Explore the vast range of titles available.

INTRODUCTION : Irritable bowel syndrome (IBS) is a common and debilitating disorder. When dietary and pharmacological interventions are not satisfactory, psychological treatment may produce good results. However, the access to such treatment is scarce, and therefore, it is of importance to make use of technical solutions. In this study, we wanted to investigate the real-world effectiveness of an Internet-delivered exposure-based cognitive behavior therapy (ECBT) for IBS and to replicate an earlier finding regarding the working mechanism of the treatment. METHODS : A total of 309 consecutively recruited patients from the Internet Psychiatry Clinic in Stockholm received ECBT for 12 weeks. The patients' IBS symptoms, quality of life, avoidance behaviors, and gastrointestinal symptom-specific anxiety were monitored, and we used a bivariate cross-lagged panel model to investigate time-related change in symptoms and avoidance behaviors. RESULTS: IBS symptoms, measured with the Gastrointestinal Symptom Rating Scale for IBS, were reduced from 48.06 (SD = 11.26) before treatment to 33.06 (SD = 10.81) 6 months after treatment (P < 0.001). The effect size (calculated by Cohen d) was 1.30 (1.08-1.51). There was a significant (P < 0.001) cross-lagged effect from reduction in avoidance behavior to reduction in symptoms but not in the reverse direction, indicating that the treatment effect is mediated by behavioral change. DISCUSSION : We conclude that ECBT is effective under real-world conditions, also when delivered through the Internet, and that an important treatment mechanism is the reduction of avoidance behaviors.

Trauma-focused cognitive behavioural therapy (TF-CBT) is an efficacious treatment model for children and adolescents with trauma-related disorders. However, few studies have been conducted in community settings, and there have been no randomized controlled trials in Asian countries. To evaluate the effectiveness of TF-CBT in regular community settings in Japan through comparison with a waitlist with minimal services control condition. Thirty Japanese children and adolescents with posttraumatic stress disorder symptoms (22 females, eight males, mean age = 13.90, range = 6-18) were randomly assigned to 12 sessions of TF-CBT or the waitlist control condition. The primary outcome measure was the Kiddie Schedule for Affective Disorders and Schizophrenia score assessed by blinded evaluators one month later. The mean number of sessions was 12 (range: 11-13) in the TF-CBT group and 4.87 (range: 3-7) in the control group. Intention to treat analysis showed that the TF-CBT group achieved significantly greater symptom reduction than did the control group. The effect size (Cohen's d) between the TF-CBT and control groups was 0.96 (p =.014) for posttraumatic symptoms and 1.15 (p =.004) for depressive symptoms. However, the TF-CBT group did not show better results than the control group with regard to improvements in anxiety symptoms, psychosocial functioning, and behavioural problems. The findings provided preliminary evidence of the effectiveness of TF-CBT for treating youth with trauma in community mental health facilities. TF-CBT in the Japanese context proved identical to the original, demonstrating that it is also suitable for use with children and adolescents in non-Western settings.

Cognitive behavioural therapy (CBT) has been extensively studied and is an effective treatment for a wide variety of mental health problems. Yet, despite its evidence base and the recommendations of clinical practice guidelines, its dissemination continues to be limited and the quality of its delivery is uneven. One of the main reasons for these concerns is the quality and intensity of training. In the Canadian context, where regulated professionals from a range of disciplines and backgrounds provide mental health services, it is essential to define sufficient training, to in turn increase positive treatment outcomes. The Canadian Association of Cognitive and Behavioural Therapies/L'Association Canadienne des therapies cognitives et comportementales (CACBT/ACTCC) has developed guidelines for training content (both knowledge and competencies), as well as training strategies and evaluation methods. This article outlines the rationale for these guidelines and details their content. The guidelines are put forward with the goal of ensuring that clinicians receive the requisite training and supervision to deliver high quality CBT. La thérapie cognitivo-comportementale (TCC) a fait l'objet d'études approfondies et s'est avérée un traitement efficace pour une variété de troubles de santé mentale. Pourtant, malgré les données probantes qui l'appuient et les recommandations des directives de pratique clinique, son expansion continue d'être limitée, et la qualité des services de TCC offerts est inégale. La qualité et l'intensité de la formation sont parmi les principales raisons de cette préoccupation. Dans le contexte canadien, où des professionnels réglementés représentant un éventail de disciplines et de milieux fournissent des services en santé mentale, il est essentiel d'établir un régime de formation suffisant afin de favoriser l'obtention de résultats positifs en matière de traitement. L'Association canadienne des thérapies cognitives et comportementales/Canadian Association of Cognitive and Behavioural Therapies (ACTCC/CACBT) a élaboré des lignes directrices relatives au contenu de la formation (connaissances et compétences), ainsi que des stratégies de formation et des méthodes d'évaluation. Cet article présente la justification de ces lignes directrices et en ventile le contenu. Les lignes directrices sont mises de l'avant dans le but de veiller à ce que les cliniciens reçoivent la formation et la supervision requises pour fournir une TCC de qualité. Public Significance Statement Cognitive behavioural therapy (CBT) is one of the most frequently researched and established psychological treatments for many health-related problems. It is critical that people who would benefit from CBT receive treatment from health care providers who are adequately trained to do so. This article reviews the research on CBT training for health care providers and presents CBT training guidelines that were developed by the Canadian Association of Cognitive and Behavioural Therapies-l'Association Canadienne des Thérapies Cognitive et Comportementales (CACBT-ACTCC), a national organisation of mental health providers whose mission includes increasing access to knowledge and training in CBT. The goal of these guidelines is to improve CBT training; thus, improving the Canadian public's access to high quality, effective psychological treatments.

Background. Over recent decades, chronic primary low back pain (CPLBP) has shown a consistent epidemiological increase worldwide. Although cognitive behavioural therapy (CBT) is not among the most commonly used interventions for this condition, several recent systematic reviews h ave demonstrated its efficacy. Given its limited implementation in clinical practice, this review aimed to assess the therapeutic validity of CBT by comparing it with physiotherapy (PT) interventions, designed according to the most recent clinical guidelin es for CPLBP.   Materials and Methods: Randomised controlled trials (RCTs) comparing CBT and PT in adults with CPLBP were included. The databases PubMed, Cochrane CENTRAL, Embase, CINAHL, Scopus, and PEDro were searched from inception to March 3, 2025. Risk of bias was independently assessed by two reviewers using the Cochrane Risk of Bias 2.0 (RoB 2.0) tool. Based on extracted data, several meta analyses were conducted, grouping outcomes into early phase, acute phase, and late phase follow ups. The certainty of evidence was evaluated according to the GRADE approach.   Results: Twelve RCTs were included, comprising a total of 1,762 participants. Meta analyses indicated very low certainty evidence that CBT is more effective than PT in reducing pain in the early p hase (n = 650, MD = −1.29, 95% CI = −2.00 to −0.59, p = 0.0003, I² = 83%), acute phase (n = 337, SMD = −0.16, 95% CI = −0.38 to +0.05, p = 0.14, I² = 0%), and late phase (n = 1108, SMD = −0.45, 95% CI = −0.87 to −0.03, p = 0.03, I² = 91%), as well as in de creasing disability in the early phase (n = 650, SMD = −1.00, 95% CI = −1.55 to −0.44, p = 0.0004, I² = 90%), acute phase (n = 337, MD = −0.27, 95% CI = −2.43 to +1.88, p = 0.80, I² = 75%), and late phase (n = 1108, SMD = −0.97, 95% CI = −1.52 to −0.41, p = 0.0007, I² = 95%). The results for early phase and late phase outcomes, for both pain and disability, were statistically significant.   Conclusions: Although supported by very low certainty evidence, these findings suggest that cognitive behavioural therap y may be a valuable intervention to integrate into clinical practice to reduce pain and improve disability in individuals with chronic primary low back pain. Further high quality randomised controlled trials are needed to confirm these results and draw more robust conclusions.

Cognitive behavioural therapy (CBT) has, in the space of 50 years, evolved into the dominant modality in psychological therapy. Mechanism/s of change remain unclear, however. In this paper, we will describe key features of CBT that account for the pace of past and future developments, with a view to identifying candidates for mechanism of change. We also highlight the distinction between 'common elements' and 'mechanisms of change' in psychological treatment. The history of how behaviour therapy and cognitive therapy developed are considered, culminating in the wide range of strategies which now fall under the heading of cognitive behavioural therapy (CBT). We consider how the empirical grounding of CBT has led to the massive proliferation of effective treatment strategies. We then consider the relationship between 'common factors' and 'mechanisms of change', and propose that a particular type of psychological flexibility is the mechanism of change not only in CBT but also effective psychological therapies in general. Good psychological therapies should ultimately involve supporting people experiencing psychological difficulties to understand where and how they have become 'stuck' in terms of factors involved in maintaining distress and impairment. A shared understanding is then evaluated and tested with the intention of empowering and enabling them to respond more flexibly and thereby reclaim their life.

The full-scale invasion of Ukraine by Russia in February 2022 led to an increase of traumatic events and mental health burden in the Ukrainian general population. The (ongoing) traumatisation can have a crucial impact on children and adolescents as they are especially vulnerable for developing trauma-related disorders such as Post Traumatic Stress Disorder (PTSD) or Depression. To date, these children have only very limited access to trauma-focused evidence-based treatments (EBTs) by trained mental health specialists in Ukraine. The fast and effective implementation of these treatments in Ukraine is crucial to improve the psychological wellbeing of this vulnerable population. This letter to the editor describes an ongoing project which implements a trauma-focused EBT called 'Trauma-Focused Cognitive Behavioural Therapy' (TF-CBT) in Ukraine during the war. In collaboration with Ukrainian and international agencies, the project 'TF-CBT Ukraine' was developed and implemented starting in March 2022. The project entails a large training programme for Ukrainian mental health specialists and the implementation of TF-CBT with children and their families in and from Ukraine. All components of the project are scientifically evaluated on a patient and therapist level, cross-sectionally and longitudinally, in a mixed-methods design. All together nine training cohorts with N = 133 Ukrainian therapists started the programme, all monthly case consultations (15 groups) and treatments of patients are still ongoing. Lessons learnt from this first large-scale implementation project on an EBT for children and adolescents impacted by trauma in Ukraine will help inform the field on challenges and also possibilities to expand such efforts. On a broader level, this project could be one small step in the process of helping children overcome the negative effects and experience resilience in the context of a war-torn nation.

Approximately 70% of mental health disorders appear prior to 25 years of age and can become chronic when ineffectively treated. Individuals between 18 and 25 years old are significantly more likely to experience mental health disorders, substance dependencies, and suicidality. Treatment progress, capitalizing on the tendencies of youth to communicate online, can strategically address depressive disorders. We performed a randomized controlled trial (RCT) that compared online mindfulness-based cognitive behavioral therapy (CBT-M) combined with standard psychiatric care to standard psychiatric care alone in youth (18-30 years old) diagnosed with major depressive disorder. Forty-five participants were randomly assigned to CBT-M and standard care (n=22) or to standard psychiatric care alone (n=23). All participants were provided standard psychiatric care (ie, 1 session per month), while participants in the experimental group received an additional intervention consisting of the CBT-M online software program. Interaction with online workbooks was combined with navigation coaching delivered by phone and secure text messaging. In a two-level linear mixed-effects model intention-to-treat analysis, significant between-group differences were found for the Beck Depression Inventory-II score (difference -8.54, P=.01), Quick Inventory of Depressive Symptoms score (difference -4.94, P=.001), Beck Anxiety Inventory score (difference -11.29, P<.001), and Brief Pain Inventory score (difference -1.99, P=.03), while marginal differences were found for the Five Facet Mindfulness Questionnaire-Nonjudging subscale (difference -2.68, P=.05). These results confirm that youth depression can be effectively treated with online CBT-M that can be delivered with less geographic restriction. Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052.

Depression remains a major global cause of disability; yet, access to optimal mental health services is limited. Self-guided internet-based cognitive behavioral therapy (iCBT) offers a scalable alternative but is generally less effective than guided programs, showing limited antidepressant effects and incomplete symptomatic and functional recovery. Adherence remains a major barrier. Recent advances in artificial intelligence (AI), particularly natural language processing, enable automated advisory and empathic feedback that may enhance engagement and therapeutic impact. Although previous trials have reported promising effects, most used heterogeneous control conditions, making it difficult to isolate the specific contribution of AI within fully self-guided interventions. This randomized controlled trial evaluated whether natural language processing-based AI feedback integrated into a fully self-guided iCBT program improves clinical outcomes and engagement compared with an otherwise identical iCBT program without AI support. We recruited 1187 adults aged 20-60 years online and randomly assigned them to AI-augmented iCBT (AI-iCBT; n=396), iCBT without AI (n=397), or a waitlist control (n=394). Both active groups received 6 weekly sessions combining video-based psychoeducation and cognitive restructuring exercises. The AI-iCBT program additionally provided automated empathic and advisory feedback. The primary outcome was depressive symptom severity (Patient Health Questionnaire-9 [PHQ-9]) at week 7 and month 3, analyzed using mixed-effects models for repeated measures under an intention-to-treat framework. Secondary outcomes included a dichotomous PHQ-9 score of ≥10, Quick Inventory of Depressive Symptomatology, Generalized Anxiety Disorder-7, Sheehan Disability Scale, and weekly participation rates. Exploratory analyses assessed the impact of AI functions on engagement and antidepressant effects in the efficacy analysis set (EAS). In intention-to-treat analyses, no significant between-group differences were observed in mean PHQ-9 scores at week 7 or month 3, whereas engagement analyses showed a significant group × week interaction, with AI-iCBT participants demonstrating consistently higher odds of weekly participation (odds ratio 1.23, 95% CI 1.09-1.39; P<.001). Exploratory analyses indicated that activation of the empathic feedback function strongly predicted adherence (odds ratio 9.99, 95% CI 5.80-17.21; P<.001), while advisory feedback was not significant. In EAS analyses, iCBT showed significant short-term improvement versus control at postintervention, whereas at follow-up, only AI-iCBT showed a significantly lower proportion of participants with a PHQ-9 score of ≥10 compared with control (difference -0.15, 95% CI -0.30 to -0.01; P=.046). No serious adverse events were reported. AI support significantly improved adherence to a fully self-administered program. In EAS analyses, AI-iCBT also showed a significantly lower proportion of participants with PHQ-9 score of ≥10 at follow-up compared with control. Empathic feedback emerged as a key mechanism for sustaining engagement, suggesting that AI communication may help maintain participation in scalable digital mental health interventions. Further research is required. University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) UMIN000019228; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000022220.

Ulcerative colitis and Crohn’s disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn’s and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn’s disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn’s disease, including patients, their families and friends.