Dietary sn-2 palmitate influences cognitive behavior by increasing the transport of liver-produced lysophosphatidylcholine VLCPUFAs to the brain.

Investigations indicated that sn-2 palmitate have positive effects on brain development, although its mechanism remains largely unexamined. This research delved into how a diet abundant in sn-2 palmitate influenced the cognitive behavior of mice and elucidated the associated mechanisms using metabolomics and lipidomics. The study demonstrated that dietary sn-2 palmitate led to improved working memory and cognition in mice, as well as an increase in brain BDNF concentration when compared to those fed blend vegetable oil (BVO). This was because sn-2 palmitate feeding promoted the synthesis of very long-chain fatty acids (VLCPUFAs) for the lysophosphatidylcholine (LPC) and lysophosphatidylethanolamine (LPE) in the liver. This led to more efficient delivery of VLCPUFAs to the brain, as indicated by elevated concentration of LPC/LPE-VLCPUFAs in the liver and heightened expression of the major facilitator superfamily domain containing 2a (MFSD2A). In essence, this paper offered a potential mechanism by which sn-2 palmitate enhanced mouse neurodevelopment.

The allocation of patients with personality disorders to a suitable treatment approach: The development of a checklist based on patients' life stories.

Treatment assignment for patients with personality disorders (PDs) involves a complex process consisting of diagnostic assessment and deciding on the most appropriate psychotherapeutic treatment. This article describes the development of a checklist for systematic analysis of life stories to support reflective and transparent assignment of patients to either dialectical behavioral therapy (DBT) or schema-focused therapy (SFT). In a first study, an email survey, focus group, and member check were conducted among eight clinical experts to identify relevant dimensions in life stories in patients with PDs. In a second study, a checklist based on these dimensions was developed in three rounds of testing with nine clinical experts and nine psychology students. Checklist results were compared to actual assigned treatment for 20 patients. Systematic evaluation of life stories, is promising in supporting the allocation of patients with PDs to a suitable treatment approach by focusing on specific and consensual dimensions in patients' life stories.

A systematic review and meta-analysis of PTSD symptoms at mid-treatment during trauma-focused treatment for PTSD.

There is concern that trauma memory processing in psychological therapies leads to PTSD symptom exacerbation. We compared PTSD symptoms at mid-treatment in trauma-focused psychological therapy to control groups. We systematically searched multiple databases and searched grey literature. We included randomised controlled trials involving adults comparing trauma-focused psychological interventions with active non-trauma-focused interventions or waitlist conditions. Twenty-three studies met our inclusion criteria. We found no evidence of PTSD symptom exacerbation at mid-treatment in trauma-focused interventions compared to control groups (g=-.16, [95 % confidence interval, CI, -.34,.03]). Sensitivity analyses with high quality studies (risk of bias assessment ≥ 7; g=-.25; [95 % CI -.48, -.03], k = 12) and studies with passive controls (g=-.32; [95 % CI -.59, -.05], k = 8) yielded small effect sizes favouring trauma-focused interventions. At post-treatment, trauma-focused interventions yielded a medium effect on PTSD symptoms compared to all controls (g=-.57; [CI -.79, -.35], k = 23). Regarding depression, trauma-focused interventions yielded a small effect size compared to controls at mid-treatment (g=-.23; [95 % CI -.39, -.08], k = 12) and post-treatment (g=-.45; [CI -.66, -.25], k = 12). This meta-analysis found no evidence that trauma-focused psychotherapies elicit symptom exacerbation at mid-treatment in terms of PTSD or depression symptoms. Instead, this meta-analysis suggests that the benefits of trauma-focused interventions can be experienced through improved depression and possibly PTSD before the conclusion of therapy. However, it is possible that symptom exacerbation occurred before mid-treatment and/or that people who experience symptom exacerbation drop out of studies and so are not included in the analysis.

From theory to practice: Revealing the real-world impact of cognitive behavioral therapy in psychological disorders through a dynamic bibliometric and survey study.

Background: Cognitive behavior therapy (CBT) is a proven treatment for many psychological disorders. It has been extensively studied and is effective for anxiety, depression, and schizophrenia. However, a bibliometric analysis of the CBT literature for these disorders is needed. This study reviewed this field's research and identifies key trends, influential studies, and gaps. Methods: Using MeSH-generated keywords and PRISMA guidelines, the Scopus database retrieved bibliographic data without temporal or geographical constraints. Data-driven studies were analyzed for performance, collaborative pattern, impact, co-word frequency, knowledge structure, and trending topics using R-package-based Bibliometrix and VOSviewer applications. The current study applied bibliometric and statistical analyses. Results: Scopus yielded 2757 studies since inception in 1979. The polynomial regression coefficient of 0.945 (R2) indicates a strong positive trend, and the research has increased at an annual rate of 12.67 %. Scholars from five countries had a noteworthy production of CBT research in treating PsD, namely the United States, the United Kingdom, Germany, Australia, and the Netherlands. Depression, oppositional defiant disorder, schizophrenia, and implementation are the clusters in the CBT research map. The thematic map needed to meet the desired criteria for representing all anticipated themes. Thematic evolution is evidence of noticeable changes that contributed to the creation of new research clusters and the disappearance of some of them. COVID-19 has significantly impacted the adoption and efficacy of internet-based interventions for mental health. The cross-sectional study provides valuable insights into the development and dissemination of CBT in Saudi Arabia, emphasizing the importance of training, awareness, and research. Conclusions: This study proposes that further investigation be conducted in contemporary literature to create a comprehensive framework for enhancing policy decisions regarding CBT.

Physiological Effects of Psychological Interventions Among Persons with Financial Stress: A Systematic Review, Meta-analysis, and Introduction to Psychophysiological Economics.

It is known that economic problems can cause psychological stress, and that psychological stress causes physiological changes often linked to disease. Here we report a systematic review and meta-analysis of studies on physiological effects of psychological treatment for individuals with economic problems. Of 5071 papers in our initial PsycInfo search, we identified 16 papers on physiological effects for psychological treatment of the economically stressed. We found 11 controlled studies, among which we found a small to moderate significant effect size, Hedges' g = 0.319, p < 0.001. The largest effect sizes were found for heart rate variability and measures of inflammation, and the smallest for measures involving cortisol. The studies were all on chronically poor populations, thus restricting generalization to other financially stressed populations such as students, athletes in training, and those stressed by relative deprivation compared with neighbors or other reference groups. None of the studies examined effects of these psychophysiological changes on disease susceptibility, and none included elements of financial planning. The nascent field of financial psychophysiology calls for more research in these areas. Even so, results suggest that financially stressed people can benefit physiologically from psychological stress management methods.

Underlying mechanisms of change in the effects of cognitive behavior therapy on posttraumatic stress disorders among Chinese children: Results from a randomized controlled trial.

BACKGROUND: Evidence for the effectiveness of group-based trauma-focused cognitive behavior therapy (TF-CBT) has existed, but little is known about how group-based TF-CBT works in the treatment of children with PTSD. The purpose of the present study is to explore the mediators for the reduction of PTSD severity in group-based TF-CBT. METHOD: We analyzed data from a randomized controlled trial conducted in China. In this trial, 234 children with PTSD were randomly assigned to the TF-CBT group or the treatment as usual (TAU) group. The primary outcome (reduction in severity of PTSD symptoms) and possible mediators (trauma memory quality, emotion regulation strategies, and resilience) were assessed at baseline and posttreatment. The mediation analysis was performed to investigate the indirect effects of possible mediators on treatment outcomes. RESULTS: The mediation model revealed that changes in trauma memory quality, maladaptive emotion regulation strategies, and resilience mediated the relationship between the group (TF-CBT vs. TAU) and PTSD at post-treatment. Adaptive emotion regulation strategies were not a key mechanism underlying PTSD reduction in group-based TF-CBT. CONCLUSION: Group-based TF-CBT might affect PTSD by reducing risk factors, like trauma memory quality and maladaptive emotion strategies. Group-based TF-CBT also might affect PTSD by increasing protective factors, like resilience. Thus, monitoring these mediators throughout treatment might be an important factor in optimizing treatment outcomes.

Effect of Group Cognitive Behavioral Therapy on Patients with Early-Onset Schizophrenia.

Objective: To study the clinical effect of group cognitive behavioral therapy to one-on-one treatment on patients with early-onset schizophrenia. Methods: Totally,133 patients with early-onset schizophrenia admitted to the Department of Psychiatry of our hospital from September 2020 to September 2023 were selected and divided into a control group and an observation group according to whether group behavioral cognitive therapy was performed. The general demographic data of the patients were collected, and the propensity score matching method was used to balance the baseline data of the 2 groups. The Positive and negative syndrome scale, Personal and Social Performance Scale, severity of illness (SI), and efficacy index (EI) were compared between the 2 groups after matching. Results: After matching, 72 patients were included in our study. Compared to the control group, observation group PANSS score were decreased including after intervention (P > .05). Both groups showed a decrease between before and after treatments. Positive and Negative Syndrome Scale reduction rate after treatment and total response rate were increased in the observation group (P <.001). Personal and Social Performance Scale of the Clinical Global Impression (CGI) scores were higher than those of the control group. In the CGI scores, there is a significant difference that SI scores were lower in the observation group (P = .002), while EI scores were higher (P <.001). Conclusion: Group cognitive behavioral therapy is beneficial to the improvement of mental symptoms and disease severity, social function, and curative effect, which is advocated and popularized.

MicroRNA-455-3P as a peripheral biomarker and therapeutic target for mild cognitive impairment and Alzheimer's disease.

MicroRNAs are small non-coding RNAs evolutionary conserved molecules. They regulate cellular processes, including RNA silencing, post-translational gene expression and neurodegeneration. MicroRNAs are involved with human diseases such as cancer, Alzheimer's disease (AD) and others. Interestingly, cerebrospinal fluids (CSF) and the blood of AD patients have altered expressions of many RNAs, which may serve as potential peripheral biomarkers. The intensive investigation from our lab revealed that microRNA-455-3 P (miR-455-3p) is a strong candidate as a potential biomarker and therapeutic target for AD. Several genes implicated in the pathogenesis of AD are directly targeted by miR-455-3p. Several years of our lab research revealed that miR-455-3p regulates important physiological processes associated with AD, such as the processing of the amyloid precursor protein (APP), TGF-ß signaling, the regulation of oxidative stress, mitochondrial biogenesis, and synaptic damages. The expression of miR-455-3p in mild cognitive impaired subjects and AD patients pointed out its involvement in AD progression. Recently, our lab generated both transgenic and knockout mice for miR-455-3p. Interestingly miR-455-3p transgenic mice showed superior cognitive learning, improved memory and extended lifespan compared to age matched wild-type mice, whereas miR-455-3-p knockout mice showed cognitive decline and reduced lifespan. Information derived from mouse models further demonstrated the advantageous impact of miR-455-3p on dendritic growth, synaptogenesis, and mitochondrial biogenesis in preventing the onset and progression of AD. The identification of miR-455-3p as a biomarker was suggested by its presence in postmortem AD brains, B-lymphocytes, and fibroblasts. Our hypothesis that miR-455-3p could be a peripheral biomarker and therapeutic target for AD.

Unraveling the optimal balance of problem-related affective experiences and need satisfaction in cognitive-behavioral therapy: A response surface analysis.

Objective: Although therapists are encouraged to balance emotionally involving work on the patient's problems with need satisfaction in therapy sessions, effects of this balance have rarely been studied empirically. Hence, we examined congruence effects between problem-related affective and need-satisfying experiences in cognitive-behavioral therapy (CBT). Method: 165 distressed family caregivers rated problem-related affective experiences, need-satisfying experiences comprising self-esteem, positive interpersonal, and control experiences, as well as coping experiences after 12 CBT sessions. We examined within-person congruence effects of problem-related affective and need-satisfying experiences on subsequent coping in multilevel response surface analysis. Further, we included between-person problem-related affective and need-satisfying experiences and pretreatment depression and anxiety as moderators of within-person effects. Results: A slight predominance of self-esteem over problem-related affective experiences as well as exact correspondence between problem-related affective and both interpersonal and control experiences was most predictive of coping. Between-person moderators supported a cross-level balance heuristic of problem-related affective and self-esteem experiences. Finally, a stronger emphasis on self-esteem and interpersonal over problem-related affective experiences proved more beneficial for patients with high anxiety and low depression. Conclusions: The findings highlight the importance of balancing problem-related affective and need-satisfying experiences in CBT and provide insights into how balancing may be tailored to specific patients.

Effects of comprehensive nursing with cognitive behavioral therapy in orthodontic osteodilated arch treatment.

BACKGROUND: This work explored the effects of cognitive behavior therapy (CBT)-based comprehensive nursing intervention (CNI) mode in arch expansion to treat patients with orthodontic osteodilated arch (OOA). AIM: To explore the application effect of CBT-based CNI model in orthodontic expansion arch treatment. METHODS: Using convenient sampling method, 81 patients with OOA were selected and rolled into a control group (Ctrl group, 40 cases) and an observation group (Obs group, 41 cases). During the treatment, patients in the Ctrl group received routine nursing intervention mode, and the those in the Obs group received CBT mode on the basis of this. Before and after intervention, the incidence of oral mucositis, the mastery rate of correct arch expansion method, self-rating anxiety scale score, soft scale index, and plaque index were compared for patients in different groups. In addition, satisfaction and complications were comparatively analyzed. RESULTS: Incidence of oral mucositis in the Obs group was lower (14.6% vs 38.5%), and the mastery rate of correct arch expansion method was obviously higher (90.2% vs 55.0%) was obviously higher (all P < 0.05). Meanwhile, the soft scale index and plaque index in the Obs group were much lower (P < 0.05). The compliance (90.24%) and satisfaction (95.12%) in the Obs group were greatly higher (P < 0.05). CONCLUSION: The CBT-based CNI mode greatly improved the mastery rate of correct arch expansion method during arch expansion in treating patients with OOA and enhanced the therapeutic effect of arch expansion and the oral health of patients, improving the patient compliance.

The importance of cultural understanding and practical solutions during the handover of a psychotherapy and psychotraumatology program in Northern Iraq into local hands.

In post war regions, especially in low-income countries, the health care systems often require immediate support. For example, after the terror of the so-called Islamic State of Iraq and Syria (ISIS) in 2014, many internally displaced persons took refuge in the Kurdistan Region of Iraq (KRI). Those displaced by war have had to face the reality that psychotherapy did not exist as a service in the Kurdish health system. Many projects and Non-Government-Organizations (NGOs) that work in post-conflict regions focus on short term and quick response and/or basic psychological services. The implementation of the "Institute for Psychotherapy and Psychotraumatology" (IPP) at the University of Dohuk, follows a long-term approach. The 3-year-program teaches students to become professional psychotherapists, with respect to evidence-based and culturally adapted methods of psychotherapy. To achieve sustainability, the project is working towards handing over the teaching and organizational responsibilities into local hands. This article highlights the chances and challenges during this transition, as well as the importance of cultural understanding and realistic, practical solutions. An honest reflection on existing cultural challenges, e.g. inflexible hierarchical structures or an "old-fashioned" religious view of homosexuality, can then lead to practical solutions. These include winning over local authorities by including them in the process, culturally adapting to customs with the help of educated locals, demonstrating non-authoritarian forms of leadership, and explicitly promoting newly graduated young lecturers into positions of authority.

The effect of aromatherapy on post-stroke depression: study protocol for a pilot randomized controlled trial.

Background: Post-stroke depression (PSD) is a prevalent psychiatric disorder affecting about one-third of stroke survivors, significantly hindering recovery and quality of life. PSD also imposes a substantial burden on caregivers and healthcare systems. Aromatherapy has shown promise in alleviating depression, anxiety, and sleep disorders. This pilot randomized controlled trial aims to assess the feasibility and preliminary efficacy of mixed herb aromatherapy in treating PSD. Feasibility outcomes encompass recruitment, intervention adherence, assessment completion and safety assessment. Secondary outcomes include evaluations of depression, anxiety, cognitive function, sleep quality, quality of life, and brain function using EEG and fNIRS. Methods: This single-blind pilot randomized controlled trial will be conducted at the Second Rehabilitation Hospital of Shanghai, enrolling ninety-nine post-stroke patients with PSD. Participants will be randomized into three groups: a Non-Active Control Group receiving standardized rehabilitation therapy, a CBT Group receiving conventional rehabilitation with bi-weekly CBT sessions, and an Aromatherapy Group receiving conventional rehabilitation with daily aromatic inhalation sessions. Interventions will last for four weeks, with efficacy assessed at baseline, post-intervention, and one month post-intervention. Rating scales will be used to measure changes in depression, sleep quality, cognitive function, and quality of life. EEG and fNIRS will specifically be used to measure changes in cerebral cortex activity and their correlations with depression. Feasibility will be evaluated through recruitment, intervention adherence, assessment completion and safety assessment. Discussion: This pilot study highlights the potential of mixed herb aromatherapy inhalation for treating PSD, addressing limitations of CBT by promoting self-management. While demonstrating feasibility through recruitment, adherence, assessment completion and safety assessment, the study also acknowledges limitations such as unequal intervention times, the lack of physical function data. And the use of culturally relevant plant powders may enhance compliance but limits generalizability. Despite these constraints, the study provides valuable preliminary data and insights into the mechanisms of aromatherapy, encouraging further research and development of effective PSD treatments.

[Relapse prevention of bipolar disorders: an explorative cluster analytical approach in a randomized controlled psychotherapy study]. / Rückfallprävention bipolarer Störungen: ein explorativer, clusteranalytischer Ansatz bei einer randomisierten, kontrollierten Psychotherapiestudie.

The aim of this study was to differentiate between types of bipolar disorders and the associated features using explorative analysis. The focus was particularly on the role of bipolar 1 and bipolar 2 disorders as well as the influence of prophylactic interventions for relapse in a randomized, controlled treatment study. A total of 274 of the 305 originally included persons could be investigated in the study. Patients participated in either cognitive behavioral group therapy (SEKT) or supportive, patient-centered group therapy (FEST). Treatment took place over 4 days separated by a 1-month interval (equivalent to 16 double hours). Depressive and manic symptoms were assessed using the longitudinal interval follow-up evaluation (LIFE). The symptoms were retrospectively assessed for the previous 6 months, with respect to each week before and after the intervention phase and for 6­month and 12-month follow-ups. The results show that the effects of both group therapies were comparable; however, there were statistically significant differences in a multivariate proportional hazards model for the factors bipolar 1 and 2 as well as the interaction of therapy with bipolar 1 and 2. In particular, bipolar 2 patients benefited significantly less from the SEKT intervention than from the FEST intervention. There were three clusters identified that separated bipolar 1 (SEKT, no comorbidity, predominantly no recurrences, younger patients), from bipolar 2 (FEST, no comorbidity, at least 1 often 2 recurrences, older patients) and from a heterogeneous group (SEKT and FEST, comorbidity). The distinction between bipolar 1 and bipolar 2 disorder is important and has so far not received sufficient attention. Bipolar 2 disorders generally have a worse course and respond particularly poorly to cognitive behavioral therapy (SEKT). An open, unstructured, supportive, patient-centered psychotherapy (FEST) is generally effective.

Suppressing UBE2N ameliorates Alzheimer's disease pathology through the clearance of amyloid beta.

INTRODUCTION: Aging is one of the risk factors for the early onset of Alzheimer's disease (AD). We previously discovered that the age-dependent increase in Ubiquitin Conjugating Enzyme E2 N (UBE2N) plays a role in the accumulation of misfolded proteins through K63 ubiquitination, which has been linked to AD pathogenesis. However, the impact of UBE2N on amyloid pathology and clearance has remained unknown. RESULTS: We observed the elevated UBE2N during the amyloid beta (Aß) generation in the brains of 5×FAD, APP/PS1 mice, and patients with AD, in comparison to healthy individuals. UBE2N overexpression exacerbated amyloid deposition in 5×FAD mice and senescent monkeys, whereas knocking down UBE2N via CRISPR/Cas9 reduced Aß generation and cognitive deficiency. Moreover, pharmacological inhibition of UBE2N ameliorated Aß pathology and subsequent transcript defects in 5×FAD mice. DISCUSSION: We have discovered that age-dependent expression of UBE2N is a critical regulator of AD pathology. Our findings suggest that UBE2N could serve as a potential pharmacological target for the advancement of AD therapeutics. HIGHLIGHTS: Ubiquitin Conjugating Enzyme E2 N (UBE2N) level was elevated during amyloid beta (Aß) deposition in AD mouse and patients' brains. UBE2N exacerbated Aß generation in the AD mouse and senescent monkey. Drug inhibition of UBE2N ameliorated Aß pathology and cognitive deficiency.

The Impact of Exercise Cognition on Exercise Behaviors: The Mediating Role of the Satisfaction of Basic Psychological Needs in Exercise for Adolescents.

In recent years, the exercise behavior of Chinese adolescents has been on the decline, which is extremely detrimental to their physical and mental health development. However, few studies have explored the mechanisms by which exercise cognition influences Chinese adolescents' exercise behavior. The present study aimed to investigate the relationship between exercise cognition and exercise behavior among Chinese adolescents and the mediating role of satisfying basic psychological needs for exercise. The study consisted of 996 adolescents (44.6% males, 55.4% females) between the ages of 12 and 15 (M = 13.34, SD = 1.059). Participants' exercise behaviors and the satisfaction of basic psychological needs for exercise data were collected via surveys. Structure equation modeling (SEM) was performed to examine the direct and indirect effects. The results were as follows: (1) adolescents' perceptions of exercise were significantly associated with exercise behavior and (2) the mediation model suggests that the satisfaction of basic psychological needs for exercise is an important mechanism by which exercise cognition influences the occurrence of exercise behavior. Therefore, it is crucial to help adolescents form good exercise cognition. Schools, families, and society should take responsibility for adolescents' formation of good exercise cognition and satisfy adolescents' basic psychological needs for exercise so as to enhance adolescents' exercise behaviors and thereby develop good exercise habits.

Improvements in emotion regulation during cognitive behavior therapy predict subsequent social anxiety reductions.

Individuals with social anxiety disorder (SAD) experience overall emotion regulation difficulties, but less is known about the long-term role of such difficulties in cognitive behavior therapy (CBT) for SAD. Forty-six patients with SAD receiving internet-delivered CBT, and matched healthy controls (HCs; n = 39), self-reported the Difficulties in Emotion Regulation Scale (DERS), Liebowitz Social Anxiety Scale (LSAS-SR), and participated in anticipatory speech anxiety behavioral experiments. Patients were measured at seven time points before, during and after CBT over a total period of 28 months, and HCs at two timepoints. Disaggregated growth curve models with a total of 263 observations were used, as well as intra-class correlation coefficients and regression models. Patients' LSAS-SR and DERS ratings were reliable (ICC = .83 and .75 respectively), and patients, relative to controls, showed larger difficulties in emotion regulation at pre-treatment (p < .001). During CBT, within-individual improvements in emotion regulation significantly predicted later LSAS-SR reductions (p = .041, pseudo-R2 = 43%). Changes in emotion regulation may thus be important to monitor on an individual level and may be used to improve outcomes in future developments of internet-delivered CBT.

For Whom and for How Long Does the "Be a Mom" Intervention Work? A Secondary Analysis of Data From a Randomized Controlled Trial Exploring the Mid-Term Efficacy and Moderators of Treatment Response.

This study explored clinical and sociodemographic moderators of treatment response to "Be a Mom", an internet-based cognitive behavioral therapy (iCBT) intervention, from baseline to postintervention, in women at high risk for postpartum depression (PPD). The study also assessed the stability of women's treatment gains from baseline to 4-months postintervention (follow-up). This open-label randomized controlled trial (RCT) involved a sample of 1,053 postpartum Portuguese women identified as being at high risk for PPD (i.e., having a score of 5.5 or higher on the Postpartum Depression Predictors Inventory-Revised); participants were allocated to "Be a Mom" intervention group or a waiting-list control group, and completed self-report measures at baseline, postintervention, and a 4-month follow-up (554 women completed follow-up assessments). Depressive and anxiety symptoms were measured using the Edinburgh Postnatal Depression Scale and the anxiety subscale of the Hospital Anxiety and Depression Scale, and flourishing/positive mental health was assessed with the Mental Health Continuum. Regression models and linear mixed models were used to examine moderators of treatment and the mid-term efficacy of the "Be a Mom" intervention, respectively. The results revealed that treatment completion, higher depression scores at baseline, and higher income levels were linked to greater symptom reduction and positive mental health enhancement. Moreover, the efficacy of the "Be a Mom" intervention was supported at the 4-month follow-up. The "Be a Mom" intervention appears to be an effective iCBT tool for reducing psychological distress and enhancing positive mental health in women at risk for PPD, with therapeutic improvements maintained over a 4-month period.

What we got wrong about depression and its treatment.

The paradigm is shifting with respect to how we think about depression and its treatment. Some of that shift can be attributed to new findings with respect to its epidemiology and genetics and the rest can be attributed to the incorporation of a new perspective derived from evolutionary theory. In brief, depression is far more prevalent than previously recognized with the bulk of additional cases involving individuals who do not go on to become recurrent. Nonpsychotic unipolar depression (but not bipolar mania which likely is a "true" disease) appears to be an adaptation that evolved to facilitate rumination in the service of resolving complex social problems in our ancestral past. Cognitive behavior therapy appears to structure that rumination so that patients at elevated risk for recurrence do not get "stuck" blaming themselves for their misfortunes, whereas antidepressant medications may suppress symptoms at the expense of prolonging the underlying episode such that patients remain at elevated risk for relapse whenever they try to discontinue. This means that patients not otherwise at risk for recurrence may be put on medications that they do not need and kept on them indefinitely whether they need to be or not.

Internet-Delivered Psychological Pain Management: A Prospective Cohort Study Examining Routine Care Delivery by a Specialist Regional Multidisciplinary Pain Service.

Several clinical trials have demonstrated the effectiveness of internet-delivered psychological-based pain management programs (PMPs). However, to date, no large studies have reported the outcomes of PMPs when delivered by specialist multidisciplinary pain services in routine care. The present study reports (n = 653) the outcomes of an internet-delivered PMP provided as routine care by a specialist Australian regional pain service over a 6-year period. High levels of treatment commencement (85%) and completion (72%) were observed, with more than 80% of patients reporting they were satisfied with the intervention. Clinical improvements were observed from pretreatment to post-treatment (% change, 95% confidence intervals (CI)) in pain-related disability (8.8%; 4.5, 12.8), depression (28.4%; 23.0, 33.4), anxiety (21.9%; 14.6, 28.5), and pain intensity (7%; 3.5, 10.5), which were maintained to 3-month follow-up. At 3-month follow-up, 27% (23, 31), 46% (41, 51), 44% (39, 49), and 22% (19, 26) reported clinically meaningful (defined as ≥ 30%) improvements in pain-related disability, depression, anxiety, and pain intensity, respectively. These results were obtained with relatively little therapist time per patient (M = 30.0, (standard deviation) SD = 18.8) to deliver the intervention. The current findings highlight the potential of internet-delivered PMPs as part of the services provided by specialist pain services, particularly those servicing large geographical regions and for patients unable to travel to clinics for face-to-face care. PERSPECTIVE: This study reports the outcomes of the routine delivery of an internet-delivered psychological PMP by a specialist pain service. The findings highlight the potential of this model of care when provided by specialist pain services, particularly for patients not unable to attend and not requiring intensive face-to-face care.

Efficacy of a Remote Play-Based Intervention for Children With Prader-Willi Syndrome.

The current study examines the efficacy of an 8-week pretend play intervention targeting social-cognitive abilities in children with Prader-Willi syndrome (PWS), ages 6-9. PWS is a rare disorder associated with various social, emotional, and cognitive challenges linked to pretend play impairments, and for which interventions are sparse. Nineteen children were quasi-randomized to receive the intervention or be part of a waitlist control group. Participants who received the intervention (n = 10) demonstrated significant improvements in various components of pretend play, most notably in organization of play, which may generalize to broader social-cognitive gains. These findings provide evidence of the intervention's efficacy in enhancing pretend play skills and related social-cognitive abilities during this critical period of development for children with PWS.