Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 4 appraisals
Current psychiatry reports
Is Technology Remaking Therapy: The Screen and the Self: Telepsychiatry, AI Therapy, and the Defense Against Intimacy
PURPOSE OF REVIEW: This paper examines several methods of technology that have challenged traditional expectations of the meaning of psychotherapy, from the widespread adoption of telepsychiatry to the subsequent emergence of AI-driven therapeutic agents (Therabots). RECENT FINDINGS: Widespread usage of new technology that impacts the therapeutic process has outpaced an analysis of how that technology might affect the meaning and effectiveness of that process. Lawsuits assume such technology causes harm, while limited data and the literature has been more mixed. From Frankenstein to CRISPR, new technology always has its cheerleaders and its detractors. The more the technology seems to impact a topic especially connected to our humanity, the deeper the convictions will be on both sides. Certainly, when it comes to psychotherapy, the introduction of new technologies such as telepsychiatry to Therabots has provoked discussion. We argue that while new technologies offer practical advantages, they risk functioning as structural defenses against the vulnerability and authentic intimacy essential to transformative psychotherapy. Through analysis of the therapeutic alliance, relational dynamics, and the psychology of vulnerability, this paper contends that the structural form of telepsychiatry does not alter the inherent nature of the therapeutic experience, whereas AI-mediated therapy may collude with maladaptive defenses, fundamentally altering the nature of the therapeutic encounter.
1 July 2026
Read appraisal →BMC medicine
WISE-Therapy (What's Important: Schedule and Engage) and bouldering psychotherapy for depression: A randomized clinical trial
BACKGROUND: Group therapies address the growing treatment demand-supply gap for depression. This study evaluated whether the novel WISE-Therapy (WISE-T; What's Important: Schedule and Engage) and Bouldering Psychotherapy (BPT) are more effective in reducing depressive symptoms in an outpatient group therapy setting than treatment as usual (TAU). METHODS: This randomized, controlled, assessor-blinded, longitudinal, clinical trial was conducted in a naturalistic monocentric setting in Erlangen (Germany) between April 2022 and March 2023, with follow-up until July 2024. 128 adults were randomly assigned to WISE-T (44), BPT (40), or TAU (44). In 10 weekly 2-hour group sessions, WISE-T focused on identifying what is important, scheduling meaningful activities, and engaging in them for long-term mental health, and BPT combined psychotherapy with bouldering, while the control group received TAU. Depression severity was measured with the Montgomery-Asberg Depression Rating Scale at baseline, post-intervention, and one-year follow-up, and analyzed with a hybrid marginal model. RESULTS: Both intervention groups showed significantly greater reduction in depressive symptoms than controls at post-intervention (WISE-T: -5.5 points, 95%-CI [-9.5 to -1.5], P = .007, d = 0.62; BPT: -4.2 points, 95%-CI [-8.2 to -0.3], P = .037, d = 0.48). Response rates were 35.3% for WISE-T, 29.7% for BPT, and 21.1% for controls. Remission rates were significantly higher in WISE-T (17.6%) than in controls (2.6%, P = .047). Treatment adherence was good with minimal adverse events reported. The secondary outcomes showed significant results for anxiety, sense of coherence, self-efficacy, and mindfulness during physical activity. CONCLUSIONS: Both interventions demonstrated efficacy in reducing depressive symptoms compared with controls in this single-center setting. The study supports the integration of both therapies into outpatient care settings. TRIAL REGISTRATION: Study procedures received approval from the Friedrich-Alexander-Universität Erlangen-Nürnberg Ethics Committee (Ref. 21-332-B) on December 13, 2021. The Trial was preregistered in March 2022 via ISRCTN12347878 .
29 May 2026
Read appraisal →European journal of psychotraumatology
Attenuating trauma- and cocaine-related intrusions by blocking memory reconsolidation with minocycline: protocol for a transdiagnostic randomized controlled trial
Background: Post-traumatic stress disorder (PTSD) and substance use disorders frequently co-occur, with their comorbidity linked to poorer treatment outcomes. Beyond this epidemiological overlap, PTSD and, in particular, cocaine use disorder (CUD) have also been conceptually linked, as maladaptive memory processes are thought to play a central role in both of their etiopathogeneses. PTSD and CUD are each characterized by intrusive memories - either trauma or cocaine related - that sustain distress and craving, respectively. These parallels have motivated transdiagnostic mechanistic research targeting memory reconsolidation. Matrix metalloproteinase-9 (MMP-9) is critically involved in synaptic plasticity and memory updating, and has been suggested as a pharmacological entry point for modulating reconsolidation-related processes.Objective: This study examines whether pharmacological interference with reconsolidation via MMP-9 inhibition by minocycline modulates trauma- and cocaine-related intrusive memories and their neurobiological correlates in PTSD and CUD.Method: In this monocentric, randomized, double-blind, placebo-controlled trial (NCT05902819), individuals with PTSD (n = 60) or CUD (n = 60) receive a single dose of minocycline - a tetracycline inhibiting MMP-9 - or placebo prior to an individualized, imagery-based reactivation of their most salient intrusive memory. Intrusive memories in day-to-day life are assessed using event-based ecological momentary assessment and pre-post intrusion questionnaires. Neurobiological correlates of maladaptive memory processing are indexed through functional magnetic resonance imaging and magnetic resonance spectroscopy, and peripheral biomarkers are obtained from blood, urine, and hair samples. Diagnostic status and comorbid symptoms are characterized using clinical interviews and standardized self-report measures.Conclusions: This trial adopts a mechanistic framework to investigate whether minocycline-augmented memory reactivation modulates intrusions and associated neurobiological markers in PTSD and CUD. By directly targeting candidate memory mechanisms shared by both disorders, it evaluates a transdiagnostic reconsolidation-based approach and is expected to inform models of intrusive memory persistence and updating. The findings may guide future development of memory-focused interventions in trauma- and addiction-related disorders. This randomized controlled trial evaluates a transdiagnostic, mechanism-focused intervention targeting maladaptive memory processes in PTSD and cocaine use disorder.Minocycline is used as an MMP-9 inhibitor to modulate intrusive trauma- and cocaine-related memories following brief imagery-based memory reactivation.The study integrates multimodal neurobiological assessments (fMRI, MRS, peripheral biomarkers) with ecological momentary intrusion measures to characterize changes in memory-related mechanisms.
14 May 2026
Read appraisal →European journal of psychotraumatology
Phase-based versus non-phase-based psychological interventions for complex PTSD: a systematic review and meta-analysis
Background: Since complex post-traumatic stress disorder (CPTSD) was incorporated to the International Classification of Diseases-11th revision (ICD-11), the construct has drawn increasing attention in clinical research due to its debilitating effects across multiple domains of functioning. However, whether stabilization (Phase 1) is necessary before exposure to traumatic memories (Phase 2) remains controversial.Objective: We examined whether phase-based interventions are more effective than non-phase-based interventions in reducing symptoms of CPTSD.Methods: On 17 June 2025, we searched the Cochrane Library, Embase, Medline, PTSDpubs, Scopus, and Web of Science as well as South Korean databases, including the Korean Citation Index, the Research Information Sharing Service, DataBase Periodical Information Academic (DBPia), and ScienceON. Randomized controlled trials of psychological interventions for individuals with clinically significant CPTSD symptoms or PTSD with at least two of the 'disturbances in self-organization' (DSO) symptom clusters were eligible. We used Hedges' g to pool effect sizes and performed subgroup analyses using Cochran's Q test. We assessed risk of bias using the Cochrane Risk-of-Bias Assessment 2 tool.Results: Across most outcomes, we observed no significant differences between phase- and non-phase-based interventions, between multi-phase and single-phase interventions, or between exposure and non-exposure interventions. However, multi-phase interventions had superior effects on PTSD, while phase-based, multi-phase, and exposure interventions showed greater improvements in DSO - affect regulation compared to their counterparts.Conclusions: This study was limited by the small number of available trials, single time-point, and heterogeneity in outcome measures, which constrained both the detection of subgroup differences and the precision of effect size estimates. Our findings provide empirical evidence for the current discourse, suggesting that non-phase-based and non-exposure-based interventions can be as effective as structured approaches in many contexts, while some outcomes may still benefit from phase-, multi-modular-, or exposure-based designs. This systematic review examined whether interventions that include a first phase of stabilization followed by a second phase of exposure to traumatic memories are more effective than other interventions.Across most outcomes, there were no clear differences between phase- and non-phase-based interventions, or between exposure and non-exposure interventions.For post-traumatic stress symptoms, interventions with more than one phase were more effective than those with a single-phase treatment. For difficulties with emotion regulation, multi-phase interventions that included stabilization before exposure showed greater benefits.
9 Apr 2026
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