2 Minute Medicine Rewind October 26, 2026

Concentrated Exposure Therapy vs Internet-Based Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: A Randomized Clinical Trial

1. Concentrated exposure therapy was associated with greater and more sustained reductions in obsessive-compulsive disorder symptom severity compared to an established internet-based cognitive behavioral therapy.

Evidence Rating Level: 1 (Excellent)

The Bergen 4-day treatment (B4DT) is a concentrated exposure and response prevention (ERP) intervention for obsessive-compulsive disorder (OCD) that compresses treatment traditionally delivered over several months into 4 days. Although B4DT improves efficiency and accessibility of ERP, it remains unclear how it compares with scalable digital cognitive behavioral therapy (CBT) interventions. This study thus evaluated the efficacy of B4DT compared with internet-based CBT (iCBT) in reducing OCD symptoms. This randomized controlled trial included adults aged 18-72 years with OCD in Germany. Participants were randomly assigned 1:1 to undergo B4DT delivered in small groups by trained therapists or an 8-week self-guided iCBT program. The primary outcome was change in OCD symptom severity, measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Outcomes were assessed at baseline, 6 weeks, 8 weeks (posttreatment), and 3 months (follow-up). In total, 119 participants were included in the study (mean [SD] age, 33.5 [10.1] years; 79 [66.4%] women). Participants who received B4DT had greater reductions in OCD symptoms (Y-BOCS) than those who received iCBT, with large effects at posttreatment (mean [SE] difference, −7.9 [0.9]; 95% CI, −9.7 to −6.0; Hedges g, −1.6) and sustained effects at 3-month follow-up (mean [SE] difference, −5.6 [1.1]; 95% CI, −7.8 to −3.4; Hedges g, −1.0). Overall, this study found that B4DT was superior to iCBT in reducing OCD symptom severity. These findings suggest that B4DT may be a scalable intervention to improve treatment access for people with OCD.

Emotion-Focused Behavioral Weight Loss Treatment for Adolescents: A Randomized Clinical Trial

1. Among adolescents, family-based behavioral treatment (FBT) plus emotion regulation was associated with less weight regain and lower emotional eating among adolescents compared to FBT alone.

Evidence Rating Level: 1 (Excellent)

The efficacy of family-based behavioral treatment (FBT) for weight loss among youth decreases in adolescence, a period where emotion regulation skills are developing. Although limited emotion regulation skills may contribute to emotional eating, emotion regulation strategies are not included in standard FBT. This study thus compared the efficacy of FBT alone with FBT plus emotion regulation on adolescent weight loss. This randomized clinical trial included adolescents 13-16 years in the US of age with body mass index (BMI) > 85th percentile but < 99.9th percentile. Parent-adolescent dyads were randomly assigned to receive 6 months of FBT alone (nutrition and physical activity education, behavior change strategies, and parenting strategies) or FBT plus emotion regulation. The primary outcome was adolescent weight (BMI z score (BMIz) and BMI as a percentage of the 95th BMI percentile [%BMIp95]). Outcomes were assessed at baseline (month 0), midtreatment (month 3), posttreatment (month 6), 6-month follow-up (month 12) and 12-month follow-up (month 18). A total of 166 dyads were included in the study (adolescents: mean [SD] age, 14.3 [1.2] years; 95 [57%] female; mean [SD] BMIz, 2.2 [0.6]; mean [SD] %BMIp95, 120.4 [21.4]; parents: mean [SD] age, 45.3 [6.5] years; 141 [85%] female; mean [SD] BMI, 32.6 [7.0]). Although there were no significant differences in posttreatment weight loss between adolescents who received FBT plus emotion regulation and those who received FBT alone, adolescents in FBT plus emotion regulation regained less weight at the 12-month follow-up (difference in BMIz, −0.09 [95% CI, −0.17 to −0.02]). Compared to adolescents who received FBT alone, those who received FBT plus emotion regulation had lower scores on emotional eating (difference in Emotional Eating Scale scores, −0.39 [95% CI, −0.63 to −0.15]). Overall, this study found that FBT plus emotion regulation was associated with less weight regain and lower emotional eating among adolescents with overweight and obesity. These findings highlight the importance of adding emotional regulation strategies to FBT to help improve maintenance of weight loss among this population.

Acetic acid chromoendoscopy for detection of neoplastic Barrett’s oesophagus: stepped wedge cluster randomised controlled trial (ACID-trial)

1. Acetic acid chromoendoscopy did not improve the overall or targeted neoplasia detection rate in patients with Barrett’s oesophagus undergoing endoscopic surveillance in routine clinical practice.

Evidence Rating Level: 1 (Excellent)

Previous studies have found acid chromoendoscopy (AAC) to have promising diagnostic value in the surveillance of Barrett’s oesophagus. Although AAC guided surveillance has been suggested to increase neoplasia detection rate in patients at high risk in Barrett’s oesophagus expert centres, its added value in routine clinical practice is unclear. This study thus examined the added value of AAC for the detection of neoplasia during Barrett’s oesophagus surveillance endoscopies in routine clinical care. This randomised clinical trial included patients >18 years old undergoing surveillance for Barrett’s oesophagus in the Netherlands. Participating hospitals sequentially shifted from surveillance without AAC (control) to AAC (intervention) in a randomised order. The primary outcome was the neoplasia detection rate. Out of the 2267 participants included in the study, 1438 (63%) were allocated to surveillance without AAC and 829 (37%) to surveillance with AAC, of whom 679 (82%) of actually received AAC. Neoplasia was diagnosed in 163 (7.2%) participants. Surveillance with AAC did not increase the neoplasia detection rate compared with surveillance without AAC; (7.4% vs 7.1%; odds ratio [OR], 0.97; 95% CI, 0.65 to 1.44). Although more suspected lesions were detected in participants receiving surveillance with AAC compared to without AAC (14.0% vs 6.4%, P<0.001), the targeted neoplasia detection rate was similar between groups (2.1% vs 1.8%; OR 1.05, 0.49 to 2.24). Overall, this study found that AAC use did not improve the overall or targeted neoplasia detection rate among patients with Barrett’s oesophagus undergoing endoscopic surveillance. These findings suggest that AAC does not provide added value in routine clinical practice.

Change in alcohol consumption and all-cause mortality among postmenopausal women diagnosed with breast cancer

1. Among postmenopausal women diagnosed with breast cancer, alcohol reduction or cessation was not associated with a decrease in all-cause mortality, whereas increasing consumption among women consuming ≥ 1 drink/day pre-diagnosis was associated with higher mortality.

Evidence Rating Level: 2 (Good)

While alcohol consumption is an established risk factor for breast cancer, the relationship between alcohol consumption and breast cancer survival remains unclear. This study thus examined the association between change in alcohol consumption and all-cause mortality among breast cancer survivors. This prospective cohort study included postmenopausal women in the US diagnosed with non-metastatic invasive breast cancer who consumed alcohol before diagnosis. Change in alcohol consumption was assessed at three time intervals: pre-diagnosis, pre- to post-diagnosis, and post-diagnosis. The primary outcome was all-cause mortality. In total, 1,558 participants were included in the study (mean age-at-diagnosis: 71 years). Over a median follow-up of 12.6 years, 750 deaths occurred, of which 130 were breast cancer-related deaths. Across all change time intervals, reduced and increased alcoholic consumption were not associated with all-cause mortality. Compared to stable consumption, alcohol cessation pre- to post-diagnosis was associated with a 39% increased risk of all-cause mortality (HR:1.39, CI:1.12–1.73). Alcohol cessation pre- and post-diagnosis was not significantly associated with all-cause mortality compared to stable alcohol consumption. Among women consuming ≥ 1 drink/day pre-diagnosis, increasing consumption was associated with an 83% higher risk of all-cause mortality (HR:1.83, 95%CI:1.02–3.31). Overall, this study found that among postmenopausal women diagnosed with breast cancer, alcohol reduction or cessation was not associated with a decrease in all-cause mortality, whereas increasing consumption among women consuming ≥ 1 drink/day pre-diagnosis was associated with higher mortality. Future studies should address study limitations, including uncontrolled confounding and low prevalence of heavy alcohol consumption in the study population.

Stool biomarkers discriminate confirmed necrotizing enterocolitis in preterm infants

1. Stool biomarkers distinguished infants with confirmed necrotizing enterocolitis (NEC) from preterm infants without NEC, with secretory immunoglobulin A showing the best individual discrimination.

Evidence Rating Level: 2 (Good)

Stool-based biomarkers have emerged as promising tools for improving the discrimination of necrotizing enterocolitis (NEC). However, previous studies have mainly focused on single biomarkers conducted at single centers. This study thus examined whether six stool biomarkers discriminated preterm infants with NEC from those without NEC in a multicenter cohort. This ancillary analysis included infants born before 32 weeks’ gestation in France. Stool samples from preterm infants with NEC (Bell stage II or higher) were collected at diagnosis, while samples from those without NEC were collected at comparable postnatal ages. The six stool biomarkers included fecal calprotectin (fCal), human β-defensin-2, α1-antitrypsin (α1-AT), secretory immunoglobulin A (sIgA), cingulin (CGN), and eosinophil-derived neurotoxin. In total, 130 preterm infants were included, of whom 42 had NEC, and 88 did not. In both groups, the median gestational age was 28 weeks (p > 0.9). The stool biomarker showing the strongest individual discrimination was sIgA (area under the curve [AUC] = 0.82), followed by fCal (AUC = 0.74) and α1-AT (AUC = 0.73). The four-biomarker model (α1-AT, EDN, hBD-2, and sIgA) yielded an AUC = 0.83, whereas the six-biomarker complete-case model yielded an AUC = 0.86. Overall, this study found that stool biomarkers distinguished infants with confirmed NEC from preterm infants without NEC, with sIgA showing the best individual discrimination, and multimarker models performing modestly better. These findings highlight the potential of these biomarkers as noninvasive tools for NEC assessment.

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