Browse papers

40 papers

Navigating Stress: Exploring the Role of Empathy in Caregiving.

Spencer H et al. · Jul 1, 2026

Stress can negatively impact caregiving behavior; while chronic stress is consistently associated with reduced caregiver sensitivity, evidence regarding acute stress remains mixed. This preregistered study examined the causal effects of acute psychosocial stress on caregiver sensitivity with an experimental pseudorandomized design. Female participants (N = 130, M age = 21.16, SD = 1.65) were assigned to either an adapted Trier Social Stress Test or a control condition, and then interacted with an infant simulator while their caregiver sensitivity was observed. We also investigated the role of situational empathic behavior and trait empathic concern in the relationship between acute stress and caregiver sensitivity. Structural equation modeling demonstrated that acute stress did not significantly decrease caregiver sensitivity. Furthermore, situational empathic behavior did not explain how acute stress affected caregiver sensitivity, nor did trait empathic concern influence how acute stress affected situational empathic behavior. However, trait empathic concern was positively associated with caregiver sensitivity, affirming that empathy is fundamental to caregiving. We discuss that effects of acute stress may be more subtle compared to chronic stress and highlight the importance of sensitive measurement instruments in continued research, which will help us to further understand how stress impacts caregiving and, consequently, child outcomes.

Psychology

Trajectories Associated With the Use and Deprescription of Benzodiazepines and Z-Drugs in a Network of Geriatric Outpatient Clinics.

do Carmo Júnior NM et al. · Jul 1, 2026

Purpose To determine the trajectories of benzodiazepine (BZD) and Z-drug use among older adults (n = 3590) followed in a network of geriatric outpatient clinics in Brazil. Methods This longitudinal study evaluated BZD and Z-drug use over a 24-month follow-up period. The proportion of use at baseline and at the end of the study period was compared using the McNemar test. Two trajectories were considered: started using and stopped using. Comparisons between trajectories and independent variables were performed using Pearson's chi-square test. Variables with p Results A small but significant reduction in overall BZD or Z-drug use was observed (17.4% to 16.0%; p = 0.007), with a marked decrease in isolated Z-drug use (6.1% to 4.0%; p Conclusions Clinical vulnerability and psychiatric conditions were associated with BZD or Z-drug use and initiation, while pharmacist consultations were associated with both initiation and discontinuation trajectories.

Psychology

"I'm Not Here to Teach You How to Be Gay:" LGBTQ+ Client Experiences of Othering in Emotionally Focused Couple Therapy.

Edwards C et al. · Jul 1, 2026

Despite the increasing emphasis on addressing the intersections of client and therapist identity to improve therapeutic outcomes, therapy clients holding marginalized identities continue to experience othering. Othering is a process that engenders marginalization and inequality based on preconceived group identity, involves the hegemonic construction of belonging and not belonging, and often entails both stereotyping and racialization. This paper reports on the experience of lesbian, gay, bisexual, transgender, queer/questioning plus (LGBTQ+) emotionally focused couple therapy (EFCT) clients' experience of othering both in their own therapy and as part of participating in a research study on tailoring EFCT to account for the unique lived experience of members of the LGBTQ+ communities. This study relied on negative case analysis in the context of thematic analysis (TA) to develop three themes: (1) understanding versus inflating identity, (2) educating the therapist, and (3) deepening discussions around identity.

Psychology

Long-Term Trends in Prescribing of Etizolam for Hypnotic Use in a Japanese University Hospital.

Nakao M et al. · Jul 1, 2026

Objectives Etizolam is a short-acting thienodiazepine widely prescribed for anxiety and insomnia despite increasing concerns regarding dependence and guideline recommendations limiting long-term benzodiazepine use. This study examined long-term prescribing trends of etizolam compared with benzodiazepine and non-benzodiazepine hypnotics. Methods We conducted a retrospective database study including 16,886,524 prescriptions issued between April 2001 and March 2022 at a tertiary university hospital in Japan. Seventeen hypnotic agents were identified (10 benzodiazepines and 7 non-benzodiazepines). Multivariable logistic regression was used to identify factors associated with prescribing hypnotic etizolam versus non-benzodiazepine hypnotics. Results Among 124,179 etizolam prescriptions, 83,927 (67.6%) were issued for hypnotic use. Although the absolute number of prescriptions declined over time, the proportion prescribed for hypnotic use remained stable. The ratio of hypnotic etizolam prescriptions to non-benzodiazepine hypnotics was higher in internal medicine than in psychiatry. In multivariable analysis, prescribing hypnotic etizolam was independently associated with internal medicine (adjusted OR 1.57), female sex, outpatient status, younger age, and earlier calendar year. Conclusions Despite declining overall use, etizolam continues to be prescribed as a hypnotic, particularly in non-psychiatric settings. These findings highlight the persistence of specialty-specific prescribing patterns and underscore the importance of targeted educational and policy interventions to promote safer hypnotic prescribing practices.

Psychology

Preschoolers' Early Sentence Comprehension: Comparing Bilingual and Monolingual Children and the Role of Executive Function and Vocabulary Development.

Rodenhurst N et al. · Jul 1, 2026

Previous research into children's comprehension of syntactic structures has investigated early awareness of transitive and intransitive structures amongst monolingual children but research into bilingual children's understanding of the same sentence structures is lacking. This study compared 46 3-5-year-old bilingual children who spoke English and an additional language with 64 monolingual, English-speaking children, in their ability to associate transitive sentences with a causal scene, and intransitive sentences with a non-causal scene. In contrast to previous studies, the current study used still images instead of videos to create eight trials per structure, increasing the number of trials and testing structure as a within-participants manipulation. Children's vocabulary and executive function skills were also tested to observe interactions with the sentence comprehension task. Both groups showed the same overall pattern of effects, though the monolingual children were reliably more likely to match the causal scene to a transitive than bilingual children: Older children associated the transitive trials with causal scenes more than the intransitive trials, whereas 3-year-olds tended to associate both the transitive and intransitive sentences with causal scenes. Executive function performance did not differ between bilingual and monolingual children and was not related to sentence interpretation, but monolingual children had higher English vocabulary scores and children with greater vocabularies were better able to distinguish causal scenes as a match for transitive sentences. The results suggest that differences in comprehension of syntactic structures are more likely to be related to age and language ability, rather than differences in the number of languages spoken. SUMMARY: Bilingual and monolingual children showed similar patterns in their ability to comprehend transitive and intransitive sentences, though monolinguals more reliably associated transitives with causal scenes. 4- and 5-year-olds were better at associating transitives with causal scenes and intransitives with either causal or non-causal, whereas 3-year-olds associated both sentences with causal scenes. Age was a better predictor of differences in interpreting transitivity than the number of languages children speak. No executive function differences between bilinguals and monolinguals were found, monolinguals had larger English verb vocabularies; vocabulary was related positively to causal scene/transitive associations.

Psychology

Building Trust and Connection: A Family Systems Perspective on Black Veteran Reintegration.

Francis L. · Jul 1, 2026

Reintegration after military deployment is often viewed as an individual process, though it occurs in family systems. Black veterans remain underrepresented in reintegration research, particularly in studies focusing on relational trust and racialized stress. Semi-structured interviews were conducted with 23 veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) revealed four interrelated themes: presence, communication, racial identity, and family role negotiation. Findings indicate that trust was built through everyday relational processes rather than immediate emotional disclosure, and racial identity served as both a resource and a strain. These findings highlight trust as a relational process shaped by family dynamics and sociocultural contexts, extending reintegration literature.

Psychology

"I'm Going to Do Everything I Can to Keep You From Having to Interact With the Police": Queer Therapists' Perceptions of Police.

Cooke S et al. · Jul 1, 2026

This study investigated queer therapists' perceptions of police bias and attitudes toward police. We used a mixed-methods explanatory approach by administering the Perceptions of Police Scale (POPS) to mental health professionals and conducted follow-up qualitative interviews with participants who identify with a queer sexuality to explore the factors influencing their perceptions of police and the ways in which they view and utilize reliance on police when a client is experiencing a mental health crisis. Quantitative data were analyzed with SPSS using correlations and t-tests to assess the relationship between sexuality and perceptions of police scores. Sexuality significantly correlated with perceptions of the police, meaning queer therapists viewed the police less favorably compared to heterosexual participants. A qualitative analysis using reflexive thematic analysis revealed seven themes that address how queer therapists perceive police and strategies utilized to decide if calling 911 for a client in crisis would be lifesaving or life-threatening.

Psychology

Augmented Reality-Assisted Training Tool for Mental Health Task-Sharers: Pilot Mixed Methods Usability Study.

Ngiam LLV et al. · Jun 25, 2026

Background The growing global mental health (MH) burden, especially in underresourced communities, calls for innovative, scalable, and culturally responsive training approaches to expand care access and improve outcomes. Task-sharing has shown promise in addressing workforce shortages but is limited by training and supervision challenges. Traditional methods, such as role-playing and standardized patients, are resource-intensive and less scalable. Virtual simulations, including augmented reality (AR), present novel opportunities for immersive and interactive training. An AR-assisted training tool can enable culturally sensitive training while fostering empathy, communication skills, and confidence in handling nuanced MH scenarios. However, AR's usability and effectiveness for MH task-sharing training remain underexplored. Objective This study aimed to assess the usability of an AR-assisted MH task-sharing training tool that uses virtual patient (VP) simulation and evaluate its potential to enhance training. Additionally, we developed design recommendations for future related XR-assisted clinical training tools. Methods We conducted a formative, explorative sequential mixed-methods usability study. A convenience sample of 5 MH trainees or workers (ages 18-60 years; female: n=3, male: n=2; identifying as African American, Asian, and Hispanic) participated. Participants were recruited through a university-affiliated MH training program. The usability testing protocol included a semistructured prestudy interview, orientation to the AR headset (Magic Leap 2), a think-aloud user testing session, and a poststudy quantitative questionnaire and qualitative interview. Usability was assessed using a modified Post-Study System Usability Questionnaire (PSSUQ), which measures system usefulness, information quality, and interface quality. Data were analyzed using descriptive statistics and thematic analysis. Results The AR simulation was positively received by participants, demonstrating above-average usability. The overall mean PSSUQ score was 3.46 (SD 1.71), with subscale scores for system usefulness (mean 3.46, SD 1.77), information quality (mean 3.76, SD 1.73), and interface quality (mean 2.83, SD 1.59). Thematic analysis highlighted high realism fostered trainees' empathy toward the VP, while increasing immersion and interaction quality. Despite some hardware limitations and user discomfort that broke immersion, participants recognized the tool's potential and usefulness for training in various MH scenarios. Based on these findings, we proposed design recommendations across environmental context, training structure, VP behavioral realism (body language, voice, eye movement, and technical hardware considerations). Conclusions This pilot study is among the first to evaluate AR-based VP simulation for training lay MH task-sharers, filling the technology and population gaps of prior VR- and desktop-focused simulation research. Preliminary empirical usability evidence from a validated instrument (PSSUQ) demonstrates above-average usability, and findings informed design recommendations for future research. These findings suggest AR-based training could provide a less resource-intensive solution for realistic MH training practice in underresourced settings. Further research includes larger sample sizes for inferential analysis, comparison studies with traditional methods, and generalizing to other MH conditions.

Psychology

Evaluating a Dual Digital Cognitive Behavioral Therapy and Health and Wellness Coaching Intervention for Anxiety and Depression: Single-Arm Pilot Study.

Kirk A et al. · Jun 25, 2026

Background Anxiety and depressive disorders remain highly prevalent and insufficiently treated, with many individuals experiencing persistent or untreated symptoms, limited access to evidence-based care, or insufficient support between clinical encounters. Adults with disabilities represent a particularly underserved subpopulation, often facing compounded barriers to mental health care and higher rates of anxiety and depression. Digital therapeutics offer a scalable opportunity to address these gaps by extending structured, evidence-based interventions beyond traditional care settings. Objective This pilot study evaluated Rauha, a novel digital therapeutic created by Toivoa Inc, that integrates cognitive behavioral therapy (CBT)-based modules with live weekly sessions led by a National Board-Certified Health and Wellness Coach (NBC-HWC), delivering structured, smartphone-based psychoeducation and interactive therapeutic exercises combined with personalized mental health coaching to support behavior change. Methods Thirteen adults with mobility and/or hearing disabilities and clinically elevated anxiety and/or depression were enrolled in a single-arm, within-participants design. Participants completed 8 weeks of CBT modules delivered via smartphone, accompanied by synchronous virtual mental health coaching. Anxiety and depression were assessed using the Hamilton Anxiety and Hamilton Depression Rating Scales, respectively, at baseline, post treatment, and at the 4-week follow-up. Results Mean reductions were significant for both anxiety (-13.05, SD 2.51; P Conclusions The findings suggest that a combined digital CBT and NBC-HWC approach can yield clinically meaningful and durable symptom reductions in depression and anxiety, coupled with high user acceptability and engagement, for adults with disabilities. These findings provide preliminary evidence supporting Rauha as a scalable, evidence-informed mental health intervention with the strong potential to improve access and address key barriers to care.

Psychology

Multimodal emotion recognition using hybrid deep feature fusion under speaker-independent evaluation.

Ibrahim E et al. · Jun 25, 2026

Emotion recognition is one of the most important and complex challenges for machines to understand, as most robots and AI agents struggle with human-centric perception and interpretation. Therefore, this paper introduces a novel multimodal emotion recognition system that analyzes emotions through two complementary channels: voice and facial expressions. The proposed approach is evaluated on the RAVDESS and CREMA-D datasets, which consist of acted emotional expressions across multiple discrete emotion categories. Utilizing an advanced multimodal deep feature fusion technique, the system combines handcrafted audio features (e.g., Mel-Frequency Cepstral Coefficients (MFCCs)) with deep visual features extracted from an attention-based VGGFace model. These features are integrated into a unified representation through a hybrid fusion strategy that jointly employs concatenation, cross-attention, gated fusion, and multiplicative fusion mechanisms to capture complementary cross-modal interactions. To ensure a comprehensive and realistic assessment, the model is evaluated under both random-split and strict speaker-independent protocols. On the RAVDESS dataset, the proposed system achieves an accuracy of 95.83% under random-split evaluation and 48.06% ± 9.76% accuracy under speaker-independent Leave-One-Speaker-Out (LOSO) testing, while on the CREMA-D dataset it attains 73.54% accuracy using random splits and 53.12% ± 2.65% accuracy under subject-exclusive speaker-independent 5-fold cross-validation.

Psychology