The UP-A is built on a deceptively simple premise: anxiety and depressive disorders share common underlying mechanisms, most notably difficulties in regulating intense emotions and a tendency to avoid or escape uncomfortable emotional experiences. Rather than teaching teenagers separate skills for panic, social anxiety, generalized worry, or depression, the protocol trains them to notice, tolerate, and respond flexibly to whatever emotion they are feeling. Its theoretical foundation draws on emotion science and cognitive-behavioral principles, emphasizing that emotional disorders persist when people fight their feelings rather than working with them. In adolescents, whose emotional systems are still developing and whose symptoms frequently shift between diagnostic categories over time, this transdiagnostic logic has particular appeal.

The Spanish research team, led by Lucía Cortés and Julia García-Escalera of the National University of Distance Education (UNED) together with clinicians from Majadahonda’s Mental Health Center in Madrid, set out to answer a practical question: could this protocol, which had shown promise in individual sessions, work in a group format inside a public mental health service? Group delivery matters enormously for cash-strapped public systems. One therapist can treat several adolescents simultaneously, waiting lists shrink, and the group itself becomes a therapeutic tool, allowing teenagers to see that peers share their struggles and to practice new emotional skills in front of an audience that understands.

The study enrolled thirty-one adolescents with a mean age of 14.03 years, 87.1 percent of whom were female, in a sixteen-session group intervention. The design included three additional group sessions for parents, reflecting growing evidence that treating an adolescent in isolation ignores the family system in which emotional problems unfold. Parents learned the same core ideas about emotions and avoidance, so they could respond to their child’s distress in ways that supported rather than undermined the skills being practiced in therapy. The intervention was delivered by clinicians within the center itself, not by researchers in a laboratory setting, which is precisely what makes the preliminary evaluation notable: it tested feasibility under the messy, realistic conditions of routine public care.

The results were encouraging on every dimension the team measured. Just over eighty percent of participants, 80.65 percent, completed the full treatment, a completion rate that compares favorably with many adolescent interventions, where dropout is a persistent challenge. Adolescents and parents alike reported high satisfaction with the program and strong therapeutic alliance, the sense of trust and collaboration between client and therapist that research consistently links to better outcomes. In a group format, alliance extends beyond the therapist to the group as a whole, and the strong ratings suggest the teenagers felt connected to both their clinicians and their peers.

The clinical findings were equally significant. Adolescents themselves reported meaningful improvements in emotional symptoms and in the emotion regulation strategies the protocol is designed to strengthen. Parents observed reductions in their children’s depressive symptoms. Independent clinician ratings, which provide a check on the self-report and parent-report data, indicated reduced diagnostic severity and improved day-to-day functioning. In other words, the teenagers were not just feeling better on questionnaires; the clinicians who assessed them saw the intensity of their diagnoses ease and their ability to handle school, family, and social life improve.

Technically, the study is a preliminary, uncontrolled evaluation rather than a randomized trial, and the authors are careful about what that means. Without a comparison group, improvements cannot be attributed with certainty to the treatment itself; some change might reflect natural remission, regression to the mean, or the simple passage of time. The predominantly female sample also limits how far the findings generalize to boys. The study was retrospectively registered on ClinicalTrials.gov, and the team explicitly calls for randomized controlled studies to confirm the results. Yet the pattern of change across three independent sources of information, adolescent self-report, parent report, and clinician rating, is the kind of convergent evidence that preliminary evaluations are designed to detect, and it justifies the investment that a full randomized trial would require.

The broader significance of the work lies in its setting. Public mental health systems across Europe and beyond face rising demand for adolescent care, chronic underfunding, and long waiting lists, while most evidence-based treatments were developed and tested in university clinics with carefully selected samples. Demonstrating that a transdiagnostic protocol can be adapted to groups and delivered by regular clinicians in a Spanish public center addresses the critical gap between research and practice. If the findings hold up in randomized trials, the group UP-A could offer public services a way to treat a wide range of emotional disorders with a single, efficient, evidence-based program, rather than maintaining separate treatment pathways for each diagnosis.

There is also a scientific story here about how the field understands adolescent emotional disorders. Symptoms of anxiety and depression co-occur so frequently in adolescence that many researchers now view them as expressions of a shared vulnerability in emotional processing rather than as distinct illnesses. The UP-A operationalizes that view, targeting the mechanisms, emotional avoidance and dysregulation, that keep disorders alive regardless of their surface presentation. A group format adds a social dimension to this mechanism-focused approach: teenagers practice accepting and tolerating difficult emotions in front of peers who are doing the same work, which may itself counteract the shame and isolation that fuel avoidance.

The Spanish team’s next steps will determine whether this promising start becomes a standard tool of public adolescent mental health care. Randomized controlled trials with comparison groups, larger and more diverse samples, and longer follow-up periods are needed to establish whether the improvements persist and whether the group format matches the effectiveness of individual delivery. For now, the study stands as a concrete demonstration that a mechanism-based, transdiagnostic therapy can survive the journey from the research manual to the group room of a public mental health center, and that the adolescents who walked into that room, most of them struggling with the tangled combination of anxiety and depression that defines modern adolescence, left it measurably better equipped to face their emotions rather than flee from them.

Subject of Research: Psychology

Article Title: Development and preliminary evaluation of a group adaptation of the unified protocol for transdiagnostic treatment of emotional disorders in adolescents (UP-A) in a Spanish public mental health center

Article References: Cortés, L., García-Escalera, J., Casanova, I., Segura, A., Valiente, R. M., & Chorot, P. (2026). Development and preliminary evaluation of a group adaptation of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in adolescents (UP-A) in a Spanish public mental health center. BMC Psychology, 14(1), Article 1456. https://doi.org/10.1186/s40359-026-05472-8

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05472-8

Keywords: UP-A, transdiagnostic treatment, adolescent mental health, group therapy, anxiety, depression, emotion regulation, public mental health, BMC Psychology, Unified Protocol, Development, preliminary

The research team, led by Michael Minor of the Essener Forschungsinstitut für Medizinmanagement (EsFoMed) in Essen, Germany, searched Embase, PubMed, and Web of Science through May 2025. Following the Cochrane Handbook and reporting under the PRISMA 2020 checklist, they screened more than 7,000 records and ultimately included eleven randomized controlled trials: eight in physiotherapy, two in speech therapy, and one in occupational therapy. Crucially, the team only accepted studies in which the group and individual interventions followed identical therapy protocols, ensuring that any observed differences could be attributed to the delivery format rather than the treatment content itself.

The scope of the included trials was remarkably broad. In physiotherapy, studies examined constraint-induced movement therapy, task-oriented circuit training, and mirror therapy for stroke patients, exercise training for children with developmental coordination disorder, pelvic floor muscle training for women with stress urinary incontinence, multimodal programs for Parkinson’s disease and chronic knee pain, and strength training for resistance-trained men. The speech therapy trials covered voice therapy for children with vocal fold nodules and narrative-based language intervention for children with cochlear implants, while the single occupational therapy study applied a developmental floortime model to toddlers with autism.

Across these eleven trials, the researchers evaluated 76 distinct outcomes spanning motor function, voice-related measures, adaptive behavior, activities of daily living, pain, quality of life, and process indicators such as attendance and satisfaction. The headline finding is that 67 of those 76 outcomes showed no statistically significant difference between group and individual therapy after intervention. Group therapy produced better results in five outcomes, individual therapy in four. In other words, the delivery format appears to matter far less than the therapy itself.

Some nuances emerged within the noise. In stroke rehabilitation, group-based circuit training and constraint-induced movement therapy occasionally favored the group format, with one trial reporting significantly higher gait speed gains measured by the six-minute walk test, and another showing larger improvements on the Motor Activity Log and Action Research Arm Test in group participants. Conversely, a mirror therapy trial found that resistance to passive movement of the finger flexors improved more in individual sessions. In the voice therapy study, individual participants achieved a higher s/z ratio while group participants scored better on the noise harmonic ratio. Therapists in the pediatric voice study also noted that group sessions were more enjoyable, with patients appearing more competitive and motivated.

One trial stood apart for its focus on healthcare delivery rather than clinical endpoints. It found that group therapy participants waited fewer days before starting treatment, allowing earlier intervention, while staff burden did not increase and nonattendance rates remained similar to individual care. This process advantage is significant given the scale of demand: in Germany alone, roughly 334 million treatments were performed in 2025, with physiotherapy accounting for approximately 271 million of them. Yet less than 0.1 percent of physiotherapy treatments, 1.6 percent of occupational therapy treatments, and 0.5 percent of speech therapy treatments were delivered in group format, despite policy that nominally prioritizes group delivery for cost-effectiveness.

The methodological verdict, however, tempers any enthusiasm. Using the Cochrane RoB 2 tool, the reviewers judged eight of the eleven studies to carry a high overall risk of bias, with the remaining three raising some concerns; no study achieved low risk across all domains. High risks clustered around deviations from intended interventions and missing outcome data, often reflecting absent pre-registered protocols and unspecified analysis plans rather than clearly flawed conduct. Applying the GRADE framework, the certainty of evidence was rated low or very low for every outcome domain, driven primarily by the very serious risk of bias and, in most domains, cumulative sample sizes below 400 participants.

The heterogeneity problem proved equally formidable. Patient populations ranged from toddlers with autism to resistance-trained males, group sizes fluctuated between two and ten participants, interventions lasted from two to twelve weeks with sessions of 30 to 180 minutes, and outcome instruments varied from the Fugl-Meyer Test to the Adaptive Behavior Assessment System. Because effect estimates were not sufficiently comparable, the authors could not perform a meta-analysis and instead synthesized results narratively. Notably, every included trial was conducted in person; despite the search strategy permitting digital formats with synchronous video communication, no qualifying telemedicine studies were identified, leaving the effectiveness of digital group therapy entirely unexamined.

The authors are careful about what their null findings do and do not mean. Most trials were powered only to detect medium or large effects, so small but clinically meaningful differences may have gone undetected. Statistical non-significance, they emphasize, is not proof of equivalence; observing similar mean outcomes differs from demonstrating equal effectiveness. The findings align with prior reviews, including work on developmental coordination disorder, stroke and ischemic heart disease recovery, post-stroke upper limb interventions, and physical therapy for urinary incontinence and low back pain, all of which similarly failed to establish consistent differences between formats while acknowledging limited evidence quality.

The practical implications remain tantalizing but unproven. Group therapy could simultaneously treat more patients, shorten waiting times, and stretch limited rehabilitation resources, and the single trial measuring process indicators offered a glimpse of that promise. But with only eleven studies, pronounced imbalance across the three therapeutic disciplines, several small pilot trials, and no cost comparisons among the included studies, the review cannot yet declare which indications suit group delivery. The authors call for future research with strong methodological frameworks, adequately powered samples, and attention to both costs and treatment effects, particularly in speech therapy and occupational therapy where evidence remains scarcest. Until then, the choice between group and individual therapy rests on judgment, logistics, and hope rather than on solid evidence.

Subject of Research: Systematic review comparing group and individual therapy delivery formats across physiotherapy, occupational therapy, and speech therapy finds no clear evidence favoring either format.

Article Title: Comparison of group and individual therapy in physiotherapy, occupational therapy, and speech therapy: a systematic review

Article References: Minor, M., Plath, E., Volland, C., Neusser, S., & Bußmann, A. (2026). Comparison of group and individual therapy in physiotherapy, occupational therapy, and speech therapy: a systematic review. Frontiers in Rehabilitation Sciences, 7, Article 1904321. https://doi.org/10.3389/fresc.2026.1904321

Image Credits: AI Generated

DOI: 10.3389/fresc.2026.1904321

Keywords: group therapy, individual therapy, physiotherapy, occupational therapy, speech therapy, systematic review, rehabilitation, randomized controlled trials, risk of bias, GRADE, telemedicine, healthcare delivery

The research, led by Katharina T. E. Morken of Haukeland University Hospital and the University of Bergen, together with colleagues at Oslo University Hospital, drew on data from the Network of Personality Disorders in Norway, a quality register covering specialised treatment units across the country. In total, 742 patients with personality disorders were followed during treatment delivered between 2017 and 2022. The scale and design of the study matter: rather than a snapshot of a single clinic, the investigators tracked patients repeatedly over time across many treatment centres, allowing them to separate changes within individual patients from stable differences between them.

At baseline, every participant underwent structured diagnostic interviews. Personality disorders were assessed with the Structured Clinical Interview for DSM-5 Personality Disorders, while other mental disorders were captured using the Mini International Neuropsychiatric Interview. Substance use was measured with the first three items of the Drug Use Disorders Identification Test and the three-item consumption version of the Alcohol Use Disorders Identification Test. Crucially, these substance use measures were repeated at six-month intervals throughout treatment, so the researchers could observe how fluctuations in a patient’s own drinking and drug use related to fluctuations in the quality of their therapeutic relationships.

The therapeutic alliance itself was measured from the patient’s perspective using two well-established instruments. For individual therapy, patients completed the Working Alliance Inventory Short Form, which breaks the alliance down into three components: the emotional bond between patient and therapist, agreement on the tasks of therapy, and agreement on its goals. For group therapy, patients completed the Group Questionnaire, which captures not only bond, work, and goal agreement but also the deeper sense of mutuality and collaboration within the group. These alliance ratings were also collected every six months, producing a dense longitudinal dataset.

To analyse this structure, the team used three-level hierarchical linear mixed models, a statistical framework designed for nested data. Repeated alliance assessments were nested within patients, and patients were nested within treatment centres. This approach allowed the investigators to ask a precise question: when a given patient reports higher substance use than their own typical level, does their alliance rating drop? This within-person design is statistically powerful because each patient serves as their own control, filtering out stable traits that might otherwise confound the association.

The headline result concerns group therapy. After accounting for time of assessment, personality disorder diagnosis, other mental disorders, gender, age, and treatment context, the researchers found a significant negative relationship between within-person increases in substance use and the work dimension of the Group Questionnaire. In plain terms, when patients used more drugs than their own average, they reported poorer mutuality in the collaborative work of their therapy groups. This is a specific and clinically meaningful finding: the work component of group alliance reflects how well members engage together in the shared task of treatment, and it is precisely this collaborative core that appears vulnerable to substance use.

Perhaps more striking is what the study did not find. There were no significant associations between substance use and total alliance scores in either group or individual treatment, and no significant links to the emotional bond in either setting. Trends emerged suggesting a negative association between substance use and agreement on tasks and goals in individual therapy, but these did not reach statistical significance. Alcohol consumption, measured by the AUDIT-C, showed no significant associations with any alliance measure. The damaging signal, in other words, was confined to drug use and to one specific facet of the group alliance.

The authors are candid about the implications of this pattern. The negative impact of comorbid substance use on the therapeutic alliance appears to be more limited than previous literature had suggested. Instead, they argue, the preponderance of alliance-related difficulties in patients with personality disorders may reflect the influence of the personality disorder itself, or other patient-level factors that have not yet been characterised. This reframing is important. If clinicians assume that substance use is the primary obstacle to alliance formation in this population, they may misattribute difficulties that actually stem from the interpersonal and emotional features of the personality disorder, such as mistrust, fear of abandonment, or unstable self-image.

For treatment planning, the study points toward pragmatism and responsiveness. The clinical significance statements accompanying the paper emphasise that a sensitive, responsive collaboration between patient and therapist may be critical when tailoring treatment for patients with combined personality disorder and substance use conditions. Because the observed effect was specific to group work and to the mutuality of collaboration, group-based programmes—the backbone of much specialised personality disorder treatment, including mentalization-based approaches delivered at several of the participating units—may need to monitor substance use actively and adjust group interventions when a patient’s use escalates. Rather than excluding these patients from group treatment, the findings suggest vigilance and flexibility.

Methodologically, the study also demonstrates the value of longitudinal, multi-level designs in psychotherapy research. Cross-sectional studies can show that patients with substance use disorders report weaker alliances, but they cannot determine whether substance use drives the alliance or whether some third factor explains both. By modelling repeated measurements within patients across eighteen treatment units, the Norwegian team could isolate the dynamic contribution of substance use with unusual clarity. The remaining uncertainty lies in the association between substance use and alliance being weaker than hypothesised, and in the possibility that missing data or unmeasured patient characteristics still shape the picture. Even so, the central message stands: in specialised personality disorder treatment, comorbid drug use specifically undermines the collaborative work of group therapy, while the broader alliance appears more resilient than feared—a finding that should reassure clinicians and sharpen their attention to the group setting where the vulnerability is real.

Subject of Research: The effect of comorbid substance use on therapeutic alliance in specialised personality disorder treatment

Article Title: The impact of comorbid substance use on individual and group therapeutic alliance in specialised personality disorder treatment: a longitudinal multi-site study

Article References: Morken, K. T. E., Molde, H., Bergwitz, A., Hummelen, B., Pedersen, G., & Kvarstein, E. H. (2026). The impact of comorbid substance use on individual and group therapeutic alliance in specialised personality disorder treatment: a longitudinal multi-site study. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08707-5

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08707-5

Keywords: therapeutic alliance, personality disorder, substance use disorder, group therapy, group cohesion, hierarchical linear models, longitudinal study, Working Alliance Inventory, Group Questionnaire, mental health, psychotherapy, comorbidity

The team cast a wide net. They searched five major scientific databases, PubMed, Web of Science, Scopus, Embase, and EBSCO, from their earliest records all the way to January 24, 2026, looking for randomized controlled trials that tested CBT or CBT-based interventions in adult cancer patients. Randomization matters here. By assigning participants by chance to either therapy or control groups, trials guard against the subtle biases that can inflate results in weaker study designs. After screening and selection, the researchers settled on thirteen randomized controlled trials encompassing 1,193 participants. That may sound modest compared with pharmaceutical mega-trials, but for psychotherapy research, where funding is scarce and recruitment difficult, it represents a substantial and hard-won evidence base.

The methodological machinery behind the analysis deserves attention, because it determines how much trust the findings deserve. The authors assessed the risk of bias in each trial using the Cochrane Risk of Bias 2 tool, the current gold standard for judging whether a study’s design could distort its results. They then graded the certainty of the evidence using the GRADE framework, which downgrades confidence when studies are inconsistent, imprecise, or indirect. The actual number crunching was performed in Review Manager 5.4, software developed by the Cochrane Collaboration specifically for meta-analysis. One technical wrinkle illustrates the care involved: two of the included trials had three arms, meaning they compared CBT against two different control conditions. Rather than letting those trials exert double influence, the researchers disaggregated them into separate intervention-control comparisons, yielding fifteen pairwise comparisons for the primary analysis of psychological distress.

The headline result concerns psychological distress itself, the composite of anxiety and depressive symptoms that shadows so many patients through diagnosis, treatment, and survivorship. Across the pooled comparisons, CBT produced a standardized mean difference of minus 0.49, with a 95 percent confidence interval spanning minus 0.70 to minus 0.28. For readers unfamiliar with effect sizes, a standardized mean difference of roughly 0.5 is conventionally described as a moderate effect, large enough to be clinically meaningful without being transformative. In practical terms, the average patient receiving CBT fared better than about two-thirds of patients in the control groups. Crucially, because the confidence interval sits entirely below zero, the analysis supports a genuine benefit rather than a statistical fluke.

The benefits did not stop at distress. CBT also reduced fatigue, one of the most common and stubborn side effects of cancer and its treatment, with a standardized mean difference of minus 0.32 and a confidence interval of minus 0.60 to minus 0.04. That interval brushes close to zero, hinting at more variability across trials, but it still favors the therapy. Fear of cancer recurrence, the pervasive worry that the malignancy will come back, fell with a standardized mean difference of minus 0.36, bounded by minus 0.56 and minus 0.16. Meanwhile, quality of life moved in the opposite, positive direction, improving by a standardized mean difference of 0.50 with a confidence interval of 0.30 to 0.70. Taken together, the pattern suggests CBT acts on the whole psychosocial experience of cancer rather than on a single symptom in isolation.

Why would a therapy built on changing thought patterns relieve physical fatigue? The answer lies in the interconnected biology and psychology of the cancer experience. Cognitive behavioral therapy teaches patients to identify distorted or catastrophic thinking, challenge it with evidence, and replace it with more balanced appraisals, while also modifying behaviors such as activity pacing, sleep habits, and avoidance. Catastrophic interpretations of bodily sensations can amplify fatigue and drive a cycle of rest and deconditioning that deepens exhaustion. Similarly, recurrent intrusive worries about the cancer returning fuel hypervigilance, sleep disruption, and emotional depletion. By interrupting these loops, CBT plausibly relieves both the mental and somatic dimensions of distress, which is precisely what the pooled data appear to show.

One of the most clinically useful parts of the analysis is its exploration of how therapy is delivered. Subgroup analyses of psychological distress suggested that group-based CBT produced greater effects than individual-based CBT. That finding carries real economic weight. Group formats allow a limited pool of trained therapists to reach many more patients, reducing cost per person and potentially shortening waiting lists in oncology departments where psychological services are chronically overstretched. They may also add therapeutic ingredients of their own, since sharing experiences with fellow patients can normalize fears and build social support. The authors are careful, however, to frame this as a subgroup signal rather than a definitive verdict, since such comparisons across a limited number of trials can be confounded by differences between the studies themselves.

Equally notable is what did not differ. The subgroup analyses found no statistically significant difference between online and face-to-face delivery of CBT. In an era when telehealth has moved from emergency stopgap to standard option, this null result is quietly revolutionary. It suggests that patients in rural areas, those too ill to travel, and those who simply prefer the privacy of their own homes may access evidence-based psychological care without sacrificing effectiveness. Digital delivery also opens the door to scalable platforms, guided self-help programs, and stepped-care models in which patients begin with lower-intensity online interventions and step up to more intensive support only when needed. For health systems wrestling with the sheer volume of cancer survivors needing psychological support, that flexibility could be decisive.

The research comes from the Department of Nursing at Nanfang Hospital and the School of Nursing at Southern Medical University, and the authors report no funding, grants, or competing interests, a transparency note that strengthens confidence in the work. The study followed PRISMA reporting guidelines, the international standard for systematic reviews, and the article is published open access under a Creative Commons license, making the full analysis freely available to clinicians and patients worldwide. Still, the authors themselves flag the limits of the evidence. Thirteen trials with roughly 1,200 participants cannot settle every question, and the certainty of the underlying evidence, as graded by GRADE, is constrained by the quality and heterogeneity of the included studies. Their explicit call is for further high-quality randomized trials with long-term follow-up, since psychological benefits that fade within months are far less valuable than those that endure.

Even with those caveats, the analysis lands at a moment when the psychological dimension of cancer care is finally receiving the attention it deserves. Professional bodies increasingly argue that distress should be screened and treated as routinely as pain, and this meta-analysis supplies the quantitative backbone for that argument. A therapy with moderate effects on distress, fatigue, fear of recurrence, and quality of life, deliverable in groups and online alike, represents one of the most cost-effective tools oncology can deploy. For the millions of people navigating life with and after cancer, the message is both simple and evidence-backed: the mind can be treated alongside the tumor, and structured, skills-based talk therapy is a proven way to do it. The next challenge is ensuring that health systems actually build the capacity to offer it to every patient who needs it.

Subject of Research: Effects of cognitive behavioral therapy on psychological distress and related outcomes in adult cancer patients

Article Title: Effects of cognitive behavioral therapy on psychological distress in patients with cancer: a systematic review and meta-analysis

Article References: Zheng, S., Tang, L., & Zhou, H. (2026). Effects of cognitive behavioral therapy on psychological distress in patients with cancer: a systematic review and meta-analysis. BMC Psychology. https://doi.org/10.1186/s40359-026-05710-z

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05710-z

Keywords: cognitive behavioral therapy, cancer, psychological distress, meta-analysis, randomized controlled trials, quality of life, fatigue, fear of cancer recurrence, psychotherapy, group therapy, online therapy, mental health