Perinatal obsessive-compulsive disorder (PNOCD) can impact up to one in five individuals in the perinatal period. Whilst effective treatment for PNOCD is available, parents experience barriers accessing this evidence-based psychological therapy. Healthcare professionals’ perspectives on barriers to accessing support are valuable to develop targeted interventions to increase access to support for PNOCD.

This study aimed to prioritise a list of barriers to accessing therapy for PNOCD, in terms of importance and amenability to change, from the perspective of healthcare professionals.

203 healthcare professionals from across primary, community and secondary care services completed a survey where they ranked barriers in terms of importance and amenability to change. Barriers were ranked within clusters and across cluster names; 47 barriers were organised into seven clusters. Rankings were analysed using descriptive statistics and the non-parametric Friedman’s test.

Professionals ranked healthcare professionals’ knowledge and training on PNOCD as the barrier which was most important and amenable to change. Parents’ knowledge and awareness of PNOCD and services, their attitudes to mental health problems, and their attitudes towards healthcare professionals and services were ranked as the second most important and amenable to change.

Professionals view their colleagues’ knowledge and training on PNOCD as the most important barrier impacting parents access to evidence-based therapy for PNOCD. Training for professionals could be targeted to increase access. Parents’ awareness and attitudes surrounding PNOCD, mental health and services were also identified by professionals as an important barrier and is recommended to be targeted to increase access.

Substantial experimental research has explored mental contamination – feelings of internal pollution proposed to result from misinterpreting perceived violations. The Mental Contamination Report (MCR) was developed to measure in-the-moment experiences of mental contamination, and has been used in seminal experiments in this domain. However, the MCR has yet to be psychometrically evaluated. The aim of the current study was to evaluate the psychometric properties of the MCR, and if warranted, propose a revised version with improved research utility.

Data for this study were collected as part of a larger experiment examining the impact of moral self-violation on mental contamination. A sample of 150 undergraduate students completed the MCR, Vancouver Obsessional-Compulsive Inventory-Mental Contamination Subscale, and the Vancouver Obsessional-Compulsive Inventory.

The original Emotions Subscale of the MCR demonstrated excellent internal consistency (${\rm{\alpha }}$=0.92) but contained emotions non-specific to mental contamination. We conducted an exploratory factor analysis (EFA) of the emotion items to identify which items load more heavily onto a mental contamination-specific factor. The EFA revealed a two-factor solution, with five items items loading strongly on the mental contamination-specific factor. For the 5-item mental contamination-specific Emotions Subscale, we found excellent internal consistency (${\rm{\alpha }}$=0.90), strong known groups validity, F2,147=63.17, p<.001, ηp2=.46, good convergent validity and mixed results for divergent validity. For the Behavioural Urges Subscale, we found overall mixed psychometric properties.

Based on the results of the psychometric analysis, a revised version of the MCR is proposed.

Despite their considerable public health impact, most people with depressive disorders do not receive treatment due to barriers that limit access to high-quality care. Since the onset of the COVID-19 pandemic, depressive symptoms have sharply increased, and access-to-care barriers were magnified by physical distancing requirements. Videoconferencing is a virtual care modality that reduces access-to-care barriers and can be used to deliver cognitive behavioural therapy (CBT), an evidence-based treatment for depressive disorders. However, it is unclear whether videoconference CBT effectively decreases depressive symptoms, particularly in a group therapy format.

This non-randomized study compared outcomes of group CBT for depressive disorders delivered via videoconference versus in-person.

Data on clinical outcomes (pre- and post-treatment depression, anxiety, and stress symptoms), treatment attendance, drop-out, and patient satisfaction were collected from adult outpatients of a mood disorders clinic who attended 14 weekly group CBT sessions either in-person (pre-pandemic; n=255) or via videoconference (during the pandemic; n=113).

Pre- to post-treatment decreases in depression, anxiety and stress symptoms did not differ between treatment modalities (β=–.01–.06, p>.05). These effects were robust to patient-level factors (i.e. age, sex, co-morbidities, medication use). Moreover, videoconference group CBT was associated with higher attendance (d=0.33) and lower drop-out (53% vs 70% of participants) compared with in-person group CBT.

Videoconference group CBT for depressive disorders appears to be a promising and effective alternative to in-person CBT. However, these findings should be interpreted in light of the study’s non-randomized design and the potential confounding effects of the COVID-19 pandemic.

This experimental study investigated whether the trait factors of world assumptions and cognitive flexibility were predictive of levels of attentional bias to threat stimuli, memory integration, and data-driven processing.

An opportunity sample of 74 participants took part in the investigation. Participants viewed a virtual reality film to induce mild distress to mimic processes that can occur in individuals when experiencing a traumatic event. A prospective experimental design was conducted involving measurements at pre-trauma exposure (Time 1), post-exposure (Time 2) and one-week follow-up (Time 3). Self-report measures of world assumptions, cognitive flexibility, and cognitive processing were administered. Eye-tracking equipment was used to assess attentional bias towards threat images, and a free recall task to assess memory integration.

A mixed effects linear model found increased cognitive bias towards trauma-related threat images pre/post-exposure, specifically for a maintenance attentional bias. Significantly greater data-driven processing was observed post-exposure, with greater conceptually driven processing observed at one-week follow-up. No significant findings were observed for memory integration. World assumptions were predictive of increased data-driven processing; the relative use of data-driven to conceptually driven processing; and trait anxiety. Cognitive flexibility was predictive of state anxiety.

These results provide additional support for the role of maintained attention, data-driven processing, and conceptually driven processing in post-trauma reactions as per established cognitive theories of post-traumatic stress disorder. More research is required to fully explore the roles of core beliefs, assumptions and cognitive flexibility in this area.

There can be heterogeneity in outcomes for individuals receiving targeted CBT for voices (CBTv), and rates of drop-out require investigation. To promote the directed provision of interventions to those most likely to benefit, it is necessary to elucidate the relationship between the factors driving the variability in engagement and response to these interventions.

This study aimed to explore the possible predictors of engagement and outcome for a transdiagnostic cohort of service users receiving Guided self-help cognitive behaviour intervention for VoicEs (GiVE), a brief, manualised CBTv intervention.

This study utilised a quasi-experimental approach to explore and analyse potential predictors of engagement and outcome for service users offered a course of GiVE within routine clinical practice. The sample consisted of 142 service users who were assessed between January 2017 and September 2019 and were offered the GiVE intervention.

The offer of the intervention was accepted by 108 (76%) service users and completed by 74 (52%). Clinically meaningful benefits on the primary outcomes of voice-related distress and recovery were reported by 54% and 48% of the service users who completed the intervention, respectively. For the prediction of engagement, only higher age was found to be associated with increased engagement, particularly for those aged 45–54 and 55–64. For the prediction of outcome, the only clinical measure found to be associated with poorer outcome was an increased anxiety score at baseline.

Engagement with and outcomes from the GiVE intervention may be enhanced with a pre-intervention consideration of age and the reduction of anxiety, respectively.

Cognitive behavioural therapy for fatigue (CBT-F) and insomnia (CBT-I) are effective therapies. Little is known on their effectiveness when severe fatigue and insomnia co-occur.

This observational study investigated whether the co-occurrence of fatigue and insomnia influences the outcomes of CBT-F and CBT-I. Furthermore, it was determined if changes in fatigue and insomnia symptoms are associated, and how often the co-occurring symptom persists after CBT.

Patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS, n = 241) received CBT-F and patients with insomnia disorder (n = 162) received CBT-I. Outcomes were fatigue severity assessed with the subscale of the Checklist Individual Strength (CIS-fat) and insomnia severity assessed with the Insomnia Severity Index (ISI). In each cohort, treatment outcomes of the subgroups with and without co-occurring symptoms were compared using ANCOVA. The association between changes in insomnia and fatigue severity were determined using Pearson’s correlation coefficient.

There were no differences in treatment outcomes between patients with and without co-occurring fatigue and insomnia (CBT-F: mean difference (95% CI) in CIS-fat-score 0.80 (−2.50–4.11), p = 0.63, d = 0.06; CBT-I: mean difference (95% CI) in ISI-score 0.26 (−1.83–2.34), p = 0.80, d = 0.05). Changes in severity of both symptoms were associated (CBT-F: r = 0.30, p < 0.001, CBT-I: r = 0.50, p < 0.001). Among patients no longer severely fatigued after CBT-F, 31% still reported insomnia; of those without clinical insomnia after CBT-I, 24% remained severely fatigued.

CBT-F and CBT-I maintain their effectiveness when severe fatigue and insomnia co-occur. Changes in severity of both symptoms after CBT are associated, but the co-occurring symptom can persist after successfully treating the target symptom.

Moral injury is a potentially deleterious mental health outcome that can follow exposure to events that challenge one’s moral code. Theoretical models suggest a multi-faceted self-concept may support adaptation following such events. However, little is known about the relationship between self-concept complexity and outcomes following potentially morally injurious events.

This cross-sectional study investigated hypothesized relationships between self-concept complexity and outcomes in adults (n=172) exposed to potentially morally injurious events.

Participants completed validated measures of event-related distress, traumatic stress, depression and anxiety, and a self-complexity task in which they provided multiple descriptors of their self-concept. Responses were coded for overall diversity, defined as number of categories of self-descriptors, and role diversity, defined as number of social and activity-based roles.

Multiple regression analyses found greater role diversity independently predicted lower event-related distress, while overall self-diversity and total number of self-descriptors did not.

Findings indicate diversity in active facets of the self (e.g. relational or activity-based roles) may buffer the effects of a potentially morally injurious event.

Approximately 24% of stroke survivors develop post-stroke depression (PSD), which is associated with poor psychological recovery, identity disruption, and reduced self-esteem. Psychological interventions often fail to address these broader challenges. The Wisdom Enhancement Timeline technique, which facilitates autobiographical reflection, has shown promise for depression in older adults. It has not yet been studied in a post-stroke population.

This study evaluated the effectiveness of the Wisdom Enhancement Timeline technique in stroke. It was hypothesised that wisdom would improve first, followed by identity/self-esteem and mood.

A multiple-baseline single-case experimental design (SCED) was used across three stroke survivors. Daily visual analogue scale (VAS) ratings measured mood, identity, self-esteem, and wisdom during the trial. The Patient Health Questionnaire-9 (PHQ-9) measured depressive symptoms at pre- and post-intervention. Visual analysis, Tau-U, generalised least squares regression (adjusting for autocorrelation), and piecewise regression evaluated intervention effects.

Improvements were observed across all participants and outcomes. Tau-U analysis indicated small-to-large effect sizes across outcomes (effect size range: 0.30–0.92). Breakpoints confirmed wisdom improved first, followed by identity/self-esteem and mood last. Regression confirmed significant level shifts across all outcomes. All participants showed clinically meaningful reductions in PHQ-9 scores, operationalised as a shift from pre-intervention scores above 10 to post-intervention scores below 10.

Wisdom-based interventions could be beneficial in a stroke population, promoting improvements in mood, identity coherence, self-esteem and wisdom. The Wisdom Enhancement Timeline technique shows promise for PSD treatment, although further research is needed to validate these effects.

Low educational literacy is associated with high rates of mental health problems. In Pakistan, only 60% of the population is literate. Traditional CBT requires literacy skills. Interventions to address the literacy barriers need to be developed.

To evaluate the feasibility, acceptability, and preliminary efficacy of a culturally adapted CBT-based animated ‘Shorts’ series for depression and anxiety in individuals with no or low educational literacy.

This randomized, rater-blind randomized controlled trial (RCT) compared an animated Shorts series and treatment as usual (TAU) with TAU alone in Pakistan. The primary outcomes were feasibility (recruitment, retention, adherence to treatment and trial processes) and acceptability (drop-outs and participants’ feedback). The secondary outcomes included the Hospital Anxiety and Depression Scale (HADS) and the WHO Disability Assessment Schedule 2 (WHODAS 2). Thirty consenting participants were randomly allocated to one of the groups in a 1:1 ratio and were assessed at baseline and the end of the intervention at 12 weeks.

The intervention was feasible and acceptable and was successful in reducing the symptoms of depression and anxiety. However, these findings need to be further confirmed in a larger RCT.

These preliminary findings are encouraging, and if future studies confirm that this approach can work, we should be able to overcome the literacy barrier in low- and middle-income countries.