Waiting times for the start of psychotherapy remain long on average. However, actual waiting times for the individual phases of the psychotherapeutic treatment process are not usually differentiated. Furthermore, distortions of the average values due to outliers are rarely taken into account. A survey of 132 psychotherapy practices in Berlin was conducted to assess waiting times for the individual phases of psychotherapy for patients who had not yet been in contact with a psychotherapy practice. The waiting times were recorded for the period from initial inquiry to the first consultation session, from the consultation session to the first trial (probationary) session, and from the last trial session to the start of guideline-based psychotherapy. The data on waiting times were all non-normally distributed. The average waiting time between inquiry and the first consultation was 4.5 weeks, but the median was only 2 weeks, with 71% of practices reporting waiting times of less than 4 weeks. The average waiting time between the consultation and the first trial session was 5.9 weeks, with a median also of just 2 weeks; 67% waited less than 4 weeks. The waiting time between the last trial session and the start of guideline-based psychotherapy was short, with a mean of 2.5 weeks and a median of only 1 week. The relevant waiting times for patients who have not yet contacted a psychotherapy practice - from inquiry to the first consultation and from the consultation to the first trial session - are significantly shorter for many patients than the averages suggest. However, too many patients still wait more than 4 weeks in both of these phases of the treatment process. Nach wie vor sind die mittleren Wartezeiten auf den Beginn einer Psychotherapie lang. Wenig untersucht wurde bisher die Differenzierung der Wartezeit auf die einzelnen Phasen des psychotherapeutischen Behandlungsprozesses. Zusätzlich wird die statistische Verzerrungen der Mittelwerte durch Ausreißer wenig berücksichtigt.In einer Befragung von 132 Psychotherapiepraxen in Berlin wurden die Wartezeiten auf die einzelnen Phasen der Psychotherapie ohne Kontakt zu einer Psychotherapiepraxis erhoben. Es wurden die Wartezeiten von Anfrage bis zur 1. Sprechstunde, von der Sprechstunde bis zur 1. probatorischen Sitzung und von letzter probatorischer Sitzung bis Beginn der Richtlinienpsychotherapie erfasst.Alle Daten der Wartezeiten waren nicht normalverteilt. Zwischen Anfrage und 1. Sprechstunde war die Wartezeit im Mittel 4,5 Wochen, im Median nur 2 Wochen, 71% der Praxen gaben Wartezeiten<4 Wochen an. Die Wartezeit zwischen Sprechstunde und 1. probatorischer Sitzung wurde im Mittel mit 5,9 Wochen, im Median ebenfalls mit nur 2 Wochen angegeben, 67% warteten weniger als 4 Wochen. Die Wartezeit zwischen letzter probatorischer Sitzung und Beginn der Richtlinienpsychotherapie war mit einem Mittelwert 2,5 Wochen und einem Median von nur 1 Woche kurz.Die relevanten Wartezeiten ohne Kontakt zu einer Psychotherapiepraxis von Anfrage bis zur 1. Sprechstunde und von der Sprechstunde auf die 1. probatorische Sitzung sind für viele Patienten deutlich kürzer als die Mittelwerte vermitteln. Allerdings warten zu viele Patient*innen mit mehr als 4 Woche für beide Phasen des Behandlungsprozesses noch zu lange.
To evaluate the effects of music relaxation training combined with hierarchical nursing management on vomiting symptoms and psychological resilience in patients with chemotherapy-induced nausea and vomiting (CINV). In this retrospective study, 142 patients with CINV treated between June 2023 and January 2025 were stratified into three groups: the control group ( n  = 46, routine multidisciplinary care), the observation group 1 ( n  = 47, additional hierarchical nursing) and the observation group 2 ( n  = 49, hierarchical nursing plus music relaxation training). All care continued over three chemotherapy cycles. Outcomes were assessed by using the Index of Nausea, Vomiting and Retching (INVR), Connor-Davidson Resilience Scale (CD-RISC), State Anxiety Inventory (S-AI), Cancer Fatigue Scale (CFS), Functional Living Index-Emesis (FLIE) and compared pre- and post-intervention. Data were analysed using the chi-squared test, t -test and one-way analysis of variance. After care, observation groups 1 and 2 showed superior outcomes to the control group across all measures. Specifically, INVR subscale scores (nausea, vomiting and retching) were significantly lower in the observation groups than in the control group, with the observation group 2 demonstrating further reductions compared with the observation group 1 (e.g., nausea: 2.81 vs. 3.87; P < 0.05). All CD-RISC dimension scores were higher in the observation groups than in the control groups and again were highest in the observation group 2 (e.g., optimism: 11.42 vs. 9.64; P < 0.05). Similarly, S-AI and CFS scores were lower in the observation groups, with the observation group 2 showing the lowest scores amongst all groups (S-AI: 29.46 vs. 34.25; CFS: 27.97 vs. 31.24; P < 0.05). Finally, FLIE nausea and vomiting subscale scores were higher in the observation groups than in the control group, with the observation group 2 scoring highest amongst groups (nausea: 56.64 vs. 53.46; vomiting: 53.48 vs. 51.37; P < 0.05). Integrated music relaxation training and hierarchical nursing may alleviate CINV symptoms, enhance psychological resilience, reduce anxiety and fatigue and improve quality of life.
Internet-based interventions (IBIs) offer scalable, low-threshold treatment options for mental health care. The therapeutic alliance is a key collaborative quality in psychological therapy, yet its role and structure in IBIs remain debated. This correlational meta-analysis synthesizes the overall alliance-outcome association (k = 82 effect sizes nested in s = 40 independent samples; n = 2,864 participants) and its variability across the Working Alliance Inventory subscales using meta-analytic multilevel models. The overall association was small to moderate (r = .21) confirming the relevance of alliance in digital contexts. Subscale-specific analyses showed that task (r = .25) and goal (r = .19) were more predictive of treatment outcomes than bond (r = .12), highlighting a shift toward cognitive-collaborative components in IBIs. Even exploratory in nature, none of the examined moderators (diagnosis, alliance rater, face-to-face contact, therapeutic approach, publication year, and country) systematically influenced the effect size. The results confirm the robustness of the prediction of the alliance on outcomes observed in the general literature and at the same time point to the particular qualities of using IBIs. Future work is needed to adapt the conceptualization and assessment of alliance in IBI. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Several clinical practice guidelines (CPGs) have been developed for complex regional pain syndrome (CRPS). The aim of our study was to appraise CPGs for non-pharmacological conservative management of CRPS. We systematically searched five electronic databases, from inception to January 2025, to include CPGs that focused on non-pharmacological conservative management of CRPS. We used AGREE-II to evaluate the quality of the CPGs. Recommendations, aims, and treatment algorithms of the CPGs were presented in a narrative format, thematic analysis, and matrixes to summarise, categorise, and compare the findings of the guidelines. Nine CPGs met the inclusion criteria, including three updated versions of previously published guidelines. After accounting for updates, six unique guidelines were appraised. Two were rated as high-quality, two as moderate-quality, and two as low-quality. All CPGs scored > 60% in the AGREE-II domains of scope/purpose and clarity of presentation, while rigour of development was the lowest-scoring domain, with only two guidelines achieving ≥ 60%. No guideline addressed updating procedures. The most common interventions recommended by CPGs were pain management (100%) followed by functional restoration (83%), stress-loading (67%), psychotherapy (67%), edema management (67%), gentle active movements (67%), vocational rehabilitation (67%), normal functional activities (67%), general PT interventions (67%), and isometric-isotonic strengthening (67%). The methodological quality of many CPGs for non-pharmacological management of CRPS is low, particularly in the domain of rigour of development. Recommendations across guidelines are variable, often lacking detail, consistency, and integration of supporting evidence. Pain management, functional restoration, and inter/multidisciplinary care were the most commonly recommended considerations, while guidance on treatment frequency, dosage, and implementation strategies was limited.
Sexual dysfunctions in individuals with social anxiety disorder (SAD) have been previously reported. However, most of these results refer to physical and behavioral measures. Psychological aspects have not been previously researched. In the present study, we utilized an online version of the "Multidimensional Sexuality Questionnaire" (MSQ) in a sample of individuals with SAD (n = 242, 40.70 ± 13.40 years, 58.7% female). We hypothesized greater difficulties for SAD individuals compared to controls without SAD through the influence of fear and avoidance symptoms. Based on multivariate analyses (MANCOVA), SAD individuals showcased significant deficiencies in almost all subscales of the MSQ compared to the control group (partial η2 = 0.016 - 0.217, all p < .001). Moreover, men with SAD were significantly more preoccupied and motivated for sexual behaviour and relationships than women with SAD (partial η2 = 0.104 - 0.159, all p < .001). These results give first insights for psychological reasons possibly underlying sexual difficulties in SAD patients. SAD individuals spend less time thinking about and are less motivated for sexuality. Assertiveness and the belief of one's control and autonomy of sexuality are less pronounced in SAD individuals. Those signs can be approached via different techniques and therapeutic interventions if difficulties with sexuality and sexual satisfaction are relevant for those affected by SAD. Not applicable.
Female Sexual Dysfunction (FSD) affects 40%-45% of women globally, with multifactorial causes including pelvic floor dysfunction and hormonal changes. While hormone therapy and psychobehavioral interventions have demonstrated efficacy, they are often limited by side effects, contraindications, variable adherence, and a lack of standardized protocols. Physical therapy (PT) approaches have emerged as promising non-invasive alternatives or adjuncts, targeting underlying neuromuscular, vascular, and structural mechanisms of FSD. This review focuses on PT approaches, evaluating their mechanisms and clinical outcomes to guide evidence-based practice. The review followed the PICO framework: Population (women with FSD), Interventions (PT modalities), Comparators (sham/control/alternative treatments), and Outcomes (sexual function scores, pelvic floor muscle parameters, safety). A systematic search was performed in PubMed, Embase, and Web of Science up to April 13, 2025. The search strategy combined relevant MeSH terms and keywords using Boolean operators across three conceptual blocks: including "Sexual Dysfunction, Physiological"[Mesh], "Hypoactive Sexual Desire Disorder", "Orgasmic Disorder" etc., AND "transcutaneous electrical nerve stimulation", "pelvic floor muscle training", "gradual dilation," etc., AND "Women"[Mesh], "Female," "female patient" etc. The full search strategy and screening flowchart is available in Supplementary Material. Inclusion criteria: Randomized controlled trials (RCTs), cohort studies, pilot studies, and case reports were included if they involved women with FSD who received PT interventions and reported outcomes related to sexual function. Exclusion criteria: non-PT interventions, non-FSD populations, and non-English publications. Study selection involved two independent reviewers screening titles/abstracts and full texts. Data on study design, population, intervention, outcomes, and key findings were extracted into standardized tables. Forty-nine clinical studies with 2742 participants were included. Electromagnetic therapy, electrical stimulation, Radiofrequency therapy, pelvic floor muscle training, multimodal pelvic floor physical therapy, vibratory stimulation, dilator therapy, and acupuncture all demonstrated potential efficacy in improving FSD-related symptoms, including sexual function, vaginal laxity, pain, and orgasmic function. Numerous physical therapy modalities have demonstrated potential efficacy in improving FSD-related symptoms, although evidence quality varies across interventions. Future large-scale RCTs with standardized protocols are needed to confirm long-term benefits and establish optimal treatment algorithms.
Normal aging is associated with alterations of functional connectivity in brain neuronal networks. Altered network connectivity may be associated with accelerated cognitive decline. Physical activity is considered a beneficial lifestyle factor for maintaining cognitive health. Higher intensities of physical activity may induce structural and functional changes in the brain, particularly in regions involved in cognitive functions. However, the underlying neural mechanisms are not widely investigated. Our aim was to examine the association between resting-state functional connectivity of brain networks previously associated with cognitive and motor functions, physical activity and cognitive performance in healthy older adults. We analyzed resting-state fMRI, physical activity and neuropsychological data of 149 healthy older adults (mean age: 68 years). Physical activity was measured by using actigraphs worn for 7 days and categorized into moderate-to-vigorous activity. Euclidean norm minus one values used to represent mean overall physical activity. We used a hypothesis driven seed-based approach and data-driven independent component analysis to examine brain network activity of a priori selected brain regions and networks. No significant associations were found in the seed-based analyses. The independent component analyses showed spatially restricted effects of moderate-to-vigorous physical activity in frontal regions of the default mode and salience networks, at p < 0.01 uncorrected. Different physical activity intensities were not significantly associated with resting-state functional connectivity of various brain networks in a sample of healthy older adults. This finding contrasts with the results of previous cross-sectional studies.
Music therapy (MT) is increasingly being integrated into intensive care unit (ICU) settings to modulate pain, stress, and emotional dysregulation. Although clinically promising, objective biomarkers for quantifying its neurophysiological effects are still missing. In this context, the electroencephalogram (EEG) represents a valid tool to assess cortical dynamics associated with cognitive-affective engagement elicited by MT. Our study aims to evaluate the role of electroencephalography as an objective tool for monitoring cortical responses to MT in the ICU. EEGs acquired from nine burn patients undergoing MT in the ICU were considered. Signals were preprocessed to improve the signal-to-noise ratio. Then, six frequency bands (delta, theta, alpha, beta, gamma, and sensorimotor rhythm) were extracted to compute band powers and derive 37 involvement indexes, which were statistically compared across three experimental phases: before, during, and after MT. Results demonstrate that involvement indexes effectively capture neurophysiological shifts induced by MT. Significant differences were observed in 22 indexes when comparing During-MT and Post-MT phases, with 2 indexes being statistically different also when comparing During-MT and Pre-MT phases; 5 indexes differed statistically when comparing Pre-MT and Post-MT phases. These results suggest a transient cortical engagement elicited during MT in ICU settings. Our findings align with previous research reporting EEG (and certain EEG-derived involvement indexes) sensitivity to capture music-induced cognitive and emotional modulation. This confirms electroencephalography potential to objectively reflect MT effects and support its integration in multidisciplinary burn care; however, analysis on larger cohorts is necessary to validate EEG as a clinical tool in MT.
Whereas biological sex differences in psychosis are well-documented in terms of clinical presentation and illness course, their moderating role in the effectiveness of cognitive interventions remains unclear. Previous studies in first-episode psychosis (FEP) suggested sex-specific responses to Metacognitive Training for psychosis (MCT) on cognitive insight and jumping to conclusions (JTC) bias, but generalizability to broader clinical populations is unknown. This retrospective study analyzed harmonized individual participant data from 633 persons with schizophrenia spectrum disorders (SSD) who received MCT across 22 international studies. Treatment effects and potential sex moderation were analyzed using repeated-measures ANOVAs and mixed-effects logistic regression on cognitive insight (Beck Cognitive Insight Scale) and JTC bias (Cognitive Biases Questionnaire for Psychosis, JTC subscale; Beads tasks). MCT produced significant improvements in cognitive insight and JTC bias, including reduced self-certainty (F = 22.899, p < .001), improved composite cognitive insight score (F = 11.787, p < .001), and decreased JTC bias on both continuous (F = 4.109, p = .044) and dichotomous measures (OR = 0.592, 95% CI: 0.356-0.984). However, no significant time × sex interactions were observed for any outcome, indicating equivalent treatment benefits across sexes. Contrary to previous FEP-specific findings, sex does not moderate MCT efficacy in heterogeneous clinical samples including established schizophrenia. These results may support MCT implementation without sex-specific adaptations in routine clinical practice.
There is evidence that treatment expectations predict treatment outcomes in pain management and other clinical conditions. However, translating these insights into clinical practice remains challenging: it is difficult to measure the multifaceted construct of expectations across diverse medical and psychological treatment modalities. Furthermore, little is known about how prior treatment experiences shape different expectation domains. A unified assessment approach is lacking, limiting comparability across studies and clinical contexts. The Generic Rating Scale for Previous Treatment Experiences, Treatment Expectations, and Treatment Effects (GEEE) seeks to overcome these limitations. The present study aims to explore the GEEE in a naturalistic clinical sample of people seeking treatment for chronic pain, which may provide preliminary evidence for its validity and applicability. An additional exploratory aim is to examine whether the GEEE is suitable for predicting treatment outcomes longitudinally in this clinical setting. Prospective longitudinal observational study with three measurement time points (baseline, 3 weeks and 16 weeks). Specialised outpatient pain treatment centre in Germany. The baseline sample comprised 219 patients with chronic pain, follow-up data were available from 140 participants at 3 weeks and 108 participants at 16 weeks, constituting the longitudinal subsamples. Primary outcomes were prior treatment experiences, current treatment expectations and treatment effects, which were assessed using the GEEE, as well as clinical outcomes of pain intensity and pain-related disability. Secondary measures included desire for pain relief, depression and anxiety symptoms, which were analysed in correlational tests to assess construct validity. Trajectories of treatment expectations and clinical outcomes were examined longitudinally, and it was assessed if baseline expectations predicted clinical outcomes over time. Regarding validation, at baseline, improvement expectations correlated weakly with expectations of worsening and side effects (Rho≈-0.14 to -0.15, p=0.028-0.034). Negative previous treatment experiences were associated with current expectations of worsening and side effects (Rho≈0.35-0.41, p≤0.002). The GEEE items on current treatment effects correlated with changes in clinical outcomes (pain intensity and pain-related disability; |r|≈0.17-0.56, all p≤0.043). Regarding prediction, treatment expectations remained stable, while pain intensity (η²G=0.076, p<0.001) and pain-related disability (η²G=0.037, p<0.001) decreased over time. Regression models predicting subjective improvement were significant at 3 weeks (R²=0.18) and 16 weeks (R²=0.29), with baseline improvement expectations emerging as a significant predictor. Models predicting pain intensity and disability at 16 weeks were also significant (R²≈0.50-0.59), and higher baseline improvement expectations were independently associated with better outcomes. We found supporting evidence for the validity of the GEEE and its applicability in longitudinal clinical research. Improvement expectations as measured with the GEEE at baseline predicted better treatment outcomes, while previous negative treatment experiences correlated with current treatment expectations. The findings underscore the value of assessing and addressing expectations and prior treatment experiences to optimise treatment outcomes.
Psychotherapy, the standard treatment for borderline personality disorder, is often difficult to access, and its application in the field is hampered by neurocognitive and psychosocial impairments. This lack of care contributes to the psychosocial stagnation of vulnerable individuals, which is costly for society, particularly in terms of repeated visits to emergency rooms and prolonged hospitalizations. This context also leads to professional burnout and harmful stigmatization. Follow-up care aims to limit these episodes by anticipating emergency situations and gradually reintegrating patients into a more personalized care pathway.
Conditioned pain modulation (CPM) is a set of psychophysical paradigms that is increasingly used clinically to evaluate descending pain modulation pathways. Impairment is common in chronic pain, suggesting CPM may serve as a mechanistic indicator. However, the lack of protocol standardization and reference data prevents clinical use in individual patients. We compared two CPM protocols with different conditioning stimulus intensities, test stimulus types, and interaction timing. We assessed CPM effect size, test-retest reliability and sensitivity to detect loss of descending inhibition. Conditioning with 0°C water led to stronger inhibition of pressure pain threshold (PPT) than conditioning with 7°C water (Cohen's d = 0.52), when tested immediately after conditioning. When tested during conditioning, effects of 7°C water immersion on heat pain sensitivity had similar magnitude (D = 0.53) and test-retest reliability (ICC = 0.77) as those on PPT (D = 0.54, ICC = 0.73). For all outcomes assessed, 95% confidence intervals (CI) of CPM effect included some facilitation instead of inhibition. The maximum degree of facilitation compatible with normal CPM (upper cutoff of CI) indicates potential sensitivity to detect individual abnormality. This was most favourable for PPT assessed after conditioning with 0°C water (decrease by more than 75 kPa or 14% of baseline PPT). In conclusion, testing during conditioning stimulation yields medium to large effect sizes and good test-retest reliability. PPT testing immediately after ice water immersion has the narrowest 95% CI and hence offers the potential to generalize CPM assessments beyond group-level differences and compare inhibition among individuals in clinical practice. Indicating the main aspects where this work adds significantly to existing knowledge in the field, and if appropriate to clinical practice. Simultaneous CPM protocols exhibit large effect sizes but are confounded by divided attention. We recommend a sequential protocol and provide model reference data for abnormal facilitation.
Suicide is a major public health issue. Efforts to prevent it must begin as soon as hospitalization. Brief mental health interventions and contacts are known to be effective. The HOPAIR study proposes an innovative combination of peer support intervention and the Hope Box tool, followed by a reminder postcard sent to suicidal individuals hospitalized in psychiatric crisis units at two research centers in Lyon. Focusing on the resources of those affected, hope, and recovery, this study highlights the work of peer support workers and advanced practice nurses while offering encouraging prospects in the field of suicide prevention.
The transition to fatherhood constitutes a substantial life event that can profoundly impact individuals and their relationships. This influence may be amplified when an anorexia nervosa (AN) is present within the family. This study aimed to examine paternal experiences during the pre- and postpartum period and assess how maternal AN influences these experiences. Six semi-structured qualitative interviews were conducted with three male partners of women with and without AN, to explore their prepartum perspectives on the paternal role, their postpartum eating behaviors, overall well-being, and the impact of the AN on their relationship. The data was analyzed in accordance with the principles of qualitative content analysis as proposed by Mayring. The analysis yielded six main categories that were deductively identified from the interview guide, with several sub-categories generated from the interview data. Many topics were raised by both groups and are in support of previous research. Group-specific aspects also emerged, such as a lower level of reflection on fatherhood among partners of women with AN. All partners of women with AN noted that the disorder affected the relationship, for example by causing conflicts. The partly distinct experiences reported by the two groups highlight the impact of maternal AN on family dynamics and emphasize the need to incorporate paternal perspectives in eating disorder research during the transition to parenthood. Integrating fathers' experiences can enhance understanding of familial dynamics and inform the development of targeted interventions to support all family members during this critical period. Evidence obtained from well-designed cohort or case-control analytic studies.
This study examines resilience's role in modulating autonomic nervous system (ANS) responses to repeated psychosocial stress, assessed via heart rate variability (HRV) and heart rate (HR) changes. Sixty healthy males completed the Trier Social Stress Test (TSST) across four sessions, each with six stress phases, to evaluate acute stress response and physiological habituation. Resilience, measured by the Brief Resilience Scale (BRS), was analyzed in relation to HR, HRV indices. Resilient individuals exhibited better physiological recovery after acute stressor, with increased RMSSD and SDNN post-stress and reduced HR, peak HR, and delta HR for repeated stressor. While HR parameters habituated to repeated stress, anticipatory anxiety (pre-TSST STAI) increased, highlighting a distinction between physiological adaptation and psychological stress anticipation. Despite RMSSD, SDNN and LF recovery after acute stressor, resilience did not significantly impact high-frequency (HF) power. Resilience appears to enhance physiological recovery after acute stressor and adaptive physiological regulation under repeated stress, supporting its role as a protective factor. These findings have implications for interventions aimed at strengthening stress resilience and reducing allostatic load.
'Ego dissolution' refers to a temporary state characterized by diminished self-referential processing, which leads to a breakdown of personal boundaries and an enhanced sense of unity with the environment. Both psychedelics, such as ayahuasca, and contemplative practices, like meditation, have been proposed as mechanisms for modulating the ego. While ayahuasca induces transient self-perception alterations, meditation promotes more sustained changes through cognitive and emotional regulation. This study examines whether ayahuasca consumption modulates the ego and compares its effects with those of meditation. A total of 37 ayahuasca users and 137 meditators participated. We used the "Delusion of Me" (DoM) index, a unidimensional self-report measure comprising three domains: acceptance, decentering, and non-attachment. It could be considered closely related to the concept of self 'as a content' and may potentially serve as a measure of ego. Meditators exhibited significantly higher DoM scores than ayahuasca users. The quadratic regression did not show a cumulative effect, with no significant relationship found between the number of ayahuasca sessions and DoM scores. Meditation practice correlated with higher DoM scores and cumulative practice showed a significant non-linear association with DoM. Conversely, repeated ayahuasca exposure demonstrated no evidence of a cumulative association in this sample.
Objective: To develop a program of psychotherapeutic rehabilitation for mental patients who abuse synthetic cannabinoids and to describe phenomenon of this comorbidity. Object of study: The total sample included 311 young men dependent on synthetic cannabinoids: 169 with specific and persistent personality disorders and 142 with paranoid schizophrenia. Methods: Follow-up, clinical-psychopathological, psychometric (ICD-10, CGI, GAF, SANS), statistical methods were used. Results and discussion: The developed psychotherapeutic rehabilitation program for people with drug addiction, replacing the need for drugs with the need to stay in socially acceptable addictive groups, allows to improve the quality and duration of remissions, reduce the frequency of drug addiction, improve their condition and functioning.
Twin registries worldwide increasingly function as large-scale research infrastructures, enabling standardized phenotyping across the lifespan, integration of biological and environmental data streams, and international cross-cohort collaborative research and replications. This development is also taking place in Germany. The GERman Twin Registry Under Development (GERTRUD; www.gertrud.info) was established in 2022 as the first nationwide research platform for recruiting twins and higher order multiples of all ages within Germany to support the large-scale genetically informative psychological, sociological, health, and neuroscience twin research at national and international levels. GERTRUD is being developed as a modular infrastructure that supports classical and extended twin family designs, combining annual core survey waves with optional embedded modules for intensive phenotyping (e.g., neuroimaging, smartphone-based assessments), biosampling, and linkage of participants' residential context to external geographic datasets via geospatial information systems (GIS). To operate within Germany's stringent data protection landscape, GERTRUD implements project-specific pseudonymisation, role-based access control, and contract-governed remote analysis access. This article describes GERTRUD's governance and legal-technical framework, its multisource data architecture, and the potential for collaboration across Germany and internationally. Examples of early data implementations further illustrate that the continuously collected multimodal twin data constitute a critical asset, essential for successful harmonization, replication, and collaborative and integrative behavioral genetics research.
Evidence-based psychological interventions are usually not accessed by marginalized groups such as refugees. Culturally adapted psychological interventions have reported larger effect sizes than nonadapted psychological interventions. However, the cultural adaptation of interventions is a lengthy process, entailing a challenge. One potential solution to overcome this challenge is the use of artificial intelligence (AI). The aim of this study was to investigate and compare the perceived cultural relevance and acceptability of 2 common cognitive behavioral therapy (CBT) techniques when translated and culturally adapted by AI versus a human psychologist. In a 2×2 factorial design, the text generator type (AI vs human psychologist) and the CBT technique (cognitive restructuring vs behavior modification) were compared. CBT technique texts translated and culturally adapted either by AI or by a human psychologist were blindly rated using the Cultural Relevance Questionnaire and the Theoretical Framework of Acceptability. Raters were Arabic-speaking refugees and immigrants, aged between 18 and 69 years, residing in Sweden, Denmark, and Germany. Raters were randomly allocated to 1 of 4 conditions. Each condition consisted of 2 stimuli. Two-factor between-subject design analyses were used to analyze the data. A significant main effect of the text generator domain type (P=.02; η²=0.045) was found in the first rating, with texts adapted by the AI domain perceived as more culturally relevant than those adapted by the human domain. No significant main effect of the CBT technique was found in the first rating (P=.10; η²=0.022). There were no differences in the second rating. Regarding acceptability, no significant main effects of text generator domain type (P=.09; η²=0.024) or the CBT technique (P=.88; η²=0.001) were found in either of the ratings. CBT technique materials adapted by AI may be perceived as similarly culturally relevant as those adapted by a human psychologist. This finding implies the potential to accelerate the cultural adaptation of psychological interventions. However, AI still needs to be used with caution and in accordance with rigorous safety standards and robust frameworks.
Auditory hallucinations (AHs) are debilitating symptoms of schizophrenia spectrum disorders (SSDs) associated with several negative outcomes. AHs are often resistant to existing pharmacological and psychological interventions. Virtual reality (VR) has emerged as a promising intervention for AHs. This systematic review and meta-analysis aimed to assess the effectiveness of VR interventions in treating AHs in SSDs. A comprehensive literature search was conducted on Embase, APA PsycINFO, and MEDLINE via the Ovid Database. Studies with a randomized controlled trial (RCT) or randomized cross-over trial design that had treatment and active or treatment-as-usual control conditions were included. Random-effects meta-analyses compared the change in the primary outcome of AH severity from baseline to post-treatment and at follow-up between the groups. Eight studies (n = 1004) met the criteria for the meta-analyses. Eight studies used avatar therapy (AT), and 1 study used a VR-based mindfulness intervention. Random-effects meta-analyses found that VR interventions were more effective than the control conditions in reducing AH severity immediately post-intervention (Hedges' g = -0.41, 95% CI [-0.62, -0.20], P < .01) and at follow-up (Hedges' g = -0.28, 95% CI [-0.40, -0.17], P < .001). This review was limited by a small sample size, study heterogeneity, and intervention homogeneity. Future research should prioritize larger RCTs of VR-based interventions for psychosis before VR can be reliably used in clinical settings. Overall, the results of this meta-analysis suggest that VR-based AT may be a promising avenue to improve AHs in SSDs.