Previous meta-analyses have integrated evidence on the effects of transdiagnostic interventions for depression and anxiety symptoms. Nevertheless, no recent study covers all types of transdiagnostic interventions administered through a wide range of delivery formats, and targeting participants with different emotional disorders (i.e., mixed samples with different anxiety disorders or mixed depression/anxiety symptomatology). We used the most recent available searches (1st January 2024) of the Metapsy meta-analytic project of randomized trials on psychotherapy for depression and anxiety to identify studies comparing an intervention targeting at least two emotional disorders with a control group (waitlist, usual care, other non-active control). We conducted random-effects meta-analyses of 94 trials (108 comparisons between a psychotherapy and a control group) with 12,443 patients (who have at least a principal diagnosis of anxiety and/or unipolar depressive disorder, or a score above a cut-off point on an anxiety or depression validated self-report scale), to examine the effects on depression and anxiety symptomatology at post-treatment. The overall effect size of the pooled outcomes of depression and anxiety was g = 0.59 (95 % CI 0.50-0.68), with high heterogeneity (I2 = 78.88; 95 % CI 74.8-82.3) and a broad prediction interval (-0.18-1.37). The effects remained comparable after a series of sensitivity analyses, including multilevel analyses, exclusion of outliers, adjustment for risk of bias, and adjustment for publication bias. The results were also comparable for depression and anxiety symptoms when considered separately (effect sizes ranged from g = 0.54 to 0.61). However, when considering the impact on anxiety symptoms in studies focusing exclusively on participants with several anxiety disorders, the effects were somewhat larger (g = 0.87). A significantly higher risk of study dropout was found in the intervention conditions compared to the control groups. Transdiagnostic interventions are probably effective at post-treatment for adults with depression and/or anxiety.

The college stage is marked by high prevalence of mental disorders, particularly anxiety, low mood, and substance abuse. Despite this, many affected students do not receive treatment, underscoring the need for preventive strategies. In respose, the CORE program, an internet-based intervention, was developed to enhance resilience and coping skills among college students. The present study, part of the ICare project (EU-634757), aims to assess the effectiveness of the CORE intervention in improving resilience and reducing symptoms of anxiety and depression in comparison to a Waiting List (WL) condition. The study was registered at ISRCTN (ISRCTN13856522). In the study the unguided internet-based intervention (CORE) was compared to a WL control group in a multicenter two-arm, single-blind, randomized controlled trial (RCT) conducted in Spain, Germany, and Switzerland. Questionnaire based evaluations occurred at baseline (BL), 8 weeks (post-intervention), 6 and 12 months after randomization. A total of 493 students with low levels of resilience participated in the study. Participants in the intervention group gained access to an internet-based program aiming to enhance resilience by learning to cope with stressors in daily life, promote self-empowerment, and improve well-being. Participants were instructed to engage in six interactive modules delivered weekly in a sequential order. The program's therapeutic content was developed following the Ryff model of well-being. The primary outcome measure used was the Connor-Davidson Resilience Scale (CD-RISC-25). Additionally, anxiety and depressive symptomatology, coping strategies, and well-being were measured. Participants in the CORE condition reported a significant increase in resilience compared to WL condition (Differences post-BL: d = 0.34, p = .0005; 6 M-BL: d = 0.24, p = .0171; 12 M-BL: d = 0.33, p = .0031). Although, a general time trend towards improvement in the resilience was observed in both groups. Participants in the CORE condition, compared to those in the WL condition, showed a significant reduction in anxiety symptoms in the short and long term (differences post-BL: d = 0.30, p = .0015; 6 M-BL: d = 0.18, p = .0857; 12 M-BL: d = 0.23, p = .0312) and depression in the short term. Furthermore, participants in CORE condition showed a significant improvement in positive functioning measurements, such as well-being and self-compassion compared to WL condition. (Differences post-BL: d = 0.25, p = .0123; 6 M-BL: d = 0.16, p = .1505; 12 M-BL: d = 0.13, p = .1835). Adherence to fully complete the intervention was approximately 59 %. In conclusion, our study revealed promising outcomes for the CORE program, indicating its efficacy. These results position the CORE program as a valuable and validated tool in fostering resilience, offering promising ways for addressing mental health challenges in academic settings.

Preventing mental disorders is important to avoiding clinical conditions. This study evaluated the efficacy of internet-based indicated prevention for anxiety and depressive disorders. In a three-arm randomized controlled trial, 566 adults with subthreshold anxiety (GAD-7 ≥ 5) and/or depressive symptoms (CES-D ≥ 16), but no clinical diagnosis in the past six months (MINI 6.0), were assigned to either an individually (IG-IMI, n = 186) or automatically (AG-IMI, n = 189) guided digital intervention, or waitlist control (WLC, n = 191). The digital intervention comprised 8 transdiagnostic, self-tailored, CBT-based sessions. The primary outcome was time to onset of any anxiety or depressive disorder over 12 months, assessed via blinded diagnostic interviews (MINI). AD/DD onset was 19.4% in IG-IMI, 14.8% in AG-IMI, and 30.9% in WLC. Cumulative incidence was 23.1% (IG-IMI), 20.7% (AG-IMI), and 36.0% (WLC; p < 0.001). Hazard ratios were 0.59 and 0.47; NNTs were 7.76 and 5.79. Both individually guided and automated interventions effectively reduced AD/DD incidence. Trial Registration: The study was preregistered in the German Clinical Trial Registration (DRKS00011099; https://drks.de/search/de/trial/DRKS00011099 ).

Importance:Cognitive behavior therapy (CBT) is a first-line treatment for most mental disorders. However, no meta-analytic study has yet integrated the results of randomized clinical trials on CBT across different disorders, using uniform methodologies and providing a complete overview of the field. Objective:To examine the effect sizes of CBT for 4 anxiety disorders, 2 eating disorders, major depression, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and psychotic and bipolar disorders on symptoms of the respective disorders using uniform methodologies for data extraction, risk of bias (RoB) assessment, and meta-analytic techniques. Data Sources:Major bibliographical databases (PubMed, PsycINFO, and Embase for all disorders) were searched up to January 1, 2024, for each disorder separately. Data analysis was performed from August 2024 to January 2025. Study Selection:Randomized clinical trials comparing CBT with inactive control conditions in adults with 1 of the mental disorders established through a clinical interview were included. Data Extraction and Synthesis:Basic characteristics of patients, CBT, and studies were extracted. RoB was assessed with the Cochrane RoB tool 2. Meta-analyses were conducted using random-effects models. Main Outcomes and Measures:The primary outcome was the standardized mean difference (Hedges g) indicating the difference between CBT and controls at posttreatment on symptoms of the respective disorders. Results:A total of 375 trials (423 comparisons) between CBT and controls were included among 32 968 patients. The overall mean (SD) patient age was 43.4 (13.7) years, and the mean (SD) proportion of women was 0.68 (0.24). Effect sizes for CBT compared to all control conditions (g) were lower than 0.5 for bipolar and psychotic disorder; between 0.5 and 1.0 for panic, social anxiety, and generalized anxiety disorders, bulimia nervosa, binge eating disorders, depression, and OCD; and larger than 1.0 for PTSD and specific phobias (range of effect sizes: 0.31 for bipolar disorder to 1.27 for PTSD). Large effect sizes (g > 0.94) were observed in waitlist-controlled trials, a control condition mostly used in anxiety and eating disorders, PTSD, and OCD. Trials using care as usual showed more modest effect sizes (0.22-1.13). Study dropout rates within the CBT conditions ranged from 8% for specific phobia to 24% for PTSD. Conclusions and Relevance:In this unified series of meta-analyses, CBT was probably effective in the treatment of mental disorders, including major depression, anxiety disorders, PTSD, OCD, and eating disorders, and possibly effective in psychotic and bipolar disorders. However, the effect sizes depended on the type of control condition.

The scientific output generated in psychology has surged in recent decades, including the number of studies investigating psychological treatments. To keep track of all this evidence, we developed the "Metapsy" meta-analytic research domain: a comprehensive system of open databases and tailored software that allows for rapid evidence generation. We leverage this novel infrastructure to summarize the effect of psychological treatment across 12 mental health problems and trace back the global expansion of psychotherapy research over the past 50 years. Including 1,029 studies with 85,952 patients, our results indicate small to moderate average benefits in treating psychosis (g = 0.32), suicidal ideation (g = 0.34), borderline personality disorder (g = 0.46), and prolonged grief (g = 0.49). In contrast, psychological interventions have large average effects on depression (g = 0.73), problem gambling (g = 0.80), panic (g = 0.83), generalized anxiety (g = 0.86), social anxiety (g = 0.95), obsessive-compulsive (g = 1.18), posttraumatic stress disorder (g = 1.18), and phobias (g = 1.25). Most available evidence (83.4%-86.1%) comes from high-income and Western countries, but their dominance is declining. We found no indication that psychotherapy is less effective in low- and middle-income countries (g = 0.38-2.41) or non-Western cultures (g = 0.74-2.20). We discuss ways to further enhance psychotherapy's public health impact, as well as how the meta-analytic research domain concept may be extended to other types of psychological research in the future. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

OBJECTIVE:To explore which cognitive behavioral therapy (CBT) self-help app usage predicted depression during a selective prevention trial. METHOD:A recent controlled trial (ECoWeB-PREVENT) randomized young people aged 16-22, at increased risk for depression because of elevated worry/rumination, negative appraisals, and/or rejection sensitivity but without past or current history of major depression, to apps that provided self-monitoring, self-monitoring plus CBT self-help, or self-monitoring plus emotional competency self-help. Self-help included coping strategies for moment-by-moment use (Tools) and self-learning/planning exercises (Challenges). On the primary outcome (depression, Patient Health Questionnaire-9 [PHQ-9]) at 3-months follow-up (primary endpoint), only the CBT app outperformed self-monitoring. In this secondary analysis, only data from participants who used the CBT or self-monitoring apps at least once were analyzed to test what app use predicted change in depression from baseline to 3 months. RESULTS:Of the original 1,262 participants (79% female), 558 were included (CBT, baseline, n = 273, PHQ-9: M = 7.48, SD = 3.9; 3 months, N = 163, PHQ-9: M = 8.83, SD = 4.92; self-monitoring, baseline, n = 285, PHQ-9: M = 7.45, SD = 4.26; 3 months, N = 183, PHQ-9: M = 7.48, SD = 3.9). Neither total app use, self-monitoring, nor use of Tools predicted change in depression (all ps > .05). Frequency of use of Challenges predicted lower depression symptoms and caseness at 3 months (β = -0.28, 95% CI [-0.53, -0.03], p = .029). Specifically, the use of behavioral activation challenges mediated the effects of the CBT app on depression over 3 months (β = -0.59, 95% CI [-1.13, -0.05], p = .03). CONCLUSIONS:Brief psychoeducation about behavioral activation principles in an app may protect young people from depression over 3 months, even when only used once. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Repetitive negative thinking (RNT), an important transdiagnostic process, is commonly assessed using trait questionnaires. While these instruments ask respondents to estimate their general tendency towards RNT, ecological momentary assessment (EMA) allows to assess how much individuals actually engage in RNT in their daily lives. In a sample of N = 1,176 adolescents and young adults, we investigated whether average levels of RNT assessed via EMA predicted psychopathological symptoms. Adjusting for trait RNT measures and baseline scores on outcome measures, we found that average levels of RNT assessed via EMA significantly predicted higher depressive and anxiety symptoms as well as lower mental well-being at baseline, one-, three-, and twelve-month follow-up. Exploratory analyses of the association between temporal dynamics of RNT (e.g., RNT inertia) and psychopathological symptoms yielded inconsistent results. The high predictive power of average scores on the EMA-based RNT measure suggests that EMA is a promising tool for assessing RNT.

Background Based on evidence that mental health is more than an absence of mental disorders, there have been calls t to find ways to promote flourishing at a population level, especially in young people, which requires effective and scalable interventions. Despite their potential for scalability, few mental wellbeing apps apps have been rigorously tested in high-powered trials, derived from models of bealthy emotional functioning. tailored to individual profiles. We aimed to test a personalised emotional competence self-help app versus a cognitive behavioural therapy (CRT) self- help app versus a self-monitoring app to promote mental wellbeing in healthy young people. Mood Dim A Newboath Faculty of Methods This international, multicentre, parallel, open-label, randomised controlled trial within a cohort multiple randomised trial (including a parallel trial of depression prevention) was done at four university trial sites in four lour countries countries (the (the UK via social media from the four respective countries. Eligible participants were aged 16-22 years with well adjusted University emotional competence profiles and no current past diagnosis of major depression. Participants were randomised (1:1:1) to usual practice plus either the emotional competence app, the CBT app or the self-monitoring tw app, by an independent computerised system, minimised by country, age, and self-reported gender, and followed up Campartment of for 12 months post-randomisation. The primary outcome mental wellbeing (indexed by the Warwick-Edinburgh Pychology.tw Mental Well Being Scale [WEMWBS) at 3-month follow-up, analysed in participants who completed the 3-month follow-up assessment. Outcome assessors were masked to group allocation. The study is registered with Clinical Trials. gov, NCT04148508, and is closed. Germany, Spain, and Belgium). m). Partic Participants were recruited from schools and universities and Health & Warm Ph PORCIN C nitat Germany Findings Between Oct 15, 2020, and Aug 3, 2021, 2532 participants were enrolled, and 847 were randomly assigned Pychatry, Unity of to the emotional competence app, 841 to the CBT app, and 544 to the self-monitoring app. Mean age was 19. 2 years (SD 1-8). Of 2532 participants self-reporting gender, 1896 (74-9%) were female, 613 (24-29%) were male, 16 (0.6%) Jaume Castel Sum were neither, and seven (0-39%) were both. 425 participants in the emotional competence app group, 443 in the CT app group, and 447 in the self-monitoring app group completed the follow-up assessment at 3 months. There was P no difference e in mental wellbeing between the groups at 3 months (global p-0-47). The emotional competence Mo app did not differ from the CBT app (mean difference in WEMWBS-0-21 [95% CI-1-08 to 0-661) or the self panensity monitoring app (0-32 1-0-54 1-19]]) and the CBT app did not differ from the self-monitoring app sunon (0-53 1-0-33 101-39]). 14 of 1315 participants were admitted to or treated in hospital (or both) for mental health related reasons, which were considered unrelated to the interventions (five participants in the emotional ho competence app group, eight in the CBT app group, and one in the self-monitoring app group). No deaths occurred. Interpretation The emotional competence app and the CBT app provided limited benefit in promoting mental wellbeing in healthy young people. This finding might reflect the low intensity of these interventions and the difficulty improving mental wellbeing via universal digital interventions implemented in low-risk populations. Funding European Commission.

BackgroundIncreasing interest has centered on the psychotherapeutic working alliance as a means of understanding clinical change in digital mental health interventions in recent years. However, little is understood about how and to what extent a digital mental health program can have an impact on the working alliance and clinical outcomes in a blended (therapist plus digital program) cognitive behavioral therapy (bCBT) intervention for depression. ObjectiveThis study aimed to test the difference in working alliance scores between bCBT and treatment as usual (TAU), examine the association between working alliance and depression severity scores in both arms, and test for an interaction between system usability and working alliance with regard to the association between working alliance and depression scores in bCBT at 3-month assessments. MethodsWe conducted a secondary data analysis of the E-COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment versus Treatment-as-usual) trial, which compared bCBT with TAU across 9 European countries. Data were collected in primary care and specialized services between April 2015 and December 2017. Eligible participants aged 18 years or older and diagnosed with major depressive disorder were randomized to either bCBT (n=476) or TAU (n=467). bCBT consisted of 6-20 sessions of bCBT (involving face-to-face sessions with a therapist and an internet-based program). TAU consisted of usual care for depression. The main outcomes were scores of the working alliance (Working Alliance Inventory-Short Revised–Client [WAI-SR-C]) and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) at 3 months after randomization. Other variables included system usability scores (System Usability Scale-Client [SUS-C]) at 3 months and baseline demographic information. Data from baseline and 3-month assessments were analyzed using linear regression models that adjusted for a set of baseline variables. ResultsOf the 945 included participants, 644 (68.2%) were female, and the mean age was 38.96 years (IQR 38). bCBT was associated with higher composite WAI-SR-C scores compared to TAU (B=5.67, 95% CI 4.48-6.86). There was an inverse association between WAI-SR-C and PHQ-9 in bCBT (B=−0.12, 95% CI −0.17 to −0.06) and TAU (B=−0.06, 95% CI −0.11 to −0.02), in which as WAI-SR-C scores increased, PHQ-9 scores decreased. Finally, there was a significant interaction between SUS-C and WAI-SR-C with regard to an inverse association between higher WAI-SR-C scores and lower PHQ-9 scores in bCBT (b=−0.030, 95% CI −0.05 to −0.01; P=.005). ConclusionsTo our knowledge, this is the first study to show that bCBT may enhance the client working alliance when compared to evidence-based routine care for depression that services reported offering. The working alliance in bCBT was also associated with clinical improvements that appear to be enhanced by good program usability. Our findings add further weight to the view that the addition of internet-delivered CBT to face-to-face CBT may positively augment experiences of the working alliance. Trial RegistrationClinicalTrials.gov NCT02542891, https://clinicaltrials.gov/study/NCT02542891; German Clinical Trials Register DRKS00006866, https://drks.de/search/en/trial/DRKS00006866; Netherlands Trials Register NTR4962, https://www.onderzoekmetmensen.nl/en/trial/25452; ClinicalTrials.Gov NCT02389660, https://clinicaltrials.gov/study/NCT02389660; ClinicalTrials.gov NCT02361684, https://clinicaltrials.gov/study/NCT02361684; ClinicalTrials.gov NCT02449447, https://clinicaltrials.gov/study/NCT02449447; ClinicalTrials.gov NCT02410616, https://clinicaltrials.gov/study/NCT02410616; ISRCTN Registry ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725?q=ISRCTN12388725&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10; ClinicalTrials.gov NCT02796573, https://classic.clinicaltrials.gov/ct2/show/NCT02796573 International Registered Report Identifier (IRRID)RR2-10.1186/s13063-016-1511-1

BackgroundExtended reality (XR), encompassing technologies such as virtual reality, augmented reality, and mixed reality, has rapidly gained prominence in health care. However, existing XR research often lacks rigor, proper controls, and standardization. ObjectiveTo address this and to enhance the transparency and quality of reporting in early-phase clinical evaluations of XR applications, we present the “Reporting for the early-phase clinical evaluation of applications using extended reality” (RATE-XR) guideline. MethodsWe conducted a 2-round modified Delphi process involving experts from diverse stakeholder categories, and the RATE-XR is therefore the result of a consensus-based, multistakeholder effort. ResultsThe guideline comprises 17 XR-specific (composed of 18 subitems) and 14 generic reporting items, each with a complementary Explanation & Elaboration section. ConclusionsThe items encompass critical aspects of XR research, from clinical utility and safety to human factors and ethics. By offering a comprehensive checklist for reporting, the RATE-XR guideline facilitates robust assessment and replication of early-stage clinical XR studies. It underscores the need for transparency, patient-centeredness, and balanced evaluation of the applications of XR in health care. By providing an actionable checklist of minimal reporting items, this guideline will facilitate the responsible development and integration of XR technologies into health care and related fields.

Background Effective, scalable interventions are needed to prevent poor mental health in young people. Although mental health apps can provide scalable prevention, few have been rigorously tested in high-powered trials built on models of healthy emotional functioning or tailored to individual profiles. We aimed to test a personalised emotional competence app versus a cognitive behavioural therapy (CBT) self-help app versus a self-monitoring app to prevent an increase in depression symptoms in young people. Methods This multicentre, parallel, open-label, randomised controlled trial, within a cohort multiple randomised trial (including a parallel trial of wellbeing promotion) was done at four university trial sites in the UK, Germany, Spain, and Belgium. Participants were recruited from schools, universities, and social media from the four respective countries. Eligible participants were aged 16-22 years with increased vulnerability indexed by baseline emotional competence profile, without current or past diagnosis of major depression. Participants were randomly assigned (1:1:1) to usual practice plus either the personalised emotional competence self-help app, the generic CBT self-help app, or the self-monitoring app by an independent computerised system, minimised by country, age, and self-reported gender, and followed up for 12 months post-randomisation. Outcome assessors were masked to group allocation. The primary outcome was depression symptoms (according to Patient Health Questionnaire-9 [PHQ-9]) at 3-month follow-up, analysed in participants who completed the 3-month follow-up assessment. The study is registered with ClinicalTrials.gov, NCT04148508, and is closed. Findings Between Oct 15, 2020, and Aug 3, 2021, 1262 participants were enrolled, including 417 to the emotional competence app, 423 to the CBT app, and 422 to the self-monitoring app. Mean age was 18 center dot 8 years (SD 2 center dot 0). Of 1262 participants self-reporting gender, 984 (78 center dot 0%) were female, 253 (20 center dot 0%) were male, 15 (1 center dot 2%) were neither, and ten (0 center dot 8%) were both. 178 participants in the emotional competence app group, 191 in the CBT app group, and 199 in the self-monitoring app group completed the follow-up assessment at 3 months. At 3 months, depression symptoms were lower with the CBT app than the self-monitoring app (mean difference in PHQ-9 -118 [95% CI -201 to -034]; p=0 center dot 006), but depression symptoms did not differ between the emotional competence app and the CBT app (063 [-022 to 149]; p=0 center dot 15) or the self-monitoring app and emotional competence app (-054 [-139 to 031]; p=0 center dot 21). 31 of the 541 participants who completed any of the follow-up assessments received treatment in hospital or were admitted to hospital for mental health-related reasons considered unrelated to interventions (eight in the emotional competence app group, 15 in the CBT app group, and eight in the self-monitoring app group). No deaths occurred. Interpretation The CBT app delayed increases in depression symptoms in at-risk young people relative to the self- monitoring app, although this benefit faded by 12 months. Against hypotheses, the emotional competence app was not more effective at reducing depression symptoms than the self-monitoring app. CBT self-help apps might be valuable public mental health interventions for young people given their scalability, non-consumable nature, and affordability. Funding European Commission. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Objective: The aim of this study was to disaggregate the between-patient and within-patient effects of emotion regulation (ER) on treatment outcome and explore relevant trait-like moderators of the within-patient effects. Method: Three hundred thirty-nine patients with heterogenous clinical conditions were admitted to psychotherapy at a clinical center. During the intake evaluation, patients completed the Inventory of Interpersonal Problems, the Outcome Questionnaire 30, and the State Difficulties of Emotion Regulation Scale. Subsequently, patients responded to the Outcome Questionnaire 30 and State Difficulties of Emotion Regulation Scale every session for the initial five sessions, followed by assessments every two sessions until the 15th session and then every four sessions until the end of treatment. Results: Multilevel models revealed significant between- and within-patient effects of ER on clinical distress. That is, patients with lower average levels of ER difficulties showed greater benefit from treatment, and lower ER difficulties over the course of treatment were associated with lower clinical distress. Furthermore, interactive models demonstrated that lower average levels of ER throughout treatment and fewer interpersonal problems at the beginning of treatment were associated with better treatment outcome. Conclusion: These findings provide evidence supporting the role of ER as a mechanism of change. The interaction between trait-like components and state-like fluctuations of ER suggests a capitalization model for the role of ER in psychotherapy.

BACKGROUND There has been an increased interest in understanding social anxiety (SA) and SA disorder (SAD) antecedents and consequences as they occur in real time, resulting in a proliferation of studies using ambulatory assessment (AA). Despite the exponential growth of research in this area, these studies have not been synthesized yet. OBJECTIVE This review aimed to identify and describe the latest advances in the understanding of SA and SAD through the use of AA. METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic literature search was conducted in Scopus, PubMed, and Web of Science. RESULTS A total of 70 articles met the inclusion criteria. The qualitative synthesis of these studies showed that AA permitted the exploration of the emotional, cognitive, and behavioral dynamics associated with the experience of SA and SAD. In line with the available models of SA and SAD, emotion regulation, perseverative cognition, cognitive factors, substance use, and interactional patterns were the principal topics of the included studies. In addition, the incorporation of AA to study psychological interventions, multimodal assessment using sensors and biosensors, and transcultural differences were some of the identified emerging topics. CONCLUSIONS AA constitutes a very powerful methodology to grasp SA from a complementary perspective to laboratory experiments and usual self-report measures, shedding light on the cognitive, emotional, and behavioral antecedents and consequences of SA and the development and maintenance of SAD as a mental disorder.

So far, there is evidence showing that the use of specific emotion regulation strategies in response to negatively-valenced stimuli shapes the way people subsequently remember them. However, still little is known about the potential effects of savouring positive events on the associated memories. The aim of the current study was to test whether upregulating positive emotions in response to daily positive events could make participants’ memories more salient and positively-valenced over time. To do so, we conducted an ecological momentary assessment study in order to identify the occurrence of positive events and provide participants with different emotion regulation strategies in real-time. To explore memory phenomenology, a surprise recall task for each event was performed one week after. Compared to the control condition, the manipulation of savouring led to recall the events with greater salience (i.e., more vivid, coherent, accessible, full of sensory details, first-person recalled memories) which, in turn, led to retrieve the memory more positively. Furthermore, the findings indicated that each strategy uniquely affected different phenomenological dimensions of memory. Together, we suggest that differences in the use of savouring strategies might impact memory, leading to the recall of events with higher salience and to the maintenance of their positivity over time.

The effectiveness of in virtuo exposure-based treatment of performance-only social anxiety disorder (SAD) has been demonstrated in several studies. However, few studies have validated virtual environments with participants suffering from generalized SAD. The goal of this study is to confirm the potential of a virtual environment in inducing anxiety in adults suffering from generalized SAD, compared to adults without SAD, when engaged in awkward social interactions. Differences between participants from two different countries were also explored. The sample consisted of 15 participants with SAD from Canada, 17 participants without SAD from Canada, 16 participants with SAD from Spain, and 21 participants without SAD from Spain. All participants were immersed in a control virtual environment and in an experimental virtual environment considered potentially anxiety-inducing for individuals with generalized SAD. As hypothesized, results showed that the experimental virtual environment induced a higher level of anxiety than the control environment among participants with SAD compared to those without SAD. The impact on anxiety of each socially threatening task performed during the experimental immersion was statistically significant. In terms of anxiety responses, no significant differences were found between participants from Canada and Spain. However, spatial presence and ecological validity were higher in Canadians than in Spaniards. Unwanted negative side effects induced by immersions in virtual reality were higher in the SAD group. This study highlights the importance for therapists to engage people with SAD in clinically relevant tasks while immersed in VR psychotherapeutic applications.

The objective of this work is to describe the supervision model used in the training of clinicians and family members of the Family Connections (FC) program. FC is a skills training program for family members of people with borderline personality disorder (BPD). This is the program that has achieved the greatest empirical support to date. Since its inception it has been supported by the National Education Alliance for Borderline Personality Disorder (NEA-BPD), whose objective is to try to promote "education" for family members of people with BPD and for clinicians. This program has been running for more than 2 decades, thanks to the solidarity efforts of numerous family members and clinicians who received the program and decided to train, to be able to help other people. Over the past few years, the NEA-BPD has expanded to countries such as the United Kingdom, Australia, New Zealand, Italy, Israel and Spain. The association "National Alliance for TLP Education" (NEABPD-SPAIN) is described, and the research projects they have carried out so far, where the effectiveness of the FC program has been tested. We consider it useful to know the work and supervision model, as well as the dissemination of the model among clinicians, researchers and family members.

Adjustment disorder (AjD) refers to a disproportionate or “maladaptive” reaction of the individual to the presence of one or more identifiable stressors. This disturbance may manifest with emotional and/or behavioral symptoms and can only be diagnosed if the criteria for any other mental disorder are not met. The most widely used diagnostic manuals still raise criticisms regarding the definition of this disorder. These controversies have led to a reduction in the amount of studies focused on the assessment and treatment of AjD, so it is an underresearched condition. Throughout this chapter, a review of the diagnostic criteria, epidemiology, assessment, and, especially, cognitive behavioral treatment (CBT) of AjD will be presented. Finally, new forms of treatment that are being tested by our research team and that make use of Information and Communication Technologies (ICTs) to try to improve the efficacy and efficiency of current interventions will be exposed.

BackgroundTo date, several evidence-based interventions have been created to help relatives of people with Borderline Personality Disorder (BPD), but few studies have analyzed the clinical situation of the family members. The aim of this study was twofold: (1) to explore the clinical symptomatology in a sample of parents of people diagnosed with BPD and compare them with a sample of a sample of people without a relative with a personality disorder, (2) to explore whether the parents of people diagnosed with BPD have psychopathology related to personality disorders (PD) or meet the diagnostic criteria for PD.MethodParticipants were 42 (39.6%) fathers and 64 (60.4%) were mothers and mothers (n = XX, −%) of people diagnosed with BPD, who were selected from a specialized PD unit for treatment. The sample of people without a relative with a PD was obtained from social network announcements. To test for differences between the two groups, Student’s t tests were performed for quantitative variables, and Chi-square tests were performed for categorical variables. Cohen’s d was calculated as a measure of the effect size.ResultsParents of people with BPD showed greater depressive and anxious symptomatology, higher levels of expressed emotion, and worse quality of life than the sample of people without a relative with a personality disorder. In addition, a high percentage of the parents of people diagnosed with BPD (50%) met the diagnostic criteria for different PD.ConclusionParents of people diagnosed with BPD may need psychological help in various aspects. Therapists are therefore advised to bear in mind the importance of carrying out a psychological assessment of family members and, if necessary, to offer psychological intervention. It is crucial to invite the family to be part of the treatment, since they can be part of the solution.Clinical Trial registration: ClinicalTrials.gov ID, NCT04160871 (registered November 15, 2019).

El objetivo de este trabajo es describir el modelo de supervisión que se utiliza en la formación de clínicos y familiares del programa Family Connections (FC). FC es un programa de entrenamiento en habilidades para familiares de personas con trastorno límite de la personalidad (TLP). Se trata del programa que ha conseguido mayor apoyo empírico hasta el momento. Desde sus inicios ha sido apoyado por la asociación National Education Alliance for Borderline Personality Disorder (NEA-BPD), cuyo objetivo es tratar de impulsar la “educación” para familiares de personas con TLP y para clínicos. Este programa lleva funcionando más de 2 décadas, gracias al esfuerzo solidario de numerosas familiares y clínicos que recibieron el programa y decidieron formarse, para poder ayudar a otras personas. A lo largo de estos últimos años, la NEA-BPD se ha expandido a países como Reino Unido, Australia, Nueva Zelanda, Italia, Israel y España. Se describe la asociación “Alianza Nacional para la Educación del TLP” (NEABPD-ESPAÑA), y los proyectos de investigación que han realizado hasta el momento, donde se ha sometido a prueba la eficacia del programa FC. Consideramos de utilidad conocer el modelo de trabajo y de supervisión, así como la diseminación del modelo entre clínicos, investigadores y familiares.

Information and communication technologies are shaping the way health is managed. The present chapter will summarize the state of the art in relation to technology use for pain assessment and treatment and will include a review of the most recent advances in the field (e.g., the use of mixed realities, online interventions, smartphone applications, and wearable devices), as well as a discussion of future research directions.