Online Psychotherapy:A Pandemic Dilemma

The COVID pandemic has allowed people to reflect and explore their emotions,their strengths and deficiencies,how they affect them and how to address them.The globally observed,pandemic-induced social distancing,has also precipitated disturbances in the domain of mental health.Almost the entire population worldwide,went through a se­ries of lockdowns,resulting in people getting isolated,some feeling trapped in the stressful environment of a forced shared living places-homes.This precipitated in exposing conflicts of various types and degrees,encountering a com­mon emotion-grief.With no access to professionals in traditional format,the online networking boom has given a ray of hope to the people in need.This research-based article explores how online therapy is being seen as a reliable and important tool for people needing help with mental health issues,by conducting a survey on the youth of Delhi-NCR.This research article explores the ways in which people reached mental health professionals and how internet-based therapies increased manifolds during pandemic.A total of 54%participants of the survey agreed to engage in online therapy practice in situation of need.

Task sharing in psychotherapy as a viable global mental health approach in resource-poor countries and also in high-resource settings

A global disparity exists between the burden of mental ill-health and the resources available to address this issue.Common mental disorders,such as mild-to-moderate depression,anxiety disorders and post-traumatic stress disorder,are associated with a significant decline in health and functioning and contribute significantly to the overall burden of disease.In view of a shortage of mental health professionals in most low-and middle-income countries,task sharing(task shifting)can make an important contribution to improving access to mental health services.Task sharing involves non-specialists in the delivery of health care.The use of lay health workers is premised on the assumption that the shorter training required for non professionals will allow an increase in the provision of required care without the need for an increase in resources and will strengthen and scale-up sustainable health systems.The need for low-tech support in the management of conunon mental disorders is widespread,and the core resource is humans trained to identify and treat those requiring mental health care.There is a strong evidence base for the effectiveness of task sharing in psychotherapy,and talk therapies,e.g.cognitive behavioral therapy,can easily be delegated to non-specialists,including non-specialist health workers,peer helpers and lay people.A(cost-)effective model of mental health care in low-resource settings as well as in high-income countries may include the medical school-based training of some psychiatrists and clinical psychologists in the treatment of referred patients with serious mental illness.These professional mental health specialists would also be trainers and supervisors of non-specialist health workers who would identify common mental health disorders and provide psychotherapy to people with these conditions in a community-based setting.Community-based generalism including task sharing rather than centralized specialism may be capable of preventing and treating many common mental disorders with minor financial expenditure.

Case studies in psychotherapy training using Austria as an example

BACKGROUND Case studies(CS)are relevant for the development of theoretical and practical competencies in psychotherapy.Despite rapid progress in the development of methods and principles for establishing CS in the last three decades,research into the aims of CS,especially in training,or how CS are to be conducted is rare.AIM To elucidate the form and methodology of CS,the objectives of CS used in training institutions(TI),and if/how TIs handle therapist allegiance.Also,this preliminary investigation will suggest avenues for further research and attempt to establish certain guidelines.METHODS In order to counteract researcher bias and enlarge the question-pool,a focus group was established.The recorded and transcribed text was analyzed with Mayring’s method of qualitative content analysis,and the generated categories were formulated as questions.The resulting questionnaire with both qualitative and quantitative queries was sent out(after pre-testing)to all 39 Austrian TIs that provide professional psychotherapy training.The answers and text passages received were then also categorized with qualitative content analysis.Data analysis was discussed by a peer group consisting of three psychotherapists trained in differing schools of psychotherapeutic methods.RESULTS 94%of Austrian institutes use CS as part of their psychotherapeutic training.Understanding of the term“case study”is inconsistent and has a wide variety of interpretations.CS serve mainly:(1)For observation of training/progress in therapeutic practice and knowledge/acquisition of the theory specific to each psychotherapeutic school;(2)To improve(self-)reflection capabilities;and(3)To expand theoretical knowledge.Most of the CS written are not accessible for students nor for the research community.More than two thirds of the CS take only the position of the author into account(the client’s position is not described).15.5%of the TIs do not consider researcher or therapist allegiance at all.CONCLUSION A more precise formulation of the term case study is needed in psychotherapeutic training.The training therapists play a key function,as they exemplify and teach how to deal with distorting factors.General guidelines as to how to conduct CS in training institutions would provide more direction to students,increase scientific rigor,and enhance synergistic effects.

Ultra-brief crisis interpersonal psychotherapy based intervention for suicidal children and adolescents

Suicidal behaviors in adolescence are a major public health concern.The dramatic rise in self-injurious behaviors among adolescents has led to an overwhelming increase in the number of those presenting to the emergency rooms.The intervention described below was constructed on the basis of brief and focused interventions that were found to be effective among suicidal adults using an adaptation of interpersonal psychotherapy for adolescents.The intervention has four main objectives:first,a focused treatment for reducing suicide risk;second,a short and immediate response;third,building a treatment plan based on understanding the emotional distress and interpersonal aspects underlying suicidal behavior;and lastly,to generate hope among adolescents and their parents.The intervention includes intensive five weekly sessions,followed by 3 mo of email follow-up.

Affect regulation in psychoanalytic treatments of patients with a borderline personality disorder–psychoanalysis and psychodynamic psychotherapy–a comparison

BACKGROUND A recent meta-analysis has confirmed that the effects of psychotherapy on patients with borderline personality disorders(BPD)are still insufficiently understood.Evidence of differences between different types of therapies has been questioned.AIM To study repetitive interaction patterns in patients with BPD undergoing either psychoanalysis or psychodynamic therapy.METHODS Psychoanalysis(PSA)or psychodynamic psychotherapy(PDT)was administered to 10 patients each,the two groups were matched.Therapy regimens were applied according to care as usual/manualized including quality control and supervision as usual.Randomization to one of the groups was done after baseline assessment.During classical PSA(n=10)and PDT(n=10),semiannually,recordings(audio or video)of five consecutive therapy sessions were taken over three years for an ex-post analysis.The patients'characteristics,such as affect parameters[Affect regulation and experience Q-sort(AREQ)],quality of object relations(quality of object relations scale)and personality traits[Shedler-Westen Assessment Procedure(SWAP-200)]were analyzed retrospectively by independent raters.Therapeutic action(psychotherapy process Q-sort)and affective(re)actions of the patients(AREQ)were then analyzed in relation to changes found in the patients'characteristics.RESULTS During the first year of therapy(PSA:n=10;PDT:n=9),the therapeutic method PSA was associated with significant improvements in the variable"SWAP Borderline",while in PDT change was not significantly different to baseline(PSA:P=0.04;PDT:P=0.33).Long-term results and follow up was available for seven participants in PSA and for five in PDT after three years;change in SWAP borderline for the whole sample was not significant at this time point when confronting to baseline(P=0.545).However,differences between PSA and PDT were significant when analyzing the“mean change”in the SWAP Borderline variable after one year of therapy(P=0.024):PSA led to slightly increased BPD symptoms,while PDT to a decrease;for the long run,variance of observed change was higher in PSA than in PDT(SDPSA±9.29 vs SDPDT±7.94).Our assumption that transference interpretations,closely followed by affective changes in the patient,could be useful modes of interaction was reproducible in our findings,especially when looking at the descriptive findings in the long-term data.The analysis of repetitive interaction structures demonstrated a very specific"time-lag"between therapeutic intervention and a corresponding increase in positive affect in successful therapy cases.CONCLUSION Exploring the change processes in the patients'characteristics and linking these changes to specific treatment strategies is of clinical importance when starting treatment and for its long-term progress.

Conscious, Explicit Memory, Implicit Memory, and Instincts as the Four-Component Mind for the Mental Origins of Psychotherapy and Personality

This paper proposes that conscious, explicit memory, implicit memory, and instincts constitute the four-component mind for the mental origins of psychotherapy and personality. The mental origin of the personality theories including the big five personality traits, the MBTI, the social style model, the Hofstede’s cultural dimensions, and the Schwartz’s theory of basic human values is from the unconscious instincts (the six social and three mental protective instincts). The three mental protective instincts that contain the three instinctive countermeasures against the three adversities are hyperactivity countermeasure against danger, phobia countermeasure against unfamiliarity-uncertainty, and comforter countermeasure against hardship. Each countermeasure is regulated (moderated) by a regulator to minimize overactive countermeasure as physical regulator to minimize overactive immunity in physical immune system. Severe adversities and ineffective regulators over-activate protective countermeasures to generate overactive countermeasures as overactive hyperactivity, overactive phobia, and overactive comforter, corresponding to dramatic-impulsive cluster, anxious-fearful cluster, and odd-eccentric cluster, respectively for personality-mental disorders in the DSM-5. Such disordered behavioral habits are stored in unconscious implicit memory which generates disordered thought patterns in pre-conscious explicit memory. For psychotherapy, cognitive behavioral therapy (CBT) normalizes disordered thought patterns in explicit memory to normalize disordered behavioral habit memory in implicit memory through the repetitive training in normalizing thought patterns, feelings, and behaviors. For psychotherapy, mindfulness meditation strengthens conscious attention (working memory) to normalize disordered behavioral habit memory through the repetitive training in directing conscious attention to the breath or body. In conclusion, the mental origin of personality-mental disorders is from the overactive mental protective instincts. The mental origin of psychotherapy is from therapeutic implicit memory and conscious attention for CBT and mindfulness meditation, respectively. The mental origin of personality is from the unconscious instincts. Therefore, the four-component mind of conscious, explicit memory, implicit memory, and instincts explains the origin, the storage, and the normalization of personality-mental disorders for psychotherapy, and provides the mental origin of personality.

Psychotherapy in anorexia nervosa: What does the absence of evidence mean?

Psychological treatment in anorexia nervosa(AN) is disheartening. Psychotherapy is the "treatment of choice" for adults though this recommendation is grounded on the absence of good quality clinical studies. This paper seeks to address the question of why improvements in the psychological treatment of AN have been thwarted, and why one of the best treatments available for adult patients is specialist supportive clinical management that has entered the stage through the backdoor of nonspecific supportive treatments originally serving as a placebo treatment assigned in randomized clinical trials to control for non-specific aspects of true psychosocial treatments. The possibility that most of the psychopathological features that characterise the AN symptoms profile could be best understood as the direct consequences of emaciation would enhance the utility of research with animal models for generating new hypothesis to improve AN treatment.

Quality of object relations modifies the effectiveness of short- and long-term psychotherapy on self-concept

The quality of object relations affects interpersonal behaviour, but it is not known whether it modifies effectiveness on personality functioning in psychotherapies of different mode and length. In this study we estimated the modifying effect of the quality of object relations on the effect of solution-focused therapy (SFT) and shortand long-term psychodynamic psychotherapy (SPP and LPP) on self-concept. A total of 326 patients were assessed at baseline with the Quality of Object Relations Scale (QORS) and 4 times during a 3-year follow-up with the Structural Analysis of Social Behavior self-concept questionnaire, comprising altogether 10 scores on different aspects of self-concept pathology. The effectiveness of SFT, but not SPP, was significantly poorer in several domains (5/10) of self-concept for patients with low QORS, i.e. those with less mature relational patterns, than for patients with high QORS, while the reversal occurred in some (3/10) self-concept domains in LPP. The results suggest that the quality of object relations has significance for treatment selection in therapies with different mode and length.

Psychotherapy: A Way Forward to Improve the Quality of Life in Otalgia Patients

Introduction: Otalgia is not only an indicator of impact of disease but also impairs the daily activities and personal behaviors as is unpleasant and disturbing for the patient. It leads to decrease in functional status up to the complete disability. Nowadays the main focus of physician is to eradicate the disease or the symptoms, leaving behind the humanistic element. In diseased state, the most important point is to assess and improve the quality of life by using multidisciplinary approach. Objective: The objective is to assess the quality of life in patients having otalgia, due to any cause. Methodology: A descriptive cross sectional study was conducted by using modified form of WHOQOL-100 and COQOL. Data was accepted, if CFI was greater than 0.9. Qualitative data were presented as frequency and percentages and quantitative data as mean with standard deviation. ANOVA was used to assess the variations among groups. Change in behavior was assessed by using the Likert scale for each domain of WHOQOL and COQOL by a ten-point scale. Results: Majority of participants about 60.2% were male and were from the age group of 16 - 30 years. Most of the sample population were from lower socioeconomic class. Looking over the WHOQOL-100, higher score represented the higher quality of life. Variation among different socioeconomic status was non-significant for positive attitudes but was highly significant (p = 0.0020) for negative attitudes. Analyzing the COQOL scoring system, higher score reported the worse symptoms. The patient with high COQOL showed strong correlation with poor WHOQOL-100 score that was p value Conclusion: The current study highlights the need of multidisciplinary approach for the better management and improving the quality of life in patients with otalgia.

Some thoughts on the common issue of psychotherapy in different cultures——report on the China conference of psychoanalysis

Distinguished Chairman,Dear colleagues,ladies and gentlemen,Good morning!It is my great honors to have the presentation here,share my thoughts with you,you may agree or disagree but start a discussion,as Chinese says:(Pao Zuan Yin Yu)throw away a brick in order to get a gem;Today in this hall,more than 1000 colleagues from almost 30 different countries,nations or districts,get together,to share our common interests

Psychiatry Trainees’ Attitudes towards Psychotherapy

Background: Psychotherapy education is one of the essential components of specialist training in psychiatry according to the Royal College of Physicians of Canada. How psychiatry trainees perceive psychotherapy has major implications for how trainees will learn about psychotherapy during training, how they will utilize it in their future practice, and how they will integrate it into their professional identity. Methods: The study involved the distribution of questionnaires to psychiatry residents at an Atlantic Canadian Medical School. The survey consisted of Likert-scaled items which assessed residents’ attitudes towards being a psychotherapist and their future study and practice plans in psychotherapy. Results: Surveys were completed by 18 out of 25 residents (72% response rate). Half of participants indicated that conducting psychotherapy was highly rewarding and the majority of residents planned to incorporate psychotherapy into their future practice. Several mean differences were also noted between those residents who completed their undergraduate medical education in Canada versus at International locations. Conclusion: Despite the recent changes in psychotherapy training requirements and concerns about psychotherapy’s role in psychiatry, many residents perceive psychotherapy skills as being important for competent psychiatry practice and plan to incorporate their psychotherapy training into their future practice. Additional implications for teaching, future research, and practice are discussed.

"Independent Self"and"Interdependent Self"reflections on the reference to the body perspective in psychotherapy and psychosomatics in China

The introduction of western psychotherapy methods to China is an enormous transcultural challenge.It touches the different concepts of"independent self"and"interdependent self"in China.The different constructions of self are contingent upon society and culture.It is important to give particular consideration to this aspect in the transfer of western(body)psychotherapy to China.In this article,the author describes general and concrete examples of his own experiences in China.

Psychotherapy in Hospitals in Brazil and Some Contributions from Psychoanalysis: A Historical Study

Psychotherapeutic practice in hospitals in Brazil started in the 1950s even before the profession of psychologist in the country was formalized, and has been building a fairly rich history because it is differentiated according to the development of the practice over the decades as a function of the various clinical methods associated with it, as a consequence of the policies and/or different theoretical orientations that have underpinned it. Twenty years after this practice began, during the 1970s, the field of mental health was configured as a major center of absorption of psychologists in an attempt to change the prevailing medical model. It is at that time that we can first see the formation of multidisciplinary teams linked to psychotherapy treatments. When we examine the relationship between the advancement of the practice and its theoretical foundations, in a field where political orientations toward the practice carried no less weight, we realize that this entire movement has led to important developments in the history of psychology in general. In order to specify what clinical practice in hospitals has contributed to psychology in general, it is necessary to follow its guidelines over the decades, where we can confirm that a certain prevalence of psychoanalysis has been and is being established. To the extent that it is characterized as a discourse directed at the subject, it is fundamental that it allows for situating the work in the hospital in an exchange with the medical field in such a way that each field may sustain its own particularities, respect their differences, and contribute, each in their own way, toward the advancement of clinical work. From the 1950s through today, clinical practice highlights a concern with asserting subjectivity in hospitals where the contributions of some psychoanalytical developments to different forms of psychotherapy have not been lacking.

The Cost-Effectiveness of Short-Term Psychodynamic Psychotherapy and Solution-Focused Therapy in the Treatment of Depressive and Anxiety Disorders during a Three-Year Follow-Up

Background: Various psychotherapies are used extensively in treating different mental disorders, but still relatively little is known about the long-term health and cost effects of different therapies. The aim of this study is to compare the cost-effectiveness of short-term psychodynamic psychotherapy (SPP) and solution-focused therapy (SFT) in the treatment of depressive and anxiety disorders during a three-year follow-up. Methods: A total of 198 outpatients suffering from mood or anxiety disorder were randomized to SPP or SFT. Symptoms were assessed using the Beck Depression Inventory, the Hamilton Depression Rating Scale, the Symptom Check List Anxiety Scale, the Hamilton Anxiety Rating Scale, and the Symptom Check List Global Severity Index. Both direct and indirect costs due to mental health problems were measured. Results: The symptoms of depression and anxiety were reduced statistically significantly according to all 5 psychiatric outcome measures during the first 7 months, after which only minor changes were observed. The differences between the two groups were small and not statistically significant. The direct costs were about equal in both groups but the indirect costs were somewhat higher in the SPP group, although not statistically significantly. The costs of auxiliary treatments were much higher than the cost of SPP or SFT. Conclusions: With regard to cost-effectiveness, there is little difference between SPP and SFT.

Impact of psychotherapy on acute coronary syndrome patients with mental disorder

Background In acute coronary syndrome(ACS),mental disorder is associated with poorer clinical outcomes,but there are still few data.Methods This study consecutively enrolled ACS patients with anxiety/depression at our center from January 2018 to July 2020.Patients were divided into a control group(n=271)and an experiment group(n=361)based on whether they underwent psychotherapy.Patients were followed up at 12 months.The primary endpoint event was adverse cardiovascular events(MACE),including death,myocardial infarction,re-angina and the target vessel revascularization.Results There were no statistical differences in admission Hamilton anxiety scale(HAMA)and Hamilton depression scale(HAMD)between the two groups.The HAMA score(9.18±2.2vs.21.26±3.9;P<0.001)and HAMD score(23.15±3.8 vs.13.28±2.7;P<0.001)were lower in the experimental group than in the control group at discharge.Multiple logistic regression analysis showed that psychological status at discharge[OR 0.20,95%CI(0.011-0.421),P=0.020]and treatment for psychological disorders[OR 0.2095%CI(0.011-0.421),P=0.020]were independent predictors of 1-year MACE.Conclusions Anxiety and depressive status at discharge were independent associated with adverse events.psychotherapy significantly reduced MACEs in ACS,particularly recurrent angina,but not myocardial infarction,revascularization or all-cause mortality.

Autonomous VR Exposure Therapy for Anxiety Disorders Using Conversational AI—Ethical and Technical Implications and Preliminary Results

The need for psychotherapy is very high and the lack of care causes a lot of suffering and high costs. This paper presents an interdisciplinary approach to creating an AI-guided exposure therapy for fear of heights in virtual reality (VR). First, ethical principles for the use of conversational AI in psychotherapy were translated into technical requirements and made measurable. Based on this, an autonomous virtual reality exposure therapy was iteratively developed with a therapist. The feasibility and implementation of the ethical principles were tested with a patient. The patient was very satisfied with the VR setup. The AI therapist was also rated positively, although there is still room for improvement regarding conversational skills. Overall, the paper shows how AI can contribute responsibly to improving the psycho-therapeutic supply. It also provides guidelines that make ethical principles tangible and measurable for developers.

Efficacy of equine-assisted psychotherapy in veterans with posttraumatic stress disorder

Background: Posttraumatic stress disorder(PTSD) is a common and debilitating disorder among war veterans. Although complementary and alternative therapies are gaining acceptance in the treatment of PTSD, the efficacy of animal-based therapies in this disorder is unknown. The goal of equine-assisted psychotherapy(EAP) is to improve the social, emotional, and/or cognitive functions of individuals with PTSD.Objective: This study aims to explore the effects of EAP on PTSD symptoms. We hypothesized that veterans with PTSD who participate in a standardized EAP program for 1 h per week for 6 weeks would experience decreased PTSD symptoms and would demonstrate increased resilience as compared with individuals who do not receive EAP intervention.Design, setting, participants and interventions: We conducted a sequentially assigned, two-arm parallel group trial comparing 6 weeks of EAP with standard, previously established, ongoing PTSD therapy.Therapy was conducted at a community EAP facility in conjunction with an academic University Hospital. Twenty adult veterans with symptomatic PTSD completed the study. Ten adult veterans with previously diagnosed PTSD were assigned to EAP and received directed interaction with trained horses for one hour a week in groups of 3 or 4 individuals, while also continuing their previously established therapies. A certified therapist supervised the sessions, and a professional horse handler was also present.Results were compared with those from 10 adult veterans who only received their standard previously established PTSD care as prescribed by their provider.Main outcome measures: Changes in salivary cortisol, scores for the PTSD Check List-Military Version(PCL-M) and the Connor-Davidson Resilience Scale(CD-RISC) after 6 weeks of study were measured.Results: Of the 20 enrolled patients, 10 served in Afghanistan, 5 served in Iraq, and 3 served in Vietnam. Subjects were(47 ± 14) years old, were predominantly male, and had a body mass index of(29 ± 7) kg/m2. They had(9.2 ± 6.1) years of military service and carried 66% ± 37% service-connected disability. PCL-M scores declined significantly in both groups and CD-RISC scores increased significantly in the EAP group. There was no difference between the groups with respect to the magnitude of change.Conclusion: As compared to the control group, a 6-week EAP program did not produce a statistically significant difference with respect to PCL-M and CD-RISC scores, or salivary cortisol. However, our results suggest that EAP may work as well as standard therapy with respect to these parameters. This study supports further inquiry into EAP as a potentially efficacious alternative for veterans suffering from PTSD.Trial registration: ClinicalTrials.gov NCT #03039361.

Effect of Cognitive Behavioral Therapy Versus Interpersonal Psychotherapy in Patients with Major Depressive Disorder： A Meta-analysis of Randomized Controlled Trials

Background： Practice guidelines have recommended cognitive behavioral therapy （CBT） and interpersonal psychotherapy （IPT） as the treatment of choice for major depression disorder （MDD）. However, whether one therapy is better than the other remains inconclusive. The aim of this study was to compare the treatment efficacy of the two treatment approaches for MDD. Methods： Using the terms ＂cognitive behavior therapy or cognitive therapy or CBTor CTor cognitive behavioral therapy＂ and ＂interpersonal psychotherapy or IPT,＂ we systematically searched PubMed, Psyclnfo and Chinese National Knowledge Infrastructure databases up to February 2017. The language was restricted to be English and Chinese. Therapeutic outcomes, characteristics, and research quality were then extracted and analyzed independently. In accessing the included studies, we followed the criteria suggested by the Cochrane Handbook for Systematic Reviews of Interventions. Results： Data for 946 patients from 10 randomized controlled trials were included in the study. Methodological quality was not optimal in most trials. Meta-analysis showed a mean difference （MD） of -1.31, 95% confidence interval （CI） （-2.49, -0.12） （P 〈 0.05） in favor of CBT according to the Beck Depression Inventory （BDI）, and however, we did not found any statistically significant difference between CBT and IPT on the Hamilton Rating Scale for depression （HRSD） （MD -0.90, 95% CI [-2.18, 0.38]）. Subgroup analyses for the studies in which patients were treated only by psychotherapy （MD -1.26, 95% CI [-2.78, 0.35]） and for those which offered more sessions of therapies （MD -0.82, 95% CI [-2.23, 0.59]） showed there was no significant difference between CBT and IPT according to BDI. Conclusions： Differences in treatment efficacy seem to vary according to different outcome measures. CBT shows an advantage over IPT for MDD according to BDI, and there is no significant difference between the two according to HRSD. These results should be interpreted with caution.

Incorporation of Massage into Psychotherapy:An Integrative and Conjoint Approach

This article presents the potential integration of psychotherapy and massage when considering the essence of their beneficial effects.The essence of this model of practice is multifaceted,combining principles from anatomy,physiology and neuroscience with psychotherapy to benefit patient care.It has been advocated that possessing multidisciplinary knowledge from these areas of science enhances psychotherapists＇ holistic care of their depressive patients.A narrative review of the literatures and a qualitative,conceptual synthesis has been performed to create a new theoretical-pragmatic construct.This article introduces the concept of massage practice as a part of psychotherapy practice and presents the potential integration of psychotherapeutic knowledge with clinical decision-making and the management of depressive symptoms.The authors emphasize the usefulness of multi- and interdisciplinary knowledge in the psychotherapeutic process and explain how this knowledge might be extrapolated and incorporated into theoretical and practical settings to benefit depressive patients.The justification for this concept is also presented.The principles set out in this article may be a useful source of information for psychotherapists concerned about their patients＇ holistic well-being in addition to the psychopathology for which they have sought treatment.Researchers and psychotherapists can obtain valuable and additional knowledge through cross-fertilization of ideas across the arguments presented here.

Not one thing at a time:When concomitant multiple stressors produce a transdiagnostic clinical picture

A condition of exposure to multiple stressors resulting in a mixed clinical picture spanning conventional categories without meeting any of them in full,encompasses a risk for a list of comorbidities preventing appropriate prevention and treatment.New transformative transdiagnostic approaches suggest changes spanning conventional categories.They base their systems of classification on biomarkers as well as on brain structural and functional dysregulation as associated with behavioral and emotional symptoms.These new approaches received critiques for not being specific enough and for suggesting a few biomarkers for psychopathology as a whole.Therefore,they put the value of differential diagnosis at risk of avoiding appropriate derived prevention and treatment.Multiplicity of stressors has been considered mostly during and following catastrophes,without considering the resulting mixed clinical picture and life event concomitant stressors.We herewith suggest a new category within the conventional classification systems:The Complex Stress Reaction Syndrome,for a condition of multiplicity of stressors,which showed a mixed clinical picture for daily life in the post coronavirus disease 2019 era,in the general population.We argue that this condition may be relevant to daily,regular life,across the lifespan,and beyond conditions of catastrophes.We further argue that this condition may worsen without professional care and it may develop into a severe mental health disorder,more costly to health systems and the suffering individuals.Means for derived prevention and treatment are discussed.