essential source of difficulties in the treatment and prevention of SAD. The study aimed to identify subtypes of adolescent SAD based on etiology-related phenotype dimensions and examine symptom and brain associations of the subtypes. We used a deeply phenotyped sample (47 phenotype subscales from 13 measures) of adolescents with SAD (n = 196) and healthy controls (n = 109) to extract etiology-relevant risk factors, based on which we identified subtypes of SAD. We compared the subtypes on clinical characteristics and brain morphometrics and functional connectivity, and examined subtype-specific links between risk factors, brain aberrance, and clinical characteristics. We identified six etiology-relevant risk factors and two subtypes of adolescent SAD. One subtype showed mainly elevated negative emotionality trait and coping style and diminished positive emotionality trait and coping style, while the other additionally had significantly high environmental risk factors, more severe impairments in social functioning, and significant abnormalities in brain structure and function. There were subtype-specific links between the risk factor profiles, brain aberrance, and clinical characteristics. The finding suggests two etiology-based subtypes of adolescent SAD, providing novel insights to the diversity of pathological pathways and precise intervention strategies.

To synthesise the effects of psychosocial interventions compared with standard care in improving psychosocial outcomes of parents of children with cancer receiving active treatment.

This was a systematic review and meta-analysis that was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

All randomised controlled trials examining the effects of psychosocial interventions for parents of children with cancer were considered eligible. All identified articles were imported into Endnote X9. Two independent authors conducted study selection and data extraction. Risk-of-Bias version 2 and the Grading of Recommendations Assessment, Development and Evaluation approach were used to evaluate the methodological quality and overall quality of the evidence, respectively. Review Manager 5.4.1 software was used for data analysis, and sensitivity and subgroup analyses were conducted to examine heterogeneity, if applicable.

Seven databases, including PubMed, Embase, Scopus, PsycINFO, CENTRAL, CINAHL and ProQuest, were searched up to 6 December 2023.

Sixteen studies involving 1379 participants were included in the systematic review, with 12 studies pooled for meta-analysis. Psychosocial intervention was effective in anxiety symptoms and depressive symptoms among parents of children with cancer. No significant differences were observed in parental stress and quality of life between psychosocial intervention and control groups.

This study showed that psychosocial intervention was beneficial for decreasing anxiety symptoms and depressive symptoms of parents of children with cancer. Future trials with a more robust methodology are needed to augment current findings.

As our systematic review showed that psychosocial interventions were effective in decreasing anxiety symptoms and depressive symptoms among parents of children with cancer, healthcare professionals could consider integrating psychosocial support for these parents.

This systematic review had no patient or public contribution.

This review was registered at PROSPERO (CRD42022384452) on 29 December 2022. (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=384452).

Non-invasive brain stimulation (NIBS) is an emerging treatment for mental disorders that is painlessness and easy to administer. However, its effectiveness for modulating fear extinction requires further elucidation. We searched eight bibliographical databases and identified randomized controlled trials of NIBS and fear extinction in healthy populations. Outcomes were evaluated based on skin conductance responses (SCRs) under three experimental stimuli: threat condition stimulation (CS+), safe condition stimulation (CS-), and their discrimination (CS+ minus CS-). We applied a random-effects model to determine effect sizes (Hedge's g) post-stimulation and assessed article quality using Physiotherapy evidence database (PEDro) scale. Twenty-one studies meeting systematic review criteria were included in this analysis, incorporating 40 independent effect sizes and data from 11 studies (n = 632) in the meta-analysis. Compared with the control group, SCRs in CS+ and discrimination were significantly reducted in the intervention group. Fear extinction was more effective in the 24-h test than immediately after NIBS. In conclusion, NIBS enhanced fear extinction, and the time interval between stimulation and testing may serve as a moderating variable.

Mindfulness-based interventions (MBI), a novel treatment, and cognitive behavioral therapy (CBT), the standard treatment, are both effective in treating anxiety in adolescents. This study determined the effectiveness of mindfulness-based interventions versus cognitive behavioral therapy in reducing symptoms of anxiety among adolescents experiencing social anxiety through a systematic review and meta-analysis.

A systematic approach was used to identify eligible studies. Electronic databases, reference lists of relevant articles, and gray literature were searched. Data was analyzed using RevMan to calculate standard mean differences with 95% confidence intervals and subgroups. Heterogeneity was measured using visual assessment, the I2 statistic, and chi-square test.

Randomized controlled trials comparing MBI to CBT for adolescents diagnosed with social anxiety or social phobia disorder were analyzed, with non-randomized studies being excluded. Structured searches in electronic databases, reference lists, and gray literature were conducted by four independent reviewers who initially identified potential articles through title and abstract screening. After a comprehensive review of full-text articles and a consensus-building process, the selection of included articles was finalized. Data was analyzed using RevMan to calculate standard mean differences with 95% confidence intervals and to examine subgroups, with heterogeneity being assessed through visual evaluation, the I2 statistic, and chi-square tests. Total number of participants was 255; 101 were male and 158 were women. Mean age was 27.5 years old, and diagnosed with Social Anxiety Disorder, Social Phobia, or DSM-IV-Defined-Anxiety-Disorder. They were divided into two groups: 125 participated in 8- to 12-week MBI sessions lasting 2 hours each, while 130 underwent 2-hour CBT sessions spanning 8, 12, or 14 weeks. There is moderate quality of evidence reporting non-significant difference on MBI vs CBT's effectiveness in alleviating symptoms of social anxiety [mean (95% CI) = -0.04 (-0.58, 0.51)].

Study found that there were no significant differences between Mindfulness-Based Interventions and Cognitive Behavioral Therapy in reducing social anxiety in adolescents. Mindfulness interventions have advantages in terms of cost-effectiveness for reducing symptoms of anxiety. Future research should include larger sample sizes and longer follow-up periods to further assess long-term effects of these interventions.

Healthcare providers (HCP) face various stressful conditions in hospitals that result in the development of anxiety disorders. However, due to heavy workloads, they often miss the opportunity for self-care. Any effort to diminish this problem improves the quality of Healthcare providers and enhances patient safety. various applications have been developed to empower Healthcare providers and reduce their anxiety, but these applications do not meet all their individual and professional needs. The objective of this study was to investigate the impact of mobile-based self-care applications on reducing anxiety in healthcare providers.

In this study, keywords such as anxiety, self-care, healthcare providers, and mobile health were used to search PubMed, Scopus, and Web of Science for papers published in the recent ten years (2014-2024). We used the PRISMA diagram to report the results. Ten out of 2515 retrieved articles that addressed the effect of mobile-based self-care applications on Healthcare providers' anxiety were included for analysis. Data were extracted using a data collection form designed based on the research objective. We used this form to collect data including the author's name, publication year, country, study type, intervention duration, study objectives, platform used, Modules presented in technologies, Methods of reducing anxiety, questionnaire details, and Effectiveness assessment. Data collected from the studies were analyzed by SPSS-21 using frequency and percentage.

Based on the results, studies were conducted in nine different countries, and the intervention duration and strategies for reducing anxiety using self-care applications ranged from two weeks to four months. The impact of mobile health applications, their content, and intervention strategies on reducing anxiety were positive. The anxiety-reduction strategies were varied among applications. Anxiety reduction strategies in this study included mindfulness, cognitive-behavioral therapy, physical activities, breathing exercises, dietary regimes, and nature exploration through virtual reality. Cognitive-behavioral therapy and mindfulness constituted the most frequently applied reduction techniques across the studies to reduce anxiety in Healthcare providers.Furthermore, the findings revealed the effectiveness of interventions in reducing other mental disorders such as anxiety, stress, depression, drug abuse, and psychotropic drug use of Healthcare providers.

The use of mobile health applications with practical strategies is effective in reducing anxiety and can also reduce other anxiety disorders in Healthcare professional.

This study aimed to explore the characteristics of appearance-related distress and the relationship between appearance-related distress, anxiety and depression symptoms in Chinese patients with cleft lip (CL).

The Derriford Appearance Scale 59 (DAS-59), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) were used to screen for appearance-related distress, anxiety, and depression symptoms in Chinese patients with CL, respectively.

A total of 63 patients with CL, comprising 43 unilateral and 20 bilateral cases, and 64 individuals without CL in the control group were included in the study. Appearance-related distress was compared between patients with CL and non-cleft individuals. The relationship between appearance-related distress and two psychological symptoms was estimated. The DAS-59 scores in patients with CL were significantly higher than those in non-cleft individuals. The DAS-59 scores in patients with CL who had anxiety or depression symptoms were significantly higher than those without symptoms, and the DAS-59 scores were correlated with GAD-7 and PHQ-9 scores. After adjustment for demographic variables, the DAS-59 scores were also positively associated with GAD-7 and PHQ-9 scores in patients with CL.

More significant appearance-related distress was observed in Chinese patients with CL compared to the control group, but it did not exhibit a correlation with the patients' diagnosis (unilateral or bilateral), sex, age, or other demographic characteristics. Furthermore, appearance-related distress plays a significant role in psychological symptoms and may serve as a predictor of anxiety and depressive symptoms.

Many studies have demonstrated that social anxiety disorder (SAD) can be effectively treated with psychotherapy, particularly cognitive-behavioral therapy (CBT), including internet-based CBT (ICBT). Despite evidence-based treatments, many individuals do not sufficiently benefit from them. Identifying the active components could help improve the effectiveness of SAD treatment. This study tested the effects of four treatment components (psychoeducation, cognitive restructuring, attention training, and exposure) within ICBT for SAD to investigate its active components.

This randomized full factorial trial consisted of four factors (i.e., treatment components) and 16 conditions. A total of 464 adults with a diagnosed SAD were recruited from the community. The primary outcome was SAD symptoms at 8 weeks (post-assessment). Secondary outcomes included SAD diagnosis, SAD symptoms at follow-up (4 months after post), depression and anxiety symptoms, quality of life, client satisfaction, and adverse effects.

Conditions including psychoeducation and exposure were significantly more effective in reducing SAD symptoms at post compared to conditions without these components. Conditions including cognitive restructuring and attention training did not show superiority over conditions without them at post. However, all treatment conditions significantly reduced symptoms compared to the condition without a treatment component. At follow-up, the superiority of psychoeducation and exposure was not significant anymore due to the version without the respective components catching up.

The findings suggest that while all treatment components of ICBT for SAD are beneficial compared to no treatment, psychoeducation and exposure include specific active components that significantly improve treatment outcomes more quickly in ICBT for SAD.

Many studies have demonstrated that social anxiety disorder (SAD) can be effectively treated with psychotherapy, particularly cognitive-behavioral therapy (CBT), including internet-based CBT (ICBT). Despite evidence-based treatments, many individuals do not sufficiently benefit from them. Identifying the active components could help improve the effectiveness of SAD treatment. This study tested the effects of four treatment components (psychoeducation, cognitive restructuring, attention training, and exposure) within ICBT for SAD to investigate its active components.

This randomized full factorial trial consisted of four factors (i.e., treatment components) and 16 conditions. A total of 464 adults with a diagnosed SAD were recruited from the community. The primary outcome was SAD symptoms at 8 weeks (post-assessment). Secondary outcomes included SAD diagnosis, SAD symptoms at follow-up (4 months after post), depression and anxiety symptoms, quality of life, client satisfaction, and adverse effects.

Conditions including psychoeducation and exposure were significantly more effective in reducing SAD symptoms at post compared to conditions without these components. Conditions including cognitive restructuring and attention training did not show superiority over conditions without them at post. However, all treatment conditions significantly reduced symptoms compared to the condition without a treatment component. At follow-up, the superiority of psychoeducation and exposure was not significant anymore due to the version without the respective components catching up.

The findings suggest that while all treatment components of ICBT for SAD are beneficial compared to no treatment, psychoeducation and exposure include specific active components that significantly improve treatment outcomes more quickly in ICBT for SAD.

Given rising mental health concerns among Pacific Islander (PI) adolescents, this population remains underserved by available mental health resources. This interpretative phenomenological analysis with focus groups (IPA-FG) examined the lived experiences and perceptions of 19 male PI adolescents (ages 14-16) from Native Hawaiian, Maori, Samoan, and Tongan backgrounds regarding mental health help-seeking behaviors. Four overarching themes emerged: stigma and judgment, cultural misalignment in professional services, impact of disclosure and perceived punitive consequences, and a complex ecosystem of trusted relationships as mental health support. Notably, participants expressed belief that disclosing mental health challenges would "ruin their lives" and held misconceptions about adults' ability to address mental health concerns. These findings are particularly significant given high suicidality rates among PI adolescents. This study provides insights for developing culturally responsive mental health interventions and highlights the urgent need to address mental health stigma within PI communities. Implications for practice are discussed.

Modifying cognitive distortions, or thinking errors, is crucial in eating disorders (ED) treatment. To address the lack of a personalized measure for ED cognitions, the Thought Inventory was developed. The study aimed to establish its feasibility and validity, identify thinking error contents and types, examine changes in belief of irrational thoughts, and investigate associations with change in ED symptoms. Hypotheses, procedure, and planned analyses were pre-registered to ensure transparency.

Participants (N = 55) completed the Thought Inventory, the Eating Disorder Examination Questionnaire, the Eating Pathology Symptom Inventory, the Frost Multidimensional Perfectionism Scale, the Beck Depression Inventory, and the Penn State Worry Questionnaire at pre-and post-ten weeks of treatment. Using the Thought Inventory, participants collaborated with study therapists to identify ED-related thinking errors and rate the degree of belief in these thoughts on a scale of 0 to 100 %.

Cognitions primarily contained self-judgments, food rules, and concern over shape, while catastrophizing/fortune telling, emotional reasoning, and should/must statements were the most common types of thinking errors. Belief in cognitions significantly decreased over treatment and change in thought belief was positively associated with change in ED symptoms.

The Thought Inventory shows promise as a personalized measure. Future research should explore whether ED cognitions, assessed in this manner, are a mechanism of change in ED treatment.

(1) Evaluate differences in demographic distributions between those with autism alone and those with autism concomitant with anxiety and (2) assess demographic factors associated with receipt of psychological therapy in patients with autism.

Using deidentified health care claims data, we extracted all encounters among children with the International Classification of Diseases-10-CM for Autism Spectrum Disorder (F84) and flagged those with concomitant anxiety (F41.9). Extracted data included age, sex, race, ethnicity, insurance status, and Rural-Urban Continuum Codes. Current procedural terminology codes for psychological services were extracted. Data were analyzed using Mann-Whitney U tests, χ 2 tests of association, and logistic regression.

Demographic differences between children/adolescents with autism alone versus autism concomitant with anxiety were noted for age, sex, and race/ethnicity, with a greater prevalence of autism/anxiety identified in older-aged children and children identifying as female and non-Hispanic White residing in an urban area. While 21% of those included in this study had received psychotherapy, the percentages within the autism only and autism/anxiety groups were 12% and 50%, respectively ( p < 0.001). Children/adolescents who were older age quartile, resided in an urban residence, and with a concomitant diagnosis of anxiety were more likely to receive psychological services, while non-Hispanic Other were less likely to, compared with the reference of non-Hispanic White.

We identified demographic disparities in the diagnosis of autism versus autism with concomitant anxiety, including age, sex, race/ethnicity, and residence location. Age quartile, urban location, and concomitant anxiety were associated with increased likelihood of receipt of psychological services.

Anxiety disorders, a prevalent mental health condition often stemming from chronic stress, are characterized by uncontrollable emotional responses, heightened psychological stress, and cognitive impairment. Ziziphi Spinosae Semen, a traditional Chinese medicine (TCM), is widely used for its calming effects. Among its flavonoid components, spinosin serves as a primary bioactive compound, playing a significant role in treating psychiatric disorders. However, the mechanisms underlying the anxiolytic effects of spinosin are not fully elucidated. This study explores the protective effects of spinosin against anxiety in mice subjected to chronic restraint stress (CRS). Male C57BL/6J mice were subjected to restraint stress modeling for 10 consecutive days, and the treatment groups were gavaged with spinosin at doses of 1.25 mg/kg, 2.5 mg/kg, and 5 mg/kg, respectively. Behavioral experiments including the elevated plus maze test (EPM), open field test (OFT), and novelty suppressed feeding test (NSF) were conducted to confirm the successful establishment of the CRS model and the anxiolytic effect of spinosin. Additionally, spinosin normalized neurotransmitter levels and mitigated inflammation and neuronal damage in the hippocampus (HPC) and prefrontal cortex (PFC). Mechanistically, spinosin treatment significantly modulated the extracellular signal-regulated kinase 1/2 (ERK1/2)/cyclic adenosine monophosphate response element-binding protein (CREB)/brain-derived neurotrophic factor (BDNF) signaling pathway, a key axis in anxiety regulation. The upregulation of ERK1/2, p-CREB, and BDNF proteins significantly alleviated anxiety, suggesting that spinosin plays a pivotal role in treating CRS-induced anxiety disorders. Our findings indicate that spinosin treatment can ameliorate anxiety and that it verifies a previously unrecognized mechanism, providing crucial evidence for future research on anti-anxiety medications.

Anxiety is a widespread psychological disorder affecting both humans and animals. It is a typical stress reaction; however, its longer persistence can cause severe health disorders affecting the day-to-day life activities of individuals. An intriguing facet of the anxiety-related disorder can be addressed better by investigating the role of neurotransmitters in regulating emotions, provoking anxiety, analyzing the cross-talks between neurotransmitters, and, most importantly, identifying the biomarkers of the anxiety. Recent years have witnessed the potential role of the gut microbiota in human health and disorders, including anxiety. Animal models are commonly used to study anxiety disorder as they offer a simpler and more controlled environment than humans. Ultimately, developing new strategies for diagnosing and treating anxiety is of paramount interest to medical scientists. Altogether, this review article shall highlight the intricate mechanisms of anxiety while emphasizing the emerging role of gut microbiota in regulating metabolic pathways through various interaction networks in the host. In addition, the review will foster information about the therapeutic interventions of the anxiety and related disorder.

Emotional dysregulation is a serious and impairing mental health problem. We examined functional activity and connectivity of neural networks involved in emotional dysregulation at baseline and following a pilot neurostimulation-enhanced cognitive restructuring intervention in a transdiagnostic clinical adult sample.

Neuroimaging data were analyzed from adults who scored 89 or higher on the Difficulties with Emotion Regulation (DERS) scale and had at least one DSM-5 diagnosis. These participants were part of a pilot randomized, double-blind, placebo-controlled trial combining a single therapeutic session of cognitive restructuring with active or sham transcranial magnetic stimulation over the dorsolateral prefrontal cortex. During the study, participants engaged in an emotional regulation task using personalized autobiographical stressors while undergoing functional magnetic resonance imaging (fMRI) before and after the pilot intervention. The fMRI task required participants to either experience the emotions associated with the memories or apply cognitive restructuring strategies to reduce their distress.

Whole-brain fMRI results during regulation at baseline revealed increased activation in the dorsal frontoparietal network but decreased activation in the supplementary motor area, cingulate cortex, insula, and ventrolateral prefrontal cortex (vlPFC). Emotion dysregulation was associated with greater vmPFC and amygdala activation and functional connectivity between these regions. The strength of functional connectivity between the dlPFC and other frontal regions was also a marker of emotional dysregulation. Preliminary findings from a subset of participants who completed the follow-up fMRI scan showed that active neurostimulation improved behavioral indices of emotion regulation more than sham stimulation. A whole-brain generalized psychophysiological interaction analysis indicated that active neurostimulation selectively increased occipital cortex connectivity with both the insula and the dlPFC. Region-of-interest functional connectivity analyses showed that active neurostimulation selectively increased dlPFC connectivity with the insula and orbitofrontal cortex (OFC).

Insufficient neural specificity during the emotion regulation process and over-involvement of frontal regions may be a marker of emotional dysregulation across disorders. OFC, vlPFC, insula activity, and connectivity are associated with improved emotion regulation in transdiagnostic adults. In this pilot study, active neurostimulation led to neural changes in the emotion regulation network after a single session; however, the intervention findings are preliminary, given the small sample size. These functional network properties can inform future neuroscience-driven interventions and larger-scale studies.

The primary aim was to investigate how respiration rate and inhalation/exhalation ratio influence self-reported state anxiety during a single slow diaphragmatic breathing exercise session. Eight hundred and twenty-eight participants completed the study at two separate geographical locations (Poland and Spain). Participants performed a 10-min online guided breathing exercise. Respiration rates were sampled from a continuous uniform distribution (ranging from 6 to 12 breaths/min). Similarly, inhalation/exhalation ratios were treated as continuous variables and sampled from a uniform distribution for each participant. An application programed for this experiment displayed visual and auditory cues adjusted for each participant. Before and after the breathing exercise, each participant filled in the Current Anxiety Level Measure questionnaire. Self-trait anxiety was measured with the Clinically Useful Anxiety Outcome Scale. A linear regression model showed that respiration rate, trait anxiety, pre-test anxiety, and nationality (Polish/Spanish) were positively related to post-test anxiety levels. Adding quadratic terms of respiration rate and inhalation/exhalation ratio did not improve model fit. Polish participants exhibited higher post-test anxiety levels compared with the Spanish subsample. Age was negatively associated with post-test anxiety. No significant relationships between inhalation/exhalation ratio and post-test anxiety level were found. Slower respiration rates during a single-session breathing exercise are linearly associated with lower post-test anxiety levels in a large and varied sample. This study is the largest to date and may offer further guidance for predicting expected effect sizes for the relationships between anxiety and respiratory dynamics.

Fear of Aversive Consequences (FOAC), such as choking or vomiting, is an important associated feature of Avoidant/Restrictive Food Intake Disorder (ARFID). However, the manifestation of FOAC in young children is poorly understood. This study aimed to describe the fears of children with ARFID symptoms and examine the concordance between parent and child ratings of fear.

Child-reported FOAC was assessed using an interview designed for children between 6 and 10 years old, the Gustatory Avoidance and Gastrointestinal Stress Symptoms (GAGSS). Parents were administered a semi-structured diagnostic interview regarding their child's symptoms, the Pica, ARFID, and Rumination Interview.

Among 68 children with ARFID diagnoses or symptoms (41.2% female, 85.3% White, mean age = 8.2 years, SD = 1.1 years; range 5.2-9.9 years), 91.2% of children endorsed at least one fear relative to 26.5% of parents. Among parent-child dyads, 36.8% disagreed about the child's fear of stomach pain (κ = 0.12) and 48.5% disagreed about the child's fear of vomiting, (κ = 0.08), both indicating low inter-rater reliability. On average, children endorsed 4.3 (SD = 2.3) fears out of 9 options. The most frequently endorsed fears were that food will "taste bad," (n = 43, 63.2%), "make you gag" (n = 37, 54.4%), and "look disgusting" (n = 36, 52.9%).

Findings highlight ways in which fear may manifest in children with ARFID that are not easily discernable by adults. Greater precision in depicting childhood fears may facilitate the earlier detection of problematic eating behaviors.

Interoception, the processing of internal bodily sensations, is associated with various mental health conditions. In particular, anxiety is often considered to be the prototypical interoceptive disorder. However, empirical evidence is mixed, with meta-analytic work reporting no relationship between anxiety and cardiac interoceptive accuracy. Less explored, however, are the mixed results relating to anxiety and self-reported interoception. This meta-analysis of 71 studies explored the relationship between self-report measures of interoception and anxiety. Across 12 measures (20 subscales), anxiety was associated with increased negative evaluations of, frequency of, and sensitivity to, bodily signals. Anxiety was also associated with greater (negative) attention to bodily signals, and difficulties describing bodily signals and emotions. However, anxiety was not associated with the use of bodily signals to inform emotions (e.g., noticing emotionally induced bodily signals). Results are discussed considering the overlap between anxiety and interoception questionnaires, the lack of specificity of certain measures, and the potential confound of individual differences in questionnaire interpretation. We also discuss limitations of anxiety measures and the clinical relevance of findings.

Family caregivers living with patients with dementia (PwD) face psychological challenges due to care burden. Technology-delivered psychosocial interventions (TPIs) have played a promising role in improving health outcomes among family caregivers living with PwD. This review aims to synthesise evidence of the effectiveness of TPIs on primary (burden and depression) and secondary outcomes (self-efficacy, stress and anxiety) for family caregivers living with PwD. Random-effects meta-analyses were performed to determine effect size. Using Cochran's Q and I2 tests, statistical heterogeneity was evaluated. Sensitivity, subgroup analyses and meta-regression were employed to explain statistical heterogeneity. Twenty-eight trials comprising 4160 family caregivers from eight countries were included. Our meta-analysis revealed that TPIs resulted in slight reduction in depression, probably resulted in a slight reduction in burden and anxiety and slight increase in self-efficacy. Subgroup differences were detected in geographical regions (Western Pacific and Southeast Asia) for burden. While there were no significant subgroup differences in other factors, TPIs with preventive function and mobile applications had a more prominent larger effect size. Meta-regression analysis showed that attrition rate was a significant moderator on depression. Results are limited by the high risk of bias of included trials, which may reduce certainty of evidence. This review suggest TPIs are recommended as an adjunct treatment for alleviating burden and depressive outcomes in healthcare institutions. PROSPERO Registration Number: PROSPERO (CRD42023387962).

Pediatric obsessive-compulsive disorder (OCD) affects approximately .25%-3% of children, and if left untreated, can cause significant impairment for the child and family. Cognitive behavioral therapy with exposure and response prevention (ERP) is the gold-standard treatment for pediatric OCD. When using ERP with children and adolescents, it is essential to assess and target family factors in treatment in order to help the youth make therapeutic progress. The following case study illustrates the successful implementation of family-based ERP in a young female with contamination OCD. It further highlights strategies for targeting family accommodation and family conflict within the course of treatment.

Challenging cognitive, somatic, and behavioral responses to climate change are often conceptualized as climate anxiety (CA). Due to the increased recognition of the impacts of climate change on mental health, a growing body of scientific literature is developing. The purpose of this manuscript is to review the current evidence base for CA and propose future research needs for this emerging construct.

Early evidence supports underlying psychological mechanisms in the development and maintenance of CA, which are similar to other anxiety-related conditions. However, the study of CA poses unique challenges to researchers. The psychological impacts that occur in the context of climate change may be adaptive depending on the imminent threat of natural disasters, forced migration, or other climate-related challenges. Due to the potentially adaptive nature of CA and limited current evidence, a coordinated research program of climate-related distress is necessary. A review of the extant literature identified current gaps in understanding the epidemiology and individual differences that promote CA. Current evidence supports the prominent role of neuroticism, intolerance of uncertainty, and rumination. The development of evidence-based models of climate-related distress may provide a more valid and comprehensive depiction of the impacts of climate change on mental health. Transdiagnostic treatment methods are likely the most appropriate intervention for climate-related distress. As models, measures, and treatments of climate-related distress are developed, it is crucial to incorporate studies of populations most at risk for climate change-related mental health effects.

Adults with multiple sclerosis (MS) frequently experience symptoms of depression and anxiety, which pose significant challenges. However, psychological support for these symptoms remains a major unmet healthcare need.

To inform the evidence base for the psychological management of adults with MS, this study examined the efficacy of cognitive behavioural therapy (CBT) interventions for improving symptoms of depression and anxiety. CBT interventions teach skills for improving the relationships between an individual's thoughts, feelings, and/or behaviours. The study also examined the role of intervention and study characteristics as moderators of treatment effects.

Medline, Embase, PsycINFO, and Cochrane Central Register of Controlled Trials were searched up to August 2024 for randomised control trials.

A meta-analysis of 15 clinical trials (1508 participants) was conducted, which found a medium significant treatment effect size for depression symptoms (g = 0.59, 95 % Confidence Interval [CI] [0.38, 0.80]) and a small significant treatment effect size for anxiety symptoms (g = 0.38 95 % CI [0.19, 0.57]). Moderator analyses revealed treatment effects for anxiety, but not depression, were significantly larger for studies conducted in non-Western countries compared to Western countries, and for those with smaller sample sizes.

CBT-based interventions appear efficacious for the management of depression and anxiety symptoms in adults with MS. However, future clinical trials with larger samples and more rigorous methodology are warranted. Further examination of intervention characteristics, including ways in which CBT is tailored and how this relates to outcomes, may help to refine interventions for people with MS.

Concussion often results in psychological symptoms, including anxiety. Post-concussion anxiety has been well documented, although much of this research has focused on collegiate athletes. The purpose of this study was to compare (1) anxiety symptoms in concussed and healthy controls over time and (2) to explore sex differences in post-concussion anxiety within the context of pubertal development. Participants (N = 126, mean age = 15.1 years old), including concussed (n = 86) and healthy adolescents (n = 40), completed the Pubertal Development Scale (PDS) and the Screen for Child Anxiety and Related Disorders (SCARED-C). The concussed groups completed SCARED-C at three visits (<10 days, 4 weeks, 3 months). Results of an analysis of covariance (ANCOVA) and multi-variate analysis of covariance (MANCOVA) found concussed adolescents reported higher SCARED-C total, generalized, and panic anxiety scores than healthy controls, after controlling for sex, age, and PDS score (PDSS). A three-way mixed ANCOVA examined the effects of sex, PDSS, time, and their interaction on SCARED-C total score in concussed adolescents while controlling for age. There was a significant three-way interaction between sex, age, and PDSS on SCARED-C total score while controlling for age. Overall, we observed increased anxiety in concussed adolescents, compared with controls, as well as greater post-concussion anxiety reported by females compared with males, including within PDSS groups. Concussion providers should be prepared to receive training to administer well-validated measures of psychopathology and should consider that female adolescents, compared with males, regardless of pubertal development, may be at greater risk for post-concussion anxiety.

Self-harm in children and young people is increasing. Parents are vital in supporting young people; however, parents may experience distress linked to the self-harm. Previous reviews have highlighted the emotional impact and need for information and support, however, have not elucidated the relationships between these themes, nor examined the quantitative data examining parents' well-being.

We conducted a mixed methods review, with qualitative meta-synthesis focusing on links between themes and quantitative synthesis of parental well-being findings, including pooled means. PsycInfo, Medline, EMBASE, AMED, CINHAL and Web of Science were searched to identify relevant records. References of included studies were also searched. Every abstract was screened by two authors. Data were extracted by one author and checked by another.

We identified 39 reports of 32 studies: 16 with qualitative data and 17 with quantitative data (one had both). Qualitative findings showed how parents' emotions were associated to their knowledge and beliefs about self-harm. Parents' emotions often evidenced the need to self-care, but emotions of guilt reduced engagement in self-care. How parents supported their young person was linked to their knowledge, and the management of their own emotions, and influenced if they could engage in self-care. Quantitative findings were mixed, however suggested poor general mental health amongst these parents.

Further good quality quantitative studies are needed, with measurement of psychological mechanisms that may underpin parental distress. Current evidence supports peer-support and interventions that go beyond information provision to address the connected factors of knowledge, emotion, self-care, and parenting behaviours.