Effectiveness and mechanisms of Intensive Short-Term Dynamic Psychotherapy for treatment-resistant depression: a reanalysis of a randomized controlled trial

IntroductionIntensive Short-Term Dynamic Psychotherapy has shown promising effects for treatment-resistant depression, but it remains unclear whether its hypothesized mechanisms — reducing emotional repression, negative affect, and psychological distress — actually mediate treatment outcomes.MethodsWe reanalyzed publicly available data from a randomized controlled trial (N = 86) comparing 20 sessions of Intensive Short-Term Dynamic Psychotherapy to waitlist control for treatment-resistant depression. Depression and process measures were assessed at baseline, post-treatment, and 3-month follow-up. Linear mixed-effects models analyzed trajectories; bootstrap mediation and cross-lagged panel analyses provided an exploratory examination of proposed process variables.ResultsTreatment produced large effects on depression at post-treatment (Cohen’s d = 1.68) that continued to increase through 3-month follow-up (d = 2.50, 95% CI [1.88, 3.11]). All proposed process measures also showed very large effects (d = 1.96–2.95). However, neither emotional repression nor negative affect significantly mediated depression improvement. Distress showed apparent mediation, but a sensitivity analysis removing the overlapping depression subscale eliminated this effect entirely, confirming it reflected construct overlap rather than a genuine indirect effect. Cross-lagged analyses revealed no temporal precedence for any process measure, indicating concurrent rather than sequential change.DiscussionThese findings confirm that this psychotherapy produces large, durable effects on treatment-resistant depression. However, the theorized sequential process — whereby reducing defensive functioning leads to improved affect regulation, which in turn alleviates depression — was not supported in the present data. Instead, the treatment appears to produce broad, simultaneous therapeutic change across multiple psychological domains. These exploratory findings suggest that understanding how psychotherapy works may require finer temporal measurement and observational methods that capture in-session processes.

There is no nature anymore

When people talk about “nature,” they’re generally talking about things that aren’t made by human beings. Rocks. Reefs. Red wolves. But while there is plenty of God’s creation to go around, it is hard to think of anything on Earth that human hands haven’t affected.

Mat Honan

In the Brazilian rainforest, scientists have found microplastics in the bellies of animals ranging from red howler monkeys to manatees. In remotest Yakutia, where much of the earth remains untrodden by human feet, the carbon in the sky above melts the permafrost below. In the Arctic Ocean, artificial light from ship traffic—on the rise as the polar ice cap melts away—now disrupts the nightly journey of zooplankton to the ocean surface, one of the largest animal migrations on the planet. The remote mountain lakes of the Alps are contaminated with all kinds of synthetic chemicals. Polar bears are full of flame retardants. Cesium-137, fallout from nuclear bomb explosions, lightly rimes the entire planet. 

These examples are mostly pollution—nuclear, carbon, chemical, light—but I raise them not to highlight the ways human industry and technology degrade the environment but to note how the things humans build change it. Nobody really knows what the exact effects of all that will be, but my point is that no part of the globe is free of human fingerprints. We have literally changed the world.  

We’ve changed ourselves as well. Humans are especially adept at bending human nature. Everything about us is up for grabs—appearance, health, our very thoughts. Pharmaceuticals, surgeries, vaccines, and hormones give us longer lives, take away our pain, ease our anxiety and depression, make us faster, stronger, more resilient. We’re getting glimpses of technologies that will let us change who our children will become before they’re even born. Electrodes implanted in people’s brains let them control computers and translate thoughts into speech. Prosthetics and exoskeletons straight out of comic books restore and enhance physical abilities, while gene-­editing technologies like CRISPR are rewriting our very DNA. And meanwhile, people have taken the sum total of all the information we have ever written down and poured it into vast calculating machines in an effort—at least by some—to build an intelligence greater than our own. 

So what even is nature, or natural, in this context? Is it “environmentalist,” in the conventional sense, to try to preserve what one could argue no longer exists? Should we employ technology to try to make the world more “natural”?  

Those questions led us to approach this Nature issue with humility. We try to grapple with them all the time—MIT Technology Review is, after all, a review of how people have altered and built upon nature.

And it’s a place to think about how we might repair it. Take solar geoengineering, for example—a subject we have covered with increasing frequency over the past few years. The basic idea of geoengineering is to find a technological fix for a problem technology caused: Burning ­petrochemicals to fuel the Industrial Revolution turned Earth’s atmosphere into a heat sink, fundamentally breaking the climate. Some geoengineers think that releasing particulate matter into the stratosphere would reflect sunlight back into space, thus reducing global temperatures. After years of theoretical discussions, some companies have begun to actively experiment with such technologies. This might seem like a great way to restore the world to a more natural state. It’s also fraught with controversy and peril. It could, for example, benefit some nations while harming others. It may give us license to continue burning fossil fuels and releasing greenhouse gases. The list goes on. 

Nature isn’t easy. 

In our May/June issue, we have attempted to take a hard look at nature in our unnatural world. We have stories about birds that can’t sing, wolves that aren’t wolves, and grass that isn’t grass. We look for the meaning of life under Arctic ice and within ourselves—and in the far future, on a distant world, courtesy of new fiction by the renowned author Jeff VanderMeer. I don’t know if any of that will answer the questions I’ve been asking here—but we can’t help but try. It’s in our nature. 

<![CDATA[Evidence links some hormonal contraceptives—especially in teens—to higher depression risk; see which types matter and how to monitor mood.]]>

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.

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.

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.

Iron dyshomeostasis in neuropsychiatric disorders

Iron is an indispensable element for the normal physiological function of the brain. In terms of neuronal metabolism, iron is involved in multiple critical biological processes such as oxygen transport, energy metabolism, DNA synthesis, neurotransmitter synthesis and myelin formation. Maintaining brain iron homeostasis is crucial for neurodevelopment and function. Iron dyshomeostasis has been associated with the onset and progression of various neuropsychiatric disorders, including Parkinson’s disease, Alzheimer’s disease, depression, schizophrenia, attention deficit hyperactivity disorder, and autism spectrum disorder. In neurodegenerative diseases such as Parkinson’s disease and Alzheimer’s disease, abnormally elevated iron levels can be detected in specific brain regions, including the basal ganglia and the prefrontal cortex. These changes are often accompanied by pathological processes such as oxidative stress, neuroinflammation, and pathological protein aggregation. Therefore, brain iron metabolism is an important entry point for understanding the pathophysiological process of neuropsychiatric disorders. Mechanistically, iron overload induces oxidative damage through the Fenton reaction, exacerbating mitochondrial dysfunction and abnormal protein aggregation. The effects of iron deficiency vary across different diseases; its impact on myelination and neurotransmitter synthesis may increase the risk of neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD), while its effects on immune activation and energy metabolism may contribute to the development of mental disorders such as depression. This article systematically reviews the current research progress of the role of cerebral iron metabolism in neuropsychiatric diseases. It focuses on the mechanisms underlying iron homeostasis imbalances in neurodegenerative and psychiatric diseases. Building on this foundation, the article analyzes the therapeutic targets and clinical significance of iron metabolism-related interventions and outlines future research directions in this field.

STAT+: BioAge says experimental pill aimed at reducing heart risks significantly reduced inflammation

BioAge Labs said Tuesday that its investigational pill for cardiovascular risk prevention significantly reduced inflammation in an early study, as more drug companies target inflammation as a way to treat a range of chronic conditions.

In a Phase 1 study of people with obesity and elevated inflammation levels, patients taking a 60-milligram dose of the drug, called BGE-102, experienced an 86% reduction in a measure of inflammation called high-sensitivity C-reactive protein (hs-CRP) after three weeks. That’s a similar level of reduction seen in patients who took a higher 120-mg dose in the study, which the company previously reported

Additionally, 87% of patients taking the 60-mg dose achieved hs-CRP levels of less than 2 mg/liter, the threshold thought to be associated with a lower risk of cardiovascular complications.

Continue to STAT+ to read the full story…

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