IntroductionDepression is among the leading causes of disability globally. Therefore, exploring the various non-medical treatment options for this condition is particularly important. The aim of the review was to assess the effect of art therapy on depressive symptoms.MethodsThe foundation of this review is a pre-planned, explorative, secondary analysis of a previously published umbrella review, encompassing the databases Cochrane Library, Embase, MEDLINE, CINAHL, ERIC, American Psychological Association PsycArticles, American Psychological Association PsycInfo, PSYNDEX, the German Clinical Trials Register, and ClinicalTrials.gov. Included were all randomized trials with any patient population receiving active visual art therapy. The outcome was depressive symptoms measured by depression assessment instruments. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and conducted a bias assessment using a modified Cochrane risk of bias tool. Data was pooled using a random-effects model and visualized in forest plots. A pooled standardized mean difference (SMD) with hedges g was calculated to measure the reduction of depressive symptoms.ResultsOf 3,100 identified reports we included 26 studies. Of these, 19 studies with 997 patients were eligible for inclusion in the meta-analysis. Overall, we found a standardized mean difference of 0.53 (95% CI: 0.30 to 0.76) for depressive symptoms, favoring the intervention group. Main sources of variation were different types of control groups, methodological quality, and patient populations.ConclusionOur results suggest that art therapy is associated with improved depressive symptoms. Therefore, art therapy should be accessible as complementary treatment for patients suffering from depressive symptoms.
A comparison between seven scales of neuropsychological assessments for cognitive impairment screening in Chinese older population: a cross-sectional study in Chongqing, China
BackgroundThe Clinical Dementia Rating Scale (CDR), the Ascertain Dementia 8 (AD8), the Mini-Cog, the Verbal Fluency Test (VFT), the Community Screener for Dementia (CSI-D), the Rey Auditory Verbal Learning Test (RAVLT), and the Activities of Daily Living Scale (ADL) represent seven commonly employed methods for community cognitive impairment screening in China that have garnered limited attention. This study aimed to assess the discriminatory power of these seven tests when administered concurrently in a single screening to detect cognitive impairment in the absence of a gold standard.MethodsWe conducted a cross-sectional survey among 1,506 elderly people aged 60 and above in the community. The cognitive and social functions of the elderly population were evaluated by using the Seven scales. The characteristics related to demographics and health were collected through questionnaire surveys, and the correlations and consistencies of the Seven scales with cognitive impairment were analyzed respectively. Multifactor logistic regression model was used to analyze the risk factors of cognitive impairment in each scale.ResultsThe positive screening proportions for the seven scales—CDR, ADL, AD8, CSI-D, Mini-Cog, VFT, and RAVLT—were 61.1%, 33.7%, 38.0%, 37.1%, 53.7%, 39.3%, and 52.9%, respectively. Agreement on cognitive impairment risk between each pair of scales was fair-to-moderate (Kappa: 0.32–0.645, all p < 0.001). Screening results differed significantly across the seven scales by age, educational, marital status, epilepsy, cerebral infarction, brain atrophy, and depression (all P < 0.001). Notably, Screen-positive proportions for cognitive impairment rose significantly with increasing age (p < 0.001); the ≥ 80-year-old group showed the highest proportions across scales. Conversely, higher educational attainment was associated with lower risk of screening positive for cognitive impairment (p < 0.001).ConclusionsOur study identified a relatively high screening positivity proportion for cognitive impairment in Chongqing, Age, Sex, Education, Marital status, Brain atrophy, Anxiety, and Depression are risk factors for screening positivity. The identified screening positivity for cognitive impairment varied across different neuropsychological assessment methods, indicating that assessment choice should be tailored to population characteristics rather than applying a one-size-fits-all approach. Selecting the appropriate tool can improve sensitivity and reduce missed diagnoses.
Changes in depression, anxiety, and post-traumatic stress symptoms among children and adolescents exposed to adverse childhood experiences following participation in the PROACT intervention in Nairobi, Kenya
IntroductionGlobally, children and adolescents exposed to Adverse Childhood Experiences (ACEs) face an increased risk of developing mental health disorders. The prevalence of these mental disorders is further amplified by the lack of access to specialised mental health treatment especially in low resource settings. There is an urgent need for scalable mental health interventions that can effectively address the needs of these vulnerable populations. Non-specialist-delivered interventions, such as PROACT (Psychoeducation, Relaxation, Problem-solving, Activation, and Cognitive Coping Therapy), represent a promising scalable approach that could help bridge the existing mental health treatment gap in low-resource settings.ObjectivesThis study aimed to assess changes in depression, anxiety, and post-traumatic stress symptoms among children and adolescents exposed to adverse childhood experiences following participation in the PROACT intervention delivered by trained social workers in Nairobi, Kenya.MethodologyMixed-methods pre-post study design was employed. Twenty purposively selected sites across Nairobi County each contributed one social worker (N = 20), who received training to deliver the intervention. A total of 40 children participated and received 4–6 PROACT sessions. Quantitative data were analysed using STATA version 17. Paired t-tests were used to compare baseline and endline scores, while mixed-effects linear regression models with participant ID as a random effect were fitted to estimate changes in outcomes over time and account for repeated measures. Statistically significant improvements were observed across all mental health outcomes. Mean anxiety scores decreased from 6.2 at baseline to 2.7 at endline (mean difference: −3.5; 95% CI: −4.7 to −2.2; p < 0.001), while mean depression scores decreased from 6.4 to 2.9 (mean difference: −3.6; 95% CI: −4.9 to −2.3; p < 0.001). Mean PTSD scores decreased from 16.7 (95% CI: 12.8–20.5) at baseline to 7.3 (95% CI: 4.4–10.1) at endline (mean difference: −9.4; 95% CI: −14.6 to −9.3; p < 0.001). Mixed-effects linear regression analyses corroborated these findings, demonstrating significant reductions in PTSD (β = −9.44), anxiety (β = −3.48), and depression (β = −3.59) symptoms (all p < 0.001).ConclusionThe PROACT intervention was feasible and acceptable when delivered by social workers in Nairobi primary healthcare facilities and was associated with improvements in mental health outcomes among children and adolescents. These findings highlight the potential of task-sharing approaches to expand access to mental healthcare in low- and middle-income countries (LMICs) and warrant further evaluation in controlled studies.
Feasibility of a Culturally Adapted Nurse-Led COPE Intervention for Caregivers of Children With Autism Spectrum Disorder
Conditions: Autism Spectrum Disorder; Psychological Distress; Depression; Anxiety
Interventions: Behavioral: Culturally Adapted Nurse-Led COPE Intervention; Other: Routine Hospital Care
Sponsors: Khyber Medical University Peshawar; Children Hospital Faisalabad
Recruiting
Interventions: Behavioral: Culturally Adapted Nurse-Led COPE Intervention; Other: Routine Hospital Care
Sponsors: Khyber Medical University Peshawar; Children Hospital Faisalabad
Recruiting
A conceptual multi-agent architecture for mental health triage in post-conflict Arabic-speaking populations: a theoretical proposition and staged validation argument
Syria’s protracted conflict has produced a mental health crisis of extraordinary scale, with post-traumatic stress, depression, and anxiety estimated at several times global baselines, set against fewer than 0.37 psychiatrists per 100,000 people. Existing AI mental health tools have been developed and evaluated primarily for English-speaking, non-humanitarian populations, and their transfer to this setting is constrained by three simultaneous structural deficiencies—extreme clinical scarcity, Arabic natural-language-processing underperformance for dialect, and cultural misalignment with Syrian idioms of distress—which we term the Triple Gap. This article is a conceptual contribution in the Hypothesis and Theory genre, and its central claim is theoretical rather than technical: that AI-assisted mental-health triage at a safety floor adequate for crisis relevant care in this setting is conditional on the joint satisfaction of three constraints—linguistic adequacy for the local dialect, cultural validity for local idioms of distress and help-seeking, and bounded clinical responsibility through human oversight. These constraints interact, so that a system satisfying fewer than all three is expected to fail in clinically consequential rather than random ways. As one possible design response to this proposition—neither the only one nor a validated one—we describe a conceptual multi-agent architecture aligned with the WHO mhGAP task-shifting model: a four-stage pipeline (screening, risk stratification, routing, follow-up) constrained by a cross-cutting cultural-adaptation layer, augmented by candidate verification mechanisms with explicit abstention, and governed by human oversight in which clinical responsibility rests with a licensed clinician. The proposal is a hybrid clinical decision support hypothesis, not an autonomous system. Because no Syrian Arabic clinical corpus yet exists, the conversational components of the design cannot presently be evaluated; we therefore set out a staged sequencing argument for future work in which the construction of a Syrian Arabic Mental Health Evaluation Corpus (SAMHEC) is the first and rate-limiting condition. We present no prototype, no corpus, and no clinical, cultural, or safety evaluation, and we make no claim of clinical validity, safety, or readiness for deployment. The contribution is the integration of multi-agent triage with task-shifting and cultural adaptation into a single conditional argument whose adequacy can be established only through the staged empirical work we describe.
Editorial: Treatment resistant depression: epidemiology, clinic, burden and treatment, volume II
Evaluating the Impact of Digital Behavioral Interventions to Address Insomnia and Depression in Breast Cancer Survivors Using an Adaptive Design
Conditions: Insomnia; Depression
Interventions: Behavioral: Digital Insomnia Program; Behavioral: Digital Mental Health Program; Behavioral: Psychoeducation
Sponsors: University of Virginia; National Cancer Institute (NCI)
Not yet recruiting
Interventions: Behavioral: Digital Insomnia Program; Behavioral: Digital Mental Health Program; Behavioral: Psychoeducation
Sponsors: University of Virginia; National Cancer Institute (NCI)
Not yet recruiting
Deprexis for Veteran Depression: Open-Label Pilot Trial Examining Feasibility, Acceptability, and Preliminary Efficacy
Background: Depression carries the highest burden of mental health–related disability in the United States. Approximately 13% of military veterans report elevated rates of depression. Despite the availability of evidence-based treatments for depression, nearly 50% of veterans in need of mental health care remain untreated. Internet-based interventions show promise in reducing this gap; however, there are currently no standard self-guided internet-based interventions for depressive symptoms in veterans. Deprexis is one such intervention that leverages cognitive behavioral therapy to target depressive symptoms. Objective: This pilot study evaluated the feasibility, acceptability, and preliminary effectiveness of Deprexis, a fully self-guided internet-based intervention for depression, in US military veterans with mild to severe depressive symptoms. Methods: This open-label pilot trial recruited 19 veterans with mild to severe depression (mean age 55.5, SD 8.2 y; baseline Quick Inventory of Depressive Symptomatology—Self-Report [QIDS-SR]: mean 16.2, SD 4.1) for an 8-week course of Deprexis, with self-report assessments at baseline, posttreatment (8 wk), and follow-up (16 wk). Primary outcomes included depressive symptoms (QIDS-SR), functional disability (World Health Organization Disability Assessment Schedule 2.0), and symptom-related disability (Sheehan Disability Scale). Feasibility was assessed through recruitment and retention rates, and acceptability was measured using validated questionnaires (Credibility and Expectancy Questionnaire and Client Satisfaction Questionnaire). Multilevel models examined change over time, with effect sizes calculated using pooled SDs from unconditional models. Results: Recruitment and retention targets were met, with 15 out of 19 (79%) participants meeting the adherence criteria (ie, ≥60 min of active program use). Of these, 14 participants completed posttreatment questionnaires and were included in the completer analyses. The program received a positive acceptability rating: of the 18 participants who completed follow-up assessments, 78% (n=14) rated services as good or excellent and 72% (n=13) were satisfied with the amount of help received. No safety concerns were reported. Among completers (n=14), QIDS-SR scores decreased from baseline to posttreatment (estimate −2.22, SE 1.44; =.14; =−0.54, 95% CI −1.07 to 0.13) and follow-up (estimate −2.85, SE 1.19; =.02; =−0.70, 95% CI −1.21 to −0.08) with moderate-to-large effect sizes. Effect sizes were similar in the total sample. Functioning (World Health Organization Disability Assessment Schedule 2.0) improved among completers at follow-up (estimate −8.09, SE 3.80; =.045; =−0.41, 95% CI −0.96 to −0.05). Disability (Sheehan Disability Scale) did not significantly improve from baseline to posttreatment or follow-up. Conclusions: This pilot trial demonstrates that Deprexis is feasible and acceptable for veterans with mild to severe depression, with preliminary evidence of effectiveness for depressive symptoms. The delayed emergence of functional improvements and sustained gains at follow-up support the potential of this scalable intervention. The results provide a strong foundation for the ongoing randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT06217198; https://clinicaltrials.gov/study/NCT06217198 International Registered Report Identifier (IRRID): RR2-10.2196/59119
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Developing a Text Messaging Intervention to Increase Uptake of the Screening and Treatment for Anxiety and Depression Program Among Community College Students: Formative Study Using a Human-Centered Design Approach
Background: Community college (CC) students face significant mental health concerns but are unlikely to receive treatment. Barriers to mental health service uptake among CC students have been delineated, but few studies have identified strategies to improve uptake. Text messaging has been used to address engagement barriers to mental health services among adolescents and adults, but little research has explored this strategy for CC students. Objective: The goal of this study was to partner with CC students to co-design and conduct pilot usability testing of a text messaging intervention to address barriers and increase uptake of a mental health screening and treatment program, called Screening and Treatment for Anxiety and Depression (STAND), offered to CC students. Methods: We conducted 2 parallel sets of 4 co-design focus groups with CC students who had varying levels of engagement with STAND. We used rapid qualitative analysis to extract key themes, create text message prototypes and refine them, and present updated prototypes to gather feedback across workshops. We also assessed six usability factors on a 5-point Likert scale: satisfaction, helpfulness, attractiveness, readability, comprehension, and likelihood of getting started with STAND after receiving texts. Results: Key themes emerged about perceptions of texting, barriers to STAND, a basic framework for the text message intervention, feedback about the format of messages, and feedback about the content of messages. Students expressed positive regard for text messaging and general agreement on key barriers to STAND. Students codeveloped a framework for the intervention, including (1) delivering introductory texts to engage students in the text messages, (2) providing a personalized approach for students to select barriers most salient for them, and (3) delivering tailored content designed by students to address each barrier. Across workshops, several themes emerged with regard to how messages should be formatted and delivered, including the following: use short messages; use not too many messages; use relevant language; use images, memes, and short videos; and make messages “human-like.” Themes related to the content of messages included the following: reminders that you are not alone, knowledge that STAND has worked for other students, expressing understanding of student context and stressors, and providing an option to speak to a team member. Mean ratings on usability factors ranged from 3.88 (SD 0.64) to 4.25 (SD 0.46). Conclusions: This study describes a process for co-designing a text messaging mental health engagement intervention with CC students that is grounded in a human-centered design approach. Further research is needed to rigorously test this intervention and make iterative refinements to improve response and effectiveness.
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Digital Reassurance Seeking in OCD
– by Jordan Karr, PhD
We all need reassurance once in a while. Receiving reassurance from a friend, loved one, or expert can reduce short-term distress, foster a sense of connection, and help us move forward in a productive way. On the other hand, excessive reassurance seeking can lead to a painful cycle of stress and doubt. For individuals with obsessive-compulsive disorder (OCD), reassurance is fleeting and is quickly followed by a resurgence of perceived threat and a compelling drive to seek additional reassurance.
As an OCD and anxiety specialist, I am no stranger to reassurance traps. I see them in the patient who repeatedly consults doctors but never fully trusts their answers; the partner who keeps asking, “Do you still love me?” while scrutinizing every response; and the teenager who needs her homework checked repeatedly but does not learn to tolerate uncertainty. While the content of excessive reassurance seeking may vary, its function remains the same, relieving anxiety momentarily while allowing obsessions to rebound more strongly in the long run. In each example, we see an individual desperately trying to protect something they hold dear while being misled by one of OCD’s most convincing lines: “What if this time the reassurance sticks?”
Psychologists have long argued that excessive reassurance seeking helps maintain OCD, anxiety, and depression (Abramowitz et al., 2002; Burns et al., 2006). What is new is the landscape. Today, reassurance is available instantly and endlessly through search engines, medical websites, social media, and artificial intelligence tools. Emerging research suggests that online reassurance seeking may be as prevalent as interpersonal reassurance seeking (Parsons & Alden, 2022). These digital reassurance traps present in a variety of forms, including:
- Excessive symptom-checking on WebMD
- Checking a loved one’s location on Find My Friends to make sure they are still alive or where they promised they would be
- Asking Google Gemini whether an intrusive thought makes you a monster, a pedophile, or a bad Christian, Muslim, or Jew
- Analyzing the contents of a partner’s Instagram to see whether their feelings have changed
- Endlessly searching Reddit for answers to existential questions
- Obsessively checking likes and read receipts to monitor the durability of a relationship
- Finding creative ways to ask ChatGPT whether you might be responsible for spreading a virus or causing someone harm
- Compulsively checking the news to confirm whether a feared event has taken place
Why do some individuals seek reassurance primarily from others in face-to-face contexts while others turn to the internet? Findings from one study suggest that individuals may be more likely to seek interpersonal reassurance when they desire emotional support, whereas online reassurance seeking is more likely when individuals feel ashamed or fear judgment from others (Parsons et al., 2025). In the same study, shame was reported more frequently among individuals with OCD. The perceived anonymity of the internet creates a compelling environment for seeking reassurance about our most distressing fears and the fears we feel ashamed to have.
Wait, hold on… shouldn’t having access to all the information on the internet be empowering? After all, there’s that famous saying, “Knowledge is Power.” Well I’m not sure what Francis Bacon would say if he could scroll on TikTok, but in the age of the internet, more information does not always mean more power or knowledge. In fact, information overload seems to trigger excessive reassurance seeking online (Yang & Luo, 2024). Once digital algorithms detect health-related concerns, users may be exposed to increasingly frequent and targeted content, further amplifying health anxiety and driving additional reassurance seeking online (Zhang et al., 2024).
Despite these challenges, evidence-based treatments offer hope. Exposure and response prevention (ERP), the gold-standard treatment for OCD, helps individuals tolerate uncertainty and break free from compulsive behaviors. ERP therapists are prepared to respond to clients who compulsively seek reassurance while taking care to avoid reinforcing a client’s anxiety and setting boundaries when appropriate. On the other hand, AI chatbots are available 24/7 and will continue to reassure users when it would be clear to a skilled therapist that more reassurance is harmful. Some helpful activities I have encouraged clients to try include:
- Going for a walk and leaving your phone behind
- When you have the urge to seek reassurance, use a timer to delay. Start with 5 minutes and gradually increase the time as you go.
- Imaginal exposure: Writing out OCD’s worst case scenario while refraining from seeking reassurance.
- Embracing the uncertainty: When you have the urge to seek reassurance, lean into the uncertainty by responding “maybe that will happen, maybe not.”
- Watch a movie that triggers obsessions but leave your phone in the other room
- Try a fast from social media. Start with a short fast and increase the length of each fast as you gain confidence.
- Agreeing with the obsessions: Whatever your OCD throws at you, respond by saying “Sure, that is true!”
Clinicians working with youth should also attend to parental accommodations that inadvertently facilitate online reassurance seeking. Supportive Parenting for Anxious Childhood Emotions (SPACE) is an evidence-based, parent-focused intervention that emphasizes increasing supportive statements while reducing unhelpful accommodations. Setting reasonable limits on smartphone use while responding with empathy and confidence can help youth build resilience and independence (i.e. “I know it’s tough to be away from your phone and I know you got this!”).
Finally, because shame plays a central role in digital reassurance traps, incorporating self-compassion practices may be beneficial. Compassion-focused exercises help individuals respond to their struggles with kindness rather than self-criticism, complementing ERP by fostering emotional resilience. I sometimes ask clients to imagine that a close friend or loved one is feeling ashamed because they are experiencing obsessions and are stuck in an OCD loop. Then, I invite them to write down how they would support this friend while paying special attention to how compassion feels in their body. By practicing compassion for others, we strengthen the same muscles in our brains that help us turn compassion inward.
If you are getting stuck in digital reassurance traps, you are not alone! Many of these technologies are brand new and we are learning how to integrate them into our lives in a healthy way. If you need help managing compulsive online habits, finding a therapist trained in ERP could be a useful step!
References
Abramowitz, J. S., Schwartz, S. A., & Whiteside, S. P. (2002). A contemporary conceptual model of hypochondriasis. Mayo Clinic Proceedings, 77(12), 1323–1330. https://doi.org/10.4065/77.12.1323
Burns, A. B., Brown, J. S., Plant, E. A., Sachs-Ericsson, N., & Joiner, T. E., Jr. (2006). On the specific depressotypic nature of excessive reassurance-seeking. Personality and Individual Differences, 40(1), 135–145. https://doi.org/10.1016/j.paid.2005.05.019
Parsons, C. A., & Alden, L. E. (2022). Online reassurance-seeking and relationships with obsessive-compulsive symptoms, shame, and fear of self. Journal of Obsessive-Compulsive and Related Disorders, 33, 100714. https://doi.org/10.1016/j.jocrd.2022.100714
Parsons, C. A., Kim, H. J., Singh, S., Lkhagva, T., Wang, J., & Alden, L. E. (2025). Covert or connected: Motivations for online and interpersonal reassurance-seeking in OCD. Journal of Anxiety Disorders, 115, 103057. https://doi.org/10.1016/j.janxdis.2025.103057
Yang, X., & Luo, X. (2024). Unpacking cyberchondria: The roles of online health information seeking, health information overload, and health misperceptions. Telematics and Informatics, 97, 102225.
Zhang, X., Zheng, H., Zeng, Y., Zou, J., & Zhao, L. (2024). Exploring how health-related advertising interference contributes to the development of cyberchondria: A stressor–strain–outcome approach. BMC Public Health, 24, 534.
Jordan Karr, PhD, is the owner of River Falls Therapy in Portland, OR. He is a licensed psychologist in Oregon and Virginia, and specializes in evidence-based therapies for OCD and anxiety disorders. Dr. Karr has experience working in outpatient, community-based, and school-based settings.
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