OBJECTIVE:The authors examined how transparency of artificial intelligence (AI) use (transparent vs. covert) and modality of therapy (telehealth vs. text based) influenced prospective patients' perceived acceptability of AI assistance and intent to continue psychotherapy. A secondary objective was to assess whether age, AI familiarity, and prior psychotherapy experience predicted these perceptions. METHODS:A preregistered, cross-sectional vignette study was conducted with 201 U.S. adults recruited from an online survey platform. Participants evaluated five psychotherapy scenarios varying by modality and disclosure, including a control scenario with no AI use. After each vignette, participants rated acceptability and intent to continue treatment. Linear mixed-effects models were used to assess vignette effects, participant characteristics, and interactions involving age and AI familiarity. RESULTS:Across all models, therapist use of AI substantially reduced perceived acceptability and continuation intent compared with the control scenario (all p<0.001). Covert use consistently produced the strongest declines. Participant characteristics did not attenuate vignette effects. Older age and greater chatbot familiarity predicted slightly higher ratings and moderated transparent conditions, reducing penalties modestly. CONCLUSIONS:Prospective patients showed strong anticipated preferences for psychotherapy without therapist use of AI. Transparency reduced, but did not eliminate, negative reactions. The findings suggest that potential implementation of AI-assisted psychotherapy requires explicit consent and careful attention to therapeutic relationship concerns.
OBJECTIVE:Internally displaced persons (IDPs) are at high risk for mental disorders, yet few have access to treatment. In northern Mozambique, a violent insurgency has displaced more than 1 million people to neighboring provinces. In this qualitative study, the authors explored how interpersonal counseling (IPC), an evidence-based intervention for common mental disorders currently being scaled in Mozambique, could be tailored to the psychosocial needs of IDPs. METHODS:Six focus groups and five in-depth interviews were conducted with stakeholders (N=53), including IDPs, community leaders, program implementers, and humanitarian organization representatives. A thematic codebook was developed, refined, and applied to all data. The four problem areas of the interpersonal framework-grief, life transitions, interpersonal disagreements, and loneliness-guided the analysis to inform IPC adaptation. RESULTS:Three of the four problem areas (grief, life transitions, and interpersonal disagreements) were relevant to this population, although they often co-occurred and intersected, complicating identification of a single focal problem area-a core element of IPC. Grief was pervasive but often ambiguous when loved ones were missing, creating tension between mourning and hope. Role transitions were also salient: many mothers faced sudden single parenthood, and adolescents left school to assume adult responsibilities. Disagreements between IDPs and local residents were also common. CONCLUSIONS:The interpersonal framework was highly relevant for IDPs, although adaptation may be required to address overlapping and context-specific challenges of displacement.
OBJECTIVE:Depression is highly prevalent in Lebanon, but the number of mental health specialists is limited; alternative interventions that increase access are needed. The authors evaluated the feasibility of group interpersonal psychotherapy (IPT-G) delivered in primary health care settings as part of national efforts to expand community-based services to address depression. METHODS:The authors conducted an open-label, mixed-methods feasibility trial in Lebanon. Fourteen providers completed IPT-G training and supervision by certified trainers to offer a nine-session IPT-G treatment using the Arabic version of the World Health Organization (WHO) manual. Participants scored ≥10 on the Patient Health Questionnaire-9 (PHQ-9) and were deemed low on suicide risk. Feasibility was assessed through provider focus groups. Participant outcomes included depression symptoms as indicated on the PHQ-9, level of functioning according to the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), and provider competency evaluated with structured rating scales. RESULTS:One hundred twenty-nine female participants were enrolled in 24 groups, with 94% attendance; 17% dropped out. PHQ-9 scores declined by 63%, and WHODAS 2.0 scores decreased by 53%, with significant improvement observed in all six WHODAS 2.0 domains. Syrian participants had higher PHQ-9 scores than Lebanese participants at multiple sessions (p<0.05). Provider competency improved significantly across three consecutive supervised group cycles (p<0.05-<0.001). Providers reported high acceptability of and a strong intent to continue IPT-G but cited needs for adequate staffing, transport, and space. CONCLUSIONS:IPT-G was feasible in a Lebanese primary care setting and improved depression and functioning, supporting readiness for expansion of its availability, given adequate supervision and resources.
Racism-the practices within a society that are intended to disenfranchise a racial or ethnic group and perpetuate inequality-has a long history in the United States, and exposure to it continues to be a source of stress for Blacks. In this Brief Report, the author reviews the negative effects of racism on general and mental health, conceptualizing racism as a form of traumatic and generational stress. The benefits of using the biopsychosocial model to address patients' health concerns are discussed. Compared with the biomedical model, this framework can help clinicians address patients' symptoms more holistically, taking into account the influence of different aspects of a person's life on their health, including the impact of racism as a chronic stressor.
OBJECTIVE:Subjective cognitive decline (SCD) is often considered an early phase of dementia and is associated with emotional distress, without approved treatments. This study in China aimed to evaluate the effects of acceptance and commitment therapy (ACT) on cognitive and emotional distress among older adults with SCD. METHODS:The study used an experimental design of two sequential phases. First, the authors screened 158 older adults with a cross-sectional survey that used standardized SCD criteria and enrolled 34 individuals (mean±SD age=65.66±5.02 years, range 60-77 years) who met the inclusion criteria (SCD with emotional distress). Second, they implemented a two-group randomized controlled trial with repeated measures (baseline and posttest) over 7 weeks to compare the outcomes of ACT with the waitlist control group. The intervention group (N=15 after two participants dropped out) received weekly ACT sessions; the control group (N=17) received the intervention after the experiment. Outcomes included executive function, emotional distress, and psychological flexibility, which were assessed at baseline and posttest. RESULTS:Compared with the waitlist control group, participants in the intervention group showed significant improvement in executive function, emotional distress, and psychological flexibility. No significant changes were observed in the control group in these areas. CONCLUSIONS:The findings support the efficacy of ACT compared with a waitlist condition, but the design limits causal inference regarding ACT-specific mechanisms. Future trials incorporating active control conditions are needed to determine the mechanisms underlying ACT-related improvement.
OBJECTIVE:The aim of this qualitative study was to evaluate the therapeutic role of canine-assisted intervention (CAI) as an adjunct to multimodal treatment in inpatient psychiatry, develop an implementation framework for an animal-assisted therapy program, and examine staff perceptions of its benefits as a complementary modality in psychiatric care. METHODS:The authors conducted a 20-minute semistructured interview with 17 psychiatric nursing staff members who were current employees in an adult inpatient psychiatric unit and who had worked with pet therapy services over the past 4 years. RESULTS:Analysis of interviews revealed that participants perceived CAI as a beneficial adjunct to psychiatric care. Staff reported that therapy sessions improved patient mood, reduced anxiety, enhanced socialization, and encouraged engagement among individuals who were often withdrawn. Interactions with therapy dogs contributed to a calmer unit environment and strengthened therapeutic relationships between patients and staff. Participants experienced personal enjoyment and stress relief during therapy visits and recommended increasing the frequency and structure of the program to further support both patient and staff well-being. CONCLUSIONS:CAI was perceived by staff as a valuable complementary therapy in the inpatient psychiatric setting, offering emotional, social, and therapeutic benefits for both patients and staff. Findings highlight improvements in mood, socialization, coping, and overall patient experience, with strong support for expanding and structuring such programs. These results suggest that CAI can play a meaningful role in enhancing multimodal psychiatric care.
This article seeks to clarify and distinguish how phenomenological definitions of empathy may be applied in psychotherapy. It argues that effective therapeutic practice relies not only on narrative engagement but also on embodied attunement, often referred to as empathic resonance. Rather than viewing the therapist's feelings as passive emotional mirroring of the client, the authors propose a critical and situated perspective in which these feelings are understood as embodied responses that emerge within the therapeutic relationship. In doing so, the authors aim to contribute to the enhancement of clinical training in psychotherapy. They specifically advocate for a stepwise approach to training, in which narrative tracking and bodily self-awareness are developed and cultivated as separate skills in the early phases of psychotherapy training. The progressive integration of these skills eventually enables therapists to use their feelings as instruments of empathy rather than sources of interference. Thus, empathic therapists do not limit themselves to a purely cognitive, intellectual understanding of a client's story. Instead, they cultivate a comprehensive form of empathy, allowing themselves to resonate with the client's experience at a bodily, prereflexive level.
Underserved communities-especially communities of color in the United States-face disproportionate exposure to trauma because of social and structural inequalities. These factors give rise to intergenerational transmission of trauma and inform cultural beliefs about psychotherapy and mental health care more broadly. Increasingly, individual psychotherapies developed in diverse settings, as well as community-based psychosocial interventions, show evidence of client engagement, acceptability, and efficacy. The authors describe upstream and immediate factors that increase vulnerability to trauma among U.S. Black communities facing adversity. Vulnerabilities and strengths shaped by colonialism and enslavement are also examined across communities of color. Although psychotherapy for communities of color can play a vital role in healing personal harms shaped by structural threats, it is insufficient without additional resources. Providers and communities must collaborate in order to understand and reduce structural stigmas that are sources of trauma and barriers to care.
OBJECTIVE:This study aimed to determine whether psychotherapy use varies by gender and age among U.S. adults with depression or daily anxiety. METHODS:Data were from the 2021-2023 National Health and Nutrition Examination Survey. The sample included adults ages ≥18 who screened positive for depression (Patient Health Questionnaire-9 score ≥10, N=728) or reported daily anxiety symptoms (N=1,708). Psychotherapy use was defined as self-reported receipt of therapy from a mental health professional in the past year. Survey-weighted logistic regression estimated associations between gender and psychotherapy use within age strata, and the margins produced predicted probabilities and gender gaps. Secondary analyses examined differences by race-ethnicity. RESULTS:When the full analytic sample was considered, psychotherapy use was higher among women than men for both depression and anxiety. For depression, the gender gap was largest among adults ages 18-25 (22 percentage points), smaller for ages 26-49 (12 points), and reversed at ages ≥50 (-1 point); young men had the lowest use (27%). For anxiety, gender gaps were 13, 12, and 4 percentage points for ages 18-25, 26-49, and ≥50, respectively. Men in the youngest and oldest age groups had the lowest psychotherapy use (24% and 23%, respectively). Mexican American adults had the lowest psychotherapy use for both depression (19%) and anxiety (27%). CONCLUSIONS:Gender disparities in psychotherapy use are greatest among younger adults, particularly for depression, and are less pronounced for anxiety. Young men show especially low use. Findings highlight opportunities for targeted outreach, referral pathways, and service models tailored to men, especially younger men, and to Mexican American adults to reduce underuse of psychotherapy.
OBJECTIVE:Cognitive-behavioral therapy for psychosis (CBTp) is a frontline psychological intervention, yet there is no widely used tool for sessional measurement. Using data from two clinical trials, the authors examined the feasibility of using the Questionnaire About the Process of Recovery (QPR) as a sessional outcome measurement tool throughout CBTp. METHODS:Sixty-two participants with schizophrenia spectrum disorders received up to 26 sessions of CBTp and were instructed to complete the QPR at each session. RESULTS:On average, participants attended 21.56 CBTp sessions and completed the QPR for 95% of the sessions. Two participants did not complete the QPR because of symptomatic or functional limitations, and one additional participant did not reliably complete the QPR. CONCLUSIONS:The QPR is a feasible tool for measuring therapeutic progress and subjective recovery for people with schizophrenia spectrum disorders who are receiving CBTp. Because measurement-based care is underused in this population, these findings demonstrate the potential utility of a personal recovery measure for capturing sessional data in CBTp.
OBJECTIVE:This study focused on the implementation of dialectical behavior therapy (DBT), an evidence-based treatment for youths with nonsuicidal self-injury and suicidal ideation, in a psychiatric residential treatment center (RTC) for children and adolescents who have complex psychological, psychiatric, substance use, and developmental disorders. METHODS:In a pilot hybrid effectiveness-implementation trial, the authors compared functioning scores of adolescent patients who received DBT (N=113) with the scores of those who received treatment as usual (N=114) in an RTC. Data were collected from 227 adolescents admitted to the RTC over a 2-year period (July 2018-June 2020). Chi-square and t-test analyses were used to explore demographic differences and differences in functioning between the two groups. RESULTS:Adolescents in the DBT group demonstrated improved overall functioning between admission and discharge, but analyses indicated a nonsignificant difference between adolescents who received DBT and those who received treatment as usual. CONCLUSIONS:This nonrandomized study suggests that DBT may be a useful psychotherapeutic treatment for adolescents, although findings are preliminary.
OBJECTIVE:Anxiety among adolescents is pervasive, necessitating novel treatment approaches, such as DNA-v (Discoverer, Noticer, Advisor, along with values), a developmental adaptation of acceptance and commitment therapy (ACT). METHODS:This study was a preliminary test of group DNA-v with a racially diverse sample of youths (N=7; mean age=16.28 years) already receiving mental health services for anxiety. Treatment comprised eight 90-minute weekly group sessions. Participants completed measures of psychological flexibility weekly, as well as anxiety and psychological inflexibility at pretreatment, posttreatment, and follow-up. Data were analyzed at the individual and aggregate level via means, percentage change, and reliable change indices. RESULTS:Psychological flexibility remained relatively stable, and psychological inflexibility and anxiety decreased slightly. Participants rated the treatment as acceptable and positive. CONCLUSIONS:This study offers initial promise for DNA-v as an intervention for racially diverse adolescents with anxiety and points to the need for more research on DNA-v.
