Tag: Anxiety

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Effectiveness of a Fully Automated Mobile Therapeutic Versus a General Chatbot in Reducing Depression and Anxiety and Improving Well-Being: Feasibility Randomized Controlled Trial

Background: Given the increasing prevalence of depression and anxiety disorders and enduring barriers to care, there is a critical need for alternative treatment options. Generative artificial intelligence (AI) chatbots show promise for increasing access to mental health care, though more direct research is needed to establish their efficacy. Objective: This pilot study aimed to test the efficacy of a generative mental health chatbot rooted in solution-focused therapy compared to the general-purpose ChatGPT and an assessment-only control (AOC) group on depression, anxiety, and well-being. Methods: A total of 185 English-speaking adults were recruited online and randomly assigned to one of three groups: AI therapy, ChatGPT, or AOC. Of these, 147 eligible participants filled out a pretreatment assessment. Over a 3-week period, the AI therapy group (n=44) was instructed to complete 3 structured, fully automated app-based sessions per week (9 total), while the ChatGPT group (n=60) was instructed to engage in 9 unstructured conversations with ChatGPT (GPT-4o–based models). The control group (n=43) received no intervention. In the AI therapy group, 39% (n=17) completed all sessions, as did 62% (n=38) of those in the ChatGPT group. Primary outcome measures, self-assessed online at baseline and postintervention, included the Patient Health Questionnaire-9 (PHQ-9), Overall Depression Severity and Impairment Scale (ODSIS) (depression), 7-item Generalized Anxiety Disorder Scale (anxiety), and World Health Organization Well-Being Index (5-item version) (well-being). Linear mixed effects models were used for data analysis. Results: Compared to AOC, both the AI therapy group (=−0.47; =.01) and the ChatGPT group (=−0.44; =.02) demonstrated significant reductions in depression scores measured by PHQ-9. The AI therapy group showed nonsignificant reductions in anxiety (=−0.37; =.11) and ODSIS depression scores (=−0.25; =.22) and an increase in well-being (=0.12; =.53) compared to AOC. Similarly, a nonsignificant reduction in anxiety (=−0.27; =.22) and ODSIS depression scores (=−0.12; =.53) and an increase in well-being (=0.20; =.29) were observed in the ChatGPT group compared to AOC. The AI therapy group did not significantly outperform the ChatGPT group on any outcomes (PHQ-9: =−0.19; =0.03; =.87; 7-item Generalized Anxiety Disorder Scale: =−0.57; =−0.11; =.62; ODSIS: =−0.59; =−0.13; =.50; and WHO: =−0.38; =−0.07; =.69). Conclusions: Both the structured generative AI chatbot and ChatGPT showed a significant reduction in depression scores compared to the control group. No significant effects were observed across other outcomes, although descriptive trends indicated improvements in anxiety. While the AI therapy group showed descriptively better outcomes for depression and anxiety, differences between groups were not significant. A larger sample and longer intervention may be needed for the emerging trends to yield clinically meaningful effect sizes. Trial Registration: OSF Registries osf.io/r76ef;
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Oral administration of kratom leaf extract alleviates anxiety-like behavior, urinary bladder pain, voiding dysfunction, and bladder hypercontractility via attenuating muscarinic receptor response in male mice exposed to chronic water avoidance stress

Psychological stress causes and deteriorates interstitial cystitis/painful bladder syndrome with urinary frequency, incontinence, bladder pain and urgency. The major alkaloid of kratom (Mitragyna speciosa), mitragynine, shows analgesic, anxiolytic, and smooth muscle relaxant effects. However, the effects of kratom leaf extract on stress-induced anxiety-like behavior, urinary bladder pain and urinary bladder dysfunction remain unknown. Therefore, this study aims to examine the effect of kratom leaf extract administration on anxiety-like behaviors, bladder pain, bladder contractile properties, and mast cell number in mice exposed to water avoidance stress. Male C57BL/6 mice were exposed to water avoidance stress (WAS) protocol for 10 consecutive days and compared with the stress-exposed mice receiving oral administration of kratom leaf extract (2.5 and 5 mg/kg of mitragynine) or solifenacin (10 mg/kg). Anxiety-like behaviors were assessed using open field test. Bladder pain sensitivity was evaluated with von Frey test, while voiding behavior was analyzed using voiding pattern analysis. Bladder contractility was examined using an in vitro organ bath technique, and urinary bladder mast cell infiltration was assessed by toluidine blue staining. Results show that mice receiving WAS had a reduction in the total duration and number of unsupported rearing behaviors, reduced voiding area, and increased bladder pain responses; however, these effects were reversed by treatment with kratom leaf extract (2.5 and 5 mg/kg of mitragynine). Interestingly, the WAS group also exhibited markedly increased tonic contractions in response to carbachol, a muscarinic agonist; these responses were attenuated in mice treated with kratom leaf extract (2.5 and 5 mg/kg) The enhanced tonic contractile response to carbachol was abolished by pre-incubation with ondansetron (a 5-HT₃ antagonist). The WAS group showed an increased total number of mast cells in the urinary bladder, which was reduced by treatment with kratom leaf extract at both 2.5 and 5 mg/kg. Our results indicate that treatment with kratom leaf extract attenuated chronic stress–induced bladder pain responses, voiding abnormalities, and mast cell numbers, and was associated with reduced contractile response to muscarinic stimulation, suggesting a potential modulatory effect on stress-induced bladder dysfunction.
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The temporal stability of core symptoms of social media addiction and their comorbidity with anxiety and depression in adolescents: a longitudinal network analysis

IntroductionSocial media addiction (SMA) is often comorbid with anxiety and depression. This study examined the temporal stability of core SMA symptoms and the bridging symptoms with anxiety and depression.MethodsA total of 1,240 adolescents (179 males, 1,061 females; mean age = 15.46 ± 0.63 years, age range: 14 – 18) completed the Bergen Social Media Addiction Scale (BSMAS), the Patient Health Questionnaire–9 (PHQ–9), and the Generalized Anxiety Disorder–7 (GAD–7) on two separate occasions in 2023 (T1) and 2024 (T2). The four symptom networks, including the BSMAS networks, two comorbidity networks (the BSMAS–GAD and the BSMAS–PHQ), and the integrated BSMAS–GAD–PHQ network, were estimated using Gaussian graphical models. Core symptom centrality was assessed using Expected Influence (EI), whereas bridge symptoms were identified using Bridge Expected Influence (BEI).Results1) Although SMA, anxiety, and depression levels of respondents rose significantly over the year, all four networks showed strong temporal stability, with the edge weights (r = .892 –.973, p < .001), the EI (r = .806 – .961, p ≤ .002), and the BEI (r = .699 – .804, p ≤ .008) highly correlated between T1 and T2; network comparison tests showed no significant changes in overall structures of all four networks, with most edges showing stable weights. 2) Within the BSMAS network, BSMAS2 (tolerance) and BSMAS6 (conflict) exhibited the highest EI at both time points. 3) In the comorbidity networks, BSMAS3 (mood modification), BSMAS5 (withdrawal), and BSMAS6 (conflict) consistently served as bridge symptoms on the SMA side at both T1 and T2. 4) Across both time points, PHQ1 (anhedonia) and PHQ7 (concentration problems) exhibited the highest BEI on the depression side, whereas GAD1 (nervousness) and GAD5 (restlessness) did so on the anxiety side. 5) These bridge symptoms were also confirmed in the integrated network.DiscussionThese findings illuminate the temporal persistence and development of symptom relationships, offering a more dynamic understanding of SMA–depression–anxiety comorbidity in adolescents.
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Psychometric properties of Lithuanian translation of the self-report version of the Liebowitz social anxiety scale in young adult sample

BackgroundSocial anxiety disorder starts in adolescence or young adulthood and may have damaging effects on psychosocial development of the individual. Any intervention starts from assessment and the Liebowitz social anxiety scale with later developed self-report version is a valuable tool for practitioners for almost four decades. Even though the original version and adaptations have consistently demonstrated good reliability, there remains considerable debate regarding the factor structure. The aim is to test the factor structure and internal consistency of Lithuanian translation of the self-report version of the Liebowitz social anxiety scale (LSAS-SR) in a non-clinical young adult sample.MethodData of 452 young adults (mean age 21.3, 69.7% female) who volunteered participate in the study was used. Two factor solutions were tested: a single-factor model, with anxiety/fear and avoidance ratings loading on one factor, and a higher-order factor model, including two second-order scales (anxiety/fear scale and avoidance scale) and four first-order subscales (social interaction anxiety, performance anxiety, social interaction avoidance, performance avoidance). Internal consistency assessed using Cronbach’s alpha.ResultsLithuanian version has excellent internal consistency for the total score, scales and subscales, with Cronbach’s alfas ranging.85-.96. Confirmatory factor analysis shows that both tested models have acceptable data fit (RMSEA = .062-.067; CFI = .93-.94), however strong associations between (sub)scales, i.e. correlations exceeding.80, suggests that the use of scale and subscale scores may be less informative, especially in cross-sectional research, but could provide nuanced information in individual assessment.ConclusionFurther research on psychometric properties of Lithuanian versions of LSAS-SR should focus on verifying these results in a representative sample and in a clinical sample as well as testing the convergent and discriminant validity.
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Number of children and maternal mental health in the context of China’s fertility policy transition: the moderating effect of employment status and the mediating effect of family environment

BackgroundHaving more children may be detrimental to maternal mental health during China’s ongoing fertility policy transition. However, under what circumstances and how number of children could be associated with maternal mental health remains understudied in China. This study examined the association between number of children and maternal anxiety and depressive symptoms among mothers of middle school students in Shanghai, China. It also explored the moderating effect of maternal employment status and the mediating effect of family environment.MethodsMothers of students from 7 middle schools in Shanghai were surveyed. In total, 4,215 valid questionnaires were obtained. The survey included sociodemographic information, the Generalized Anxiety Disorder Scale (GAD-7), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Chinese version of the Family Environment Scale (FES-CV). Multiple linear regression analysis was performed to examine the association between number of children and maternal anxiety/depressive symptoms. Model 1 and Model 4 of SPSS PROCESS were then employed to examine the moderating effect of employment status and the mediating effect of family environment.ResultsThe rates of clinically significant anxiety and depressive symptoms among mothers were 13.6% and 17.6%, respectively. The moderating effect of maternal employment status was significant. Among unemployed mothers, number of children was positively associated with both maternal anxiety and depressive symptoms, whereas among employed mothers, number of children was not associated with maternal anxiety or depression. Among unemployed mothers, family environment mediated the association between number of children and maternal anxiety/depressive symptoms through the pathways of family conflict and organization. Among employed mothers, family environment suppressed the association between number of children and maternal anxiety/depressive symptoms through the pathways of family conflict, intellectual-cultural orientation, organization, control, and independence.ConclusionOur findings suggest that number of children per se is not necessarily associated with worsened maternal mental health. Instead, the potential changes in employment participation and family environment that accompany having more children may be more relevant. Therefore, stakeholders, clinicians, and researchers should therefore focus on these aspects when addressing maternal mental health.
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Effect of a nursing-based information–motivation–behavioral model on older patients with type 2 diabetes mellitus

BackgroundOlder patients with type 2 diabetes mellitus (T2DM) frequently encounter challenges, including a diminished capacity for self-management, a high prevalence of negative emotions, and cognitive decline and physiological changes attributable to long-term disease burden, leading to compromised glycemic control and impaired quality of life. Traditional diabetes nursing interventions often lack systematic strategies to address the psychological and cognitive needs specific to this patient population. The Information-Motivation-Behavioral Skills (IMB) model is a theoretical framework designed to promote health behavioral changes; however, research investigating its specific application in regulating psychological state and managing cognitive function in older patients with T2DM remains limited.AimTo investigate the effectiveness of a nursing intervention based on the IMB model in older patients with T2DM.MethodsData from 86 older patients with T2DM were divided into 2 groups: intervention (structured IMB model-based nursing + routine care [n = 43]); and control (conventional T2DM care [n = 43]). Psychological state (Self-Rating Anxiety and Depression Scales [SAS, SDS]), cognitive function (Mini-Mental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA]), glycemic control (fasting blood glucose [FBG], 2 h postprandial blood glucose [2hPBG], and glycated hemoglobin A1c [HbA1c]), and satisfaction with nursing were compared between the 2 groups before and after a three-month intervention.ResultsSAS and SDS scores significantly decreased in both groups after intervention, with a more pronounced reduction in the intervention group (P < 0.05). MMSE and MoCA scores improved in both groups, with significantly higher scores in the intervention group (P < 0.05). Glycemic control (FBG, 2hPBG, and HbA1c) improved substantially in the intervention group (P < 0.05). Satisfaction with nursing among the intervention group (95.35%) was significantly greater than that in the control group (79.07%) (P < 0.05).ConclusionThe IMB model-based nursing intervention alleviates anxiety and depression, improves cognitive function, enhances glycemic control, and increases satisfaction with nursing in older patients with T2DM, thus meriting broader clinical implementation.
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Coping under pressure: police-specific stressors and mental health in Catalonia police forces

IntroductionPolice officers are exposed to elevated psychological risks due to both operational and organizational stressors. Additionally, police officers tend to resort to avoidant coping strategies, which exacerbate poor mental health outcomes, such as burnout and PTSD.MethodsThis study aims to examine clinical symptoms (stress, anxiety, depression), coping styles, and perceived stressors among police forces from Catalonia, Spain. A total of 741 officers completed an online survey comprising DASS-21, PSQ-Op, PSQ-Org, Brief COPE and brief open-ended questions. ResultsOverall, both operational and organizational stressors were significant predictors of clinical symptoms, with the latter revealing a more pronounced impact. Avoidant coping emerged as the strongest risk factor for distress, while problem-focused coping emerged as a possible protective factor, especially against depression. Both gender and years of service influenced coping strategies: i) female officers reported higher use of adaptive coping, while male officers scored higher in avoidant coping; and ii) more experienced officers reported lower anxiety symptoms but also lower use of active coping strategies. DiscussionThese findings underscore the importance of addressing both organizational culture and individual-level factors in promoting psychological resilience, while considering gender and career stage to support sustainable mental health within police forces.
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Popular Online Content as a Treatment-as-Usual Control in Digital Mental Health Intervention Trials: Secondary Analysis of Two Online Randomized Controlled Trials With Repeated Measures

Background: Treatment-as-usual (TAU) conditions are intended to reflect the support typically received in routine treatment settings. For digital mental health interventions (DMHIs) delivered online, TAU conditions should reflect the usual patterns of online help-seeking. The lack of ecologically valid TAU control conditions has been a gap in effectiveness trials of online DMHIs. In this study, mental health–related popular online content (eg, advice TikToks, lived experience vlogs, and self-care infographics) was examined as a valuable TAU control condition. Objective: This study examined the feasibility of popular online content as a TAU control condition in DMHI trials. Methods: This study was a secondary analysis of two randomized controlled trials. Both trials recruited participants online, primarily via an online study recruitment platform. In study 1 (N=916), US adults with elevated depression or anxiety were randomized to either (1) complete a single-session DHMI for depression and anxiety (n=291), (2) search the web for popular online content relevant to their struggles (n=312), or (3) search a curated library of mental health–related popular online content (n=313). In study 2 (N=431), US adults with elevated loneliness were randomized to (1) complete a single-session DHMI for loneliness (n=136), (2) search a curated library of popular online content related to loneliness (n=145), or (3) complete an attention-matched control condition (n=150). All 6 programs took approximately 10 to 20 minutes to complete and were entirely self-guided. Participants rated each program’s credibility and expected benefit, as well as their feelings of distress (study 1) and loneliness (study 2). The studies did not involve interaction between participants and the research team. Results: In study 1, dropout during the treatment was 4.8% (14/291) for the single-session intervention, 25.9% (81/312) for online help-seeking, and 9.6% (30/313) for the curated library. The curated library’s credibility and expected benefit score did not differ from that of the single-session intervention (Cohen =0.08; =.88) and was higher than that of unguided help-seeking (Cohen =0.23; =.01). In study 2, dropout was higher in the curated library condition (7/145, 4.8%) than in the single-session intervention and the attention-matched control condition (0/136, 0.0% and 0/150, 0.0%). The mean credibility and expected benefit score for the curated library was comparable to that of the attention-matched control condition (Cohen =0.00; >.99) but lower than that of the single-session intervention (Cohen =0.32; =.02). Changes in distress and loneliness from baseline to 8-week follow-up did not differ across the conditions in study 1. All effect sizes were small in study 1 (Cohen <0.15 and no comparisons were statistically significant >.06). Similarly, in study 2, all effect sizes were small (Cohen <0.12), and no comparisons were statistically significant (>.25). Conclusions: Curated libraries of popular online content are a feasible, ecologically valid TAU benchmark for effectiveness trials of online DMHIs. Future research on TAU conditions in online help-seeking contexts should better align with observed DMHI attrition rates and account for the increasingly central role of conversational artificial intelligence in online mental health support. Trial Registration: OSF Registries 3DYMA; https://osf.io/3dyma and NVD79; https://osf.io/nvd79; ClinicalTrials.gov NCT05687162; https://clinicaltrials.gov/study/NCT05687162
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Altered static and dynamic regional homogeneity in basal ganglia–thalamocortical circuits and their association with neuropsychiatric manifestations in Wilson’s disease

PurposeWilson’s disease (WD) is an autosomal recessive disorder caused by ATP7B mutations, resulting in impaired copper metabolism and progressive neuropsychiatric manifestations. This study investigated spatiotemporal alterations in regional brain activity using static and dynamic resting-state fMRI with regional homogeneity (ReHo), and their relationships with clinical features.MethodsResting-state fMRI data were acquired from WD patients and healthy controls (HCs). Static and dynamic ReHo analyses were performed to characterize local synchronization strength and temporal variability of spontaneous neural activity. Group differences were assessed across the basal ganglia, thalamus, cerebellum, and cortical regions. Associations between altered ReHo metrics and clinical measures were evaluated with FDR correction for multiple comparisons.ResultsCompared with HCs, WD patients exhibited widespread ReHo abnormalities involving the basal ganglia (putamen and globus pallidus), thalamus, cerebellum, and cortical regions. Static ReHo in the left putamen and globus pallidus was positively associated with anxiety severity, while right putaminal ReHo was negatively associated with neurological severity and positively associated with disease duration. Dynamic ReHo in the left middle frontal gyrus showed negative associations with depression severity and disease duration. All brain–behavior correlations survived FDR correction, indicating robust effects.ConclusionWD is characterized by disrupted spatiotemporal organization of local functional synchronization within cerebellar and basal ganglia–thalamo–cortical circuits. These findings support a network-level dysfunction model involving subcortical synchronization deficits and cortical temporal instability, which together underpin neuropsychiatric manifestations and disease progression.