INTRODUCTION:Internet-delivered psychological treatments have been developed and tested in many trials and are also implemented. AREAS COVERED:The authors focus on treatment preferences when clients are allowed to choose treatment orientation and how the treatment is set up. The literature was searched using Medline, Google Scholar and Scopus in November 2025, locating eight preference studies. They showed benefits in treatment satisfaction when preferences are included and possibly improved outcomes. The second focus was on tailored internet-delivered cognitive behavior therapy (ICBT). The authors review six recent controlled studies published from 2000 onwards on various subjects including COVID-19, domestic violence, chronic pain, climate distress, depression in older adults in Lithuania, and young adults with anxiety and depression in Brazil. These examples are in line with previous findings showing that tailored ICBT is effective, despite there being no clear benefits over diagnosis-specific or transdiagnostic ICBT. Finally, the authors reviewed published findings from two trials demonstrating that self-tailoring can work without clinician input. EXPERT OPINION:There are robust findings showing that tailored internet interventions are effective, with further indication that preferences and self-tailoring may work too. Future research will likely incorporate artificial intelligence tools to a greater extent to improve treatment efficacy.

BackgroundPrevious qualitative research suggests that the biopsychosocial explanatory models of mental illness are not always supported in non-Western cultures. This underscores the importance of exploring explanatory models of mental distress among hard-to-reach groups, such as refugees. The main objective of the current study was to explore what Arabic-speaking refugee youth and young adults conceptualize as their mental distress and if they experience lower functioning or if their mental distress relates to unmet needs in the daily life.MethodA qualitative study design was applied to analyze the responses to the Psychological Outcome Profiles Questionnaire (PSYCHLOPS). An inductive approach using content analysis was utilized to explore what Arabic-speaking refugee youth and young adults conceptualize as their mental health problem. Alderfer’s Existence-Relatedness-Growth theory was employed deductively to understand which needs are unmet in relation to their mental distress.ResultsThe identified problems fell into one of three main domains: challenges within the self, difficulties in exile and challenges in the encounter with ‘the other’. The mental health problems hindered existence needs and needs of relatedness, as described by the Alderfer’s existence-relatedness-growth (ERG) theory.

PURPOSE:The study aimed to characterize the multidimensional burden of tinnitus on health-related quality of life (HRQoL) using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) moving beyond symptom severity alone. METHOD:A cross-sectional analysis was conducted using baseline data (N = 428, Mage = 54.9 years, 51.9% female) from several clinical trials examining the efficacy of internet-based cognitive behavioral therapy for tinnitus. Data were collected using a series of online questionnaires including demographic, audiological, and clinical variables. HRQoL was assessed using the EQ-5D-5L profile dimensions. RESULTS:Participants primarily reported no problems with mobility (76.6%), self-care (92.5%), and usual activities (65.2%); however, pain/discomfort (33.4%) and anxiety/depression (40.2%) were the most affected EQ-5D-5L dimensions at baseline. Higher tinnitus severity was consistently associated with worse outcomes across all dimensions (p < .05). A 10-point increase in Tinnitus Functional Index (TFI) scores was associated with 53% and 51% higher odds of worse usual activities and anxiety/depression, respectively. Participants reporting a fully healthy EQ-5D-5L profile had substantially lower tinnitus severity compared with those with any reported problems (mean TFI: 39.0 vs. 55.3, d = 0.78). Cluster analyses identified a smaller subgroup with markedly poorer multidimensional health, characterized by higher tinnitus severity and greater psychological and sleep-related distress, with no significant differences in demographic or audiological characteristics between profiles. CONCLUSIONS:Tinnitus severity is associated with multidimensional reductions in HRQoL, particularly in functional activity and emotional health. The identification of a high-burden profile characterized by anxiety, depression, sleep disturbance, and activity limitation highlights the need for integrated, biopsychosocial approaches to tinnitus management. SUPPLEMENTAL MATERIAL:https://doi.org/10.23641/asha.33307416.

Background:Chronic Pain (CP) affects approximately one in five adults and is associated with emotional distress, disability, reduced productivity and substantial healthcare and societal costs. Acceptance and Commitment Therapy (ACT) has demonstrated effectiveness in improving emotional, behavioral and functional outcomes in individuals with CP, but access to ACT is frequently limited by geographic, organizational and workforce barriers. Internet-based interventions may help overcome these limitations by increasing accessibility, reducing treatment costs and improving scalability. Objective:This study evaluates the effectiveness and cost-effectiveness of MobACT, a guided internet-based ACT programme for Italian adults with CP. The primary effectiveness endpoint is the post-intervention assessment (T1). Methods and analysis:This two-arm randomized controlled trial will allocate adults with medically verified CP to either immediate MobACT or waitlist control (1:1). Participants in the waitlist control condition will receive access to MobACT only after completion of the T1 assessment, following the primary between-group comparison. A 6-month follow-up (T2) will be conducted in the intervention group only to examine maintenance of treatment effects. The primary outcome will be pain acceptance, assessed with the Chronic Pain Acceptance Questionnaire. Pain intensity and pain interference will be key clinical secondary outcomes. Additional secondary outcomes include quality of life, sleep quality, central sensitization, pain catastrophizing, psychological flexibility, self-efficacy, coping, anxiety, and depressive symptoms. Weekly assessments of sleep quality and changes in pharmacological treatment will also be collected during the active intervention period. The economic evaluation will compare the two conditions from healthcare and societal perspectives using service utilization data, productivity indicators, and EQ-5D-3L-derived quality-adjusted life years. Ethics and dissemination:Ethical approval was obtained from the Ethics Committee of Università Cattolica del Sacro Cuore, Milan (Approval No.: 146/24). Results will be disseminated through peer-reviewed publications, international conferences and stakeholder reports for patient organizations. Trial registration number:ClinicalTrials.gov Identifier: NCT07270588.

Background:Chronic pain (CP) is a leading cause of disability worldwide and is associated with substantial psychological, functional, and social burden. Acceptance and Commitment Therapy (ACT) has demonstrated efficacy in improving pain acceptance and functioning; however, access to psychological care remains limited. Internet-based interventions (IBIs) may help bridge this gap. To date, no ACT internet-based intervention has been developed and tested for individuals with CP in Italy. The present pilot randomized controlled trial (RCT) evaluated feasibility, acceptability, usability, and exploratory changes in pain acceptance of MobACT, a guided internet-based ACT intervention translated and adapted for the Italian context. Methods:A two-arm pilot RCT with parallel groups (1:1 allocation) was conducted. Forty adults with CP were randomized to either the MobACT intervention (n = 20) or a waitlist control group (n = 20). The seven-week guided intervention was delivered via the Iterapi platform. Feasibility outcomes included recruitment, retention, usability, satisfaction, intervention experience, and participant feedback. The primary exploratory clinical outcome was pain acceptance, measured using the Chronic Pain Acceptance Questionnaire (CPAQ-20) at baseline (T0) and post-intervention (T1). Feasibility, usability, and participant experiences were explored through post-intervention questionnaires and semi-structured interviews analyzed using thematic analysis. Results:Pain acceptance significantly improved over time across participants (p < .001), but the time × group interaction was not significant (p = .978), indicating no evidence of a differential change between MobACT and waitlist during the pilot period. Reliability of the CPAQ-20 was good at both time points (α = 0.802-0.842). Qualitative findings indicated high usability, satisfaction, and perceived applicability of ACT strategies. Participants reported increased awareness, reduced rumination, improved emotional regulation, and greater engagement in valued activities, despite limited changes in pain intensity. Conclusions:Findings support the feasibility, acceptability, and usability of MobACT as a culturally adapted internet-based ACT intervention for CP in Italy. Exploratory outcome findings should not be interpreted as evidence of efficacy; rather, they support further evaluation in a larger, fully powered RCT with more comprehensive engagement monitoring and longer follow-up.

Internet-based cognitive behaviour therapy (ICBT) is now a well-established treatment modality supported by numerous controlled trials. Platforms for delivering these interventions have become critical infrastructure for both research and clinical practice, yet platform descriptions remain rare in the literature. In this article, we provide an updated description of the Iterapi platform, originally reported by Vlaescu et al., 2016. Over the past decade, Iterapi has been used in more than 100 published research studies, spanning over 35 clinical conditions (including depression, anxiety disorders, insomnia, tinnitus, loneliness, and climate anxiety) across at least 20 countries on five continents. We describe the platform's core architecture and functionality, including treatment modules, questionnaire systems, communication tools, and automation features. We also report on significant developments since 2016, including enhanced security and regulatory compliance (GDPR, data protection impact assessments), new features for ecological momentary assessment, electronic identification and incorporation of artificial intelligence. Finally, we outline future directions including mobile application development, digital phenotyping, just-in-time adaptive interventions, and the role of emerging regulatory frameworks. This update is intended as a practical resource for researchers and clinicians considering platform-based delivery of internet interventions.

Internet-delivered psychotherapies show promise for adolescent major depression (MDD), but little is known about which baseline characteristics predict improvement or moderate differential effects between internet-delivered cognitive-behavioral therapy (ICBT) and psychodynamic therapy (IPDT). This study examined pretreatment predictors and moderators of symptom change in a randomized trial comparing the treatments. This secondary analysis used data from a non-inferiority trial (n = 272) in which adolescents with MDD received 10 weeks of guided ICBT or IPDT. Mixed-effects models tested predictors and moderators of change in self-rated depression. Anxiety symptoms, length of depressive episode, emotion regulation, personality disorder severity, attachment, self-compassion, suicidal ideation, and baseline depression were examined as predictors and moderators. Higher self-compassion predicted steeper improvement across treatments, as the only significant predictor. Comorbid anxiety moderated outcome where higher anxiety was associated with significantly greater improvement in IPDT relative to ICBT, with no difference at average levels. At the lowest levels of anxiety, ICBT showed significantly better outcomes. No other significant moderators emerged. Findings suggest that baseline variables may influence the rate of improvement in internet-delivered therapy for adolescent MDD, as well as help guide treatment selection. Replication is needed to establish the clinical utility of these variables.

Background: Despite an elevated risk for developing mental health problems, evidence-based treatment options for this population remain scarce. The current study aimed to examine the efficacy of a culturally adapted internet-based cognitive behavioral therapy (iCBT) program for youth and young adults with mild to moderate mental health problems. Method: Raha is a culturally adapted, guided, and tailored iCBT program for mild to moderate mental health problems. One hundred twenty-five Arabic-speaking refugee youth and young adults aged 15-29 years were randomly allocated to either a 10-week CA-iCBT condition or a wait-list control condition. The Hopkins Symptom Checklist (HSCL-25) served as the primary outcome measure and was assessed at pre-treatment, 4week follow-up, post-treatment, and at 6-months post-treatment. Treatment effects were evaluated using a latent growth model. Results: In the intention-to-treat analysis, anxiety and depressive symptoms on the HSCL-25 were significantly reduced in the treatment group compared with the wait-list control group, with a between-group effect size at post-treatment of Cohen's d = 1.43 [0.97,1.89]. Treatment effects were sustained at the 6-month follow-up. Significant moderate-to-large effects were also observed across most secondary outcome measures. Conclusion: The findings of this study indicate that CA-iCBT is effective in reducing symptoms of common mental health problems in a population that generally underutilizes traditional mental health services.

Background/Objectives: Tinnitus affects various aspects of health, yet its impact on occupational functioning remains less well explored. This study investigated the impact of tinnitus on work productivity, the role of comorbidities of anxiety, depression, and quality of life, and explored whether an evidence-based intervention may potentially influence workplace functioning. Methods: The study used cross-sectional and longitudinal data and employed mixed methods design to enable comparing work productivity before and after undertaking ICBT for tinnitus. Data were collected from 449 participants (64% employed; mean age of 54.4 years) who were seeking to enroll in an internet-based psychological intervention. Of these, 200 also completed an internet-based cognitive behavioral therapy intervention (ICBT). Data were analyzed using descriptive statistics, analysis of variance, qualitative content analysis and comparisons made between those whose work was unaffected due to tinnitus and those who worked less. Results: Pre-intervention, 81% reported no change in work patterns. Because of tinnitus 11% worked fewer hours, 7% had stopped working, and 1% received disability allowance. Participants were significantly less effective in their work capacity prior to undertaking the intervention compared to post-intervention and at follow-up; for the overall sample and post-intervention improvements were observed in tinnitus distress, anxiety, depression, and insomnia. There was significant time difference between group interactions for tinnitus, anxiety and insomnia but not for depression and quality of life when comparing those working and not working. Qualitative findings highlighted challenges related to attention, fatigue, and communication, as well as coping strategies and role modifications. Conclusions: Further studies are required to build on this exploratory research. The present findings underscore the need for workplace policies recognizing tinnitus as a potential disability and providing reasonable accommodation and options to access tinnitus interventions. Clinical interventions should also consider how to improve workplace functioning in individuals with bothersome tinnitus. Future research should explore ways to address cognitive load and enhance productivity.

BackgroundThe rising number of refugees and migrants has created growing mental health needs that health care systems struggle to address. Providing assessment and treatment for mental health problems in a digital format could help increase access to care and facilitate the provision of adapted interventions. Psychologists are key stakeholders in the delivery and influence of clinical services within routine care settings, but there are limited data on their perspectives regarding the use of digital solutions to assess and treat common mental health problems in refugees and migrants. ObjectiveThis study aimed to examine psychologists’ usage, knowledge, and attitudes toward digital mental health solutions for assessing and treating common mental health problems in refugees and migrants within the Swedish health care system. MethodsA cross-sectional online survey was conducted among psychologists in Sweden between December 2023 and February 2024. Responses included Likert-scale items and categorical variables, which were analyzed using descriptive statistics, independent samples t tests, and Fisher exact test to explore differences between subgroups. ResultsA total of 81 psychologists responded to the survey. Among them, 58 (72%) were women, and nearly half (40/81, 49%) worked in a public health care region. Respondents showed the highest acceptance for guided internet-based cognitive behavioral therapy (ICBT), blended treatment, and videoconferencing therapy. Only 20% (16/81) reported using digital solutions for refugees or migrants with mental health problems. Most respondents had low or very low knowledge of digital assessment and screening (61/81, 75%) and digital treatment (58/81, 72%) for these groups. Those using digital formats for refugees and migrants, or working in a setting that did so, had significantly higher ratings on all 5 knowledge items compared to those that did not (P<.001 to P=.01). Respondents emphasized the importance of digital solutions being provided in refugees’ and migrants’ native languages (70/81, 86%) and being culturally adapted (56/81, 69%). Those using digital formats for refugees and migrants considered cultural adaptation less necessary (P=.05). The preferred implementation approach was through specialized or decentralized units in primary care (66/81, 81%). ConclusionsWhile psychologists recognize the potential of digital mental health solutions, significant barriers remain, including limited knowledge and experience with using digital formats for refugees and migrants. Psychologists prefer digital solutions in the native language of refugees and migrants that are implemented at the primary care level. The need for cultural adaptation should be further explored. Addressing psychologists’ preferences could facilitate the future integration and implementation of digital formats for refugees and migrants in routine care settings.

Abstract Background Emotion dysregulation is a transdiagnostic construct associated with psychiatric symptomatology. Improving strategies to regulate emotions is an important focus in several psychological treatments. In the current study we investigated the effects of a brief seven-session emotion regulation skills training group for adolescents and parents in a randomised controlled trial in a naturalistic setting. Methods This non-blinded, randomised study recruited participants from two child and adolescent psychiatric outpatient clinics during Mars 2019 to January 2023. A total of 118 adolescents, 14 to 17 years old, were assessed and randomised to either a seven-session emotion regulation skills training group or to a control group. The intervention was transdiagnostic and open to all patients with few exclusion criteria. Both groups received treatment as usual consisting of multidisciplinary child and adolescent psychiatric care. Self-reported emotion dysregulation measured with the Difficulties in Emotion Regulation Scale was compared between the two arms after the intervention. Secondary outcomes were alexithymia, emotional awareness, symptoms of depression and anxiety and quality of life. Results Of 58 adolescents randomised to emotion regulation skills training group, 48 started the intervention and 36 completed it and were included in the final analysis. In the control group, 41 participants of the 60 randomised remained in the final analysis. Of the primary outcome measure Difficulties in Emotion Regulation Scale, only one subscale, Lack of Emotional Clarity, significantly decreased for the emotion regulation skills training group compared to the control group. There were no significant differences in overall emotion dysregulation. Significant reductions of Alexithymia, measured by Toronto Alexithymia Scale, were found in the intervention group compared to the control group. No other significant differences were found between groups in secondary outcomes. Exploratory within-group analyses pointed to a reduction in overall emotion dysregulation, indicating a further effect at three months post-intervention. Conclusions The brief group-based emotion regulation skills training for adolescents and parents in child and adolescent psychiatric outpatient clinics, delivered adjunctive to treatment as usual, appears to improve certain aspects of emotion regulation, specifically emotional clarity and alexithymia. While it did not show effects on psychiatric symptoms or quality of life, explorative analyses indicate that it may reduce overall emotion dysregulation over time. Trial registration NCT03900533.

Background Internet-based cognitive behaviour therapy (ICBT) is an evidence-based treatment for depression, and therapist contact has been associated with favourable outcomes. Some studies have examined what patients communicate to their therapists in ICBT and whether this communication is associated with adherence and treatment outcomes. However, findings remain limited and further research is needed. Objectives This study aimed to describe communicative patient behaviours during ICBT as expressed in messages to therapists, and to investigate whether the frequency of these behaviours was associated with adherence and treatment outcomes. Methods The content of 483 messages sent from patients in ICBT for depressive symptoms to their therapists were analysed through qualitative content analysis and labelled in different categories. Correlations between category frequency and adherence and outcome (measured post-treatment and at 1- and 2-year follow-up) were calculated. Results In total, 15 categories were identified. The category expressing pride was positively correlated with reduction of depressive symptoms at 1-year follow-up. Categories expressing needs and expressing frustration/resignation were more prevalent among patients who later relapsed compared to those who did not. Eleven categories showed significant positive correlations with adherence (number of completed modules), while one showed a significant negative correlation. Conclusions A large part of patient communication in ICBT is related to adherence, though only a small proportion is associated with outcomes. Therapists in ICBT should pay attention to the content of patients' messages, as certain themes may indicate how therapy is progressing.

Background: Post-traumatic stress disorder (PTSD) is highly prevalent among refugees due to their exposure to traumatic events; however, many demonstrate resilience that mitigates its impact. Given the ethnocultural diversity of refugee populations, questions remain regarding whether their symptom presentation aligns with diagnostic and therapeutic frameworks developed in Western contexts. Furthermore, evidence is limited on how resilience relates to PTSD symptom clusters.Objective: We examined (a) the contribution of PTSD symptom clusters to the overall PTSD construct in traumatized individuals with a refugee background, and (b) the structural relationships between PTSD symptom clusters and psychological resilience.Method: The study included 267 (61% male) young adults (Mage = 25.21) with a refugee background who had experienced trauma. Questionnaires measured PTSD symptoms, psychological resilience and socio-demographic characteristics. Confirmatory factor analyses (CFA) and structural equation modeling (SEM) were utilized.Results: Hyperarousal, negative alterations in cognition and mood (NACM), and re-experiencing symptom clusters were stronger indicators of PTSD, compared to avoidance symptoms. Additionally, resilience exhibited a stronger association with hyperarousal and NACM than re-experiencing, while its association with avoidance was not significant.Conclusions: Hyperarousal represents an important symptom cluster within this population, possibly reflecting the impact of migration-related ongoing stressors. The findings also suggest patterns that may be related to ethnocultural differences in symptom expression and coping strategies. Higher resilience is associated with lower PTSD symptoms, but this association is contingent upon the strength of individual PTSD symptom clusters. Further research is warranted to replicate and extend these results.

The objective of the study was to examine how therapists in clinical practice experience sudden dropouts from psychotherapy. We interviewed 12 licensed psychotherapists regarding sudden dropouts. The interviews were analysed using thematic analysis (TA). Three main themes and seven subthemes were identified. The first main theme was: Struggling to understand and explain the dropout. The subthemes were: “the patients’ problem was too difficult”, “trouble cooperating” and “problematic emotional bond”. The second main theme was: Continuing when something is wrong. The subthemes were: “difficulties maintaining presence”, “emotional withdrawal and sense of failure as a therapist”. The last third main theme was: Therapists processing feelings after the dropout. The subthemes were: “doubting your own capacity”, “to be abandoned”, “sense of relief and lessons learned”. Sudden treatment dropouts often elicit negative emotions such as guilt, shame, and sorrow. They may also bring a sense of relief. Abrupt termination of therapy can affect therapists both professionally and personally, with the impact sometimes persisting long after the client has dropped out from therapy.

The current study assessed the effectiveness and acceptability of the Children and Grief (C G) program in mitigating symptoms of post-traumatic stress disorder (PTSD) among children and adolescents aged 10–17 years, following a terrorist attack on a school in Afghanistan. A total of 204 Afghan (Hazara) children and adolescents exposed to the Sayed al-Shuhada school terrorist attack participated in the C G group-based intervention. Seven weekly sessions of 90 min were delivered at an established psychosocial center within the school building in Kabul. The sessions focused on teaching coping skills for PTSD. Outcomes were measured using the Children’s Revised Impact of Events Scale (CRIES-8) and the General Health Questionnaire (GHQ-28) at post-intervention and one-month follow-up. A repeated-measures analysis of variance (ANOVA) was used on quantitative data. Both written and verbal feedback were collected from participants, and the subjective experience of program delivery was explored with 10 group facilitators. The results indicated a large effect size, suggesting a significant reduction in PTSD symptoms and an increase in psychological wellbeing. These findings suggest that the C G program shows promise for treating PTSD in children and adolescents within emergency settings. Randomized controlled trials, exploration of participants’ response style, and longitudinal studies are warranted.

Online Mindfulness-Based Cognitive Therapy (MBCT) is a promising intervention for mental health, but its effectiveness in reducing depressive symptoms remains underexplored. While key mechanisms of change have been identified in traditional MBCT, their role in online delivery formats needs further investigation. This study aimed to evaluate the effectiveness of synchronous and asynchronous online MBCT in reducing depressive symptoms and to examine potential mechanisms of change. In this randomized clinical trial, 170 individuals with mild to moderate depression were assigned to a 6-week synchronous online MBCT group (n = 58), asynchronous online MBCT group (n = 59), or waitlist control (n = 53). Depression, anxiety, mindfulness, cognitive fusion, rumination, self-compassion, resilience, and experiential avoidance were assessed at baseline, post-treatment, and 3-month follow-up. Posttest assessments were completed by 42 participants (72

BACKGROUND:Mental health conditions such as depression, anxiety, and post-traumatic stress disorder (PTSD) are highly prevalent among forcibly displaced populations. Prevalence rates of common mental health conditions have been studied in refugee groups. However, research is sparse regarding the heterogeneity of psychiatric symptoms and quality of life (QoL) profiles among individuals with recent displacement experiences. METHODS:The current study employed Latent Profile Analysis (LPA) to identify profiles of psychopathology and QoL in a sample of 510 recently arrived refugees in Sweden. The associations of profile membership with socio-demographic factors were thereafter investigated. RESULTS:Three distinct profiles were identified: a severe psychopathology/low QoL profile (36.27%), a PTSD-dominant/preserved QoL profile (33.14%) and a mild psychopathology/high QoL profile (30.59%). Nationality and residence status were moderately associated with profile membership. Individuals with Afghan nationality were over-represented, and those with Syrian nationality under-represented, in the severe psychopathology/low QoL profile. This association is likely explained by residence status: 82% of individuals in the severe psychopathology/low QoL profile lacked a residence permit, with only 3.6% of Afghans having received a residence permit, compared to 59.1% of Syrians. CONCLUSIONS:The results underscore the heterogeneity of psychopathological symptoms and QoL in individuals with recent displacement experiences, as well as a significant influence of contextual factors like residence status on their mental health and QoL. These findings may have implications for informing psychological treatments and migration policies.

Psychological distress is common among breast cancer survivors. Psychosocial interventions can be effective but rarely consider heterogeneity of symptoms. The present study investigated the effects of therapist-supported tailored internet-delivered cognitive behavioral therapy (ICBT) for cancer-related psychological symptoms in breast cancer survivors. Seventy breast cancer survivors reporting elevated levels of depressive and/or anxiety symptoms were recruited and randomized to take part in either ICBT (n = 35) or a moderated online discussion forum (n = 35). The ICBT condition was tailored according to the problems reported by the participant. Questionnaires assessing psychiatric and cancer-related psychological symptoms, quality of life, and benefit finding were used. Data were collected before and after the treatment phase at week 10, as well as after six months, and the study was completed back in 2008. The results at the posttreatment indicated significant differences across all outcomes favoring the ICBT condition. Effect sizes ranged between small (Cohen's d = -0.35) for body change stress, and large for symptoms of depression and anxiety (Cohen's d = -0.89). Symptom levels were sustained for the ICBT group at follow-up but with few between-group differences. The results indicate that tailored ICBT can help breast cancer patients who experience psychological distress following medical treatment.

Obsessive-compulsive disorder (OCD) affects a substantial proportion of society and is associated with high economic burden. Despite the availability of effective treatments, many individuals do not receive evidence-based treatments due to barriers to accessibility, affordability, and scalability. Augmented Reality Exposure Therapy (ARET) has emerged as a promising alternative to conventional face-to-face therapy. We aim to evaluate an AR-based cognitive-behavioral self-help intervention for contamination-related fear, ZeroOCD. Specifically, we will assess whether ZeroOCD reduces the severity of contamination fear at post-intervention and at the 6-month follow-up, as well as its cost-effectiveness and user-friendliness compared with cognitive behavior therapy (CBT) delivered via videoconferencing and a waitlist control condition. A three-arm randomized controlled trial (RCT) will be conducted, comparing: (1) ZeroOCD with minimal therapist guidance, (2) CBT delivered via videoconferencing, and (3) a waitlist control condition. A total of 189 participants experiencing fear of contamination will be recruited from the Dutch (n = 63), German (n = 63), and Swedish-speaking (n = 63) general population. Recruitment and data collection began in September 2025 and are expected to continue through 2026. This study aims to improve access to evidence-based treatment for OCD by evaluating a scalable, AR-based self-help intervention with minimal therapist involvement. ClinicalTrials.gov NCT07194473; https://clinicaltrials.gov/study/NCT07194473