The Bergen 4-day treatment (B4DT) for obsessive compulsive disorder (OCD) is a concentrated form of exposure and response prevention that has been implemented at the Icelandic Anxiety Centre. The aim of the present study was to assess 12-month results of 86 participants undertaking the treatment. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was administered at pre-, post-, and 3- and 12-month follow-up, accompanied by measures on generalised anxiety (GAD-7), depression (PHQ-9), and functional impairment (WSAS). The mean pre-treatment score on Y-BOCS was 30.5 (SE=0.5), the post-treatment score was 10.7 (SE=0.4), and the 12-month follow-up score was 11.5 (SE=0.9). There was no significant difference in Y-BOCS scores from post-treatment to 3- and 12-month follow-up, which indicates that treatment gains were maintained over time. Functional impairment, along with symptoms of anxiety and depression, decreased significantly from pre- to post-treatment, with further reductions in functional impairment observed at the 12-month follow-up. All participants completed treatment, and at 12-month follow-up, 83.7% had responded and 67.4% recovered. Among the participants that had responded or remitted at post-treatment, 22% had a worse outcome at 12-month follow-up, but 54% of the participants in the response or no change categories at post-treatment had a better outcome at follow-up. These results support the effectiveness and long-term benefits of the B4DT when implemented outside of its country of origin.Key learning aims The Bergen 4-day treatment (B4DT) is a highly intensive format of exposure and response prevention (ERP) for OCD. Treatment gains from the B4DT for OCD are sustained for at least 12 months, with 67% of patients remaining recovered and 84% showing improvement. Approximately half of those who do not fully benefit initially experience further improvement by the 12-month follow-up. Drop-out rates are negligible, which is unusual for exposure and response prevention. The B4DT demonstrates effectiveness beyond its country of origin.

Depression is a leading cause of global disease burden. Although psychotherapy and pharmacotherapy effectively reduce depressive symptoms, access to high-quality care remains limited. This study examined whether a Continuous Quality Improvement (CQI) process incorporating measurement-based care and benchmarking could enhance depression treatment outcomes in specialized mental healthcare. Data were drawn from two outpatient mental health clinics in Stockholm, Sweden. First, patient-reported outcome measures (PROMs) were used to compare local clinical results with a meta-analytic benchmark. Next, a CQI framework was implemented to improve outcomes. The sample included 415 patients receiving treatment for depression. Compared to the benchmark, the clinical sample had higher pre-treatment depression severity, attended more appointments, and had lower data attrition. Initial year-to-year analyses showed that treatment effects were significantly lower than the benchmark (Hedge’s g = 0.87–1.01 vs. g = 1.51). After implementing the CQI process, treatment effects improved (g = 1.25–1.27) and were no longer inferior to the benchmark. These findings suggest that integrating measurement-based care, benchmarking, and CQI can improve depression treatment outcomes in specialized settings and may help close the gap between real-world care and evidence-based standards.

Externalizing disorders (Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)) are frequent among children and adolescents referred to mental health services. Despite numerous studies linking emotion dysregulation to both severity and symptoms of externalizing disorders, the strength of the relationship is unclear. The purpose of this systematic review and meta-analysis was to evaluate the correlation between emotion dysregulation (deficits in emotion regulation and emotional lability) and symptoms of externalizing disorders. Embase OVID, Ovid MEDLINE and PsycINFO were systematically searched for eligible studies published up to June 2025. In total 75 studies involving 11,913 participants were included, with 63 studies on ADHD, 9 on ODD, 2 on ODD/CD, and 1 on ADHD/ODD/CD. Results showed a moderate correlation between emotion dysregulation and symptoms of externalizing disorders (r=0.35), with a higher correlation for emotional lability (r=0.47) than for emotion regulation (r=0.24). No significant moderating effects were found for age, gender, continent, informant, ADHD subtype, comorbidity or medication status. The findings indicate that emotion dysregulation, especially emotional lability, has a significant relation to symptoms of externalizing disorders. PROSPERO [CRD420251061853].

Background: Stress-related disorders are the leading cause of long-term sickness absence (>90 days) in Sweden, and most patients are treated within primary health care. However, few treatments effectively address both symptoms and return to work. Work-focused Cognitive Behavioural Therapy (W-CBT) is a newly developed treatment approach combining conventional CBT techniques with a module focusing on return to work. This study aims to test the feasibility and acceptability of a new W-CBT treatment manual for patients on sick leave due to stress-related disorders in primary health care, and to explore changes in work functioning and symptoms. Methods: The study was conducted at two primary health care centres in the Stockholm Region, Sweden. Adult patients on sick leave due to long-term stress-related disorders received treatment with W-CBT. The primary outcome measures concerned the feasibility and acceptability of the treatment, including the recruitment process and patients' perceptions of the treatment. The secondary outcome measures concerned work functioning and symptoms. Linear mixed-effects models with random intercepts and slopes were used for all secondary outcome measures. Results: Recruitment proceeded largely as planned. A total of 31 patients were included, of whom 30 completed treatment (median age 38 years, 63% women). All participants except one were recruited from one of the two primary health care centres. All participants perceived the treatment as effective and rated it as highly acceptable. Post-treatment, 81% (21/26) of participants were no longer on sick leave. Self-rated work functioning and symptoms showed high between-individual variability, but all measures improved post-treatment and were maintained at 6-months follow-up. Conclusions: The results indicate that W-CBT for patients on sick leave due to stress-related disorders is feasible and acceptable to deliver in a primary health care setting. In addition, work functioning and symptoms improved following treatment and were maintained at 6 months, while the observed between-individual variability suggests that treatment trajectories may differ considerably across patients. These findings warrant a full-scale controlled trial to evaluate treatment effects. Trial registration: The study was retrospectively registered on 3 November 2025 at the Open Science Framework (https://doi.org/10.17605/OSF.IO/3QE9J) before data analyses were performed.

Background Common mental disorders (CMDs) are a major cause of sickness absence and work disability. Although cognitive behavioural therapy (CBT) effectively reduces symptoms, effects on return-to-work (RTW) outcomes are limited. Work-focused CBT (W-CBT) integrates RTW processes into treatment, but the evidence base remains heterogeneous with unresolved methodological challenges. This systematic review and meta-analysis evaluated the effectiveness of W-CBT on psychiatric and work-related outcomes, examined moderators of treatment effects, assessed methodological rigor, and identified common intervention components, with particular attention to how RTW outcomes are analyzed. Methods Systematic searches were conducted in Medline, PsycINFO, and Web of Science from inception to December 2025. Randomized and non-randomized studies evaluating CBT with an integrated work focus among working-age adults on sickness absence due to CMDs were included. Random-effects meta-analyses were performed using multilevel models with cluster-robust standard errors to address outcome dependency. Moderator analyses examined treatment content, number of sessions, and study characteristics. RTW outcomes were evaluated regarding their statistical properties, summary measures, and analytic methods used in primary studies. Risk-of-bias was assessed using Cochrane Risk of Bias toos version 2 and ROBINS-I. Results Twenty-four studies comprising 26 W-CBT treatment conditions (n = 3,279 participants) were included. Large within-group improvements in psychiatric symptoms were observed and maintained at follow-up, while between-group effects were statistically significant but small. At post-treatment, 56% of participants had returned to work, increasing to 87% at follow-up, with a higher likelihood of full RTW in W-CBT compared with controls. Greater CBT content, stronger work focus, and higher treatment dose were associated with larger symptom improvements. However, RTW outcomes showed substantial heterogeneity. Many studies used analytic approaches assuming normally distributed data for outcomes that were bounded, skewed, or zero-inflated, or reported hazard ratios with limited comparability, constraining valid synthesis. Conclusions W-CBT is associated with meaningful symptom improvement and increased likelihood of RTW. However, misalignment between RTW outcome properties and analytic methods represents a major threat to validity. Future research requires improved outcome definitions, appropriate statistical modeling, and greater methodological consistency.

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.

The Bergen 4-day treatment (B4DT) for obsessive-compulsive disorder (OCD) is a concentrated form of exposure and response prevention that has been evaluated and implemented nationwide in Norway. Its effectiveness has yet to be fully established in other countries. A total of 86 patients with OCD underwent the treatment at the Icelandic Anxiety Centre (KMS) from 2018 to 2023. Of these, 61.6% were classified as having severe symptoms, and 38.4% with moderate symptoms. Of the sample, 72.1% had previously received psychological treatment for OCD and 86.0% had at least one comorbid disorder, depression being the most common (50.0%). Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was administered pre-treatment, posttreatment, and at 3-month follow-up, along with measures on general anxiety, depression, and occupational impairment. The mean score on Y-BOCS was 30.5 (SD = 3.6) pre-treatment, 10.6 (SD = 4.1) posttreatment and 10.9 (SD = 5.4) at 3-month follow-up. By the end of treatment, 94.9% of the patients had responded and 68.0% were in remission. At the 3-month follow-up, 92.5% were responders and 67.9% remitters. Participants were satisfied with the treatment and had improved in terms of occupational functioning, which was maintained at follow-up. These preliminary results suggest that the B4DT may be a swift and effective treatment format for OCD.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with estimated worldwide prevalence of 7.2 % in children and adolescents. Comorbidity of psychiatric disorders is considered common in ADHD and has been found to contribute to poorer prognosis. Despite decades of research, the actual prevalence of comorbid psychiatric disorders in children and adolescents with ADHD is unclear. The purpose of this systematic review and meta-analysis was to investigate the prevalence of comorbid disorders in children and adolescents with ADHD. Embase OVID, Ovid MEDLINE and PsycINFO were systematically searched for eligible studies published up to February 2025. In total 121 studies involving 39,894 children and adolescents with ADHD diagnosis were included. The most common comorbid disorders were Oppositional Defiant Disorder (34.7 %), Behavior Disorders (30.7 %), Anxiety Disorders (18.4 %), Specific phobias (11.0 %), Enuresis (10.8 %), and Conduct Disorder (CD) (10.7 %). All individual disorders studied had a higher prevalence among children and adolescents with ADHD than in the general population. Few gender differences were found; higher prevalence of CD among boys and higher of OCD in girls. The findings indicate that comorbid psychiatric disorders are highly prevalent in children and adolescents with ADHD and must be considered in both assessment and treatment of ADHD.PROSPERO registration: ID CRD42022359965.

BACKGROUND:Pediatric anxiety disorders are prevalent, particularly among children with anxious parents. This trial evaluated a program for anxious parents aimed at preventing offspring anxiety disorders and symptoms over 12 months. METHODS:This parallel, randomized, controlled, open-label trial was conducted at Karolinska Institutet, Stockholm, Sweden. Inclusion criteria comprised heightened parental anxiety and the child (5-9 years old) not currently meeting criteria for an anxiety disorder. The program, Confident Parents-Brave Children (CPBC) involves six video conferencing group sessions. An external researcher randomly allocated (1:1) participants to CPBC or a self-help control. The primary outcome was change in clinical severity ratings (CSR) between pre- and 12-month assessments, assessed by the Anxiety Disorders Interview Schedule. Secondary outcomes included parent-rated child anxiety symptoms and parental self-efficacy. The study was preregistered at ClinicalTrials.gov (NCT04722731). RESULTS:The trial included 215 parents (91% female) and 277 children (48% girls, mean age 7.0). At the 12-month assessment, no statistically significant difference was found between conditions on the primary outcome (change in CSR), OR = 0.67 (95% CI: 0.30, 1.48). No statistically significantly lower prevalence of anxiety disorder at the 12-month assessment was found in the CPBC group compared with the control group, OR = 0.57 (95% CI: 0.24, 1.31). When stratifying by age, children 5-6 years in CPBC showed lower risk of increased CSR, OR = 0.24 (95% CI: 0.08, 0.77), and anxiety diagnosis, OR = 0.23 (95% CI: 0.05, 0.84), compared to controls. Regarding secondary outcomes, CPBC children exhibited larger decreases in anxiety symptoms than control children from pre- to the 12-month assessment, Cohen's d = .35 (95% CI: 0.15, 0.55). Parents in both conditions showed increased parental self-efficacy over time, with no significant between-group effect. The 12-month assessment was completed by 204 parents (95%). CONCLUSIONS:The CPBC may have potential for preventing anxiety in young children; however, further research is warranted.

BACKGROUND:Specific phobia of vomiting (SPOV), also called emetophobia, is a debilitating condition that shares features with several other anxiety disorders and obsessive-compulsive disorder (OCD). Approximately half of sufferers from SPOV do not fully benefit from current treatment modalities. AIMS:Bergen 4-day treatment (B4DT) is a highly concentrated form of exposure and response prevention developed for OCD. This case series reports on the first participants undertaking the treatment for SPOV. METHOD:Five female participants underwent the B4DT adapted to SPOV. The Specific Phobia of Vomiting Scale (SPOVI) and Emetophobia Questionnaire (EmetQ-13) were administered pre-treatment, post-treatment, and at 3- and 6-month follow-up. Participants were also shown a 27-minute video portraying vomit-related stimuli of increasing intensity at pre- and post-treatment. The time participants managed to watch the video and their subjective anxiety and nausea were assessed at regular intervals. Reliable and clinically significant change were calculated on SPOVI post-treatment and at 6-month follow-up. RESULTS:Four of the participants achieved clinically significant change and the fifth reliable improvement, and these results were maintained at 6-month follow-up. The participants watched the vomit-related stimuli video for an average of 10 minutes pre-treatment whereas all completed it post-treatment, experiencing considerably less anxiety. These results were maintained at 6-month follow-up. CONCLUSION:The B4DT may be a robust and time-effective treatment format for SPOV with low attrition rates, but further research is needed to verify this.

BACKGROUND:Severe disruptions in mental healthcare services were reported during the COVID-19 pandemic. However, little data are available on whether services were able to maintain treatment efficacy during this period. OBJECTIVE:The aims of this study were to 1) compare outpatient mental healthcare treatment effects before and during the COVID-19 pandemic, and 2) explore whether the proportion of remote visits affected treatment outcomes. METHODS:Using a clinical cohort from two outpatient mental healthcare clinics in Stockholm, Sweden, we analyzed data from 2290 patients to compare treatment outcomes in years 2017-2019 ("before" the COVID-19 pandemic) vs. years 2020-2022 ("during" the COVID-19 pandemic). Primary outcomes were symptom reductions on patient-reported measures of depression, anxiety disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). RESULTS:We found a significant increase of remote visits during the COVID-19 pandemic (OR = 10.9, 95 % CI [10.49-11.27]). There were no statistically significant differences on treatment outcomes in the periods before vs. during the pandemic for any of the disorders under study. The proportion of remote visits did not have an effect on treatment outcomes. CONCLUSIONS:This large-scale naturalistic study indicates that treatment outcomes during the COVID-19 pandemic were maintained despite unprecedented disruptions.

There is a knowledge gap regarding clinically representative therapy given in routine settings, that is treatment as usual (TAU), for patients with common mental health problems (CMHP). This review and meta-analysis aimed to investigate what characterizes clinically representative therapy in Nordic routine clinics and meta-analyze the outcome of such treatment. Databases (PubMed, EMBASE, PsychINFO, and SveMed+) were searched for TAU, CMHP, and Nordic countries, together with backward and forward search in Scopus (7 November 2022). Studies were either randomized controlled trials (RCT) or open trials, using prospective study designs, examining heterogeneous outpatient groups in routine treatment. Within- and between-group effect sizes (ES), using random effects model, and moderator analyses were calculated. Eleven studies (n = 1,413), demonstrated a small to moderate within-group ES with high heterogeneity (g = 0.49, I2  = 90%). ESs in RCTs were significantly smaller than in open trials. TAU had a marginally smaller ES (g = -0.21; adjusted for publication bias g = -0.06) compared to a broad set of clinical interventions. Clinically representative therapy in the Nordic countries demonstrated a wide variety of characteristics and also a marginally lower ES compared to other interventions. The ESs were smaller than other meta-analyses examining evidence-based treatments in routine treatment.

Metacognitive interventions have received increasing interest the last decade and there is a need to synthesize the evidence of these type of interventions. The current study is an updated systematic review and meta-analysis where we investigated the efficacy of metacognitive interventions for adults with psychiatric disorders. We included randomized controlled trials that investigated either metacognitive therapy (MCT; developed by Wells) or metacognitive training (MCTraining; developed by Moritz). Ovid MEDLINE, Embase OVID, and PsycINFO were searched for articles published until May 2024. The final analyses included 21 MCT- and 28 MCTraining studies (in total 3239 individuals). Results showed that MCT was more efficacious than both waiting-list control conditions (g = 1.84) as well as other forms of cognitive behavior therapies (g = 0.43). MCTraining was superior to treatment as usual (g = 0.45), other psychological treatments (g = 0.46) and placebo conditions (g = 0.15). Many of the included studies lacked data on blinding procedures, reporting of inter-rater reliability, treatment adherence, competence, treatment expectancy and pre-registration procedures. We conclude that both MCT and MCTraining are probably efficacious treatments but that future studies need to incorporate more quality aspects in their trial designs.

PurposeIntensive Care Unit (ICU) staff report that a large part of the work-related distress they experience is related to communication situations with colleagues, patients, and relatives. Based on these findings, the aim of the present study was to preliminary evaluate the effects of a novel Communication Skills Training (CST) program on mental health among ICU staff.MethodsThe CST program was delivered to the entire work force of an ICU at a Swedish hospital and was evaluated as an uncontrolled clinical trial with three repeated measures. 100 participants were eligible and included in the analyses. The theoretical framework for the program was learning theory and cognitive behavioral therapy. The program was delivered by two psychologists and included one full-day lecture and three subsequent two-hour supervision sessions. Changes in mental health was evaluated with self-report questionnaires measuring perceived stress, general mental health, work engagement, and psychological flexibility.ResultsAnalyses of three repeated measures showed significant improvements with 1.3 points lower perceived stress and 2.0 points lower general mental health after the intervention. No differences were seen in measures of work engagement or psychological flexibility.ConclusionFindings of the study supports the utility of the CST program as an intervention to target perceived stress and general mental health within intensive care. These findings should be further validated in trials with improved design.

Knowledge about how to enhance group cognitive behavioral therapy (GCBT) outcomes is needed. In a randomized controlled effectiveness trial, we examined group cohesion (the bond between group members) and the alliance (the client-clinician bond) as predictors of GCBT outcomes. The sample was 88 youth (M age 11.7 years, SD = 2.1; 54.5% girls; 90.7% White) with anxiety disorders. Observers rated group cohesion and alliance in 32 sessions from 16 groups. We examined early group cohesion and alliance (r = .50, p < .001) and group cohesion and alliance change from early to late in treatment in relation to outcomes using generalized estimation equations accounting for nesting within groups (ICCs .31 to .55). The outcomes were diagnostic recovery, clinical severity, and parent- and youth-reported anxiety symptoms, each at post-treatment, 12-months, and 4-years follow-up. There were more significant associations with 4-years follow-up than earlier outcomes. Clinical severity and parent-reported anxiety symptoms were more frequently predicted than diagnostic recovery. Clinician- and parent-reported outcomes were far more frequently significantly predicted by cohesion and alliance than youth-rated outcomes. We conclude that group cohesion and alliance are related but distinct variables, both associated with some GCBT outcomes for as long as 4 years after treatment.

Various Cognitive Behavioral Therapy (CBT) programs for externalizing disorders in children and adolescents are supported by a substantial body of empirical evidence. Most of the research evidence comes from efficacy studies conducted in university settings, but there is less knowledge about the effect of these treatments in routine clinical care. The purpose of this meta-analysis was to investigate the effectiveness of CBT in non-university settings for Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD). Embase OVID, Ovid MEDLINE and PsycINFO were systematically searched for eligible studies published up to May 2020. In total, 51 treatment effectiveness studies involving 5295 patients were included. The average within-group effect size at post-treatment was significant (g = 0.91), and there were large effect sizes for both ADHD (g = 0.80) and CD/ODD (g = 0.98). At post treatment, remission rates were 38% for ADHD and 48% for CD/ODD, and the overall attrition rate was 14%. Benchmarking against efficacy studies showed that CBT in routine clinical care yields remission rates, within-group effect sizes and attrition rates that are very similar to those found in university settings. The findings support the transportability of CBT for externalizing disorders from university settings to routine clinical care. PROSPERO registration: CRD42020147524.

OBJECTIVE:Cognitive behavior therapy (CBT) is a recommended treatment for eating disorders (ED) in adults given its evidence, mainly based on efficacy studies. However, little is known about how CBT works in routine clinical care. The goal of the present meta-analysis is to investigate how CBT works for various ED when carried out in routine clinical settings. METHOD:Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for articles published until June 2023. The outcome of CBT, methodological quality, risk of bias (RoB), and moderators of treatment outcome were examined and benchmarked by meta-analytically comparing with efficacy studies for ED. Fifty studies comprising 4299 participants who received CBT were included. RESULTS:Large within-group effect sizes (ES) were obtained for ED-psychopathology at post-treatment (1.12), and follow-up (1.22), on average 9.9 months post-treatment. Attrition rate was 25.5% and RoB was considerable in the majority of studies. The benchmarking analysis showed that effectiveness studies had very similar ESs as efficacy studies (1.20 at post-treatment and 1.28 at follow-up). CONCLUSION:CBT for ED is an effective treatment when delivered in routine clinical care, with ESs comparable to those found in efficacy studies. However, the evidence needs to be interpreted with caution due to the RoB in a high proportion of studies. PUBLIC SIGNIFICANCE:Eating disorders are common in the population and often lead to multiple negative consequences. CBT has been found effective for ED and is recommended in clinical guidelines. Since these recommendations are primarily based on university studies we wanted to investigate how CBT performs in routine clinical care. Our meta-analysis found that CBT worked as well in routine care as in university setting studies.

Meta-analyses of school-based CBT have shown that prevention for anxiety symptoms typically report small but significant effects. There is limited knowledge regarding which youths may benefit most and least from such programs, and characteristics of youth who respond differentially to interventions of different intensity. The present study examined predictors of school-based CBT outcomes among 302 youths (mean age 14.0 years, SD 0.8, 84% female) who participated in a randomized waitlist-controlled trial comparing a 10-session and a 5-session group intervention. Potential predictors included youth and parental factors, and credibility and expectancy of the interventions. Pre-intervention anxiety and depression levels, and clinician rated severity were examined as moderators of intervention effects. Outcomes were youth-, and parent-reported youth anxiety and depressive symptoms at post-intervention and 1-year follow-up. Higher parent-reported impairment from youth anxiety predicted larger parent-reported anxiety and depressive symptom change, whereas higher caregiver strain was associated with less symptom change. Higher parent rated credibility and expectancy was associated with improved outcomes at post-intervention. At 1-year follow-up, no predictors of outcome were identified. No moderators were identified. Families with high levels of caregiver strain associated with youth anxiety may need extra support regardless of length of intervention program. Parents' credibility and expectancy of interventions should be targeted to optimize school-based CBT.

Although different cognitive behavioral therapies (CBT) have strong research support for treatment of adult post-traumatic stress disorder (PTSD) more knowledge is needed about the performance of CBT in routine clinical care. The present study is a systematic review and meta-analysis of CBT for PTSD in adults treated in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for studies published until the end of May 2022. The effectiveness of CBT, methodological quality, and moderators of treatment outcome were examined, and benchmarked by meta-analytically comparing with efficacy studies for PTSD. Thirty-three studies, comprising 6482 participants, were included. The within-group effect sizes (ES) for PTSD-severity at post-treatment (1.75), and follow-up (1.70), on average 6 months post-treatment, were large. The effectiveness studies had very similar ESs as efficacy studies at post-treatment (1.75 vs. 1.72) and follow-up (1.70 vs. 2.02), based on the benchmarking analysis. As the heterogeneity was large, we can only cautiously consider CBT for PTSD an effective treatment when delivered in routine clinical care. The outcomes of effectiveness studies for PTSD seem to be comparable to the results obtained in efficacy studies. PROSPERO REGISTRATION ID: CRD42021228828.

The chapter describes a certain form of exposure treatment for specific phobias in children called one-session treatment (OST) since the entire treatment is done in one session maximized to 3 h. In addition to exposure, OST often consists of participant modeling, cognitive restructuring, psychoeducation, skills training, and social reinforcement. A tentative meta-analysis of research studies, with participants 4–17 years old, yielded a very large within-group effect size of the clinician severity rating at post-assessment, which even increased significantly at follow-up assessment on average 6 months later. Type of specific phobia, age, or gender did not significantly moderate the effect size. The chapter also describes how to introduce the treatment strategy to children/parents, strategies for increasing collaboration, a step-by-step guide for implementation, homework practice and maintenance program, and challenges with the implementation of OST.