Psychotherapy schools often describe overlapping process phenomena in non-interoperable vocabularies. This pluralism is clinically valuable but computationally costly: datasets become difficult to compare, clinically load-bearing distinctions are collapsed into convenience labels, and artificial intelligence (AI) systems inherit annotation schemes rather than a clinically interpretable intermediate representation. Building on the Perceive–Assess–Dose–Safeguard (PAD-S) framework and the Conflict-Square Algorithm (CSA), this theory article asks a narrower question than the prior PAD-S and CSA papers: can the same variables be formulated as a candidate shared representation layer between heterogeneous observation models and school-specific intervention policies? The proposed layer projects a high-dimensional biopsychosocial state into four clinically observable process coordinates—defensive/avoidant organization (DEF), anxiety/arousal and tolerance (ANX), progression toward direct experience and action (PRO), and self-attack/shame processes (SUP)—plus a safety threshold that constrains admissible intervention intensity. The contribution is architectural rather than empirical: it isolates the representational role from earlier decision-grammar and transcript-coding roles; clarifies the distinction between observations, representation, and policy; specifies a minimal falsifiable family of state-transition models; illustrates translation across four pragmatic therapy families; and defines a staged validation order from reliability and function linkage to transcript-level predictive operationalization and only then sparse equation discovery. The framework should therefore be read as a candidate shared representation layer for computational psychotherapy and computational psychiatry rather than as a therapy protocol, a fitted predictive model, a complete generative theory, or an autonomous decision system. No new dataset, fitted classifier, transcript-level predictive result, or discovered equation is reported here. The article aims instead to state what would count for or against PAD-S/CSA as a clinically interpretable interface for later empirical modeling.
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Morning. In the same way that Athena orchestrated the logistics around Telemachus’s journey in the first three books of “The Odyssey,” I hope some gods out there are coordinating a “Survivor” season 50 win for Cirie Fields. She’s earning it, but I wouldn’t mind some divine intervention to make sure.
Circulating Oxytocin Changes in Response to MDMA vs. Placebo in Adult Patients With Autism Spectrum Disorder and Matched Healthy Controls
Conditions: Autism Spectrum Disorder
Interventions: Diagnostic Test: MDMA; Diagnostic Test: Placebo
Sponsors: University Hospital, Basel, Switzerland
Not yet recruiting
Interventions: Diagnostic Test: MDMA; Diagnostic Test: Placebo
Sponsors: University Hospital, Basel, Switzerland
Not yet recruiting
The Impact of Digital Detox Training on Screen Use, Sleep Quality, and Healthy Lifestyle Behaviors in Adolescents
Conditions: Digital Screen Addiction and Sleep Quality in Adolescents
Interventions: Behavioral: Digital Detox Intervention
Sponsors: Şırnak Üniversitesi
Completed
Interventions: Behavioral: Digital Detox Intervention
Sponsors: Şırnak Üniversitesi
Completed
Prevalence of Cognitive Distortion Markers in a Suicide Prevention Chat Service: Mixed Methods Study
Background: Suicide helplines increasingly employ chat services to aid those in urgent need, but the wording and structure of text-driven exchanges may affect their effectiveness. Objective: Given the association of cognitive distortions with depression and anxiety, this study investigated their prevalence in the language of individuals seeking help from the Dutch 113 suicide helpline. Methods: We observed the prevalence of cognitive distortions for both help seekers and counselors in a large volume of chat sessions (N=71,148) of the Dutch 113 suicide chat helpline using natural language processing. The results were compared to 2 large collections of online text data from Dutch social media and web content. Results: We found that nearly all types of cognitive distortions are more prevalent in the language of help seekers compared to the control group of helpline counselors. Distortions of the personalizing, emotional reasoning, and mental filtering types were, respectively, 20.22, 7.87, and 4.53 times more prevalent among help seekers, revealing a distinct pattern of thought and language among individuals affected by suicidality. Conclusions: Our results raise the prospect of improving the effectiveness of online therapeutic interventions that target cognitive distortions through lexical analysis that detects the cognitive and lexical markers of suicidality.
<img src="https://jmir-production.s3.us-east-2.amazonaws.com/thumbs/00f57a522b7e20d230db8854f4090023" />
<![CDATA[Study links schizophrenia’s earlier onset to higher genomic deletion CNV burden, showing future potential for personalized care.]]>
Oxygen extraction fraction is differentially associated with pathological biomarkers in Alzheimer’s disease and non-Alzheimer’s dementias
IntroductionWe aimed to understand the pathophysiological differences between 16 Alzheimer’s disease (AD) and 15 non-AD dementia patients by quantifying oxygen extraction fraction (OEF) in cortical (CGM) and deep gray matter (DGM) regions.MethodsTo achieve this, we used a novel MRI-based OEF mapping technique, QQ, which estimates OEF from routine multi-echo gradient echo data. Multiple linear regression analyses were performed to compare the associations between OEF and white matter hyperintensities (WMH) or cognitive impairment (measured by Montreal Cognitive Assessment (MoCA) between the two groups.ResultsIn the AD and non-AD group, OEF showed negative associations with WMH in DGM and positive associations with MoCA in DGM and CGM.DiscussionOur study suggests that QQ is a promising tool for differentiating between AD and non-AD dementias, by revealing abnormalities in tissue oxygen usage and their relationships to microvascular changes and cognitive impairment.
Quality, reliability, and transparency of late-life depression videos on Chinese social media: a cross-sectional study of Douyin, Rednotes, and BiliBili
BackgroundLate-life depression is common in older adults and is often under-recognized. Short-video platforms have become a major source of mental health information. However, content quality and transparency remain uncertain.MethodsWe conducted a cross-sectional assessment of highly viewed videos on late-life depression on three Chinese platforms. We searched each platform using the keyword in Chinese “Late-life depression”. We selected the top 200 videos by view count on Douyin, Rednotes (Xiaohongshu), and BiliBili. After exclusions, 562 videos were included (Douyin, n=188; Rednotes, n=188; BiliBili, n=186). Two medically trained raters scored videos using the Global Quality Score (GQS), modified DISCERN (mDISCERN), and JAMA benchmark criteria. We also coded content categories and creator types. We assessed platform differences using non-parametric tests. We examined associations between a limited engagement proxy, defined as the comment-to-view ratio, and quality scores using Spearman correlation.ResultsVideo duration differed across platforms (p<0.001). Engagement indicators were higher on Douyin and Rednotes than on BiliBili. Symptoms were the most common topic on all platforms. Prevention and intervention ranked second on Douyin and Rednotes. On BiliBili, causes and case-based analysis were also common. Overall quality was moderate. Mean GQS ranged from 2.96 to 3.05. Transparency was limited. Mean JAMA ranged from 1.91 to 2.04. Reliability was slightly higher on BiliBili based on mDISCERN. Creator type was strongly associated with scores. Expert and institutional videos scored higher than general and marketing-oriented accounts. Correlations between visible audience interaction and quality were weak.ConclusionHighly viewed late-life depression videos on major Chinese platforms show moderate quality and limited transparency. Exposure does not reliably signal higher-quality information. Platforms and health authorities should strengthen source disclosure and promote evidence-based content from qualified creators.
Safety and preliminary efficacy of Aurora: a pilot, non-randomized clinical trial of a culturally adapted digital cognitive behavioral therapy intervention for anxiety and depression in Mexico
Background/objectiveAnxiety and depressive disorders are leading causes of disability worldwide, and access to evidence-based psychological treatment remains limited in many middle-income countries. Digital cognitive–behavioral therapy (CBT) interventions have emerged as scalable tools to address this treatment gap, yet few have undergone clinical evaluation in Latin American populations. This study aimed to assess the safety and preliminary efficacy of Aurora, a Spanish-language, culturally adapted digital CBT program, when used as an adjunct to pharmacotherapy in adults with generalized anxiety disorder.MethodsIn a multicenter, open-label, non-randomized pilot study, 34 adults diagnosed with generalized anxiety disorder receiving stable pharmacological treatment were assigned through pragmatic, convenience-based allocation either to an experimental group (Aurora plus medication; n = 24) or to a control group receiving medication alone (n = 10). The sample had a mean age of 39.85 ± 12.88 years, with a predominance of women (22/34). Participants were followed for 12 weeks with assessments at baseline and weeks 4, 8, and 12. Clinical outcomes included anxiety severity measured by the Generalized Anxiety Disorder-7 (GAD-7), pathological worry assessed by the Penn State Worry Questionnaire (PSWQ), and depressive symptoms evaluated using the Patient Health Questionnaire-9 (PHQ-9). Safety was monitored through structured adverse-event reporting. Statistical analyses included linear mixed-effects models for longitudinal outcomes, ordinal logistic regression for severity transitions, and negative binomial regression and Fisher’s exact test for adverse events, with false discovery rate correction applied where appropriate.ResultsAurora demonstrated a favorable safety profile, with no serious adverse events and comparable adverse-event incidence between groups under structured clinical monitoring at weeks 4, 8, and 12. Anxiety symptoms (GAD-7) showed a significant effect of time (F3,96 = 169.65; p < 0.001), indicating reductions across both groups. Pathological worry (PSWQ) demonstrated significant group (F1,31.12 = 6.96; p = 0.013) and group × time interaction effects (F3,93.4 = 7.86; p < 0.001), with greater reductions in the Aurora group, particularly at weeks 8 and 12. At week 12, ordinal analyses indicated higher odds of lower worry severity in the intervention group (β = 2.53; p = 0.004; OR = 12.5). Depressive symptoms decreased similarly in both groups. Positive effect increased progressively across intervention modules, and module-embedded cognitive measures of anxiety and depression showed significant reductions over time.ConclusionThis pilot study provides preliminary, hypothesis-generating evidence that a culturally adapted digital CBT intervention can be safely integrated with pharmacotherapy and may be associated with enhanced improvements in anxiety-related outcomes, particularly pathological worry, in a Mexican clinical population. However, the non-randomized design, small sample size, and baseline imbalances limit causal inference and generalizability, and findings should be interpreted with caution. Larger randomized controlled trials are needed to confirm efficacy, determine long-term clinical impact, and guide the implementation of digital therapeutics in Latin American mental health systems.
Real-world effectiveness of medication-assisted treatment and psychotherapy for opioid use disorder: a national multi–health care organization analysis
BackgroundHarm reduction strategies for opioid use disorder (OUD) emphasize pragmatic, evidence-based approaches that reduce overdose risk, relapse, and other adverse outcomes without requiring abstinence. Medication for opioid use disorder (MOUD) and structured psychotherapy represent core harm-reduction modalities, yet their real-world comparative effectiveness, alone and in combination, remains underexplored at scale.MethodsA retrospective cohort study was conducted using the TriNetX Research Network, comprising de-identified electronic health records from 112 U.S. health systems. 18,047 adults aged 18–45 were identified with a diagnosis of opioid dependence (ICD-10 F11.20) between 2016 and 2025. Subjects were assigned to eight mutually exclusive treatment cohorts: no treatment (Cohort 1); buprenorphine alone (Cohort 2); methadone alone (Cohort 3); psychotherapy alone (30 minutes (Cohort 4), 45 minutes (Cohort 5), or 60 minutes (Cohort 6)); buprenorphine + psychotherapy (Cohort 7); and methadone + psychotherapy (Cohort 8), with combination treatments defined within a ±30-day window. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) for remission (F11.21, F11.11) within 12 months.ResultsBuprenorphine (aHR = 2.33; 95% CI: 1.85–2.94), methadone (aHR = 2.50; 95% CI: 2.05–3.04), and psychotherapy (30 min: aHR = 2.18; 45 min: aHR = 2.38) were each independently associated with significantly higher remission compared to no treatment. The combination of buprenorphine + psychotherapy yielded the strongest effect (aHR = 5.26; 95% CI: 2.68–10.32). Anxiety diagnoses and gabapentinoid prescriptions were positively associated with remission; benzodiazepine co-prescription was negatively associated.ConclusionsIn this first national-scale, multi–health-care-organization analysis, both pharmacologic and psychosocial harm-reduction interventions were independently associated with improved OUD remission, with additive benefit when integrated. These findings underscore the value of embedding comprehensive, multimodal harm-reduction services within routine care and support policies promoting equitable access to both MOUD and behavioral health supports across diverse health systems.