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Recent reviews and meta-analyses of metacognitive therapy for schizophrenia-spectrum disorder (SSD) have included uncontrolled studies, single-session interventions, and/or analyses limited to a single form of metacognitive therapy. We sought to evaluate the efficacy of metacognitive therapies more broadly based on controlled trials (CT) of sustained treatments. We conducted a pre-registered meta-analysis of controlled trials that investigated the effects of meta-cognitive therapies on primary positive symptom outcomes, and secondary symptom, function and/or insight measures. Electronic databases were searched up to March 2022 using variants of the keywords, ‘metacognitive therapy’, ‘schizophrenia’, and ‘controlled trial’. Studies were identified and screened according to PRISMA guidelines. Outcomes were assessed with random effects models and sample, intervention, and study quality indices were investigated as potential moderators. Our search identified 44 unique CTs with usable data from 2423 participants. Data were extracted by four investigators with reliability >98%. Results revealed that metacognitive therapies produced significant small-to-moderate effects on delusions ( g = 0.32), positive symptoms ( g = 0.30) and psychosocial function ( g = 0.31), and significant, small effects on cognitive bias ( g = 0.25), negative symptoms ( g = 0.24), clinical insight ( g = 0.29), and social cognition ( g = 0.27). Findings were robust in the face of sample differences in age, education, gender, antipsychotic dosage, and duration of illness. Except for social cognition and negative symptoms, effects were evident even in the most rigorous study designs. Thus, results suggest that metacognitive therapies for SSD benefit people, and these benefits transfer to function and illness insight. Future research should modify existing treatments to increase the magnitude of treatment benefits.

The correct version of the table is below. Description of sample: diagnosis and outcomes variables (n = 36,293) Diagnosis Serious legal trouble past 12 m Lifetime incarceration Lifetime violence to others n 12m n life n (%) OR (95% CI) c n (%) OR (95% CI) c n (%) OR (95% CI) c No diagnosis 22618 17775 154 (0.7%) Ref 809 (4.6%) Ref 1660 (9.4%) Ref Any SU, MI or PD 13675 18518 502 (3.7%) 6.1*** (5.1; 7.4) 3321 (18.0%) 4.7*** (4.2; 5.2) 6547 (35.4%) 4.9*** (4.5; 5.3) Any SU or MI 12126 17755 467 (3.9%) 6.4*** (5.3; 7.7) 3181 (18%) 4.7*** (4.2; 5.2) 6117 (34.5%) 4.7*** (4.3; 5.1) Any MI or PD 10797 13843 394 (3.6%) 6.2*** (5.2; 7.5) 2402 (17.4%) 4.5*** (4.0; 5.1) 5419 (39.2%) 5.8*** (5.3; 6.2) Any SU or PD 9514 13219 462 (4.9%) 8.3*** (6.9; 10.0) 3034 (23.1%) 6.3*** (5.6; 7.1) 5681 (43.1%) 6.6*** (6.1; 7.2) Comorbid SU and MI 2214 5470 171 (7.7%) 14.0*** (11.3; 17.4) 1428 (26.2%) 7.4*** (6.6; 8.4) 2743 (50.2%) 8.8*** (8.1; 9.7) Comorbid SU and PD 2039 3455 205 (10.1%) 19.5*** (15.7; 24.2) 1287 (37.4%) 13.2*** (11.5; 15.2) 2522 (73.0%) 24.3*** (21.5; 27.5) Comorbid MI and PD 3480 4198 207 (5.9%) 10.6*** (8.5; 13.3) 1186 (28.3%) 8.9*** (7.8; 10.3) 1665 (20.6%) 17.3*** (15.4; 19.4) Comorbid SU and PD and MI 1323 2671 132 (10.0%) 19.0*** (14.6; 24.6) 963 (36.1%) 12.4*** (10.7; 14.5) 1944 (72.8%) 23.7*** (20.8; 26.9) Any MI 8532 12296 286 (3.4%) 5.6*** (4.6; 6.9) 1938 (15.8%) 4.0*** (3.6; 4.5) 4411 (35.9%) 5.0*** (4.6; 5.4) Schizophrenia/Psychosis 337 902 28 (8.3%) 17.5*** (10.6; 28.9) 218 (24.2%) 6.5*** (4.9; 8.6) 381 (42.2%) 6.9*** (5.3; 9.0) Any Mood Disorder 4894 8639 198 (4.0%) 7.1*** (5.7; 8.9) 1382 (16.1%) 4.1*** (3.6; 4.6) 3252 (37.7%) 5.4*** (4.9; 5.8) Major Depression 3961 7430 149 (3.8%) 6.6*** (5.1; 8.4) 1061 (14.4%) 3.5*** (3.1; 4.0) 2584 (34.8%) 4.7*** (4.3; 5.2) Persistent Depressive 1185 2017 52 (4.4%) 7.6*** (5.4; 10.8) 371 (18.5%) 5.0*** (4.2; 5.9) 849 (42.3%) 6.7*** (5.8; 7.7) Bipolar 1 565 752 37 (6.5%) 12.7*** (8.0; 20.1) 235 (31.5%) 9.8*** (7.6; 12.5) 491 (65.5%) 17.0*** (14.0; 20.7) Any Anxiety Disorder 4700 5989 155 (3.3%) 5.5*** (4.3; 7.0) 1108 (16.9%) 4.3*** (3.8; 4.9) 2313 (38.7%) 5.6*** (5.1; 6.2) Specific Phobia 2035 2279 51 (2.5%) 4.3*** (3.0; 6.2) 353 (15.5%) 3.9*** (3.2; 4.6) 853 (37.5%) 5.4*** (4.7; 6.2) Social Anxiety 980 1255 37 (3.8%) 5.9*** (3.9; 8.9) 274 (22.0%) 5.9*** (4.9; 7.2) 552 (44.1%) 7.0*** (6.0; 8.3) Panic 1103 1811 52 (4.7%) 7.0*** (4.7; 10.3) 353 (19.6%) 5.2*** (4.2; 6.3) 797 (44.1%) 6.9*** (6.1; 7.9) Agoraphobia 549 690 22 (4.0%) 6.1*** (3.5; 10.6) 158 (23.1%) 6.3*** (4.8; 8.3) 342 (49.7%) 8.4*** (7.0; 10.1) Generalized Anxiety 1908 2708 82 (4.3%) 7.2*** (5.2; 10.0) 505 (18.7%) 4.8*** (4.1; 5.6) 1170 (43.2%) 6.7*** (6.0; 7.6) Posttraumatic Stress 1778 2337 87 (4.9%) 7.7*** (5.6; 10.6) 531 (22.8%) 6.3*** (5.4; 7.4) 1248 (53.4%) 9.8*** (8.7; 11.1) Eating Disordera 385 615 6 (1.6%) 2.3 (1.0; 5.6) 89 (14.5%) 3.8*** (2.7; 5.2) 251 (40.8%) 6.2*** (5.1; 7.5) Any Substance Use Disorder 5808 10929 352 (6.1%) 10.5*** (8.6; 12.7) 2671 (24.6%) 6.7*** (6.0; 7.6) 4449 (40.8%) 6.1*** (5.5; 6.7) Alcohol Abuse 5133 10000 306 (6.0%) 10.2*** (8.3; 12.5) 2388 (24.0%) 6.6*** (5.8; 7.4) 4032 (40.4%) 6.0*** (5.4; 6.6) Drug Abuse 1487 3548 154 (10.4%) 19.9*** (15.5; 25.5) 1342 (38.1%) 13.1*** (11.3; 15.1) 1960 (55.4%) 11.2*** (9.9; 12.5) Any personality disorderb NA 5745 315 (5.5%) 10.6*** (8.3; 13.5) 1650 (28.8%) 9.1*** (8.0; 10.4) 3754 (65.3%) 17.3*** (15.6; 19.1) Borderlineb NA 4300 250 (5.8%) 11.3*** (8.9; 14.3) 1240 (28.9%) 9.4*** (8.2; 10.7) 2911 (67.7%) 19.4*** (17.4; 21.7) Antisocialb NA 1600 132 (8.3%) 16.6*** (12.2; 22.6) 714 (44.8%) 18.5*** (15.7; 21.8) 1356 (84.8%) 49.8*** (41.8; 59.4) Schizotypalb NA 2438 148 (6.1%) 12.7*** (9.7; 16.6) 685 (28.2%) 8.8*** (7.4; 10.5) 1522 (62.4%) 15.0*** (13.1; 17.1) Sample is limited to people with data on functional impairment. Lower scores indicate poorer perceived functioning. *p<.05, **p<.01, ***p<.001. a Includes bulimia, anorexia nervosa. b Only lifetime personality disorder diagnoses are available. c Data weighted to adjust for non-response.

Abstract Deficits in social and occupational function are widely reported in psychosis, yet no one measure of function is currently agreed upon as a gold standard in psychosis research. The aim of this study was to carry out a systematic review and meta-analysis of functioning measures to determine what measures were associated with largest effect sizes when measuring between-group differences, changes over time, or response to treatment. Literature searches were conducted based on PsycINFO and PubMed to identify studies for inclusion. Cross-sectional and longitudinal observational and intervention studies of early psychosis (≤5 years since diagnosis) that included social and occupational functioning as an outcome measure were considered. A series of meta-analyses were conducted to determine effect size differences for between-group differences, changes over time, or response to treatment. Subgroup analyses and meta-regression were carried out to account for variability in study and participant characteristics. One hundred and sixteen studies were included, 46 studies provided data (N = 13 261) relevant to our meta-analysis. Smallest effect sizes for changes in function over time and in response to treatment were observed for global measures, while more specific measures of social and occupational function showed the largest effect sizes. Differences in effect sizes between functioning measures remained significant after variability in study and participant characteristics were accounted for. Findings suggest that more specific measures of social function are better able to detect changes in function over time and in response to treatment.

Purpose Head and neck cancer (HNC) patients often suffer from shame and stigma due to treatment limitations or due to societal factors. The purpose of this study was to assess perceived body image, depression, physical and psychosocial function, and self-stigma, as well as to identify factors that predicted shame and stigma in patients with HNC. Methods This cross-sectional study recruited 178 HNC patients from the outpatient radiation department of a medical center in Northern Taiwan. Patients were assessed for patient reported outcomes using the Body Image Scale (BIS), the Hospital Anxiety and Depression Scale–Depression Subscale (HADS–Depression Subscale), the University of Washington Quality of Life Scale (UW-QOL) version 4.0, and the Shame and Stigma Scale (SSS). Data were analyzed by descriptive analysis, Pearson’s product-moment correlation, and multiple regression. Results The two top-ranked subscales of shame and stigma were: “speech and social concerns” and “regret”. Shame and stigma were positively correlated with a longer time since completion of treatment, more body image concerns, and higher levels of depression. They were negatively correlated with being male and having lower physical function. Multiple regression analysis showed that female gender, a longer time since completing treatment, higher levels of body image concern, greater depression, and less physical function predicted greater shame and stigma. These factors explained 74.7% of the variance in shame and stigma. Conclusion Patients’ body image concerns, depression, time since completing treatment, and physical function are associated with shame and stigma. Oncology nurses should assess and record psychological status, provide available resources, and refer appropriate HNC patients to counselling.

Parents of children with neurodevelopmental disorders (NDD) have been found to experience higher levels of parenting stress compared to parents of typically developing children as well as parents of children with other forms of psychopathology. We aimed to examine parenting stress in parents with children with attention-deficit/hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD), and the possible associations between parenting stress, child psychosocial functioning and the parent’s own symptoms of NDD. Participants consisted of 86 mothers and 37 fathers of children 8–18 years old (n = 97) diagnosed with ADHD and/or ASD. Parents were interviewed with the Swedish Parental Stress Questionnaire (SPSQ) and completed self-rating scales: Autism Symptom Self-ReporT for Adolescents and Adults (ASSERT) and the ADHD-Rating Scale (ADHD-RS). The Children’s Global Assessment Scale (C-GAS) was used as a clinical-rated measure of child psychosocial functioning. Results showed that both mothers and fathers experienced high levels of parenting stress, although mothers, when compared with the child’s father, reported higher levels in the domains of role restriction, health problems and total scale. No differences in parenting stress were found relating to their child’s diagnosis. Both parental NDD symptoms and child psychosocial functioning were found to be associated with levels of parenting stress in mothers, and the association remained in the adjusted model accounting for family context factors and child factors. Parental stress should be considered when planning interventions for families with children with ADHD or ASD. Highlights Parents of children with NDD experience limitations on their personal freedom and identity because of their parenting responsibilities. We found no differences in parenting stress between parents of children with ADHD, ASD or both diagnoses. The mother’s level of parenting stress was linked to both her own symptoms of NDD and her child’s psychosocial functioning.

Background Cortical thickness (CT) alterations, mismatch negativity (MMN) reductions, and cognitive deficits are robust findings in first-episode psychosis (FEP). However, most studies focused on medicated patients, leaving gaps in our understanding of the interrelationships between CT, MMN, neurocognition, and psychosocial functioning in unmedicated FEP. This study aimed to employ multiple mediation analysis to investigate potential pathways among these variables in unmedicated drug-naïve FEP. Methods We enrolled 28 drug-naïve FEP and 34 age and sex-matched healthy controls. Clinical symptoms, neurocognition, psychosocial functioning, auditory duration MMN, and T1 structural magnetic resonance imaging data were collected. We measured CT in the superior temporal gyrus (STG), a primary MMN-generating region. Results We found a significant negative correlation between MMN amplitude and bilateral CT of STG (CT_STG) in FEP (left: r = −.709, P < .001; right: r = −.612, P = .008). Multiple mediation models revealed that a thinner left STG cortex affected functioning through both direct (24.66%) and indirect effects (75.34%). In contrast, the effects of the right CT_STG on functioning were mainly mediated through MMN and neurocognitive pathways. Conclusions Bilateral CT_STG showed significant association with MMN, and MMN plays a mediating role between CT and cognition. Both MMN alone and its interaction with cognition mediated the effects of structural alterations on psychosocial function. The decline in overall function in FEP may stem from decreased CT_STG, leading to subsequent MMN deficits and neurocognitive dysfunction. These findings underline the crucial role of MMN in elucidating how subtle structural alterations can impact neurocognition and psychosocial function in FEP.

Background This study aimed to systematically review the evidence from randomized controlled trials (RCTs) and to conduct a meta-analysis of the effects of yoga on physical and psychosocial outcomes in cancer patients and survivors. Methods A systematic literature search in ten databases was conducted in November 2011. Studies were included if they had an RCT design, focused on cancer patients or survivors, included physical postures in the yoga program, compared yoga with a non-exercise or waitlist control group, and evaluated physical and/or psychosocial outcomes. Two researchers independently rated the quality of the included RCTs, and high quality was defined as >50% of the total possible score. Effect sizes (Cohen’s d ) were calculated for outcomes studied in more than three studies among patients with breast cancer using means and standard deviations of post-test scores of the intervention and control groups. Results Sixteen publications of 13 RCTs met the inclusion criteria, of which one included patients with lymphomas and the others focused on patients with breast cancer. The median quality score was 67% (range: 22–89%). The included studies evaluated 23 physical and 20 psychosocial outcomes. Of the outcomes studied in more than three studies among patients with breast cancer, we found large reductions in distress, anxiety, and depression ( d  = −0.69 to −0.75), moderate reductions in fatigue ( d  = −0.51), moderate increases in general quality of life, emotional function and social function (d = 0.33 to 0.49), and a small increase in functional well-being (d = 0.31). Effects on physical function and sleep were small and not significant. Conclusion Yoga appeared to be a feasible intervention and beneficial effects on several physical and psychosocial symptoms were reported. In patients with breast cancer, effect size on functional well-being was small, and they were moderate to large for psychosocial outcomes.

Intimate partner violence includes psychological aggression, physical violence, sexual violence, and stalking from a current or former intimate partner. Past research suggests that exposure to intimate partner violence can impact cognitive and psychological functioning, as well as neurological outcomes. These seem to be compounded in those who suffer a brain injury as a result of trauma to the head, neck or body due to physical and/or sexual violence. However, our understanding of the neurobehavioral and neurobiological effects of head trauma in this population is limited due to factors including difficulty in accessing/recruiting participants, heterogeneity of samples, and premorbid and comorbid factors that impact outcomes. Thus, the goal of the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium Intimate Partner Violence Working Group is to develop a global collaboration that includes researchers, clinicians, and other key community stakeholders. Participation in the working group can include collecting harmonized data, providing data for meta- and mega-analysis across sites, or stakeholder insight on key clinical research questions, promoting safety, participant recruitment and referral to support services. Further, to facilitate the mega-analysis of data across sites within the working group, we provide suggestions for behavioral surveys, cognitive tests, neuroimaging parameters, and genetics that could be used by investigators in the early stages of study design. We anticipate that the harmonization of measures across sites within the working group prior to data collection could increase the statistical power in characterizing how intimate partner violence-related head trauma impacts long-term physical, cognitive, and psychological health.

COVID-19 has disrupted the lives of families across the United States and all over the world. Stress is known to have a negative impact on parent–child feeding interactions; hence, the purpose of this study is to examine how COVID-related parenting stress, which was measured using a newly developed scale, is related to parent mental health, nonresponsive feeding, and children’s self-regulation of eating. 119 parents of children ages 2–7 years old filled out questions about COVID-related parenting stress, mental health, nonresponsive feeding behaviors, and children’s self-regulation of eating. A series of multiple regressions were run to predict parent anxiety and psychological distress from COVID-related parenting stress. COVID-related parenting stress was found to be a significant predictor of both parent anxiety and psychological distress. When COVID-related parenting stress was further broken down into COVID-Related Job/Financial Security Stress and COVID-Related Family Safety/Stability Stress, COVID-Related Job/Financial Security Stress predicted psychological distress while COVID-Related Family Safety/Stability Stress predicted parent anxiety. Moderation analyses were also run to test the difference across the parents of children under 5 years of age and those of children who were 5 years of age and older regarding the association of COVID-related parenting stress and either parent anxiety or psychological distress. There was no significant difference across age. Lastly, COVID-related parenting stress and nonresponsive feeding practices were simultaneously entered into a multiple regression to predict children’s self-regulation of eating, and COVID-related parenting stress and parent distrust in appetite were both found to decrease children’s ability to self-regulate energy intake. Based on findings from this study, researchers interested in improving children’s self-regulation of eating and long-term health outcomes should continue to target the reduction of nonresponsive parent feeding behaviors, but they should also aim to look beyond specific parent feeding behaviors by attempting to help parents manage stressors in their lives.