Spiritually integrated group therapy aims to support coping, meaning-making, and existential recovery in patients receiving psychiatric care. SPIRIT (Spiritual Psychotherapy for Inpatient, Residential and Intensive Treatment) is a structured, flexible protocol implementing this approach into intensive or residential settings. This study examines (1) the impact of SPIRIT on patients’ lives and (2) their needs in terms of aftercare to determine whether and how its benefits can be sustained long term. Data were collected from multiple sources: patient evaluation forms (n = 118); in-depth interviews with patients (n = 19) and caregivers providing the therapy (n = 8); and two focus groups with both caregivers and patients. Transcripts were analyzed using qualitative content analysis. Results indicate that for most participants, the therapy positively impacted their lives through increased awareness or behavioral change, highlighting the relevance of maintaining these insights after group therapy, either at home or within the treatment setting. We recommend broader training of mental health professionals, and the introduction of programs like these to the entire care team to ensure awareness and support. A ‘dual motor model’ is proposed. Addressing religious, spiritual, and meaning-related themes in ongoing therapy and the psychosocial and pastoral support network can support recovery both by reducing symptoms and by fostering a health-promoting context.
Background:Major Depressive Disorder (MDD) is clinically and biologically heterogeneous. Here, we leveraged the genetics of individual depressive symptoms to dissect the disorder's underlying heterogeneity. Methods:We utilized the BIObanks Netherlands Internet Collaboration (BIONIC). A series of genome-wide association studies (effective-N range: 14,407 - 47,110) compared controls (N=48,286) with partially different subsets of lifetime MDD cases (range: 3,892-15,577), each endorsing one of 12 individual DSM-based depressive symptoms. Results were combined in genetic correlations that informed factor analyses with Genomic Structural Equation Modeling, decomposing underlying MDD liability dimensions. The identified factors were assessed and further characterized using multivariate regression of neurodevelopmental/psychiatric and cardiometabolic traits. Results:All symptoms demonstrated substantial SNP-based heritability (h 2 SNP : 0.088 - 0.127). Despite high between-symptom genetic correlations, factor analyses yielded two highly correlated (rg=0.85) but still distinct latent factors: factor 1 (F1), capturing appetite/weight loss, insomnia, guilt/worthlessness, psychomotor slowing and suicidality, and factor 2 (F2), reflecting concentration problems, anhedonia, depressed mood, appetite/weight gain and fatigue. Overall, F1 had a stronger genetic overlap with neurodevelopmental/psychiatric phenotypes (e.g., autism: standardized estimate β=0.45, p=4.49×10-4; schizophrenia: β=0.40, p=1.73×10-4), while F2 significantly overlapped with cardiometabolic traits (e.g., metabolic syndrome: β=0.44, p=8.69×10-4; coronary artery disease: β=0.31, p=0.009). Conclusions:We identified two genetic dimensions of MDD, each linked to partially distinct clinical manifestations and underlying biology, with one reflecting neurodevelopmental/psychiatric liabilities and the other capturing a strong cardiometabolic vulnerability. Disentangling such distinct dimensions may help guide patient stratification and targeted treatment, thereby advancing precision psychiatry.
INTRODUCTION:Major depressive disorder (MDD) affects 11%-19% of adolescents globally. Early treatment is vital, but the risk of relapse is high, with 46% relapse within 5 years, which threatens a chronic course. Hence, better solutions are needed. Repetitive transcranial magnetic stimulation (rTMS) is effective in adults, but its use in adolescents is limited. While studies-including trials and meta-analyses-exist, their generalizability is unclear. This review evaluates rTMS's efficacy and safety for adolescent MDD. METHODS:Following PRISMA guidelines, a comprehensive literature review was conducted using English-language databases Embase, PubMed, PsycINFO, and the Cochrane Database of Systematic Reviews. We included studies published up to February 2025. Data were pooled to calculate standardized mean change (SMC), proportions, log odds ratios, and their respective 95% confidence intervals (CI), measuring effectiveness, response rate, and suicidality. We systematically described adverse effects. RESULTS:We identified 687 studies, 42 underwent full-text assessment, and 19 were included. The within-intervention group pooled SMC between pre-post scores of depression severity was -2.15 (95% CI [-2.58, -1.73]), indicating a strong effect but with high heterogeneity (I 2 = 87.13%). For RCT-only studies, the pooled SMC was -0.90 (95% CI [-1.90, 0.11]), showing a smaller effect. The pooled response rate was 54% (95% CI [42%; 66%]) with similarly high heterogeneity (I 2 = 82.25%). A large reduction in suicidal ideation was observed (pooled SMC = -2.78, 95% CI [-5.98, 0.42]), albeit this was based on a limited number of studies (n = 3) and the SMC was not statistically significant. Mild and transient adverse effects were reported. The majority of studies were rated as having a high risk of bias. CONCLUSION:Our findings demonstrated that rTMS is effective, safe, and well-tolerated by adolescents with MDD. However, high heterogeneity of methods, bias, and inclusion of uncontrolled trials demand more rigorous trials, whereby adaptive designs could potentially increase the empirical availability.
This case report explores how anthroposophic art therapy (AAT) contributed to the reduction of obsessive-compulsive and anxiety symptoms in a woman with contamination-related OCD (“Sasha”). The case was drawn from a randomized controlled trial on art therapy for anxiety (Abbing et al., 2019) and selected for in-depth analysis, as Sasha was the only participant formally diagnosed with OCD. Quantitative data (anxiety, distress, emotion regulation, and executive functioning) and qualitative data from therapist notes and interviews were examined using a phenomenological approach.During the 10-week intervention, Sasha showed a marked reduction in compulsive behavior and anxiety. Improvements were also observed in validated measures of emotion regulation and executive functioning, domains often impaired in OCD. Qualitative findings highlighted key therapeutic elements—such as structured art exercises and a supportive, adaptive therapeutic stance—that promoted emotional awareness, self-regulation, and a more compassionate self-relation.Integrating process observations with outcome data suggests that symptom reduction did not occur in isolation, but was embedded in a broader psychological shift toward greater self-compassion. Enhanced emotion regulation appeared to play a central role in this process, supporting increased tolerance of emotional arousal and reduced reliance on avoidant and self-critical coping patterns characteristic of OCD.This case illustrates the potential of art therapy to address emotional and cognitive dimensions of OCD through experiential and compassionate processes. Further research is warranted to examine the effectiveness of AAT for OCD and to explore self-compassion as a potential mechanism of change.
