Search Results (82)

Background: Functional dizziness and persistent postural-perceptual dizziness (PPPD) involve mutually reinforcing vestibular symptoms and anxiety. Non-pharmacological interventions, such as vestibular rehabilitation therapy (VRT) and cognitive behavioral therapy (CBT), aim to address both mechanisms, yet their overall effectiveness remains unclear. Methods: We systematically examined randomized controlled trials (RCTs) published between 2000 and 2025 that evaluated VRT, CBT, or multimodal approaches for adults with functional or chronic dizziness (including PPPD and related functional dizziness constructs) accompanied by significant anxiety. Twelve RCTs (513 participants) met the criteria, involving individuals with PPPD, chronic subjective dizziness, chronic vestibular disorders with prominent anxiety, and residual dizziness after benign paroxysmal positional vertigo. Results: Conventional VRT delivered in clinic or as structured home-based programs produced small-to-moderate improvements in dizziness-related disability versus usual care. Combining VRT with CBT or psychologically informed components yielded larger and more consistent reductions in disability and maladaptive dizziness-related beliefs. CBT-based interventions reduced anxiety and dizziness-related distress compared with supportive controls. Emerging modalities, including virtual-reality-based VRT, non-invasive neuromodulation, and heart-rate-variability biofeedback, showed potential, although they were limited by small samples and methodological issues. Most trials had some risk-of-bias concerns and evidence certainty ranged from very low to moderate. Conclusions: Integrated multimodal rehabilitation shows promise, although larger, high-quality RCTs using standardized procedures and outcome measures are required. Full article

Background/Objectives. Chronic benzodiazepine (BDZ) use is frequently maintained beyond recommended durations due to neuroadaptation, psychological dependence, and withdrawal-related issues. Passiflora incarnata L., herba (P. incarnata) has shown anxiolytic and GABAergic activity that may mitigate withdrawal symptoms, while cognitive-behavioural therapy (CBT) targets maladaptive beliefs and behaviours sustaining BDZ misuse. This study investigates the independent and interactive effects of P. incarnata and CBT on BDZ dose reduction during a three-month tapering program. Methods. This retrospective observational study included 186 outpatients with anxiety or depressive disorders in clinical remission undergoing BDZ tapering, of whom 93 received a dry extract of P. incarnata as adjunctive treatment and 93, matched for diagnosis, age and sex, followed a standard tapering protocol. BDZ doses were assessed at baseline and three months. CBT was recorded as a binary variable based on the information documented in the medical records. An ANCOVA was performed to assess the impact of CBT and P. incarnata on BDZ reduction (change in mg diazepam equivalents), adjusting for sex, age, education, baseline anxiety and depression scores, initial BDZ and antidepressant dosage. A subgroup analysis was conducted to investigate the role of P. incarnata dosage in BDZ reduction. Results. Both CBT and P. incarnata were associated with significantly greater reductions in BDZ dosage at three months (CBT: p = 0.005, effect size: 0.032; P. incarnata: p < 0.001, effect size: 0.128). A significant interaction between CBT and P. incarnata was also observed (p = 0.037, effect size: 0.018), indicating a synergistic effect when both interventions were combined. Baseline sociodemographic characteristics, BDZ and antidepressant dosage and symptom severity did not differ significantly between groups. Patients taking 400–600 mg of P. incarnata dry extract showed a higher BDZ reduction compared to those taking 200 mg. Conclusions. These findings suggest that P. incarnata and CBT exert independent yet complementary effects in supporting BDZ tapering. Their combination appears to enhance dose reduction beyond either intervention alone, supporting a multimodal approach that addresses both neurobiological and psychological components of BDZ addiction. Prospective controlled studies are needed to confirm these results and to clarify their impact on long-term discontinuation outcomes. Full article

The rapid expansion of mindfulness research has generated both enthusiasm and controversy regarding its actual clinical value. While meditation is often regarded as the central mechanism of mindfulness-based interventions, other components such as psychoeducation and informal practice may play an equally significant role in improving mental health outcomes. This critical review examines the relative contributions of these elements to the therapeutic impact of mindfulness and clarifies the extent to which its effects are comparable to established treatments, particularly Cognitive Behavioral Therapy (CBT). Evidence from meta-analyses and high-quality trials indicates that mindfulness programs achieve moderate efficacy in reducing symptoms of anxiety, depression, and stress, but effect sizes are frequently inflated by methodological limitations. Importantly, cognitive and emotional regulation skills, especially acceptance and non-judgment, appear to sustain long-term benefits more consistently than meditation alone. These findings highlight the need for rigorous longitudinal studies and component-focused designs to identify the mechanisms that drive clinical change. By distinguishing between evidence-based applications and overstated claims, this review contributes to a more balanced understanding of mindfulness and its appropriate integration into healthcare. Full article

Objective: This study aimed to investigate the effects of dual-task stroboscopic visual training (DTSVT) on balance, functional mobility, and gait in children who are hard-of-hearing. Methods: This randomized controlled study included 31 children (17 girls, 14 boys) with congenital sensorineural hearing loss. Participants were assigned to one of three groups: control group, conventional balance training (CBT) group, and DTSVT group. The CBT and DTSVT groups participated in an exercise program for 16 weeks, twice weekly, for 40 min (a total of 24 sessions). Static balance was assessed using the Tandem Romberg test and Single-Leg Stance (SLS) test, while dynamic balance was evaluated using the Functional Reach Test (FRT), balance disc test, and the Four Square Step Test (FSST). The Pediatric Balance Scale (PBS) was used as a subjective balance assessment. Functional mobility was assessed using the Timed Up and Go (TUG) Test, Step Test, 10 m Walk Test (10 MWT), and Functional Gait Assessment (FGA). Postural sway parameters were recorded using the GyKo device, including Sway Area (EA, cm²), Distance Length (DL, cm), Length (anterior–posterior (AP)) (cm), Length (medial–lateral (ML)) (cm), Mean Distance (D) (cm), Mean Distance (AP) (cm), and Mean Distance (ML) (cm). Results: Significant between-group differences were primarily observed in favor of the DTSVT group post-treatment, particularly in PBS scores, GyKoDL values during the eyes-open SLS test, and TUG test completion times (p < 0.05). Some baseline differences were noted among groups in functional reach distance, FSST completion time, and eyes-closed duration on the Balance Disc test (p < 0.05). Within-group comparisons revealed significant improvements in FSST times in both intervention groups, reduced postural sway parameters during the FRT in the DTSVT and control groups, and increased eyes-closed Tandem Romberg duration in the CBT group (p < 0.05). Most other outcome measures did not demonstrate statistically significant changes either within or between groups (p > 0.05). Conclusions: Dual-task stroboscopic visual training was more effective than conventional balance training in improving specific aspects of balance and functional mobility in children who are hard-of-hearing. These findings highlight the potential of adding cognitively demanding and visually engaging balance tasks to rehabilitation programs for this population. Larger and more diverse samples in future studies are needed to enhance the generalizability of these results. Studies that assess balance and gait using standardized clinical or laboratory tests may be particularly valuable. Given the small sample size and multiple comparisons, the results should be considered preliminary and exploratory. Full article

Third-wave cognitive-behavioral therapies (CBT3) have progressively shifted the focus of psychotherapy from symptom reduction to process-based and transdiagnostic mechanisms of change, emphasizing self-identification as a core dimension. Within this evolution, the Self-Identification Program (SIP) represents a conceptual and clinical advancement particularly relevant to mood disorders, where maladaptive self-identification, rumination, and self-judgment play central roles. SIP directly targets dysfunctional self-identification—the reification of transient and maladaptive mental contents as defining features of a self—through a framework integrating the three levels of CBT3: mindfulness (CBT3.1), loving/kindness and compassion (CBT3.2), and deconstructive insight into the nature of a self (CBT3.3). Theoretically, SIP aligns with dimensional psychiatry (AMPD, HiTOP, RDoC) and recent advances in behavioral linguistics (Relational Frame Theory) and psychotherapy (Process-Based Behavioral Therapy). By integrating linguistic, affective, and neuroscientific perspectives, SIP bridges contextual behavioral science and contemplative practice, offering a unified, process-based model of identity transformation. Clinically, SIP extends CBT3 beyond mindfulness and loving/kindness and/or compassion training to specifically address the mechanism by which self-identification becomes a source of suffering—namely, the mistaken identification with an independent and permanent self. In doing so, SIP provides a novel, mechanistically grounded pathway toward enduring change in depressive and bipolar spectrum disorders. Full article

Background/Objectives: Inpatient psychiatric rehabilitation plays a critical role in the recovery of adults with serious mental illness (SMI), offering structured, supportive care to improve functioning and community integration. Despite its clinical relevance, there is considerable heterogeneity in how these programs are structured, delivered, and evaluated. This scoping review aimed to map the core components and reported outcomes of adult inpatient psychiatric rehabilitation programs and to identify elements associated with program effectiveness. Methods: A scoping review was conducted according to PRISMA-ScR guidelines. Four electronic databases (MEDLINE, Web of Science, PsycINFO, and Google Scholar) were systematically searched for articles published between inception and 2024. Studies were eligible if they described inpatient psychiatric rehabilitation programs for adults and reported on clinical, functional, or system-level outcomes. Data extraction included program characteristics, intervention components, effectiveness indicators, and study limitations. A qualitative thematic synthesis was conducted, and methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. Results: Fifteen studies met the inclusion criteria. Core rehabilitation components included structured psychosocial interventions (e.g., CBT, psychoeducation), vocational and occupational support, recovery-oriented goal setting, and transitional care planning. Most programs demonstrated positive outcomes, including reduced readmissions, improved functional and psychosocial functioning, and enhanced quality of life. Effectiveness appeared to be influenced by the duration of rehabilitation, multidisciplinary team involvement, and continuity of care post-discharge. However, outcome measures varied considerably, and few studies used standardized assessment tools or included long-term follow-up. Conclusions: This review highlights common features of effective inpatient psychiatric rehabilitation programs and underscores the need for standardized outcome measures, implementation fidelity assessments, and longitudinal research. Findings can guide service planning, inform policy development, and support recovery-oriented inpatient care. Full article

Advances in immersive technologies, such as Metahuman Creator integrated with Unreal Engine, offer new opportunities for interactive and realistic digital learning in nursing education. While computer-based training (CBT) has demonstrated benefits for self-directed learning, limited research has examined the usability and reliability of Metahuman-based digital textbooks (DTs) in clinical nursing education. This study aims to evaluate the usability of a Metahuman-based CBT DT for nursing interventions using a multi-method approach combining user testing and expert heuristic evaluation. A total of 12 undergraduate nursing students and 4 nursing education experts used the program, which included two clinical scenarios (nursing care for ileus and upper gastrointestinal bleeding), and completed the user version of the Mobile App Rating Scale (uMARS). Experts conducted a heuristic evaluation based on eight mobile usability principles. Quantitative data were analyzed using descriptive statistics, and qualitative feedback was evaluated through inductive content analysis. The students rated the overall usability as high (mean uMARS score = 4.25/5), particularly for layout and graphics. Experts provided moderately positive ratings (mean = 3.71/5) but identified critical issues in error prevention, consistency, and user control. Qualitative feedback emphasized the need for automatic data saving, clearer navigation, improved credibility of information sources, and enhanced interactivity. Full article

Objectives: Prolonged opioid use leads to tolerance and hyperalgesia in patients with chronic pain. Apart from an increase in pain, opioid use also leads to several other adverse effects. Nevertheless, the prevalence of opioid use as a treatment for chronic pain remains high, and opioid withdrawal interventions deserve more attention. This study evaluates the effects of a guideline for an opioid withdrawal intervention method that is nested in cognitive behavioral treatment (CBT) and is specifically for patients with a history of long-term opioid use and chronic pain. Methods: We conducted a clinical, exploratory, and mixed-methods study involving pre- and post-measurements on opioid use and health-related quality of life (SF-36), as well as a qualitative analysis of patient experiences (interviews) to evaluate the program. Results: A total of 29 patients were included in the study; 23 of these patients no longer used opioids, and some continued withdrawal under the guidance of their general practitioner. Quality of life improved in all domains, including the amount of pain experienced. No patients reported increased pain levels, and most experienced significantly fewer adverse side effects. Patient satisfaction was high, with no negative long-term side effects of the intervention reported. Conclusions: In light of the results of this study, it is important to address opioid use in patients with chronic pain. There are strong arguments in favor of motivating patients to withdraw from using opioids to treat chronic pain, which can be achieved in combination with CBT. Full article

Adolescence is a developmental stage characterized by increased vulnerability to technology use. Several models have been proposed to explain the psychological processes involved in addictive use. In response to this evidence, therapeutic and preventive intervention programs aim to reduce key symptoms in order to promote health and protect adolescents. This study presents a systematic review and meta-analysis on the effectiveness of psychological therapeutic and preventive interventions for problematic use of Information and Communication Technologies (ICTs) in adolescents (aged 10–21). A total of nine studies (five RCTs and four non-RCTs) with 744 participants were analyzed. The search was conducted following PRISMA guidelines and using the PICO framework. Included studies involved face-to-face or online psychological therapeutic and preventive interventions targeting adolescents, with a particular focus on cognitive behavioral therapy (CBT). Results indicate significant effects in favor of the experimental group in reducing symptoms associated with Internet, video game, social media, and instant messaging addiction, with pooled effect sizes of SMD = −1.53 (RCTs) and SMD = −1.13 (non-RCTs). Despite heterogeneity and potential publication bias, the evidence supports the effectiveness of these interventions, particularly CBT, family therapy, and executive function training. A multidisciplinary approach, early detection, and treatment personalization are recommended. Methodological limitations were identified, highlighting the need for more rigorous future research with attention to gender differences and cultural adaptation. Full article

Parents of premature infants in the Neonatal Intensive Care Unit (NICU) are at elevated risk of anxiety, depression, stress, and trauma, which may impair bonding and infant development. This scoping review synthesized preventive and treatment interventions designed to reduce parental psychological distress in the United States. Guided by PRISMA-ScR, systematic searches were conducted in PubMed, Scopus, MEDLINE, and PsycINFO. Eligible studies were those that examined interventions for parents of preterm infants (<37 weeks’ gestation) initiated before, during, or within one year after NICU discharge. Excluded were studies limited to abstracts or qualitative designs; those not addressing parental depression, anxiety, post-traumatic stress disorder, or stress; and those involving congenital anomalies or conducted outside the United States. Eighteen studies met the inclusion criteria, including ten prevention-focused and seven treatment-focused studies. Eight reported significant reductions in distress, with cognitive behavioral therapy (CBT) and the Creating Opportunities for Parent Empowerment (COPE) program showing the strongest evidence. However, most interventions targeted mothers, highlighting underrepresentation of fathers. Overall, findings underscore the need for interventions that address both parents, include diverse populations, and evaluate participant engagement to improve clinical applicability. Full article

Background: Juvenile fibromyalgia (JFM) is a chronic pain disorder characterised by widespread musculoskeletal pain, functional impairment, fatigue, and mood disturbances. Treatment remains challenging, considering the multifactorial nature of the condition and the limited high-quality evidence supporting pharmacological or non-pharmacological interventions. Objectives: This review aimed to critically appraise level I evidence from randomised controlled trials assessing the efficacy and safety of pharmacological and non-pharmacological treatments for adolescents with JFM. Methods: Seven published peer-reviewed clinical trials were examined, including studies investigating duloxetine, milnacipran, pregabalin, cognitive-behavioural therapy (CBT), and the integrated Fibromyalgia Integrative Training Teens (FIT) program, which combines CBT with neuromuscular training. Outcomes of interest included pain intensity, functional disability, depression symptoms, physical activity, and adverse events. Results: Pharmacological agents such as duloxetine, milnacipran, and pregabalin demonstrated modest improvements in pain, but failed to produce consistent benefits in function or mood, and were associated with a high incidence of adverse effects. CBT significantly improved functional disability and depression symptoms, yet it had a limited impact on pain reduction or objectively measured activity levels. The FIT Teens program showed superior outcomes in pain intensity and biomechanical function compared to CBT alone, suggesting a synergistic effect of combining psychological and physical reconditioning strategies. Conclusions: Current evidence supports the use of multimodal treatment approaches in JFM. Non-pharmacological interventions, particularly when integrated with structured exercise, offer meaningful benefits with minimal safety concerns. Larger, methodologically rigorous trials are needed to establish optimal treatment pathways and long-term outcomes for this complex and underserved paediatric population. Full article

Background: Tobacco use remains a major public health concern among young adults and is often complicated by co-occurring addictive behaviors. Objective: This study analyzed motivation for change, assessed with the decisional balance framework, in relation to multiple addictions among young smokers seeking treatment. Methods: Ninety-eight participants from the University of Granada enrolled in either an app-based cognitive–behavioral therapy (CBT) program (n = 35) or a traditional face-to-face CBT program (n = 63). Recruitment relied on self-identification and voluntary participation. Standardized instruments were applied to measure nicotine dependence (FTND), behavioral and substance-related addictions (MULTICAGE CAD-4), cannabis dependence (SDS), and motivation for change (DBQ). Logistic and stepwise regression analyses were conducted to identify predictors of treatment choice and motivational outcomes. Results: Younger participants and students were more likely to choose the app-based program. Compulsive buying was linked to perceiving more disadvantages of smoking, whereas sex addiction, cannabis dependence, and other substance addictions were associated with perceiving fewer disadvantages. Conclusions: Treatment preferences and motivational profiles differ according to age, academic status, and co-occurring addictions. These findings highlight the need to tailor smoking cessation strategies to individual profiles and support the role of mobile health tools in engaging digitally oriented populations. Full article

Attention-deficit/hyperactivity disorder (ADHD) presents unique challenges for middle school students, a population navigating heightened academic, social, and emotional demands. This review examines empirical literature on school-based interventions targeting ADHD in middle school populations, a group often under-represented in intervention research. This review synthesizes findings from studies on academic accommodations, organizational training (e.g., HOPS), self-management strategies, mental health supports (e.g., CBT), and integrated programs like STAND and the Challenging Horizons Program. Evidence suggests that targeted school-based interventions can improve executive functioning, task engagement, academic performance, and social–emotional outcomes. However, interventions vary in efficacy depending on implementations’ fidelity, individual differences, and contextual supports (such as family involvement and school resources). Although promising, many interventions are limited by scalability, sustainability, and a lack of rigorous longitudinal data. This paper identifies critical gaps in middle school-specific research and highlights the need for future studies on long-term outcomes, student self-advocacy, and the reduction of stigma. Overall, this review underscores the potential of multi-component, school-based approaches to mitigate academic and behavioral challenges in middle school students with ADHD. We also call for expanded efforts to tailor and sustain these interventions in real-world educational settings. Full article

(1) Background: This study aimed to identify baseline demographic, clinical, and psychosocial predictors of treatment response in adolescents with anorexia nervosa (AN) undergoing an intensive 20-week enhanced cognitive behavioral therapy (CBT-E) program, which included inpatient and day patient phases. Treatment outcomes were assessed at the end of intensive treatment (EOIT) and at a 20-week follow-up. (2) Methods: A prospective cohort of 68 adolescents under the age of 16 consecutively admitted to intensive CBT-E was evaluated. Baseline measures included body mass index (BMI)-for-age percentiles, percentage of expected body weight (%EBW), eating disorder psychopathology (EDE-Q), general psychopathology, and functional impairment. (3) Results: Of those who began treatment, 83.4% completed the program and 70.2% were available for follow-up assessment. Based on intent-to-treat analysis, 94.1% achieved a “good BMI outcome” and 73.5% met criteria for “full response” at EOIT. At follow-up, 64.7% maintained a good BMI and 55.9% sustained a full response. Completers’ analysis indicated that baseline body weight, clinical impairment, general psychopathology, and weight regain influenced treatment outcomes. However, no baseline demographic or clinical variables predicted treatment completion or outcome at either time point at intention-to-treat analysis, except that younger age at admission was linked to higher eating disorder psychopathology at follow-up. (4) Conclusions: In treatment completers, certain baseline clinical factors and weight regain influenced outcomes, while in the full sample, younger age predicted greater residual psychopathology at follow-up. These findings, if confirmed, emphasize the need for early intervention, focused support for weight regain, and potential adaptations of CBT-E for early adolescents. Full article

Objectives: This study assessed the effectiveness of a cognitive behavioral therapy (CBT)-based fine dust education program, grounded in the Health Belief Model (HBM), on elementary students’ fine dust knowledge, related behaviors, and mental health (depression, anxiety, stress, sleep quality). Methods: From September to November 2024, 95 students (grades 4–6) living near a coal-fired power plant in midwestern South Korea were assigned to either an intervention group (n = 44) or a control group (n = 51). The intervention group completed a three-session CBT-based education program; the control group received stress management education. Assessments were conducted at weeks 1, 2, 4, and 8 using standardized mental health and behavior scales (PHQ: Patient Health Questionnaire, GAD: Generalized Anxiety Disorder Assessment, PSS: Perceived Stress Scale, ISI: Insomnia Severity Index). Results: A chi-square test was conducted to compare pre- and post-test changes in knowledge and behavior related to PM2.5. The intervention group showed significant improvements in seven fine dust-related knowledge and behavior items (e.g., PM2.5 awareness rose from 33.3% to 75.0%; p < 0.05). The control group showed limited gains. Regarding mental health, based on a mixed-design ANCOVA, anxiety scores significantly declined over time in the intervention group, with group and interaction effects also significant (p < 0.05). Depression scores showed time effects, but group and interaction effects were not significant. No significant changes were observed for stress, sleep, or group × PM2.5 interactions. Conclusions: The CBT-based education program effectively enhanced fine dust knowledge, health behaviors, and reduced anxiety among students. It presents a promising, evidence-based strategy to promote environmental and mental health in school-aged children. Full article