One important factor for preschool children’s well-being and development is the relationship with their teachers. The International Child Development Programme (ICDP) is a health promotion and prevention programme for caregivers of children. There is research about ICDP as a parenting programme but almost none about its usefulness for professional caregivers. This study aims to explore perceived changes in preschool educators and children after participating in ICDP. Written evaluations by educators were analysed using qualitative content analysis. The educators reported strengthened and improved professional role, changed perception and improved approach towards the children. The educators also reported positive changes in the children, e.g., improved social behaviour, emotional balance and verbal communication, as well as increased self-agency. Our study suggests that ICDP is a plausible intervention for professional development in relational work, which educators experience as beneficial for both themselves and the children. More research is necessary to strengthen these tentative conclusions.

Objectives: Despite recognised cognitive deficits related to substance use, as well as high mortality and treatment attrition rates, metacognition has never been studied in patients with opioid use disorder (OUD) undergoing opioid maintenance treatment (OMT). Design: This exploratory pilot study used a quantitative longitudinal design to assess metacognition in patients with opioid use disorder at treatment initiation and at a one-year follow-up and to explore its association with executive functioning. Methods: Forty-eight adults initiating OMT were enrolled in the study. All participants completed the Indiana Psychiatric Illness Interview (IPII), and recorded transcripts were analysed with the metacognition assessment scale (MAS-A). Additionally, measures of executive function, as well as sociodemographic, psychiatric comorbidity and substance use, were obtained within two weeks of OMT initiation. IPII and MAS-A were repeated at a one-year follow-up. Results: Participants displayed widespread performance of metacognition in the four subscales self-reflectivity, understanding others' minds, decentration and notably, low levels of mastery. Self-reflectivity and mastery were significantly positively correlated with verbal fluency. Higher levels of decentration were associated with fewer self-reported executive function difficulties. No significant changes in metacognition were detected at the one-year follow-up. Conclusions: This longitudinal pilot study provides the first evidence of metacognitive functioning in OMT patients. Metacognitive performance was characterised by low levels of mastery, limited correlation with executive function and no improvement observed over the one-year follow-up period. The preliminary findings are interpreted and discussed with caution, emphasising the relevance of metacognition for future research and clinical interventions in OUD populations.

Objective: Internet-delivered psychotherapies show promise for adolescent major depression (MDD), but little is known about which baseline characteristics predict improvement or moderate differential effects between internet-delivered cognitive-behavioral therapy (ICBT) and psychodynamic therapy (IPDT). This study examined pretreatment predictors and moderators of symptom change in a randomized trial comparing the treatments.

Method: This secondary analysis used data from a non-inferiority trial (n = 272) in which adolescents with MDD received 10 weeks of guided ICBT or IPDT. Mixed-effects models tested predictors and moderators of change in self-rated depression. Anxiety symptoms, length of depressive episode, emotion regulation, personality disorder severity, attachment, self-compassion, suicidal ideation, and baseline depression were examined as predictors and moderators.

Results: Higher self-compassion predicted steeper improvement across treatments, as the only significant predictor. Comorbid anxiety moderated outcome where higher anxiety was associated with significantly greater improvement in IPDT relative to ICBT, with no difference at average levels. At the lowest levels of anxiety, ICBT showed significantly better outcomes. No other significant moderators emerged.

Conclusions: Findings suggest that baseline variables may influence the rate of improvement in internet-delivered therapy for adolescent MDD, as well as help guide treatment selection. Replication is needed to establish the clinical utility of these variables.

Background: Internet-delivered psychodynamic therapy (IPDT) has been found to be effective for adolescents with depression in previous randomized controlled trials. The present study aimed to evaluate an adaptive, feedback-informed version of IPDT, designed to improve outcomes for participants identified early as at risk of non-response.

Methods: A randomized controlled trial targeting adolescents aged 15–19 years with mild to moderate major depressive disorder. Participants were recruited through social media, national and local advertising, schools, and user organizations. After three weeks of standard IPDT, participants classified as at risk by a prediction algorithm were randomized to either adapted or standard treatment. The planned sample size was 240 participants. Despite extensive nationwide recruitment efforts during 2024, only 35 participants were enrolled before the study was discontinued.

Results: Recruitment difficulties were primarily due to recent European Union regulations prohibiting profiling-based online advertising for minors, which eliminated access to previously effective social media recruitment channels. Participants who completed treatment showed significant pre- to post-treatment improvements in depressive symptoms (d = 1.08), anxiety (d = 0.74), and emotion regulation (d = 0.79). The predictive algorithm showed promising results in classifying patients as responders or non-responders.

Conclusions: Although the trial was underpowered, the findings provide promising within-group effects and valuable lessons for future digital mental health research involving minors. New recruitment infrastructures that comply with data protection laws are needed to ensure feasibility of online psychotherapy trials. Continued development of adaptive, feedback-informed IPDT for adolescents with depression is needed.

Introduction: Borderline personality disorder (BPD) is a complex and heterogeneous condition. Psychotherapy reduces symptom severity; however, characteristics of the individual may influence treatment outcomes. This systematic review examined whether specific baseline variables moderate the effect of psychotherapy on BPD severity through individual participant data meta-analysis (IPD-MA).

Methods: A literature search up to 12 May 2025 across 10 databases (including PubMed, Medline, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane CENTRAL) identified randomised clinical trials (RCTs) comparing psychotherapy to treatment as usual (TAU) or clinical management control interventions (CM) for BPD. Authors of included trials were contacted to retrieve IPD. IPD-MAs employed a one-stage random-effects approach to estimate treatment effects and potential moderators in bivariate linear mixed-effects models. The study was registered with PROSPERO (CRD42021210688).

Results: Out of 33,696 records identified, 42 RCTs (3,848 participants) were eligible. IPD was obtained from 19 trials (1,482 participants). All trials had an overall high risk of bias or some concerns regarding risk of bias. There was a high rate of missing data across trials (378/1,482, 25.1%). IPD-MA showed that psychotherapy significantly reduced BPD severity compared to TAU/CM (β: −0.25, 95% CI: −0.43 to −0.07, SE: 0.09, p = 0.0065; 19 trials, 1,104 participants). Significant negative moderators were co-occurring depressive disorder(s) (β: 0.31, 95% CI: 0.03 to 0.59) and exposure to sexual trauma (β: 0.60, 95% CI: 0.16 to 1.04), while positive moderators were co-occurring anxiety disorder(s) (β: −0.34, 95% CI: −0.64 to −0.03) and alcohol use disorder(s) (AUD) (β: −0.34, 95% CI: −0.67 to −0.01).

Conclusion: Psychotherapy may be especially beneficial for BPD with co-occurring anxiety. Patients with co-occurring AUD should not be excluded from treatment; rather, treatment motivation should be emphasised. Further, clinicians should prioritise trauma-informed care.

Background: Borderline personality disorder (BPD) is often accompanied by interpersonal dysfunction. Psychotherapy can improve interpersonal functioning, but individual characteristics may moderate outcomes. This systematic review used individual participant data meta-analysis (IPD-MA) to examine such moderators.

Method: A literature search up to 26 November 2025 across 10 databases (including PubMed, Medline, Embase, PsychINFO, CINAHL, Web of Science, and Cochrane CENTRAL) identified randomised clinical trials (RCTs) investigating the effects of psychotherapy on interpersonal functioning in individuals with BPD compared to treatment as usual (TAU) or clinical management control interventions (CM). Authors of included trials were contacted to retrieve IPD. IPD-MAs employed a one-stage random-effects approach to estimate treatment effects on interpersonal functioning and potential moderators in bivariate linear mixed-effects models. The study was registered with PROSPERO (CRD42021210688).

Results: Out of 23,735 identified records, 32 RCTs (2762 participants) met inclusion criteria. Individual participant data (IPD) were available for 17 trials (1431 participants). All trials were rated as having either high risk of bias or some concerns. Missing data were common, with 321 out of 1431 participants (23%) lost to follow-up. Meta-analyses of both aggregate data and IPD yielded comparable effect estimates, though statistical significance differed (IPD-MA: β = −0.21, CI: −0.45 to −0.02, SE = 0.12, p = 0.0778; 17 trials, 1071 participants). In unadjusted analyses, the presence of co-occurring anxiety disorder(s) (β = −0.40, 95% CI: −0.73 to −0.08) and a higher number of co-occurring disorders (β = −0.08, 95% CI: −0.15 to −0.01) were associated with larger treatment effects (not significant after alpha correction).

Conclusion: Psychotherapy appears to be effective for individuals with BPD. Although moderator effects did not remain statistically significant after alpha correction, unadjusted analyses suggested larger treatment effects in individuals with co-occurring anxiety and greater clinical complexity. Importantly, these findings indicate that such comorbidities may not be a contraindication for psychotherapy for BPD.

Introduction: Adolescent depression poses a major public health concern with substantial clinical and societal implications. Both internet-delivered cognitive behavioural therapy (ICBT) and internet-delivered psychodynamic therapy (IPDT) have shown efficacy, but questions remain regarding long-term efficacy and cost-effectiveness. The present study presents a 12-month follow-up and cost-comparison from a randomized controlled trial (RCT) comparing ICBT and IPDT for adolescent depression.

Methods: Participants were 272 adolescents aged 15–19 with a primary diagnosis of major depressive disorder. The primary outcome was depressive symptoms measured with the QIDS-A17-SR while the secondary outcome was anxiety symptoms measured with the GAD-7. Costs were assessed both by comparing costs of treatment and healthcare use 12-month post-treatment using the TIC-P.

Results: Results were stable at the 12-month follow up compared to treatment endpoint, for both depressive and anxiety symptoms. There were no significant group differences at the 12-month follow-up. There were no differences in treatment costs or in costs for healthcare use one-year post-treatment.

Discussion: This study suggests that treatment gains from IPDT and ICBT for adolescent depression remain stable during a 12-month follow-up period, with no differences between the treatments one-year post-treatment. Furthermore, it suggests comparable costs for the treatments. Interpretation of health-care use data was restricted due to the COVID-19 pandemic taking place during the follow-up period. This adds to the literature suggesting that ICBT and IPDT can be seen as viable alternatives for treating adolescent depression. More research into the long-term effects and cost-effectiveness is needed.

The aim of the present study was to evaluate the feasibility and analyze preliminary data of the effectiveness of affect phobia therapy (APT) adapted to a structured group format. APT is a treatment that targets emotional avoidance and deficiency in emotion regulation that often leads to psychological dysfunction. The target group was patients with comorbid substance use disorder (SUD) and ADHD with core features of affect phobia/emotion dysregulation. Patients in three group treatments with the aim of having eight participants in each group (n = 22) were included in an open design, where targeted symptoms psychological distress, craving, affect phobia, self-compassion, emotion dysregulation, and substance use were evaluated, with repeated measurements every week from the start of therapy to follow-up 4 weeks after the end of treatment. The results showed an increase in self-compassion and a decrease in affect phobia, but no change in symptoms of psychological distress or emotional dysregulation. No reliable reduction in alcohol or drug use could be related to treatment. Craving fluctuated throughout the study period and patients' drinking patterns changed toward more social drinking. The main finding of the study was that affect phobia therapy in a structured group format is a feasible treatment for the patient group and that the therapy showed preliminary effectiveness in increasing adaptive affective functioning and self-compassion. Future randomized controlled trials are needed for conclusive evidence on efficacy, also examining whether the therapy can help reduce substance use.

Objective

To explore factors and processes surrounding sudden gains (SGs) in internet-delivered psychodynamic therapy (IPDT) for adolescent depression.

Method

Based on a randomized controlled trial, 22 patients’ chat therapy sessions in close connection, both before and after an SG, were analyzed using reflexive thematic analysis, with a focus on the therapeutic process as well as the patients’ descriptions of their improvement.

Results

In the majority of cases, SGs in IPDT were preceded by a process that can be summarized in four themes: “I worked hard with the support of my therapist; “I began to understand myself through the self-help materials”; “I applied my new understanding in everyday life”; and “I became more aware of my feelings and less self-critical.”

Conclusion

SGs in IPDT seem to be not just statistical phenomena but meaningful psychological experiences, preceded by recurring therapeutic patterns extending over multiple sessions. In this process, engaged work facilitates the acquisition and application of new self-knowledge, leading to significant changes in emotional awareness and self-criticism.

Background  Research investigating executive functions in opioid-dependent patients undergoing opioid maintenance treatment (OMT) is scarce. This study aimed to assess executive function in patients with opioid use disorder at treatment initiation and one-year follow-up, exploring its correlation with psychiatric comorbidity within the patient group. Additionally, associations between executive functions and factors such as age at substance use initiation, duration of substance use, and current substance use were explored.

Methods  Forty-nine adults (mean age: 40.6 [11.4]) with opioid use disorder initiating OMT participated in a naturalistic study with a one-year follow up. Participants underwent subtests of the Delis-Kaplan Executive Function System (D-KEFS) and self-assessed their cognitive function using the BRIEF-A form. Psychiatric diagnoses were determined using MINI, while symptoms of personality disorders were assessed using the SCID II screening form. Blood and saliva samples were collected for alcohol and drug markers.

Results  Most participants exhibited impaired Cognitive flexibility (67%), with varying levels of impairment in Verbal fluency and problem-solving functions (25–30%). The majority rated their executive functions as poor. At the one-year follow-up, Verbal fluency had improved (p <.05), but other executive functions remained unchanged. Stimulant use was associated with reduced Verbal fluency and Cognitive flexibility (p <.1). Older age and longer substance use duration correlated with poorer Verbal fluency (p <.05), while earlier onset of substance use correlated with poorer self-reported executive functioning (p <.05) but unexpectedly with better Cognitive flexibility (p <.1). Symptoms of borderline personality disorder was related to poorer self-reported executive functioning (p <.001), symptoms of Narcissistic Personality Disorder was related to poorer Cognitive flexibility (p <.1), and symptoms of Antisocial Personality Disorder was related to better problem-solving (p <.1).

Conclusions  Executive function impairment is common in patients starting OMT, with specific functions more affected. The varied results of correlations between psychiatric comorbidity, substance use, and executive function indicate patient heterogeneity. While some executive functions show slight improvement over time, complex functions appear resistant to change, suggesting lasting damage which may influence treatment outcomes. Overall, patient variability in executive function highlights the need for personalized treatment approaches in OMT.