The eagerly anticipated fifth edition of Dr Stahl's essential textbook of psychopharmacology is here! Using Dr Stahl's unique 'visual language', the book is the single most readable source of information on disease and drug mechanisms for all students and mental health professionals seeking to understand and utilize current therapeutics, and to anticipate the future for novel medications. The new edition includes over 500 new or refreshed figures, an intuitive color scheme, 14 new uses for older drugs and 18 brand new drugs, coverage of Parkinson's Disease Psychosis, behavioural symptoms of dementia, and mixed features in major depressive episodes, and expanded information on the medical uses of cannabis and hallucinogen assisted psychotherapy. This product combines the fifth edition of the textbook with a one-year subscription to www.stahlonline.org, providing access to the full range of Dr Stahl's content. The one-year subscription is activated via a code provided with the printed book.
Sina Elahimanesh, Mohammadali Mohammadkhani, Sara Zahedi Movahed
et al.
While large language models (LLMs) excel at open-ended dialogue, effective psychotherapy requires structured progression and adherence to clinical protocols, making the design of psychotherapist chatbots challenging. We investigate how different LLM-based designs shape perceived therapeutic dialogue in a chatbot grounded in the Self-Attachment Technique (SAT), a novel self-administered psychotherapy rooted in attachment theory. We compare three architectural variants: (1) a multi-agent system utilizing finite state machine aligned with therapeutic stages and a shared long-term memory, (2) a single-agent using identical knowledge-base and the same prompts, and (3) an unguided LLM. In an eight-day randomized controlled trial (RCT) with N=66 Farsi-speaking participants, balanced across the three chatbots, the multi-agent system is perceived as significantly more natural and human-like than the other variants and achieves higher ratings across most other metrics. These findings demonstrate that for therapeutic AI, architectural orchestration is as critical as prompt engineering in fostering natural, engaging dialogue.
BACKGROUND Fewer than 25% of patients with borderline personality disorder (BPD) receive guideline-adherent psychotherapy. Digital therapeutics can help reduce this gap. Therefore, we tested the effectiveness and safety of priovi, a digital therapeutic for BPD. METHODS We conducted a pragmatic, assessor-blind, parallel-group, randomised controlled trial, recruiting patients with BPD, according to DSM-5 classification, of at least moderate severity on the 23-item Borderline Symptom List (BSL-23) via online advertisements in Germany. Patients were aged 18 years or older, agreed on an emergency plan for suicidal crises, and gave informed consent to participate. Patients were excluded if they had a primary diagnosis of a substance use disorder or a diagnosis of a psychotic disorder. Simple computerised coin-toss randomisation (1:1) without stratification was used to assign patients to either the unguided digital therapeutic based on schema therapy together with treatment as usual (TAU; intervention group) or TAU alone (control group) and study investigators were masked to group assignment until after the analysis of the primary outcome and main safety outcome. All patients could use any form of usual care. The control group received freely available BPD-specific self-help material. The primary outcome was the time by treatment interaction in the intention-to-treat sample at 3 months measured by BSL-23 score. Safety was established via the number of serious adverse events (ie, suicide attempts, other life-threatening events, and hospitalisation), assessed via online questionnaire. Individuals with BPD were involved in the development of the digital therapeutic, but not in the design of this study. The trial was registered on German Clinical Trials Register (DRKS00028888) and is completed. FINDINGS Between May 3 and Oct 20, 2022, 1766 patients were screened for eligibility and 580 patients (520 [90%] women, 47 [8%] men, and 13 [2%] gender diverse) were randomly assigned to the intervention group (n=302) and control group (n=278). Ethnicity data were not recorded. At the primary timepoint of 3 months, 35 (12%) patients dropped out of the intervention group and 15 (5%) of the control group. The median age of patients was 29 years (IQR 24-37). Intention-to-treat analysis with linear mixed models showed a significant time by treatment interaction (p=0·0005) at 3 months in favour of the intervention group (d=0·24 [95% CI 0·07-0·42]). Regarding safety, there were significantly fewer suicide attempts in the intervention group (n=7) than in the control group (n=21; incidence rate ratio 0·34 [95% CI 0·14-0·79]; p=0·0081) and there were no differences regarding other serious adverse events. INTERPRETATION This trial provides tentative evidence of the effectiveness and absence of safety concerns of the digital therapeutic, priovi, in the treatment of individuals with BPD. FUNDING GAIA.
Abd. Hamid Cholili, M. Mahbubi, Rofiqo Azizaturrahmi
et al.
The Quran Education Park (TPQ) plays a vital role in accustoming children's behavior to become moral individuals with Koranic character and making the Al-Quran their guide for life. However, the results of field observations show that the discipline of students at TPQ is low. One way to foster discipline in children is by giving consequences as extrinsic reinforcement for their behavior; one form of reinforcement is the token economy. This research aims to determine the influence of the token economy on improving TPQ students' discipline. This research uses a quantitative approach with experimental research methods; the sample is 20 children, and data analysis uses the Paired Sample t-test technique. The results of the paired sample t-test are 0.000 < 0.05, which shows the significant influence of implementing the token economy in improving the disciplinary attitudes of TPQ students. Apart from that, there was an increase in the average score between the pre-test and post-test of 4.30.
The article examines whether hypersexuality should be regarded as norm or pathology. It is emphasized that despite the fact that the presence of such a phenomenon as pathological hypersexuality cannot be denied some authors speak against its and sexual addiction inclusion into classification systems due to the following circumstances: (1) allegedly now there is an insufficient number of verified actual data for establishing diagnostic criteria in order to identify this behaviour as a mental disorder, and allegedly studies have not revealed yet whether such pathological symptoms, which are consistent with these marks, as anxiety and the problem with control of impulses are really connected with excessive sexual behaviour; (2) consideration of people with hypersexuality as having mental pathology allegedly just reflects cultural dislike for an unusual sexual behaviour, while labelling of sexual drives as “extreme” simply stigmatize those people who do not meet norms of their culture or norms of a group of persons of the same age; (3) compulsive sexual behaviour was qualified as abnormal by “moralists from medicine” who act as “civil inspectors” and enforce their orthodox views; (4) the oftener psychologists and lawyers declare some or other forms of behaviour uncontrolled compulsions the fewer people are held liable for their actions, even if these actions harm other people; (5) the opinion is expressed that there are no clear differences between normal and pathological levels of sexual desires and behaviour.The author believes that hypersexuality can be both physiological and pathological. Sometimes in certain cases it is really difficult to distinguish whether one should designate hypersexuality as norm or pathology. The article informs that instead of “Excessive sexual drive” (ICD-10, code F52.7) ICD-11 introduced code 6C72 “Compulsive sexual behaviour disorder”. Its characteristic is given. However, it is reported that there are currently several conceptualizations of pathological hypersexuality: obsessive-compulsive, addictive, caused by impairment of impulse control, as well as the model, which was determined by the author and connected with persistent genital arousal disorder and restless genital syndrome. In the author’s opinion, each of the above mentioned conceptualizations (models) of pathological hypersexuality is useful in certain cases because better than others it characterizes the state of the definite patient. These models can “interlace/intersect” in the same patient, and their manifestations can replace one another in the dynamics of the course of hypersexuality. The author believes that attempts to deny the presence of pathological hypersexuality misinterpret the reality, are unscientific and not consistent with numerous clinical observations.
Background: Regular physical activity has a positive impact on brain function, improves perception, and significantly influences academic achievement.
Objective: This study aimed to determine the association of physical activity, motor skills, and academic performance in high school students in Hayatabad, Peshawar.
Methodology: A total of 349 students were recruited using stratified random sampling from both public and private high schools within the Hayatabad region, Peshawar, Pakistan from December 2020 to May 2021. Only students in 9th and 10th grades from public and private schools who met the inclusion and exclusion criteria, were included. PA was assessed using the short version of the International Physical Activity Questionnaire (IPAQ). Academic performance was documented based on grades and percentages from recent exams, following Peshawar Board of Education rules. Motor skills were evaluated through vertical jumps, average hand strength, sit-and-reach flexibility, and 60-second pushups.
Results: A statistically significant association was observed between PA and academic performance in high school students (P<0.05). Similarly, there was a statistically significant association between motor skills including vertical jump, handgrip strength and academic performance (P<0.05). However, no statistically significant associations were found between sit-and-reach test performance, (60s) push-ups and academic performance (P>0.05).
Conclusion: In conclusion, this study demonstrates an association between physical activity (PA) and academic performance in high school students. However, motor skills including vertical jump and handgrip strength is associated with academic performance in high school students.
Keywords: Physical activity, Motor skills, Academic performance, Academic achievement
Vocational rehabilitation. Employment of people with disabilities, Therapeutics. Psychotherapy
This study presents PsychoLexTherapy, a framework for simulating psychotherapeutic reasoning in Persian using small language models (SLMs). The framework tackles the challenge of developing culturally grounded, therapeutically coherent dialogue systems with structured memory for multi-turn interactions in underrepresented languages. To ensure privacy and feasibility, PsychoLexTherapy is optimized for on-device deployment, enabling use without external servers. Development followed a three-stage process: (i) assessing SLMs psychological knowledge with PsychoLexEval; (ii) designing and implementing the reasoning-oriented PsychoLexTherapy framework; and (iii) constructing two evaluation datasets-PsychoLexQuery (real Persian user questions) and PsychoLexDialogue (hybrid simulated sessions)-to benchmark against multiple baselines. Experiments compared simple prompting, multi-agent debate, and structured therapeutic reasoning paths. Results showed that deliberate model selection balanced accuracy, efficiency, and privacy. On PsychoLexQuery, PsychoLexTherapy outperformed all baselines in automatic LLM-as-a-judge evaluation and was ranked highest by human evaluators in a single-turn preference study. In multi-turn tests with PsychoLexDialogue, the long-term memory module proved essential: while naive history concatenation caused incoherence and information loss, the full framework achieved the highest ratings in empathy, coherence, cultural fit, and personalization. Overall, PsychoLexTherapy establishes a practical, privacy-preserving, and culturally aligned foundation for Persian psychotherapy simulation, contributing novel datasets, a reproducible evaluation pipeline, and empirical insights into structured memory for therapeutic reasoning.
As mental health issues rise among college students, there is an increasing interest and demand in leveraging Multimodal Language Models (MLLM) to enhance mental support services, yet integrating them into psychotherapy remains theoretical or non-user-centered. This study investigated the opportunities and challenges of using MLLMs within the campus psychotherapy alliance in China. Through three studies involving both therapists and student clients, we argue that the ideal role for MLLMs at this stage is as an auxiliary tool to human therapists. Users widely expect features such as triage matching and real-time emotion recognition. At the same time, for independent therapy by MLLM, concerns about capabilities and privacy ethics remain prominent, despite high demands for personalized avatars and non-verbal communication. Our findings further indicate that users' sense of social identity and perceived relative status of MLLMs significantly influence their acceptance. This study provides insights for future intelligent campus mental healthcare.
The proliferation of Large Language Models (LLMs) and Intelligent Virtual Agents acting as psychotherapists presents significant opportunities for expanding mental healthcare access. However, their deployment has also been linked to serious adverse outcomes, including user harm and suicide, facilitated by a lack of standardized evaluation methodologies capable of capturing the nuanced risks of therapeutic interaction. Current evaluation techniques lack the sensitivity to detect subtle changes in patient cognition and behavior during therapy sessions that may lead to subsequent decompensation. We introduce a novel risk ontology specifically designed for the systematic evaluation of conversational AI psychotherapists. Developed through an iterative process including review of the psychotherapy risk literature, qualitative interviews with clinical and legal experts, and alignment with established clinical criteria (e.g., DSM-5) and existing assessment tools (e.g., NEQ, UE-ATR), the ontology aims to provide a structured approach to identifying and assessing user/patient harms. We provide a high-level overview of this ontology, detailing its grounding, and discuss potential use cases. We discuss four use cases in detail: monitoring real user interactions, evaluation with simulated patients, benchmarking and comparative analysis, and identifying unexpected outcomes. The proposed ontology offers a foundational step towards establishing safer and more responsible innovation in the domain of AI-driven mental health support.
Recent advancements in large language models (LLMs) have shown their potential across both general and domain-specific tasks. However, there is a growing concern regarding their lack of sensitivity, factual incorrectness in responses, inconsistent expressions of empathy, bias, hallucinations, and overall inability to capture the depth and complexity of human understanding, especially in low-resource and sensitive domains such as psychology. To address these challenges, our study employs a mixed-methods approach to evaluate the efficacy of LLMs in psychotherapy. We use LLMs to generate precise summaries of motivational interviewing (MI) dialogues and design a two-stage annotation scheme based on key components of the Motivational Interviewing Treatment Integrity (MITI) framework, namely evocation, collaboration, autonomy, direction, empathy, and a non-judgmental attitude. Using expert-annotated MI dialogues as ground truth, we formulate multi-class classification tasks to assess model performance under progressive prompting techniques, incorporating one-shot and few-shot prompting. Our results offer insights into LLMs' capacity for understanding complex psychological constructs and highlight best practices to mitigate ``semantic drift" in therapeutic settings. Our work contributes not only to the MI community by providing a high-quality annotated dataset to address data scarcity in low-resource domains but also critical insights for using LLMs for precise contextual interpretation in complex behavioral therapy.
The evolution of psychotherapeutic treatments from Freud to digitally administered evidence-based treatments reflects a history of progressive advance. This history is characterized by identification of problems with the current state of the art, followed by solutions inspired and supported by advances in basic science and technology leading to subsequent recognition of other limitations revealed by the new advance. The common thread running through this process is (a) increasing specificity of the psychotherapeutic interventions, (b) increasing evidence of efficacy and safety, (c) increasing integrity and reliability in the delivery of the intervention, (d) increased equality of access, and (e) recognition of the need for regulation to provide protection for the public from unsafe or ineffective products. This evolution of psychotherapeutic treatments, not surprisingly, has been foreshadowed by the precursor history of the evolution of pharmacologic treatment. Although intellectual history is lumpy and does not sort itself into discrete and coherent epochs, such sorting is a useful heuristic for describing the advance of medicine and the therapeutic enterprise. This paper will discuss six successive epochs of psychotherapy. For each it will discuss the problem of the preceding era it sought to solve, the advance it brought to the field, the emerging science and technology that supported that advance, and the precursor development in pharmacological treatments that foreshadowed that epoch of psychotherapy. Finally, it will conclude with some observations about the proximate future.
Background: Lateral epicondylitis, commonly known as tennis elbow, is characterized by pain and functional limitations at the elbow due to overuse. This study focuses on evaluating the effects of Tyler twist wrist extensor-strengthening exercises, aiming to provide insights into an effective intervention for this condition.
Objective: This study aimed to determine the effects of Tyler twist wrist extensor strengthening exercises on pain, disability, and grip strength in patients with lateral epicondylitis.
Methodology: A randomized controlled trial was conducted at Cina Medical Center Rawalpindi from February 2022 to January 2023. Fifty-two participants meeting the inclusion criteria were assigned to either Group A or Group B. Group A received eccentric Tyler twist exercises in addition to conventional physiotherapy, while Group B received conventional physiotherapy alone. Pain, functional disability, and grip strength were assessed at baseline, the second week, and the fourth week. Data was analyzed with SPSS version 25. Demographics and descriptive data is presented in form of percentages, frequencies and mean + SD. Normality of the data is determined via Shapiro Wilk Test. We applied mixed-way ANOVA to find the interaction between two groups.
Results: Within-group analysis demonstrated a significant improvement in pain, functional disability, and grip strength for both groups (p-value < 0.01). Between-group analysis revealed a significant difference in pain, functional disability, and grip strength.
Conclusion: The addition of eccentric Tyler twist exercises to conventional therapy showed a statistically significant difference in terms of pain, functional disability, and grip strength in patients with lateral epicondylitis.
Keywords: Extensor Carpi Radialis Brevis, Lateral Epicondylitis.
Vocational rehabilitation. Employment of people with disabilities, Therapeutics. Psychotherapy
Salma M. Abdalla, Catherine K. Ettman, Samuel B. Rosenberg
et al.
Abstract Substantial literature documents the impact of mass traumatic events on post-traumatic stress disorder (PTSD) in populations. However, the trajectory of PTSD in the US population during the pandemic and the association between assets, Covid-19 related stressors, and PTSD over time remains unclear. The Covid-19 and Life Stressors Impact on Mental Health and Well-Being (CLIMB) is a nationally representative, longitudinal panel of US adults in Spring 2020 (N = 1270), 2021 (N = 1182), and 2022 (N = 1091). Using the four-item PC-PTSD-4, we assessed the prevalence of probable PTSD in the US population over three years. Using generalized estimating equations (GEE) and logistic regression at each wave, we estimated associations of demographics, assets, and stressors with probable PTSD. Here we report that the overall prevalence of PTSD decreases from 22.2% in 2020 to 16.8% in 2022 (p = 0.02). Persons with household incomes below $20,000 report higher prevalence of probable PTSD compared to other income groups. The GEE model shows higher odds of probable PTSD among persons with household incomes below $20,000 (OR = 2.17 (95%CI: 1.35,3.50)) relative to $75,000 or more; and high stressor scores (OR = 2.33 (95%CI: 1.72,3.15)) compared to low stressor scores. High stressor scores are associated with higher odds of probable PTSD in 2020 (OR = 2.69 (95%CI: 1.56,4.66)), 2021 (OR = 4.58 (95%CI: 2.52,8.30)), and 2022 (OR = 3.89 (95%CI: 2.05,7.38)) compared to low stressor scores. This analysis highlights the pandemic’s prolonged influence on population mental health, particularly among persons with fewer economic assets and those experiencing more pandemic-related stressors. Reducing mental health disparities requires interventions to address inequities.
Vaginismus is the fear of pain associated with the involuntary contraction of the outer third part of vagina upon entry. These women are usually phobic about intercourse and avoid penetration. Although rare in western cultures, vaginismus is the most common clinical reason for referral for female sexual dysfunction in Turkey where sex therapy is the usual psychotherapy approach used. This article focuses on the treatment of vaginismus through combining homogeneous group therapy and psychodrama with sex therapy techniques for treating women referred with vaginismus. It also headlines those characteristics of women and men that mainly arise from cultural factors.
Formulation of the Problem. In this article the focus is made on the parental subsystem of the family system, where the marriage subsystem is represented by age indicators, and the sibling subsystem is considered through the prism of marriage partners as parents (adult members of the family system). The phenomenon of parenthood is presented as a correspondence to the family system, according to which the parental subsystem includes: 1) parents as marriage partners - husband and wife; 2) parents as a team; 3) parents as separate individuals - mom and dad - with their parental attitudes, attitudes, relationships with children, etc. Taking into account such a view, parenthood is interpreted as a historically specific system of relationships between spouses, as well as parents and children, and is a subsystem whithin the family system as a relatively independent entity. Problem Analysis. The empirical part presented a comparison of the average values of personal and interpersonal factors of family members in relation to their age differences: the 1st age category consisted of subjects aged 20–30 years old; in the 2nd – 31–40 years old; in the 3rd – 41–50 years; in the 4th – 51–60 years old. Conclusions. Trends important for our research were revealed: representatives of the 1st category are characterized by a high degree of closedness, isolation, fixation of interests on the phenomena of their inner world, increased fatigue, irritability, tendency to hypochondria, emotional coldness, etc. Representatives of the 2nd (31-40 years old) and 3rd categories of parents (41-50 years old) demonstrate a lower expressed level of parental protection during the upbringing of a child. They are characterized by an authoritarian parenting style, a strict attitude towards the child, participation in the child's upbringing occurs only when needed or necessary, quite often there is not enough time, energy and attention to the child. Subjects of the 4th category (50-60 years old) have a higher risk of hypochondriacal instructions regarding the child. The "weak point" of such family members is increased insecurity, fear of making a mistake, exaggerated ideas about the child's illness.
Since the beginning of humanity, questions about our identity, purpose, and origins have been at the forefront of our existential concerns. This case study article aims to approximate practical answers to these questions. Drawing upon the Morenian theoretical perspective that posits that our identities are shaped by the roles we play, arguing that becoming aware of those roles can enable us to make informed decisions about how we think, feel, and act. By noticing and paying attention to our roles, we can pause and reflect on our behaviour, recalibrate our actions and emotions, and strive towards becoming the person we aspire to be. The Play of Life technique, which utilises 3D physical or digital figures to access subcortical and non-verbal areas of the brain, can be particularly effective in this regard. By bypassing rational constructs, this technique can reveal new insights about ourselves that would otherwise be obscured. Rather than simply asking for more information, the Play of Life practitioner asks the participant to "show me" using these 3D images, which can serve as a reflection of themselves. The Play of Life app is readily available for free at www.app.Playoflife.com.
We carry out a trajectory for different investigations and studies carried out in the last 15 years about psychotherapies and online interventions to conclude with the description of an online training experience developed during the year of the COVID-19 pandemic. We conducted various trainings in which 400 public and private Mental Health professionals participated in Spanish and Portuguese speaking countries. The observations about the online intervention modalities used (textual, videoconference, telephone, collective creation platforms and video games) and the type of intervention (individual, family and group) were significant. The online trainings lasted 25 hours, in groups that worked with multivideoconference by Zoom combined with a textual virtual campus, through forums, contributed articles and written work carried out by the participants. 1500 pages of text produced by students and teachers participating in the experience were recorded. Preliminary conclusions of various investigations and training experiences developed are presented.
Mental health has increasingly become a global issue that reveals the limitations of traditional conversational psychotherapy, constrained by location, time, expense, and privacy concerns. In response to these challenges, we introduce SoulSpeak, a Large Language Model (LLM)-enabled chatbot designed to democratize access to psychotherapy. SoulSpeak improves upon the capabilities of standard LLM-enabled chatbots by incorporating a novel dual-memory component that combines short-term and long-term context via Retrieval Augmented Generation (RAG) to offer personalized responses while ensuring the preservation of user privacy and intimacy through a dedicated privacy module. In addition, it leverages a counseling chat dataset of therapist-client interactions and various prompting techniques to align the generated responses with psychotherapeutic methods. We introduce two fine-tuned BERT models to evaluate the system against existing LLMs and human therapists: the Conversational Psychotherapy Preference Model (CPPM) to simulate human preference among responses and another to assess response relevance to user input. CPPM is useful for training and evaluating psychotherapy-focused language models independent from SoulSpeak, helping with the constrained resources available for psychotherapy. Furthermore, the effectiveness of the dual-memory component and the robustness of the privacy module are also examined. Our findings highlight the potential and challenge of enhancing mental health care by offering an alternative that combines the expertise of traditional therapy with the advantages of LLMs, providing a promising way to address the accessibility and personalization gap in current mental health services.
In psychotherapy, therapeutic outcome assessment, or treatment outcome evaluation, is essential to mental health care by systematically evaluating therapeutic processes and outcomes. Existing large language model approaches often focus on therapist-centered, single-session evaluations, neglecting the client's subjective experience and longitudinal progress across multiple sessions. To address these limitations, we propose IPAEval, a client-Informed Psychological Assessment-based Evaluation framework, which automates treatment outcome evaluations from the client's perspective using clinical interviews. It integrates cross-session client-contextual assessment and session-focused client-dynamics assessment for a comprehensive understanding of therapeutic progress. Specifically, IPAEval employs a two-stage prompt scheme that maps client information onto psychometric test items, enabling interpretable and structured psychological assessments. Experiments on our new TheraPhase dataset, comprising 400 paired initial and completion stage client records, demonstrate that IPAEval effectively tracks symptom severity and treatment outcomes over multiple sessions, outperforming baseline approaches across both closed-source and open-source models, and validating the benefits of items-aware reasoning mechanisms.