Background: The use of artificial intelligence for psychological advice shows promise for enhancing accessibility and reducing costs, but it remains unclear whether AI-generated advice can match the quality and empathy of experts.

Method: In a blinded, comparative cross-sectional design, licensed psychologists and psychotherapists assessed the quality, empathy, and authorship of psychological advice, which was either AI-generated or authored by experts.

Results: AI-generated responses were rated significantly more favorable for emotional (OR = 1.79, 95 % CI [1.1, 2.93], p = .02) and motivational empathy (OR = 1.84, 95 % CI [1.12, 3.04], p = .02). Ratings for scientific quality (p = .10) and cognitive empathy (p = .08) were comparable to expert advice. Participants could not distinguish between AI- and expert-authored advice (p = .27), but perceived expert authorship was associated with more favorable ratings across these measures (ORs for perceived AI vs. perceived expert ranging from 0.03 to 0.15, all p < .001). For overall preference, AI-authored advice was favored when assessed blindly based on its actual source (β = 6.96, p = .002). Nevertheless, advice perceived as expert-authored was also strongly preferred (β = 6.26, p = .001), with 93.55 % of participants preferring the advice they believed came from an expert, irrespective of its true origin.

Conclusions: AI demonstrates potential to match expert performance in asynchronous written psychological advice, but biases favoring perceived expert authorship may hinder its broader acceptance. Mitigating these biases and evaluating AI's trustworthiness and empathy are important next steps for safe and effective integration of AI in clinical practice.

Exhaustion disorder (ED) was introduced to the Swedish version of the International Classification of Diseases, 10th edition (ICD-10) 2005. Primarily characterized by general fatigue and cognitive deficits, ED has become one of the most common mental health diagnoses in Sweden. Little is still known regarding the discriminative validity of the ED diagnosis and how it relates to other diagnostic constructs. The study aimed to investigate the discriminative validity of ED compared with two similar diagnoses, major depressive disorder (MDD) and adjustment disorder (AD). Using data from a sample of patients with a principal diagnosis of either ED (n = 352), MDD (n = 99), or AD (n = 302), we compared demographic and clinical variables and scores on self-report symptom scales. Results showed that ED patients were of a higher age and had a higher frequency of sickness absence than MDD and AD patients. There was a substantial overlap of symptoms between ED and MDD, only differing on two of nine self-report symptom scales, with ED patients rating lower work ability d = −0.37 and alcohol consumption d = −0.57. Compared with AD patients, ED patients reported more severe symptoms in every symptom domain. Given the prevalent use of ED diagnosis, its diagnostic validity and clinical usefulness merit further attention.

A behavioral defense against disease involves detecting sickness cues in others and responding adaptively, such as by avoiding social interactions. While studies have shown that humans can discriminate sickness cues above chance in faces after sickness induction, whether this discrimination affects approach-avoidance behaviors remains uncertain. Here, we investigated how facial sickness cues influence judgments of trustworthiness, serving as a proxy measure for social avoidance. In a prior study, facial photographs were taken of 21 individuals when sick (two hours after an endotoxin injection causing a transient systemic inflammation) and healthy (following placebo injection). In the current study, participants in two separate experiments viewed these paired facial photographs and were asked, in a two-alternative forced-choice paradigm, to identify which face appeared sick (n = 94) or more trustworthy (n = 82). Participants discriminated sick faces significantly above chance (73.1 %), with females (76.0 %) performing significantly better than males (69.3 %). Additionally, sick faces were perceived as significantly less trustworthy, being selected in only 34.9 % of trials. Notably, the higher the sickness discrimination accuracy for a particular face, the less likely that face was to be judged as trustworthy. Moreover, females (30.5 %) were significantly less likely than males (39.5 %) to judge sick faces as the more trustworthy looking. Individual differences in participants’ disease vulnerability, disgust sensitivity, and frequency of sickness, as well as facial stimulus participants’ inflammatory response intensity measured via interleukin-6 blood concentrations, body temperature, and sickness symptoms, did not predict sickness discrimination accuracy or trustworthiness judgments. Together, these findings suggest that visual sickness cues negatively affect trustworthiness judgments, potentially reflecting social avoidant behaviors towards individuals who appear sick. While judgments of facial trustworthiness may be considered a social inference about whether an individual is safe to approach, future research should also include manifest measures of approach-avoidance in response to sickness cues.

Sick humans and other animals often withdraw from social interactions. It has been suggested that social withdrawal might enable avoidance of contagious individuals, but experimental evidence is lacking on how the state of sickness may affect perception of sick others. Here, we investigated if individuals were more likely to rate others as sick, while being sick themselves, compared to when healthy. Furthermore, we assessed whether the intensity of the fever response and sickness behavior would predict changes in sickness detection. Thirty-four participants were experimentally made sick using an intravenous injection of the bacterial endotoxin lipopolysaccharide (LPS condition; dose of 1.0 ng/kg body weight) and completed a sickness detection task during the peak of the inflammatory and sickness response. Participants performed the same task when they were healthy (control condition, n = 32), in a randomized order before or after the main study day. In the sickness detection task, participants watched photos of individuals’ faces as well as video recordings of the same individuals walking, and rated the individual on each stimulus as sick or healthy. The photos and video recordings were obtained from twenty-two individuals who had participated in a previous study, and had been made sick with an intravenous injection of lipopolysaccharide (2.0 ng/kg body weight) on one occasion, and remained healthy after an intravenous injection of a placebo (0.9 % NaCl) on another occasion. Participants could detect sick individuals based on photos and walking patterns above chance level during both the LPS and the control condition. There was no significant difference in how often participants identified sick faces and sick walkers in the LPS condition – when they were sick themselves – compared to in the control condition. However, healthy walkers (but not healthy faces) were more often rated as sick by participants in the LPS condition compared to the control condition. Neither the fever response nor the intensity of sickness behavior predicted changes in sickness detection. The results do not indicate more accurate sickness detection in others during own sickness. Nevertheless, the data from walking patterns indicate that sick individuals may be more prone to categorize healthy individuals as sick. If replicated, this could in speculation be related to a need to reduce the risk of becoming infected while already fighting a pathogen.

Introduction: Stress-related disorders such as adjustment disorder (AD) and exhaustion disorder (ED) are associated with substantial suffering and high societal costs. Cognitive behavioral therapy (CBT) is a promising treatment for symptom reduction but has not been rigorously compared with other active treatments. This study aimed to investigate the efficacy of CBT compared to an active control treatment (General Health Promotion; GHP) for individuals diagnosed with AD or ED. Methods: A total of 300 adults diagnosed with AD or ED were randomly assigned to a 12-week CBT (n = 151) or GHP (n = 149), both delivered as therapist-supported online treatments. The primary outcome was post-treatment scores on the 10-item Perceived Stress Scale. Secondary outcomes included several mental health symptom domains and functional impairment. All outcomes were assessed at baseline, post-treatment, and at 1-year follow-up. The trial was pre-registered on Clinicaltrials.gov (NCT04797273). Results: The CBT intervention was not superior to GHP in reducing symptoms of perceived stress and secondary symptoms. Both treatments generated large within-group effect sizes pre- to post-treatment (Cohen's d = 1.19 and 1.06, respectively) and results were maintained to the 1-year follow-up. The diagnostic group moderated the treatment effect pre- to post-treatment and indicated that CBT was superior to GHP for individuals diagnosed with AD but not for those diagnosed with ED. Conclusions: Common factors likely play an important role in symptom reduction for individuals with stress-related disorders. A refined understanding of the conceptualization of stress-related disorders and which specific mechanisms to target in respective patient groups is needed to improve treatment outcomes.

Background: Patients with advanced non-small cell lung cancer (NSCLC) face poor prognosis. However, new therapies like immune checkpoint inhibitors (ICIs) have improved survival. Nevertheless, ICIs act through immune activation – a proposed underlying mechanism of frequently reported symptoms such as sleep and circadian disturbances. The objective of this study was to longitudinally investigate sleep and circadian rest-activity rhythms and associations with psychological symptoms in NSCLC during ICI treatment. Methods: Newly diagnosed NSCLC patients were included in this prospective study, assessing insomnia severity, total sleep time, circadian rest-activity rhythms, and psychological symptoms (fatigue, depression, and stress) during the first five months of ICI treatment, using validated questionnaires, sleep diaries and actigraphy. Results: Forty-nine patients were included. Prior to treatment, patients slept on average 5.8 hours/night and 49 % reported clinical levels of insomnia. Spontaneous improvements in insomnia severity and total sleep time were observed, along with marginal but non-significant improvements in circadian rest-activity rhythm robustness. Insomnia severity was significantly associated with higher levels of fatigue (p = .004), depression (p = .007), and perceived stress (p = .033). Moreover, lower circadian rest-activity robustness was associated with more fatigue (p = .021). At baseline, mean levels of fatigue, depression, and perceived stress were below clinical levels and declined further over time. Conclusion: Sleep disturbances, circadian disruption, and psychological symptom burden in NSCLC patients were greatest prior to and shortly after initiation of ICI treatment, with gradual improvement over the first five months. However, inter-individual differences in sleep and circadian disturbances were evident and linked to psychological symptoms.

Introduction: Stress-related disorders, including adjustment disorder and exhaustion disorder, are associated with cognitive complaints and prolonged sickness absence (SA). This study evaluated the effects of cognitive behavioral therapy (CBT) compared with an active control treatment (entitled General Health Promotion: GHP) on these outcomes and examined the association between cognitive impairment and SA. Methods: In this randomized clinical trial, 300 participants were randomized to CBT or GHP. SA data from the Swedish Social Insurance register were collected from 1 year before to 1 year after treatment. Cognitive functioning, assessed via a validated test battery, was measured at baseline, posttreatment, and 1-year follow-up (1YFU). Hurdle negative binomial models evaluated SA and linear mixed-effects models analyzed cognitive outcomes. Results: CBT and GHP had comparable effects on SA and cognitive functioning with no significant between-group effects (all p > 0.05). Analyzing effects across the entire sample, the number of SA days among those with any SA did not significantly change (p = 0.946) but the likelihood of having any SA decreased significantly by the 1YFU (OR = 0.92, 95% CI [0.87–0.96], p < 0.001). Independent of treatment group, overall cognitive functioning improved both posttreatment (d = −0.42, 95% CI [−0.6 to −0.25], p < 0.001) and at 1YFU (d = −0.72, 95% CI [−0.91 to −0.54], p < 0.001). Improvements in cognitive functioning pre- to posttreatment were associated with fewer SA days at the 1YFU (IRR = 0.54, 95% CI [0.33–0.87], p = 0.01). Conclusion: This study found no specific effect of CBT on SA or cognitive functioning for individuals with stress-related disorders. Cognitive functioning improved regardless of treatment. Early support before SA initiation is likely important to prevent long-term SA.

Motivations to avoid infectious disease seem to influence prejudice toward some groups, including groups not explicitly associated with infectious disease. The standard explanation for this phenomenon is based on signal detection theory and proposes that some prejudices partially arise from pathogen detection mechanisms that are biased toward making false alarms (false positives) in order to minimize misses (false negatives). Therefore, pathogen detection mechanisms arguably categorize a broad array of atypical features as indicative of infection, which gives rise to negative affect toward people with atypical features. We tested a key hypothesis derived from this explanation: specific appearance-based prejudices are associated with tendencies to make false alarms when estimating the presence of infectious disease. While this hypothesis is implicit in much work on the behavioral immune system and prejudice, direct tests of it are lacking and existing relevant work contains important limitations. To test the hypothesis, we conducted a cross-sectional study using a large U.S. sample (N = 1450). Using signal detection theory methods, we assessed tendencies to make false alarms when identifying infection threats. We further assessed prejudice toward multiple relevant social groups/categories. Results showed weak evidence for the key hypothesis: for only one of four tested target groups were tendencies to make false alarms in sickness detection significantly associated with prejudice. However, this relation was not significant when controlling for a potential confound. These results cast doubt on the notion that individual differences in appearance-based prejudices arise from individual differences in tendencies to make false alarms in assessing pathogen threats.

Objectives: Approximately one in five adults experiences chronic pain, often in co-occurrence with depression, insomnia, anxiety, and lower self-rated health. Elevated levels of cytokines, e.g. tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), interleukin 8 (IL-8), and interleukin 10 (IL-10), have been identified in patients with chronic pain. Depression, insufficient sleep, poor self-rated health, and pain intensity have also been associated with inflammatory biomarkers. This study aimed to investigate the interrelationships between inflammatory biomarkers and depression, insomnia, anxiety, self-rated health, sickness behavior, and pain intensity in patients with chronic pain. Methods: Self-report questionnaires and blood samples analyzed for plasma levels of inflammatory biomarkers were collected from 80 adult patients with chronic pain. Associations between inflammatory biomarkers (TNF-α, IL-6, IL-8, IL-10, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)) and depression, insomnia, anxiety, self-rated health, sickness behavior, and pain intensity, were analyzed using bivariate Spearman rank correlation coefficients and regression analyses. Results: Participants were mainly women (72.5 %), with a mean age of 50.8 years, and a reported mean pain duration of 16.7 years. There were significant correlations between insomnia and CRP (rs =.26, p <.05); sex and ESR (rs =.29, p <.05); age and IL-6 (rs =.29, p <.05) and IL-8 (rs =.30, p <.05); BMI and IL-6 (rs =.50, p <.001), CRP (rs =.63, p <.001) and ESR (rs =.42, p <.001). Ratings of depression were positively and significantly related to ratings of sickness behavior and anxiety (β =.32 and β =.40, respectively), explaining 49 % of the total variance in depression ratings. Insomnia was positively and significantly related to sickness behavior (β =.37) explaining 31 % of the total variance in insomnia ratings. Inflammatory biomarkers, however, did not contribute significantly to the models. Conclusions: Participants reported high levels of symptoms, yet the associations between these ratings and the inflammatory biomarkers were either absent or weak. Also, despite high levels of self-reported sickness behavior, overall the inflammatory status remained within the normal range. Ratings of sickness behavior contributed more than inflammatory markers in explaining ratings of depression and insomnia. The present results point to the complexity of chronic pain, and the challenges of identifying biomarkers that explain symptomatology.

Psychological constructs related to health outcomes and well-being, such as metacognitive beliefs, have been linked to executive functions in general, and cognitive flexibility more specifically. However, such effects have previously only been discussed on a theoretical level and behavioral flexibility has most often been measured through self-report, only approximating information processing capacities. Objectively measured executive functions may be a more potent predictor of health outcomes. We set out to test whether cognitive flexibility capacity was associated with sick leave in a medium sized company. We included 111 subjects of widely different occupations and assessed their executive functions using Delis-Kaplan Executive Function System test battery (D-KEFS). To assess cognitive flexibility capacity, we included Design Fluency (DF) and Verbal Fluency (VF) and computed these into an index of cognitive flexibility (DFVF). Detailed information on sick leave for the last 5 years was gathered from the company. Our results showed that there was a significant negative correlation between DFVF and sick leave [rs(109) = −0.23, p = 0.015] in the full group as well as in the group that had at least 1 day of sick leave [rs(72) = −0.25, p = 0.03]. The results withstood adjustment for sex, age, occupation, and several core executive functions as well as autistic and ADHD-traits. The results remained for separate analyses using DF or VF. Our main findings were conceptually replicated in a group of bipolar disorder patients. This study shows that objectively measured capacity of cognitive flexibility is associated with key health outcomes such as sick leave.