搜索结果：Cognitive behaviour therapy

This study aimed to assess whether resource activation (i.e., fostering strengths and healthy aspects of the patient), aggregated across therapy sessions during telephone-based cognitive-behavioral therapy (TEL-CBT), is associated with post-therapy psychosocial resource utilization (i.e., the extent to which individuals utilize resources to achieve motivational goals) among family caregivers of people with dementia, controlling for baseline resource utilization. Additionally, we analyzed the trajectory of resource activation and investigated predictors of interindividual differences in growth patterns, as well as phase-specific associations with post-therapy resource utilization. One hundred and twenty family caregivers received 12 sessions of TEL-CBT. Caregivers and therapists rated resource activation after each session. Caregivers rated utilization of resources related to well-being, coping with daily hassles, and social support before and after therapy. Multiple linear regression analyses indicated that mean resource activation aggregated across therapy sessions, as reported by caregivers but not therapists, was significantly associated with post-therapy resource utilization after adjusting for baseline levels. Using piecewise latent growth curve models, we found that caregiver-rated resource activation at the beginning of therapy was significantly associated with post-therapy resource utilization related to well-being and social support. Pre-therapy utilization of social support resources was negatively associated with caregiver-rated resource activation in the final therapy phase, and utilization of well-being resources before therapy was positively related to therapist-rated resource activation at the beginning of therapy. The findings are consistent with the interpretation of resource activation experienced by patients as a candidate mechanism of change. Early resource activation during therapy appears particularly relevant.

Latin America faces a high dementia burden, with increased prevalence of factors associated with cognitive decline. Multidomain lifestyle interventions might delay cognitive decline, but populations from Latin America remain under-represented in dementia prevention trials. We aimed to investigate the feasibility of a culturally adapted, multidomain, systematic lifestyle intervention and investigate its effects on global cognitive function in at-risk older adults (aged 60-77 years). The LatAm-FINGERS Initiative for Cognitive Change (hereafter referred to as LatAm-FINGERS) was a single-blind, multicentre, randomised clinical trial conducted in 11 Latin American countries (Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Peru, and Uruguay). Individuals aged 60-77 years with high risk of dementia (cardiovascular risk factors, ageing, and dementia risk score &#x2265;6), and suboptimal cognitive performance were randomly assigned (1:1) to receive either a 2-year systematic lifestyle intervention (SLI group) or a flexible lifestyle intervention (FLI group). Randomisation was stratified by the study centre to ensure balance and implemented using permuted blocks of eight. Participants and intervention staff were not masked to group assignment, but individuals who assessed outcomes were masked throughout the trial. The SLI provided structured multidomain lifestyle interventions with supervised support and monitoring; FLI offered health advice. Primary outcomes were trial feasibility (evaluated using selected RE-AIM measures: Reach, Implementation, and Maintenance) and the intervention's effects on global cognitive composite trajectories over 2 years (change in the global cognitive composite score over 2 years). This trial is registered at ClinicalTrials.gov (NCT06492967) and has been completed. Participants were enrolled between Oct 27, 2021, and July 7, 2023; the last participant completed follow-up on Nov 7, 2025. Among 1719 assessed, 1065 participants included in the analytic sample were randomly assigned to the SLI group (n=539) or the FLI group (n=526). Mean age was 67&#xb7;5 years (SD 4&#xb7;7), 795 (75%) of 1065 participants were women, and 270 (25%) were men. Self-reported race and ethnicity were: 624 (59%) Mestizo, 288 (27%) White, 72 (7%) Mulatto, 25 (2%) Mixed or other, 18 (2%) Black, 14 (1%) Indigenous, and 24 (2%) did not report race or ethnicity. 877 (82&#xb7;3%) of 1065 completed the 2-year follow-up. Recruitment effectiveness (Reach) was 62&#xb7;0%; mean adherence to the SLI group (Implementation) was 71&#xb7;6% over the entire trial; and frequencies of complete cognitive outcomes data (Maintenance) were 87&#xb7;9% at 6 months, 85&#xb7;3% at 12 months, 81&#xb7;4% at 18 months, and 84&#xb7;8% at 24 months in the SLI group compared with 86&#xb7;3% at 6 months, 78&#xb7;9% at 12 months, 73&#xb7;4% at 18 months, and 79&#xb7;8% at 24 months in the FLI group. Dropouts were higher in the FLI group than in the SLI group (20&#xb7;2% vs 15&#xb7;2%; p=0&#xb7;042). Global cognitive composite scores increased over time in both groups, with a mean annual change of 0&#xb7;31 SD (95% CI 0&#xb7;28-0&#xb7;34) per year in the SLI group and 0&#xb7;20 SD (0&#xb7;17-0&#xb7;23) per year in the FLI group (mean between-group difference of 0&#xb7;11 SD per year [0&#xb7;06-0&#xb7;15; p<0&#xb7;0001]). Overall, 478 adverse events were reported (412 in the SLI group and 66 in the FLI group). The most common adverse events were musculoskeletal symptoms (113 [21%] in the SLI group, 13 [2%] in the FLI group), upper respiratory infections (50 [9%] in the SLI group, one [<1%] in the FLI group), and COVID-19 infection (31 [6%] events in the SLI group). Serious adverse events occurred in 50 (9%) participants in the SLI group and 24 (5%) participants in the FLI group; none were related to the intervention. There were eight deaths (three in the SLI group and five in the FLI group), and none were related to the intervention. A culturally adapted multidomain lifestyle intervention was feasible across Latin America and resulted in greater cognitive improvements than a flexible health-advice intervention in older adults at risk of cognitive decline. These findings extend the evidence base for multidomain lifestyle interventions to populations historically under-represented in dementia research, supporting their feasibility and scalability as strategies to reduce cognitive decline risk amid the rapidly growing burden of dementia in low-income and middle-income countries. Alzheimer's Association. For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.

Ovarian cancer is the most lethal gynecologic malignancy and is frequently diagnosed at an advanced stage. Chemotherapy remains a cornerstone of treatment but is commonly associated with psychological distress, including anxiety, depression, fatigue, and reduced quality of life (QoL). This systematic review and meta-analysis evaluated the effects of cognitive behavioral therapy (CBT) in women with ovarian cancer undergoing chemotherapy. The study was registered in PROSPERO and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Randomized controlled trials published between 2018 and 2025 were identified through PubMed, Scopus, ScienceDirect, and Google Scholar. Risk of bias (RoB-2) was assessed using the Cochrane RoB 2 tool. Outcomes included depression and anxiety measured by the Self-Rating Depression Scale (SDS), Patient Health Questionnaire-8, Hospital Anxiety and Depression Scale (HADS), and Self-Rating Anxiety Scale (SAS), fatigue, fear of cancer recurrence assessed by Fear of Cancer Recurrence Inventory-Short Form, and QoL evaluated using the EORTC QLQ-C30. Meta-analysis was performed using RevMan version 5.4. CBT significantly reduced depressive symptoms measured by SDS (mean difference [MD] = -5.11; 95% confidence interval [CI] -6.45 to -3.76; P < 0.00001; I 2 = 0%). Anxiety was significantly reduced across both HADS (MD = -2.35; 95% CI -3.94 to -0.77; P = 0.004; I 2 = 0%) and SAS scales (MD = -6.22; 95% CI -7.63 to -4.80; P < 0.00001; I 2 = 0%). Fatigue was also significantly decreased (MD = -0.76; 95% CI -1.31 to -0.20; P = 0.008; I 2 = 0%), while overall QoL improved (MD = 1.26; 95% CI 0.58-1.94; P = 0.0003; I 2 = 38%). These findings suggest that CBT provides beneficial supportive effects in reducing psychological distress and improving QoL in women with ovarian cancer undergoing chemotherapy.

Posttraumatic stress disorder (PTSD) affects up to 25% of trauma-exposed adolescents; yet, access to evidence-based treatment remains limited in rural regions. Trauma-focused cognitive behavioral therapy (TF-CBT) is the first-line intervention, but structural barriers such as long travel distances and therapist shortages hinder implementation. Digital and blended formats may improve accessibility, but evidence for adolescents with PTSD is limited. Shame and self-criticism are common following interpersonal trauma and can reduce engagement; compassion-focused strategies target these mechanisms and aim to enhance emotional safety. This protocol outlines a pilot randomized controlled trial (RCT) evaluating the feasibility of delivering blended trauma-focused cognitive behavioral therapy with compassion (bTF-CBT-C) for adolescents with PTSD in routine clinical care. A secondary aim is to assess the acceptability of the intervention among adolescents and caregivers. In addition, the study explores patterns and variability in clinical outcomes to inform the design of a future noninferiority trial. A 2-arm parallel-group pilot RCT will randomize 40 adolescents (12-17 years) with DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) PTSD to bTF-CBT-C or standard TF-CBT in routine child and adolescent psychiatric services. The intervention includes an approximately 5-week web-based stabilization phase, followed by 7-14 therapist-led sessions delivered primarily via videoconference, with some in-person sessions. Primary outcomes will assess feasibility (recruitment, retention, adherence, data completeness, and adverse events) and acceptability (satisfaction, alliance, and qualitative interviews). Exploratory outcomes include PTSD symptoms, self-compassion, emotion regulation, depression, anxiety, suicidality, and dissociation. Assessments will be conducted at baseline, poststabilization, posttreatment, and 6-month follow-up. Feasibility and acceptability will be summarized descriptively. Exploratory analyses using analysis of covariance and mixed effects models will estimate variance parameters, confidence intervals, and descriptive change trajectories without hypothesis testing. Qualitative data will be analyzed using reflexive thematic analysis. Recruitment started in February 2026, and data collection is projected to be completed by December 2028. Feasibility and acceptability outcomes, along with exploratory clinical patterns, will be reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) extension for pilot and feasibility trials. Findings will inform the refinement of the intervention, the assessment of trial feasibility, and the selection of outcomes for a fully powered noninferiority RCT. The study will also contribute to understanding how compassion-focused strategies may support emotional safety and engagement in trauma-focused treatment for adolescents.

Cognitive behavior therapy (CBT) has strong research support for obsessive-compulsive disorder (OCD). However, less is known about long-term follow-up effects of CBT in OCD. A systematic review and meta-analysis was conducted of different types of CBT for OCD in adults and children/adolescents. Four databases were systematically searched for studies published until March 2025. The effectiveness of CBT, methodological quality, and moderators were examined at post and follow-up. Forty-seven studies were included, comprising 2,817 participants. Attrition was lower in child (6.5%) than in adult studies (14.2%). Very large within-group effect sizes (ES; Hedges's g) were obtained for OCD-severity at post-treatment (2.35), and follow-up (2.54), on average 2.5&#x2009;years post-treatment. Adult studies maintained the ES from post to follow-up, whereas child studies showed a significant further improvement. Average response rates were 70% post-treatment and 69% at follow-up. Mean recovery rates were 48% post-treatment and 52% at follow-up. The degree of change in OCD severity during initial treatment was a strong moderator of the long-term follow-up ES. Exposure and response prevention, cognitive therapy, and the combination all yielded very large ESs with no significant difference between them. In conclusion, CBTs for OCD are effective and the effects are maintained at long-term follow-up.

In patients undergoing lumbar spinal fusion, a randomised controlled trial examined the effect of an early cognitive behavioural rehabilitation intervention designed to reduce sedentary behaviour. The intervention consisted of graded activity and pain education (GAPE). The objective of this qualitative study was to explore participants' experiences with GAPE following the three-month intervention period. This study employed an interpretive qualitative design. Participants were purposefully recruited 3&#xa0;months post-surgery. Semi-structured individual interviews were conducted, and data were analysed using a Template Analysis approach by a research group adopting an intermediate epistemological stance. A total of 11 participants were included. Based on the data, a final template was developed comprising four themes and associated subthemes: (1) An angel in the house post-surgery, (2) Embodied experiences and regaining control, (3) Master in my own house, and (4) Bridging personalised rehabilitation across settings. The study showed that GAPE provided meaningful support during the early post-surgical period after lumbar spinal fusion. Important factors included individually formulated goals, a strong therapeutic alliance, appropriate timing, and graded activity. These components helped participants understand their bodies and pain, thereby enhancing their safety and bodily confidence. Trusting relationships with physiotherapists and home-based sessions made rehabilitation both manageable and personally meaningful. Overall, GAPE supported participants' early recovery after lumbar spinal fusion by combining personalised goals, trusting therapeutic relationships, and home-based, graded activity, thereby enhancing bodily confidence and making rehabilitation manageable and meaningful. Strengths of the study include participant diversity and a reflexive, multidisciplinary research team, which strengthened data richness and transparency. However, the overrepresentation of highly educated participants and researcher involvement in intervention development may limit generalisability and introduce potential bias.

Evaluate changes in subjective-objective sleep discrepancies among participants with insomnia and a history of moderate-to-severe traumatic brain injury (TBI) following computerized cognitive behavioral therapy for insomnia (cCBT-I). An outpatient setting at a Department of Veterans Affairs medical center. United States veterans between the ages of 18 and 60 years with current insomnia and a history of moderate-to-severe TBI (N = 36). A secondary analysis of intervention-arm data from a randomized controlled trial. Participants completed an online cCBT-I program called SleepEZ. The program was primarily self-guided, with adjunctive assistance provided by a study clinician. Subjective sleep outcomes were measured using the Consensus Sleep Diary, which were collected nightly throughout the entire intervention. Objective sleep outcomes were measured using wrist-based actigraphy, which were collected during the initial and final weeks of the program. Subjective-objective sleep discrepancies were calculated for total sleep time (TST), sleep onset latency (SOL), waking after sleep onset (WASO), early morning awakening (EMA), and sleep efficiency. Measure agreement was estimated with Bland-Altman plots. Changes in subjective-objective sleep discrepancies were estimated through multilevel modeling. Poor agreement was observed for all 4 sleep outcomes. At baseline, participants overreported SOL and EMA on sleep diaries. However, WASO was greatly underreported, resulting in higher TST values calculated using sleep diaries compared with actigraphy. Following cCBT-I, overreporting of SOL decreased and sleep efficiency discrepancies grew larger, driven by improvements in subjective, but not objective, sleep measures. The concurrent use of subjective and objective measures is recommended to fully capture sleep health when treating insomnia after moderate-to-severe TBI. Further research is needed to elucidate mechanisms contributing to subjective-objective sleep discrepancies-potentially including specific aspects of cognitive impairment, striatal hyperactivity, or sleep pressure homeostasis-which may inform novel targets for post-TBI insomnia treatments among those with more severe injuries.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of cognitive-behavioural therapy for the management of subacute and chronic NP in adults.

Background: Post-traumatic growth (PTG) refers to positive psychological changes resulting from the struggle with highly challenging or traumatic life events. Psychosocial interventions have demonstrated efficacy in promoting psychological well-being in the aftermath of traumatic experiences. Cognitive Behavioral Therapy (CBT) is among the most extensively studied such interventions, aligning with the PTG model's prerequisites for growth. Objective: The aim of this systematic review was to assess the efficacy of CBT and CBT-based interventions in promoting PTG. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching PubMed, Scopus, and Google Scholar databases from inception to December 2024. Eligibility criteria included: (a) the inclusion of a CBT or CBT-based intervention, (b) measurement of PTG using the Post-Traumatic Growth Inventory (PTGI), (c) study participants having experienced traumatic life events, and (d) articles written in English. Risk of bias was assessed independently by two reviewers. Due to the heterogeneity of included studies, a qualitative narrative synthesis approach was adopted. Risk of bias was assessed using the RoB-2 tool for RCTs, ROBINS-1 for quasi-experimental studies and Newcastle-Ottawa scale for cohort studies. Certainty of evidence, assessed using the GRADE framework, is considered low. Results: A total of 19 studies were included (13 randomized controlled trials, 3 quasi-experimental, and 3 longitudinal studies). While traditional CBT produced mixed results in fostering PTG, CBT-based therapeutic protocols-particularly those explicitly designed to target PTG or incorporating structured cognitive-emotional techniques-demonstrated more consistent benefits. Limitations of the included studies include measurement of PTG as a secondary outcome, small sample sizes, and the presence of confounding variables. Conclusions: Further high-quality, multicenter randomized controlled trials with standardized protocols are needed to clarify the role of CBT in promoting growth after trauma.

Worry is common and distressing in psychotic disorders, contributing to the onset and persistence of persecutory delusions. A previously developed 8-week manualized cognitive behavioral therapy (CBT)-worry intervention has shown efficacy in treating persecutory delusions, compared with standard care. We aimed to test CBT-worry's impact on persecutory delusions at 8&#xa0;weeks, as previously reported, delusions at 24&#xa0;weeks, and secondary clinical outcomes, relative to an active comparison therapy. A two-arm, assessor-blinded, randomized controlled trial was conducted. Sixty-two adults with a non-affective psychotic disorder and current persecutory delusion were randomized to CBT-worry (n&#x2009;=&#x2009;32) or befriending (n&#x2009;=&#x2009;30). The preregistered primary clinical outcome was persecutory delusion severity. Outcomes were assessed at baseline, post-treatment (8&#xa0;weeks), and at follow-up (24&#xa0;weeks). Regarding primary outcomes, CBT-worry was not superior to befriending in treating persecutory delusions at post-treatment or follow-up (P's&#x2009;>&#x2009;.05). For secondary exploratory outcomes, CBT-worry demonstrated superiority over befriending for self-reported worry (d&#x2009;=&#x2009;.26, P&#x2009;=&#x2009;.006), depression (d&#x2009;=&#x2009;.23, P&#x2009;=&#x2009;.018), perseveration (d&#x2009;=&#x2009;.21, P&#x2009;=&#x2009;.024), insomnia (d&#x2009;=&#x2009;.25, P&#x2009;=&#x2009;.01), and asocial beliefs (d&#x2009;=&#x2009;.23, P&#x2009;=&#x2009;.022) and assessor-rated affective symptoms (d&#x2009;=&#x2009;.36, P&#x2009;<&#x2009;.001) post-treatment. At follow-up, no significant between-group treatment effects were found after correction for multiple comparisons. A brief CBT-worry intervention did not outperform befriending in the treatment of persecutory delusions. CBT-worry did, however, demonstrate significant benefit for affective symptoms post-treatment, compared to befriending. At follow-up, gains were maintained in CBT-worry but were also observed in befriending, minimizing group differences. Limitations include a small sample size, lack of a non-clinical control, and 20% drop-out. ClinicalTrials.gov (NCT04748679).

Obstructive sleep apnea (OSA) is associated with cognitive decline, but short-term studies show limited cognitive benefits of its treatment with continuous positive airway pressure (CPAP). We examined whether longer follow-up exhibits greater cognitive differences associated with CPAP use. We analyzed 777 participants from the 2011 National Health and Aging Trends Study (NHATS) with linked Medicare claims, with one or more claims for OSA and no baseline cognitive impairment. CPAP treatment was defined by one or more CPAP claims. Cognitive trajectories from 2011 to 2021 were estimated using a factor score derived from annual cognitive performance assessments and compared by CPAP treatment status using adjusted generalized linear mixed models. Cognitive performance declined over follow-up. CPAP-treated participants declined by -0.03 standard deviation (SD) units per year (95% confidence interval [CI]: -0.04, -0.02). Untreated participants experienced a 69% faster decline (CPAP-by-time interaction: -0.02; 95% CI: -0.04, -0.001). CPAP therapy may slow cognitive decline in older adults with OSA.

Background: As a crucial transitional period from campus to society, providing comprehensive undergraduate health psychological care is essential for addressing Social Anxiety Disorder (SAD). Current global healthcare research is actively exploring innovative digital interventions, with a specific focus on leveraging Augmented Reality (AR) as a transformative auxiliary tool in clinical settings. Methods: This study investigates the factors influencing the acceptance of AR-assisted Cognitive Behavioral Therapy (CBT) within student healthcare frameworks by developing a research model based on the Technology Acceptance Model (TAM). The framework incorporates key clinical and behavioral constructs: self-efficacy (SE), facilitating conditions (FC), and social influence (SI). Results: SE, FC, and SI significantly and positively impact the willingness to adopt AR technology for mental health purposes. Based on these findings, practical recommendations are provided for healthcare technology developers, therapists, and university psychological care providers to enhance the integration of AR-assisted CBT. Conclusions: Strengthening these digital pathways is vital for improving healthcare outcomes and enabling students to navigate future social and professional environments effectively. Because the sample consisted solely of Chinese undergraduate students, the findings should be interpreted within this specific cultural and educational context and require further validation in cross-cultural and multi-regional samples.

Most applications for depression lack comprehensive theoretical integration and qualitative assessments of university students' needs remain insufficient. This study aimed to explore the needs and experiences of university students with depressive symptoms and develop a theory-driven app design framework tailored to the target population. A post-positivist qualitative framework was used to recognize the value of subjective experience. Semi-structured interviews were conducted with 32 students with moderate to moderately severe depression. Reflexive thematic analysis was used to identify themes in the data. Three themes emerged: app design, help-seeking processes, and core features of cognitive behavioral therapy. Students emphasized the importance of discreet, user-friendly design, such as positive naming, privacy protection, and flexible reminder functions. Although some expressed concerns regarding the empathy and reliability of artificial intelligence, others valued its anonymity and capacity to provide immediate support. Regarding theoretical integration, participants considered monitoring emotions and physical sensations essential but also highlighted the need for diverse and personalized methods. The conceptualization of self-monitoring data was considered useful for facilitating clinical consultations. Students considered theory-based health education as effective for improving mental health knowledge and promoting help-seeking awareness. The findings support clinical decision-making in developing more effective digital tools.

Anxiety disorders are highly prevalent in childhood and adolescence, but access to treatment is limited. Internet-based cognitive behavioral therapy (ICBT) has been proposed as an effective treatment to increase accessibility to evidence-based treatment. This systematic review and meta-analysis aimed to investigate the efficacy of ICBT for children and adolescents with anxiety disorders and explore moderating effects of control conditions, age, parental involvement, and therapist support on treatment outcomes. Systematic searches were conducted in PsycInfo, PubMed, SCOPUS, Embase, and Web of Science to identify randomized controlled trials comparing ICBT with control conditions controlling for the effects of time or nonspecific effects of treatment. Studies should include children and adolescents aged 6-18&#x2009;years with anxiety disorders. The searches identified 1241 papers, of which 11 studies met the inclusion criteria. The adjusted pooled effect size estimate for the random-effects meta-analysis demonstrated a medium statistically significant effect in favor of ICBT over control conditions (g&#x2009;=&#x2009;0.740, 95% CI 0.555-0.925). The overall quality of evidence (GRADE) was rated as low due to risk of bias and inconsistencies in reporting. No significant moderators of treatment effects were identified. This meta-analysis supports the use of ICBT as a treatment option for children and adolescents with anxiety disorders. Additionally, the results suggest that therapist support format may be a relevant treatment component to explore in future studies. However, all findings must be subjected to additional testing, and more high-quality studies including long-term follow-ups are needed to assess the effects of ICBT and clarify the impact of moderators.

To estimate an optimal treatment selection in data from a recent RCT comparing short-term psychodynamic (STPP) and cognitive behavioral therapy (CBT) for depression. An estimator from causal inference with a valuesearch optimization was applied to estimate the optimal treatment choice for 100 patients diagnosed with major depressive disorder. Cross-validated prediction was performed, and the population mean outcome under optimal treatment was estimated. Outcomes (psychosocial functioning and depressive symptoms) for estimated optimal treatment were stratified by treatments received and compared for concordant versus discordant assignments. Large effect sizes were observed (range 0.41-2.07). "Positive beliefs about rumination" was found to be an important predictor, with higher baseline levels favoring CBT. An improvement of more than 30% relative to randomized treatment was considered clinically significant. For most patients (75%), CBT was identified as the optimal treatment, whereas patients in the optimal STPP group showed the greatest benefit for concordant assignment. The valuesearch method showed effective personalization, with greater improvement than typically reported in other methods of personalization with similar therapies and outcomes. A simple parametric user-specified treatment regime is easy to interpret, and robustness to model misspecification is appealing. Limited external validity is expected (small sample), and prospective validation is needed to guide clinical treatment selection. Head-to-head comparisons with other methods are required to draw conclusions about relative performance.

Stroke is a leading cause of global disability in the aging population, with cognitive impairments playing a significant role. Prior research has shown that subjective cognitive concerns (SCCs) can predict later dementia and serve as an essential indicator for poststroke functional rehabilitation. The use of smartphone-based ecological momentary assessment (EMA) in real-world environments may help us understand how SCCs relate to daily functioning in individuals aging with stroke, thereby guiding cognitive rehabilitation and prevention efforts. Our study aimed to use EMA to examine the real-time associations between SCCs and daily activity participation in persons aging with stroke. This longitudinal observational study used smartphone-based EMA for real-time assessment of individual cognitive concerns and participation in various daily activities. EMA survey items, including SCCs (concentration and learning) and participation in daily activities (location, company, current activity, and self-appraisals of performance, help needed, satisfaction, and engagement), were collected 5 times per day for 2 weeks. Multilevel models were used to analyze the data. A total of 202 individuals with mild-to-moderate chronic stroke participated in the study (n=90, 44.6% female; n=89, 44.1% Black; n=182, 90.1% ischemic stroke; mean age 59.7, SD 11.7 years). SCCs were concurrently lower when participants engaged in activities of daily living (ADL; B=-0.04, 95% CI -0.07 to -0.01; P=.02), instrumental ADL (B=-0.05, 95% CI -0.07 to -0.02; P<.001), cognitively stimulating activities (B=-0.05, 95% CI -0.08 to -0.02; P<.001), and social activities (B=-0.05, 95% CI -0.08 to -0.02; P=.002); when participants were located in a friend's home (B=-0.10, 95% CI -0.17 to -0.02; P=.001); and when they spent time with family members (B=-0.07, 95% CI -0.10 to -0.04; P<.001), friends (B=-0.05, 95% CI -0.10 to -0.01; P=.01), and spouse or partners (B=-0.04, 95% CI -0.07 to -0.01; P=.02). Conversely, SCCs were higher when participants were in the hospital (B=0.39, 95% CI 0.25-0.53; P<.001). Additionally, greater SCCs were concurrently associated with worse ratings of performance (B=-0.05, 95% CI -0.06 to -0.05; P<.001), satisfaction (B=-0.05, 95% CI -0.06 to -0.05; P<.001), and activity engagement (B=-0.05, 95% CI -0.06 to -0.04; P<.001). EMA provides an effective means of understanding the links between poststroke cognition and participation in daily activities. Our findings suggest that ADL, instrumental ADL, cognitively demanding activities, and socially engaging activities may lessen cognitive concerns among stroke survivors, implying that clinicians should schedule these activities to help reduce poststroke cognitive issues. Conversely, interventions that enhance cognition may increase participation in these challenging activities. Tracking cognition, everyday activity involvement, and their interactions in real-world settings could ultimately help develop rehabilitation and prevention strategies for individuals at risk of dementia due to stroke.

Some patients experience increased daytime sleepiness during early dCBT&#x2011;I, which may affect function and adherence. This study aimed to investigate daytime sleepiness during dCBT&#x2011;I, explore its influencing factors, and evaluate its predictive value for treatment efficacy. A retrospective analysis was conducted on 2271 insomnia patients treated at the sleep clinic of Hangzhou Seventh People's Hospital from November 2016 to January 2024. Daytime sleepiness and sleep quality were assessed using the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). ESS scores significantly increased at week 2, 4, and 6, peaking at week 2. Sex, medication use, snoring, and baseline ESS were significant influencing factors. Patients with early increased sleepiness showed greater PSQI reduction rates at subsequent follow&#x2011;ups. Univariate and multivariable linear regression confirmed that week 2 ESS exacerbation independently predicted higher PSQI reduction at weeks 4, 8, 12, and 16 (all p < 0.05). Transient increased daytime sleepiness often occurs in the early stage of dCBT&#x2011;I, which is related to multiple factors and can serve as a predictor of subsequent treatment efficacy.

Depression is prevalent and debilitating. Although interventions exist, they are rarely delivered in accessible, scalable ways that retain their effectiveness. Cognitive behavioral immersion (CBI) is a coach-led cognitive behavioral skills program delivered in social virtual worlds that offers a potential solution. This parallel-group, web-based randomized controlled superiority trial compared CBI accessed via virtual reality headsets (CBI-VR) or flat-screen devices (CBI-FS) to a delayed access control. Inclusion criteria included a clinical level of depression symptoms, age &#x2265;18 years, able and willing to give informed consent, access to a computer with an internet connection, and ability to speak and read English. Eligible participants were randomized using a random number generation script in a 1:1:1 ratio to conditions. CBI consisted of 8 weekly 1-hour groups led by coaches who taught cognitive behavioral skills. The intervention lasted 8 weeks; follow-up lasted 6 months. The primary outcome was depression symptoms; secondary outcomes were anxiety symptoms and quality of life. Recruitment and study procedures were conducted online. Outcomes were assessed through electronic self-report questionnaires. The study was unblinded. Hierarchical linear modeling was used to examine differences in rates of change among conditions. We explored the sense of presence as a potential mediator of intervention response. Participants were recruited from February 2024 to January 2025; n=102 were randomized to each condition. Participants randomized to CBI-VR and CBI-FS attended an average of 5 intervention sessions. Primary analyses included all participants in the intent-to-treat sample that completed &#x2265;2 outcome surveys to estimate within-person change (CBI-VR: n=98; CBI-FS: n=86; control: n=102). CBI-VR showed faster reductions in depressive and anxiety symptoms than either CBI-FS (depression: &#x3b2;=.21; 95% CI 0.02-0.40; P=.03 and anxiety: &#x3b2;=.20, 95% CI 0.03-0.38; P=.02) or the control (depression: &#x3b2;=.31, 95% CI 0.13-0.48; P<.001 and anxiety: &#x3b2;=.18, 95% CI 0.01-0.34; P=.03) across the 8-week intervention, with improvements largely maintained over the 6-month follow-up. CBI-VR also showed greater improvements in general quality of life (&#x3b2;=-1.02; 95% CI -1.63 to -0.40; P=.001) and psychological well-being (&#x3b2;=-1.01, 95% CI -1.44 to -0.59; P<.001) than the control from pre- to postintervention. The sense of physical presence in the environment was associated with CBI-VR's effects on depression symptoms (ab=-0.85, 95% CI -1.71 to -0.15). No adverse effects occurred in any group. This study evaluated the efficacy of an innovative coach-led cognitive behavioral skills group delivered via VR. To our knowledge, our trial is the first to demonstrate that CBI delivered via VR is effective. These findings extend prior work on digital cognitive behavioral therapy by supporting CBI-VR as an effective and viable intervention package for depression and anxiety symptoms. These findings may help inform future research on suitable technology that can help bridge mental health care gaps.

Behavioral Activation therapy is an effective treatment for major depressive disorder. Conceptually, the mechanisms through which it acts are thought to involve alterations to reinforcement learning, and several recent studies have supported this in laboratory settings. However, it remains unclear whether reinforcement learning mechanisms are involved in a realistic treatment setting. In a randomized controlled observational study in the UK NHS talking Therapy service, 152 participants with low mood received reinforcement learning assessments using an affective Go/No-Go task. The assessment timepoints were randomized between subjects, with assessments occurring either before (control; n&#x2009;=&#x2009;78) or during BA therapy (active; n&#x2009;=&#x2009;74). Changes in Pavlovian biases were quantified using computational modeling. Anhedonia improved during treatment, but not before (p&#x2009;=&#x2009;0.047; d&#x2009;=&#x2009;0.53). The active treatment group showed significant changes in Pavlovian parameters compared to controls (pFDR&#x2009;=&#x2009;0.012; d&#x2009;=&#x2009;0.65). Pavlovian biases became more positive in the active group (M&#x2009;=&#x2009;0.44, SD&#x2009;=&#x2009;0.81) and more negative in the control group ([Formula: see text], SD&#x2009;=&#x2009;0.70). Changes in aversive Pavlovian bias statistically mediated treatment effects on symptoms of anhedonia ([Formula: see text], p&#x2009;=&#x2009;0.036, bootstrap; p&#x2009;=&#x2009;0.0280). Behavioral Activation modified Pavlovian biases early in treatment by simultaneously strengthening appetitive and diminishing aversive responses. Reduction in aversive bias statistically mediated improvements in anhedonia, suggesting a specific cognitive mechanism through which Behavioral Activation exerts its therapeutic effects. The study provides evidence that online measurements of cognitive function may have potential as mechanistic biomarkers.