TMS-induced plasticity improving cognitive control in OCD I: Clinical and neuroimaging outcomes from a randomised trial.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for obsessive-compulsive disorder (OCD). The neurobiological mechanisms of rTMS in OCD have been incompletely characterized. We compared clinical outcomes and changes in task-based brain activation following three different rTMS stimulation protocols, all combined with exposure and response prevention (ERP). METHODS: In this three-arm proof-of-concept randomized trial, 61 treatment-refractory adult OCD patients received 16 sessions of rTMS immediately prior to ERP over 8 weeks, with task-based functional MRI (tb-fMRI) scans and clinical assessments pre- and post-treatment. Patients received either: high frequency (HF) rTMS to the left dorsolateral prefrontal cortex (DLPFC)(n=19(6M/13F)); HF rTMS to the left pre-supplementary motor area (preSMA)(n=23(10M/13F)); or control rTMS to the vertex(n=19(6M/13F)). Changes in tb-fMRI activation pre-post treatment were compared using both a Bayesian region-of-interest and a general linear model whole-brain approach. RESULTS: Mean OCD symptom severity decreased significantly in all treatment groups (delta=-10.836, p<0.001, 95% CI[-12.504,-9.168]), with no differences between groups. Response rate in the entire sample was 57.4%. The DLPFC rTMS group showed decreased planning-related activation post-treatment that was associated with greater symptom improvement. No group-level activation changes were observed for the preSMA or vertex rTMS groups. Participants with greater symptom improvement in the preSMA group showed decreased error-related activation, and symptom improvement in the vertex group was associated with increased inhibition-related activation. CONCLUSIONS: PreSMA and DLPFC rTMS combined with ERP led to activation decreases in targeted task networks in individuals showing greater symptom improvement, although we observed no differences in symptom reduction between groups.

Serotoninergic antidepressants combination in psilocybin-assisted psychotherapy: a case report.

Psilocybin has reemerged as a promising treatment for difficult-to-treat depression (DTD). Although there is limited evidence regarding interactions between psilocybin and other psychotropic drugs, clinical trials require that patients discontinue their antidepressants before study entry to isolate the benefits of psilocybin and to minimize the risk of adverse events. We present the first case of an adult patient with DTD who received psilocybin-assisted psychotherapy (PAP) in combination with two serotoninergic antidepressants (duloxetine and vortioxetine). Since he displayed a partial response after the first PAP session, he agreed to discontinue duloxetine (but refused to stop vortioxetine) before the second PAP session to see if it could improve the therapeutic efficacy of psilocybin. However, his anxiety and depressive symptoms worsened. Psilocybin was well-tolerated in both PAP sessions; mild headaches were the main adverse effects experienced by the patient, and there were no cardiovascular safety concerns. This case report suggests that serotoninergic antidepressants combination with psilocybin appears to be safe and that antidepressant discontinuation prior to PAP may not be necessary. Since the continuation of antidepressants during PAP has the potential to improve treatment acceptability and accessibility, future research should assess whether psilocybin can be administered concurrently with antidepressants.

Emotion Regulation, Relationship and Therapeutic Change in Analytical Psychology and Contemporary Psychodynamic Approaches.

All contemporary psychotherapies agree that (failing) emotion regulation is central to psychological disorders and that psychotherapy is about improving emotion regulation. In his research on the "emotion-laden" complex Jung put an emphasis on the role of failing emotion regulation in contributing to psychological disorders as well as to change in the process of psychotherapy, but he left this field of research and took a very different direction in favour of his archetype concept. Psychodynamic approaches generally argue that changes in emotion regulation are accomplished through corrective emotional experiences in the therapeutic relationship. Insights from affective neurosciences and attachment research have had a major influence on how the therapeutic relationship is constructed in contemporary psychodynamic approaches. There is a lack of similar developments in analytical psychology, which leads to substantial differences between the models of Jungian psychotherapy in contrast to other contemporary psychodynamic approaches. The implications of these differences for the practice of psychotherapy and especially the role of the therapeutic relationship are pointed out.

Toutes les psychothérapies actuelles s'accordent sur le fait que la régulation (défaillante) de l'émotion est au centre des désordres psychologiques et que la psychothérapie vise à améliorer la régulation de l'émotion. Dans sa recherche sur le « complexe à haute charge émotionnelle ¼, Jung a mis l'accent sur le rôle de la régulation défaillante de l'émotion comme participant aux désordres psychologiques ainsi qu'au changement dans le processus de psychothérapie. Mais il a abandonné ce champ de recherche et pris une direction très différente, y préférant son concept de l'archétype. Les approches psychodynamiques plaident généralement en faveur de l'idée que les changements dans la régulation de l'émotion sont atteints par les expériences émotionnelles corrective dans la relation thérapeutique. Des apports venant des neurosciences affectives et des recherches sur l'attachement ont eu une influence majeure sur comment la relation thérapeutique est construite dans les approches psychodynamiques actuelles. De tels développements font défaut dans la psychologie analytique, ce qui conduit à des différences considérables entre les modèles de psychothérapie jungienne en contraste avec les autres approches psychodynamiques actuelles. L'article souligne les conséquences de ces différences dans la pratique de la psychothérapie, tout particulièrement en ce qui concerne le rôle de la relation thérapeutique.

Todas las psicoterapias contemporáneas coinciden en que la regulación (fallida) de las emociones es central a los trastornos psicológicos y que la psicoterapia consiste en mejorar la regulación de las emociones. En su investigación sobre el complejo "de tonalidad afectiva", Jung hizo hincapié en el rol de una fallida regulación emocional en el desarrollo de los trastornos psicológicos, así como al cambio en el proceso de psicoterapia, pero abandonó este campo de investigación y tomó una dirección muy diferente en favor de su concepto de arquetipo. En general, los enfoques Psicodinámicos sostienen que los cambios en la regulación de las emociones se logran a través de experiencias emocionales correctivas en la relación terapéutica. Los conocimientos de las neurociencias afectivas y la investigación sobre el apego han tenido una gran influencia en cómo comprender la conformación de la relación terapéutica en los abordajes psicodinámicos contemporáneos. Faltan desarrollos similares en la psicología analítica, lo que conduce a diferencias sustanciales entre los modelos de la psicoterapia Junguiana en contraste con otros enfoques psicodinámicos contemporáneos. Se señalan las implicaciones de estas diferencias para la práctica de la psicoterapia y se destaca especialmente el rol de la relación terapéutica.

An updated meta-analysis of the relation between adult attachment style and working alliance.

Objective: Previous meta-analyses have shown that client-rated working alliance is negatively correlated with attachment anxiety and attachment avoidance. The purpose of this study is to provide an updated meta-analysis of the relation between alliance and the two dimensions of attachment insecurity. Method: Random effects models were used to examine the relation between the working alliance and attachment anxiety and the relation between the working alliance and attachment avoidance. Results: The overall relation between alliance and attachment anxiety was r = -.09 (p = .01, k = 33, I2 = 43.7%). The overall relation between alliance and attachment avoidance was r = -.13 (p < .001, k = 33, I2 = 44.7%). There was no evidence that these relations varied across study characteristics such as client race or the number of therapists in the study. Conclusion: The results support the negative relations between client-rated alliance and both dimensions of client-rated attachment insecurity. Further research is needed to identify the factors that moderate this relationship, using a more diverse sample of study characteristics and a wider range of measures.

Impacts of Telehealth Adoption on the Quality of Care for Individuals With Serious Mental Illness: Retrospective Observational Analysis of Veterans Affairs Administrative Data.

Background: Telehealth implementation can be challenging for persons with serious mental illness (SMI), which may impact their quality of care and health outcomes. The literature on telehealth's impacts on SMI care outcomes is mixed, necessitating further investigation. Objective: We examined the impacts of facility-level telehealth adoption on quality of care metrics over time among patients with SMI. Methods: We analyzed Veterans Affairs (VA) administrative data across 138 facilities from January 2021 to December 2022. We performed longitudinal mixed-effects regressions to identify the relationships between the proportion of facility-level telehealth visits and SMI specialty care quality metrics: engagement with primary care; access and continuity of care across a range of mental health services including psychotherapy or psychosocial rehabilitation, SMI-specific intensive outpatient programs, and intensive case management; and continuity of mental health care after a high-risk event (eg, suicide attempt). Results: Facilities with a higher proportion of telehealth visits had reduced access and continuity of physical and mental health care for patients with SMI (P<.05). Higher telehealth adoption was associated with reduced primary care engagement (z=-4.04; P<.001), reduced access to and continuity in SMI-specific intensive case management (z=-4.49; P<.001; z=-3.15; P<.002), reductions in the continuity of care within psychotherapy and psychosocial rehabilitation (z=-3.74; P<.001), and continuity of care after a high-risk event (z=-2.46; P<.01). Telehealth uptake initially increased access to intensive outpatient but did not improve its continuity over time (z=-4.47; P<.001). Except for continuity within SMI-specific intensive case management (z=2.62; P<.009), continuity did not improve over time as telehealth became routinized. Conclusions: Although telehealth helped preserve health care access during the pandemic, telehealth may have tradeoffs with regard to quality of care for some individuals with SMI. These data suggest that engagement strategies used by SMI-specific intensive case management may have preserved quality and could benefit other settings. Strategies that enhance telehealth implementation-selected through a health equity lens-may improve quality of care among patients with SMI.

The "Fact of the Matter": A Model for Working with Activated Internal Object Relations in Psychodynamic Couple Therapy.

Extensive clinical scholarship has described the application of object-relational principles, particularly the operation of projective identification, to psychodynamic psychotherapy with couples. The author explores the way in which a more complete depiction of projective processes, one that incorporates each partner's intrapersonal management of multiple internal object relations, interacting interpersonally in the couple therapy process, can explain the escalating cycles of conflict between couples that are elaborated in the family-systems literature, and be helpful in understanding the object-relational substrate of chronic conflict in couples more generally. A description of how to map each partner's internal object world through the identification of these cycles in the early couple therapy process is elaborated in a theoretical model and illustrated with case material.

Kaës' Internal Groups and Actual Groups: A Relational Perspective.

Rene Kaës (2007), an influential French psychoanalyst relatively unknown to English-speaking readers, extends the field of psychoanalytic investigation and practice to groups. Building on Klein, Anzeiu, Bion, and Lacan, Kaës presents a dual-axes theory in which early oedipal and sibling complexes structure unconscious dynamics of internal groups. According to Kaës, analytic group psychotherapy provides access to the phantasies, affects, and action tendencies contained within internal groups that would be otherwise inaccessible. While a few reference articles have appeared in the English literature, Kaës' bold assertions, core concepts, and praxis have not been subject to critical evaluation. I introduce Kaës' main ideas, demonstrate their influence on my group work, and by comparing two case examples, from his practice and mine, articulate our differences, some of which arise from different conceptions of and approaches to intersubjectivity. The discussion continues in the final section which briefly considers the nature of psychoanalytic learning and how we may employ the therapeutic group to reach this goal.

The Role of Intolerance of Uncertainty and Religiousness in Schizotypal Personality and Life Satisfaction: A Cross-Sectional Study.

Intolerance of uncertainty is an important trans-diagnostic determinant of mental disorders. It is related to psychotic symptoms and religiousness. Religiousness is related to schizotypal personality and wellbeing. Therefore, in a cross-sectional study, we studied the effects of intolerance of uncertainty and religiousness on schizotypal personality and the schizotypal personality-mediated effects of intolerance of uncertainty and religiousness on life satisfaction. On a sample of 734 college students (age, M = 20.3, SD = 3.48), intolerance of uncertainty, religiousness, life satisfaction, and schizotypal personality were measured through paper-pencil questionnaires. The results showed that intolerance of uncertainty had positive (direct) relationships with all schizotypal personality dimensions. However, intolerance of uncertainty had positive (mediated by ideas of reference and magical thinking) and negative (mediated by eccentric behavior) indirect effects on life satisfaction. Religiousness had direct as well as indirect (mediated by eccentric behavior) positive effects on life satisfaction. However, the behaving (mediated by ideas of reference) and belonging (mediated by magical thinking) sub-dimensions of religiousness had some indirect negative effects on life satisfaction. Thus, the present study shows that intolerance of uncertainty is an important contributor to psychotic proneness. Religiousness is largely health-enhancing. Moreover, there is a nuanced pattern of interactional relationship between intolerance of uncertainty, religiousness, schizotypal personality, and life satisfaction. We have discussed the theoretical and applied implications of the findings.

A cohort study of engagement in telehealth psychotherapy versus in-person services.

OBJECTIVE: Although telehealth psychotherapies have been studied for over 20 years, mental health services remained largely delivered in person until the COVID-19 pandemic forced clinics to reconsider the utility of telehealth psychotherapy. This study aims to compare patient engagement in in-person versus telehealth services in outpatient psychotherapy for mood and anxiety disorders. METHOD: A cohort investigation was conducted, using a propensity score matched sample, extracted from an electronic health record (EHR) to compare engagement in psychotherapy for 762 patients who used in-person services before the pandemic to a cohort of 762 patients who used telehealth psychotherapy after the onset of COVID-19. The authors compared cohorts on initial engagement in psychotherapy services following an initial intake, number of psychotherapy sessions attended, and the rate of missed sessions. RESULTS: There was a 26% increase in the total number of individual psychotherapy sessions attended when the clinics transitioned to telehealth services (p < .001). In addition, patients who received telehealth psychotherapy were five times more likely to not cancel or miss any scheduled sessions (p < .001). CONCLUSION: These results indicate that telehealth services may result in improved treatment engagement for outpatient centers focused on brief evidence-based psychotherapies for mood and anxiety disorders.

Effect of Psychotherapy on Intolerance of Uncertainty: A Systematic Review and Meta-Analysis.

Intolerance of uncertainty (IU) is the tendency to react negatively on affective, cognitive and behavioural levels to uncertain situations and to harbour negative beliefs about the implications of uncertainty. IU has been linked to psychopathology and shown to impact treatment outcomes. This study systematically reviewed the literature and performed a meta-analysis of the effects of psychotherapy on IU. A total of 22 studies (1491 participants) were identified in online searches and included in the meta-analyses. Analyses were performed on studies with passive and active control conditions. The pooled effect on IU from studies with passive control was large (g = -0.94 [95% CI -1.25 to -0.62]) but with significant heterogeneity. Pooled effects on IU from studies with active controls were not significant. Moderator analysis showed that among studies with a passive control condition, studies that recruited participants from clinical care facilities produced smaller effect sizes. Among studies with an active control condition, study quality significantly moderated the results, with higher quality leading to a larger effect size. These results indicate that changes in IU may be difficult to reliably achieve in psychotherapy and leave many questions about the effect of psychotherapy on IU unanswered, such as what active components produced the observed changes in studies with passive control.

Assessing the effectiveness of internet-based interventions for mental health outcomes: an umbrella review.

Internet-based interventions (IBIs) for behavioural health have been prevalent for over two decades, and a growing proportion of individuals with mental health concerns prefer these emerging digital alternatives. However, the effectiveness and acceptability of IBIs for various mental health disorders continue to be subject to scholarly debate. We performed an umbrella review of meta-analyses (MAs), conducting literature searches in PubMed, Web of Science, Embase, Cochrane and Ovid Medline from their inception to 17 January 2023. A total of 87 MAs, reporting on 1683 randomised controlled trials and 295 589 patients, were included. The results indicated that IBIs had a moderate effect on anxiety disorder (standardised mean difference (SMD)=0.53, 95% CI 0.44 to 0.62) and post-traumatic stress disorder (PTSD) (SMD=0.63, 95% CI 0.38 to 0.89). In contrast, the efficacy on depression (SMD=0.45, 95% CI 0.39 to 0.52), addiction (SMD=0.23, 95% CI 0.16 to 0.31), suicidal ideation (SMD=0.23, 95% CI 0.16 to 0.30), stress (SMD=0.41, 95% CI 0.33 to 0.48) and obsessive-compulsive disorder (SMD=0.47, 95% CI 0.22 to 0.73) was relatively small. However, no significant effects were observed for personality disorders (SMD=0.07, 95% CI -0.13 to 0.26). Our findings suggest a significant association between IBIs and improved mental health outcomes, with particular effectiveness noted in treating anxiety disorders and PTSD. However, it is noteworthy that the effectiveness of IBIs was impacted by high dropout rates during treatment. Furthermore, our results indicated that guided IBIs proved to be more effective than unguided ones, playing a positive role in reducing dropout rates and enhancing patient adherence rates. PROSPERO registration number: CRD42023417366.

The significance of connectedness: avoidant personality disorder patients' subjective experiences of change after attending a specialized treatment program.

Objectives: This study aimed to inquire into the subjective experiences and meaning-making of change of people diagnosed with avoidant personality disorder (AvPD) after attending a treatment program developed for AvPD. Methods: Eighteen AvPD patients were interviewed 1 year after completing their treatment using a semi-structured interview guide. The interviews were analyzed through reflexive thematic analysis. Results: Three main themes were found to capture the various subjective experiences of change. The first main theme "being more alive" included the subthemes "talking and listening together" and "opening up and grounding into myself." The second main theme was "still longing for more," and the third main theme "I cannot even manage therapy" included the subthemes "as if we were together" and "capitulation." Conclusion: Although these findings may not be specific to AvPD, they shed light on the importance of attending to the dynamic interplay of intersubjectivity, social motivations, and agency in a therapeutic context. Discovering a sense of agency within an interpersonal context in which the patient feels connected may lead to them opening up for development in accordance with their social motivational intentions.

Access to Psychotherapy Notes: Review of Legal Standards for Mental Health Clinicians.

Patients' access to their psychotherapy records may be assumed to be well protected; however, the matter is intricately regulated. In fact, the statutes and rights pertaining to patient access to psychotherapy notes vary across states. Taken together, federal and state laws indirectly and inconsistently delineate lawful access-as well as clinical exceptions to providing access-to psychotherapy notes. Federal law defers to state laws when the latter afford individuals greater access to their notes. Both federal and individual state levels vary in providing for possible conditions under which access may be restricted. Right of access to psychotherapy notes is a matter of importance for all mental health clinicians in the United States. Awareness and integration of pertinent laws and regulations allow clinicians to manage such matters without a negative impact on their clinical care. Further consideration of how clinical practice interacts with other dimensions of health care administration (clinical, ethical, and legal) may serve to enhance the integrity of a clinician's work and the ability to adapt to difficult clinical circumstances with confidence.

Recognition of psychological comorbidity and psychotherapeutic treatment status of ventricular assist device patients.

BACKGROUND: Due to its high impact on quality of life and mental health, close monitoring and often psychotherapy is recommended for patients with a ventricular assist device (VAD). This study investigates the psychological comorbidity and the corresponding psychotherapeutic treatment situation of VAD patients. Special attention is also given to the professional perspective VAD team (assistant and senior cardiologists and specialized nurses). METHODS: We conducted a cross-sectional observational study. Data from 50 VAD patients (mean age = 53.52, standard deviation = 13.82 years, 84.0% male) and their VAD team were analyzed. The presence of a psychological disorder was evaluated by structured clinical interviews for DSM-IV (SCID-I-Interviews). Patients answered a questionnaire regarding their current psychotherapeutic treatment status and their attitude towards psychotherapy. The VAD team answered a questionnaire about the patients' needs for psychotherapy and indicated whether they addressed this topic with the patient. Data were analyzed descriptively, by analysis of variance and t-test. RESULTS: A total of 58% of VAD patients suffered from at least one significant psychological disorder, 79.3% of those were not in psychotherapy. The VAD team could not identify the patients who suffered from a psychological disorder (F = 1.90; p = 0.18). They perceived more need for psychotherapy than they addressed with their patients (T = 3.39; p < 0.001). CONCLUSIONS: While there is a high psychological morbidity among VAD patients, only few receive psychotherapy. Psychological comorbidity is not easily detected by the VAD team. Standardized psychosocial care could be implemented by regular psychological assessments and further information of patients and their VAD teams.

Inpatients with a history of suicide attempts in routine clinical care exhibit specific characteristics regarding sociodemographics, life events, personality, and symptom burden.

Research indicates that patients with a lifetime history of suicide attempts are particularly burdened. However, investigations of their characteristics and comparisons with other patients are scarce. This study aimed to fill this research gap, using routine clinical data and guided by theoretical models. Data of N = 706 patients (54.4% women) was collected at the psychosomatic inpatient/day-clinic unit of a German university clinic. It comprised sociodemographic data and information about previous experiences (e.g., childhood abuse and neglect), symptom measures (e.g., the PHQ-9) and individual differences (e.g., the level of personality functioning assessed with the OPD-SQS). Groups were compared using independent t-tests or χ2-tests. Of the total sample, 118 patients (16.7%) reported suicide attempts. Those with a history of suicide attempts were more likely to have a migration background and a lower level of education, smoke (heavily) and use illegal substances. They reported lower levels of personality functioning, more current symptoms and traumatic previous experiences of abuse and neglect. Screening for previous suicidal behavior as well as associated factors can yield valuable information for clinical practice. Many group differences map onto previously observed specific risk factors for suicidal behavior, supporting the conceptual models and underscoring their relevance among clinical populations as well.

Emergence of Artificial Intelligence Art Therapies (AIATs) in Mental Health Care: A Systematic Review.

The application of artificial intelligence art therapies (AIATs) in mental health care represents an innovative merger between digital technology and the therapeutic potential of creative arts. This systematic review aimed to assess the effectiveness and ethical considerations of AIATs, incorporating robots, AI painting and AI Chatbots to augment traditional art therapies. Aligning with the Preferred Reporting Items for systematic reviews (PRISMA) guidelines, we meticulously searched PubMed, Cochrane Library, Web of Science and CNKI, resulting in 15 selected articles for detailed analysis. To ensure methodological quality, we applied the Joanna Briggs Institute (JBI) criteria for quality assessment and extracted data using the PICO(S) format, specifically targeting randomised controlled trials (RCTs). Our findings suggest that AIATs can profoundly enhance the therapeutic experience by providing new creative outlets and reinforcing existing methods, despite possible drawbacks and ethical challenges. This examination underscores AIATs' potential to enrich mental health therapies, emphasising the critical importance of ethical considerations and the responsible application of AI as the field evolves. With a focus on expanding treatment efficacy and patient expressiveness, the promise of AIATs in mental health care necessitates a careful balance between innovation and ethical responsibility. Trial Registration: PROSPERO: CRD42024504472.

A second chance for first impressions: evidence for altered impression updating in borderline personality disorder.

BACKGROUND: Individuals with borderline personality disorder (BPD) frequently alter between idealizing and devaluing other persons, which has been linked to an increased tendency to update self-relevant beliefs and impressions. We hypothesized that increased impression updating could stem from reduced attitude contextualization, i.e., a process in which impression-disconfirming information is linked to contextual cues. METHODS: Individuals diagnosed with BPD and controls (recruited online, with unknown diagnostic status) completed an impression formation paradigm. They first learned about the positive or negative behaviors of others in one Context A (e.g., Person 1 is helpful), followed by learning about behaviors of the opposite valence in a second Context B (Person 1 is rude). We also manipulated between participants whether the observed behaviors were directed toward the study participants (self-relevant) or, more generally, at other people (other-relevant). The contexts were marked by differently-colored backgrounds (e.g., yellow vs. blue), to avoid influences of prior knowledge or experiences. After exposure to information in both contexts, participants rated their impressions of the persons in Context A, Context B, and, crucially, a previously unknown Context C (white background). We examined whether the initial or an updated impression (re-)emerged in Context C. RESULTS: Initial impressions remained stable and dominated the ratings of controls across contexts A, B, and C for both self-relevant and other-relevant behaviors, consistent with contextualizing impression-disconfirming information. As expected, however, individuals with BPD only showed updated impression ratings in Context C for self-relevant behaviors, consistent with the assumed reduced tendency to contextualize impression-disconfirming self-relevant information. Further exploratory analyses suggest that more severe BPD symptoms predicted more pronounced impression updating in the self-relevant condition. CONCLUSIONS: The findings help to illuminate the mechanisms underlying interpersonal problems in individuals with BPD. People with BPD are not just more inclined to discard positive first impressions but to re-evaluate disliked others when they behave positively, contributing to the volatility of interactions with others. Contextualization has known and modifiable antecedents, and the study may thus provide potential targets for therapeutic intervention. Future studies will need to replicate the findings with specified controls.

Secretan's Syndrome: It Is Time to Talk About It.

Secretan's syndrome is a rare condition; the exact etiology remains unclear. It has no specific treatment and the care must be multidisciplinary and personalized. We report a case of a young female patient who presented with a unilateral and painful swelling of the dorsum of the right hand. The diagnosis and treatment of this patient were challenging.

Acupressure in Psychotherapy as an Unsinkable Rubber Duck: A reply to.

In a recent publication entitled "Integrating the Manual Stimulation of Acupuncture Points Into Psychotherapy: A Systematic Review with Clinical Recommendations," appearing in this journal, Feinstein (2023) aims to aggregate the evidence on Emotional Freedom Techniques (EFT) across the "hierarchy of evidence." EFT is based on the premise that tapping facilitates alterations in "energy meridians" and that these alterations reduce psychological symptoms or disorders. This commentary addresses several concerns with the Feinstein (2023) review including the pseudoscientific concept of energy meridians, the lack of evidence that tapping on acupressure points is the active ingredient that resolves psychological disorders, serious methodological flaws with EFT research, and the incompatibility of EFT with the ethical practice of psychology. Thus, we disagree with Feinstein's (2023) conclusion that "The body of research on acupoint tapping that has emerged over the past two decades and the increasing quality of the study designs appears promising" (p. 61) and instead argue that EFT represents a pseudoscientific, "unsinkable rubber duck" (i.e., a belief that people continue to hold despite evidence to the contrary).

Originalbeiträge (Originals). Network meta-analysis: science or alchemy? ­What works best in generalized anxiety disorder?

Recently Papola et al. (2023) published a network meta-analysis (NMA) on psychotherapy of generalized anxiety disorder (GAD) and concluded that cognitive-behavioral therapy (CBT) should be considered the first-line treatment for GAD. However, there are several concerns with regard to the procedures and the conclusions of this NMA and of NMA in general. We show that these concerns question the conclusions by Papola et al. Furthermore, we place concerns about thisNMAin a broader context and question whether existing evidence is consistent with the notion that one form of psychotherapy can be regarded as the gold standard for mental disorders and for all patients and therapists.