Metacognitive interventions have received increasing interest the last decade and there is a need to synthesize the evidence of these type of interventions. The current study is an updated systematic review and meta-analysis where we investigated the efficacy of metacognitive interventions for adults with psychiatric disorders. We included randomized controlled trials that investigated either metacognitive therapy (MCT; developed by Wells) or metacognitive training (MCTraining; developed by Moritz). Ovid MEDLINE, Embase OVID, and PsycINFO were searched for articles published until May 2024. The final analyses included 21 MCT- and 28 MCTraining studies (in total 3239 individuals). Results showed that MCT was more efficacious than both waiting-list control conditions (g = 1.84) as well as other forms of cognitive behavior therapies (g = 0.43). MCTraining was superior to treatment as usual (g = 0.45), other psychological treatments (g = 0.46) and placebo conditions (g = 0.15). Many of the included studies lacked data on blinding procedures, reporting of inter-rater reliability, treatment adherence, competence, treatment expectancy and pre-registration procedures. We conclude that both MCT and MCTraining are probably efficacious treatments but that future studies need to incorporate more quality aspects in their trial designs.

Background: Pediatric anxiety disorders are prevalent, particularly among children with anxious parents. This trial evaluated a program for anxious parents aimed at preventing offspring anxiety disorders and symptoms over 12 months. Methods: This parallel, randomized, controlled, open-label trial was conducted at Karolinska Institutet, Stockholm, Sweden. Inclusion criteria comprised heightened parental anxiety and the child (5–9 years old) not currently meeting criteria for an anxiety disorder. The program, Confident Parents–Brave Children (CPBC) involves six video conferencing group sessions. An external researcher randomly allocated (1:1) participants to CPBC or a self-help control. The primary outcome was change in clinical severity ratings (CSR) between pre- and 12-month assessments, assessed by the Anxiety Disorders Interview Schedule. Secondary outcomes included parent-rated child anxiety symptoms and parental self-efficacy. The study was preregistered at ClinicalTrials.gov (NCT04722731). Results: The trial included 215 parents (91% female) and 277 children (48% girls, mean age 7.0). At the 12-month assessment, no statistically significant difference was found between conditions on the primary outcome (change in CSR), OR = 0.67 (95% CI: 0.30, 1.48). No statistically significantly lower prevalence of anxiety disorder at the 12-month assessment was found in the CPBC group compared with the control group, OR = 0.57 (95% CI: 0.24, 1.31). When stratifying by age, children 5–6 years in CPBC showed lower risk of increased CSR, OR = 0.24 (95% CI: 0.08, 0.77), and anxiety diagnosis, OR = 0.23 (95% CI: 0.05, 0.84), compared to controls. Regarding secondary outcomes, CPBC children exhibited larger decreases in anxiety symptoms than control children from pre- to the 12-month assessment, Cohen's d =.35 (95% CI: 0.15, 0.55). Parents in both conditions showed increased parental self-efficacy over time, with no significant between-group effect. The 12-month assessment was completed by 204 parents (95%). Conclusions: The CPBC may have potential for preventing anxiety in young children; however, further research is warranted.

Family therapy for eating disorders (ED) is well-established and represents the treatment choice for ED in children and adolescents according to guidelines, with cognitive behavior therapy (CBT) as a second line treatment. There is limited knowledge about how these treatments work in routine clinical care. The goal of the present meta-analysis is to investigate the effectiveness of family therapy and CBT for various EDs in children and adolescents when carried out in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were searched for articles published until December 2023. The outcome of family therapy and CBT, methodological quality, risk of bias, and moderators of treatment outcome were examined and benchmarked by meta-analytically comparing with ED efficacy studies. Forty-four effectiveness studies comprising 3251 family therapy or CBT patients were included. Large to very large within-group effect sizes (ES) were found for ED-psychopathology (0.80) and weight measures for AN (1.64) at post treatment. The attrition rate was 15%. Risk of bias was considerable. Moderate to large ES were found for family therapy and CBT, respectively. The benchmarking analysis showed that effectiveness studies had comparable ESs to efficacy studies (0.80 and 0.84 for the ED-psychopathology at post treatment). The findings support family therapy and CBT for ED in children and adolescents as effective treatments when delivered in routine clinical care, with effects comparable with those found in efficacy studies. The evidence needs to be interpreted with caution because of the risk of bias in a high proportion of studies.

Knowledge about how to enhance group cognitive behavioral therapy (GCBT) outcomes is needed. In a randomized controlled effectiveness trial, we examined group cohesion (the bond between group members) and the alliance (the client-clinician bond) as predictors of GCBT outcomes. The sample was 88 youth (M age 11.7 years, SD = 2.1; 54.5% girls; 90.7% White) with anxiety disorders. Observers rated group cohesion and alliance in 32 sessions from 16 groups. We examined early group cohesion and alliance (r = .50, p < .001) and group cohesion and alliance change from early to late in treatment in relation to outcomes using generalized estimation equations accounting for nesting within groups (ICCs .31 to .55). The outcomes were diagnostic recovery, clinical severity, and parent- and youth-reported anxiety symptoms, each at post-treatment, 12-months, and 4-years follow-up. There were more significant associations with 4-years follow-up than earlier outcomes. Clinical severity and parent-reported anxiety symptoms were more frequently predicted than diagnostic recovery. Clinician- and parent-reported outcomes were far more frequently significantly predicted by cohesion and alliance than youth-rated outcomes. We conclude that group cohesion and alliance are related but distinct variables, both associated with some GCBT outcomes for as long as 4 years after treatment.

The Bergen 4-day treatment (B4DT) for obsessive-compulsive disorder (OCD) is a concentrated form of exposure and response prevention that has been evaluated and implemented nationwide in Norway. Its effectiveness has yet to be fully established in other countries. A total of 86 patients with OCD underwent the treatment at the Icelandic Anxiety Centre (KMS) from 2018 to 2023. Of these, 61.6% were classified as having severe symptoms, and 38.4% with moderate symptoms. Of the sample, 72.1% had previously received psychological treatment for OCD and 86.0% had at least one comorbid disorder, depression being the most common (50.0%). Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was administered pre-treatment, posttreatment, and at 3-month follow-up, along with measures on general anxiety, depression, and occupational impairment. The mean score on Y-BOCS was 30.5 (SD = 3.6) pre-treatment, 10.6 (SD = 4.1) posttreatment and 10.9 (SD = 5.4) at 3-month follow-up. By the end of treatment, 94.9% of the patients had responded and 68.0% were in remission. At the 3-month follow-up, 92.5% were responders and 67.9% remitters. Participants were satisfied with the treatment and had improved in terms of occupational functioning, which was maintained at follow-up. These preliminary results suggest that the B4DT may be a swift and effective treatment format for OCD.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with estimated worldwide prevalence of 7.2 % in children and adolescents. Comorbidity of psychiatric disorders is considered common in ADHD and has been found to contribute to poorer prognosis. Despite decades of research, the actual prevalence of comorbid psychiatric disorders in children and adolescents with ADHD is unclear. The purpose of this systematic review and meta-analysis was to investigate the prevalence of comorbid disorders in children and adolescents with ADHD. Embase OVID, Ovid MEDLINE and PsycINFO were systematically searched for eligible studies published up to February 2025. In total 121 studies involving 39,894 children and adolescents with ADHD diagnosis were included. The most common comorbid disorders were Oppositional Defiant Disorder (34.7 %), Behavior Disorders (30.7 %), Anxiety Disorders (18.4 %), Specific phobias (11.0 %), Enuresis (10.8 %), and Conduct Disorder (CD) (10.7 %). All individual disorders studied had a higher prevalence among children and adolescents with ADHD than in the general population. Few gender differences were found; higher prevalence of CD among boys and higher of OCD in girls. The findings indicate that comorbid psychiatric disorders are highly prevalent in children and adolescents with ADHD and must be considered in both assessment and treatment of ADHD.

Background: Severe disruptions in mental healthcare services were reported during the COVID-19 pandemic. However, little data are available on whether services were able to maintain treatment efficacy during this period.

Objective: The aims of this study were to 1) compare outpatient mental healthcare treatment effects before and during the COVID-19 pandemic, and 2) explore whether the proportion of remote visits affected treatment outcomes.

Methods: Using a clinical cohort from two outpatient mental healthcare clinics in Stockholm, Sweden, we analyzed data from 2290 patients to compare treatment outcomes in years 2017–2019 (“before” the COVID-19 pandemic) vs. years 2020–2022 (“during” the COVID-19 pandemic). Primary outcomes were symptom reductions on patient-reported measures of depression, anxiety disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).

Results: We found a significant increase of remote visits during the COVID-19 pandemic (OR = 10.9, 95 % CI [10.49–11.27]). There were no statistically significant differences on treatment outcomes in the periods before vs. during the pandemic for any of the disorders under study. The proportion of remote visits did not have an effect on treatment outcomes.

Conclusions: This large-scale naturalistic study indicates that treatment outcomes during the COVID-19 pandemic were maintained despite unprecedented disruptions.

Background: Specific phobia of vomiting (SPOV), also called emetophobia, is a debilitating condition that shares features with several other anxiety disorders and obsessive-compulsive disorder (OCD). Approximately half of sufferers from SPOV do not fully benefit from current treatment modalities.

Aims: Bergen 4-day treatment (B4DT) is a highly concentrated form of exposure and response prevention developed for OCD. This case series reports on the first participants undertaking the treatment for SPOV.

Method: Five female participants underwent the B4DT adapted to SPOV. The Specific Phobia of Vomiting Scale (SPOVI) and Emetophobia Questionnaire (EmetQ-13) were administered pre-treatment, post-treatment, and at 3- and 6-month follow-up. Participants were also shown a 27-minute video portraying vomit-related stimuli of increasing intensity at pre- and post-treatment. The time participants managed to watch the video and their subjective anxiety and nausea were assessed at regular intervals. Reliable and clinically significant change were calculated on SPOVI post-treatment and at 6-month follow-up.

Results: Four of the participants achieved clinically significant change and the fifth reliable improvement, and these results were maintained at 6-month follow-up. The participants watched the vomit-related stimuli video for an average of 10 minutes pre-treatment whereas all completed it post-treatment, experiencing considerably less anxiety. These results were maintained at 6-month follow-up.

Conclusion: The B4DT may be a robust and time-effective treatment format for SPOV with low attrition rates, but further research is needed to verify this.

There is a knowledge gap regarding clinically representative therapy given in routine settings, that is treatment as usual (TAU), for patients with common mental health problems (CMHP). This review and meta-analysis aimed to investigate what characterizes clinically representative therapy in Nordic routine clinics and meta-analyze the outcome of such treatment. Databases (PubMed, EMBASE, PsychINFO, and SveMed+) were searched for TAU, CMHP, and Nordic countries, together with backward and forward search in Scopus (7 November 2022). Studies were either randomized controlled trials (RCT) or open trials, using prospective study designs, examining heterogeneous outpatient groups in routine treatment. Within- and between-group effect sizes (ES), using random effects model, and moderator analyses were calculated. Eleven studies (n = 1,413), demonstrated a small to moderate within-group ES with high heterogeneity (g = 0.49, I² = 90%). ESs in RCTs were significantly smaller than in open trials. TAU had a marginally smaller ES (g = −0.21; adjusted for publication bias g = −0.06) compared to a broad set of clinical interventions. Clinically representative therapy in the Nordic countries demonstrated a wide variety of characteristics and also a marginally lower ES compared to other interventions. The ESs were smaller than other meta-analyses examining evidence-based treatments in routine treatment.

Objective: Cognitive behavior therapy (CBT) is a recommended treatment for eating disorders (ED) in adults given its evidence, mainly based on efficacy studies. However, little is known about how CBT works in routine clinical care. The goal of the present meta-analysis is to investigate how CBT works for various ED when carried out in routine clinical settings. Method: Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for articles published until June 2023. The outcome of CBT, methodological quality, risk of bias (RoB), and moderators of treatment outcome were examined and benchmarked by meta-analytically comparing with efficacy studies for ED. Fifty studies comprising 4299 participants who received CBT were included. Results: Large within-group effect sizes (ES) were obtained for ED-psychopathology at post-treatment (1.12), and follow-up (1.22), on average 9.9 months post-treatment. Attrition rate was 25.5% and RoB was considerable in the majority of studies. The benchmarking analysis showed that effectiveness studies had very similar ESs as efficacy studies (1.20 at post-treatment and 1.28 at follow-up). Conclusion: CBT for ED is an effective treatment when delivered in routine clinical care, with ESs comparable to those found in efficacy studies. However, the evidence needs to be interpreted with caution due to the RoB in a high proportion of studies. Public Significance: Eating disorders are common in the population and often lead to multiple negative consequences. CBT has been found effective for ED and is recommended in clinical guidelines. Since these recommendations are primarily based on university studies we wanted to investigate how CBT performs in routine clinical care. Our meta-analysis found that CBT worked as well in routine care as in university setting studies.