ØCD: protocol for the development and evaluation of a cognitive-behavioral prevention program for obsessive-compulsive disorder.

BACKGROUND: Obsessive-compulsive disorder (OCD) imposes significant burdens on individuals, families, and healthcare systems and the COVID-19 pandemic appears to have exacerbated OCD symptoms. Currently, there are no validated prevention programs for OCD, highlighting a critical gap in mental health services. This study aims to develop and validate the first ØCD prevention program, for at-risk adults, utilizing cognitive-behavioral therapy (CBT) and exposure response prevention (ERP) techniques. METHODS: A single-blind, randomized controlled trial comparing the ØCD prevention program to a waitlist control group will be conducted. Participants, at-risk adults (18-65 years) with subclinical OCD symptoms (OCI-R score ≥ 12), will be recruited for the study. The ØCD prevention program compresise of six online group sessions incorporating CBT and ERP techniques over three modules. The primary outcomes are OCD symptom severity (measured by the Obsessive-Compulsive Inventory- revised form; OCI-R), depression symptoms (measured by the Patient Health Questionnaire; PHQ-9), and anxiety symptoms (measured by the Generalised Anxiety Disorder 7-item; GAD-7). Secondary outcomes include OCD-related beliefs, experiential avoidance, resilience, quality of life, uncertainty intolerance, automatic thoughts, and distress. Outcome measures will be collected at baseline, at completion of the intervention, and one year later (follow-up). At follow-up, we will also analyze the OCD diagnostic incidence, using the Structured Clinical Interview for DSM-5. We will employ a multivariate analysis of variance (MANOVA) to explore whether significant differences exist between groups across dependent variables. To compare the OCD incidence levels from the pre-test to the follow-up we will use the chi-squared test. DISCUSION: The present study may contribute novel data on the efficacy of OCD prevention approaches, leading to the development of an evidence-based OCD prevention program that could alleviate individual and societal burdens associated with OCD. TRIAL REGISTRATION: This trial was approved by the University Ethical Review Authority (937/ 28.11.2023) at Babeș-Bolyai University and is registered on clinicaltrials.gov (ID: NCT06262464).

Online Parenting Programs for Children's Behavioral and Emotional Problems: a Network Meta-Analysis.

Online parenting programs to support parents of children with behavioral problems and emotional problems have become widely available in recent years. Research has consistently shown their positive effects on child development, parents' adaptive parenting practices, and parents' mental health. However, knowledge is lacking on which type of content is more suitable to be delivered online. Our work addresses this knowledge gap by conducting traditional and network meta-analyses to improve our understanding of (1) how effective online parenting programs are to improve children's behavior and emotional problems, and (2) what clusters of components are most likely to yield the strongest effects. Following the PROSPERO preregistration, we systematically searched PsycINFO, MEDLINE, Web of Science, and Cochrane. Of the 8292 records retrieved, 28 records on 27 randomized controlled trials (N = 5,312) met the inclusion criteria. Results show moderate effect sizes of online parenting programs on reduced child behavioral and emotional problems, parents' ineffective parenting practices, and parents' mental health problems. Online programs adopting a learning theory perspective, either with or without additional parental self-care and parents as therapist approaches, are most likely to yield the strongest effects on child behavioral problems. Online programs adopting a learning theory perspective, parental self-care and parents as therapist approaches, with or without additional relationship perspectives, are most likely to yield the strongest effects on child emotional problems. Online parenting programs seem promising tools for improving child behavioral and emotional problems. Future research should identify the circumstances that allow parents and children to benefit more from specific components in these programs.

Are gains in emotional symptoms and emotion-regulation competencies after the REThink therapeutic game maintained in the long run? A 6-month follow-up.

Emotional disorders are the most prevalent mental health conditions affecting children and adolescents. Thus, it becomes essential to develop and test early intervention strategies that are accessible, attractive, and can effectively improve their emotional functioning. A randomized control trial compared the prevention effects of the REThink therapeutic game to those of a standard face-to-face prevention program, and a waitlist which was transformed at follow-up into care as usual. Out of 142 healthy children and adolescents who completed the intervention stage, 137 (mean age: 12.84, SD: 1.97) completed a follow-up assessment measuring emotional symptoms, depressive mood and emotion regulation. We also tested potential moderators of its long-term effects, such as parental psychological control, parent attachment and childhood trauma. Our results highlighted the fact that the REThink intervention had a durable impact on the children's mental health and their ability to regulate their emotions. Moreover, we found that trauma, parent psychological control and parent attachment moderated the maintenance of the improvements. Future research needs to further document how to personalize the game and prevention program components to better address the characteristics of the youths at risk for mental health problems. ClinicalTrials.gov NCT03308981, from 13.10.2017.

Family still matters: Human social motivation across 42 countries during a global pandemic.

The COVID-19 pandemic caused drastic social changes for many people, including separation from friends and coworkers, enforced close contact with family, and reductions in mobility. Here we assess the extent to which people's evolutionarily-relevant basic motivations and goals-fundamental social motives such as Affiliation and Kin Care-might have been affected. To address this question, we gathered data on fundamental social motives in 42 countries (N = 15,915) across two waves, including 19 countries (N = 10,907) for which data were gathered both before and during the pandemic (pre-pandemic wave: 32 countries, N = 8998; 3302 male, 5585 female; M age  = 24.43, SD = 7.91; mid-pandemic wave: 29 countries, N = 6917; 2249 male, 4218 female; M age  = 28.59, SD = 11.31). Samples include data collected online (e.g., Prolific, MTurk), at universities, and via community sampling. We found that Disease Avoidance motivation was substantially higher during the pandemic, and that most of the other fundamental social motives showed small, yet significant, differences across waves. Most sensibly, concern with caring for one's children was higher during the pandemic, and concerns with Mate Seeking and Status were lower. Earlier findings showing the prioritization of family motives over mating motives (and even over Disease Avoidance motives) were replicated during the pandemic. Finally, well-being remained positively associated with family-related motives and negatively associated with mating motives during the pandemic, as in the pre-pandemic samples. Our results provide further evidence for the robust primacy of family-related motivations even during this unique disruption of social life.

Effectiveness of Outpatient Rational Emotive Behavior Therapy Over One Decade.

OBJECTIVE: The aim of this article was to explore the effectiveness of rational emotive and cognitive-behavioral therapy (REBT) in a clinical setting. METHODS: This study included 349 patients of the Albert Ellis Institute who sought psychotherapy from 2007 to 2016. Analyses were conducted by using the intent-to-treat principle, and outcomes were measured after three sessions of therapy (to measure early response) and at the end of 20 sessions. Outcome Questionnaire-45 was used to measure patient functioning. RESULTS: Patients reported significant improvements in their functioning after participating in REBT, with a medium effect size for early response after three sessions of psychotherapy and at the end of the 20 sessions. CONCLUSIONS: The authors' findings documented that REBT can be effectively transported from a research setting to clinical practice.

Changes in irrational beliefs are responsible for the efficacy of the REThink therapeutic game in preventing emotional disorders in children and adolescents: mechanisms of change analysis of a randomized clinical trial.

The mechanisms of change are rarely investigated in the field of gamified interventions for preventing emotional disorders in children and adolescents despite the wide recognition for the advantages they offer as prevention tool. Therefore, the aim of the present study was to investigate the mechanisms of change of a therapeutic game (REThink), specifically mediators and moderators of its efficacy. We conducted a randomized controlled trial, involving 165 children (age range 10-16 years), who were randomly distributed across three groups: the REThink group (N = 54), the Rational Emotive Behavior Education group (N = 55) and the Waitlist condition (N = 56). Results indicated that changes in irrational beliefs were significant mediators for the REThink intervention on depressive mood and overall negative emotions. Age did not moderate the effect of REThink, which indicates that the program was equally effective for children and adolescents.Trial Registration ClinicalTrials.gov NCT03308981.

Is REThink therapeutic game effective in preventing emotional disorders in children and adolescents? Outcomes of a randomized clinical trial.

Therapeutic games represent a promising solution for addressing emotional difficulties in youths. The aim of the present study was to investigate the effectiveness of the REThink game, in helping children and adolescents, to develop psychological resilience. Therefore, 165 children aged between 10 and 16 years were randomly assigned in one of the three groups: 54 participants in the REThink condition, 55 participants in the Rational Emotive Behavior Education condition, and 56 participants in the waitlist condition. Results indicated that the REThink intervention had a significant impact on emotional symptoms (a moderate-effect size, d = 0.46) and on depressive mood (a large-effect size, d = 0.84). Furthermore, REThink had a significant impact on children's ability to regulate their emotions, with a significant effect on emotional awareness (d = 0.64), and on the ability for emotional control (d = 0.69). In conclusion, the implications of the REThink game are discussed in relationship with resiliency building programs designed for youths. TRIAL REGISTRATION: ClinicalTrials.gov NCT03308981.

Traumatic Diaphragmatic Lesions - Considerations Over a Series of 15 Consecutive Cases.

Introduction: Diaphragmatic injuries are produced by blunt or penetrating thoracoabdominal trauma. They are potentially life-threatening due to the herniation of abdominal organs into the pleural cavities and severe associated lesions. The aim of this retrospective study was to analyse the clinical presentation and management of patients admitted with diaphragmatic rupture in our institution. Material and Method: We performed a 5-year retrospective study of patients admitted with acute blunt or penetrating diaphragmatic rupture in the Department of General Surgery of "Bagdasar- Arseni" Emergency Hospital. We have studied sex, age, mechanism of trauma, side-location, timeto-diagnosis, concomitant injuries, surgical treatment and outcome. Results: Fifteen patients (8 males, 7 females, mean age: 42 years) with diaphragmatic rupture (left-side: 13, right-side: 2) following blunt (8 patients) or penetrating (7) trauma were included. Patients with blunt diaphragmatic injury had larger tears and abdominal viscera herniation was observed in 6of these cases. A direct suture was performed for all 15 patients. Laparotomy was the surgical approach preferred in most of the cases. Mortality rate was 20%, mainly caused by severe associated lesions. Conclusion: Although traumatic diaphragmatic lesions are frequently associated with severe cerebral and thoraco-abdominal trauma that is also the main cause of death, a prompt diagnosis and treatment can lead to good outcome.

Global Study of Social Odor Awareness.

Olfaction plays an important role in human social communication, including multiple domains in which people often rely on their sense of smell in the social context. The importance of the sense of smell and its role can however vary inter-individually and culturally. Despite the growing body of literature on differences in olfactory performance or hedonic preferences across the globe, the aspects of a given culture as well as culturally universal individual differences affecting odor awareness in human social life remain unknown. Here, we conducted a large-scale analysis of data collected from 10 794 participants from 52 study sites from 44 countries all over the world. The aim of our research was to explore the potential individual and country-level correlates of odor awareness in the social context. The results show that the individual characteristics were more strongly related than country-level factors to self-reported odor awareness in different social contexts. A model including individual-level predictors (gender, age, material situation, education, and preferred social distance) provided a relatively good fit to the data, but adding country-level predictors (Human Development Index, population density, and average temperature) did not improve model parameters. Although there were some cross-cultural differences in social odor awareness, the main differentiating role was played by the individual differences. This suggests that people living in different cultures and different climate conditions may still share some similar patterns of odor awareness if they share other individual-level characteristics.

Therapeutical Aspects Regarding Pancreatic Pseudocysts.

Frequently appearing as a complication of pancreatitis, pancreatic pseudocysts are rare appearances in current medical practice. Multiple therapeutical options are available, from minimum invasive methods to complex open surgical techniques. The indications of drainage include symptomatic pseudocysts, large pseudocysts along with the development of complications such as hemorrhage, secondary infection, and rupture. Choosing the best drainage technique is often a challenge. Multiple factors need to be considered in managing a pseudoocyst, including its location, dimension and the patient's general state and comorbidities. Thus, a therapeutical algorithm may be of great use in choosing the most feasible technique for the diagnosed lesion that is also patient-adapted.

Internet-Based Psychotherapy for Adult Depression: What About the Mechanisms of Change?

INTRODUCTION: Internet-based cognitive behavioral therapy for depression (iCBT) has been advanced as a valuable alternative treatment option, generating promising results. However, little is known about its underlying mechanisms of change. OBJECTIVE: We aimed to provide an overview of the state of the art regarding the mechanisms of iCBT for adult depression, in the context of iCBT efficacy. METHOD: We conducted a systematic qualitative review of 37 randomized clinical trials, assessed the risk of bias in the included studies, and used a systematic evaluative framework to establish the scientific status of iCBT, based on evidence regarding clinical efficacy and mechanisms of change. RESULTS: Findings indicated that iCBT mechanisms of change are clearly underinvestigated, although iCBT is relatively efficacious, at least in the short term. The quality of iCBT randomized clinical trials proved to be suboptimal. CONCLUSIONS: The iCBT theory should be clearly specified and adequately investigated to design and implement highly efficacious therapeutic packages. Without considering the iCBT mechanisms of change along with iCBT efficacy, the extent to which iCBT is an empirically validated treatment remains questionable.

The MoodWheel app: validation and factor structure of a new tool for the assessment of mood based on the experience sampling method.

BACKGROUND: The MoodWheel app is a newly developed tool that uses experience sampling method (ESM) for assessing negative and positive emotions, based on the circumplex model of emotions and the binary model of distress, and including behavioral and heart rate (HR) measurement via photoplethysmography and the possibility to personalize the application with additional measures. Aims: This study was designed to assess the factorial structure, reliability and validity of the MoodWheel (MW) application for evaluating emotions in children, adolescents. METHODS: A sample of 490 children and adolescents were recruited from the schools. Internal consistency was assessed via Cronbach's alpha test. Concurrent validity was assessed by evaluating the correlations between MW and Profile of Emotional Distress scale (PED) scores, in terms of functional/dysfunctional negative and positive emotions. RESULTS: Results obtained show that MW has good to excellent internal consistency and test-retest reliability, while the convergent validity was also adequate. Moreover, we found support for the organization of the MW based on the binary model of distress, given the predictive value found for the irrational and rational beliefs. CONCLUSIONS: The MW application is a useful and easy to use tool that can be used for the accurate measurement of emotions, which will be complimented in future with additional behavioral parameters to provide a comprehensive and dynamic assessment.

Gamified Assessment of the Emotion Regulation Abilities in Youth: Validation of the REThink Online System.

Objective: Emotional problems in the youth population are a major issue that can have a significant negative impact for their future development as adults. Their emotion regulation (ER) abilities represent a preventive measure for those emotional problems. REThink is an online therapeutic game that was proved to be effective in rigorous studies, and is based on the rational emotive behavioral therapy, with seven levels built to train various emotional regulation skills. Each level has a section that can be used for the assessment of the targeted skills within the level. The present study aimed at investigating the reliability and validity of the evaluation modules from the REThink game regarding the assessment of ER abilities in children/adolescents. Methods: In accordance with established guidelines, 110 children and adolescents aged 8-14 years old were recruited. Following parental informed consent, the participants filled out the standard questionnaires and, subsequently, they played the evaluation module of the REThink game. The reliability aspect was investigated by evaluating internal consistency, while validity was evaluated by using concurrent and predictive validity analyses. Results: The results revealed statistically significant positive associations between the game scores obtained by the participants and the emotion regulation scale. In terms of predictive validity, there were significant negative associations between game scores and the presence of emotional and behavioral problems. Moreover, in terms of the reliability of the REThink game, an acceptable value for the internal consistency was observed. Conclusion: In conclusion, the REThink therapeutic game was proved to be a valid measure for assessing emotion regulation abilities in children and adolescents. Clinical Trial Registration No. NCT04788901.

Comparative efficacy of PsyPills and OCAT mobile psychological interventions in reducing depressive, anxiety and stress symptoms: A blinded randomized clinical trial.

BACKGROUND: Digital applications, such as in smartphone apps format, have shown high suggestive evidence for their efficacy in reducing general distress, but rigorous studies of their efficacy in symptom change and the mechanisms involved are still needed. METHODS: In the current multi-arm parallel-group randomized trial, participants aged 18-65 with smartphone access were recruited through social media. They were randomly assigned to two app interventions (PsyPills and OCAT) or an active placebo group (shamOCAT). The primary outcome was psychological distress measured up to one month. RESULTS: A total of 229 participants from diverse regional and demographic groups of the general population of Romania were randomly allocated into the three groups (PsyPills n = 80; OCAT n = 70; shamOCAT n = 79) and included in intention-to-treat analyses. Both the PsyPills (MD = -522; 95%CI = -10.00 to -0.44; d = 0.48) and OCAT (MD = -6.30; 95%CI = -11.39 to -1.21; d = 0.58) reduced significantly, with medium effect sizes, the psychological distress levels compared with the control group at follow-up. For the separate outcomes, only PsyPills showed significant medium reduction effects for anxiety symptoms (MD = -2.17; 95%CI = -3.83 to -0.50; d = -0.60), while OCAT showed reduction effects of small size for depression (MD = -1.50 (95%CI = -3.53 to 0.54, d = -0.34), that was however statistically nonsignificant. LIMITATIONS: We registered high attrition and low adherence rates. Also, lower-than-planned effects might have been statistically underpowered to detect. CONCLUSION: The results support the high potential of both apps as scalable tools to provide low-intensity self-guided interventions for common psychological problems in the general population and expand opportunities for further research (e.g., confirm and capitulate on the differential effects).

Sociodemographic Correlates of Mental Health Treatment Seeking Among College Students: A Systematic Review and Meta-Analysis.

OBJECTIVE: College students have high rates of mental health problems and low rates of treatment. Although sociodemographic disparities in student mental health treatment seeking have been reported, findings have not been synthesized and quantified. The extent to which differences in perceived need for treatment contribute to overall disparities remains unclear. METHODS: A systematic search of PubMed, PsycInfo, and Embase was conducted. Studies published between 2007 and 2022 were included if they reported treatment rates among college students with mental health problems, stratified by sex, gender, race-ethnicity, sexual orientation, student type, student year, or student status. Random-effects models were used to calculate pooled prevalence ratios (PRs) of having a perceived need for treatment and of receiving treatment for each sociodemographic subgroup. RESULTS: Twenty-one studies qualified for inclusion. Among students experiencing mental health problems, consistent and significant sociodemographic differences were identified in perceived need for treatment and treatment receipt. Students from racial-ethnic minority groups (in particular, Asian students [PR=0.49]) and international students (PR=0.63) reported lower rates of treatment receipt than White students and domestic students, respectively. Students identifying as female (sex) or as women (gender) (combined PR=1.33) reported higher rates of treatment receipt than students identifying as male or as men. Differences in perceived need appeared to contribute to some disparities; in particular, students identifying as male or as men reported considerably lower rates of perceived need than students identifying as female or as women. CONCLUSIONS: Findings highlight the need for policy makers to address barriers throughout the treatment-seeking pathway and to tailor efforts to student subgroups to reduce treatment disparities.

Preventing mental illness in children that experienced maltreatment the efficacy of REThink online therapeutic game.

Exposure to child maltreatment (CM) is considered to predispose children to devastating consequences in terms of mental health. Thus, it is a public health priority to provide these children with early preventive interventions that are accessible on a large scale, adapted to their needs, and effective in supporting their mental health. Here we report a randomized control trial to test the efficacy of the REThink online therapeutic game, as compared with a Care as Usual (CAU) control group in the prevention of mental illness in maltreated children. Out of 439 children aged 8-12 that were recruited, 294 children with self-reported maltreatment histories were included in the current study, and were allocated, 146 participants in the REThink group and 148 participants in the CAU group. All children completed pre- and post-intervention assessments measuring mental health, emotion regulation, and irrational cognitions. We also tested potential moderators for these effects, such as the severity of CM and the security of parent attachment. Our results show that children receiving the REThink game intervention outperform the CAU group at post-test, showing a significantly lower level of emotional problems, mental health difficulties, use of maladaptive emotion-regulation strategies such as catastrophizing, rumination, and self-blame, and irrational cognitions. Moreover, children with higher CM severity benefit the most from the REThink game, while children with lower parent attachment security benefit the least. Future research is needed, to investigate the long-term efficacy of the REThink game in promoting the mental health of children exposed to CM.

The REThink Online Therapeutic Game: A Usability Study.

BACKGROUND: Children and adolescents' help-seeking behaviors are often limited by fear, uncertainty, and stigma, as well as challenges with finding the right intervention, help, and a lack of familiarity with the process. A promising direction for the development of therapeutic interventions targeted at children is embedding them into gamified interventions, known as therapeutic or serious games. The aim of this paper is to describe the protocol of the beta REThink therapeutic game and to evaluate the usability of the game in a sample of children and adolescents. METHODS: The study was delivered in schools, where 137 children and adolescents aged between 9 and 16 years old played the levels of the REThink game, followed by filling in the usability questionnaire. FINDINGS: The results show above average evaluations for all levels of the game, for every dimension evaluated, namely presence/immersion, enjoyment, learning effectiveness, narratives, goal clarity, adequacy of learning material, and motivation. This study contributes to the literature on the usability of cognitive behavioral therapy-based therapeutic games for improvements in the emotion regulation abilities of children and adolescents, which can guide researchers interested in testing the REThink game in different protocols, as well to encourage its use by mental health specialists and parents.

Student Burnout in Children and Adolescents: The Role of Attachment and Emotion Regulation.

In an effort to explain the factors contributing to the development of student burnout, a construct that has received attention in relation to academic outcomes, including burnout, is emotion regulation. Further, attachment theory has been used to explore the variations in the use of particular emotion regulation strategies, and attachment has received support as a contributing factor. The aim of the study is to explore the role of attachment security and emotion regulation strategies associated with student burnout symptoms in a sample of 602 Romanian children and adolescents (55% female) aged 8-16 (M = 10.45) from 18 schools. A secondary objective was to explore the gender differences in burnout symptoms. The results show that attachment security negatively predicts student burnout symptoms. Further, a higher attachment security positively predicts the use of adaptive emotion regulation strategies, which, in turn, are negatively related to student burnout. Emotion regulation strategies mediate the relationship between attachment and burnout symptoms. No gender differences have been identified. The study has practical implications for both parents and specialists, bringing to attention the importance of secure attachment in children, which could further encourage the use of adaptive emotion regulation strategies.

The efficacy of online parenting interventions in addressing emotional problems in children and adolescents: A meta-analysis of randomized controlled trials.

BACKGROUND: Parenting interventions offer opportunities for reducing emotional problems in children and adolescents, based on addressing parental risk and protective factors. Online parenting interventions were developed more recently to increase access to interventions for parents, and the aim of this systematic review and meta-analysis is to investigate their efficacy. METHODS: We conducted a meta-analysis pooling studies that tested online parenting interventions having as outcome emotional problems in children/adolescents. We considered as secondary outcome parent mental health and moderation effects for the type of population, intervention characteristics, and risk of bias. RESULTS: Thirty-one studies met the inclusion criteria and were included in the meta-analysis. For child/adolescent emotional problems, at post-intervention, 13 studies were pooled, yielding an ES of g = -0.26 (95% CI [-0.41, -0.11]; p < .001) favoring the online parental interventions over wait-list, while at follow-up five RCTs were pooled, yielding an ES of g = -0.14 (95% CI [-0.25, -0.02]; p = .015) favoring the parental online interventions over wait-list. Moderation analyses suggest that longer online parenting programs are more effective in improving child emotional problems. CONCLUSIONS: Online parent programs have positive effects on reducing emotional symptoms in children and adolescents. Future research will need to develop and investigate the efficacy of the programs that can personalize their contents and delivery methods.

Particular aspects of treating rectal cancer: The watch and wait approach.

Background: Rectal cancer is one of the most common malignant pathologies worldwide. Currently, the standard treatment of this pathology consists of radio-chemotherapy followed by low anterior resection with total mesorectal excision or abdominoperineal proctectomy for medium/low rectal cancer. Objectives: In recent years, another treatment strategy has been proposed, stemming from the finding that up to 40% of patients receiving neoadjuvant treatment had a complete pathological response. This method, also referred to as the watch and wait approach, implies delaying surgery and following a rigorous protocol for patients who have developed a complete response to neoadjuvant treatment with a good oncologic outcome. The objective of this study was to highlight the merits of this approach in selected patients. Case Reports: In this study, we present two patients with low-rectal tumors who developed complete response post neoadjuvant therapy and for whom the watch and wait protocol has been applied over the past 4 years. Conclusion: Although the watch and wait protocol appears to be a feasible option in the management of patients with a complete clinical and pathological response post neoadjuvant therapy, more prospective studies and randomized trials comparing this approach with standard surgical treatment are required before establishing it as the standard of care for distal rectal cancer. Therefore, establishing universal criteria for the selection and assessment of the patients with a complete clinical response following neoadjuvant treatment is required.