Posttraumatic stress disorder (PTSD), anxiety disorders, and alcohol use disorders commonly co-occur among veterans, resulting in greater impairment in the quality of life and other health outcomes than single disorders. Despite the availability of evidence-based psychotherapies, including integrated treatments addressing both anxiety/PTSD and alcohol use, treating comorbid disorders remains challenging. Leveraging providers' skills through modular, adjunctive materials focused on alcohol use might improve their ability to provide transdiagnostic care. Veterans (N = 6) with alcohol use disorder and anxiety and/or PTSD were recruited for an open pilot trial of Bridging the Gap, an adjunctive cognitive-behavioral manual used with the Unified Protocol. Pre- and posttreatment indicators of clinical impact, feasibility, and acceptability were examined; three cases illustrate the delivery of the clinical materials. Small-to-large effects for anxiety and PTSD outcomes and small effects for alcohol outcomes were observed. Bridging the Gap can support providers in delivering key elements of transdiagnostic care.
Anxiety disorders are prevalent in autistic adolescents, yet barriers to treatment access exist. The current article describes (a) the development of an internet-delivered, therapist-assisted cognitive behavioral therapy protocol adapted for autistic adolescents with co-occurring anxiety and/or obsessive-compulsive disorder and (b) preliminary feasibility, acceptability, and effectiveness data. Ten autistic adolescents between the ages of 11 and 17 were enrolled. Based on qualitative feedback and quantitative data (i.e., program usage, completion, and satisfaction), the intervention demonstrated strong acceptability and feasibility. Among the eight participants who completed treatment, there were statistically significant reductions in clinician- and parent-rated anxiety symptoms, but not child-rated anxiety symptoms. Posttreatment response and remission rates were 37.5% and 25%, respectively. Further evaluation in a randomized controlled trial is warranted.
Mixed reality exposure and response prevention (MERP) has been proposed as an innovative format to address barriers that limit the implementation of traditional in vivo exposure and response prevention (ERP) in obsessive-compulsive disorder (OCD). This case report illustrates the clinical application of MERP in a 57-year-old woman with chronic contamination-related OCD who had previously completed extensive outpatient psychotherapy, including cognitive behavioral therapy with ERP, with only temporary improvement. As part of a randomized controlled trial, she received six therapist-led MERP sessions in which disorder-relevant virtual contamination cues were superimposed onto the real therapy environment to enable immersive exposure while maintaining ecological validity. MERP was well accepted, and no adverse events occurred. Symptom severity decreased from severe to moderate on the Yale-Brown Obsessive-Compulsive Scale (26-20), with marked improvement in obsessions, reduced avoidance, and increased ability to refrain from neutralization. The patient reported a greater sense of agency and successful transfer of exposure principles into daily life. The case highlights typical challenges observed in MERP, including fluctuations in sense of immersion, technical limitations that affect stimulus stability, and covert mental neutralization, and outlines practical strategies to address them. Overall, the report demonstrates that MERP is a feasible and acceptable delivery format for ERP in contamination-related OCD and provides clinically relevant insights for optimizing its implementation in routine care.
College students' life satisfaction has been widely regarded as a crucial psychological concern worldwide. As a pivotal developmental stage, the college period significantly shapes individuals' well-being, which influences both their academic experiences and future outcomes. Scholars have increasingly focused on identifying key predictors of life satisfaction to guide effective interventions. This study explores how self-esteem and psychological flexibility influence life satisfaction among 991 Chinese university students. Using validated scales, we found that both factors positively predicted satisfaction. Notably, psychological flexibility moderated this relationship-strengthening it when low and weakening it when high, indicating a buffering effect. We discuss the theoretical and practical implications of these findings for student well-being.
Many Veterans see a clinician shortly before suicide. Clinicians report a lack of training in firearm secure storage conversations as a barrier to initiating these conversations. We aimed to determine the needs of Veterans Health Administration mental health clinicians for training in discussing secure storage. A needs assessment survey of attitudes, barriers, facilitators, and desired training topics was sent to mental health clinicians at 15 Veterans Administration medical centers in the South, including Texas. Of clinicians completing the needs assessment ( N = 566), most (93%) endorsed “usually” to “always” discussing secure storage. Reported barriers included Veterans not being open to such discussion (30.3%) and clinician discomfort (21.9%). Clinicians wanted more training regarding secure storage, scripts for conversations, and repairing rapport. Clinicians can discuss secure storage with Veterans to reduce suicide risk. Our results highlight the need to develop training to support clinicians in discussing secure storage with Veterans to prevent suicide.
In the current preregistered meta-analysis, we examined the relation between indicators of treatment amount and effectiveness of individual psychotherapy for generalized anxiety disorder (GAD). We synthesized within-subjects effects from existing randomized controlled trials of individual psychotherapy for adults with GAD (k = 41 studies; n = 1,607 participants). Using random-effects meta-regression, we found that duration of therapy and number of sessions were unrelated to treatment effectiveness. Studies with sessions lasting longer than 60 minutes produced larger effects than sessions shorter than 60 minutes (b = 0.62, 95% confidence interval [CI] [0.21, 1.05]). We also found a trivial relation between therapist contact time and treatment effect (b = 0.02, 95% CI [-0.01, 0.06]). These effects varied based on moderating variables. Our results highlight that more time spent in each session may yield larger treatment effects. Future research should aim to examine different "doses" of psychotherapy in efforts to optimize patient outcomes.
Debate exists on whether cognitive components of anxiety and depression, specifically worry, postevent processing (PEP), and rumination, are best understood as independent constructs (i.e., symptom-specific) or as one transdiagnostic construct (i.e., repetitive negative thinking [RNT]) and whether the process or content of RNT is most relevant to symptom severity. We investigate whether RNT, measured transdiagnostically, explains additional variance in symptom severity than worry, rumination, and PEP. We explore whether the content of RNT thoughts or the process of engaging in RNT is associated with symptom severity. Undergraduates (n = 646) completed measures of RNT, PEP, worry, rumination, and symptom severity. Transdiagnostic RNT explained additional variance in symptom severity beyond PEP, worry, or rumination, and vice versa. RNT content and process predicted greater psychological symptom severity. Both the process and the content of RNT (both general and symptom-specific) are associated with depression and anxiety symptom severity.
Acceptance and commitment therapy (ACT) is a supported intervention used with active-duty soldiers and veterans. In this multiple baseline study, we tested a 10-session ACT protocol for veterans with social anxiety disorder (SAD) using a culturally adapted protocol of ACT for veterans. At the individual level, three of four participants showed responses to treatment. Average self-monitored avoidance behaviors across all four participants decreased from 44.55 per day at pretreatment to 29.71 during treatment and further to 10.18 at follow-up. Average levels of self-reported anxiety moderately decreased by comparison. Finally, self-reports of psychological flexibility, sleep, suicidality, anxiety, and depression all moved in appropriate directions throughout treatment. Descriptions of exercises tailored to veteran populations are included. Limitations and future directions are discussed.
Pathological doubt in obsessive-compulsive disorder (OCD) suggests core deficits in memory and metamemory, but the nature of these deficits and their response to treatment remain unclear. This study aimed to address this gap by investigating (a) whether memory and metamemory problems in OCD are due to retrieval or encoding processes, and (b) the effect of cognitive behavioral therapy (CBT) on these functions. Sixty OCD patients and 60 matched healthy controls completed 3 episodic memory tasks involving different stimuli, with assessments of judgment-of-learning and feeling-of-knowing. OCD patients then completed a 10-week CBT intervention and were reassessed post-CBT and at 6-month follow-up. At baseline, OCD patients showed significantly lower memory and metamemory performance than controls. Following the intervention, they demonstrated significant improvements in clinical symptoms, memory, and metamemory, which were maintained at follow-up. The findings suggest that OCD-related memory and metamemory impairments involve both encoding and retrieval processes and that CBT is an effective treatment for improving both clinical and cognitive outcomes.
Bipolar disorder is a chronic condition marked by mood instability and elevated suicide risk, particularly among U.S. veterans, with treatment nonadherence contributing to poor outcomes. Historically focused on lithium clinics and symptom management, bipolar disorder treatment began to shift in 1996 with the introduction of the Life Goals Program, an evidence-based self-management curriculum that emphasizes self-directed management and personal goal attainment. This case study features a U.S. male veteran with bipolar I disorder who completed 12 telehealth Life Goals sessions over 6 months. A multidisciplinary Veterans Affairs team conducted ongoing mood and risk monitoring, and self-report measures were collected at baseline, postintervention, and follow-up. Results showed reductions in depression and edginess, along with increased life satisfaction. The case illustrates the program's potential to support self-management and improve outcomes in individuals with bipolar disorder. While promising, future research-including randomized controlled trials-is needed to establish the program's broader efficacy.
Relapse following treatment is a frequent occurrence in individuals with eating disorders (EDs), highlighting the importance of developing preventive interventions. The GG Eating Disorders (GGED) module is designed to address dysfunctional beliefs that contribute to the development and maintenance of these disorders through its use within a mobile application. The aim of this exploratory case series study is to analyze the efficacy of GGED in reducing ED-related dysfunctional beliefs and eating symptomatology and increasing body satisfaction and self-esteem among three patients with EDs in remission. Following the use of GGED, patients showed a decrease in most dysfunctional beliefs and ED symptoms, accompanied by an increase in body satisfaction and self-esteem. However, these changes did not reach clinical significance in all patients. The GGED module has the potential to serve as a very useful tool in maintaining cognitive changes following cognitive behavioral therapy and thus preventing relapse.Clinical Trial Registration: This study was registered with ClinicalTrials.gov (Identifier NCT06842862).
Obsessive-compulsive disorder (OCD) is a debilitating, often chronic condition with symptoms that are time-consuming and can cause distress or impairment. OCD can involve and have a significant impact on families. Although calls for family-inclusive treatment for OCD exist, results on its effectiveness are mixed. This case report presents Jane, a young adult with OCD in psychiatric residential treatment, and how her symptoms were profoundly affected and maintained in part by maladaptive family processes. Attachment-based family therapy is used in conjunction with exposure and response prevention to reduce Jane's symptoms, minimize family accommodations, address underlying family processes, and improve family dynamics. Treatment outcomes were assessed through standardized tools, clinician observations, and patient self-reports. By the conclusion of treatment, Jane saw reductions in OCD, anxiety, and depressive symptoms, an increase in well-being, and improved family communication. Implications and recommendations will be discussed.
Cognitive impairment is a core feature of schizophrenia, significantly affecting patients' daily functioning and quality of life. Cognitive rehabilitation nursing (CRN) has emerged as a promising nonpharmacological approach to improve cognitive deficits. This systematic review and meta-analysis aimed to evaluate the efficacy of CRN in enhancing cognitive function in patients with schizophrenia. A systematic literature search was conducted in Web of Science, PubMed, and Scopus for studies published between 2020 and 2025, using a combination of controlled vocabulary and free-text terms. Eligible studies were original, peer-reviewed articles examining CRN interventions in individuals with schizophrenia, with cognitive or functional outcomes. Fifteen studies comprising 19 intervention arms met the inclusion criteria. Methodological quality was assessed using the Cochrane RoB-2 (Risk of Bias 2) tool for randomized trials and ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) for nonrandomized studies. Standardized mean differences (SMDs) with Hedges' g correction were calculated under a random-effects model. Heterogeneity was examined using I² statistics, and publication bias was evaluated through funnel plots and Egger's test. A total of 19 intervention arms from 15 studies were included. Overall, cognitive rehabilitation yielded a small but favorable effect across cognitive domains (SMD = 0.35, p = .084), with a significant moderate-to-large effect observed for executive function (SMD = 0.63, p = .035), particularly in studies employing computerized, individualized, or virtual reality-based interventions. Effects on global cognition, memory, and functional outcomes were smaller and nonsignificant, while social cognition, assessed in one study, showed a small negative effect (SMD = -0.34, p = .046). Pharmacological and game-based interventions showed inconsistent efficacy. Substantial heterogeneity was present (I² = 85.3%), with outcome domain emerging as a significant moderator (p < .001). Publication bias analysis indicated potential small-study effects, although no missing studies were identified via the trim-and-fill method. This meta-analysis supports the effectiveness of CRN in improving cognitive outcomes in schizophrenia, with the strongest effects on executive function. Targeted, multimodal, and tech-enhanced interventions showed the greatest promise. Despite heterogeneity, the findings were consistent, reinforcing CRN's role in multidisciplinary psychiatric care.
Existential obsessions-persistent, intrusive doubts about unanswerable questions such as the nature of reality, identity, free will, and death-are an understudied and underrecognized presentation of obsessive-compulsive disorder (OCD). Although these symptoms align with core OCD features, their abstract and philosophical content distinguishes them from more commonly studied presentations. This article provides a conceptualization of existential obsessions, outlining their phenomenology, cognitive-behavioral underpinnings, and implications for assessment and treatment. We identify four primary content domains, namely, metaphysical, thanatological, ontological, and deterministic obsessions, and draw on established OCD models to explain their development and maintenance. Sociocultural and developmental influences are also highlighted. We then outline treatment recommendations based on the conceptual model and present a research agenda to address gaps in the literature, including the need for targeted assessment tools, empirical tests of proposed mechanisms, and treatment trials. Just as other manifestations of OCD have gained clarity through empirical study, existential obsessions merit scientific attention to enhance recognition and improve outcomes.
This study explores the distinct roles of religiosity and scrupulosity in relation to cognitive factors-obsessive beliefs, fear of self, and inferential confusion-across contact and mental contamination (MC). Unlike prior research, it examines how religiosity and scrupulosity differentially predict contamination concerns through these cognitive factors. A sample of 235 undergraduates (83.4% female, M = 18.84 years) completed self-report measures assessing contamination types, scrupulosity, religiosity, fear of self, inferential confusion, and obsessive beliefs. Results showed that scrupulosity, compared with religiosity, was a stronger predictor of contamination, particularly MC, suggesting the importance of distinguishing between normative religious belief and pathological doubt. Fear of self and inferential confusion mediated the link between scrupulosity and MC, while inferential confusion alone mediated contact contamination. These findings highlight the distinct cognitive pathways underlying mental and contact contamination and emphasize the clinical relevance of targeting scrupulosity, fear of self, and inferential confusion-rather than religiosity-in interventions for contamination-related obsessive-compulsive disorder symptoms. Limitations include the sample's limited generalizability, cross-sectional design, and Western context, which may not fully capture cultural and religious influences.
Research has shown that disgust-based contamination obsessive-compulsive disorder (OCD) is often challenging to treat due to neurological and behavioral differences that can inhibit short-term habituation. This article presents a case study of using a novel functional approach to exposure and response prevention for disgust-based OCD focused on facilitating practice in avoided situations, incorporating concepts from acceptance and commitment therapy as well as emerging literature on using judicious safety behaviors to enable repeated practice. This case involves a 39-year-old male patient with disgust-based contamination OCD treated using this approach. Following a short course of psychotherapy combined with self-directed practice, the patient's measured level of OCD severity (Yale-Brown Obsessive Compulsive Scale) was reduced by 56% over a 5-month period, with the patient meeting remission at posttreatment.
The existing research on attachment has been predominantly limited to Western adult populations and parental attachment relationships, leaving significant gaps in our understanding of adolescent development. The present study addresses these limitations by investigating how insecure attachment to mothers, fathers, and peers is associated with psychological distress in early adolescence (grades 7-9), with particular attention to the mediating role of loneliness. This developmental period represents a critical window for intervention, as patterns of social-emotional adjustment established during early adolescence often persist into adulthood. Our sample comprised 813 junior high school students who completed 3 well-validated self-report measures: the Relationships Structures Questionnaire assessing attachment patterns; the University of California, Los Angeles Loneliness Scale measuring subjective social isolation; and the Depression Anxiety Stress Scales-21 evaluating psychological distress. Using structural equation modeling, we tested three mediation models to examine both direct and indirect pathways from insecure attachment to psychological distress through loneliness. The results revealed several important patterns: First, we observed moderate positive correlations between anxious and avoidant attachment styles (r = .38-.44), suggesting that these insecure attachment patterns frequently co-occur. Second, structural models demonstrated significant total effects of insecure attachment on psychological distress across most relationship figures, with the notable exception of avoidant peer attachment. Third, while both anxious and avoidant attachment positively predicted psychological distress, avoidant peer attachment exhibited a negative association with distress symptoms. Fourth, and most crucially, loneliness emerged as a significant mediator in all models, explaining substantial portions of the attachment-distress relationship. Gender, attachment style, and loneliness together explained 36%-38% of the variance in distress. These findings have important theoretical and practical implications. Theoretically, they extend attachment research beyond its traditional focus on parental relationships by demonstrating the unique and combined influences of multiple attachment figures during early adolescence. Practically, the robust mediating role of loneliness suggests that interventions targeting both attachment security and social connection may be particularly effective for reducing adolescent distress. We recommend that family education programs incorporate attachment-informed parenting strategies while school counseling interventions address peer relationships and loneliness directly.
One potential explanation for difficulty in treating trichotillomania despite increased research on evidence-based treatments is the heterogeneity in symptom presentation. An individualized treatment approach may help increase treatment response and recovery. Additionally, understanding which processes help improve treatment outcomes in psychosocial interventions may be particularly important. This study examined how changes in trichotillomania-specific psychological inflexibility related to week-to-week levels of hair-pulling severity and distress. We also explored a potential bidirectional relationship between hair-pulling severity and trichotillomania-specific psychological inflexibility. Results indicated that trichotillomania symptom severity predicted trichotillomania-specific psychological inflexibility and vice versa, suggesting a bidirectional relationship. Additionally, trichotillomania-specific psychological inflexibility may play a more central role in trichotillomania symptom changes. Moreover, distress was strongly predicted by current trichotillomania-specific psychological inflexibility. Trichotillomania-specific psychological inflexibility appears to be a process of change in treatment for trichotillomania. Clinical implications are discussed.
Although exposure with response prevention (ERP) is the frontline treatment for obsessive-compulsive disorder (OCD), several challenges exist in its implementation. Emerging technologies, including mobile health (mHealth) apps and extended reality (XR), offer innovative solutions to overcome these challenges. In response, we surveyed OCD therapists to establish the utilization of emerging technologies in clinical practice and investigate accompanying barriers. A total of 223 therapists reported their use, interest, and perceived barriers regarding mHealth and XR tools in clinical practice. While 62.1% presently reported using mHealth apps-mostly mindfulness and mood tracking-fewer therapists used them for ERP-specific tasks. Despite high interest in XR by OCD therapists, only 9.1% had used XR in ERP. Barriers to technology utilization included lack of knowledge, limited training, and uncertainty about evidence to support use. Findings highlight a need for clinical resources, therapist training, and further research to determine how to optimize the implementation of ERP using novel technologies.
