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This clinical trial aims to assess the effectiveness of internet-based Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) during the COVID-19 pandemic in reducing stress, anxiety, and depression, and psychological flexibility. 40 adolescents with subclinical features of emotional disorder randomly divided into two groups of intervention and control. The participants first completed DASS-21 and AAQ-2 questionnare online. Then, the intervention group received 12 sessions of UP-A through video calls on WhatsApp, 2 days per week each for 45 min. UP-A is an emotion-focused, cognitive-behavioral therapy consisting of 5 core modules or components that target temperamental characteristics, particularly neuroticism and resulting emotion dysregulation. Eventually the stress, anxiety, and depression levels decreased in intervention group and their psychological flexibility increased immediately and 3 months after the intervention. Clinical trial registration This study was registered by Iranian Registry of Clinical Trials (Prospective, ID: IRCT20210428051113N1, Registration date: 14/06/2021; https://en.irct.ir/trial/55900 ).

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BACKGROUND: The COVID-19 pandemic accelerated telehealth adoption across disease cohorts of patients. For many patients, routine medical care was no longer an option, and others chose not to visit medical offices in order to minimize COVID-19 exposure. In this study, we take a comprehensive multidisease approach in studying the impact of the COVID-19 pandemic on health care usage and the adoption of telemedicine through the first 12 months of the COVID-19 pandemic. OBJECTIVE: We studied the impact of the COVID-19 pandemic on in-person health care usage and telehealth adoption across chronic diseases to understand differences in telehealth adoption across disease cohorts and patient demographics (such as the Social Vulnerability Index [SVI]). METHODS: We conducted a retrospective cohort study of 6 different disease cohorts (anxiety: n=67,578; depression: n=45,570; diabetes: n=81,885; kidney failure: n=29,284; heart failure: n=21,152; and cancer: n=35,460). We used summary statistics to characterize changes in usage and regression analysis to study how patient characteristics relate to in-person health care and telehealth adoption and usage during the first 12 months of the pandemic. RESULTS: We observed a reduction in in-person health care usage across disease cohorts (ranging from 10% to 24%). For most diseases we study, telehealth appointments offset the reduction in in-person visits. Furthermore, for anxiety and depression, the increase in telehealth usage exceeds the reduction in in-person visits (by up to 5%). We observed that younger patients and men have higher telehealth usage after accounting for other covariates. Patients from higher SVI areas are less likely to use telehealth; however, if they do, they have a higher number of telehealth visits, after accounting for other covariates. CONCLUSIONS: The COVID-19 pandemic affected health care usage across diseases, and the role of telehealth in replacing in-person visits varies by disease cohort. Understanding these differences can inform current practices and provides opportunities to further guide modalities of in-person and telehealth visits. Critically, further study is needed to understand barriers to telehealth service usage for patients in higher SVI areas. A better understanding of the role of social determinants of health may lead to more support for patients and help individual health care providers improve access to care for patients with chronic conditions.

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INTRODUCTION: With the spread of COVID-19, certain population groups, including pregnant women, were more susceptible than others. This disease can lead to postpartum complications, including mental disorders, in mothers. Few studies have investigated the impact of mindfulness-based interventions on mental health, and the most effective counseling approach to promote mental health has not been identified. OBJECTIVE: This study aimed to determine the impact of online mindfulness-based counseling on improving mental health among women with a history of COVID-19 during pregnancy in Iran. METHODS: The present study was a quasi-experimental design conducted on 100 women with a history of coronavirus infection during pregnancy referred to the Mother's Clinic of Yahya Nejad and Ayatollah Rouhani Educational-Treatment Hospital, affiliated with Babol University of Medical Sciences, Iran, via convenience sampling. The women were randomly assigned to the intervention (mindfulness-based counseling) and control groups. The intervention group received eight 45-min weekly mindfulness-based counseling sessions over 8 weeks. Data were collected via a demographic information questionnaire and the Goldberg General Health Questionnaire before and after the intervention, which were completed by both groups. Independent t-tests and analysis of covariances (ANCOVAs) were used to compare the outcomes of the two groups. RESULTS: After controlling for confounding variables, the mean mental health scores before and after counseling were 29.42 ± 4.49 and 19.80 ± 3.88, respectively, in the intervention group and 26.26 ± 2.29 and 25.92 ± 2.15, respectively, in the control group. The mean mental health score in the intervention group was significantly lower than that in the control group (F = 266.7, p < 0.001). The mean scores for somatic symptoms (F = 89.30, p < 0.001), depression symptoms (F = 142.71, p < 0.001), anxiety and insomnia symptoms (F = 120.56, p < 0.001), and social dysfunction scores (F = 127.77, p < 0.001) were significantly different between the two groups after counseling. CONCLUSION: The findings indicated that online mindfulness-based counseling positively affects mental health and its domains during the postpartum period. However, further randomized clinical trials are needed before a definitive conclusion can be drawn. TRIAL REGISTRATION: We were not allowed to register according to the law of our country.

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OBJECTIVE: Conceptual similarities between depressive and negative symptoms complicate biomarker and intervention development. This study employed a data-driven approach to delineate the neural circuitry underlying depressive and negative symptoms in schizophrenia spectrum disorders (SSDs). METHODS: Data from three studies were analyzed (157 participants with SSDs) to assess brain-behavior relationships: two neuroimaging studies and a randomized trial of repetitive transcranial magnetic stimulation (rTMS). Partial least squares correlation (PLSC) was used to investigate associations between resting-state functional connectivity and depressive and negative symptoms. Secondary analyses of rTMS trial data (active, N=37; sham, N=33) were used to assess relationships between PLSC-derived symptom profiles and treatment outcomes. RESULTS: PLSC identified three latent variables (LVs) relating functional brain circuitry with symptom profiles. LV1 related a general depressive symptom factor with positive associations between and within the default mode network (DMN), the frontoparietal network (FPN), and the cingulo-opercular network (CON). LV2 related negative symptoms (no depressive symptoms) via negative associations, especially between the FPN and the CON, but also between the DMN and the FPN and the CON. LV3 related a guilt and early wakening depression factor via negative rather than positive associations with the DMN, FPN, and CON. The secondary visual network had a positive association with general depressive symptoms and negative associations with guilt and negative symptoms. Active (but not sham) rTMS applied bilaterally to the dorsolateral prefrontal cortex (DLPFC) reduced general depressive but not guilt-related or negative symptoms. CONCLUSIONS: The results clearly differentiate the neural circuitry underlying depressive and negative symptoms, and segregated across the two-factor structure of depression in SSDs. These findings support divergent neurobiological pathways of depressive symptoms and negative symptoms in people with SSDs. As treatment options are currently limited, bilateral rTMS to the DLPFC is worth exploring further for general depressive symptoms in people with SSDs.

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Existing research supports the therapeutic value of hope in different therapies and for diverse patient groups. Patients who are socially inhibited tend to have a particularly difficult time in group therapy, and the experience of hope in that context may be especially poignant for them. The present study investigated the impact of hope on the outcome of a group-based treatment and whether this impact differed for patients depending on their level of social inhibition. The sample consisted of 49 consecutively admitted patients who completed treatment in an intensive, integrative group therapy program. Patients completed four self-report measures to assess hope, social inhibition, quality of life, and depression. Regression with moderation analysis was employed. The analyses revealed that social inhibition significantly moderated the impact of hope on treatment outcome, indicating that hope had a more pronounced effect among those patients with relatively higher levels of social inhibition.

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Well-being therapy (WBT) is a short-term psychotherapeutic strategy, based on the technique of self-observation via the use of a structured diary and the guide of a therapist, with the goal of increasing psychological well-being, thus reaching euthymia and a balance among psychic forces. WBT showed to be suitable for application in residual symptoms of unipolar and bipolar depression, since the sequential combination with cognitive-behavioural therapy (CBT) led to a decrease in the relapse rate of recurrent depression. WBT also showed clinical utility in the treatment of cyclothymia, which represents one of the stages of bipolar disorder. Further, WBT seems to have efficacy in treatment-resistant depression and in case of withdrawal syndromes (in particular the so-called persistent post-withdrawal disorder) following antidepressant decrease, switch or discontinuation. In brief, WBT is a rather new but promising therapeutic strategy in the management of unipolar and bipolar depression. This chapter offers an overview of WBT possible applications.

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Virtual reality (VR) is a promising supplemental or alternative approach for treating depression. Focusing on the unique affordances of VR, such as immersive therapeutic settings and uniform treatment delivery, this study explores both the current applications and future potential of VR technology in treating and assessing depression. VR provides users with an "immersive" and "presence" experience through multisensory stimulation. VR is an emerging paradigm in healthcare, particularly in psychiatric treatment, and presents compelling possibilities for its role in therapeutic interventions by facilitating realistic and controlled environments for both clinicians and patients. VR technology offers promising advancements in augmenting traditional cognitive-behavioral therapy (CBT) methods for treating depression, with applications in psychoeducation, behavioral activation, and cognitive restructuring. Various VR assessment techniques including biomarkers and machine learning have been discussed in this study. Although the field remains experimental, the immersive nature of VR holds the potential for more personalized and accurate therapeutic interventions and assessments. Further research is required for definitive conclusions.

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Depression, or major depressive disorder (MDD), is a widespread mental health condition marked by enduring feelings of sorrow and loss of interest. Treatment of depression frequently combines psychotherapy, medication, and lifestyle modifications. However, the occurrence of treatment resistance in certain individuals makes it difficult for physicians to effectively manage this disorder, calling for the implementation of alternative therapeutic strategies. Recently, precision medicine has gained increased attention in the field of mental health, paving the way for more personalized and effective therapeutic interventions in depression. Also known as personalized medicine, this approach relies on genetic composition, molecular profiles, and environmental variables to customize therapies to individual patients. In particular, precision medicine has offered novel viewpoints on depression through two specific domains: proteomics and metabolomics. On one hand, proteomics is the thorough study of proteins in a biological system, while metabolomics focuses on analyzing the complete set of metabolites in a living being. In the past few years, progress in research has led to the identification of numerous depression-related biomarkers using proteomics and metabolomics techniques, allowing for early identification, precise diagnosis, and improved clinical outcome. However, despite significant progress in these techniques, further efforts are required for advancing precision medicine in the diagnosis and treatment of depression. The overarching goal of this chapter is to provide the current state of knowledge regarding the use of proteomics and metabolomics in identifying biomarkers related to depression. It also highlights the potential of proteomics and metabolomics in elucidating the intricate processes underlying depression, opening the door for tailored therapies that could eventually enhance clinical outcome in depressed patients. This chapter finally discusses the main challenges in the use of proteomics and metabolomics and discusses potential future research directions.

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This chapter primarily focuses on the progress in depression precision medicine with specific emphasis on the integrative approaches that include artificial intelligence and other data, tools, and technologies. After the description of the concept of precision medicine and a comparative introduction to depression precision medicine with cancer and epilepsy, new avenues of depression precision medicine derived from integrated artificial intelligence and other sources will be presented. Additionally, less advanced areas, such as comorbidity between depression and cancer, will be examined.

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Posttraumatic stress disorder (PTSD) is a serious health condition that adversely affects the mind and body. Current first-line treatment for PTSD tends to focus on the mind and overlook the impacts of trauma on the body. Trauma Center Trauma-Sensitive Yoga (TCTSY) is an evidence-based adjunctive therapy for complex trauma and PTSD that uses a body-based approach to trauma healing. Although designed to be used in group or individual contexts, previous studies have focused only on TCTSY facilitated in groups. The present study examined the effects of one-to-one TCTSY (i.e., one participant receiving TCTSY services, not in a group TCTSY context) on anxiety, depression, posttraumatic stress, interoception, substance use, and sleep over time. Using an observational approach, all certified TCTSY facilitators received the study invitation to share with clients who were enrolled in one-to-one TCTSY services. Ten clients participated in the study across four countries (women n = 8; mean age 44.80 ± 11.91; PTSD diagnosis n = 9). Clients completed Qualtrics surveys at TCTSY sessions in June-December 2022. Linear mixed-model analyses found that anxiety, depression, posttraumatic stress symptoms, attention regulation, self-regulation, and body listening significantly improved over time. There were no significant changes in sleep or substance use from pre- to post-study. TCTSY is a somatic approach for managing trauma symptoms and enhancing interoceptive awareness. Extensions of the present study are warranted to further understand the effects of one-to-one TCTSY for trauma care.

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OBJECTIVE: To describe the profile of individuals with depression who received assistance at CAPS in Brazil between 2013 and 2019, focusing on their clinical and demographic characteristics, and to calculate the estimated coverage of CAPS across the national territory and its constituent federal units. METHODS: Descriptive, ecological, time-series study with secondary data from national databases, referring to care provided at CAPS in the country for adults aged 18 years or over-diagnosed with depression (F32-32.9 and F33-F33.9). The estimated coverage of CAPS was calculated for 2013 and 2019 using registered and active services. RESULTS: There was a 107% increase in the number of patients with depression receiving treatment at CAPS between 2013 and 2019. Women accounted for 77% of the patients, with the majority falling within the age range of 41 to 61years (49%). The predominant racial demographics were white (38%) and brown (34%). The diagnosis of depressive episodes was prevalent among 65% of the patients, and individual care was administrated to 75% of them. The presumed CAPS coverage was 71% in 2013 and increased to 87% in 2019 nationwide, although significant discrepancies were observed among different states. CONCLUSION: Progress was evident in the implementation of CAPS across Brazil during the period spanning 2013 to 2019. Nonetheless, disparities persist among the federative units, and there remains an underutilization of group and family care within CAPS services.

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BACKGROUND: Five-guaranteed elderly individuals are a special group of the elderly Chinese population faced with unique challenges; these individuals lack any financial resources (including support by relatives), and are solely reliant on the government to provide food, clothing, medical care, and housing as well as burials. In this article, we aim to investigate mood problems (depression, anxiety) and cognitive functioning in Five-guaranteed elderly individuals, and to validate the effectiveness of two promising interventions, graphene far-infrared intervention (GFII; an exploratory and noninvasive technique) and social network intervention (SNI), for elderly people to lay the foundation for future social service work. METHODS: To address the emotional and cognitive difficulties experienced by this special group, we designed this study, which is the first to apply GFII in this population. We also administered SNI given the social isolation of these individuals, in addition to a corresponding control group. 108 elderly individuals in 3 elder care facilities were screened to evaluate eligibility to participate in the current study, including 44 from Facility A (allocated to the GFII group), 43 from Facility B (allocated to the SNI group), and 21 from Facility C (allocated to the control group). GFII lasts for four weeks, with professionally trained carers putting on and removing intervention caps for half an hour each day. SNI lasts for three weeks, three times a week, and consists of a total of nine themed activities. The length of an activity is 90 min. We also did pre- and post-test comparisons of depression, anxiety and cognition in each group of older adults. RESULTS: The results showed that GFII led to immediate improvements in anxiety and cognitive impairment in the five-guaranteed elderly individuals, and the improvement in cognitive function was sustained over time. Moreover, SNI group showed significant improvements in cognitive function after the intervention period. CONCLUSIONS: The GFII is a promising intervention that can be applied to intervene in cognitive and mood disorders in older adults. The GFII has short-term interventions for anxiety in older adults, but long-term effects for cognitive impairment. SNI also had an interventional effect on cognition.

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Mindfulness-based interventions (MBIs) for depression use regular mindfulness practice as a means of helping patients build skills that allow them to respond more adaptively to negative mood. Although effects of practice are assumed to accumulate over time, little is known about the trajectories of change in skills and symptoms beyond the duration of standard eight-week interventions. Forty-four patients with persistent depression were recruited to participate in a 6-month blended MBI and provided self-reports of depressive symptomatology and their ability to decenter, the core skill cultivated in MBIs, at baseline, mid-intervention and after the end of the intervention. Trajectories of change were analysed using latent change score modelling. Thirty-one participants (70 %) completed the intervention having engaged in 68.6 % of practices on average. Trajectories of change in decentering and depression were best described by a combination of a constant change component and a limiting factor indicating decreasing rates with higher previous gains. Bivariate analyses showed significant lagged change to change coupling linking earlier changes in decentering with later changes in symptoms. The findings suggest that decentering skills increase throughout longer periods of practice and drive changes in symptoms to move patients closer to recovery or remission.

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BACKGROUND: Patients with depression struggle with significant emotion regulation difficulties, which adversely affect their psychological well-being and hinder recovery. Traditional therapeutic approaches often fail to adequately address these challenges, leading to a persistent gap in effective mental health care. This research seeks to address this gap by investigating the impact of emotion regulation skills training on patients with depression. AIM: To assess the difficulties in emotion regulation among patients with depression and evaluate the impact of an emotion regulation skills training intervention on those with higher levels of emotion regulation difficulties, specifically focusing on increasing the use of adaptive emotion regulation strategies and reducing the use of maladaptive emotion regulation strategies. METHOD: A quasi-experimental research design was utilized, using three tools: a socio-demographic and Clinical Data structured interview schedule, Difficulties in Emotional Regulation Scale, and Cognitive Emotion Regulation Questionnaire. Eighty patients with depression were recruited to assess those with higher levels of emotion regulation difficulties; out of those with greater difficulties, 30 patients were chosen to participate in the emotion regulation skills training intervention. RESULT: The 80 studied subjects' emotion regulation difficulties scores ranged from 158 to 169 (164.5 ± 3.21), and they indicated less use of adaptive cognitive emotion regulation strategies and more use of maladaptive cognitive emotion regulation strategies (56.07 ± 2.67). Regarding the intervention group, the overall mean score of the 30 patients' emotion regulation difficulties decreased from 167.35 ± 2.21 pre-intervention to 105.85 ± 3.33 post-intervention (p < 0.0001). Cognitive emotion regulation total scores improved markedly from 54.07 ± 1.66 to 35.2 ± 3.46 (p < 0.01). IMPLICATION: Healthcare providers should routinely assess emotion regulation difficulties in patients with depression and integrate personalized treatment plans that target individual emotion regulation difficulties. CONCLUSION: The findings suggest that the emotion regulation intervention has the potential to improve emotion regulation difficulties and cognitive emotion regulation strategies among patients with depression.

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BACKGROUND: Loneliness, anxiety and depressive symptoms are common among older residents in long-term care facilities (LTCFs), which can negatively impact their quality of life and increase mortality rates. Addressing these psychological health issues is an important task for nursing staff. There is a need for easy and accessible interventions to improve older residents' negative emotions. Tactile massage (TM) is a form of touch therapy that induces oxytocin, which can help individuals feel relaxed, experience pleasure and reduce anxiety. TM can also provide a sense of security and care for individuals. OBJECTIVE: This study aimed to evaluate the effects of TM in improving older residents' psychological health in LTCFs. DESIGN: In this study, we applied a two-arm randomised controlled trial research design. METHODS: We used convenience sampling to enrol 55 older residents in three long-term care facilities who were randomly assigned to an intervention group and a comparison group. The intervention group received TM by research assistants on both hands for 15 min per time, twice a week for 4 weeks and the comparison group received regular care. Data were collected before and after the intervention. Generalised estimating equations (GEEs) were used to evaluate the effectiveness of the intervention. RESULTS: There were no significant differences in loneliness, anxiety, depressive symptoms, happiness, ear temperature, heart rate or diastolic blood pressure between the two groups after the intervention. However, the intervention group had significant improvements in comfort (B = 0.86, p < 0.001), relaxation (B = 1.00, p < 0.001), respiratory rate (B = -0.16, p = 0.021) and systolic blood pressure (B = - 4.17, p = 0.002) compared to the control group. CONCLUSIONS: TM can help older residents who live in LTCFs feel relaxed and comfortable. IMPLICATIONS FOR PRACTICE: TM can be easily implemented as it requires no tools. We recommend that nursing staff and healthcare professionals incorporate TM as part of their care routines. They also can encourage family members to perform TM on residents during their visits to enhance residents' comfort and relaxation. REPORTING METHOD: The Consolidated Standards of Reporting Trials (CONSORT) checklist was used for this paper. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05052138).

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BACKGROUND: Adolescence and early adulthood are pivotal stages for the onset of mental health disorders and the development of health behaviors. Digital behavioral activation interventions, with or without coaching support, hold promise for addressing risk factors for both mental and physical health problems by offering scalable approaches to expand access to evidence-based mental health support. OBJECTIVE: This 2-arm pilot randomized controlled trial evaluated 2 versions of a digital behavioral health product, Vira (Ksana Health Inc), for their feasibility, acceptability, and preliminary effectiveness in improving mental health in young adults with depressive symptoms and obesity risk factors. METHODS: A total of 73 participants recruited throughout the United States were randomly assigned to use Vira either as a self-guided product (Vira Self-Care) or with support from a health coach (Vira+Coaching) for 12 weeks. The Vira smartphone app used passive sensing of behavioral data related to mental health and obesity risk factors (ie, activity, sleep, mobility, and language patterns) and offered users personalized insights into patterns of behavior associated with their daily mood. Participants completed self-reported outcome measures at baseline and follow-up (12 weeks). All study procedures were completed via digital communications. RESULTS: Both versions of Vira showed strong user engagement, acceptability, and evidence of effectiveness in improving mental health and stress. However, users receiving coaching exhibited more sustained engagement with the platform and reported greater reductions in depression (Cohen d=0.45, 95% CI 0.10-0.82) and anxiety (Cohen d=0.50, 95% CI 0.13-0.86) compared to self-care users. Both interventions also resulted in reduced stress (Vira+Coaching: Cohen d=-1.05, 95% CI -1.57 to --0.50; Vira Self-Care: Cohen d=-0.78, 95% CI -1.33 to -0.23) and were perceived as useful and easy to use. Coached users also reported reductions in sleep-related impairment (Cohen d=-0.51, 95% CI -1.00 to -0.01). Moreover, participants increased their motivation for and confidence in making behavioral changes, with greater improvements in confidence among coached users. CONCLUSIONS: An app-based intervention using passive mobile sensing to track behavior and deliver personalized insights into behavior-mood associations demonstrated feasibility, acceptability, and preliminary effectiveness for reducing depressive symptoms and other mental health problems in young adults. Future directions include (1) optimizing the interventions, (2) conducting a fully powered trial that includes an active control condition, and (3) testing mediators and moderators of outcome effects. TRIAL REGISTRATION: ClinicalTrials.gov NCT05638516; https://clinicaltrials.gov/study/NCT05638516.

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OBJECTIVE: To assess the effectiveness of Internet-based self-help interventions in treating depression in adolescents and young adults. METHODS: A systematic search was conducted across six databases, including PubMed, to identify randomized controlled trials (RCTs) that satisfied the specified inclusion and exclusion criteria. The intervention measure consisted of Internet-based self-help interventions. RESULTS: A total of 23 randomized controlled trials (RCTs) were included in this analysis. Meta-analysis indicated that Internet-based self-help therapies significantly reduced depression scores in adolescents and young adults. (OR = -0.68, 95%CI [-0.88, -0.47], P < 0.001). We examined the effects of patient recruitment from various regions, medication usage, therapist involvement, weekly intervention time, and intervention duration. Patients selected from school, primary healthcare centers, clinics and local communities had better results. Intervention lasting 30 to 60 min and 60 to180 minutes per week were effective in the short term. CONCLUSION: The internet-based self-help intervention can be effective in treating depression in adolescents and young adults. However, factors such as patient recruitment locations, medication usage, Therapists' involvement, weekly intervention time, and intervention duration interacted with the outcome. Subgroup analysis on potential adverse effects and gender was impossible due to insufficient data from the included studies.

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Dyadic conditions of patients with heart failure and their caregivers may affect both patient self-care and caregiver contribution to patient self-care (CCPS). The purpose of this study was to examine the relationships of patient-caregiver physical function and depressive symptoms to the patient self-care (maintenance and management) and CCPS. Data from 55 were analyzed using an Actor-Partner Interdependence Model to address the aim through AMOS. Patient self-care was very poor. Better patient physical function was related to better patient self-care management (actor effect) and poorer CCPS maintenance (partner effect). Better caregiver physical function was related to CCPS management (actor effect). Severer patient depressive symptoms were related to poorer patient self-care maintenance (actor effect) and poorer CCPS management (partner effect). Physical function and depressive symptoms in patient-caregiver dyads were related to patient self-care and CCPS. To improve patient self-care and CCPS, dyadic support for physical function and depressive symptoms is needed.

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BACKGROUND: Non-motor symptoms (NMS) such as impaired cognition, anxiety, and depression can have a strong adverse effect on the quality of life (QoL) of Parkinson's disease (PD) patients. The clinical application of cognitive behavioral therapy (CBT) offers an opportunity to improve cognitive function, mental health, and overall QoL for these patients. OBJECTIVE: CBT is frequently applied as a treatment option aimed at benefiting the mental health of PD patients, but the relative utility of CBT in this patient population has yet to be rigorously assessed. The present review was thus conducted with the goal of examining the relative safety and efficacy of CBT as a treatment option for PD patients suffering from cognitive impairment, anxiety, and depression, with a particular focus on the impact of CBT on PD patient QoL. METHODS: The PubMed, Embase, Medline, and Cochrane Library databases were searched for all studies published from their inception to present using keywords including "cognitive behavioral therapy" and "Parkinson's disease". Two reviewers independently screened these published studies and extracted relevant data from studies that met with defined inclusion/exclusion criteria, in addition to assessing the risk of bias. Those randomized controlled trials (RCTs) assessing the impact of CBT on older PD patients were eligible for study inclusion. In total, 22 articles incorporating 1,053 patients were included in this meta-analysis. Study quality was examined as per the Cochrane risk of bias framework. Heterogeneity and associated outcomes were assessed based on mean difference (MD), I2, and 95% confidence interval (95%CI) values. RESULTS: In total, 22 RCTs were ultimately found to be eligible for inclusion in the present meta-analysis. The results of this meta-analysis indicated that CBT significantly impacted cognition as compared to other treatment options (including placebo treatment, clinical monitoring, clinic-based treatment, psychoeducation, physical activity training, health enhancement) (I2 = 49%, MD = 0.23, 95%CI: 0.03-0.44, P = 0.03). CBT was also associated with significant improvements in PD patient QoL (I2 = 0%, MD = 3.45, 95%CI: 1.13-5.57, P = 0.04), anxiety symptoms (I2 = 57%, MD = -2.01, 95%CI: -4.01-0.01, P = 0.05), and depression symptoms (I2 = 74%, MD = -3.94, 95%CI: -6.47 to -1.42, P = 0.04). CONCLUSIONS: These results reveal that CBT can have beneficial effects on PD patient cognitive status and QoL. Notably, CBT represents an effective option for treating NMS such as anxiety and depression in PD patients. These results offer strong evidence in favor of applying CBT as a means of enhancing the mental health, cognition, and QoL of individuals with PD. However, additional high-quality large-scale studies will be essential to confirm and expand upon these results.

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