Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 5 appraisals
Journal of affective disorders
The association between obsessive-compulsive symptoms and self-compassion: A meta-analysis and systematic review.
BACKGROUND: Self-compassion, defined as the ability to respond to personal suffering with mindful awareness, self-directed kindness, and recognition of shared humanity, has been linked to reduced risk and severity of psychopathology. No systematic reviews have examined the relationship between self-compassion and obsessive-compulsive (OC) symptoms. METHOD: We conducted a systematic review and meta-analysis of peer-reviewed quantitative studies reporting associations between validated measures of self-compassion and OC symptoms. Eleven studies (N = 3336) met inclusion criteria. Random-effects models estimated pooled correlations for total symptoms and four core OC symptom dimensions (symmetry/ordering, unacceptable thoughts, checking/responsibility, and contamination/washing). Moderator analyses examined clinical status and cultural orientation. RESULTS: Across studies, self-compassion was moderately and negatively associated with OC symptom severity (r = -0.34, 95% CI [-0.39, -0.30]), with moderate heterogeneity (τ2 = 0.002, I2 = 40%). All four symptom dimensions were inversely associated with self-compassion, with the strongest association for unacceptable thoughts (r = -0.41). Neither clinical status nor cultural orientation significantly moderated effects. Funnel plot symmetry and fail-safe N analyses indicated minimal publication bias. DISCUSSION: Findings suggest that lower self-compassion is reliably linked to greater OC symptom severity across studies, samples (clinical vs. community), and cultures (individualist vs collectivist), particularly for unacceptable thoughts. These results highlight self-compassion as a potential therapeutic target in OCD, warranting further investigation through longitudinal and interventional studies.
15 July 2026
Read appraisal →Journal of medical Internet research
Virtual Exposure With Response Prevention for Obsessive-Compulsive Disorder: Randomized Controlled Trial
BACKGROUND: Despite being highly effective and guideline-recommended for obsessive-compulsive disorder, exposure with response prevention is often underused due to barriers from both therapists and patients. Virtual reality may help address these barriers. OBJECTIVE: This study aimed to assess the efficacy and acceptance of virtual exposure with response prevention (VERP) in patients with contamination obsessive-compulsive disorder (conOCD) and checking obsessive-compulsive disorder (checkOCD) and to identify factors influencing treatment success. METHODS: Within a randomized controlled trial, 80 participants (40 with conOCD and 40 with checkOCD) were allocated to an intervention group, which received outpatient care as usual (CAU) supplemented by 6 weekly VERP sessions (VERP group), or to a control group receiving CAU alone (CAU group). Assessments occurred at baseline (t0), postintervention (t1), and at 3-month follow-up (t2). The reduction in obsessive-compulsive symptoms, as measured with the Yale-Brown Obsessive-Compulsive Scale, served as the primary outcome. RESULTS: Overall, obsessive-compulsive symptoms showed no greater improvement in the VERP group compared to the CAU group from t0 to t1 or t2 (ηp2=0.003-0.014). In exploratory subsample analyses, we observed a trend toward an interaction effect, showing greater reduction in obsessions among participants with checkOCD from t0 to t1 (F1,52=3.91; P=.05; ηp2=0.070) and greater anxiety reduction among participants with conOCD from t0 to t2 (F1,45=4.11; P=.05; ηp2=0.084). Exploratory moderation analysis suggested that adding VERP to CAU was more effective for those in the VERP group who had not prematurely discontinued prior psychological treatment and those with checking behavior. Sense of presence was only moderate, unrelated to outcome, and patient satisfaction with VERP was positive overall. CONCLUSIONS: While overall symptom reduction did not significantly differ between groups, exploratory analyses suggested trend-level differences in treatment response across obsessive-compulsive disorder subtypes and patient characteristics. These findings should be interpreted cautiously and are best viewed as hypothesis-generating.
28 May 2026
Read appraisal →Translational psychiatry
Multi-session CBM-I for social anxiety: examining psychopathology, cognitive, neural, and psychophysiological effects in a randomized controlled trial
Cognitive Bias Modification - Interpretation (CBM-I) aims to alter maladaptive interpretations in social anxiety, yet effects are often small and outcome measures are diverse. Although CBM-I has shown promise, its underlying mechanisms remain unclear and integration with psychophysiological and neural measures has been limited. In this randomized controlled trial, eighty-eight participants with high levels of social anxiety completed two lab sessions, an online training in between, and online follow-up. Participants filled out questionnaires, completed interpretation bias tasks, and underwent neuro-psychophysiological assessments. Active CBM-I trained positive resolutions of ambiguous social scenarios, while the sham version used neutral scenarios. The primary outcome, i.e., scores on the Liebowitz Social Anxiety Scale (LSAS), decreased across time in both groups, without group differences. However, the Brief Fear of Negative Evaluation decreased only in the active group. Interpretation bias shifted more strongly toward positive outcomes in the active group. Autonomic measures confirmed sensitivity to stress induction but did not differentiate between conditions. Electrophysiological results paralleled subjective ratings, as participants exhibited ambivalent responses to socially relevant stimuli but clearly differentiated responses toward neutral stimuli. Baseline correlations indicated strong convergence across self-report and interpretation tasks. Mediation analyses showed that reductions in negative interpretations mediated the effect of the training group on LSAS scores at follow-up. These findings identify interpretation bias as a modifiable mechanism underlying social anxiety and underscore its role as a transdiagnostic marker. Targeting interpretation bias through easily accessible and applicable online interventions may strengthen preventive and therapeutic approaches for social anxiety and related disorders.
25 May 2026
Read appraisal →Sleep
Effects of a guided digital intervention on sleep and mental health outcomes in university students - a randomized controlled trial
STUDY OBJECTIVES: To evaluate the effectiveness of a guided digital intervention targeting sleep and circadian rhythms in university students. METHODS: We randomized 195 university students with self-reported insomnia (Insomnia Severity Index ≥10) from nine Dutch Universities to receive either the 5-week guided digital cognitive-behavioral therapy for insomnia "i-Sleep & BioClock", or digital sleep psychoeducation and sleep monitoring. Online assessments were at baseline, 3 (mid-treatment), 6 (post-treatment), and 18 (follow-up) weeks. The primary outcome was insomnia severity at 6 weeks. Secondary outcomes were symptoms of depression and anxiety; functioning; quality of life (QoL); academic performance; and sleep and light exposure diary outcomes. RESULTS: From Nov 1st 2023 until Sept 5th 2024, we randomly assigned 96 students (age 23.8 ± 3.8, 75.4% female) to the intervention and 99 to the control condition, stratified by university and gender. Fifty-one percent completed the post-treatment assessment, and 30% the follow-up. 31% were intervention completers. Linear mixed models showed no significant time x treatment interaction for insomnia severity ("i-Sleep & BioClock": baseline ISI M = 16.8, SD = 4.0; post-treatment ISI M = 10.2, SD = 3.9; Digital psychoeducation: baseline ISI M = 16.5, SD = 3.6; post-treatment ISI M = 11.1, SD = 4.2). The difference in change between groups was -1.17 points (95% CI -2.72 to 0.38), p=.14, Cohen's d = -0.31. Most secondary outcomes showed no significant time x treatment effects. CONCLUSIONS: "i-Sleep & BioClock" was not more effective than online psychoeducation on most outcomes, possibly due to active elements present in both conditions or low adherence. Future research should identify factors for early disengagement and investigate which intervention components drive improvements in sleep. CLINICAL TRIAL: Effectiveness of a Guided Self-help Intervention for Improving Sleep in University Students, https://clinicaltrials.gov/study/NCT06023693, prospectively registered at ClinicalTrials.gov on August 3rd, 2023.
14 May 2026
Read appraisal →Psychological medicine
Treatment effect modifiers of virtual reality-based versus standard cognitive behavioral therapy for paranoia in schizophrenia spectrum disorders: an exploratory moderator analysis of clinical and demographic characteristics in the FaceYourFears trial
BACKGROUND: This exploratory study examined baseline characteristics modifying treatment effects on paranoia in individuals diagnosed with schizophrenia spectrum disorders following a 10-session virtual reality-based cognitive behavioral therapy for psychosis (VR-CBTp) or standard CBTp. METHODS: All participants in the FaceYourFears trial were included (n=254; CBTp n=128; VR-CBTp n=126). General linear and logistic regression models examined baseline variables associated with end-of-treatment paranoia. In covariate analyses, regression coefficients quantified associations across treatments. In moderation analyses, interaction terms (randomization x moderator) were tested, with corresponding regression coefficients estimated and assessed at the 25th (low), 50th (medium), and 75th (high) percentiles of continuous variables. RESULTS: Across treatments, higher baseline avolition, safety behavior, delusion severity, and cognitive biases were associated with end-of-treatment paranoia. Moderation analyses revealed interactions for avolition, delusion severity, and negative other-beliefs. Although avolition and delusion severity were associated with poorer outcomes overall, individuals with high avolition and those with moderate-to-high delusion severity improved more in VR-CBTp than CBTp, whereas participants with lower delusion severity showed better outcomes in CBTp. No demographic (age, gender, education, and occupation) or other clinical characteristics (diagnosis, paranoia, social anxiety, depression, anhedonia, total negative symptoms, functioning, core beliefs, or interpersonal trauma) were significantly associated with outcome. CONCLUSIONS: This exploratory study generates hypotheses for future research, including VR-CBTp's potential to engage individuals with high avolition. Given the modest effects and largely nonsignificant findings, both CBTp and VR-CBTp appear suitable for a wide range of individuals with paranoia, highlighting the importance of considering patient preferences.
2 May 2026
Read appraisal →