IntroductionAttention-Deficit/Hyperactivity Disorder (ADHD) is a condition characterized by persistent patterns of inattention and/or hyperactivity-impulsivity. This case highlights the potential benefit of integrating Immersive Virtual Reality (IVR) with cognitive-behavioral therapy (CBT) in the rehabilitation of a child with ADHD. It contributes to emerging evidence by showing how a combined approach may simultaneously target executive, attentional, and motor domains within a single intervention.Case presentationAn 8-year-old child with deficits in sustained and selective attention, impaired executive functioning (including planning and working memory), impulsivity, and difficulties in motor regulation, as revealed during baseline assessments, impacting daily functioning. The patient was diagnosed with combined-type ADHD and underwent a 12-week CBT intervention, followed by integrated IVR-CBT intervention targeting executive functions and self-control, once a week for 12 weeks. The intervention was conducted using the CAREN (Computer Assisted Rehabilitation Environment), an immersive virtual reality platform integrating multisensory input and interactive tasks to promote cognitive and motor engagement. Post-intervention assessments showed improvements in sustained and selective attention, planning, working memory, and balance. There was also an increase in involvement and a reduction in impulsivity.ConclusionThe findings support the hypothesis that immersive, embodied interventions targeting both executive and sensorimotor processes may represent a promising novelty adjunctive rehabilitation approach. Further studies are needed to evaluate efficacy, generalizability, and to confirm these findings in larger samples. This case report was prepared in accordance with the CARE Guidelines.
Circadian dimensions in insomnia disorder: mechanistic evidence, candidate phenotypes, and a phenotype-stratified research framework
Insomnia disorder is one of the most common sleep disorders and is traditionally conceptualized in terms of hyperarousal, altered sleep homeostasis, and cognitive-behavioral perpetuating factors. The two-process model of sleep regulation indicates that sleep initiation and maintenance depend not only on homeostatic sleep pressure but also on circadian phase, amplitude, and stability. Evidence suggests that some patients presenting with insomnia complaints have misalignment between endogenous circadian phase and the intended sleep window, whereas others show reduced rest-activity amplitude, increased sleep-timing variability, or abnormal light exposure patterns. This narrative review integrates clinical, measurement, mechanistic, and intervention evidence on circadian dimensions in insomnia disorder and proposes a candidate circadian phenotyping framework for future validation. The framework combines sleep diaries, actigraphy, light exposure assessment, dim-light melatonin onset (DLMO), and core body temperature rhythms to distinguish circadian rhythm sleep-wake disorder (CRSWD)-dominant insomnia complaints, insomnia disorder with circadian modifiers, and comorbid insomnia disorder and CRSWD. Cognitive behavioral therapy for insomnia (CBT-I) remains first-line treatment. Fixed wake time, morning light, evening light restriction, timed low-dose melatonin, scheduled activity, and multicomponent approaches are positioned as candidate adjunctive modules to be tested in phenotype-stratified trials. These phenotypes are not diagnostic categories, clinical decision algorithms, or treatment guidelines. The review instead translates circadian evidence in insomnia into testable propositions, including provisional phenotype definitions, recommended measurement strategies, falsifiable predictions, and future trial designs. Operational thresholds, reproducibility, predictive validity, incremental treatment benefit, optimal parameters, safety, implementation feasibility, and cost-effectiveness require prospective phenotype-stratified randomized trials and long-term follow-up.
STAT+: Swing Therapeutics acquired by medical VR platform XR Health
Swing Therapeutics, developer of a Food and Drug Administration-cleared digital treatment for fibromyalgia, has been acquired by medical virtual reality company XR Health.
Swing is XR Health’s sixth acquisition in the last two years and finds the VR developer taking a new business direction as it aims to be a go-to source of digital treatments for disease. The terms of the deal were not disclosed because, as XR Health CEO Eran Orr explained, “it won’t be the last” acquisition for the company.
XR Health, Orr claimed, has dozens of different apps on its platform currently and delivered a million user sessions in 2025. Offerings include a range of meditation and cognitive behavioral therapy-based VR experiences targeted at mental health issues, pain, hot flashes, and more. XR Health’s large packages of VR treatments are registered with the FDA but not cleared.
Circadian–immune crosstalk in insomnia disorder: mechanisms and therapeutic implications
Insomnia disorder (ID) is a common sleep–wake disorder characterized by persistent difficulty initiating or maintaining sleep, early-morning awakening, or non-restorative sleep, accompanied by daytime functional impairment. ID has traditionally been explained by the hyperarousal model, which emphasizes cognitive, emotional, cortical, neuroendocrine, and autonomic overactivation. However, this model alone does not fully account for the chronic persistence, relapse tendency, and multisystem associations of ID. Emerging evidence suggests that circadian rhythm disruption, impaired melatonin signaling, hypothalamic–pituitary–adrenal (HPA) axis activation, autonomic imbalance, and low-grade inflammation may also contribute to the development and maintenance of ID. Available evidence indicates that sleep disturbance is more consistently associated with selected inflammatory markers, particularly C-reactive protein (CRP) and interleukin-6 (IL-6), whereas findings for tumor necrosis factor-alpha (TNF-α) remain less consistent. The circadian system regulates sleep, endocrine function, metabolism, and immune-inflammatory activity through the suprachiasmatic nucleus, melatonin and cortisol rhythms, peripheral clock genes, and rhythmic immune-cell responses. Disruption of this temporal network may alter melatonin secretion, inflammatory rhythmicity, and stress-related neuroendocrine responses, thereby contributing to the persistence of insomnia symptoms. Compared with previous reviews that have separately discussed hyperarousal, circadian rhythm disruption, melatonin signaling, or sleep-related inflammation, this review integrates these processes into a circadian–immune perspective for understanding ID. We summarize alterations in sleep–wake rhythms, melatonin signaling, HPA-axis activity, autonomic regulation, and immune-inflammatory responses in ID, and discuss potential intervention strategies, including light management, melatonin and melatonin receptor agonists, cognitive behavioral therapy for insomnia (CBT-I), physical activity, time-restricted eating, and stress management. This review aims to provide a mechanistic basis for understanding the chronicity and heterogeneity of ID and for developing individualized intervention strategies.
HALO-TRIAL: High, Medium And LOw Intensity Psychotherapy for Binge Eating Disorder
Conditions: Binge Eating Disorder; Binge Eating Episodes; Binge Eating/Loss of Control Eating; Binge Eating Disorders; Binge Eating; Binge Eating Behaviour; Binge Eating Disorder Associated With Obesity; Eating Disorder Binge; Eating Disorders
Interventions: Behavioral: Cognitive Behavioral Therapy Enhanced – Individual; Behavioral: Cognitive Behavioral Therapy Enhanced – Group; Behavioral: Cognitive Behavioral Therapy – Guided Self Help; Behavioral: Systemic Narrative Therapy – Group
Sponsors: Herlev and Gentofte Hospital; Jascha Fonden; BETA-HEALTH Foundation; Mental Health Centre Ballerup; Region Capital Denmark; University of Copenhagen
Recruiting
Interventions: Behavioral: Cognitive Behavioral Therapy Enhanced – Individual; Behavioral: Cognitive Behavioral Therapy Enhanced – Group; Behavioral: Cognitive Behavioral Therapy – Guided Self Help; Behavioral: Systemic Narrative Therapy – Group
Sponsors: Herlev and Gentofte Hospital; Jascha Fonden; BETA-HEALTH Foundation; Mental Health Centre Ballerup; Region Capital Denmark; University of Copenhagen
Recruiting
Efficacy of CBT-I With Adjuvant Melatonin in Older Adults Chronic Insomnia
Conditions: Insomnia; Aging; Sleep Disorders
Interventions: Behavioral: Cognitive behavioural therapy for insomnia; Dietary Supplement: Melatonin 3 mg immediate-release; Behavioral: Psychoeducation; Drug: Placebo Oral Tablet
Sponsors: The University of Hong Kong; Chinese University of Hong Kong
Not yet recruiting
Interventions: Behavioral: Cognitive behavioural therapy for insomnia; Dietary Supplement: Melatonin 3 mg immediate-release; Behavioral: Psychoeducation; Drug: Placebo Oral Tablet
Sponsors: The University of Hong Kong; Chinese University of Hong Kong
Not yet recruiting
Trauma Therapy for Weight-Based Bullying in Children
Conditions: Pediatric Obesity; Weight-based Bullying; Psychological Trauma
Interventions: Behavioral: Trauma Therapy for Weight-Based Bullying Informed by TF-CBT
Sponsors: Western University
Not yet recruiting
Interventions: Behavioral: Trauma Therapy for Weight-Based Bullying Informed by TF-CBT
Sponsors: Western University
Not yet recruiting
Digital Cognitive Behavioral Therapy for Older Adults With Symptoms of Depression: Feasibility Cohort Study
Background: Depressive symptoms are common among older adults and can significantly impact their quality of life. However, many older adults face barriers to accessing psychological treatment. Internet-based cognitive behavioral therapy (iCBT) is a promising alternative to face-to-face treatments, but its feasibility among older adults has been less extensively studied than in adult populations. Objective: This study evaluated the feasibility of guided iCBT for adults aged 55 years and older with mild to moderate depressive symptoms recruited from the general population. Methods: This study is a feasibility study with a single-group, pretest-posttest design (n=21), in which all participants received guided iCBT for 8 weeks. Assessments were conducted at baseline (T0) and after the intervention (T1). The primary outcome was feasibility, conceptualized as satisfaction, usability, engagement, and uptake of iCBT. Secondary outcome measures included depression severity, working alliance, and technical alliance. Results: Participants were mostly highly educated (13/21, 61.9%), female (18/21, 85.7%), had an average age of 59.85 (SD 4.19; range 55-68) years, and reported moderate digital literacy. Feasibility outcomes indicated high satisfaction and engagement and moderate usability. Working alliance was rated as good by both participants and coaches, and technical alliance was rated as moderate by the participants. There was a nonsignificant modest decrease in depressive symptoms (Cohen <i>d</i>=0.47). Of the 20 participants who started the intervention, all completed the first 2 modules, but completion declined across the remaining 6 modules, with only 1 (5%) participant completing all modules. Conclusions: This study found that guided iCBT has the potential to be a feasible option for older adults experiencing depressive symptoms, with participants reporting generally positive satisfaction, moderate engagement, and a moderate therapeutic bond with their coaches. However, below-average usability ratings and a moderate technical alliance suggest that some aspects of the platform require improvement. Future research should focus on improving usability and adherence, as well as testing the intervention in a larger and more diverse population.
Institutional Member Updates: Summer 2026
Institutional Members are clinics and programs in the US and around the globe that offer residential and/or intensive treatment for OCD and related disorders, are specialty outpatient clinics with a large staff dedicated to treating OCD, or provide low-cost treatment options through research studies.
Below are quarterly updates from our Institutional Members organized alphabetically. Click the (+) to open each menu and read updates and find contact information for clinics near you:
Do you work at a residential program, intensive outpatient program (ITP), or specialty outpatient clinic and looking to advertise your services? Learn more about becoming an Institutional Member and having your program updates included below!
The post Institutional Member Updates: Summer 2026 appeared first on International OCD Foundation.
What Are Intrusive Thoughts?
When a child confesses a frightening thought that seemed to come out of nowhere — “What if I hurt someone with this knife?” “What if mom dies in a car accident?” “What if germs get into this paper cut and I die of an infection?” — you can both find it confusing and disturbing. But in most cases these intrusive thoughts are not evidence of a problem.
Intrusive thoughts are unwanted ideas, images, or urges that pop into the mind seemingly out of nowhere. They might feel embarrassing, violent, sexual, or just plain strange — and they feel completely out of character, which is exactly why they’re so upsetting. “An intrusive thought is a lot like your brain sending junk mail,” says Theresa Welles, PhD, a clinical psychologist and director of the Bubrick Center for Pediatric OCD at the Child Mind Institute. “Just because it shows up doesn’t mean it’s important or true or something you even want.”
It also doesn’t necessarily mean that a child has OCD or another mental health disorder. Though intrusive thoughts are associated with OCD — in which unwanted thoughts (called obsessions) drive children to perform rituals (called compulsions) to alleviate them — for many children they are just fleeting thoughts. It’s only when kids become unable to let them go that they are concerning. Another way to think about it, says Dr. Welles, is that “the brain’s job is to generate thoughts, the same way an apple tree’s job is to produce apples. Not every apple is perfect — some are misshapen or wormy. And not every thought is meaningful or worth paying attention to. Having a thought is not the same as wanting it or intending to act on it.”
Who has intrusive thoughts
“Everyone who has a brain has them,” says Caitlyn Downie, LCSW, director of trauma and resilience at the Child Mind Institute. “It’s part of the human existence.” A child might suddenly imagine something terrible happening to a parent, or a teenager might have a violent or sexual thought that feels shocking or shameful. Most of the time, these pass quickly — unpleasant, but easy enough to brush aside.
That’s the key distinction: not the thought itself, but what happens after it. The concern isn’t that the thought appeared — it’s how the child responds, how often it returns, and whether it starts getting in the way of daily life.
For some children — particularly those who are anxious, perfectionistic, or who have OCD — intrusive thoughts become “sticky.” Instead of passing through, the thought snags. The child starts paying attention to it, trying to figure it out or make it go away, which only makes it feel more powerful. “Young people lack the experience to recognize that thoughts aren’t the same as intentions, desires, or actions,” Dr. Welles says. “The thoughts feel alarming. So the child pays more attention, and the more attention they give it, the more often it returns.” That loop of fear and self-doubt is what parents and clinicians need to be alert to.
When should parents be concerned?
Many children are too ashamed or frightened to describe what’s actually going on, so parents may never hear about the thought itself. Instead, changes in behavior are often the first clue. Look for signs like:
- Increased distress, irritability, or moodiness
- Avoidance of something that wasn’t previously a problem
- Trouble concentrating or sleeping
- Excessive guilt or repeated reassurance seeking
- Rituals like checking, counting, washing hands, or going through routines in a specific way
It’s worth seeking professional support when intrusive thoughts are frequent and intense, hard to shake, causing real distress, or getting in the way of school, friendships, or daily routines.
Why intrusive thoughts feel so frightening
When an intrusive thought appears, it can set off the body’s alarm system — the same ancient survival mechanism that helped people run from danger or fight it off. In anxiety and OCD, that alarm bell rings when there’s no real emergency. The child has a thought, the body reacts with panic, and the child assumes the thought must be important because it feels big and important.
Children may also fall into what clinicians call thought-action fusion. “That’s the mistaken belief that having a thought makes it more likely to happen,” explains Dr. Welles, “or that it reveals something terrible about who they are.” A child who thinks, “What if I hurt my baby brother?” may become convinced the thought means they secretly want to — but intrusive thoughts are often the precise opposite of what a child would ever want. Paradoxically, Dr. Welles says, “for most people with anxiety disorders and OCD, these thoughts are the actual opposite of what they would ever do.”
How parents can help
The first thing to do is stay calm — harder than it sounds if the thought is violent, sexual, or taboo. Children look to their parents to gauge whether something is truly dangerous, so if you look horrified, your child takes that as confirmation the thought is something to fear.
When a child shares an intrusive thought, Downie suggests responding with warmth and curiosity: “Say something like, ‘I appreciate you telling me — it sounds like that was really scary.’ It also helps to normalize it: ‘A lot of people have thoughts they don’t particularly like.’” Some other responses that can help:
- “That sounds really upsetting — I’m glad you told me.”
- “Having a thought doesn’t mean you want it or that it’ll ever happen.”
- “You don’t have to figure this out right now.”
The goal is to help your child feel less alone and less ashamed, without treating the thought like a five-alarm emergency. And do your best to avoid reassurance. Reassuring the child about the contents of a specific thought (for example, responding to a child who asks, “Are you sure I’m a good person?” with “Yes, you’re a good person”) can actually make things worse, especially in kids with OCD. They feel very temporary relief but then the thought creeps back and they need more reassurance. It becomes a cycle. Instead try: “I know this feels awful. And I know you can handle it.”
It also helps to redirect the child to something concrete: getting dressed, eating breakfast, watching a show, texting a friend. With younger kids, you might guide them in doing slow breaths or suggest they move to another room so they distract themselves from the thought. With teens, you might mean teach them to resist the urge to Google their fears or thoughts, confess, or ask the same question over and over again. “The idea,” Downie says, “is to validate the feeling without validating the fear. You’re saying: ‘I hear you, this is hard, and you can get through it.’”
What can cause intrusive thoughts?
Intrusive thoughts aren’t a diagnosis on their own — they’re a symptom that can show up across a range of conditions, or in children who have no diagnosis at all. Disorders they may be associated with include:
- OCD: The most closely associated condition. Common themes include harm, contamination, sexual thoughts, and religious or moral fears.
- Generalized anxiety: Tends to involve repetitive “what if” worries about everyday concerns — school, safety, family, the future.
- Social anxiety: Brings intrusive thoughts about embarrassment, rejection, or being judged by peers.
- PTSD: Can involve intrusive memories, images, or sensations tied to a traumatic event. “A child who has experienced trauma may worry about being harmed again or even about harming someone else,” Downie notes, “but that doesn’t mean every child with trauma will have intrusive thoughts.”
- Depression: Often involves intrusive thoughts that fit a negative self-image: I’m worthless. I’m a burden. I’m a bad person.
- Autism spectrum disorder: Repetitive thoughts often center on a special interest and aren’t typically unwanted or distressing the way OCD thoughts are — though they can look similar from the outside.
- Psychotic disorders: Young people with psychosis tend to experience intrusive thoughts as fixed and real, without the self-awareness that typically accompanies anxiety-driven ones. Psychotic disorders such as schizophrenia are rare in children, though early signs can appear in the teenage years.
How intrusive thoughts are treated
Treatment depends on what’s driving the thoughts and how much they’re disrupting the child’s life:
- For OCD, the gold-standard treatment is exposure and response prevention (ERP), a specialized form of cognitive behavioral therapy (CBT) where children practice sitting with intrusive thoughts without doing compulsions. Over time, they learn to tolerate uncertainty and discover that the thought, however uncomfortable, isn’t actually dangerous.
- For anxiety, the same treatments are helpful. CBT helps children understand the connection between thoughts, feelings, and behaviors, and ERP helps kids learn to tolerate the anxiety these thoughts generate, and it gradually diminishes.
- For trauma, treatment may include trauma-focused CBT. Mindfulness, DBT skills, and breathing exercises can also help regulate the nervous system.
- Family involvement matters a great deal. “Parents often need help learning how to respond without accidentally feeding the anxiety cycle,” Dr. Welles says. SPACE (Supportive Parenting for Anxious Childhood Emotions) is an evidence-based approach that helps parents reduce accommodation and support their child’s brave behavior instead.
- For moderate-to-severe OCD or anxiety, medication — typically an SSRI — may also be worth discussing with a psychiatrist or pediatrician.
Helping your child trust their own mind
One of the hardest things about intrusive thoughts is that they can make children afraid of their own minds — convinced that every thought needs to be examined or explained away before they can relax. But no one gets to have only pleasant, well-behaved thoughts.
What children can learn is that a thought can be upsetting without being meaningful, loud without being true, and it can pass through without becoming a verdict on who they are. As parents, the most powerful thing you can offer is a calm, steady presence — taking it seriously without treating it as a catastrophe. When your child sees you aren’t panicked, they get to borrow some of that calm for themselves.
Frequently Asked Questions
Intrusive thoughts are unwanted ideas, images, or urges that pop into your mind unexpectedly. They often feel upsetting or out of character, but they’re essentially “junk mail” from the brain — not meaningful or important.
Yes, everyone can have them. Most children (and adults) experience intrusive thoughts at times, and in many cases they pass quickly without causing problems.
They’re a normal byproduct of how the brain works, but they can become more frequent or “sticky” in kids who are anxious, perfectionistic, or dealing with conditions like OCD or trauma. Paying extra attention to the thought can also make it return more often.
No. Having an intrusive thought doesn’t mean you want to act on it or that it reflects who you are. In fact, these thoughts are often the opposite of what someone would ever want or do.
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