Shalvata Mental Health Center

IntroductionMajor depressive disorder (MDD) is a prevalent, episodic and recurrent condition that adversely affects function across everyday life. Recent studies highlight the importance of everyday function in MDD treatment. Given the dynamic nature of everyday functioning, using comprehensive and real‐time data collection, such as ecological momentary assessments (EMA), is necessary. Although mood disorder research widely uses EMA, its clinical use to assess everyday function is limited. Therefore, this article aimed to provide an in‐depth review of everyday function domains assessed by EMA in MDD.MethodsA systematic review was conducted in accordance with PRISMA guidelines. We searched PubMed, Cochrane, CINAHL, PsycINFO, Social Work s, Web of Science and Scopus using search terms related to MDD and EMA, from database inception through October 2025. Analysis focused on identifying functional domains, mapping EMA clinical applications, sampling methods and psychometric properties.Consumer and community involvementNo consumer and community involvement was included in this study.ResultsOf 46,271 records, 39 met the inclusion criteria. Seven domains were identified: rest and sleep, social participation, daily activities, physical activity, media use, leisure and health management. Beyond monitoring activity patterns, our mapping revealed EMA's unique value in capturing behaviour–emotion interactions and contextual influences. This within‐person focus uncovers real‐time dynamic mechanisms rather than static deficits. Methods were diverse but demonstrated high compliance, confirming EMA's feasibility.ConclusionEMA offers a unique pathway to bridge the gap between clinical research and functional recovery. By providing high‐resolution data on real‐time everyday functioning, EMA enables the design of precision psychiatry interventions tailored to individual occupational patterns. Implementing these ecological assessments can facilitate a transition from generalized care to human‐centred, responsive treatments that directly address daily life barriers.

ABSTRACT Background Moral injury (MI) is a potential clinical problem associated with distress following exposure to potentially morally injurious events (PMIEs). While previous studies have linked PMIEs to MI outcomes such as shame and trust violation, few have examined the role of pre-enlistment personality traits in predicting MI. This study investigates whether pre-deployment aggression contributes to MI outcomes among recently discharged Israeli combat veterans, both directly and indirectly, through exposure to PMIEs. Design A six-year longitudinal study. Methods 169 Israeli combat veterans were assessed at four time points: pre-enlistment (T1), pre-deployment (T2), post-deployment (T3), and post-discharge (T4) with validated self-report questionnaires. Results Structural equation modeling results showed pre-deployment aggression (T2) significantly predicted post-discharge MI outcomes of shame and trust violation (T4), above and beyond combat exposure and negative life events. Additionally, PMIE-betrayal (T3) emerged as a key mediator linking aggression (T2) to MI outcomes (T4). Conclusions Pre-enlistment aggression is a significant risk factor for MI, primarily through its association with betrayal-based PMIEs. These findings highlight the importance of early screening for aggression traits, and the need for targeted interventions to address MI, particularly interventions focused on betrayal-related distress and self-directed moral emotions.

War-related stressors, such as economic loss, traumatic loss, and forced displacement, are well-documented risk factors for psychopathology. The mechanisms connecting war-related stressors to psychiatric symptoms remain unclear, particularly among civilians in conflict zones. Betrayal-related moral injury-feeling abandoned or let down by trusted leaders or institutions-can erode a sense of safety and justice and intensify distress. The present study examined whether such appraisals represent a psychological pathway linking war-related stressors to depression, posttraumatic stress disorder (PTSD), and anxiety. Civilians (N = 681, Mage = 31.3 years, SD = 5.6) exposed to conflict zones in southern and northern Israel following the October 7, 2023, events were recruited using an online platform. We conducted a longitudinal study with assessments in February, March, and May 2024 (Days 1, 30, and 90, respectively), evaluating participants' exposure to war-related stressors, betrayal-related moral injury (measured using the Moral Injury Events Scale), and depression, PTSD, and anxiety symptoms. We hypothesized that betrayal would mediate the relationships between war-related stressors and all symptom types. Economic loss directly influenced all three outcomes, whereas traumatic loss directly affected only PTSD. Betrayal mediated the associations between both economic and traumatic loss and psychopathology outcomes-depression, PTSD, and anxiety-but did not mediate the associations between displacement and these outcomes. The findings underscore the role that a sense of betrayal may play in the relationships between economic and traumatic loss and mental health outcomes. Targeted interventions addressing betrayal may help mitigate these symptoms in civilians exposed to trauma. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Abstract Understanding the nuanced mechanisms of effective patient-therapist dialogue is crucial for advancing psychotherapy research and practice. This study examines the role of discourse diversity – an understudied factor – in patient adherence to therapy. Using the MATRIX, an evidence-based coding system that transforms full session transcripts into coded sequences, we quantified discourse diversity both within sessions and over the course of therapy. Our dataset comprised 265 sessions from 53 short-term psychodynamic therapies, each scheduled for one year. The number of sessions completed during this prescribed course of therapy was used as an indicator of patient adherence to the therapy process. Based on the median treatment length, therapies were categorized into short- and long-treatment groups. Linear regression models examined changes in discourse diversity over time and their association with treatment length. Results showed a significantly greater increase in discourse diversity in the long-treatment group, suggesting that sustained commitment to therapy is linked to evolving dialogue. Moreover, patient and therapist diversity levels were highly correlated, indicating a mutually shaped, reciprocal process. Additional analysis comparing observed and simulated therapies revealed a distinct discursive pattern unique to psychotherapy. These findings suggest that an evolving and dynamic dialogue may be important for improving patient adherence to therapy. They provide preliminary support for using discourse diversity as an indicator of treatment progress, with potential applications for optimizing psychotherapy processes and assessing therapeutic progress in research and clinical settings.

BackgroundAlthough 90% of the global adolescent population resides in low and middle-income countries (LMICs), cross-national mental health research has primarily focused on high-income countries. This systematic review aims to examine cross-national studies, including LMICs, focusing on adolescent mental health and psychosocial problems.MethodsPeer-reviewed articles comparing adolescent mental health or psychosocial issues across countries were included if published in English and based on observational study designs. Six databases were searched from inception to January 2024. Risk of bias was assessed using the JBI tool and additional cross-national quality criteria. A narrative synthesis was conducted following the Synthesis Without Meta-analysis guidelines.ResultsThe search identified 172 studies including data from over 12 million adolescents across 166 countries. The most used international survey was the Health Behaviour in School-aged Children study, and most studies employed cross-sectional designs with school-based, self-reported questionnaires. Adolescent mental health research involved 166 countries, while 52 countries were not represented in any of the studies. The inclusion of LMICs in cross-national research increased over time. Internalising problems and bullying were well-researched topics, but studies on externalising behaviours were limited. The number of publications increased over time, particularly after 2020. Variations by income level were observed, with traditional bullying more prevalent in LMICs.DiscussionThis review provides important insights into global patterns and gaps in adolescent mental health research. It highlights the need to address methodological heterogeneity, including the use of validated and culturally adapted measures, comprehensive reporting of sampling procedures, sample sizes, response rates and greater attention to generalisability. In addition, the targeted inclusion of under-represented regions is essential to addressing global disparities and informing effective interventions.PROSPERO registration numberCRD42024505077.

Objective Maintaining relevance in a psychodynamic dialogue is a nuanced task, requiring therapists to balance between following patients’ free associations while avoiding less effective interventions. Identifying less effective sequences of talk is especially challenging given the diversity of psychodynamic approaches and methodological barriers to analyzing session discourse. This study introduces a novel approach using the MATRIX coding system, an evidence-based tool, to differentiate content correlated with better session outcomes. Method Transcripts of 367 sessions were coded using the MATRIX. Therapist Out-of-MATRIX utterances, indicating a deviation from core therapeutic focus, were examined for their predictive value. Outcome measures included the next-session alliance and patient functioning scores. Two machine-learning-based models, using the Random Forest algorithm, predicted session-by-session changes in clinical outcomes based on MATRIX codes, and interpreted using the SHapley Additive exPlanations. Results Therapist Out-of-MATRIX utterances accurately predicted next-session changes in alliance and patient functioning scores. Our model also identified an optimal dose-effect relationship for the number of Out-of-MATRIX interventions needed for effective therapy session. Conclusion This study demonstrates the potential of using contemporary research tools to analyze therapeutic discourse, revealing how psychotherapy produces its benefits. Its scope extends beyond prediction, providing practical recommendations on how to enhance therapists’ performance and outcomes.

A sharp increase in posttraumatic stress disorder (PTSD) symptoms has been detected in Israel following the terror attacks of October 7th 2023. To examine the role of potential resilience factors, we investigated the moderating effects of social support and coping strategies in the relationship between trauma exposure and severity of PTSD and emotional distress symptoms. Approximately 20 days following the terror attack, 415 Israeli adults were assessed for PTSD symptoms, general distress, extent of social support and coping strategies. The results indicated a significant moderating effect for perceived social support (B = −1.02, SE = 0.47, p = .031), indicating a significantly stronger association between trauma exposure and PTSD symptoms for individuals with low support (B = 5.22, SE = 0.91, p < .001), compared to for individuals with high support (B = 2.49, SE = 0.87, p = .004). This effect was significant for social support from a significant other and friends (B = −1.24, SE = 0.49, p = .011 and B = −0.86, SE = 0.42, p = .042, respectively), but not from family. Coping orientation to problems had no moderating effect on these associations. These findings underscore the importance of social support as a protective factor in the aftermath of collective trauma and sets the stage to consider this factor as a pivotal element in resilience-oriented interventions.

Abstract Date Presented 03/21/24 Assessing mood homeostasis (MH) and its associations with occupational balance, participation, and quality of life to guide the development of a novel intervention for people with major depressive disorder and promote effective health care. Primary Author and Speaker: Shani Volovic Shushan Contributing Authors: Adi Stern, Naomi Josman, Uri Nitzan