Petra Skeffington

Introduction: Persons with multiple sclerosis (MS) frequently experience symptoms of anxiety. There is an unmet need for effective and accessible interventions to reduce anxiety in this population.

Objectives/Aims: To conduct a systematic review and metaanalysis on the effect of exercise on anxiety in MS, exploring participant and intervention characteristics.

Methods: We searched eight databases until November 2024 for randomised controlled exercise trials with an inactive control group in adults with MS. Trial quality was assessed using the Cochrane Risk-of-Bias Tool 2.0. Intervention development was assessed based on the Medical Research Council’s (MRC) framework for developing interventions. We pooled standardised mean difference (SMD) effect sizes (Hedge’s g) and their 95% confidence intervals for continuous data in a pairwise meta-analysis.

Results: From 6096 records, 18 trials (n=709 participants) were included. Sixteen exercise interventions, demonstrated improvements in anxiety symptoms compared to inactive control, reflected as a small positive effect (SMD: 0.26, 95% CI: 0.04, 0.48). Risk of bias was high, due to self-reported measures. Few trials were pre-registered, and none focussed on anxiety as the main outcome. Authors infrequently reported detailed intervention design; only two trials reported co-design collaboration with both patient and clinician stakeholders.

Conclusion: Exercise interventions may improve symptoms of anxiety in people with MS. Studies should be designed using the MRC framework, pre-register protocols, reduce risk of bias in their outcome measurement, and assess anxiety as a primary outcome in participants with clinical levels of anxiety.

Psychedelic use in naturalistic settings in Australia is increasing. Although the risks and harms of psychedelics from a physical perspective are low, psychedelic drugs carry a unique psychological risk profile which is increased in uncontrolled settings. Harm reduction support services align with the Australian Government’s Federal Drug strategy, which includes harm reduction as the third pillar in the overall harm minimisation approach to drug use for the period of 2017–2026. This study examined the harm reduction behaviours which users of psychedelics in naturalistic settings currently use, and any harm reduction interventions which have been developed for this population. A scoping review was undertaken using online databases, Psychinfo, Medline, CINAHL and Scopus. Articles were included if they explored or informed harm reduction practices for users of psychedelic drugs in naturalistic settings, which included articles that investigated motivations for psychedelic use. Twenty-seven papers were included, which contained only four intervention-based studies. Harm reduction or benefit enhancing strategies were categorised into three themes: before psychedelic use, during psychedelic experience and after the experience (integration). The review found that users of psychedelic drugs in naturalistic settings employ several different harm minimisation strategies, predominantly before and during use. Motivation for use, social setting and dosage amount were all found to influence the strategies used. There were a limited number of evaluated interventions for users of psychedelics in naturalistic settings, identifying the need for further research in this area. Challenges for harm reduction campaigns such as low uptake of drug checking services and low trust in government institutions were identified. Further research needs to consider the differing motivations of psychedelic users and recognise strategies that promote benefit enhancement and reduce risk.

Introduction
Persons with multiple sclerosis (MS) frequently experience symptoms of anxiety. There is a large unmet need for effective and accessible interventions.

Objectives
To assess the effect of exercise on symptoms of anxiety in persons with MS, consider characteristics associated with effectiveness, and evaluate intervention design reporting.

Methods
This systematic review and meta-analysis included randomised controlled exercise trials in persons with MS. MEDLINE, Embase, PsycINFO, CENTRAL, CINAHL, Scopus, Web of Science and PEDro were searched up to November 2024. The primary outcome was the post-intervention difference in anxiety symptoms between intervention and inactive control groups. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. We pooled standardised mean differences using a restricted maximum likelihood random-effects model.

Results
This systematic review of 18 randomised controlled trials identified a small positive effect of exercise on anxiety symptoms in persons with MS (SMD: 0.26, 95% CI: 0.04, 0.48) with moderate heterogeneity between trials (I2: 37.94%, τ2: 0.0962). All trials had a high risk of bias, as they relied on self-reported anxiety measures in unblinded participants. Few trials were pre-registered, and none focused on anxiety as the primary outcome. Authors infrequently reported intervention designs incorporating stakeholder engagement, expert engagement, and evidence-based and/or behavioural frameworks.

Conclusions
Exercise can reduce symptoms of anxiety in persons with MS. This is a promising result, given that exercise is beneficial for general health and is a safe and accessible treatment option.

Background: People with multiple sclerosis (MS) have unique needs during a disaster, increasing preparation requirements. The content and patient-level suitability of disaster preparation tools is unknown. This scoping review aimed to determine the range and content of disaster preparation resources that are freely available online and suitable to assist people with MS.

Methods: Resources were identified via the Turning Research Into Practice medical database, Google, and disability-related websites. The included resources were disability specific and have been published since 2017. Resources were inductively analyzed and presented according to the target audience and themes. Findings were compared with stakeholder preferences.

Results: Fifty-nine resources were identified, targeting carers (27.1%), health care professionals (10.2%), and people with disabilities (89.8%). Resource content themes were advanced planning, informing others, practical preparations, and review. Consumer involvement was reported in 2 resources. Stakeholder preferences for disaster preparedness content were not well reflected in the resources.

Conclusions: The review identified online disaster preparedness resources suitable for people with MS and highlighted important gaps. More inclusive resources can be created with consumer involvement in design. Identified themes inform professionals about resources to recommend to patients based on their needs. Health care professionals can aid preparation by addressing resource gaps, particularly regarding health condition management.

South Korea is a collectivist culture informed by Confucian philosophy and filial piety values that influence family and social life. Filial piety is an important value, characterized by respect, obedience, love, and care for one’s elders with a goal of retaining social and familial harmony. Filial piety has also been cited as potentially causative in creating emotional pain and impacting mental health outcomes for South Korean children due to its hierarchical nature, often resulting in an interpersonal injury by a parent toward a child. This is conceptualized as ‘unfinished business’ in Emotion-Focused Therapy (EFT) where the pain continues into adulthood. An empty-chair dialogue is used to support resolution of this interpersonal injury and has been extensively researched demonstrating efficacy in North American contexts. However, as EFT gains popularity in many collectivist cultures, limited cultural scrutiny of empty-chair work has taken place in these settings. Filial piety may be at odds with the resolution process that requires acknowledgment and expression of this pain and unmet needs from the parent. As EFT gains momentum in South Korea, both the cultural experience of unfinished business and the particular events in the intervention process need to be investigated to support best outcomes for clients.

The experience of hearing voices is common to an estimated 7% of the general population, with the presence of negative content being the best predictor of whether individuals will require clinical support. Whilst largely neglected in the literature to date, there are calls to consider the significance of voice content for reducing voice-related distress. However, no quantitative and comprehensive measure of voice content with suitability for research and clinical use exists. This pilot study aimed to demonstrate preliminary psychometric properties of a newly developed measure, the Perth Voice Content Questionnaire (PVCQ), designed to measure the intensity and themes of positively and negatively valenced voice content, primarily of the dominant voice. The PVCQ and measures of voice severity and related beliefs were completed by 47 voice-hearing participants. The measure was found to be internally consistent, loaded onto two distinct factors of positive and negative content, and these factors were associated with voice-related distress and negative beliefs about voices and positive beliefs about voices, respectively, indicating good validity. The PVCQ offers the first self-report measure of voice content, with preliminary psychometric properties indicating its suitability for clinical and research use.

Serotonergic psychedelics and related substances have been explored as potential adjuncts in substance-assisted psychotherapy (SAPT) for treating various disorders. SAPT can be divided into three phases: preparation, administration and integration. Integration is commonly defined as the comprehension and effective application of insights from psychedelic experiences into everyday life. However, there is limited research regarding the most appropriate therapeutic approach during SAPT. In this article, we discuss the current evidence for different therapeutic frameworks for integration sessions when serotonergic psychedelics and entactogens are used as adjuncts to psychotherapy. We conducted a systematised review of the literature following PRISMA guidelines and searched PsycINFO, MEDLINE and Cochrane Library databases. The final synthesis included 75 clinical trials, mixed-methods investigations, treatment manuals, study protocols, quasi-experiments, qualitative investigations, descriptive studies, opinion papers, reviews, books and book chapters, published until 11 November 2022. The effects that various therapeutic approaches for integration sessions have on therapeutic outcomes have not been investigated by means of rigorous research. Most of the available evidence we retrieved was not supported by empirical data, thus limiting any conclusive statements regarding appropriate therapeutic frameworks for integration sessions for SAPT. Current clinical studies have used a range of therapeutic frameworks with the majority drawing from the humanistic–experiential tradition. While integration is regarded as crucial for the safe application of SAPT, there is currently an insufficient evidence base to suggest that any type of therapy is effective for guiding integration sessions. A systematic investigation of different therapeutic frameworks for integration and additional therapy-related factors is needed.

Serotonergic psychedelics and related substances have been explored as potential adjuncts in substance-assisted psychotherapy (SAPT) for treating various disorders. SAPT can be divided into three phases: preparation, administration, and integration. Integration is commonly defined as the comprehension and effective application of insights from psychedelic experiences into everyday life. However, there is limited research regarding the most appropriate therapeutic approach during integration sessions in SAPT. In this article, we discuss the current evidence for different therapeutic frameworks for integrations sessions when serotonergic psychedelics and entactogens are used as adjuncts to psychotherapy. We conducted a systematized review of the literature following PRISMA guidelines and searched PsycINFO, MEDLINE, and Cochrane Library databases. The final synthesis included 75 clinical trials, mixed-methods investigations, treatment manuals, study protocols, quasi-experiments, qualitative investigations, descriptive studies, opinion papers, reviews, books and book chapters, published until November 11, 2022. The effects that various therapeutic approaches for integration sessions have on therapeutic outcome have not been investigated by means of rigorous research. Most of the available evidence we retrieved was not supported by empirical data, thus limiting any conclusive statements regarding appropriate therapeutic frameworks for integration sessions for SAPT. Current clinical studies have used a range of therapeutic frameworks with the majority drawing from the humanistic-experiential tradition. While integration is regarded as crucial for the safe application of SAPTHowever, there is currently an insufficient evidence base to suggest that any type of therapy is most effective for guiding integration sessions. Systematic investigation of different therapeutic frameworks for integration and additional therapy-related factors is needed.