Internet-Based Cognitive Behavioral Therapy for Panic Disorder Among Arabic-Speaking Patients: Case Series

Background: Internet-based cognitive behavioral therapy (ICBT) has shown promise for the treatment of panic disorder (PD), but little is known about its feasibility and use across cultures and languages. Objective: This study examines the feasibility and preliminary outcomes of an Arabic-translated ICBT program for PD and describes how patients experienced the program. Methods: Six Arabic-speaking women (aged 21‐50 years, mean 35, SD 10 years) with a primary diagnosis of PD underwent a 16-week guided ICBT program using an Arabic-translated protocol. PD symptoms (Panic Disorder Severity Scale–Self-Report [PDSS-SR]), anxiety sensitivity (Anxiety Sensitivity Index-3 [ASI-3]), and agoraphobic avoidance (Mobility Inventory [MI]) were assessed pretreatment, posttreatment, and 3 months later. The outcomes were analyzed descriptively. Four patients also participated in individual, semistructured posttreatment interviews about their experience of the program, which are reported descriptively as the patient-perspective component of the case series. Results: The program was completed by 4 of the 6 (67%) patients. Among completers, PDSS-SR scores decreased from 11‐18 pretreatment to 0‐7 posttreatment, ASI-3 scores decreased from 18‐59 to 0‐4, and MI scores decreased from 1.44‐3.82 to 0.00‐1.60, indicating reduced agoraphobic avoidance. Follow-up data were available for 3 of the 4 (75%) completers: 2 maintained their gains, and 1 showed a partial return of symptoms. The fourth reported a recurrence of symptoms posttreatment but could not be reached for follow-up. During the interviews, all 4 patients expressed positive views of the program. Conclusions: Arabic-translated ICBT appeared feasible and was associated with reductions in panic symptoms and anxiety sensitivity among Arabic-speaking patients with mild-to-moderate PD. These preliminary findings support further investigation with larger samples.
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Suicidal Ideation Endorsed on the Patient Health Questionnaire-9 at Intake and Treatment Outcomes in Gambling Disorder Care: Retrospective Cohort Study

<strong>Background:</strong> Gambling disorder (GD) carries a disproportionate burden of suicide risk. Clinicians frequently encounter patients with suicidal ideation (SI) at treatment entry, yet no published study has examined whether SI at intake predicts treatment engagement or symptom change in GD care. <strong>Objective:</strong> This study aimed to determine (1) the prevalence of SI at treatment entry among adults seeking GD care, (2) how clinical and demographic characteristics differ by SI status, and whether SI at intake predicts differential (3) treatment engagement or (4) improvement in gambling symptom severity. <strong>Methods:</strong> This retrospective cohort study used de-identified clinical data from Birches Health, a US-based virtual behavioral health provider. Eligible patients entered care for GD between June 2, 2024, and April 20, 2026; completed at least one session; and had baseline Patient Health Questionnaire-9 (PHQ-9) data (N=1518). SI was defined as a score of ≥1 on PHQ-9 item 9. Baseline characteristics were compared using t and χ2 tests. Engagement was defined as appointments attended within 90 days of the first session and modeled using negative binomial regression; initiation of care was compared by SI status among all patients who completed an intake PHQ-9. Gambling Symptom Assessment Scale (G-SAS) trajectories were modeled using linear mixed-effects models with natural spline terms for time and SI-by-time interactions, adjusting for depression severity (Patient Health Questionnaire-8 [PHQ-8]), age, and gender. Sensitivity analyses addressed engagement definitions, follow-up patterns, and alternative codings of item 9. <strong>Results:</strong> SI was endorsed by 465 (30.6%) patients. Patients with SI had higher depression and gambling severity (PHQ-8 mean 15.2, SD 5.5; G-SAS mean 22.6, SD 11.4) than those without SI (PHQ-8 mean 8.7, SD 5.3; <i>P</i>&lt;.001; d=1.20; G-SAS mean 19.1, SD 11.9; <i>P</i>&lt;.001; d=0.30) but did not differ on age, gender, or most psychiatric comorbidities. Patients with SI were less likely to initiate care (465/2009, 23.1%) than those without SI (1053/3958, 26.6%; <i>P</i>=.004). Among patients who initiated care, SI was not associated with appointments attended in the first 90 days (incidence rate ratio 1.04, 95% CI 0.92-1.17; <i>P</i>=.54) or with retention. By day 90, model-based G-SAS scores declined from 20.8 to 12.2 among patients with SI and from 18.9 to 11.4 among those without SI. Patients with SI had higher adjusted baseline G-SAS scores (b=1.85, 95% CI 0.21-3.49; <i>P</i>=.03), but change over time did not differ significantly between groups. Findings were consistent across sensitivity analyses. <strong>Conclusions:</strong> SI at intake is common among adults entering GD treatment and is associated with more severe depressive and gambling symptoms. Among patients who started treatment, gambling symptoms declined substantially in both groups, with no significant differences in engagement or symptom improvement by SI status. Patients with SI can experience meaningful improvement in gambling symptoms during outpatient treatment.

Can Video Games Make Kids Violent? Answers to Parents’ Top Gaming Questions

Dave Anderson PhD
By: Dave Anderson, PhD

Vice President, Public Engagement and Education; Senior Psychologist, ADHD and Behavior Disorders Center Read More

A child psychologist on Grand Theft Auto VI, aggression, meltdowns, and how to keep gaming in balance

A new installment of the mega-popular Grand Theft Auto video game will be released soon, and in a lot of homes the request has already landed: Can I play it? It’s one of the most anticipated game releases in years, and it has prompted a wave of questions from parents who listen to Thriving Kids, a podcast from the Child Mind Institute.

Parents are also wondering when gaming becomes a problem, what to do about meltdowns when it’s time to stop, and how to handle games that eat into sleep and schoolwork. Here are my answers to nine of the questions we received, starting with Grand Theft Auto VI.

My 13-year-old wants GTA 6. Should I let them play it?

Like earlier games in the series, GTA 6 involves committing acts of violence and robbery, a lot of swearing, and characters who draw players into all kinds of actions that would be crimes in real life. But it’s also a world that can be genuinely fascinating to explore and figure out.

There are a few ways to approach your child’s request. First, check the rating. GTA 6 is rated M for Mature (17+), and in some other countries it’s rated even higher. This is highly adult content.

Second, consider your child’s maturity level. Some 13-year-olds have already been exposed to this kind of content and handle it well, meaning it doesn’t seem to affect their behavior, their language, how they treat their peers, or basic habits like sleep and homework.

Other 13-year-olds may be more vulnerable. A child with ADHD, for example, may already struggle with executive functioning, time management, or stopping something they enjoy to do homework or go to sleep — playing video games may make those challenges worse. But these are concerns with any game a child engages with, whatever its content.

A child who already struggles with impulsiveness, verbal or physical aggression toward peers, or foul language may also be more vulnerable. We probably don’t want that child repeatedly practicing similar behavior through the game.

If you look at this content and decide it isn’t right for your 13-year-old, that’s a sound decision. And if you know your child well and feel they can handle it, you don’t need to feel guilty about that either.

Can playing Grand Theft Auto make kids more violent?

Parents have worried about violent video games encouraging kids to commit violence since the 1990s. Such a link is not supported by research.

But aggression is different from violence. A more developed body of research suggests that violent games may make kids who are already prone to impulsivity or aggression — such as verbal aggression, bullying, or physical aggression — more aggressive. Playing violent video games can also allow people to “rehearse” aggressive thoughts and acts, and some experimental research suggests this can translate to more aggressive thinking or behavior, especially when kids play a lot or play with friends.

But keep in mind: There are more powerful factors that can influence a child’s behavior. The effect of violent video games is small in relation to the quality of the parent-child relationship, whether a child has been exposed to violence or trauma at home, and how closely parents keep track of where their teens are and who they spend time with.

So, here’s the short answer: When it comes to violent acts, the research doesn’t support a link. When it comes to aggressive thoughts and a slightly higher chance of aggressive behavior, there is some evidence. And there are many real-world factors in a child’s life that matter more than the games they play.

My child says everyone else is playing GTA. How should I respond?

As a psychologist, I generally advise parents not to be the most permissive parent in their child’s friend group, but not to be the strictest, either. It’s best to aim for somewhere in the middle. The research on parenting points the same way. The goal is to lead with support and add structure when kids need it.

You may not think your child is ready for this content. You may worry it could make a mental health challenge worse, or your child may already be prone to aggressive speech or teasing that borders on bullying. Those are all good reasons not to let them practice those things in their free time, and you can feel confident holding that boundary. You might say: “Sometimes I’ll be in line with your friends’ parents, and sometimes I won’t. I love you, and I want to help you experience lots of other things in life.”

You can also try a middle path with conditions attached: Your child can only play the game in a shared space where you can see and hear what’s going on. They can explain the game to you, and you can keep an eye on their behavior outside the game, putting more limits if you see any concerning changes. But be clear with your child about what you’re worried about and what would lead you to step in. Gaming that starts cutting into sleep or schoolwork, for example, is a clear signal to set a limit.

My child watches Grand Theft Auto content on YouTube but doesn’t play the game. Is that different?

Lots of kids watch streamers play the games they like on YouTube or Discord or watch short-form clips on social media. For a child who isn’t allowed to play a popular game, watching can be a way to understand it and stay in the conversation with friends.

Still, it’s reasonable to be cautious. Research is still emerging on how short-form video affects kids’ attention — and an algorithm may keep feeding them more violent content. So, you might nudge your child away from short clips and toward longer videos that follow a story.

It can help to know what they’re watching. Is the channel about the graphics and gameplay? Is it about glorifying violent acts? Or is it about how a team works together to complete a quest? You might start by watching together and let your child watch on their own once you’ve approved the content, or only when you’re around to keep an eye on it.

Age matters here, too. For kids in middle school or younger, I’d monitor more closely — any site where they watch gaming videos will probably serve up more content with similar themes. With an older teen watching on their own device, it’s reasonable to say, something like, “Help me understand why this is valuable to you. Let’s watch some together, and then I’ll trust you to watch on your own.”

My child can focus on something like Grand Theft Auto for hours but can’t focus on homework. Why?

Almost everyone focuses better on something they enjoy than on something they don’t. It’s why so many of us procrastinate, scrolling social media or knocking out small, easy tasks instead of the one big thing we need to do. Kids are no different.

We want to teach kids how to sequence and prioritize tasks, how to bring their focus to something even when it isn’t the most interesting option, and how to build persistence. (My recent Thriving Kids episode with Julia Leonard, PhD, goes deeper on persistence.)

A helpful first step is bundling. If you’re going to allow your child to play video games, make sure it comes after homework. Your child shows you evidence that their homework is finished, and then they get access to games, whether that’s up until dinner, bath time, or getting ready for bed. They can also earn more time by getting down to work sooner. If you aren’t home in the afternoon, gaming can start once you get home.

Are some kids more vulnerable to problematic gaming than others?

Problematic gaming — excessive gaming at the cost of one’s well-being — follows a recognizable pattern. A child plays for very long stretches, more and more over time, and becomes increasingly distressed when they have to stop. Gaming starts to crowd out the things that matter for their development: schoolwork, real-life friendships, sleep, even eating properly.

Problematic gaming rarely happens on its own. Often a child has a co-occurring mental health condition. A child who is depressed may withdraw from activities and friends and find comfort and distraction in gaming, which then reinforces their depression. A child who struggles to make friends may find it easier to connect with people online and retreat into the digital world, making it harder to make friends in real life. A child with attention challenges may find it harder to put the brakes on fun and novel activities to do something less rewarding.

So yes, some kids are more vulnerable. But there are effective treatments both for the underlying conditions and for setting boundaries around gaming. For some kids, that means enforcing a break from gaming — for a short time or a longer one — because they can’t yet put on the brakes on gaming themselves. For others, it may mean moderation, with conditions in place to make sure their other responsibilities get done.

My child melts down when it’s time to stop playing. What should I do?

A meltdown at the end of gaming time can be a sign of problematic gaming, but on its own it’s just one indicator among several. It’s actually very common, especially for younger kids, to have a meltdown when they’re asked to stop something they enjoy and to do something less fun, like come to dinner, start homework, take a bath, or go to bed.

So, think of this as a lesson in emotion regulation, a set of skills kids learn in stages.

The first step to helping kids self-regulate is modeling. How do you regulate your own emotions, and do you talk about it out loud? Do you take deep breaths, step away for a break, reach out to someone, or do something distracting for a moment to reset?

The second step is reinforcement. How do you respond when your child does calm down? Do you give them positive feedback? Can they earn an activity or a special privilege when they practice these skills?

The third step is teaching these skills directly. Does your child know what emotion regulation looks like? (You can learn more about how to teach emotion regulation skills to kids of any age through the free resources, including short videos, that we have here.)

Finally, when your child does melt down, can you sit with their big feelings? As long as they aren’t screaming at you, refusing to go to bed, or getting physically aggressive, you can calmly acknowledge it by saying something like, “I know it’s hard to stop playing, but it’s time to get ready for bed.”

When that isn’t enough, a consequence can help. Tell your child that their gaming time depends on their ability to stop calmly. For example, a child who gets 30 minutes of gaming at night and melts down when it ends might lose 10 of those minutes the next day. Just make sure consequences, when needed, are applied consistently.

Many parents’ first instinct is simply to take the game away. That is an option, and you may need to use it. But try this process first — it can build skills that help with almost anything you’re trying to teach your child.

Should gaming be earned through chores, homework, or good behavior?

Much of life runs on a kind of social contract. When you get your responsibilities done, finish your homework, treat your sister kindly, and speak respectfully to your parents, you have access to certain privileges. For younger kids, that might be a favorite activity or dessert. As kids get older, it might be an allowance. For teenagers, it might be their social life, their curfew, rides, or a little money for meals out with friends. And in the working world, meeting your responsibilities is how you earn your salary.

That doesn’t mean every privilege has to depend on chores, homework, and good behavior. Systems like this take energy to run, so save them for when your child really needs to build a skill and fade them back as that need lessens. A child who does the dishes now and then, picks up their room, does their homework, and keeps safe hands around their sister may not need their 30 minutes of gaming tied to any of it. You can simply give them a set amount of gaming time each day.

When you are seeing problems with contributions at home, effort at school, or behavior, video games can absolutely be made contingent on those things.

What should parents do if they think gaming is affecting sleep, school, or friendships?

Sleep, school, and friendships are core areas of a child’s wellness and development.

Whenever parents ask about screens, video games, or phones, I go through a checklist. Think about your child’s diet and hydration, physical activity, sleep, mood, friendships online and off, investment in school and homework, and whether they take part in at least one extracurricular activity or hobby. We also want to think about their relationships with parents and friends, and whether they have a supportive adult in their life.

These are the building blocks of a child’s wellness. When a child’s screen time is in balance with them there is less cause for concern.

When gaming cuts into sleep, set a time when screens end, and keep all devices out of your child’s room at bedtime.

When schoolwork is slipping, structure the afternoon so homework comes before gaming.

When you’re worried about extracurriculars or time with friends in real life, look for ways to restore that balance. You can remove games for a short or long period if you need to. Kids don’t need games to live.

At the same time, we don’t want to dismiss kids’ interests or tell them gaming is terrible. You can say: “This is your interest, and I want to support you in it. I also want to support your wellness as a whole.”

Sometimes restoring that balance is still really hard. It may lead to a lot of conflict, big fights, or your child becoming more aggressive or disrespectful. That’s the time to reach out for help, perhaps with a school counselor or therapist.

This blog post is adapted from the Thriving Kids episode “Can Video Games Influence Children and Teen Behavior?” Listen on Apple Podcasts, watch on YouTube, or subscribe wherever you get your podcasts. Have a question for a future episode? Email podcast@childmind.org.

The post Can Video Games Make Kids Violent? Answers to Parents’ Top Gaming Questions appeared first on Child Mind Institute.

Prenatal maternal psychiatric disturbance and offspring neurodevelopmental disorders: a retrospective case–control study from Egypt

BackgroundMaternal mental health during pregnancy is an under-recognized predictor of offspring neurodevelopment, particularly in low-resource settings with limited perinatal mental health screening. This study investigated the association of the presence and diagnostic subtype of neurodevelopmental disorders (NDDs) in offspring with maternal depression, anxiety, stress, physical or verbal abuse, and perceived social support during the last trimester of pregnancy in an Egyptian sample.MethodsA retrospective case–control design compared 200 mothers of children diagnosed with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD) or attention deficit disorder (ADD) (cases) with 300 mothers of typically developing children (controls) aged 3–17 years. Participants were recruited in Egypt through a university hospital, charitable medical convoys, a private child psychiatry clinic and the community, and controls were frequency-matched on child age, sex and maternal socioeconomic status (SES). Mothers retrospectively reported depression, anxiety and stress (Depression Anxiety Stress Scales-21), perceived social support (Multidimensional Scale of Perceived Social Support), and physical or verbal abuse and emotional distress during the last trimester; child behavior was described with the Strengths and Difficulties Questionnaire. Associations were estimated with logistic regression adjusted for child age, sex, maternal SES and maternal age, with covariates selected a priori. Because SES matching was not achieved and recruitment sources differed between groups, sensitivity analyses included restriction to the only site that recruited both cases and controls.ResultsCase mothers had significantly higher severity of depression, anxiety and stress, more physical or verbal abuse (45.2% vs. 13.7%) and lower perceived social support than control mothers (all p <.001). In models adjusted for child age, sex, maternal SES and maternal age, abuse (odds ratio [OR] = 4.09, 95% CI 2.52–6.64), depression (OR = 2.94, 95% CI 2.33–3.70 per severity category), anxiety (OR = 1.99, 95% CI 1.70–2.32) and stress (OR = 2.12, 95% CI 1.74–2.58) were associated with higher odds of case status, and perceived social support with lower odds (OR = 0.45, 95% CI 0.36–0.56 per scale point). Associations were similar at the single site that recruited both cases and controls. When all exposures were modelled together, depression (OR = 2.56), anxiety (OR = 1.37) and social support (OR = 0.45) remained associated with case status, whereas the abuse estimate was attenuated (OR = 1.84, 95% CI 0.96–3.54); because this mutually adjusted model conditions on potential mediators of abuse, its estimate should not be interpreted as either a total association or a direct effect. Among cases, maternal psychosocial factors only weakly distinguished autism from ADHD.ConclusionPrenatal psychosocial adversity and maternal psychological distress, particularly depression and anxiety, were strongly associated with offspring NDDs in this Egyptian sample, and depression and anxiety remained associated after mutual adjustment. Because exposures were recalled after the child’s diagnosis and cases and controls were recruited largely from different sources, these estimates may overstate the true associations. Because exposures were recalled retrospectively in a case–control design, these associations cannot be interpreted as causal, but they support the embedding of screening for maternal mental health and violence within routine antenatal care in similar under-resourced settings.

Value of joint hypermobility assessment as a clinical marker in psychiatric emergency care

IntroductionAnxiety disorders are among the most frequent reasons for psychiatric emergency consultations, yet their identification remains challenging. Joint hypermobility syndrome has consistently been associated with anxiety in both clinical and community samples, but its usefulness in psychiatric emergency settings has not been investigated.AimTo investigate whether joint hypermobility is associated with anxiety in psychiatric emergency care, to examine its relationship with illness severity and global functioning, and to evaluate its predictive value for an anxiety diagnosis at discharge.Material and methodsThis prospective study included 400 consecutive patients attending the psychiatric emergency department of a general hospital. Participants were assessed using the Severity of Psychiatric Illness (SPI) scale, the Anxiety Screening Questionnaire (ASQ-15), the Global Assessment of Functioning (GAF) scale, and a validated self-administered questionnaire developed by Hakim and Grahame for joint hypermobility. Associations between joint hypermobility and anxiety diagnoses were examined using bivariate analyses (ANOVA and chi-squared test) and multivariable logistic regression.ResultsAt discharge, 61.2% of patients diagnosed with an anxiety disorder met criteria for joint hypermobility (score ≥3), compared with only 17.4% of patients with other diagnoses (χ² = 39.34, p < 0.0001). In the multivariable logistic regression model, joint hypermobility was independently associated with an anxiety diagnosis at discharge (OR = 4.70, 95% CI 2.31–9.56), together with lower psychiatric illness severity, and younger age. The final model showed good discriminative ability (AUC = 0.863). Joint hypermobility screening demonstrated a sensitivity of 68.1% and a specificity of 80.6% for anxiety disorders at discharge.ConclusionJoint hypermobility is associated with anxiety disorders in psychiatric emergency care and may provide a simple, low-cost clinical marker to support the identification of anxiety disorders in this setting. Further studies are warranted to confirm its diagnostic utility and generalizability.

Preliminary diagnostic performance of the MOXO continuous performance test in young adults undergoing ADHD assessment

IntroductionAttention-deficit/hyperactivity disorder (ADHD) diagnosis in young adults is often challenging due to symptom overlap with affective disorders and the inherent subjectivity of clinical evaluations. While Continuous Performance Tests (CPTs) provide objective metrics, their preliminary diagnostic performance and concordance with clinical evaluations relative to self-report questionnaires require evaluation in clinical settings. This study explored the diagnostic performance of the MOXO-CPT and formally examined its incremental predictive value beyond commonly used self-report measures in young adults assessed for ADHD.Materials and methodsA total of 118 young adults (aged 18–25 years) consecutively referred with attention-related complaints completed the MOXO-CPT and self-report scales (ASRS, WURS-25, STAI, RRS-SF). ADHD diagnoses were established via comprehensive semi-structured clinical interviews based on DSM-5 criteria by an experienced psychiatrist blinded to test and questionnaire scores. Multivariable logistic regression and Receiver Operating Characteristic (ROC) analyses evaluated independent predictors and discriminative performance relative to this clinical reference standard.ResultsADHD was diagnosed in 58.5% (n=69) of the cohort, while the remaining 41.5% (n=49) comprised a clinical comparison group predominantly presenting with alternative psychiatric conditions (63.3%). Participants with ADHD showed poorer performance across all MOXO-CPT indices (attention, timing, impulsivity, and hyperactivity) compared to the non-ADHD clinical comparison group. In multivariable modeling, average or above-average performance on the attention and hyperactivity indices was independently associated with a lower likelihood of ADHD diagnosis. ROC analysis indicated that the MOXO-CPT attention index demonstrated favorable discriminative capacity relative to the clinical diagnosis (AUC = 0.87, sensitivity = 81.2%, specificity = 85.7%), whereas other indices showed acceptable-to-poor discriminative performance.DiscussionIn this help-seeking sample of young adults, the MOXO-CPT attention index demonstrated promising discriminative ability in differentiating ADHD from a non-ADHD clinical comparison group predominantly presenting with anxiety and depressive disorders. These preliminary findings suggest that distractor-embedded continuous performance testing may serve as a useful objective adjunct for distinguishing ADHD from common psychiatric mimics in outpatient settings, rather than a stand-alone tool or a general screening instrument for healthy populations.

Study of Anxiety Free Experiences at the Dentist

Conditions: Dental Phobia; Dental Anxiety in Children; Dental Fear; Dental Fear and Anxiety

Interventions: Behavioral: One-Session Treatment for Dental Phobia (OSTD); Behavioral: Psychoeducation and Relaxation Training (RELAX)

Sponsors: University of Texas Rio Grande Valley; National Institute of Dental and Craniofacial Research (NIDCR)

Recruiting