Background: University students experience elevated psychological distress, with limited access to mental health services. While cognitive behavioral therapy (CBT) demonstrates efficacy for anxiety and depression, treatment gaps persist due to access barriers and insufficient between-session support. Large language model (LLM) chatbots could improve and scale CBT delivery. However, the scientific evaluation of chatbot-enhanced protocols is just emerging. Objective: This pilot study aimed to assess the feasibility, acceptability, and preliminary efficacy of an LLM-based ChatBot as an adjunct to group Unified Protocol (UP) therapy for between-session support in university students with subclinical anxiety and depression symptoms. Methods: A single-arm feasibility trial recruited university students aged 18 years and older with moderate subclinical symptoms (Social Phobia Inventory: 21‐40, Patient Health Questionnaire-9: 5‐14, or Generalized Anxiety Disorder-7: 5‐14), excluding those with current psychiatric disorders, suicidal ideation, or psychotropic medication use. The intervention comprised 4 weekly group UP counseling sessions complemented by an adjunctive Claude 3.7-Sonnet LLM ChatBot programmed with UP-based therapeutic prompts for between-session support rather than a stand-alone therapeutic agent. Primary feasibility outcomes included treatment adherence, chatbot engagement metrics, and system usability (System Usability Scale). Secondary outcomes assessed changes in generalized anxiety (Generalized Anxiety Disorder-7 Scale), social anxiety (Social Phobia Inventory), depression (Patient Health Questionnaire-9), and well-being (Short Warwick-Edinburgh Mental Wellbeing Scale) using paired tests. Qualitative feedback was collected through focus group interviews and analyzed using thematic analysis. Results: Of 72 screened participants, 37 met eligibility criteria and 19 initiated treatment (mean age 22.06, SD 1.78 years; 70.6% female). Retention was high with 17 completers (10.5% dropout rate). Among completers, 94.1% (16/17) attended ≥3 group sessions. The engagement with the CBT ChatBot was substantial: participants were active on a median of 23 days during the 34-day study period and exchanged a median of 15 messages in total. System usability was rated as excellent (mean 84.94, SD 10.98 out of 100). Pre-to-post comparisons revealed significant improvements in generalized anxiety (mean change −3.00, SD 3.46; =3.01, =.004; Cohen =0.71) and mental well-being (mean change +2.29, SD 3.65; =−2.17, =.02; Cohen =0.69). Social anxiety and depression showed nonsignificant trends toward improvement. Qualitative feedback highlighted the CBT ChatBot’s accessibility and nonjudgmental support while noting limitations in personalization. No adverse events or inappropriate chatbot interactions occurred. Conclusions: Augmenting a group UP therapy with an LLM ChatBot demonstrated high feasibility, acceptability, and preliminary efficacy signals for university students with subclinical symptoms. The hybrid intervention package achieved strong retention and engagement while maintaining safety. These findings support progression to a randomized controlled trial to definitively evaluate this technology-enhanced approach for expanding access to evidence-based mental health interventions.
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Passive Smart Home Monitoring for Delirium-Relevant Anomaly Detection in People Living With Dementia: Proof-of-Concept Study
<strong>Background:</strong> Delirium superimposed on dementia is associated with poor outcomes yet remains underdetected in home settings. Current detection relies on face-to-face clinical assessment (eg, the Confusion Assessment Method criteria), which is rarely applied outside hospitals. <strong>Objective:</strong> This proof-of-concept study developed a theory-driven framework for detecting delirium-consistent anomalous patterns in home-dwelling people with dementia, using passive smart home sensor data. <strong>Methods:</strong> The Technology Integrated Health Management dataset, an open access resource comprising a clinically derived cohort of older adults (aged 50 years) with a confirmed diagnosis of dementia or mild cognitive impairment, was used. The analysis included 13 patients who had at least 50% valid data for at least one 10-day analysis window, with data collected between April 1, 2019, and June 30, 2019. Individualized anomaly detection algorithms, including Isolation Forest and Long Short-Term Memory models, were applied to identify delirium-related anomalies within each participant. Predictor features consisted of theory-driven digital markers approximating key Confusion Assessment Method criteria, including agitation, disrupted sleep-wake cycles, and disorientation (indexed by activity entropy), along with clinically relevant indicators, such as physiological instability (early warning scores) and urinary tract infections. <strong>Results:</strong> Using matched thresholds, the Isolation Forest identified 77 anomalies (anomaly rate: 15.65%), and the Long Short-Term Memory model identified 78 anomalies (anomaly rate: 15.85%), with anomalies typically occurring in short temporal clusters; agreement between methods ranged from 0% to 40% across individuals. Feature importance analyses indicated that activity entropy, sleep quality, and early warning scores were the most influential features, with stronger interfeature correlations observed during anomaly periods than during nonanomaly periods. <strong>Conclusions:</strong> This study demonstrates the technical feasibility of detecting delirium-related anomalies through passive smart home monitoring. While lacking ground truth validation, the approach shows promise for early intervention in community settings. Future validation studies with clinically confirmed delirium labels are essential. <strong>Trial Registration:</strong>
Correction: Barriers and Facilitators in the Implementation of the Systematic Medical Appraisal, Referral, and Treatment (SMART) Mental Health Digital Intervention in Rural India: Mixed Methods Process Evaluation Study
Logotherapy techniques to unlock resilience among Ukrainian refugees: a pre-post quasi-experimental design
The ongoing Russian-Ukrainian war has triggered a significant refugee crisis, resulting in widespread trauma, displacement, and mental health challenges among affected populations. This study aimed to explore the potential usefulness of logotherapy, a meaning-centered therapy, in addressing the mental health needs of Ukrainian refugees. The research was conducted in a naturalistic scenario of a group of 20 Ukrainian refugees residing in Europe who received a tailored logotherapy or meaning-centered psychological support, compared with controls who did not. Meaning-oriented techniques, namely, Socratic Dialogue, Modification of Attitude, Paradoxical Intention, and Dereflection were used during the intervention. Participants were assessed in a pre-post quasi-experimental design using validated self-report measures for anxiety (Generalized Anxiety Disorder-7), depression (Beck Depression Inventory), and general health (General Health Questionnaire-12). The improvements were clearly observed as reductions in their self-reported anxiety and depressive symptoms after the meaning-centeres psychological support. Overall, these preliminary findings indicate that logotherapy may be a promising and feasible approach to psychological support for refugee populations. However, given its pilot nature and quasi-experimental design, causal conclusions cannot be drawn, and further research using larger, randomized, and methodologically rigorous designs is warranted to examine long-term effects and broader applicability.
Psychological distress experiences among patients living with HIV: a qualitative systematic review
BackgroundHIV patients endure psychological distress throughout the phases of diagnosis, treatment, and rehabilitation, which considerably affects their quality of life. A thorough comprehension of patients’ psychological distress experiences is crucial for healthcare workers to devise focused solutions for enhanced care. This study aims to consolidate evidence concerning psychological distress in HIV patients and elucidate its sources and influencing factors.DesignA systematic review and meta-synthesis of qualitative studies.MethodsA thorough literature review was performed across eight electronic databases from inception to June 2025.Qualitative studies were selected if pertinent to the psychological distress experiences of HIV patients. The quality of qualifying studies was assessed utilizing JBI qualitative research quality evaluation standard. The thematic synthesis method was utilized to amalgamate the findings.ResultsA total of 1583 studies were identified through database research, and 11 studies were incorporated into the review. Three analytical themes emerged from the findings: individual factors including disease diagnosis and emotional dilemma; environmental factors including economic hardship, social environment and limited access to health support; interpersonal factors including decline in marital intimacy and insufficient support from family and friends.ConclusionPsychological distress is a subjective phenomenon influenced by the interaction of individual, environmental, and interpersonal factors, commonly seen in HIV patients. Effective therapeutic care requires understanding psychological distress prevalence and causes. Individualized, sustainable, and adaptive psychosocial care interventions should be taken to alleviate psychological distress, improve patients’ mental health and facilitate their reintegration into society.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/view, identifier CRD420251050269.
FEEL-GOOD: A Multicenter Trial of a Mindfulness-Based Group Therapy in Young Adults With Early Psychosis
Conditions: Early Onset Psychosis; First Psychotic Episode Within the Last 5 Years; First-episode Psychosis; Schizophrenia Spectrum Disorders (SSD); Psychosis; Psychosis NOS; Randomized Controlled Trial (RCT)
Interventions: Behavioral: FEEL GOOD; Other: Treatment as Usual (TAU)
Sponsors: Stephanie Mehl; German Research Foundation; Universitätsklinikum Hamburg-Eppendorf; Central Institute of Mental Health, Mannheim; University Hospital Augsburg; Ludwig-Maximilians – University of Munich; Charite University, Berlin, Germany; University Hospital of Cologne; Vivantes Klinikum am Urban; Philipps University Marburg
Recruiting
Interventions: Behavioral: FEEL GOOD; Other: Treatment as Usual (TAU)
Sponsors: Stephanie Mehl; German Research Foundation; Universitätsklinikum Hamburg-Eppendorf; Central Institute of Mental Health, Mannheim; University Hospital Augsburg; Ludwig-Maximilians – University of Munich; Charite University, Berlin, Germany; University Hospital of Cologne; Vivantes Klinikum am Urban; Philipps University Marburg
Recruiting
Study on Mental Health Promoting Effects of Natural Psychotherapy for Adolescents
Conditions: Anxiety Disorders; Depressive Disorder; Mental Health
Interventions: Behavioral: Multi-modal Nature-based Meditation; Behavioral: Intervention diary
Sponsors: Beijing HuiLongGuan Hospital; Capital Normal University; Tsinghua University
Not yet recruiting
Interventions: Behavioral: Multi-modal Nature-based Meditation; Behavioral: Intervention diary
Sponsors: Beijing HuiLongGuan Hospital; Capital Normal University; Tsinghua University
Not yet recruiting
Focused ultrasound ablation for psychiatric disorders
Modern circuit-based neurosurgical interventions address a critical unmet need for patients with treatment-resistant psychiatric illness. Magnetic resonance–guided high-intensity focused ultrasound (HIFU) enables incisionless, millimeter-precision thermoablation via staged sonications with real-time monitoring, reshaping the risk–benefit profile of traditional neurosurgical interventions for psychiatric disorders.Here, we review the clinical evidence for HIFU ablation and contrast it with alternative platforms, including radiofrequency ablation, radiosurgery, laser interstitial thermal therapy, and deep brain stimulation.
Digital Health Monitoring and Intervention Suite for Stress in Frontline Nurses: Prospective Cohort Trial
Background: Stress among health care workers (HCWs) contributes to burnout, workforce attrition, and adverse patient outcomes. Although virtual reality (VR), psychoeducation, ecological momentary assessments (EMAs), and wearables have independently shown promise in stress research, no integrated digital suite has combined controlled stress induction, intervention delivery, and longitudinal real-world monitoring in HCWs. Objective: This study aimed to evaluate the feasibility, engagement, and preliminary effectiveness of a multimodal Digital Health Monitoring and Intervention suite for Stress framework integrating VR simulation, psychoeducation, EMAs, and wearable biometrics. We examined (1) the impact of VR simulation and psychoeducation on stress outcomes and (2) associations between physiological and self-reported mental health outcomes. Methods: Ninety-nine nurses (mean age 33.7, SD 8.9 yr, 87% female) were enrolled in 2023. We conducted a single-arm prospective cohort study (NCT05923398). Using convenience sampling, participants were recruited from social media advertisements, flyers, and email notices distributed through professional listservs. Participants completed ≥2-week baseline monitoring, a single VR session (2 runs separated by a brief psychoeducation intervention), and 12-week follow-up. In-VR stress was assessed using the Subjective Units of Distress Scale (SUDS) and 4-item Moral Injury Outcome Scale (MIOS-4), with synchronous heart rate variability. Longitudinal outcomes included weekly and biweekly EMAs alongside 70 wearable-derived features. Paired tests, aligned rank transform ANOVA, and Pearson correlations informed study objectives, with P values adjusted for multiple comparisons. Qualitative content analysis classified emotional responses during and after VR. Results: VR significantly increased subjective stress across checkpoints in both runs, with attenuation in Run B relative to Run A (all <.001). No significant heart rate variability differences were observed between runs (.15). During VR, 92% (91/99) of participants felt stressed, 36% (36/99) reported anxiety or nervousness, and 51% (50/99)‐78% (77/99) endorsed anger, guilt, shame, and/or betrayal. Most (59/99, 60%) HCWs returned to an emotional baseline post-VR, although 12% (12/99) reported lingering distress. Immediate reliable improvements in anger, guilt, shame, and/or betrayal occurred for 50% (50/99)‐75% (74/99) of participants post intervention. Anxiety (mean −0.53, SD 2.34; .03) and stress (mean −3.05, SD 11.35; .01) decreased 2 weeks post intervention, but were not sustained at 12 weeks. Increased sleep restlessness was the only wearable feature showing significant changes (mean 2.46%, SD 5.43; <.001). In-VR stress correlated with 12-week real-world stress (SUDS: =0.57‐0.58; MIOS-4: =0.58‐0.61; all .01). Data completion exceeded 90%, with 71% achieving full compliance. Conclusions: This study moves beyond single-tool interventions to demonstrate the feasibility and preliminary effectiveness of an integrated, multimodal stress platform within a single coordinated framework. This trial demonstrates high engagement, short-term symptom responsiveness, ecological validity, and emotional safety. The framework provides a scalable model for proactive stress identification, skills training, and implementation in high-risk occupational settings. Randomized controlled trials are needed to establish sustained efficacy and optimize deployment for real-world implementation. Trial Registration: ClinicalTrials.gov NCT05923398; https://clinicaltrials.gov/study/NCT05923398 International Registered Report Identifier (IRRID): RR2-10.2196/54180
Examining the Social and Mental Health Benefits of Virtual and In-Person Physical Activity Intervention Among Postsecondary Students: Quasi-Experimental Study
Background: Physical activity (PA) is a promising prevention approach for supporting mental health and enhancing social inclusion among postsecondary students. However, it is unclear whether similar outcomes are realized when PA programming is delivered in-person versus virtually. Objective: Using data from a multiphase research project, the purpose of the study was to examine the influence of on-campus PA programming (virtual and in-person delivery) on mental ill health symptoms (ie, anxiety and depression), social inclusion indices (ie, social connectedness, emotional ties, and social relationship quality), and well-being. Three objectives were addressed: (1) to assess pre-post change in symptoms, social inclusion indices, and well-being for virtual and in-person delivery; (2) to evaluate whether outcome change over time differed by delivery mode; and (3) to examine whether change in symptoms and social inclusion indices predicted change in well-being for both delivery modes. Methods: Physically inactive postsecondary students experiencing mental ill health participated in a 6-week structured and supervised PA program. Pre-post intervention data were collected across 3 phases, and the analytical samples included: 1. In-person delivery (n=87; 82%, 69/84 young adults; 86%, 74/86 women; 38%, 33/86 White; 20%, 17/86 Chinese; 86%, 75/87 with mental illness; 2. Virtual delivery (n=62; 69%, 42/61 young adults; 95%, 59/62 women; 34%, 21/62 White; 21%, 13/62 South Asian; 55%, 34/62 with mental illness), and 3. Data from students who received in-person or virtual delivery: (n=92; 67%, 61/91 young adults; 90%, 83/92 women; 32%, 29/92 White; 20%, 18/92 South Asian; 59%, 54/92 with mental illness). Data were analyzed using 2-tailed paired samples tests to address objective 1, a 2 (delivery mode) × 2 (time: pre-post) repeated-measures ANOVA to address objective 2, and hierarchical regression analyses to address objective 3. Results: Both virtual and in-person PA delivery were effective for symptom reduction and social inclusion improvements across all outcomes (<.001), with moderate-to-large effects. There was no significant time × delivery mode (=0.72, ²=0.04, =.60) interaction effect. Change in social inclusion indices explained unique variance in well-being, beyond covariates (gender, mental illness, and ethno-racial identity), and symptom reduction for virtual ( = 0.75, 008001) and in-person ( = 0.72, =0.16, <.001) PA delivery. Conclusions: Online distance learning is increasing across postsecondary settings worldwide, underscoring the need for accessible, technology-enabled mental health prevention interventions. The results provide support for the effectiveness of virtual and in-person PA programming for reducing symptoms of anxiety and depression, while also enhancing social inclusion indices and overall well-being. Social inclusion indices were also a key contributor to improved well-being, emphasizing the relevance of social factors in both virtual and in-person PA-based mental health prevention strategies for postsecondary students.
