Revisiting the concept of bout: associations of moderate-to-vigorous physical activity sessions and non-sessions with mortality.

INTRODUCTION: Current physical activity guidelines recommend 150 min of moderate-to-vigorous physical activity (MVPA) for health benefits, regardless of the pattern of MVPA. However, MVPA that occurs in sessions (MVPA-S) may have different health implications compared to MVPA that is not accumulated in sessions (MVPA-nonS). This study aimed to investigate the associations of MVPA-S and MVPA-nonS with mortality. METHODS: We conducted a cohort study of the National Health and Nutrition Examination Survey 2003-2006 (n = 5,658) with accelerometer-measured physical activity at baseline and mortality followed through December 31, 2019. A session was defined as a time window of 30 min or longer where the average intensity was at or above 2020 counts/minute. MVPA accumulated within such sessions was quantified as MVPA-S, while MVPA accumulated outside the sessions was quantified as MVPA-nonS. We examined the joint association of MVPA-S and MVPA-nonS by classifying the participants into four groups (both < 75 min/week [referent], MVPA-S ≥ 75 and MVPA-nonS < 75, MVPA-S < 75 and MVPA-nonS ≥ 75, and both ≥ 75). We used 75 min as the cut-point because it is half of the guideline-recommended MVPA volume where a strong MVPA-mortality association has been observed in previous studies, and because it was close to the median of MVPA-nonS (75 min/week was the 54th percentile), allowing a sufficient sample size in each group for testing statistical significance. The hazard ratios and 95% confidence intervals were estimated with adjustment for important confounders. RESULTS: During 13.9 years of follow-up (74,988 person-years), there were 1,424 deaths, out of which 472 were related to cardiovascular diseases (CVD). Compared to the referent combination (both < 75), the hazard ratios in the other three combinations were 0.48 (0.33-0.69), 0.85 (0.71-1.01), and 0.45 (0.30-0.67) for all-cause mortality; and were 0.34 (0.17-0.70), 0.96 (0.69-1.33), and 0.40 (0.17-0.90) for CVD mortality, respectively. Results were largely consistent in the spline-based models, age- and sex-stratified analyses, complete-case analysis, competing risk analysis, and the analysis excluding deaths within two years of follow-up. CONCLUSION: In conclusion, MVPA accumulated in sessions that lasted at least 30 min was associated with significant reductions in all-cause and CVD-specific mortality risks. The health implications of MVPA that were not accumulated in such sessions warrant further investigation.

The role of readiness and confidence to change in the treatment of atypical anorexia nervosa and bulimia nervosa.

OBJECTIVE: Atypical anorexia nervosa (AN) is a serious eating disorder that is more common in the population than AN. Despite this, people with atypical AN are less likely to be referred or admitted for eating disorder treatment and there is evidence that they are less likely to complete or benefit from existing interventions. This study examined whether baseline readiness and/or confidence moderated outcomes from 10-session cognitive behavioral therapy among people with atypical AN and bulimia nervosa (BN), and whether the impact of these variables differed between diagnoses. METHODS: Participants (n = 67; 33 with atypical AN) were a subset from an outpatient treatment study. Linear mixed model analyses were conducted to examine whether baseline readiness and/or confidence moderated outcomes. RESULTS: People with BN who had higher levels of readiness or confidence at baseline had steeper decreases in eating disorder psychopathology over time. There was no evidence that readiness or confidence moderated outcomes for people with atypical AN. DISCUSSION: This study suggests that the moderators that have been identified for other eating disorders may not apply for people with atypical AN and highlights a need for future work to routinely investigate whether theoretically or empirically driven variables moderate outcomes in this little-understood population. PUBLIC SIGNIFICANCE STATEMENT: People with bulimia nervosa with higher readiness and confidence experienced greater decreases in eating disorder symptoms than people with lower readiness and confidence when treated with cognitive behavioral therapy. These findings did not apply to people with atypical anorexia nervosa. Results demonstrate that future work is urgently required to identify helpful treatments for people with atypical anorexia nervosa as well as the variables that have a positive impact on outcomes in treatment for these individuals.

Systemic adverse events and all-cause mortality following same-session bilateral intravitreal anti-VEGF injections: a systematic review.

PURPOSE: To review the risk of systemic adverse events and all-cause mortality following same-day bilateral anti-VEGF injections. METHODS: Twelve literature databases were searched for studies on same-session bilateral intravitreal anti-VEGF injections. Studies reporting on systemic adverse events and mortality were included. Data extraction was made independently by two authors and discussed afterwards until consensus was reached. RESULTS: Seven studies were included with a total of 13,406 intravitreal anti-VEGF injections (6703 bilateral injections sessions) given to 689 patients. Across all studies, mean age of patients ranged from 55.7 to 82.5 years, and mean follow-up times ranged from 1.3 to 41 months. Six studies reported on systemic adverse events: Two cases of non-fatal cardiac adverse events were reported after 12,964 injections (6482 bilateral injection sessions) in 626 patients. Four studies reported on death: 12 deaths were recorded after 6233 bilateral injection sessions in a total population of 554 subjects. CONCLUSIONS: We suggest that the risk of non-fatal systemic adverse events and death after same-session bilateral anti-VEGF injection is reasonably low, but larger studies with follow-ups of several years are needed to quantify the exact risk. STUDY REGISTRATION: Prospectively registered in PROSPERO, registration ID: CRD42023428254, registration date: 20/05/2023.

The long-term prognosis of endovascular thrombectomy in patients with acute left iliofemoral vein thrombosis combined with left iliac vein compression.

OBJECTIVE: This study investigated the long-term outcomes of different thrombus removal methods in patients with acute left iliofemoral vein thrombosis (IFDVT) accompanied by left iliac vein compression (LIVC). METHODS: This was a single-center cohort study. 240 patients with acute left-sided IFDVT complicated by LIVC were categorized based on their treatment approach into two groups: those receiving anticoagulation alone (No-PCDT group) and those undergoing anticoagulation combined with pharmacomechanical catheter-directed thrombolysis (PCDT group). The PCDT group was further divided into three subgroups: anticoagulation combined with percutaneous mechanical thrombectomy (PMT group), anticoagulation combined with catheter-directed thrombolysis (CDT group), and anticoagulation combined with both percutaneous mechanical thrombectomy and catheter-directed thrombolysis (PMT+CDT group). The incidence of post-thrombotic syndrome (PTS) was assessed using Villalta scores and Venous Clinical Severity Scores (VCSS). Patients were followed up for 24 months to compare long-term outcomes. RESULTS: The No-PCDT group consisted of 123 individuals, while the PCDT group comprised 117, with 36 in the CDT subgroup, 41 in the PMT subgroup, and 40 in the PMT+CDT subgroup. The follow-up period ranged from 3 to 24 months. The PCDT group was associated with a reduced incidence of PTS and a lower risk of high VCSS (Villalta scale ≥5 or presence of ulcer: 22% PCDT vs. 39% No-PCDT; OR, 0.446; 95% CI, 0.253-0.787; P=0.005; and VCSS≥4: 22% PCDT vs. 34% No-PCDT; OR, 0.551; 95% CI, 0.311-0.978; P=0.042). Among the three subgroups of PCDT cohort, compared to the CDT group, the PMT group showed a decreased incidence of PTS and a lower risk of high VCSS (Villalta scale ≥5 or ulcer: 12% PMT vs. 39% CDT; OR, 0.218; 95% CI, 0.069-0.690; P=0.010; and VCSS≥4: 12% PMT vs. 36% CDT; OR, 0.246; 95% CI, 0.077-0.781; P=0.017). The PMT+CDT group also demonstrated a reduced incidence of PTS (18% PMT+CDT vs. 39% CDT; OR, 0.333; 95% CI, 0.116-0.958; P=0.041) compared to the CDT group, but did not show a significant reduction in the risk of high VCSS (20% PMT+CDT vs. 36% CDT; P=0.121). Compared to the PMT group, the PMT+CDT group did not significantly reduce the incidence of PTS (12% PMT vs. 18% PMT+CDT; P=0.504) or the rate of high VCSS (12% PMT vs. 20% PMT+CDT; P=0.343). CONCLUSIONS: In patients with acute left IFDVT complicated by LIVC, PMT may serve as a more efficacious method for thrombus removal compared to CDT and combined PMT+CDT in reducing both the incidence of PTS and the risk of high VCSS.

Comparative Efficacy of Acute Exercise Intervention on Anxiety in Adolescents and Young Adults: A Network Meta-Analysis.

Acute exercise is a promising non-pharmacological therapy for alleviating anxiety. However, the effects of different types of acute exercise on anxiety in adolescents and young adults remain unclear. Therefore, our study aims to conduct a network meta-analysis to compare the effectiveness of various exercise interventions in improving anxiety in adolescents and young adults. We conducted an online literature search in five databases: PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO. The search was conducted from inception to March 1, 2023, and was limited to English-language publications. Pairwise and network meta-analyses were performed using random-effects models. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was applied to rate the certainty of evidence. A total of 33 studies involving 1121 participants were included. The network meta-analysis results revealed that mind-body exercise was the most effective intervention for reducing anxiety in adolescents and young adults (SMD = -0.36, 95% CI: -0.70, -0.03, moderate certainty). Additionally, aerobic exercise (SMD = -0.16, 95% CI: -0.28, -0.03, high certainty) showed significant reduction in anxiety, while resistance exercise (SMD = -0.09, 95% CI: -0.33, 0.14, moderate certainty) and multicomponent exercise (SMD = -0.01, 95% CI: -0.59, 0.57, moderate certainty) did not show significant reduction in anxiety. Moderate certainty evidence suggests that acute mind-body exercise may be the most effective type of exercise for reducing anxiety in adolescents and young adults. Future research should focus on conducting more multi-arm randomized controlled trials to provide more direct evidence on the relative effectiveness of different exercise interventions.

Effectiveness of buzz session teaching and perception among medical students: an academic interventional study.

This interventional study was designed to evaluate the effectiveness of buzz session teaching in large groups and assess undergraduate medical students' perceptions of the buzz session teaching method. The study involved 100 first-year medical students divided into two groups, i.e., group I as "buzz first" and group II as "didactic first" comprising 50 students each. The topic "Physiology of the Cerebellum" was taught to group I through a buzz session and to group II through a didactic lecture. After a week, group I received a didactic lecture on the topic "Anterolateral Pathway in the Spinal Cord," whereas group II was taught the same by a buzz session. The students of both groups underwent a multiple choice question exam related to the taught topic immediately and again after 15 days of the teaching session. All students were provided feedback on a five-point Likert scale for the buzz session. According to students' perceptions, buzz sessions boosted communication skills and confidence levels by 94.8% and 96.3%, respectively. Of the students, 93.7% felt that the buzz session helped them retain more information and 94.1% thought they made the classroom environment more lively. More buzz sessions were desired by 94.8% of the participants. There was no difference in the marks gained for the acquired topics using buzz sessions and didactic lectures as teaching methods (P > 0.05). The students scored more marks in the tests taken after the buzz session than after the didactic lecture at 15 days of instruction (P < 0.05). The study concluded that students enjoyed the buzz session teaching method. The buzz session increased short-term retention.NEW & NOTEWORTHY In this current interventional study, we assessed the effectiveness of a buzz session as a novel teaching tool for large-group physiology instruction in first-year undergraduate medical students. Furthermore, we assessed student responses to see how the buzz session was perceived. Experimental evidence indicates that the buzz sessions led to greater retention after 15 days than the didactic lecture approach for physiology teaching in a preclinical context.

Predictors of engagement with between-session work in Cognitive Behavioural Therapy (CBT)-based interventions: a mixed-methods systematic review and "best fit" framework synthesis.

Between-session work (BSW) acts as the vehicle to translate skills learnt in therapy sessions into adaptive changes in everyday life, a key goal in Cognitive Behavioural Therapies (CBT). Despite a well-established relationship between engagement with BSW and enhanced treatment outcomes, difficulties completing between-session tasks are common and factors affecting patient engagement with BSW are poorly understood. This mixed-methods systematic review and "best fit" framework synthesis explored predictors of engagement with BSW in CBT-based interventions. Comprehensive searches were conducted across five databases, identifying 59 eligible studies. This combined theory and empirical evidence approach depicted ten predictor themes related to between-session engagement, spanning individual, relational and contextual concepts. While ambiguous findings were generated by existing evidence, several factors emerged as relatively consistent predictors of engagement with BSW: positive patient beliefs regarding BSW and treatment such as perceived helpfulness, and practitioner competency in planning and reviewing BSW, including providing a rationale and addressing difficulties were associated with greater engagement. Conversely, patient in-session resistance, including counter change talk, was an indicator of disengagement between-sessions. The impact of patient symptomology, sociocultural environment, practitioner beliefs and the therapeutic relationship is unclear. The conceptual model presented offers a testable framework for researchers and a guideline for practitioners.

The potential value of brief waitlist interventions in enhancing treatment retention and outcomes: a randomised controlled trial.

People with eating disorders are often placed on lengthy waitlists for treatment. This is problematic, as increased time spent on waitlists has been shown to predict dropout. We examined whether providing brief interventions to people on a waitlist improved retention or outcomes in treatment. Participants (N = 85) were referred to a university training clinic for 10-session cognitive behavioural therapy for non-underweight patients with eating disorders (CBT-T). While waitlisted for CBT-T, participants were randomised to one of two waitlist interventions or a control condition. In one waitlist intervention (CRT-Brief), participants received a cognitive remediation therapy session at the start of the waitlist period. In the other waitlist intervention (brief contact), participants were sent a short supportive email and psychoeducation halfway through the waitlist period. The control condition was waitlist as usual. There was no evidence to suggest that the waitlist interventions improved symptoms during the waitlist period or CBT-T. However, participants who received a waitlist intervention were three times more likely to complete treatment. The present study suggests that providing even brief contact while people are waitlisted for eating disorder treatment significantly improves retention. However, replication in a more adequately powered study is required.

Effects of Training and Calibration Data on Surface Electromyogram-Based Recognition for Upper Limb Amputees.

Surface electromyogram (sEMG)-based gesture recognition has emerged as a promising avenue for developing intelligent prostheses for upper limb amputees. However, the temporal variations in sEMG have rendered recognition models less efficient than anticipated. By using cross-session calibration and increasing the amount of training data, it is possible to reduce these variations. The impact of varying the amount of calibration and training data on gesture recognition performance for amputees is still unknown. To assess these effects, we present four datasets for the evaluation of calibration data and examine the impact of the amount of training data on benchmark performance. Two amputees who had undergone amputations years prior were recruited, and seven sessions of data were collected for analysis from each of them. Ninapro DB6, a publicly available database containing data from ten healthy subjects across ten sessions, was also included in this study. The experimental results show that the calibration data improved the average accuracy by 3.03%, 6.16%, and 9.73% for the two subjects and Ninapro DB6, respectively, compared to the baseline results. Moreover, it was discovered that increasing the number of training sessions was more effective in improving accuracy than increasing the number of trials. Three potential strategies are proposed in light of these findings to enhance cross-session models further. We consider these findings to be of the utmost importance for the commercialization of intelligent prostheses, as they demonstrate the criticality of gathering calibration and cross-session training data, while also offering effective strategies to maximize the utilization of the entire dataset.

Applications of Alpha Neurofeedback Processes for Enhanced Mental Manipulation of Unfamiliar Molecular and Spatial Structures.

This study explores a novel approach to enhancing cognitive proficiency by targeting neural mechanisms that facilitate science and math learning, especially mental rotation. The study specifically examines the relationship between upper alpha intensity and mental rotation skills. Although prior neurofeedback research for increasing upper alpha highlights this correlation, mostly with familiar objects, novel chemistry and math learning prompts envisioning unfamiliar objects which question the persistence of this correlation. This study revisits the upper alpha and mental rotation relationship in the context of unfamiliar objects with a single neurofeedback session and examines the efficiency of manual and automatic neurofeedback protocols. Results will provide a basis for integrating neurofeedback protocols into learning applications for enhanced learning. Our study encompassed three cohorts: Group 1 experienced an automatic neurofeedback protocol, Group 2 received a manual neurofeedback protocol, and the control group had no neurofeedback intervention. The experimental phases involved EEG measurement of individual upper alpha (frequency of maximal power + 2 Hz) intensity, mental rotation tasks featuring geometric and unfamiliar molecular stimuli, one neurofeedback session for applicable groups, post-treatment upper alpha level assessments, and a mental rotation retest. The neurofeedback groups exhibited increased levels of upper alpha power, which was correlated with improved response time in mental rotation, regardless of stimulus type, compared to the control group. Both neurofeedback protocols achieved comparable results. This study advocates integrating neurofeedback into learning software for optimal learning experiences, highlighting a single session's efficacy and the substantial neurofeedback protocol's impact in enhancing upper alpha oscillations.

Virtual reality exposure therapy for fear of spiders: an open trial and feasibility study of a new treatment for arachnophobia.

PURPOSE: This analogue pilot study examined the feasibility (i.e. preliminary results, safety, acceptability) of a new single-session treatment for adults with a fear of spiders. MATERIALS: It used state-of-the-art consumer available VR-hardware for therapist-assisted exposure (VRET-AP). The VRET-AP is largely adapted from Öst's one-session treatment for arachnophobia (Öst, 1987), with the aim of addressing shortcomings of previous VRET treatments, such as marked differences in procedures compared to available and evidence based in-vivo treatments. METHOD: Participants (N = 12) were screened for fear of spiders using the Spider Phobia Questionnaire (SPQ), Fear Questionnaire (FQ) and the Behavioral Approach Test (BAT), prior to and directly after treatment in a repeated measures quasi-experimental design. In addition, acceptance and completion rates were measured and participants were interviewed about their experience of the treatment. Mean ratings as well as Reliable Change Index (RCI) for individual trajectories were analyzed. RESULTS: The results from the preliminary data indicates potential for improvements with large effect sizes (d = 0.90-1,384) in all measurements of spider fear at post-treatment. Reliable Change Index (RCI) analysis showed that spider fear diminished in all twelve participants although the change was certain in only two. None deteriorated. All that responded accepted the treatment and all 11 participants completed all levels in the treatment. No concerns or adverse effects were reported in the interviews which largely confirm the quantitative results. CONCLUSION: VRET-AP is a feasible alternative for delivering effective treatment for fear of spiders and the results motivate larger, randomized trials of VRET-AP involving participants diagnosed with arachnophobia.

Pain-free bite force in a healthy population: Within-session test-retest reliability in different sitting positions.

BACKGROUND: Pain-free bite force (PFBF) is a promising measure to evaluate bite function in temporomandibular disorders (TMDs), yet the reliability of the measure is unknown. OBJECTIVES: Establish the (1) within-session test-retest reliability of PFBF in a healthy population for a single and mean of three trials in supported and unsupported sitting; (2) standard error of measurement (SEM) and minimal detectable change (MDC). METHODS: Thirty healthy participants (n = 15 female, mean [SD] age = 34.4 [11.0] years) completed two sessions (30-60 min apart) comprising three PFBF trials on each side, in both supported and unsupported sitting, to provide data for 60 (30 participants × two sides) test-retest assessments. Test-retest reliability for the first trial and mean of three trials in each position were determined using intraclass correlation coefficients (ICCs), before calculating the corresponding SEM and MDC for males (M) and females (F) respectively. RESULTS: Within-session reliability was considered excellent for a single trial in supported sitting (ICC = 0.85; SEM M/F = 99/84 N; MDC M/F = 275/232 N) and unsupported sitting (ICC = 0.91; SEM M/F = 72/59 N, MDC M/F = 200/163 N), and for a mean of three trials in supported sitting (ICC = 0.89; SEM M/F = 66/79 N, MDC M/F = 182/220 N) and unsupported sitting (ICC = 0.92; SEM M/F = 64/59 N, MDC M/F = 177/164 N). CONCLUSION: Single and a mean of three trials in supported and unsupported sitting appear reliable methods to measure PFBF in a healthy population. Testing PFBF using a mean of three trials in unsupported sitting appears superior over other methods though due to higher test-retest reliability, and lower SEM and MDC. Future studies should examine the reliability of PFBF in TMD populations.

A modified triple tibial osteotomy for management of canine cranial cruciate ligament disease: retrospective assessment of 309 procedures (2017-2020).

CASE HISTORY: Medical records from a single referral hospital (Animal Referral Hospital, Sinnamon Park, Australia) of dogs treated with modified triple tibial osteotomy (TTO) for management of cranial cruciate ligament (CrCL) disease from June 2017 to June 2020 were reviewed. Modifications to the originally described TTO procedure included a modified wedge angle calculation and performing the tibial osteotomies without the use of pre-drilled guide holes. CLINICAL FINDINGS: A total of 253 dogs met the inclusion criteria. Two dogs were excluded, leaving 251 dogs that had undergone 309 procedures for assessment, and data from these, including complications, were reviewed. Complete, partial competent, and partial incompetent rupture of the cranial cruciate ligament was identified in 202/309 (65.4%), 79/309 (25.6%), and 28/309 (9.1%) stifles, respectively. Medial meniscal injury was identified in 207/309 (67.0%) stifles at the time of initial surgery. TREATMENT AND OUTCOME: Fifty-eight dogs had bilateral procedures, including both single-session and staged surgeries, and 48 of these were available for analyses. The modifications to the TTO procedure described herein resulted in a median wedge angle of 21° and a median post-operative tibial plateau angle of 5.8°. Tibial compression testing following surgery indicated elimination of cranial tibial thrust in all stifles in this series. The most common intra-operative complication was tibial tuberosity fracture (15/309; 4.9%). Minor post-operative complications occurred in 37/309 (12.0%) procedures, with infection being the most common (27/309; 8.7%). Major post-operative complications occurred in 9/309 (2.9%) procedures. The intra- and post-operative complication rates for dogs undergoing bilateral single-session TTO were both 8.3% (2/24). The intra- and post-operative complication rates for dogs undergoing bilateral staged TTO were both 4.2% (1/24). The low number of complications for both the bilateral single-session and bilateral staged TTO groups precluded statistical analysis. All complications resolved uneventfully as determined by the attending surgeon. CLINICAL RELEVANCE: The modified TTO technique described here was safe and effective for the management of canine CrCL disease in the dogs included in the case series. Findings of this study suggest that, with careful case selection, the modified TTO may be performed as a bilateral single-session procedure in dogs with concurrent bilateral cranial cruciate ligament disease. Future studies analysing the effects of these modifications on stifle biomechanics would be beneficial. ABBREVIATIONS: CrCL: Cranial cruciate ligament; SSI: Surgical site infection; TPA: Tibial plateau angle; TPLO: Tibial plateau levelling osteotomy; TTA: Tibial tuberosity advancement; TTO: Triple tibial osteotomy.

Fluctuations in therapist responsiveness facing clients with borderline personality disorder: Starting therapy on the right foot.

OBJECTIVE: The present paper focuses on therapist responsiveness during the initial therapy session with clients with borderline personality disorder (BPD), aiming to analyze therapist responsiveness at short intervals during the initial session and determine if it can predict therapeutic alliance from both therapist and client viewpoints. METHOD: A sample of 47 clients participated in the study for 10 sessions of therapy. Therapeutic alliance from therapists' and clients' perspectives was rated after each session; external raters assessed therapist responsiveness during the initial session. Multiple linear regression models and linear mixed models with backward variable selection based on AIC were run to analyze whether specific therapist behaviors during session one predicted therapeutic alliance rated from therapists' and clients' perspectives. RESULTS: The results indicate that therapists normalizing and validating clients' experiences during the first session are crucial for establishing therapeutic alliance for BPD clients; however, for therapists, the increase in variability of emotions verbalized by clients during the initial session negatively impacts therapeutic alliance. CONCLUSION: The study contributes to further understand the impact of therapists' behavior at the beginning of therapy with BPD clients. Therapist responsiveness is crucial for therapy outcome but is methodologically challenging; therefore, efforts in this direction should be pursued.

Session Reactions Scale-3: Initial psychometric evidence.

Objective: This study aimed to develop an updated brief self-report post-session measure, suitable for collecting systematic feedback on clients' session reactions in the context of measurement-based care (MBC). Method: The Session Reactions Scale-3 (SRS-3; 33 items) was developed by extending and adjusting the Revised Session Reactions Scale. In Study 1, the psychometric properties of the SRS-3 were tested on N = 242 clients. In Study 2, a brief version of the SRS-3 (SRS-3-B; 15 items) was developed using a combination of conceptual, empirical, and pragmatic criteria. In Study 3, the psychometric properties of the SRS-3-B were tested on a new sample of N = 265 clients. Results: Exploratory factor analysis supported the use of the SRS-3-B as a two-factor (helpful reactions, hindering reactions) or unidimensional (overall session evaluation) instrument. The SRS-3-B was meaningfully related to another process measure (Individual Therapy Process Questionnaire) both on the item and factor levels. Conclusions: The SRS-3-B is a reliable process measure to elicit rich and clinically meaningful feedback from clients within the MBC context and as a research instrument to assess the helpful and hindering aspects of therapy sessions.

Evolution of Single-Session Therapy: A Bibliometric Analysis.

OBJECTIVE: This bibliometric analysis aimed to explore the publication and citation metrics of the research literature on single-session therapy (SST) to understand its current status, trends, and future prospects. METHODS: Seventy-five keywords were validated by subject matter experts. Publications from 1972 through September 2023 were extracted from the bibliometric website Lens.org. Publication trends, citation patterns, prominent journals, and influential authors were examined as part of the bibliometric analysis. Citation network analysis, bibliographic coupling of authors, and coauthorship network analysis were also performed. RESULTS: A total of 301 SST publications, including 18 books, 85 book chapters, and 176 journal articles, were found, published by 493 authors. The citation- and publication-related metrics suggested a growing level of subject matter expertise over time. Initially, single-author publications held more prominence than collaborative work, but this pattern shifted. From 2011 to 2020, scholarly interest surged, resulting in 144 publications during this period. CONCLUSIONS: This bibliometric analysis, the first systematic exploration of the SST knowledge base, can be used to expand and enrich future SST research.

Points of departure: A qualitative study exploring relational facilitators and barriers in the first treatment session.

Objective To explore how patients and therapists in an outpatient specialized substance use disorder treatment setting experienced the first treatment session, and to identify relational facilitators and barriers seen from both patient and therapist perspectives.Method: The study is based on a qualitative approach and semi-structured interviews of patients (n = 12) and therapists (n = 12). Interviews were conducted soon after the first treatment session and analyzed in accordance with reflexive thematic analysis.Results: We identified subthemes for patients and therapists, respectively. In addition, we found that patients and therapists described certain comparable experiences and actions which we integrated as core themes: (a) feeling uncertain about what to expect; (b) forming first impressions; (c) balancing multiple concurrent concerns; (d) seeking feedback from the other; and (e) sensing a way forward. The subthemes specify patients' and therapists' unique meanings and approaches to each core theme. Finally, we summarized unique and shared relational facilitators and barriers.Conclusion: Patients and therapists use the first session to form an impression of the other, but they are also concerned with the impression they themselves give. They, therefore, monitor the other's in-session reactions and responses which constitute facilitators or barriers for their own further relational actions.

Within- and between-session changes of in-session reflective functioning of mothers in dyadic parent-infant psychotherapy.

This study investigated if in-session reflective functioning (RF) of mothers improved between and within sessions of brief dyadic focused parent-infant psychotherapy (fPIP) for the treatment of regulatory disorders in infants.In-session RF was coded for 44 therapy sessions from N = 11 mothers randomly selected from a RCT on the efficacy of fPIP as part of secondary analyses. A new rating system distinguished self-focused and child-focused in-session RF. Cumulative ordinal regression models were applied to analyze the dynamics of in-session RF within and across sessions, controlling for word count of each statement.While in-session RF improved significantly within sessions, between-session RF improved significantly only in the second session compared to the first with a significant decrease observed in the last session. Child-focused in-session RF was significantly lower than self-focused in-session RF at the beginning of the sessions but improved significantly stronger than self-focused in-session RF during sessions.In-session RF (particularly in child-focused statements) can be regarded as a dynamic change process relevant within each session of dyadic fPIP. Improvements made on a session-by-session basis may not be maintained until the next session. Implications for practitioners and in-session RF research are discussed.

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.

Psychotherapists' Experience with In-Session Use of Routine Outcome Monitoring: A Qualitative Meta-analysis.

Routine outcome monitoring (ROM) has become an increasingly utilized tool in therapeutic practice that has the potential to improve therapy outcomes. This study aimed to synthesize the findings of existing qualitative studies investigating how clinicians use ROM in their work with clients. A systematic search of qualitative studies on clinicians' experience with the use of ROM in mental health services was conducted via PsycInfo, PsycArticles, Medline, Web of Science, and Scopus databases. Qualitative meta-analysis was used to synthesize the finding of the primary studies. Forty-seven studies met the inclusion criteria. The analysis resulted in 21 meta-categories organized into six clusters, namely (1) obtaining clinically relevant information, (2) adapting treatment, (3) facilitating communication, (4) enhancing the therapeutic relationship, (5) facilitating change in clients, and (6) personalized usage of ROM. The meta-analysis revealed that clinicians utilized ROM in diverse ways, including both informational and communicational functions. From the clinicians' perspective, ROM was an element that, on the one hand, introduced additional structure and standardization in treatment and, on the other hand, allowed for greater flexibility and tailoring of treatment.