ObjectiveThis systematic review and meta-analysis of randomized controlled trials aims to analyze the efficacy of mindfulness-based interventions and biofeedback on headache frequency, pain intensity, headache-related disability, psychological distress, and quality of life in adult patients with migraine.MethodsThe review followed the PRISMA statement and was registered in PROSPERO (CRD420261381587). A structured search was conducted across PubMed, Scopus, and PsycInfo for RCTs published in English between May 2016 and May 2026. Seven clinical trials (n = 535 participants) met the inclusion criteria. Methodological quality and risk of bias were evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool.ResultsThe pooled analysis for headache frequency (n = 6 studies) showed no statistically significant differences between groups (MD = −0.59; 95% CI: −1.81 to 0.62; p = 0.34). Conversely, significant improvements favoring the experimental groups were found for headache-related disability measured with the HIT-6 scale (n = 6 studies; MD = −2.28; 95% CI: −4.47 to −0.08; p = 0.04), pain intensity (n = 3 studies; SMD = −0.39; 95% CI: −0.64 to −0.14; p = 0.002), and health-related quality of life (n = 3 studies; MD = +5.21; 95% CI: 1.95 to 8.47; p = 0.002). No statistically significant differences were observed for anxiety (p = 0.30) or depression (p = 0.88).ConclusionInterventions incorporating Mindfulness-Based Interventions and Biofeedback do not significantly reduce objective migraine attack frequency compared to control conditions, nor do they yield distinct differences in affective outcomes (anxiety/depression)—which may partly reflect subclinical baseline depression scores in episodic cohorts, active-comparator effects, and instrument heterogeneity. However, they exhibit statistically significant efficacy in decreasing subjective pain intensity, mitigating headache-related functional disability, and restoring health-related quality of life, supporting their role as valuable complementary strategies for self-regulation and clinical coping in migraine management.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261381587, Identifier: CRD420261381587.
Mentalization Orientated Psychoeducation Group for Adult ADHD (MOPAD)
Conditions: ADHD – Attention Deficit Disorder With Hyperactivity
Interventions: Behavioral: The MOPAD study tests whether an introductory Mentalization-Based Treatment (iMBT)
Sponsors: Surrey and Borders Partnership NHS Foundation Trust
Not yet recruiting
Interventions: Behavioral: The MOPAD study tests whether an introductory Mentalization-Based Treatment (iMBT)
Sponsors: Surrey and Borders Partnership NHS Foundation Trust
Not yet recruiting
Transcranial pulse stimulation in the treatment of cognitive disorders of aging: a systematic review
IntroductionNon-invasive brain stimulation techniques, specifically transcranial pulse stimulation (TPS) are of increasing interest due to their potential to fill in gaps left by current pharmacological treatments in cognitive disorders of aging. The current review’s aims were to systematically determine what cognitive disorders of aging have been studied with TPS as a treatment and to narratively summarize what is known about the effectiveness of TPS treatment in the aging subpopulation through neurocognitive performance metrics and neuroimaging metrics.MethodsThis review is PRISMA 2020 compliant. Searches were conducted in PubMed, PsycINFO (through PsycNET to include all APA Databases), Embase, and Scopus. Title/Abstract screening, full text screening, and extraction were completed by two independent reviewers with discrepancies worked out through discussion. Outcomes were systematically chosen for formal analysis where dual reviewers completed risk of bias and certainty of evidence assessments, and remaining outcomes were synthesized narratively.Results11 studies were included, consisting of 10 nonrandomized studies and 1 randomized controlled trial (RCT). Due to follow ups and suspected cohort overlap, the 11 studies are not representative of 11 independent patient cohorts. Included studies examined Alzheimer’s Disease and related dementias, mild neurocognitive disorder, mild cognitive impairment and Parkinson’s Disease through a variety of neurocognitive performance metrics and neuroimaging metrics. Formal synthesis showed a preliminary trend for positive change from before to after stimulation, particularly in neuropsychological batteries measuring global cognition, however number of contributing results and overall certainty of evidence were both very low. Neuroimaging results varied with trends of statistically significant functional changes, though also limited by limited literature and low certainty.DiscussionThough there is a continued need for high quality research and randomized controlled trials using TPS in the treatment of neurocognitive disorders of aging, the current evidence indicates potential for promising changes in neurocognitive performance metric outcomes and functional neuroimaging measures from before to after stimulation pending additional controlled trials. Though there is currently not enough high quality evidence to support clinical recommendations, what is known could support the use of TPS in the treatment of neurocognitive disorders of aging should RCTs continue to support positive improvements associated with this non-invasive intervention.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251246424.
Risk and protective factors for suicidality in older adults: an umbrella review and framework for multidimensional suicide risk assessment
IntroductionSuicidality in older adults is a major public health concern influenced by psychiatric, psychological, physical, functional, social, and socioeconomic factors. However, the evidence remains fragmented, and protective factors have received substantially less attention than risk factors.MethodsThis umbrella review followed JBI methodology and was reported in accordance with the PRISMA 2020 statement. PubMed, Scopus, and Web of Science were searched from inception to 30 June 2026 for systematic reviews and/or meta-analyses examining risk or protective factors for suicidal ideation, suicidal behavior, suicide attempts, suicide death, or self-harm in adults aged 50 years or older. Methodological quality was assessed using the JBI Critical Appraisal Checklist. Overlap was evaluated using the corrected covered area.ResultsEighteen systematic reviews were included, comprising 551 eligible primary-study occurrences and 423 unique publications. Depression and other mental disorders showed the strongest and most consistent associations with suicidality. Other substantial and recurrent risk indicators included loneliness, chronic pain, disability, and psychiatric comorbidities. Associations varied across suicidal ideation, suicide attempts, suicide death, and self-harm. Evidence regarding protective factors was less extensive. Purpose or meaning in life, resilience, psychological well-being, social support, connectedness, and sense of belonging were the most consistently reported protective factors.ConclusionsLate-life suicidality is associated with interacting psychiatric, physical, functional, and social factors. Clinical practice may benefit from the use of brief, multifaceted screening tools in routine care to capture these co-occurring vulnerabilities. Ultimately, suicide risk assessment in older adults must move beyond a narrow disorder-based approach toward multidisciplinary models that seamlessly integrate mental health with physical and psychosocial indicators.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261458149, identifier CRD420261458149.
Inflammatory Process Identified as Link Between Pulmonary Hypertension and Cognitive Decline
A study by University of Pittsburgh and UPMC researcher-clinicians has uncovered why many pulmonary hypertension (PH) patients report symptoms of cognitive decline.
The team carried out a multimodal investigation involving brain MRI studies, blood-based molecular profiling, and functional studies in mouse models, and linked specific brain abnormalities in pulmonary hypertension to the same inflammatory processes that drive the disease in the lungs and heart. The findings suggest that cognitive decline may be present in other vascular and inflammatory conditions beyond pulmonary hypertension. The results also point to neural targets that may be relevant for future diagnostic, prognostic, and therapeutic approaches.
“Patients often assume memory issues or trouble concentrating are unrelated to their pulmonary hypertension,” said research lead Stephen Chan, MD, PhD, Vitalant Chair in Vascular Medicine and director of the Vascular Medicine Institute and Center for Pulmonary Vascular Biology and Medicine at the Pitt School of Medicine and UPMC. “Our findings suggest those symptoms are a central part of the disease process and deserve attention.”
Chan is senior author of the researchers’ published paper in Journal of Clinical Investigation, titled “Cerebellar and frontal lobe alterations in pulmonary hypertension implicate an inflammatory lung vascular/brain axis.”
Millions of people are affected by pulmonary hypertension, which causes high blood pressure in the blood vessels of the lungs. Common symptoms include shortness of breath, chest pain, and feeling lightheaded. More recently scientists have linked pulmonary hypertension with cognitive issues such as impaired executive function and memory problems. “Cognitive impairment is increasingly recognized in pulmonary hypertension (PH), a disease traditionally viewed as limited to the heart and lungs,” the authors wrote. “Given that inflammation is shared by PH and neurodegenerative diseases, we investigated its role in driving brain and cognitive deficits in PH.”
Recent research by Chan identified a genetic variant in a gene called NCOA7, which produces a protein of the same name. In a quarter of pulmonary hypertension patients, this variant drives inflammatory responses and worsens the odds of survival. Chan hypothesized that the same variant might be connected to brain inflammation that leads to cognitive impairment in people with pulmonary hypertension.
To test that theory, Chan and colleagues used brain MRI scans and blood tests to look for brain changes that were unique to pulmonary hypertension. They first compared the brain scans of people with pulmonary hypertension against those without, using data from a large public health database and a smaller group of UPMC patients to test and confirm their hypothesis.
Patients with pulmonary hypertension in both test groups had a consistent and substantial loss of brain tissue and weakened communication between two brain regions involved in memory, attention and planning—the cerebellum, at the base of the brain, and the frontal lobe, just behind the forehead. Notably, the same brain changes were absent in people with other heart, lung, and psychiatric conditions. “Using structural and functional MRI data from UK Biobank (N = 248 PH) and a prospective validation cohort, we identified reduced cerebellar white matter volume, thinner frontal gyri, and weakened cerebellar-frontal connectivity in patients with PH but not in other heart or lung diseases,” the team reported. These changes were accompanied by worsened executive function and processing speed.”
The brain differences could not be explained by low blood oxygen, poor heart function, or the medications used to treat the disease—evidence that the changes are specific to pulmonary hypertension, rather than a side effect of the disease’s effects on the heart and lungs.
By analyzing genetic data from both groups of patients and conducting additional laboratory studies, the team found that the NCOA7 variant already linked to blood vessel inflammation in pulmonary hypertension is also connected to inflammation in the cerebellum of these patients.
Examining cerebellum tissue from patients and mice with pulmonary hypertension, they saw signs that brain immune cells—microglia—had become overactive, and evidence that neurons were changing in response. Mice that both developed the disease and lacked the NCOA7 gene had more severe cerebellar damage than mice with pulmonary hypertension alone, establishing that the gene plays a causal role in regulating brain inflammation in this disease. “Postmortem analysis and PH mouse models showed cerebellar microglial activation and structural deficits worsened by NCOA7 deficiency,” the investigators wrote in summary. “Collectively, these findings support PH-associated cerebellar–frontal brain deficiencies linked to chronic neuroinflammation and NCOA7 dysfunction.”
Chan suspects that this mechanism is active in other diseases beyond pulmonary hypertension. “I believe that NCOA7 deficiency may underlie a spectrum of inflammatory conditions—including those that may contribute to dementia and aging,” Chan said. “If so, these findings could introduce new diagnostic and therapeutic avenues for preserving brain function in a much broader group of people.” The authors added: “From a translational perspective, the association of inflammatory plasma biomarkers with structural and functional brain alterations may inform new diagnostic and prognostic strategies … Our findings also open avenues for testing whether PH-associated neuroinflammatory changes are therapeutically reversible.”
Current guidelines for managing pulmonary hypertension do not include cognitive screening, and no biological marker exists to predict or track how much the disease affects the brain. This study points to a potential marker and identifies inflammation as a potential therapeutic target for preserving brain function and quality of life.
“This changes the way we look at a disease like pulmonary hypertension,” said Chan. “In medicine, we typically treat the symptoms of one organ system; but the reality is that our bodies are very complex, and disease processes may be affecting multiple parts of the body in a variety of ways.”
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Dance- and movement-based interventions for autism spectrum disorder: a systematic review and exploratory meta-analysis
ObjectivesAutism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition characterized by difficulties in social communication, restricted and repetitive behaviors, and impaired adaptive functioning. Although behavioral and developmental interventions remain central to ASD management, the effects of dance- and movement-based interventions (DMIs) across different functional domains have not been fully clarified. This study aimed to systematically evaluate the effects of DMIs on overall autism symptom severity, social communication/social responsiveness, and motor function in individuals with ASD.MethodsThis systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Eligible DMIs included formal dance/movement therapy or dance movement psychotherapy and other structured dance- or purposeful movement programs in which movement constituted a central therapeutic or rehabilitative component. PubMed, Web of Science, Embase, the Cochrane Library, and PsycINFO were searched from inception to August 2026. Randomized and non-randomized controlled studies were not combined in the same primary meta-analysis. Randomized studies reporting sufficiently comparable outcomes were synthesized using standardized mean differences (SMDs) with 95% confidence intervals (CIs) under random-effects models. Risk of bias was assessed using RoB 2 and ROBINS-I, and certainty of evidence was evaluated using GRADE.ResultsTwelve controlled studies involving individuals with ASD were included and showed substantial variation in intervention format, comparator conditions, outcome measures, and risk of bias. Exploratory RCT-only meta-analyses included three studies for social communication/social responsiveness (n = 76; SMD = −0.68, 95% CI: −1.58 to 0.23; p = 0.15; I² = 72%) and three studies for motor function (n = 55; SMD = 2.04, 95% CI: −0.52 to 4.61; p = 0.12; I² = 92%); certainty of evidence was very low for both domains. Overall autism symptom severity was represented by one randomized trial (n = 30; SMD = −3.09, 95% CI: −4.19 to −1.99), resulting in low-certainty evidence and precluding pooling. Narrative synthesis identified potentially favorable signals in joint engagement, cooperative behavior, interpersonal synchrony, emotion inference, and gesture imitation, but these findings arose from small and heterogeneous studies.ConclusionThe current evidence base for DMIs is small, heterogeneous, and of low to very low certainty. Structured narrative synthesis suggests possible domain-specific benefits, whereas exploratory pooled estimates for social communication/social responsiveness and motor function remain inconclusive. DMIs may have potential as complementary interventions for ASD, but larger, methodologically rigorous randomized trials with standardized interventions and outcome measures are required.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261495230, identifier CRD420261495230.
Effects of Telerehabilitation on Quality of Life, Physical Capacity, and Symptom Burden Within the Post–COVID-19 Condition: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Background: Post–COVID-19 condition (PCC) is characterized by persistent symptoms and functional limitations that impair quality of life, and rehabilitation is an important component of its management. Because access to conventional face-to-face rehabilitation may be limited, telerehabilitation has emerged as an accessible alternative. However, the effectiveness of telerehabilitation across clinical outcomes remains uncertain, and the influence of different delivery modes is not well understood. Objective: This study aimed to evaluate the effects of telerehabilitation on health-related quality of life (HRQoL), physical capacity, and symptom burden in adults with PCC, and to determine whether delivery mode (synchronous, asynchronous, or hybrid) modified these effects. Methods: Seven databases (PubMed, Cochrane Library, Web of Science, Scopus, Embase, EBSCO, and PEDro) were searched for randomized controlled trials published from January 2020 through December 2025. Eligible trials enrolled adults with PCC and compared telerehabilitation with usual care or another control condition. The primary outcome was HRQoL; secondary outcomes included functional capacity assessed by the 6-minute walk test and sit-to-stand test, dyspnea, fatigue, and symptoms of anxiety and depression. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Mean differences or standardized mean differences (SMDs) with 95% CIs were pooled using random-effects models with the Hartung-Knapp-Sidik-Jonkman adjustment. Heterogeneity was quantified using I² and τ², with 95% prediction intervals reported where estimable. Certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Results: A total of 22 randomized controlled trials involving 2294 participants were included. Telerehabilitation was associated with significant improvements in HRQoL (SMD 1.26, 95% CI 0.07-2.45; <i>P</i>=.04), dyspnea (SMD 1.95, 95% CI 0.60-3.31; <i>P</i>=.005), and functional aerobic capacity (6-minute walk test : mean difference 77.79 meters, 95% CI 30.44-125.14; <i>P</i>=.001). Fatigue was also significantly reduced (SMD 0.89, 95% CI 0.16-1.62; <i>P</i>=.02), but no significant effects were observed for lower-limb strength (sit-to-stand test: SMD 0.55, 95% CI –0.15 to 1.25; <i>P</i>=.12) or symptoms of anxiety and depression (SMD 0.12, 95% CI –0.13 to 0.38; <i>P</i>=.36). No significant differences between delivery modes were observed for HRQoL (<i>P</i>=.93), functional aerobic capacity (<i>P</i>=.29), or dyspnea (<i>P</i>=.16). A significant subgroup difference was observed for lower-limb strength (<i>P</i>=.02). Conclusions: Telerehabilitation may improve quality of life, aerobic capacity, and symptom burden in PCC and offer an accessible option for post-COVID rehabilitation, although the certainty of evidence was generally limited. Asynchronous delivery appears feasible for general reconditioning, whereas its benefit for lower-limb strength and the value of synchronous supervision remain uncertain. Clinical Trial: PROSPERO CRD42023490863; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023490863
Effect of soft Chinese martial arts on depressive symptoms among college students: a systematic review and meta-analysis
ObjectivesMental health problems are a growing concern among college students worldwide. While exercise is a proven mental health intervention, a quantitative synthesis on the effects of soft Chinese martial arts, as a unique mind-body practice, on depression in this specific population is lacking. This study aimed to fill this gap by systematically evaluating the effectiveness of soft Chinese martial arts interventions in alleviating depressive symptoms among college students.MethodsLiterature with publication dates up to July 31, 2025 was searched in seven databases, including PubMed/MEDLINE, Embase, Web of Science, Scopus, CENTRAL, PsycINFO, and CNKI. Studies were systematically screened according to the PRISMA guidelines, and the quality of the included literature was assessed using the Cochrane Risk of Bias tool. The size of the effect was expressed by means of SMD and 95% confidence interval, and subgroup analyses were performed to explore sources of heterogeneity.ResultsA total of 11 RCTs (11 independent datasets) involving 750 participants were included in the analysis. The meta-analysis revealed a significant overall effect of soft Chinese martial arts on reducing depressive symptoms in college students (SMD = –0.71, 95% CI: –1.23 to –0.18, p = 0.008). Subgroup analyses suggested potential moderating effects of intervention duration, frequency, and session length. For example, the effect size for the 9-14 week subgroup was SMD = –1.35 (95% CI: –2.10 to –0.60) and for the 20-60 minute single session duration subgroup was SMD = –0.69 (95% CI: –1.36 to –0.03). Heterogeneity was high (I2 = 82.6%, p < 0.001). Egger’s test was not statistically significant (p = 0.397), but publication bias cannot be ruled out due to the small number of studies.ConclusionSoft Chinese martial arts, particularly Tai Chi and Baduanjin, may be an effective non-pharmacological intervention for reducing depressive symptoms in college students, providing preliminary evidence for mental health programs. However, results should be interpreted with caution because of high heterogeneity, risk of bias, and possible publication bias. The certainty of evidence is very low according to the GRADE framework.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1129413, identifier CRD420251129413.
Acupuncture–antidepressant combinations for clinically diagnosed depressive disorders in China: a systematic review and network meta-analysis
IntroductionTo evaluate the short-term efficacy and safety of acupuncture–antidepressant combinations for clinically diagnosed depressive disorders among participants recruited in China using a network meta-analysis.MethodsPubMed, Embase, the Cochrane Library, Web of Science, CNKI, and Wanfang were searched from inception to February 2025 for randomised controlled trials of acupuncture–antidepressant combinations and relevant pharmacological or acupuncture-related comparators. The principal efficacy outcome was change in Hamilton Depression Rating Scale (HAMD/HDRS) scores; safety outcomes included nausea/vomiting, dry mouth, headache, and treatment discontinuation. Risk of bias was assessed using RoB 2. Random-effects Bayesian network meta-analyses were conducted in R version 3.6.0 using gemtc version 0.8.1. Mean differences or odds ratios are presented with 95% credible intervals (CrIs), together with posterior rank-position probabilities. A standardised mean difference (SMD)-based sensitivity analysis assessed the influence of pooling HAMD-17 and HAMD-24.ResultsSeventy-seven trials (7,031 participants) were included in the systematic review. Within the principal connected eight-node efficacy network, manual acupuncture plus selective serotonin reuptake inhibitors produced the largest reduction versus SSRI monotherapy (mean difference −3.37; 95% CrI −3.86 to −2.89) and the highest probability of occupying Rank 8 (the most effective position). Electroacupuncture plus SSRIs was also associated with a greater reduction in HAMD scores than SSRIs alone (MD −2.98; 95% CrI −3.66 to −2.31). Manual acupuncture plus SNRIs also favoured combination treatment (MD −3.16; 95% CrI −6.03 to −0.28), although the interval was comparatively wide. The SMD sensitivity analysis retained benefit for both EA + SSRIs and MA + SSRIs relative to SSRIs, although their relative ordering differed from the raw-MD analysis. The available adverse-event networks did not identify statistically clear differences from SSRI monotherapy; however, sparse events and very wide CrIs limit the strength of this finding.ConclusionManual acupuncture plus an SSRI was associated with the largest short-term HAMD reduction in the primary raw-MD network. Relative treatment ordering differed in the SMD sensitivity analysis. The estimates should be interpreted cautiously because clinical heterogeneity, risk-of-bias concerns, sparse safety data, and limited follow-up preclude claims of equivalent safety or a preferred first-line strategy.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/View/CRD420251029584, identifier CRD420251029584.
Sumud as a framework for collective resilience: a systematic review of implications for transcultural psychiatry and psychotherapy
BackgroundResilience is increasingly understood as a dynamic, ecological process; however, prevailing psychiatric models continue to emphasize individual traits, thereby neglecting collective and culturally embedded forms of endurance. Sumud (Arabic: صمود), broadly translating as steadfastness, perseverance, and endurance, sustains identity, dignity, and daily life under chronic adversity across the Arab world and functions as a relational and ethical orientation. This review examines sumud as a resilience framework for transcultural psychiatry and psychotherapy.AimsTo synthesize conceptualizations of sumud in relation to resilience, coping, and adaptation, and to evaluate implications for narrative, family-based, group, community-oriented, and arts-informed therapeutic approaches.MethodsA PRISMA 2020-guided systematic narrative review was conducted. Four electronic databases (PubMed, Scopus, Web of Science, and Embase) were searched covering publications up to 1 June 2026. English-language studies were eligible if they explicitly examined sumud as a cultural, psychological, or collective construct with relevance to resilience, coping, or psychotherapy. Eligible publication types included qualitative, quantitative, and mixed-methods empirical studies; theoretical and conceptual papers; ethnographies; narrative analyses; and reviews. Data were thematically synthesized using a predefined extraction matrix. The review was registered with PROSPERO (CRD420261279052).ResultsThirty-nine studies met the inclusion criteria. Descriptively sumud emerged as a multilevel, collective form of resilience enacted through family systems, intergenerational narratives, cultural practices, and institutional structures. Substantively, it supported meaning-making, emotional regulation, and identity continuity. Critically, ethical tensions and cumulative burdens were documented, particularly for women, caregivers, and professionals., and rigorously evaluated, sumud-informed psychotherapeutic interventions remain scarce, notwithstanding a general preference in mental health studies for social-ecological models and narrative, family-based, group, and arts-based therapeutic approaches.ConclusionsTheoretically, sumud challenges individualistic psychiatric frameworks by offering a culturally embedded, collective model of resilience. Clinically, it urges clinicians to engage with patients’ narratives, relational worlds, and cultural practices, while remaining attentive to the costs of endurance. Prospectively, in the context of ongoing conflicts and humanitarian crises affecting parts of the Middle East and Gulf region, sumud warrants renewed scholarly and clinical attention for the development of culturally responsive, resilience-informed psychotherapies.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD420261279052.