Ji-Won Hur

Background: Despite the high prevalence of depressive disorders, access to effective treatment remains limited due to financial, geographic, and social barriers. Online self-help groups offer a promising and scalable form of peer-based support beyond traditional clinical settings. Integrating cognitive behavioral therapy (CBT) techniques such as cognitive restructuring and behavioral activation into self-help groups may enhance their effectiveness. Objective: This study evaluated the efficacy of a cognitive behavioral therapy–based online self-help group (COS) that integrates structured CBT techniques with peer-led group support as a low-intensity intervention for individuals with depressive symptoms. A randomized controlled trial (RCT) comparing COS with a CBT-based mobile application was conducted. Additionally, a separately recruited waitlist control group was included as a supplementary comparison condition. Methods: Participants were recruited online. After eligibility screening via a structured clinical interview, participants were randomly assigned to a COS group (n=79) or a CBT-based mobile application group (n=39). An additional waitlist control group (n=48) was recruited separately during the second phase of the study. The COS intervention involved 7 videoconferencing sessions that incorporated peer-led group discussions, sharing lived experiences, and core CBT techniques such as cognitive restructuring. The primary outcome measure was depressive symptoms, assessed using the Beck Depression Inventory-II, and the secondary outcome was suicidal ideation, estimated using the Beck Scale for Suicide Ideation, measured at baseline, postintervention, and 3-month follow-up. Linear mixed models were used to evaluate group × time interaction effects. Reliable change indices were also calculated to assess clinical significance. All statistical tests were 2-tailed. Results: Among participants assigned to the COS group, 61% (48/79) completed all 7 sessions, and 84% (66/79) attended 5 or more sessions. A significant time × group interaction was observed for depressive symptoms ( F _4,288.47 =7.23, P <.001). The COS group exhibited a substantial reduction in depressive symptoms from baseline to postintervention ( t _285.76 =10.77, two-tailed; P <.001), with a large within-group effect size ( d =1.38); this improvement was maintained at the 3-month follow-up. Suicidal ideation also significantly decreased in the COS group ( t _277.11 =4.55, two-tailed; P <.001), with sustained effects at follow-up. Clinically meaningful improvement in depressive symptoms, as defined by the reliable change index, was observed in 75% (56/75) of COS participants. While both the COS and app-based CBT groups achieved comparable reductions in depressive symptoms, only the COS group demonstrated a significant reduction in suicidal ideation. Conclusions: This RCT provides evidence that a structured, CBT-informed online self-help group can reduce depressive symptoms and suicidal ideation. The COS program offers a scalable, accessible alternative to traditional therapy, particularly in settings with limited access to mental health professionals.

Nonsuicidal self-injury (NSSI) is associated with altered emotional processing. However, the neural correlates of cognitively demanding emotion regulation remain elusive. This fMRI study explored the neural underpinnings of emotional working memory (WM) in individuals with NSSI, focusing on task-induced deactivation as a potential neural response to emotionally demanding contexts. Thirty-two individuals with NSSI and 28 controls completed an emotional WM task that varied WM load (0-back vs. 2-back) and emotional distractor types (Neutral vs. Negative). Neural activity was analyzed for associations with self-reported emotion dysregulation, emotion reactivity, and behavioral performance. Despite comparable behavioral performance across groups, the NSSI group showed greater task-induced deactivation in early visual processing regions (e.g., calcarine sulcus). The deactivation patterns in the bilateral calcarine sulci were positively associated with reaction time and negatively associated with accuracy, suggesting a link to task performance efficiency. These findings provide tentative evidence that NSSI may be associated with altered task-induced deactivation in early visual processing regions. This pattern may reflect increased visual-perceptual suppression when emotional interference is anticipated, highlighting the potential relevance of task-induced deactivation for understanding emotion-cognition interactions in this clinical population.

Prior research has highlighted various risk factors for nonsuicidal self-injury (NSSI), yet inconsistencies remain regarding their predictive value and sex-specific effects. This study examined how childhood maltreatment, current perceived stress, and alexithymia contribute to the engagement and severity of NSSI, with a focus on sex differences. A total of 731 individuals participated in this study (233 males, 498 females). The sample consisted of 481 individuals with NSSI (124 males, 357 females) and 250 control participants without a history of NSSI (109 males, 141 females). Logistic and multiple regression analyses were conducted separately by sex to test the differential predictive value of the factors. Among males, physical abuse significantly predicted NSSI engagement, and current stress was uniquely linked to greater NSSI method versatility. Conversely, in females, emotional abuse, current stress, and alexithymia emerged as key predictors of NSSI engagement, while sexual abuse, physical neglect, and alexithymia predicted greater severity. These findings underscore the existence of distinct, sex-specific pathways linking early adversity, emotional processing difficulties, and proximal stress to both the engagement and severity of NSSI. Tailoring prevention and intervention strategies to account for these sex-specific patterns is required to improve clinical outcomes.

The present study investigated the mechanisms linking childhood maltreatment to symptoms of depression and anxiety in adulthood, with a focus on proximal p

Suicide is a major global public health concern, accounting for over 700,000 deaths annually (World Health Organization [WHO], 2022). Among young adults, it ranks as one of the leading causes of mo...

Introduction: We aim to evaluate the efficacy of interactive virtual reality (VR) therapy for social anxiety disorder (SAD) compared to an active comparator condition. We will also investigate the utility of digital phenotyping as a novel objective assessment tool for monitoring treatment responses. Methods: This single-blind, parallel-group, randomized controlled trial will recruit 100 adults aged 19–40 meeting DSM-5-TR criteria for SAD. Participants will be randomized 1:1 to: (1) an interactive social anxiety-specific VR therapy developed through multidisciplinary collaboration involving psychiatrists, psychologists, service designers, and digital artists; or (2) a metaphor-based VR therapy for generalized anxiety, as an active comparator. Both groups will complete six VR sessions over 3 weeks, administered twice a week. Analysis: The primary efficacy endpoint is change from baseline to post-treatment in social anxiety symptoms, assessed by the Korean version of the Liebowitz Social Anxiety Scale–Self Report (K-LSAS-SR). The Korean Social Avoidance and Distress Scale (K-SADS) and Social Interaction Phobia Scale (K-SIPS) are designated as key secondary endpoints, tested using a pre-specified fixed-sequence hierarchical procedure that preserves the family-wise type I error rate at α = 0.05 without alpha penalty. The secondary outcomes include depressive symptoms, interpersonal competence, and smartphone-derived digital phenotypes (activity, sleep). All assessments will be conducted at baseline, mid-treatment, post-treatment, and at 3-month follow-up. The primary analysis will use a linear mixed-effects model (LMM) to evaluate the group × time interaction at post-treatment. Ethics and dissemination: Approved by the Institutional Review Board of Korea University Anam Hospital (IRB No: 2024AN0537). The results will be disseminated through peer-reviewed publications, academic conferences, and institutional reports. We aim to validate the efficacy of VR therapy and establish digital biomarkers for precision psychiatric approaches to the treatment of SAD.

Background: Although sociodemographic characteristics related to extreme social withdrawal (ESW) have been investigated, the role of subjective socioeconomic status (SES) and the differential effects of interpersonal and non-interpersonal trauma remain underexplored. This study examined the effects of distal (i.e. subjective SES, interpersonal, and non-interpersonal trauma) and proximal (i.e. a history of psychiatric diagnosis and depressive symptoms) risk factors on ESW. Methods: Participants were 98 young adults with ESW and 740 controls, all aged 19−35 years. Measures included sociodemographic characteristics, subjective SES, interpersonal and non-interpersonal trauma exposure, history of psychiatric diagnosis, and depressive symptoms. Hierarchical logistic regression and path analysis were conducted for statistical analyses. Results: Hierarchical logistic regression analysis revealed that interpersonal trauma, psychiatric diagnosis, and depression were significantly associated with ESW. Path analysis further demonstrated a significant direct effect of interpersonal trauma on ESW, as well as indirect effects whereby subjective SES, interpersonal trauma, and non-interpersonal trauma influenced ESW through psychiatric diagnoses and depressive symptoms. Conclusions: These findings provide a more comprehensive account of the mechanisms underlying ESW and highlight the complex interplay of socioeconomic, traumatic, and psychiatric factors. Interventions should adopt a multifaceted approach that addresses not only behavioral withdrawal but also socioeconomic inequality, trauma exposure, and co-occurring psychiatric symptoms.