Adjustment disorder (AjD) is highly prevalent among university students and is associated with significant distress and impaired academic functioning, yet evidence-based interventions remain limited. This randomized controlled trial evaluated the effectiveness and mechanisms of a six-week internet-delivered Unified Protocol (iCBT-UP) for students with AjD, compared with an active control (iPMR) and a wait-list control. A total of 181 students meeting ICD-11 criteria for AjD were randomized (2:2:1) to iCBT-UP (n = 79), iPMR (n = 63), or wait-list (n = 39). Assessments were conducted at baseline, post-treatment, and one-month follow-up. Outcomes included AjD, academic adjustment, experiential avoidance, self-compassion, and mindfulness. Daily diary assessments captured changes in self-compassion, mindfulness and psychological flexibility. Treatment effects were examined using mixed repeated-measures ANOVA and mediation analyses. Both active interventions significantly reduced AjD symptoms relative to wait-list, whereas only iCBT-UP improved academic adjustment. Reductions in experiential avoidance and increases in self-compassion mediated the effects of iCBT-UP on decreases in AjD symptoms. Self-compassion also mediated the effects of iCBT-UP on improvements in academic adjustment. Daily diary analyses showed increases in self-compassion and psychological flexibility in both active conditions. These findings support transdiagnostic CBT as an effective intervention for AjD and highlight key mechanisms of change.
Social Anxiety Disorder (SAD) is a prevalent mental health disorder characterized by a significant prevalence of 5% in recent years. Diverse therapeutic methods can be used to address social anxiety symptoms. Our study sets out to address the gap in literature in comparing two major therapeutic methods: CBT and ACT, respectively. Additionally, we used Virtual Reality (VR) methods to induce social anxiety in laboratory conditions to monitor scale-based progress as well as physiological indicators for all groups. The current paper conducts a 3-arm Quasi-Experimental Pilot Study which aims to compare the two therapeutic approaches via dedicated mobile applications. The main objective of the study is to compare the efficacy of the interventions in reducing social anxiety, including physiological symptoms. From the total number of randomized participants (N = 27, aged between 16 and 58, SD = 8.36), 22 completed the intervention, and displayed a significant decrease in social anxiety symptoms measured on LSAS-SR with a large effect size from pre- to post-measurements accompanied by significant changes in other variables assessed on a secondary note till follow-up, according to ANOVA. However, the results were not maintained in ITT analyses. ACT-informed digital interventions show potential benefits; however future rigorous trials considering limitations are necessary.
Cognitive behavior therapy (CBT) has strong research support for obsessive-compulsive disorder (OCD). However, less is known about long-term follow-up effects of CBT in OCD. A systematic review and meta-analysis was conducted of different types of CBT for OCD in adults and children/adolescents. Four databases were systematically searched for studies published until March 2025. The effectiveness of CBT, methodological quality, and moderators were examined at post and follow-up. Forty-seven studies were included, comprising 2,817 participants. Attrition was lower in child (6.5%) than in adult studies (14.2%). Very large within-group effect sizes (ES; Hedges's g) were obtained for OCD-severity at post-treatment (2.35), and follow-up (2.54), on average 2.5 years post-treatment. Adult studies maintained the ES from post to follow-up, whereas child studies showed a significant further improvement. Average response rates were 70% post-treatment and 69% at follow-up. Mean recovery rates were 48% post-treatment and 52% at follow-up. The degree of change in OCD severity during initial treatment was a strong moderator of the long-term follow-up ES. Exposure and response prevention, cognitive therapy, and the combination all yielded very large ESs with no significant difference between them. In conclusion, CBTs for OCD are effective and the effects are maintained at long-term follow-up.
