Evidence-based practices (EBPs) in supported employment (SE) improve vocational outcomes for individuals with serious mental health conditions, yet their implementation and sustainment at scale remain limited. Thinking Skills for Work (TSW), a cognitive remediation intervention, is an EBP that increases vocational outcomes for SE participants. This study evaluated the Integrated Scaling Approach (ISA), designed to increase adoption of EBPs, such as TSW, across service systems. A field trial of ISA was conducted across SE programs in a single U.S. state. ISA strategies addressed scale-up by building stakeholder engagement and staff-organizational-system capacity, across three phases (preparation, implementation, and sustainment). Using a concurrent mixed-methods design, quantitative data assessed TSW implementation, while qualitative interviews and focus groups examined facilitators and barriers to scaling and sustainment. Nine agencies, managing twelve SE sites, enrolled in the study. Eight completed all ISA phases. Nineteen staff achieved TSW certification, and sixteen completed a Train-the-Trainer program. Eighty-five clients received TSW during the trial. The state modified its evaluation process to monitor TSW implementation. Qualitative findings indicated that structured training, implementation team engagement, and intervention flexibility, facilitated adoption. Long term sustainment was not achieved due to workforce shortages, resource constraints, and the absence of sustained system-level support, exacerbated by the COVID-19 pandemic. The ISA promoted short-term adoption and workforce capacity for an evidence-based employment intervention across multiple organizations, but not long-term sustainment. These findings underscore the necessity of integrating long term system-level policies and funding mechanisms with implementation strategies to achieve sustainable scale-up of EBPs in mental health systems.
Repetitive negative thinking as a transdiagnostic bridge between childhood trauma and depression: Integrating emotion regulation flexibility, stress sensitization, and neurocognitive mechanisms
Childhood trauma is a major risk factor for depression; however, not every affected individual develops clinically significant depressive symptoms. This underscores the importance of identifying transdiagnostic mechanisms that account for vulnerability and resilience. Repetitive negative thinking (RNT), which includes both rumination and worry, has recently been framed as a more general cognitive process that may help clarify how early adverse experiences contribute to the emergence and persistence of depression. This narrative review integrates current evidence regarding RNT as a possible transdiagnostic link connecting childhood trauma to depression, with particular focus on its interactions with emotion regulation flexibility, stress sensitization, and neurocognitive processes underlying self-referential cognition, cognitive control, and threat processing. Findings from developmental psychopathology, cognitive neuroscience, and affective science indicate that childhood trauma is often associated with persistent RNT, diminished regulatory flexibility, and increased sensitivity to stress—factors that are each independently related to depressive symptoms. Emerging evidence also suggests that these mechanisms are likely interrelated and may collectively increase susceptibility to depression across diagnostic categories. Nonetheless, substantial variability in trauma features, developmental timing, outcome measures, and study designs along with the dominance of cross-sectional research, limits the ability to draw definitive causal conclusions. Taken together, the existing literature indicates the value of a transdiagnostic perspective while highlighting important methodological and conceptual shortcomings. Future longitudinal and mechanistic studies are required to specify causal pathways and to test whether interventions aimed at RNT and related regulatory processes can meaningfully enhance the prevention and treatment of depression associated with trauma.
Spatiotemporal remodeling in habenula marks the onset of depression-related phenotypes
Nature Neuroscience, Published online: 19 October 2026; doi:10.1038/s41593-026-02488-6
Molina et al. show in chronically stressed mice that neuronal and transcriptional adaptations in the habenula coincide with the onset of depressive phenotype, guiding temporally defined antidepressant interventions.
Adapted Group Therapy Compared With Usual Care for Anxiety and Depression in Adults With an Autism Diagnosis
Conditions: Autism Spectrum Disorder (ASD); Anxiety; Depression
Interventions: Behavioral: Autism-adapted group cognitive behavioral therapy
Sponsors: Lovisenberg Diakonale Hospital; Helse Sor-Ost
Not yet recruiting
Interventions: Behavioral: Autism-adapted group cognitive behavioral therapy
Sponsors: Lovisenberg Diakonale Hospital; Helse Sor-Ost
Not yet recruiting
Sumud as a framework for collective resilience: a systematic review of implications for transcultural psychiatry and psychotherapy
BackgroundResilience is increasingly understood as a dynamic, ecological process; however, prevailing psychiatric models continue to emphasize individual traits, thereby neglecting collective and culturally embedded forms of endurance. Sumud (Arabic: صمود), broadly translating as steadfastness, perseverance, and endurance, sustains identity, dignity, and daily life under chronic adversity across the Arab world and functions as a relational and ethical orientation. This review examines sumud as a resilience framework for transcultural psychiatry and psychotherapy.AimsTo synthesize conceptualizations of sumud in relation to resilience, coping, and adaptation, and to evaluate implications for narrative, family-based, group, community-oriented, and arts-informed therapeutic approaches.MethodsA PRISMA 2020-guided systematic narrative review was conducted. Four electronic databases (PubMed, Scopus, Web of Science, and Embase) were searched covering publications up to 1 June 2026. English-language studies were eligible if they explicitly examined sumud as a cultural, psychological, or collective construct with relevance to resilience, coping, or psychotherapy. Eligible publication types included qualitative, quantitative, and mixed-methods empirical studies; theoretical and conceptual papers; ethnographies; narrative analyses; and reviews. Data were thematically synthesized using a predefined extraction matrix. The review was registered with PROSPERO (CRD420261279052).ResultsThirty-nine studies met the inclusion criteria. Descriptively sumud emerged as a multilevel, collective form of resilience enacted through family systems, intergenerational narratives, cultural practices, and institutional structures. Substantively, it supported meaning-making, emotional regulation, and identity continuity. Critically, ethical tensions and cumulative burdens were documented, particularly for women, caregivers, and professionals., and rigorously evaluated, sumud-informed psychotherapeutic interventions remain scarce, notwithstanding a general preference in mental health studies for social-ecological models and narrative, family-based, group, and arts-based therapeutic approaches.ConclusionsTheoretically, sumud challenges individualistic psychiatric frameworks by offering a culturally embedded, collective model of resilience. Clinically, it urges clinicians to engage with patients’ narratives, relational worlds, and cultural practices, while remaining attentive to the costs of endurance. Prospectively, in the context of ongoing conflicts and humanitarian crises affecting parts of the Middle East and Gulf region, sumud warrants renewed scholarly and clinical attention for the development of culturally responsive, resilience-informed psychotherapies.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD420261279052.
Context presentation and native conversation structure in large language model responses to escalating suicide risk: a controlled multimodel evaluation
BackgroundLarge language models are increasingly used for informal mental health support, yet their safety during escalating suicide-risk conversations may depend on how prior information is presented. Native multi-turn conversations and reconstructed cumulative prompts differ not only in the presence of prior model responses but also in prompt reconstruction, information concentration, message positioning, explicit integration cues, and conversation-state processing.ObjectiveThis study compared suicide-risk recognition, direct safety inquiry, response urgency, and timely real-world intervention across isolated current-turn prompts, reconstructed cumulative user-only prompts, and native continuous multi-turn conversations.MethodsWe conducted a controlled repeated-measures evaluation of ChatGPT, Gemini, and Doubao using 12 standardized five-turn trajectories: 4 direct suicide-risk trajectories, 4 implicit or internally inconsistent risk trajectories, and 4 non-suicidal high-distress controls. Each trajectory was evaluated under three context-presentation formats. The 24 model-trajectory combinations were treated as matched repeated-measures units nested within 8 independent risk-trajectory blocks. Primary contrasts were estimated using exact trajectory-level sign-flip tests and trajectory-block bootstrap confidence intervals. Turn-level outcomes were analyzed using multilevel mixed-effects models. Exploratory condition-by-model heterogeneity was assessed using a trajectory-blocked exact permutation sensitivity analysis, with a trajectory-clustered interaction model used only as a secondary asymptotic check.ResultsTimely appropriate intervention occurred in 10/24 isolated current-turn observations (41.7%), 21/24 reconstructed cumulative observations (87.5%), and 12/24 native continuous observations (50.0%). On average across the three systems, reconstructed cumulative presentation exceeded isolated input by 45.8 percentage points (95% trajectory-block bootstrap CI, 25.0 to 66.7; Holm-adjusted exact P = .031), whereas native continuous performance was 37.5 percentage points lower than reconstructed cumulative performance (95% trajectory-block bootstrap CI, −50.0 to −25.0; Holm-adjusted exact P = .031). Exploratory model-specific analyses indicated substantial heterogeneity: the native-versus-reconstructed contrast was largest for Doubao, smaller and statistically imprecise for Gemini, and absent for ChatGPT.ConclusionsOn average across the three evaluated systems, reconstructed cumulative user-only prompts outperformed native continuous conversations, although exploratory model-specific patterns were heterogeneous. Because the formats also differed in prompt reconstruction, information salience, message positioning, explicit integration instructions, and native conversation-state processing, the contrast cannot isolate the causal effect of prior model responses.
Content, Engagement, and Information Quality of Borderline Personality Disorder Videos on TikTok: Mixed Methods Analysis
Background: TikTok has become a major source of mental health information, yet concerns persist regarding the quality and reliability of psychiatric content disseminated on the platform. While misinformation has been documented for several mental disorders, no study has specifically examined how borderline personality disorder (BPD) is portrayed on TikTok. Objective: This study aims to characterize TikTok content related to BPD by describing its thematic content, engagement patterns, presenter characteristics, and indicators of information quality using a mixed methods secondary analysis. Methods: This mixed methods observational study performed a secondary analysis of a previously established dataset of publicly available TikTok videos related to mental health. A total of 207 videos addressing BPD or BPD-like traits were included. Quantitative analyses summarized video characteristics, engagement metrics, presenter backgrounds, content type, intent, and authenticity indicators using descriptive statistics. Qualitative data were analyzed using reflexive thematic analysis following Braun and Clarke’s methodology to identify recurrent narratives related to BPD. Results: Among the 207 included videos, 185 (89.4%) were in English and 199 (96.1%) targeted the general public. Most creators (n=124, 59.9%) did not disclose professional credentials, whereas psychiatrists (n=18, 8.7%) and psychologists (n=16, 7.7%) represented the largest identified professional groups. Seven overarching themes were identified: understanding personality disorders, treatment and management, interpersonal relationships, myths and misconceptions, co-occurring disorders, personal experiences, and diagnosis and classification. Videos focused on personal experiences generated the highest audience engagement (mean weighted likes 2389, SD 6529; favorites 333, SD 707; shares 117, SD 287), whereas treatment-focused videos demonstrated substantially lower engagement (mean weighted likes 222, SD 360; favorites 54, SD 77; shares 19, SD 40). Opinion-based or mixed-content formats predominated across most themes. Reference-based information remained limited, ranging from 0% to 33.3% depending on thematic category, while misinformation was observed across multiple themes, particularly understanding personality disorders (20/81, 24.7%) and diagnosis and classification (14/48, 29.2%). Experiential and relational narratives were substantially more prominent and engaging than evidence-based psychoeducational content. Conclusions: TikTok discourse surrounding BPD is dominated by experiential narratives that foster engagement but frequently rely on opinion-based rather than evidence-based information. Although many videos may provide validation and reduce stigma, the limited use of references and the persistence of misinformation highlight the need for the greater involvement of mental health professionals in producing accessible, accurate, and engaging digital content. To our knowledge, these findings provide the first focused overview of BPD-related content on TikTok and may inform future strategies to improve the quality of online mental health information.
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Understanding anxiety disorders among Iranian mothers and their children exposed to conflict using an extended transactional model of stress and coping
ObjectiveThe psychological impact of war on families is profound. However, the mechanisms linking war-related stressors to anxiety among mothers and their children remain insufficiently understood, particularly in Middle Eastern contexts. Grounded in an extended transactional model of stress and coping, this study examined the direct and indirect relationships between war-related stressors, cognitive appraisal, coping strategies, and anxiety among Iranian mothers and their children following a recent military conflict. The study also investigated the mediating roles of appraisal and coping processes and the moderating roles of religiosity and social support.MethodA cross-sectional design was employed approximately three months after a major military escalation. A stratified proportional sample of 343 Iranian mothers (aged 24 years and older) with at least one child aged 5–10 years living in conflict-affected areas completed validated self-report measures. Data were analyzed using partial least squares structural equation modeling (PLS-SEM).ResultsThe extends model explained substantial variance in maternal anxiety (R² = .80) and child anxiety (R² = .72). War-related stressors were significantly and positively associated with both maternal anxiety and child anxiety. In addition, maternal anxiety was significantly associated with child anxiety. Challenge appraisal, problem-focused coping, and cognitive restructuring mediated the relationship between war-related stressors and maternal anxiety. Emotion-focused coping positively mediated the relationship between war-related stressors and child anxiety. Religiosity and social support were found to buffer the association between war-related stressors and maternal anxiety, such that higher levels of religiosity and social support weakened the positive relationship between war-related stressors and anxiety among mothers.ConclusionsThis study extends the transactional model of stress and coping by supporting an integrated framework within a conflict-affected Middle Eastern population. The findings indicate distinct pathways linking war-related stressors to maternal and child anxiety and highlight the importance of interventions that address cognitive appraisal, strengthen adaptive coping strategies, and mobilize spiritual and social resources in conflict-affected families.
Anxiety and depressive symptoms and health-related quality of life in girls with central precocious puberty versus isolated premature thelarche: a comparative cross-sectional study
IntroductionPrevious studies have examined psychological symptoms and health-related quality of life (HRQoL) in girls with central precocious puberty (CPP) and isolated premature thelarche (IPT), but findings from direct comparisons have been inconsistent. We aimed to compare anxiety and depressive symptoms and HRQoL between girls with CPP and IPT and to examine associations between psychological symptom burden and HRQoL.MethodsThis comparative cross-sectional study included 50 girls (mean age, 8.33 ± 0.23 years), including 18 with idiopathic CPP and 32 with IPT. Breast development had first been recognized before 8 years of age in all participants. Psychological questionnaires were administered on the same day as the endocrinological evaluation. Anxiety and depressive symptoms were assessed using SCARED, RCADS-CV, and CDI, and self-reported HRQoL was assessed using PedsQL 4.0. Between-group comparisons incorporated Benjamini–Hochberg false-discovery-rate correction. Spearman correlations and exploratory hierarchical linear regression were performed.ResultsNo between-group differences in anxiety, depressive symptoms, or HRQoL remained statistically significant after FDR correction. Clinically elevated SCARED scores occurred in 38.9% of girls with CPP and 53.1% with IPT (p=0.333), while CDI scores ≥19 occurred in 11.1% and 18.8%, respectively (p=0.694). In the combined sample, psychological symptom scores were inversely correlated with PedsQL total scores (Spearman’s rs=−0.568 to −0.720; all p<0.001). In exploratory regression adjusted for endocrine phenotype, BMI SDS, and symptom duration, SCARED (β=−0.382, p=0.003) and CDI (β=−0.481, p<0.001) scores were associated with lower PedsQL total scores.DiscussionHigher anxiety and depressive symptom scores were associated with lower HRQoL in this clinical sample. The absence of statistically significant CPP–IPT differences does not establish equivalence or exclude a contribution of endocrine factors. Larger longitudinal studies are needed to confirm these associations.
Kamishoyosan reduces anxiety-like behavior by modulating GABAA receptor subunit expression in a premenstrual syndrome rat model
IntroductionPremenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) involve psychological symptoms that impact women’s quality of life. PMS pathogenesis is characterized by fluctuations in steroid hormones and γ-aminobutyric acid type A receptor (GABAAR) subunits. Kamishoyosan (KSS) is a Kampo medicine typically used to treat menstrual-related symptoms. This study aimed to elucidate the anxiolytic effect of KSS and its underlying mechanisms in a progesterone withdrawal (PWD)-induced PMS rat model.MethodsKSS was administered via feed mixing, and elevated plus maze test and molecular biological analysis were conducted.ResultsPWD rats showed increased anxiety-like behavior and expression of GABAAR α4 and δ subunits mRNA in the hippocampal CA1 region, suggesting that decreased inhibitory GABA synaptic signaling contributes to anxiety-like behavior. KSS administration reduced anxiety-like behavior and the expression of GABAAR α4 and δ subunits, but no significant effect was observed on steroid hormone levels.DiscussionThese findings suggest that KSS exerts anxiolytic effects by reversing changes in α4 and δ subunit expression without affecting steroid hormone fluctuations. The different mechanism of action of KSS compared with GABAAR agonists may provide a novel therapeutic strategy for PMS.