<![CDATA[Lifestyle medicine pillars help reshape depression and anxiety treatment in psychiatry.]]>
Effects of bifrontal-transcranial direct current stimulation combined with music listening on sleep quality, cortical activation and functional connectivity in patients with insomnia: a randomised controlled trial by fNIRS
BackgroundAlthough music listening and transcranial direct current stimulation (tDCS) alone have certain effects in the treatment of insomnia, the sleep regulatory effects and neural mechanisms of the combined treatment in patients with insomnia disorder (ID) are unclear. This study aimed to investigate the efficacy of combined bifrontal-tDCS (F3: anode, F4: cathode) with music listening in patients with ID using functional near-infrared spectroscopy (fNIRS).Methods76 ID patients were randomly divided into an intervention group (n=38) and a control group (n=38), and received 4 weeks of a total of 20 sessions of music + tDCS therapy and music + sham tDCS therapy (30-second stimulation with fade-in/fade-out to mimic somatic sensations), respectively. The Pittsburgh Sleep Quality Index Scale (PSQI), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), and Perceived Stress Scale (PSS-14) were compared between the two groups before and after treatment. Oxy-haemoglobin (HbO2) concentration and functional connectivity (FC) were assessed during the verbal fluency task using fNIRS.ResultsCompared with the control group, the PSQI total score (mean difference: -2.57 points, 95% CI: -4.43 to -0.71, p = 0.001), PSQI sub-scores except “sleep disturbance and daytime dysfunction”, SDS and SAS scores of the intervention group improved significantly after treatment. It was observed by fNIRS that the HbO2 concentration in the medial prefrontal cortex (mPFC), left dorsolateral prefrontal cortex (DLPFC), right ventrolateral prefrontal cortex, and right superior frontal cortex (SFC) increased significantly after treatment in the intervention group but was not superior to the control group. In addition, the FC enhancement of left SFC-left DLPFC and left SFC-mPFC after treatment was significantly better in the intervention group than in the control group, and the PSQI improvement was positively correlated with the FC enhancement of channel-averaged and left SFC-right DLPFC.ConclusionsCombining bifrontal-tDCS with music listening is more helpful in improving sleep quality and prefrontal functional connectivity in ID patients compared with music listening alone. For ID patients, music electrical stimulation headphones may be a safe, effective, and convenient new treatment strategy.Clinical trial registrationhttps://www.chictr.org.cn/, identifier ChiCTR2400086233.
PAD-S/CSA as a candidate shared representation layer for computational psychotherapy: minimal architecture and a staged validation roadmap
Psychotherapy schools often describe overlapping process phenomena in non-interoperable vocabularies. This pluralism is clinically valuable but computationally costly: datasets become difficult to compare, clinically load-bearing distinctions are collapsed into convenience labels, and artificial intelligence (AI) systems inherit annotation schemes rather than a clinically interpretable intermediate representation. Building on the Perceive–Assess–Dose–Safeguard (PAD-S) framework and the Conflict-Square Algorithm (CSA), this theory article asks a narrower question than the prior PAD-S and CSA papers: can the same variables be formulated as a candidate shared representation layer between heterogeneous observation models and school-specific intervention policies? The proposed layer projects a high-dimensional biopsychosocial state into four clinically observable process coordinates—defensive/avoidant organization (DEF), anxiety/arousal and tolerance (ANX), progression toward direct experience and action (PRO), and self-attack/shame processes (SUP)—plus a safety threshold that constrains admissible intervention intensity. The contribution is architectural rather than empirical: it isolates the representational role from earlier decision-grammar and transcript-coding roles; clarifies the distinction between observations, representation, and policy; specifies a minimal falsifiable family of state-transition models; illustrates translation across four pragmatic therapy families; and defines a staged validation order from reliability and function linkage to transcript-level predictive operationalization and only then sparse equation discovery. The framework should therefore be read as a candidate shared representation layer for computational psychotherapy and computational psychiatry rather than as a therapy protocol, a fitted predictive model, a complete generative theory, or an autonomous decision system. No new dataset, fitted classifier, transcript-level predictive result, or discovered equation is reported here. The article aims instead to state what would count for or against PAD-S/CSA as a clinically interpretable interface for later empirical modeling.
Impact of Play Interventions on Stress and Anxiety Using EEG and AI.
Conditions: Anxiety; Stress
Interventions: Behavioral: playful intervention
Sponsors: Universidad Autonoma de Baja California
Not yet recruiting
Interventions: Behavioral: playful intervention
Sponsors: Universidad Autonoma de Baja California
Not yet recruiting
Prevalence of Cognitive Distortion Markers in a Suicide Prevention Chat Service: Mixed Methods Study
Background: Suicide helplines increasingly employ chat services to aid those in urgent need, but the wording and structure of text-driven exchanges may affect their effectiveness. Objective: Given the association of cognitive distortions with depression and anxiety, this study investigated their prevalence in the language of individuals seeking help from the Dutch 113 suicide helpline. Methods: We observed the prevalence of cognitive distortions for both help seekers and counselors in a large volume of chat sessions (N=71,148) of the Dutch 113 suicide chat helpline using natural language processing. The results were compared to 2 large collections of online text data from Dutch social media and web content. Results: We found that nearly all types of cognitive distortions are more prevalent in the language of help seekers compared to the control group of helpline counselors. Distortions of the personalizing, emotional reasoning, and mental filtering types were, respectively, 20.22, 7.87, and 4.53 times more prevalent among help seekers, revealing a distinct pattern of thought and language among individuals affected by suicidality. Conclusions: Our results raise the prospect of improving the effectiveness of online therapeutic interventions that target cognitive distortions through lexical analysis that detects the cognitive and lexical markers of suicidality.
<img src="https://jmir-production.s3.us-east-2.amazonaws.com/thumbs/00f57a522b7e20d230db8854f4090023" />
Safety and preliminary efficacy of Aurora: a pilot, non-randomized clinical trial of a culturally adapted digital cognitive behavioral therapy intervention for anxiety and depression in Mexico
Background/objectiveAnxiety and depressive disorders are leading causes of disability worldwide, and access to evidence-based psychological treatment remains limited in many middle-income countries. Digital cognitive–behavioral therapy (CBT) interventions have emerged as scalable tools to address this treatment gap, yet few have undergone clinical evaluation in Latin American populations. This study aimed to assess the safety and preliminary efficacy of Aurora, a Spanish-language, culturally adapted digital CBT program, when used as an adjunct to pharmacotherapy in adults with generalized anxiety disorder.MethodsIn a multicenter, open-label, non-randomized pilot study, 34 adults diagnosed with generalized anxiety disorder receiving stable pharmacological treatment were assigned through pragmatic, convenience-based allocation either to an experimental group (Aurora plus medication; n = 24) or to a control group receiving medication alone (n = 10). The sample had a mean age of 39.85 ± 12.88 years, with a predominance of women (22/34). Participants were followed for 12 weeks with assessments at baseline and weeks 4, 8, and 12. Clinical outcomes included anxiety severity measured by the Generalized Anxiety Disorder-7 (GAD-7), pathological worry assessed by the Penn State Worry Questionnaire (PSWQ), and depressive symptoms evaluated using the Patient Health Questionnaire-9 (PHQ-9). Safety was monitored through structured adverse-event reporting. Statistical analyses included linear mixed-effects models for longitudinal outcomes, ordinal logistic regression for severity transitions, and negative binomial regression and Fisher’s exact test for adverse events, with false discovery rate correction applied where appropriate.ResultsAurora demonstrated a favorable safety profile, with no serious adverse events and comparable adverse-event incidence between groups under structured clinical monitoring at weeks 4, 8, and 12. Anxiety symptoms (GAD-7) showed a significant effect of time (F3,96 = 169.65; p < 0.001), indicating reductions across both groups. Pathological worry (PSWQ) demonstrated significant group (F1,31.12 = 6.96; p = 0.013) and group × time interaction effects (F3,93.4 = 7.86; p < 0.001), with greater reductions in the Aurora group, particularly at weeks 8 and 12. At week 12, ordinal analyses indicated higher odds of lower worry severity in the intervention group (β = 2.53; p = 0.004; OR = 12.5). Depressive symptoms decreased similarly in both groups. Positive effect increased progressively across intervention modules, and module-embedded cognitive measures of anxiety and depression showed significant reductions over time.ConclusionThis pilot study provides preliminary, hypothesis-generating evidence that a culturally adapted digital CBT intervention can be safely integrated with pharmacotherapy and may be associated with enhanced improvements in anxiety-related outcomes, particularly pathological worry, in a Mexican clinical population. However, the non-randomized design, small sample size, and baseline imbalances limit causal inference and generalizability, and findings should be interpreted with caution. Larger randomized controlled trials are needed to confirm efficacy, determine long-term clinical impact, and guide the implementation of digital therapeutics in Latin American mental health systems.
Real-world effectiveness of medication-assisted treatment and psychotherapy for opioid use disorder: a national multi–health care organization analysis
BackgroundHarm reduction strategies for opioid use disorder (OUD) emphasize pragmatic, evidence-based approaches that reduce overdose risk, relapse, and other adverse outcomes without requiring abstinence. Medication for opioid use disorder (MOUD) and structured psychotherapy represent core harm-reduction modalities, yet their real-world comparative effectiveness, alone and in combination, remains underexplored at scale.MethodsA retrospective cohort study was conducted using the TriNetX Research Network, comprising de-identified electronic health records from 112 U.S. health systems. 18,047 adults aged 18–45 were identified with a diagnosis of opioid dependence (ICD-10 F11.20) between 2016 and 2025. Subjects were assigned to eight mutually exclusive treatment cohorts: no treatment (Cohort 1); buprenorphine alone (Cohort 2); methadone alone (Cohort 3); psychotherapy alone (30 minutes (Cohort 4), 45 minutes (Cohort 5), or 60 minutes (Cohort 6)); buprenorphine + psychotherapy (Cohort 7); and methadone + psychotherapy (Cohort 8), with combination treatments defined within a ±30-day window. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) for remission (F11.21, F11.11) within 12 months.ResultsBuprenorphine (aHR = 2.33; 95% CI: 1.85–2.94), methadone (aHR = 2.50; 95% CI: 2.05–3.04), and psychotherapy (30 min: aHR = 2.18; 45 min: aHR = 2.38) were each independently associated with significantly higher remission compared to no treatment. The combination of buprenorphine + psychotherapy yielded the strongest effect (aHR = 5.26; 95% CI: 2.68–10.32). Anxiety diagnoses and gabapentinoid prescriptions were positively associated with remission; benzodiazepine co-prescription was negatively associated.ConclusionsIn this first national-scale, multi–health-care-organization analysis, both pharmacologic and psychosocial harm-reduction interventions were independently associated with improved OUD remission, with additive benefit when integrated. These findings underscore the value of embedding comprehensive, multimodal harm-reduction services within routine care and support policies promoting equitable access to both MOUD and behavioral health supports across diverse health systems.
Comparing Acupuncture With Medication to Reduce Anxiety and Depression in China
Conditions: Anxiety Depression
Interventions: Drug: Selective serotonin reuptake inhibitor (SSRI); Other: Acupuncture
Sponsors: Duke Kunshan University; Kunshan Hospital of Traditional Chinese Medicine; Kunshan Mental Health Center; National Natural Science Foundation of China
Not yet recruiting
Interventions: Drug: Selective serotonin reuptake inhibitor (SSRI); Other: Acupuncture
Sponsors: Duke Kunshan University; Kunshan Hospital of Traditional Chinese Medicine; Kunshan Mental Health Center; National Natural Science Foundation of China
Not yet recruiting
Enhancing Sleep and Mental Health: Longitudinal, Observational, Real-World Study From a Digital Mental Health Platform
Background: Poor sleep is closely linked to mental health challenges and workplace burnout. Mental health and workplace stressors can impair sleep, while good sleep quality supports cognitive and emotional resources to cope with daily challenges. Despite positive outcomes of maintaining good sleep, many people struggle to get enough restorative sleep at night. Given the bidirectional relationship between sleep and mental health, evidence-based digital mental health solutions may offer an accessible and scalable approach to improving sleep quality. Objective: This study examines whether engagement with an employer-sponsored, multimodal digital mental health platform is associated with improvements in sleep quality over time, and whether changes in sleep quality are associated with concurrent changes in mental health and burnout outcomes. Methods: This 12-month prospective, observational study followed working adults who were newly registered to an employer-sponsored digital mental health platform (Modern Health). The platform leveraged technology (mobile and web) to connect employees with comprehensive provider-led and self-guided care through therapy, coaching, on-demand digital resources, and group psychoeducational sessions. Participants [N=578; 61.1% (n=353) women; mean age 33.88, SD 8.73 years; 40.3% (n=233) people of color] completed measures of self-rated sleep quality, depression, anxiety, and burnout (exhaustion, cynicism, and professional efficacy) at baseline and after 3 and 12 months of accessing the platform. Upon registering for the platform, participants were given an initial care recommendation, but could flexibly engage in any combination of services. Participants in this study engaged with at least one care modality, including therapy, coaching, psychoeducation sessions, and self-guided mental health resources. We examined perceived sleep quality and associations with other study variables at baseline, changes in perceived sleep quality over time, and whether changes in sleep quality correlated with concurrent changes in mental health and burnout. Results: At baseline, 42% (243/578) reported poor sleep quality and were more likely to have higher levels of depression, anxiety, and burnout. A generalized linear mixed-effects model showed that each additional month of platform access was related to an increased odds of having good sleep quality by 3.7% (=.02). Linear mixed-effects models found that higher sleep quality over time was associated with lower depression, anxiety, exhaustion, cynicism, and efficacy (all <.001). Among participants reporting poor sleep quality at baseline, 44% (62/141) reported good sleep quality at 12 months. Within this subgroup, paired sample tests showed significant reductions in depression (−48.3%) and anxiety (−38.3%), and increased cynicism, burnout, though cynicism levels remained below the cutoff for high burnout (23.9%; all <.01). Conclusions: Use of an employer-sponsored digital mental health platform was associated with meaningful improvements in self-reported sleep quality over 12 months. These gains were associated with significant reductions in depression, anxiety, and burnout symptoms, highlighting broader well-being benefits of comprehensive mental health care.
Comparing Perceptions of ChatGPT Use in Health Attitude Contexts Among Users and Nonusers: Cross-Sectional Study
Background: In light of the growing use of artificial intelligence (AI) in health care, individuals’ access to and use of health information are transforming. ChatGPT, an AI chatbot, provides immediate responses to health queries, with the potential to influence health-related attitudes, thereby raising concerns related to privacy, reliability, and security. Objective: This study aimed to investigate the perceived usefulness, risks, anxiety, and social influence of ChatGPT on health attitudes among users and nonusers in Saudi Arabia. Methods: A cross-sectional study was conducted using an online survey based on a validated tool. In total, 337 participants aged 18 years and older responded to questions assessing their perceptions of ChatGPT on health-related attitudes. Results: Data showed that 76.1% (194/255) of the respondents used ChatGPT, with the majority being younger and more highly educated. The main uses for health-related purposes were health education (43/194, 22.2%) and physical activity guidance (31/194, 16%). The analysis showed that users considered ChatGPT useful for health-related decisions, with 45.9% (89/194) finding it easy to learn and use, but concerns about privacy (106/194, 54.7%) and reliability (87/194, 44.9%) remained. Among nonusers, security risks (39/61, 63.9%) were the major barrier to using AI-based tools for health purposes, and 68.9% (42/61) found such tools attractive and engaging. There were no statistically significant differences between users and nonusers across all examined sociodemographic characteristics (>.05). Conclusions: The study established the potential of ChatGPT in improving health decision-making and revealed cultural, privacy, and trust issues that may affect its implementation. These findings underscore the importance of strengthening the security of AI-based applications to enhance public acceptability of related health policies and to support the safe integration of tools such as ChatGPT into the health care system.
