Introduction: Anxiety disorders and depression represent a global public health challenge due to their high prevalence, severely impacting quality of life (QoL) and functioning, and imposing a massive economic burden on public systems. This study evaluates the effectiveness of a group transdiagnostic cognitive behavioural therapy (TD-CBT) protocol through a stepped wedge cluster randomised controlled trial (SW-CRT) in Spanish primary care (PC). Methods: The sample consisted of 316 PC patients (73.4% female; mean age=44 years) with mild-to-moderate symptoms of anxiety and depression. An immediate intervention group was compared with a delayed intervention group (three months on a waiting list). Patients were assessed at pre-treatment, post-treatment, and 3- and 9-month follow-ups using mixed linear models. Results: Results revealed significant reductions in anxiety and depression symptoms with large effect sizes (d > 1.2) that remained stable up to 9 months. Improvements in QoL and functioning were heterogeneous, showing sustained long-term gains in work and family domains, but not in broader QoL or social functioning. No significant differences were found in clinical efficacy between groups, with solid reliable recovery rates (∼50%) and minimal deterioration. However, delayed access to treatment significantly increased long-term dropout rates (64.2% in the delayed group vs. 44.0% in the immediate group at 9 months). Conclusions: In conclusion, group TD-CBT is an effective and safe intervention offering robust functional and symptomatic recovery. Crucially, while delayed treatment does not reduce clinical efficacy for completers, immediate access is essential to maximize patient retention and optimize resources in the public system.
Introduction: Cognitive impairment and depression frequently co-occur, exacerbating disability. Identifying accessible interventions to enhance cognition in people with depression is imperative. Computerized cognitive training (CCT) is a potential strategy, but its clinical efficacy across settings remain unclear. We investigated the efficacy of CCT and potential moderators of cognitive and functional outcomes in individuals with depressive symptoms. Methods: In this systematic review and meta-analysis (PROSPERO: CRD42020204209), we searched MEDLINE, Embase, and PsycINFO from inception to June 22, 2026 for randomized controlled trials (RCTs) of CCT in adults (≥18 years) with clinically significant depressive symptoms. Primary outcome was change in overall cognition. Secondary outcomes included depressive symptoms, psychosocial and daily functioning. Results: Fifty-three 53 RCTs (3831 participants) were included. CCT was efficacious for overall cognition (49 RCTs, (g=0.23; 95% CI 0.14 to 0.32; τ2=0.095) and depressive symptoms (35 RCTs, g=0.22; 95% CI 0.08 to 0.37; τ2=0.066) with substantial heterogeneity across studies, and did not extend to psychiatric symptoms and daily function. Greater cognitive benefits were associated with multidomain training, higher doses, session durations >30 min, and ≤3 sessions per week. Efficacy was independent of baseline symptom severity, and comparable across delivery modes. Conclusions: CCT can improve cognition, depression and subjective outcomes in people with major or comorbid depression, but efficacy varies across outcomes, settings and intervention design factors. Future work is needed to confirm these factors, and examine what approaches and dose is required to enhance cognitive and functional outcomes of CCT.
Introduction: Complex trauma-related posttraumatic stress disorder (PTSD) and comorbidities pose a significant mental health burden in children. However, the comparative effectiveness of psychological interventions and shared therapeutic components remains unclear. Methods: We conducted a systematic review, network, and component network meta-analysis of randomized controlled trials of psychological interventions for children and adolescents with complex trauma. PubMed, Embase, Web of Science, PsycINFO, and Cochrane Library were searched up to September 2024. PTSD was the primary outcome; retention and comorbid symptoms (depression, anxiety, dissociation, externalizing problems) were secondary outcomes. Results: Forty-eight studies (6,017 participants) were included in this review. Multimodal group interventions (SMD −1.68, 95% confidence interval [CI] −3.04 to −0.32), phase-based trauma-focused cognitive behavioral therapy (TF-CBT) with parental involvement (−1.12, −1.53 to −0.70), TF-CBT (−1.06, −1.59 to −0.52), non-TF-CBT with parental involvement (−0.93, −1.70 to −0.17), eye movement desensitization and reprocessing (−0.85, −1.60 to −0.10), and phase-based TF-CBT (−0.79, −1.20 to −0.39) significantly reduced PTSD. Exposure emerged as the only significantly effective component for PTSD (−0.85, 95% credible interval [CrI] −1.60 to −0.06). Efficient component combinations included affective modulation with a therapeutic foundation of psychoeducation and nonspecific elements for PTSD (−0.97, 95% CrI −1.92 to −0.01) and exposure plus parental involvement with the same foundation for depression (−2.11, 95% CrI −4.06 to −0.20). Conclusion: Trauma-focused approaches were the most effective treatments for pediatric PTSD and emotional comorbidities related to complex trauma. A more cost-effective intervention approach may prioritize exposure techniques, incorporate affective modulation, and include parental involvement when feasible.
BACKGROUND:Cognitive deficits in Major Depressive Disorder (MDD) are clinically debilitating, persist after remission, and predict worse long-term outcomes, yet factors determining which patients are most at risk remain poorly understood. Cognitive reserve (CR) - the brain's capacity to buffer negative effects of structural alterations on cognitive functioning - is assessable through brief, clinically applicable proxy measures and may serve as a practical stratification factor in MDD. METHODS:CR of 539 MDD patients (65% female) and 549 healthy controls (65% female) from the Marburg-Münster Affective Disorders Cohort Study was estimated from educational years, occupational attainment, and verbal IQ. We examined the association of CR with cognitive impairment, tested whether CR moderates the relationship between MRI-based connectome alterations and cognitive performance, and predicted two-year disease course characteristics from baseline CR, benchmarked against polygenic risk and childhood maltreatment. RESULTS:Low CR was associated with increased cognitive impairment, especially in MDD patients (OR=6.24, p=0.003). CR moderated the association between cognitive performance and white matter network connectivity (t=2.780, pFWE=0.006). Low baseline CR predicted increased episode duration and symptom severity (psFDR<0.001) over two years, with effect sizes statistically indistinguishable from those of polygenic risk and childhood maltreatment. CONCLUSIONS:CR identifies MDD patients at risk for cognitive impairment and worse disease progression, with prognostic utility comparable to polygenic risk and childhood maltreatment. The moderating effect of CR on the brain network-cognition association provides a neurobiological rationale for this vulnerability. These findings support incorporating CR into routine clinical assessment to guide risk stratification and personalized treatment planning.
BACKGROUND:Anxiety disorders are the most frequent mental disorders worldwide. Although exposure therapy is the gold-standard treatment for anxiety disorders, almost half of patients fail to achieve sufficient improvements. While much has been learned about for whom psychotherapy works and why, far less is understood about when it works. Emerging evidence indicates that estradiol and progesterone may affect fear extinction, yet studies examining the effects of menstrual cycle phase on exposure therapy outcomes remain lacking. This study is the first to investigate to what extent biologically informed menstrual cycle phase affects exposure therapy outcomes in women with spider phobia. METHOD:N=45 women with spider phobia in 1) the early to mid-follicular phase, 2) the mid-luteal phase, or 3) using hormonal contraceptives (HC), participated in a group-based exposure therapy. Symptoms were assessed at baseline, one-week post-therapy, and at 12-14 weeks follow-up, using the Spider Phobia Questionnaire (SPQ), the Fear of Spiders Questionnaire (FSQ), and a behavioral approach test (BAT). RESULTS:Both phobic fear and avoidance behavior improved significantly over time. Although improvement did not differ between menstrual cycle groups, higher progesterone levels on the day of exposure therapy were associated with less improvement in behavioral avoidance. CONCLUSION:The present findings provide preliminary evidence that ovarian hormones on the day of exposure therapy may affect exposure-based outcomes, particularly reductions in behavioral avoidance. More research in larger samples is needed to further investigate menstrual cycle phase effects in exposure-based treatment. If replicated, the findings would attest to the potential of bio-rhythm informed psychotherapy.
