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Generation Alpha (born 2010-2024) and Generation Beta (born 2025-2039) represent an unprecedented developmental archetype defined by total digital integration and ubiquitous artificial intelligence (AI). This empirical study evaluated specialized psychological adaptation mechanisms, parenting models, and mental health intervention frameworks across these cohorts. Utilizing a mixed-methods design, quantitative data were gathered from $N = 300$ parents (Gen Alpha parents and expectant/early Gen Beta parents) using the Modified Parental Stress Scale (PSS) and Child Behavior Checklist (CBCL), supplemented by qualitative interviews with $N = 20$ pediatric mental health experts. Independent samples $t$-tests confirmed that Gen Alpha/Beta display significantly higher digital dependency anxiety ($M = 38.60, p < .001$) alongside superior visual-spatial intelligence ($M = 44.10, p < .001$) relative to normative baselines. Crucially, a proactive "Digital Integration" co-navigation parenting framework yielded significantly lower parental stress ($M = 29.50$) compared to rigid "Digital Detox" restriction models ($M = 42.80, p < .001$). A preventive clinical framework focusing on Social-Emotional Learning (SEL) and cognitive impulse management is proposed.

This study examined the association between intolerance of uncertainty and psychological distress among emerging adults aged 18-29 years. A quantitative, cross-sectional correlational design was used with online convenience sampling. Of 181 survey submissions, one record was excluded because age was missing and one because the respondent was aged 17 years; a further 18 respondents who reported a previous mental-health diagnosis were excluded. The final analytical sample comprised 161 participants (M age = 23.60, SD = 3.09; 67.1% women). Intolerance of uncertainty was measured with the 12-item Intolerance of Uncertainty Scale (IUS-12), and nonspecific psychological distress with the Kessler Psychological Distress Scale (K10). Mean IUS-12 and K10 scores were 32.11 (SD = 9.44) and 24.31 (SD = 8.09), respectively. Internal consistency estimates were .887 and .913. Pearson's correlation indicated a positive association between IUS-12 and K10 scores, r(159) = .632, p < .001, 95% CI [.529, .717]. Spearman's correlation was also positive and significant (rs = .595, p < .001, 95% bootstrap CI [.475, .699]). Higher intolerance of uncertainty was associated with greater self-reported psychological distress in this sample. The cross-sectional design, convenience sampling, self-report measures, and diagnosis-based screening limit causal inference and generalisability.

Background and Purpose: Non-suicidal self-injury (NSSI) is a global concern in adolescent mental health. Rural boarding middle school students, as a unique and vulnerable population, remain understudied regarding the potential heterogeneity and longitudinal trajectories of NSSI. This study aimed to identify latent classes of NSSI among this group, examine their transition patterns over time, and evaluate the effectiveness of an emotion management group intervention. Methods: Study 1 cross-sectionally surveyed 927 adolescents; we split samples into non-NSSI and NSSI subgroups and ran latent profile analysis (LPA) only among participants with NSSI ( n =285). Study 2 conducted a 6-month follow-up of 550 participants and applied latent transition analysis (LTA) to examine class shifts and predictive factors. Study 3 was a randomized controlled trial in which 30 students from the High-NSSI received an 8-week emotion-management group intervention. Intervention effects were evaluated using repeated-measures ANCOVA with demographic covariates. Results: Within the NSSI subgroup ( n = 285), two classes were identified: a High-NSSI class ( n = 21, 7.4%) and a Low-NSSI class ( n = 264, 92.6%). Poor sleep quality and bullying victimization independently predicted High-NSSI membership. Longitudinal analysis revealed high stability in the Low-NSSI class (91%) and high fluidity in the High-NSSI class (83% transitioning to low-risk). The emotion-management intervention significantly reduced both NSSI frequency and negative affect. Discussion: These findings demonstrate that clinically meaningful NSSI subtypes exist among rural boarding adolescents and that sleep quality and bullying are key modifiable risk factors. The results support a stepped-care approach in school settings, where the High-NSSI class requires intensive intervention and the Low-NSSI class may benefit from less intensive, universal supports. The emotion-management group intervention is an effective school-based program for the most severe NSSI subtype. Keywords: non-suicidal self-injury, latent profile analysis, latent transition analysis, emotion management, group intervention

Mental health disorders are a major concern with millions of people living with mental illnesses, but only a small fraction of them have access to treatment due to stigma attached, lack of resources and trained personnel. Therefore, the inclusion of mental healthcare services in primary health care (PHC) is essential for improving its accessibility. The present review investigates the effectiveness, the different models, and the barriers in integrating mental health services into primary health care in India. The review was conducted following the PRISMA protocol using database like PubMed and Scopus between January 2016 and January 2026. The systematic search yielded 62 results, of which 23 were selected based on established inclusion criteria and were subsequently analyzed thematically. Successful integration of mental health services into primary healthcare was identified as including, but not limited to, task-sharing, use of digital technologies, use of telepsychiatry, and creating an improved policy-driven system. Task-sharing with lay personnel was found to greatly increase the identification and management of people with mental illnesses, while digital technology and telepsychiatry led to better access to mental health services, especially in rural areas. Barriers to implementing integrated mental health services included a lack of training, stigma, insufficient workforce, and limited infrastructure. Integrated mental health services into primary healthcare exist and demonstrate positive results, but to sustain successful implementation, the identified barriers to integration must be eliminated or mitigated to reduce the existing treatment gap for mental illness in India.

In April 2026, US President Donald Trump signed an executive order fast-tracking access to psilocybin and ibogaine for the treatment of serious mental illness. This follows decades in which psychedelics had been vilified as a group of drugs entirely lacking in therapeutic potential, associated with counter-cultural groups such as hippies, and whose use was both criminalised and widely stigmatised. Our central questions are: How have the substances, practices, understandings and relationships that comprise psychedelic use developed, and shifted, over time? And how might we best understand the overall structure and dynamics of such changes? We argue that the recent psychedelic renaissance cannot be understood as the simple ‘discovery’ of a therapeutic potential that previously lay dormant in the substances themselves. It is better grasped as a part-process of longer-term informalisation processes, bound up with shifting balances of power between established and outsider groups and with the changing behavioural and emotional standards – the social canons – through which psychedelic use has become refigured. Drawing on the figurational sociology of Norbert Elias and relational work on substance use and health, we trace the shift in psychedelics from counter-cultural sacrament to therapy and technology of the self. Through dialogue with a multimodal, multi-source evidential base, we develop the concept of ‘pharmaceuticalisation from below’ to characterise both the contemporary uptake of psychedelics and the broader figurational dynamics this expresses.

Introduction: Psychological factors can be important for the physical performance of developing female football players, but research is needed to assess their impact. Objective: To determine the effectiveness of a motivational psychological intervention strategy to improve physical performance in female U-15 football players from a football school in Zone 8 of Guayaquil, Ecuador. Method: Pre-experimental design with a single group and pretest-posttest measurements. Thirty football players participated. For the evaluation of the motivational climate, the PMCSQ-2 was used, while the YYIR1 and the Cooper Test were the instruments employed to assess physical performance. The intervention consisted of 12 sessions of 45 minutes over six weeks. The Shapiro-Wilk test was applied and then the Student's t-test for dependent samples. Results: The overall PMCSQ-2 score did not show statistically significant changes (t(29) = −1.37; p = 0.182; d = −0.250). On the contrary, statistically significant differences with large effect sizes were found for both the YYIR1 (t(29) = −16.08; p < 0.001; d = −2.936) and the Cooper Test (t(29) = −19.54; p < 0.001; d = −3.567). Discussion: Improvements are evident in the evaluated physical indicators, without significant changes in the overall motivational score. This divergence indicates that the physical response and the perception of the motivational climate do not always develop at the same pace. Conclusions: The intervention was associated with significant improvements in physical performance, which supports its application in youth women's football.

Counselling researchers have spent decades arguing about why counselling works. One philosophical camp locates the active ingredient in specific techniques tied to specific disorders. The other locates it in factors common to all bona fide therapies, chiefly the relationship between counsellor and client. This article develops a process-based perspective on the debate, examining how relational and technical elements are used within an unfolding therapeutic interaction. Drawing on the equivalence findings, the contemporary alliance literature, the unresolved question of causal mediation, the routine outcome monitoring evidence, and Australian decolonising scholarship, I propose a culturally situated responsive calibration model. The model reframes the therapist’s continuous, feedback-informed adjustment of relational and technical elements, made within the client’s cultural frame of wellbeing, as a proposed proximal mechanism of change. Calibration is not a new observation about good practice. Building on established responsiveness theory, the proposed contribution is to organise testable episodes of clinical judgement around feedback, action, and the client’s definition of wellbeing. Four testable propositions are advanced, including tests of whether calibration adds explanatory value beyond established process and treatment measures. Implications for practice, training, and measurement are outlined. The model is offered as a conceptual framework awaiting empirical testing, not as an established finding.

Background: Rural women in India are often confronted with situations that make it difficult for them to access formal mental health services such as inaccessibility, internalized stigma, believing that suffering is due to external causes and gender inequalities. These barriers delay receiving formal care for mental health and make these women resort to informal ways of coping such as community support and local faith healers. Methods: This study aimed to explore the informal coping strategies and beliefs around mental health among 100 rural women over the age of 18 years residing in Amroha district of Uttar Pradesh, India. Being a qualitative study, the method employed for the survey was focused group discussions and the participants were included through a convenience snowball sampling. The discussions were held in Hindi language for the ease of the participants and were recorded for analysis which was done through a thematic analysis approach. Results: The results highlighted six broad themes: (1) burden of responsibilities and emotional burnout, (2) physiological manifestations of psychological distress, (3) normalization of chronic stress, (4) psychological distress arising from marital conflict and gender-based adversity, (5) reliance on spiritual and informal coping strategies in place of formal mental healthcare, and (6) emotional suppression and silent tolerance. Conclusions: The findings suggest the urgent need to design culturally aligned psychotherapeutic interventions that focus on creating awareness through psychoeducation that could reduce stigma as well as helping rural women deal with their unmet mental health challenges.

Mental health systems face a persistent gap in accessible, continuous, and person-centred support. Conversational AI can expand access to psychoeducation, emotional check-ins, self-management, and service navigation, but may also introduce risks of digital exclusion, cultural mismatch, privacy concerns, unsafe advice, and overreliance on automation. This paper develops a conceptual framework integrating Orange Technology, which promotes emotional wellbeing, cultural sensitivity, social connectedness, and resilience, with empathetic AI for mental health support. An integrative literature review examined peer-reviewed systematic reviews and WHO and UN guidance published from 2021 to 2026. Evidence suggests that conversational AI can improve depression, distress, anxiety, and engagement, although effects are heterogeneous and may decline over time. Personalization and empathic interaction may enhance engagement, while the framework's effects on community resilience, cultural sensitivity, and community resource integration require further empirical validation. The framework therefore positions AI as a supportive, human-in-the-loop layer rather than a replacement for clinicians, families, peers, or communities. It connects emotional sensing, empathetic dialogue, personalized support, escalation pathways, community connection, inclusive access, and governance, while aligning mental health innovation with SDG 3, 9, and 17.

Health shocks—such as new diagnoses of chronic disease—can disrupt daily life and create potential “teachable moments” for behavioral improvement. Yet, existing evidence on post-diagnosis behavior change remains mixed and largely limited to high-income countries. This study addresses a major empirical gap by examining whether chronic disease diagnoses are associated with measurable within-person changes in health behaviors among middle-aged and older adults in Thailand, a rapidly aging middle-income society. We analyzed four waves (2015–2022) of the Health, Aging, and Retirement in Thailand (HART) survey. The analytic sample comprised adults aged ≥45 years with no baseline diagnosis of cancer, diabetes, or cardiovascular disease (N = 2,891; 9,577 person-wave observations). Self-reported physician-diagnosed conditions were used to construct disease-status indicators. Behavioral outcomes included smoking, current alcohol use, sufficient physical activity (≥150 minutes/week), normal body mass index (BMI) (18.5–23), and waist obesity (sex-specific cutoffs). Individual fixed-effects linear probability models with survey-wave fixed effects and adjustment for time-varying covariates (log income, activities of daily living [ADL] score, and marital status) estimated within-person associations, with standard errors clustered at the individual level. Disease-specific models and models including interactions with sex assessed heterogeneity. In pooled analyses, the disease-status indicator was not significantly associated with smoking, alcohol use, physical activity, BMI, or waist obesity. In contrast, a diabetes diagnosis was associated with a reduction of 3.6 percentage-point in current alcohol use, and both diabetes and cancer diagnoses were associated with reductions in frequent drinking. Models including interactions with sex suggested larger diagnosis-associated reductions in selected alcohol-use outcomes among men, although statistical evidence varied by outcome and disease type. Among middle-aged and older Thai adults, chronic disease diagnoses were associated with selective, rather than comprehensive, changes in health behaviors. Diagnosis alone is insufficient to support changes across multiple health behaviors, underscoring the need for structured post-diagnosis counselling, follow-up, and gender-sensitive secondary prevention in aging middle-income populations.

Caregivers of children with neurodevelopmental disorders experience significant multifaceted burdens. However, little qualitative research has been done to explore caregivers’ lived experiences in relation to the effect of burden and coping strategies in the study area. The study sought to investigate caregivers’ awareness problems, coping mechanisms, and support systems in caring for children with neurodevelopmental disorders in Addis Ababa, Ethiopia. The study was conducted in three public, non-teaching hospitals in Addis Ababa, Ethiopia. Using a descriptive phenomenological technique. In-depth interviews were conducted with 15 purposively selected caregivers. The data was analyzed using Braun and Clarke’s six-phase framework technique. The analysis found six interrelated themes: Awareness and Perception of Neurodevelopmental Disorders (NDDs), Emotional Responses to Diagnosis and Adaptation, Caregiving Roles and Responsibilities, Multidimensional Burden and Challenges, Coping Strategies and Adaptation Mechanisms, and Support Systems and Structural Barriers. Bronfenbrenner’s ecological systems theory was used to explain how personal, institutional, and systemic factors explain participants’ experiences and interpret caregiving realities. These findings underscore the call for integrated and collaborative efforts to address individual and system-level challenges among caregivers. Enhancing support systems, mitigating stigma, and correcting systemic inadequacies can improve caregiver well-being and optimize care for children with NDDs.

Background Trans, non-binary and gender diverse (TNBGD) sexual function has historically been narrowly defined as physical capacities following medical and surgical gender affirming (GA) interventions; and this population's sexual health has been researched more in terms of external influences considered risky rather than being founded in individuals' desires and needs. This can produce discrepancies between services and people who access them. This study explores the service-related barriers, facilitators and compensatory strategies for TNBGD people seeking healthcare related to sexual function. Methods Based on qualitative interview data from n = 19 TNBGD adults in the UK, the dataset was deductively analyzed using Levesque's framework of healthcare access. Results TNBGD people face barriers in distance and transport to appropriate sexual health services, overlaps between sexual healthcare and GA services, and limits in professionals' TNBGD specific knowledge and cultural competence. To navigate these TNGBD people pursued independent knowledge acquisition, were selective during clinical interactions and access, and sought to meet their needs outside clinical settings. The analytical themes demonstrate varied barriers and their interrelatedness. For example, acceptability of a service was informed by the appropriateness of clinician's knowledge and interactions. In turn, TNBGD people's anticipation of un (der) met needs motivated compensatory measures, such as seeking information online or from peers before approaching formal services or sometimes instead of approaching them. Conclusions Healthcare services' design and delivery can present significant barriers to TNBGD adults seeking healthcare to support their sexual function. Providers' ways of interacting may offset some of the barriers and TNBGD adults may deploy strategies that enable them to access care that leads to satisfactory health outcomes. However, while significant barriers persist, TNBGD adults are liable to have unmet needs and consequent health inequalities.

Introduction In Japan, noriuchi refers to a collaborative gambling practice in which multiple players pool money used for betting and later split the final net profit or loss. This cross-sectional online study aimed (a) to estimate the prevalence of noriuchi among adult Japanese gamblers and (b) to examine how the frequency of noriuchi participation relates to gambling involvement and problem gambling severity. Methods In February 2022, an online survey was administered via Rakuten Insight, Inc. to adults aged 20 years or older. Participants were eligible if they reported gambling at least monthly in at least one of nine gambling activities during the past 12 months ( N = 2,000). Noriuchi participation frequency was assessed on a four-point scale (never, less than monthly, monthly or more, weekly or more). Outcomes included monthly gambling days, monthly gambling expenditure, and problem gambling severity measured with the Japanese version of the Problem Gambling Severity Index (PGSI). Results Overall, 498 participants (24.9%) reported noriuchi experience in the past 12 months; among them, 198 (39.76%) met the PGSI criterion for problem gambling. After adjustment for demographic covariates, noriuchi participation was associated with greater problem gambling severity across several gambling activities. Associations with monthly gambling days and expenditure were more limited and varied across gambling activities, with significant increases primarily observed among those engaging in noriuchi weekly for certain gambling activities. Discussion These findings suggest that noriuchi is associated with problem gambling severity, whereas its associations with gambling frequency and individual gambling expenditure are less consistent.

This study evaluated the implementation and operational viability of the LGU Malay Mental Health Ordinance using the seven-component Project EMBRACE framework. The study addressed a local evidence gap by examining not only whether ordinance activities were implemented but also whether the workforce, referral, infrastructure, monitoring, and partnership conditions required for sustained delivery were present. A convergent parallel mixed-methods design was used. Quantitative data were obtained from 50 program implementers through a validated researcher-developed questionnaire (Cronbach's alpha = 0.962), while qualitative data were collected through Focus Group Discussions with 10 adult mental health service clients from Mainland Malay and Boracay Island. Means and standard deviations summarized five-point viability ratings, and qualitative transcripts were thematically analyzed; the two strands were integrated by comparing convergent, complementary, and divergent findings. The ordinance obtained an overall viable assessment, but component results were uneven. Wellness of Daily Living (M = 3.75), Mental Disorder (M = 3.65), Substance Abuse and Other Forms of Addiction (M = 3.72), and Provision of Services for Mental, Neurologic, and Substance Disorders (M = 3.45) were rated Viable. Extreme Life Experience (M = 3.11), Neurologic Disorders (M = 3.37), and Enhancement of Mental Health Facilities and Partnerships (M = 3.29) were Moderately Viable. Service-user accounts generally supported these patterns and highlighted limited specialist access, psychosocial workforce gaps, dependence on external referrals, and infrastructure constraints. The findings indicate that Malay has established a functional community mental health foundation, but long-term viability requires prioritized investment in crisis-response personnel, neurologic referral capacity, facilities, formal partnerships, continuity-of-care mechanisms, and integrated monitoring.

Background: Emerging adulthood is a vulnerable developmental period for suicidal ideation. Psychological pain is often associated to its occurrence, however, the factors related to the transition from psychological pain to suicidal ideation remain unclear. This study aimed to analyze the mediating capacity of entrapment and the moderating capacity of meaning in life in the relationship between psychological pain and suicidal ideation during emerging adulthood. Methods: Participants were Spanish emerging adults who completed a battery of questionnaires through LimeSurvey platform. A moderated mediation was conducted. Results: The model explained 63.8% of the variance in suicidal ideation. Entrapment mediated the relationship between psychological pain and suicidal ideation. Furthermore, at low levels of meaning in life, psychological pain was positively associated with suicidal ideation, while at high levels, the association was no longer significant. Conclusions: These findings highlight the importance of assessing psychological pain and entrapment as potential risk factors of suicidal ideation during emerging adulthood, and support the development of interventions aimed at fostering their meaning in life.

This study examined teacher self-efficacy, Social-Emotional Learning (SEL) integration, and their predictive relationships with teacher effectiveness in the Academic Recovery and Accessible Learning (ARAL) Program in the Tagbilaran City Division, Bohol, Philippines. Anchored in Social Cognitive Theory, the Prosocial Classroom Model, the CASEL SEL Framework, Self-Determination Theory, and Emotional Intelligence Theory, the study employed an explanatory sequential mixed-methods design. Quantitative respondents comprised 202 ARAL teachers and 23 school heads or designated supervisors from eight public junior high schools. The qualitative phase involved 15 teachers and five supervisory participants. Data were collected using a validated, researcher-developed questionnaire, open-ended questions, and interviews, and analyzed through descriptive statistics, multiple regression, Welch’s t-test, and thematic analysis. Findings revealed high teacher self-efficacy (M = 3.99), SEL integration, and teacher effectiveness. SEL integration significantly and positively predicted content knowledge and pedagogy (R² = .154), assessment and reporting (R² = .520), and learning environment (R² = .537), whereas teacher self-efficacy showed no statistically significant unique contribution after accounting for SEL integration. Teachers’ and supervisors’ assessments showed no significant differences. Challenges included learner disengagement, language barriers, diverse learning needs, inadequate instructional resources, insufficient training, and monitoring difficulties. Professional commitment, instructional adaptability, supportive relationships, and administrative assistance facilitated implementation. The study recommends sustained SEL-focused professional development, differentiated instruction, strengthened supervision, and systematic learner monitoring. It supports Sustainable Development Goals 4 (Quality Education), 3 (Good Health and Well-Being), and 8 (Decent Work and Economic Growth) through inclusive learning recovery, socio-emotional support, and teacher welfare. Its sustainability contribution lies in informing institutional capacity-building, equitable educational opportunities, and continuing professional support for effective ARAL implementation.

Transphobia can be understood as a set of practices that produce discrimination, exclusion, and violence against transgender people and transvestites, selecting their behavioral repertoires under aversive control. In the field of Behavior Analysis, Brazilian production on the subject remains limited and poorly systematized. This study aimed to integrate behavioral analysis research on the contingencies to which transgender people are subjected in Brazil. A systematic review of the literature was conducted according to PRISMA 2020, with searches in journals in the field and on Google Scholar. After applying the eligibility criteria, six studies were included. The findings indicate convergence in the understanding of transphobia as a process sustained by coercive contingencies that produce functional effects such as escape, avoidance, and psychological distress. It is concluded that Behavior Analysis offers relevant contributions to the functional understanding of transphobia and points to the need to expand socially committed research and interventions.Keywords: transphobia; behavioral-analysis; gender; LGBTQIA+; review

Background Cumulative exposure to adverse childhood experiences (ACEs) is associated with an increased risk of substance use, overdose, and suicide. Rural children are more likely to experience most ACEs. There is limited literature contextualizing rural individuals’ experiences with ACEs. Public Health 3.0 calls for multisector partner engagement to generate collective impact. The purpose of this study was to evaluate rural providers’ perspectives on challenges and recommendations for ACEs mitigation in their community from a cross-sector context. Participants and setting Participants were 74 providers enrolled in an online ACEs training. Participants lived and/or worked in five rural Missouri counties with high drug overdose death rates. Methods This was a conventional content analysis of written responses to structured discussion prompts from three training modules. Analysis included familiarization, inductive identification of major codes, and refinement of codes, followed by independent coding by two authors until consensus, and reporting major patterns. Artificial intelligence supported preliminary code development. An adapted Sequential Intercept Model (SIM) framework organized challenges and recommendations by setting. Results Results included personal stories about how ACEs impacted their communities through overdose, suicide, homelessness, unemployment, and adverse health effects. Settings included schools, government, healthcare, daycares, criminal justice, Extension, fire departments, libraries, and nonprofits. Participants recommended expanding the ACEs definition to include satanic abuse, bullying, incest, war, genocide, military family stressors, and death of a loved one. Intervention recommendations included whole-family interventions, community-wide training, trauma-informed training, expanded access to treatment, classes in prison/jails, and fostering positive childhood experiences. Conclusion Community voice is necessary to contextualize setting-specific insights that inform development of upstream interventions appropriate for and tailored to the community. Participants identified both strategies that could be incorporated into everyday practice—including empathy, listening, providing judgment-free and safe spaces, providing food for children experiencing hunger, encouraging positive childhood experiences, mentoring, and connecting individuals with resources for food, shelter, clothing, and mental health—and broader structural changes that may require policy-level action. The adapted SIM organizes these concepts.

Background Psychedelic retreats are increasingly used to promote wellbeing outside clinical settings, yet the psychological processes associated with sustained improvements in wellbeing remain poorly understood. From a public mental health perspective, identifying mechanisms that support positive mental health beyond symptom reduction is of growing importance. Methods This naturalistic longitudinal study followed 173 participants attending guided psilocybin retreats conducted within a structured framework of preparation, dosing, and integration. Mental wellbeing was reported before the retreat and across a 12-month follow-up period. Longitudinal changes were examined using linear mixed-effects models. Mediation analyses investigated whether changes in connectedness, neuroticism (anxiety facet), spiritual transcendence, and absorption were associated with changes in wellbeing. Mystical-type experiences were examined as potential predictors of these psychological changes. Results Participants reported substantial and sustained improvements in mental wellbeing over 12 months, moving from levels below Swedish population norms at baseline toward comparable levels at follow-up. Connectedness showed the strongest statistical association with improvements in wellbeing and accounted for the largest proportion of variance in wellbeing change, followed by reductions in the anxiety facet of neuroticism and absorption. Spiritual transcendence was associated with wellbeing improvements when examined separately but did not retain unique effects in the multiple mediation model. More intense mystical-type experiences predicted greater increases in connectedness, spirituality, and absorption, as well as greater reductions in neuroticism (trait anxiety). The association between mystical experiences and wellbeing was substantially attenuated when connectedness was included in the model, suggesting that connectedness may act as a candidate mediator linking mystical-type experiences to longer-term wellbeing, though the observational design precludes causal inference. Conclusions These findings extend prior work on psychedelic-assisted therapy to naturalistic retreat settings, suggesting that connectedness may represent a key psychological process linking psychedelic retreat experiences to sustained improvements in mental wellbeing. From a public mental health perspective, the results highlight the potential importance of social and relational factors in promoting wellbeing beyond the treatment of mental illness. Future controlled studies are needed to clarify the relative contributions of psychedelic, social, and contextual components.

Background Stroke is a leading cause of disability worldwide and is frequently accompanied by psychological and functional impairments. Acceptance and Commitment Therapy (ACT), a third-wave behavioral intervention focusing on psychological flexibility, has been increasingly applied in stroke rehabilitation. Although previous reviews have suggested beneficial effects of ACT in stroke patients, whether these benefits persist in the short term after the intervention ends, and the certainty of the evidence, remain unclear. Methods A systematic review and meta-analysis was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420261325108). Randomized controlled trials evaluating ACT in stroke patients were included. Pooled effects were calculated using random-effects models, with separate analyses for post-intervention and follow-up outcomes. Sources of heterogeneity were explored using subgroup analyses and meta-regression. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using the GRADE framework. Results Twenty-two RCTs involving 1,975 participants were included. ACT may be associated with reductions in depressive symptoms (post-intervention: SMD = −1.32, 95% CI: −1.80 to −0.84; follow-up: SMD = −0.76, 95% CI: −1.07 to −0.45) and anxiety symptoms (post-intervention: SMD = −1.36, 95% CI: −1.90 to −0.82; follow-up: SMD = −0.51, 95% CI: −1.42 to 0.40, not significant); depressive symptoms remained statistically significant at follow-up. Heterogeneity was considerable for both outcomes at post-intervention ( I 2 = 93.68% for depression and 93.60% for anxiety), so the pooled estimates represent average effects across studies. ACT may also be associated with improvements in psychological flexibility, quality of life, and sleep quality; however, these outcomes were based on a limited number of studies and showed considerable heterogeneity ( I 2 = 74.68 to 92.26%), so they should be interpreted cautiously. However, no statistically significant effects were observed for activities of daily living, neurological function, or hope. ACT did not appear to increase dropout rates in the available studies ( K = 16; RR = 0.99, 95% CI: 0.58–1.69). Meta-regression analyses indicated that intervention duration may not be a significant moderator of treatment effects. The certainty of evidence ranged from very low to moderate, mainly due to risk of bias and inconsistency. Conclusion Acceptance and Commitment Therapy may be a useful adjunctive intervention for improving psychological outcomes in people with stroke. However, evidence for functional recovery remains insufficient. Future high-quality RCTs with standardized protocols, larger samples, and longer follow-up are needed to confirm the long-term effectiveness of ACT. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/ , identifer CRD420261325108.