Focus (American Psychiatric Publishing)最新文献

{"title":"Combined Treatments in Psychiatry: Toward a True Synthesis.","authors":"Andrew D van der Vaart, Scott T Aaronson","doi":"10.1176/appi.focus.20260019","DOIUrl":"10.1176/appi.focus.20260019","url":null,"abstract":"","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 3","pages":"267-268"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contextual Engagement to Enhance Effective Transcranial Direct Current Stimulation: A Theoretical and Mechanistic Perspective.","authors":"Mascha van 't Wout-Frank, Noah S Philip","doi":"10.1176/appi.focus.20260005","DOIUrl":"10.1176/appi.focus.20260005","url":null,"abstract":"<p><p>Transcranial direct current stimulation (tDCS) is a form of noninvasive brain stimulation that delivers a low amount of electrical energy to targeted brain regions. Recently, a tDCS device was approved by the U.S. Food and Drug Administration for treatment of major depressive disorder. Although this is an important step forward, the observed effect size was modest, and finding ways to improve tDCS efficacy is important. One way to do so is to leverage contextual dependence of tDCS effects. tDCS modulates neuronal excitability in a state-dependent manner, and concurrent cognitive, emotional, or behavioral engagement are important contextual factors that might further improve acute and longer-lasting outcomes. The authors outline the theoretical rationale for integrating therapeutic engagement with tDCS and the need for longer follow-up to assess efficacy, drawing on mechanistic insights, and describe a prior use case of tDCS concurrent with a virtual reality context to underscore this use.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 3","pages":"307-313"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical Issues in Combined and Novel Treatment.","authors":"Jacob M Appel","doi":"10.1176/appi.focus.20260008","DOIUrl":"10.1176/appi.focus.20260008","url":null,"abstract":"","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 3","pages":"331-335"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Neuromodulation and Yoga Intervention for Chronic Pain.","authors":"Niki P Sabetfakhri, Alexandra L Aaronson, Kelly Krese, Sadie Walker, Amy A Herrold","doi":"10.1176/appi.focus.20250049","DOIUrl":"10.1176/appi.focus.20250049","url":null,"abstract":"<p><p>Chronic pain is a multidimensional syndrome that frequently co-occurs with psychiatric disorders. Long-term management remains inadequate, and clinical guidelines increasingly recommend nonpharmacologic, multimodal approaches. This narrative review provides a rationale for combining intermittent theta burst stimulation (iTBS) with yoga to offer a synergistic treatment strategy for chronic pain. Literature was identified through targeted PubMed searches supplemented by manual review of reference lists. iTBS is a time-efficient transcranial magnetic stimulation protocol that increases cortical excitability in the primary motor cortex and engages descending pain-inhibitory pathways while inducing a transient window of heightened neuroplasticity. Yoga engages complementary bottom-up mechanisms-autonomic regulation, sensorimotor integration, interoceptive awareness, and cognitive-affective reframing-through postures, breath regulation, and meditation. The authors review chronic pain as a multifactorial construct, synthesize evidence for each treatment modality, and present the rationale for delivering yoga within the post-iTBS plasticity window to prime pain-relevant circuits. They then highlight the first pilot trial of this combined treatment among veterans with co-occurring mild traumatic brain injury and chronic musculoskeletal pain, in which six weekly sessions of iTBS followed by manualized group yoga were feasible, safe, and associated with significant pain improvement. The authors also shed light on limitations of the pilot and future directions for this work.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 3","pages":"278-293"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enduring Effects for Cognitive Behavior Therapy in the Treatment of Depression and Anxiety.","authors":"Steven D Hollon, Michael O Stewart, Daniel Strunk","doi":"10.1176/appi.focus.26024120","DOIUrl":"10.1176/appi.focus.26024120","url":null,"abstract":"<p><p>Recent studies suggest that cognitive and behavioral interventions have enduring effects that reduce risk for subsequent symptom return following treatment termination. These enduring effects have been most clearly demonstrated with respect to depression and the anxiety disorders. It remains unclear whether these effects are a consequence of the amelioration of the causal processes that generate risk or the introduction of compensatory strategies that offset them and whether these effects reflect the mobilization of cognitive or other mechanisms. No such enduring effects have been observed for the psychoactive medications, which appear to be largely palliative in nature. Other psychosocial interventions remain largely untested, although claims that they produce lasting change have long been made. Whether such enduring effects extend to other disorders remains to be seen, but the capacity to reduce risk following treatment termination is one of the major benefits provided by the cognitive and behavioral interventions with respect to the treatment of depression and the anxiety disorders. Reprinted from <i>Annu Rev Psychol</i> 2006; 57:285-315, with permission from Annual Reviews. Copyright © 2006.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 3","pages":"347-362"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanisms of Action and Change in Psychedelic-Assisted Therapies: A Holistic Framework for Ethical, Competent Clinical Care.","authors":"Lynnette A Averill, Logan Neitzke-Spruill","doi":"10.1176/appi.focus.20260006","DOIUrl":"10.1176/appi.focus.20260006","url":null,"abstract":"<p><p>Psychedelic-assisted therapies (PATs) are emerging as novel combination treatments for selected stress- and trauma-related psychiatric conditions, particularly in cases where existing pharmacologic and psychotherapeutic approaches have provided limited benefit. Although current mechanistic models emphasize neuroplasticity, large-scale network changes, and modulation of neurotransmitter systems, these are insufficient to explain how therapeutic change emerges within the broader context of preparation, altered states of consciousness, interpersonal relationships, meaning-making, and integration. The authors introduce a non-neuroreductionist, multilevel framework that distinguishes mechanisms of action from mechanisms of change, highlighting how neuroplasticity, memory updating, relational processes, contextual factors, and meaning-making may interact to support therapeutic change. They draw on relevant evidence and clinical theory to describe how these treatments may create time-limited windows that support experiential relearning. Ethical considerations; limitations; and implications for practice, including the possibility that vulnerability may be increased when safeguards are inadequate, are discussed. Guidance is provided for clinicians who encounter PATs in practice.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 3","pages":"314-325"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redefining Combined Treatment in Psychiatry.","authors":"","doi":"10.1176/appi.focus.26024116","DOIUrl":"10.1176/appi.focus.26024116","url":null,"abstract":"","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 3","pages":"336-337"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synergistic and Scalable: A Review of Integrated Digital and Biological Interventions.","authors":"Hatice Nur Eken, Rebecca Byrne Price","doi":"10.1176/appi.focus.20250048","DOIUrl":"10.1176/appi.focus.20250048","url":null,"abstract":"<p><p>The use of digital therapeutics in psychiatry is rapidly expanding. From internet-based psychotherapy to cognitive training modules, digital therapeutics have the potential to scale evidence-based psychiatric care. Concurrently, biological treatments that modulate neuroplasticity are reshaping expectations for the speed and durability of symptom change. This review describes clinical evidence for integrating digital and biological interventions to leverage treatment-induced windows of enhanced neuroplasticity. It provides an overview of existing digital therapeutics and then reviews synergistic combination treatments, outlining evidence that pairing approaches may improve the efficacy of one or both components. Finally, it discusses clinical implications for psychiatrists, including current use cases, practical limitations, and evolving regulatory and reimbursement pathways for digital therapeutics. Overall, integrated digital and biological treatments have promise for enhancing treatment outcomes and improving access. Future directions include adequately powered, well-controlled randomized trials, mechanistic studies of neuroplasticity, and real-world effectiveness research.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 3","pages":"269-277"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Invasive Brain Stimulation as a Tool to Decrease Chronic Pain in Current Opiate Users: A Parametric Evaluation of Two Promising Cortical Targets.","authors":"Julia P Imperatore, Daniel M McCalley, Jeffrey J Borckardt, Kathleen T Brady, Colleen A Hanlon","doi":"10.1176/appi.focus.26024119","DOIUrl":"10.1176/appi.focus.26024119","url":null,"abstract":"<p><strong>Background: </strong>Poorly controlled chronic pain can lead to non-prescription use of opiates, which is a growing crisis in our communities. Transcranial magnetic stimulation (TMS) is a non-invasive therapeutic tool which has emerged as a potential treatment option for these patients. It is still unclear, however, if the dorsolateral prefrontal cortex (DLPFC) or the motor cortex (MC) is a more effective treatment location. The purpose of this study was to directly compare the effects of DLPFC versus MC TMS on pain severity and the urge to use opiates among chronic pain patients.</p><p><strong>Methods: </strong>Twenty-two individuals with chronic pain currently using prescription opiates were randomized to receive 10, 3000 pulse sessions of 10 Hz repetitive TMS (rTMS) to the left DLPFC (110% resting motor threshold) or left MC (90% resting motor threshold). Multivariate linear models were used to evaluate the effect of TMS on pain and opiate use, including items from the Brief Pain Inventory (BPI) as well as subjective ratings of pain, distress, and the urge for opiates.</p><p><strong>Results: </strong>Twenty participants (91%) completed all 10 treatment sessions and follow up visits. There was a main effect of stimulation site (F_7,210=3.742, p=0.001), wherein MC stimulation decreased pain interference significantly more than DLPFC stimulation (F_1,216=8.447, p=0.004). While both sites had comparable effect sizes on stress, pain, and discomfort, MC stimulation had larger effects on pain interference (Cohen's d: 0.7) and urge to use opiates (Cohen's d: 0.5) than DLPFC stimulation.</p><p><strong>Conclusion: </strong>These data suggest that the MC may be a promising target for decreasing opiate dependence and pain interference among chronic pain patients.Reprinted from <i>Drug Alcohol Depend</i> 2021; 218:108409, with permission from Elsevier. Copyright © 2021.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 3","pages":"341-346"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining TMS and Ketamine for Treatment-Resistant Depression: Clinical Rationale, Current Evidence, and Practical Guidance.","authors":"Ian A Cook","doi":"10.1176/appi.focus.20260014","DOIUrl":"10.1176/appi.focus.20260014","url":null,"abstract":"","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"24 3","pages":"326-330"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}