Religiously Integrated Cognitive Behavioral Therapy (RCBT) has increasingly emphasized the incorporation of clients’ religious beliefs and practices into psychotherapy. However, many existing approaches tend to utilize religious concepts primarily as supportive therapeutic tools within an already established cognitive-behavioral framework, often detaching them from their original epistemological and ontological contexts. In response to this limitation, the present article introduces the TMTT model (Tafakkur–Muḥāsaba–Tawba–Tawakkul) as a conceptually grounded and process-oriented framework for religiously integrated psychotherapy rooted in the Islamic intellectual tradition. The model proposes a form of integration in which religious concepts function not merely as therapeutic content but as organizing principles structuring the therapeutic process itself. The article presents the philosophical foundations, developmental rationale, and clinical structure of the TMTT model. Drawing upon the revivalist tradition of Ilm an-Nafs and contemporary process-oriented psychotherapy frameworks, the model conceptualizes psychological change as a multidimensional process involving cognitive awareness, moral evaluation, repentance-based reorientation, and trust-based values-consistent action. Each core component—tafakkur (contemplation), muḥāsaba (self-reckoning), tawba (repentance/turning back to Allah), and tawakkul (reliance on Allah)—is examined through four dimensions: its conceptual background in the Islamic intellectual tradition, its therapeutic function within TMTT, its comparison with related constructs in modern psychotherapy and CBT, and its clinical implementation. The article further discusses the model’s developmental status, limitations, implementation challenges, and future research directions. TMTT is positioned as an early-stage, theoretically coherent clinical framework that remains open to empirical refinement and manual development. By integrating cognitive, emotional, behavioral, moral, and spiritual processes within a unified meaning-oriented structure, the TMTT model offers a preliminary proposal for structurally integrating Islamic concepts into psychotherapy while preserving their conceptual integrity.
Cognitive Behavioral Therapy (CBT) is widely used in the management of Functional Neurological Disorder (FND); however, its reported efficacy varies across studies. Existing systematic reviews often rely on limited or outdated evidence and do not sufficiently differentiate the impact of session structure, therapeutic approach, and delivery format. This review aims to evaluate the clinical effectiveness of CBT for FND by examining variations in session formats, therapeutic components, and modes of delivery, and to explore its applicability in non-Western contexts, particularly in Pakistan. In accordance with PRISMA guidelines, this systematic review included randomized controlled trials (RCTs), prospective studies, and case series investigating CBT for FND across Western and Eastern settings. Findings were interpreted within the bio-psycho-social framework. Most studies implemented a structured 12-session, weekly CBT protocol lasting approximately 60 min per session. Interventions primarily involved manualized CBT emphasizing psychoeducation and cognitive restructuring. Treatment was predominantly delivered individually in face-to-face outpatient settings, although some studies incorporated group formats or combined CBT with physiotherapy. Overall, CBT demonstrated improvements in symptom severity, functional outcomes, and psychosocial well-being. The evidence supports CBT as an effective intervention for FND symptom management. However, its impact appears influenced by cultural and healthcare contexts, underscoring the importance of culturally sensitive and region-specific adaptations, particularly for implementation in Pakistan.
Recent research highlights the link between poor sleep and emotion regulation difficulties. However, few studies have investigated emotion regulation changes following cognitive behavioral therapy for insomnia (CBT-I), the first-line treatment. In this quasi-experimental study, fifteen patients with chronic insomnia undergoing a 6-week CBT-I program at the National Institute of Mental Health, Czech Republic (NIMH-CZ), were compared to fifteen matched controls continuing treatment as usual. Both groups completed self-report measures of emotion regulation difficulties, insomnia severity, and hyperarousal at baseline and after six weeks. Due to residual group differences, age was included as a covariate. CBT-I significantly reduced insomnia severity compared to controls, but no large impact was observed in emotion regulation difficulties or hyperarousal owing to treatment. However, these results show only preliminary indicators that emotion regulation difficulties remain relatively intact after treatment and no firm conclusion can be drawn due to limits of this study. Findings therefore require scrutiny in larger samples. Further research is warranted to understand the mechanisms underlying therapeutic change in insomnia treatment.
Rumination and low distress tolerance are common psychological difficulties among divorced women. Acceptance and Commitment Therapy (ACT) has been proposed as a promising intervention for improving emotional regulation and psychological flexibility. In this parallel-group randomized controlled trial, 34 divorced women referred to counseling centers in Arak, Iran, were randomly assigned to an intervention group (ACT) or a control group (no treatment). Participants completed the Ruminative Responses Scale and the Distress Tolerance Scale at baseline and post-intervention. The ACT program consisted of eight 90-minute weekly sessions delivered by a trained therapist. Data were analyzed using non-parametric tests. ACT led to a significant reduction in rumination (pre: 61.94 ± 11.30; post: 41.82 ± 14.26; p < 0.001) and a significant increase in distress tolerance (pre: 36.59 ± 8.47; post: 62.06 ± 2.06; p < 0.001) compared with the control group. Between-group differences at posttest were statistically significant for both outcomes. ACT appears to be an effective intervention for reducing rumination and increasing distress tolerance among divorced women. Trial Registration: IRCT20231219060475N1.
Emotional disorders are the most prevalent worldwide. Similarly, a significant proportion of individuals experience subclinical symptoms of anxiety and/or depression, which negatively impact their lives. Therefore, preventive interventions are crucial to mitigate symptom progression. The Unified Protocol (UP), a transdiagnostic intervention, has been adapted for individuals with subclinical symptoms. Despite promising results, these studies have identified limitations (e.g., the need for longer-duration adaptations). This study aims to explore the perceptions of mental health professionals about the characteristics (e.g., structure, content) that a brief preventive version of the UP (UP-Prevent) should incorporate. Two focus groups were conducted with nine psychologists trained and experienced in delivering the UP. A thematic content analysis was employed, and three main themes, nine subthemes, and twenty-three topics were identified. The structure, content, and modules of the UP were adapted for the development of UP-Prevent, reducing sessions to six, and the language and the assessments were simplified.
Bipolar disorder (BD) significantly compromises overall functioning. Evidence supporting the benefits of cognitive-behavioral therapy (CBT) in BD highlights the need to explore its application in diverse clinical contexts. This single-case study implemented and analyzed a CBT intervention in a 59-year-old woman diagnosed with BD type I, conducted through individual online sessions. Both diagnosis and case formulation were essential for treatment progress. The identification of mixed features during mood episodes was particularly relevant, as it informed psychopharmacological adjustments and clarified the participant’s treatment nonadherence. Although the literature does not consistently report effective treatments for episodes with mixed features, this case highlights the ethical responsibility to integrate the best available evidence with specialized training and personal psychotherapy. The findings underscore the potential contributions of CBT to symptom reduction and treatment adherence, while reinforcing the need for more robust studies to establish its efficacy in BD, particularly during episodes characterized by mixed features.
This study aimed to explore the relationship between repetitive negative thinking (RNT) and general psychological symptoms while investigating the moderating role of self-compassion. A sample of 776 non-clinical individuals participated in the study. Participants completed measures assessing RNT, self-compassion, and general psychological symptoms. Moderation analysis revealed a significant interaction effect, indicating that self-compassion moderated the relationship between RNT and general symptoms. Specifically, higher levels of self-compassion weakened the association between RNT and symptoms. This finding underlines the importance of interventions targeting self-compassion to mitigate the adverse effects of RNT on overall psychological well-being. Moreover, emphasizing RNT’s transdiagnostic nature underscores its relevance across various psychological disorders. Implications for clinical practice and interventions aimed at targeting RNT and fostering self-compassion are discussed.
Post-traumatic stress disorder (PTSD), anxiety, and depressive disorders are highly prevalent among individuals affected by armed conflict. In Colombia, over 9 million people have been exposed to such violence, contributing to elevated emotional distress. This study validated the Overall Anxiety Severity and Impairment Scale (OASIS) and the Overall Depression Severity and Impairment Scale (ODSIS), two brief five-item tools designed to assess symptom severity and impairment. Data were collected from clinical (N = 198), community (N = 159), and conflict-affected (N = 284) samples (total N = 641). Confirmatory factor analysis, reliability estimates, item response theory, and ROC analyses supported a unidimensional structure, strong internal consistency (OASIS ω = 0.91; ODSIS ω = 0.92), and measurement invariance across groups. ROC-derived cut-offs were 11 (OASIS) and 12 (ODSIS). While validity and cut-off data were limited to conflict-affected individuals, findings support the utility of OASIS and ODSIS for screening anxiety and depression across diverse Colombian populations.
Pediatric obsessive-compulsive disorder (OCD) is a neuropsychiatric condition characterized by distressing cyclical obsessions and compulsions. Cognitive-behavioral therapy with exposure and response prevention (CBT/ERP) is a first-line treatment, and increasing research focus has explored the role of caregiver involvement and varied delivery formats (i.e., group, virtual). We piloted an 8-week group for youth and their caregivers offered via a format of family choice to determine effectiveness, acceptability, and feasibility. Participants included 16 youth and their caregivers, and we found good acceptability and feasibility. Mean OCD severity on the CY-BOCS significantly decreased from baseline (M = 21.93, SD = 7.96) to post-treatment (M = 16.62, SD = 5.53) while controlling for other mental health services. This study shows promise for group CBT/ERP with caregiver involvement using a patient-centered approach to select delivery format. Further research is needed to understand how to maximize caregiver integration and virtual options to increase access to care.
Understanding the trajectories of obsessive-compulsive disorder (OCD) symptoms (OCS) in non-clinical populations holds promise for the prevention of OCD. We investigated data-driven trajectories of OCS and predictors of these trajectories in a non-clinical sample. United States residents (N = 400) completed the Obsessive-Compulsive Inventory Revised Questionnaire (OCI-R), the Patient Health Questionnaire (PHQ-9), and the Generalised Anxiety Disorder scale (GAD-7) on four occasions across 6 months. Latent class growth analysis revealed two OCI-R total score trajectories (sustained higher and sustained lower OCI-R total scores). Higher PHQ-9 scores, higher GAD-7 scores, and seeking professional mental health support were significant predictors of membership to the sustained higher OCI-R total score trajectory. Across OCI-R subscales, we identified between two and four trajectories, with varied predictors of unfavourable OCS trajectories across OCI-R subscales. These findings highlight the importance of monitoring and treating co-occurring depression and anxiety and the value of differentiating between OCS dimensions.
Prior research has examined the accuracy of the causal attribution process, which has been linked to the onset and maintenance of depressed mood. The current study attempted to replicate findings from these two studies, but also presented an important extension of the work with an addition of a mood priming paradigm. Participants were 498 undergraduate participants from the U.S. Results from the current study partially replicated previous findings. Participants reporting a depressogenic attributional style demonstrated pessimistically biased attributions (more stable and global attributions for negative events than objective coders), while those reporting a nondepressogenic attributional style did not demonstrate significant bias. With regard to dysphoria, both dysphoric and non-dysphoric participants were found to be pessimistically biased in their attributions, however dysphoric participants were more pessimistically biased than their non-dysphoric counterparts. In an important extension of these findings, increases in dysphoria and depressogenic attributions in response to the mood prime were both significantly predictive of decreases in attributional accuracy (i.e., increases in pessimistic bias).
We developed a Body-focused Emotional Acceptance and Release technique (BEAR) to aid the processing of prolonged grief. BEAR consists of a brief imaginal exposure to a painful memory, after which the therapist guides the client to mindfully experience their emotion-related bodily sensations for about 8 min. As proof-of-concept, we tested BEAR in two sessions on twelve individuals with problematic grief, using an AAB case-series design. We observed significant reductions in grief experiences and emotionality, persisting at one-month follow-up. Participants’ willingness to feel emotions remained unchanged. Participants mentioned changes in emotions, emotion regulation, and memory. They considered BEAR comfortable, and the intervention proved easy to implement. Three case descriptions illustrate the procedure and findings. Based on these promising findings, we recommend further testing of BEAR as a stand-alone technique, or as an add-on to existing therapies for Prolonged Grief Disorder, as well as other disorders characterized by problems in emotional memory.
Cognitive interference theory posits that evaluation anxiety leads to increased levels of off-task thoughts which interfere with cognitive processing. Cognitive behavioral therapy (CBT) focuses on managing anxiety by counterarguing negative thoughts and increasing positive thoughts. This approach requires monitoring and control of thoughts which may place additional demands on working memory. Acceptance and Commitment Therapy (ACT) uses techniques that emphasize non-control of self-talk. ACT would thus not increase working memory resources and may promote better cognitive performance. A sample of 75 university students were randomly assigned to a 2-hour ACT intervention (ACT), a CBT intervention, and a healthy living placebo-control condition (HL). Afterwards, they completed a working memory task (Stroop Color-Word) under anxiety inducing conditions. Results demonstrated that the ACT group had significantly better performance on the Stroop task relative to the CBT and HL groups. The ACT group also reported significantly lower levels of cognitive interference and higher levels of psychological flexibility and mindfulness-acceptance.
Cognitive remediation therapy (CRT) can improve impaired cognitive function in individuals with schizophrenia. Although previous studies suggest a relationship between eye movement (EM) and neurocognition, whether CRT can improve impaired EM and cognitive dysfunction remains unknown. Therefore, this study aimed to clarify whether CRT improves impaired EM and top-down attention (TA) in individuals with schizophrenia. Changes in EM in a free-viewing task and reaction times as an index of TA in a visual search task pre- and post-CRT were compared between CRT and control groups. Compared with the control group, the CRT group showed potential enhancement in EM, which is a novel finding. However, CRT exhibited no significant effect on TA. Although the sample size was small, which may limit generalizability, this empirical study could facilitate the development of a novel comprehensive understanding of the mechanisms underlying CRT that target specific neurophysiological deficits in schizophrenia.
The aim of this study was to represent gender-based network models within a multinational sample to enhance the understanding of the interaction and clustering of indicators from the perspective of multivariate systemic models that describe the psychological phenomenon of automatic thoughts. A total of 3,964 participants from six countries (Saudi Arabia, China, Spain, Georgia, Turkey, and Peru), aged between 18 and 72 years (M = 25.0; SD = 9.20; 63.8
This study examined self-compassion and experiential avoidance mediation pathways including the relationship of self-esteem, and the indirect effect of Acceptance and Commitment Therapy (ACT) on self-esteem through self-compassion and experiential avoidance (mediation). This study utilized a quasi-experimental, a matched-group pre-test–post-test design. Participants (experimental group = 20, control group = 17) were first matched based on self-esteem scores and gender, and then assigned to groups. The analyses were conducted with the PROCESS macro. As a result of the mediation analysis, the effect of mediation of being in the experiment and the control group was found in the prediction of the Rosenberg Self-Esteem Scale post-test score after controlling the Self-Compassion Scale-Short Form (SCS-SF) and the Avoidance and Fusion Questionnaire – Youth 8 (AFQ-Y8) pre-test scores on the SCS-SF and the AFQ-Y8 post-test scores. These findings suggested that ACT-based interventions can be clinically effective in improving adolescents’ self-esteem by enhancing self-compassion and reducing experiential avoidance and cognitive fusion. Such interventions may be beneficial in school-based mental health programs.
This study developed and evaluated the efficacy of an individual cognitive behavioral therapy for substance users with insomnia. Individual Cognitive Behavioral Therapy for Insomnia in Substance (CBT-I-SUD) was a five-session program consisting of sleep restriction, stimulus control, sleep hygiene, cognitive therapy, and relaxation techniques. Participants were recruited from a drug addiction rehabilitation center of a national forensic hospital in Korea. Twenty-nine qualified participants were randomly assigned to receive individual CBT-I-SUD (trial group, 15 participants) and individual CBT for depression–substance use disorder (CBT-D-SUD; control group, 14 participants). Sleep, substance abuse, and emotion-related outcome measures were used to evaluate the therapy. The program led to significant improvement in insomnia severity, sleep quality, craving, readiness for change, treatment eagerness, and depression. For substance users who need to be cautious about taking sleeping pills, this program is expected to have a positive effect on insomnia, preventing relapses, and controlling emotions.
Existing findings regarding the relationship between rumination and mental health are conflicting, necessitating more systematic analysis to clarify the contradictions. This PRISMA-compliant study explores the relationship between rumination and positive indicators (i.e., well-being) and negative indicators (i.e., sleep quality) of mental health, as well as potential moderators. The literature search yielded 49 articles, including 180 effect sizes and 45287 participants. Meta-analysis revealed that rumination was significantly negatively correlated with well-being (r = -0.252, p < 0.001), and positively correlated with sleep quality (r = 0.333, p < 0.001). In the moderation analysis, the dimension of rumination (i.e., reflection, brooding, and symptom-focused rumination) exerted a significant moderating effect in the relationship between rumination and sleep quality. Likewise, the dimension of well-being (i.e., life satisfaction, positive emotions, negative emotions, and self-esteem) significantly moderated the association between rumination and well-being. Rumination appears to reduce sleep quality and well-being among adolescents, with research demonstrating a cross-cultural and cross-group consistency in its threat to adolescent mental health.
