Learning from feedback provided by others is important for navigating complex social environments. Aberrant processing of such social feedback is implicated in the psychopathology of several mental health disorders including social anxiety and depression. Recent psychiatric research increasingly adopts transdiagnostic approaches that examine mechanisms and constructs cutting across traditional diagnostic categories.

Here, we applied reinforcement learning models together with transdiagnostic measures of psychopathology to formally assess social evaluation learning. Human participants (n = 193) completed the Social Evaluation Learning Task, learning whether computer personas ‘liked’, ‘disliked’, or were ‘neutral’ toward them. Participants also completed six questionnaires assessing socially relevant psychiatric traits.

Computational modeling revealed that a model with separate learning parameters for positive and negative feedback best accounted for the learning behavior. Exploratory factor analysis identified three transdiagnostic factors. A factor reflecting social avoidance predicted enhanced learning from negative feedback and a reduced positive learning bias. Socially avoidant individuals with heightened negative learning rates additionally showed slower decision times specifically in positive social contexts. A second factor linking with emotional insensitivity for others predicted a lower choice accuracy in both positively and negatively valenced conditions. No significant associations emerged for a third factor reflecting depressive and mood-related symptoms.

These results demonstrate how transdiagnostic trait dimensions shape social learning mechanisms through specific behavioral and computational processes.

Psychosis, social anxiety, and autism are clinical constructs that share important phenotypic features, particularly social dysfunction. A critical determinant of social functioning is an individual’s ability to recognize when social cues, such as eye gaze, are meant for them. Emerging computational modeling data in psychosis suggest that altered gaze perception stems from deficits in evidence accumulation – the process of gathering and integrating information – when processing social cues. We investigated whether aberrant evidence accumulation during gaze perception is associated with social functioning or, as a secondary aim, with psychopathology in a transdiagnostic sample with varying levels of psychotic, socially anxious, or autistic characteristics.

We examined gaze perception in 111 individuals (aged 14–30) with varying levels of social dysfunction, psychosis proneness, social anxiety, and autistic traits. Drift diffusion models (DDM) characterized key processes driving perceptual judgements in a self-referential gaze perception task, including the efficiency of evidence accumulation. We tested whether evidence accumulation was associated with social functioning, social cognition, and these different psychopathology dimensions.

Impaired evidence accumulation during gaze perception showed strong associations with impaired social cognition and modest associations with diminished social functioning and elevated psychosis and social anxiety symptoms. Evidence accumulation was not associated with autism traits.

Evidence accumulation for social cues relates to social cognition – a key determinant of social functioning. It may also be relevant to real-world social functioning and multiple psychopathology dimensions, including psychosis and social anxiety. Therefore, evidence accumulation should be investigated as a mechanism supporting social difficulties and related psychopathology.

Impairments in spatial working memory (SWM) have been observed in several disparate psychiatric conditions. The present study investigated how SWM varied across a range of psychiatric disorders in a large sample of young adults using the SWM test from the Cambridge Neuropsychological Test Automated Battery.

A sample of 575 participants aged 18–29 years was enrolled from the general community and evaluated for psychiatric disorders using several screening evaluations. Performance on the SWM test was assessed, with outcome measures of strategy and total errors. Using Z-scores and Cohen’s d effect sizes, SWM was compared between each psychiatric disorder and healthy controls.

The majority of psychiatric diagnoses examined demonstrated SWM deficits in both strategy and total errors. Large effect sizes in strategy were observed for bulimia, post-traumatic stress disorder, major depressive disorder, social phobia, and agoraphobia. Large effect sizes in total errors were observed for agoraphobia, major depressive disorder, social phobia, intermittent explosive disorder, obsessive-compulsive disorder, bulimia, post-traumatic stress disorder, and gambling disorder.

Our findings suggest that SWM impairment is a transdiagnostic element of psychiatric illness rather than serving as a specific feature of any one diagnosis. Future directions include the exploration of how SWM deficits may be utilized in prognostic and therapeutic interventions.

Executive function (EF) deficits are consistently linked to psychopathology symptoms, though the mechanisms linking poor EF to symptom expression remain unclear.

The study used the Research Domain Criteria (RDoC) approach to examine relationships between teacher-reported latent psychopathology symptoms, including a general psychopathology factor (P-Factor), and EF in young children with emerging mental health problems. Participants were 804 children (70.8% male; aged 49–89 months) referred by their teachers for cognitive, emotional, or behavioral problems at school. To assess psychopathology, teachers completed the Strengths and Difficulties Questionnaire (SDQ). EF measures included inhibition, cognitive flexibility, working memory, sustained attention, and episodic memory, assessed using the NIH Toolbox, Automated Working Memory Assessment, and the Amsterdam Neuropsychological Test battery.

Structural equation modeling (incorporating confirmatory factor analysis) showed reasonable model fit and supported a P-Factor structure. Correlational analyses explored EF–psychopathology associations, followed by a sensitivity analysis controlling for sex. We observed patterns of cognitive processes that showed inverse associations between EF performance and specific clinical problems. Sustained attention was positively associated with emotional problems but negatively associated with hyperactivity problems. Sex-stratified analyses revealed distinct patterns, with inhibition problems strongly linked to conduct and hyperactivity problems, but in females only.

The findings support poor EF as a transdiagnostic risk factor associated with incremental vulnerability for childhood psychopathology. Divergent findings for sustained attentional processes suggest they can be adaptive in some contexts but maladaptive in others. Screening for EF difficulties in children could enhance early identification and inform interventions.

Formal thought disorder (FTD) is a highly disabling transdiagnostic feature that impedes communication and social ties. Progress in understanding and treating FTD has been hampered by the uncertainties in its assessment.

We examined if a short 3–5min assessment of transcribed speech can capture the latent dimensions and network structure of FTD and predict functional outcomes.

In a transdiagnostic sample (N = 666) with a single longitudinal follow-up over 3–12 months (n = 244), we administered the short form of the Thought and Language Index to measure eight individual features of FTD. We determined the baseline factor structure of FTD, its temporal invariance at follow-up, and the predictive validity of FTD dimensions on the global single-item Social and Occupational Functioning Assessment Scale scores at baseline and follow-up. We identified the most influential and putative primary phenomena within the FTD syndrome, using network analysis.

Factor analyses revealed a stable three-factor model of FTD: impoverishment (poverty of speech, weakening of goal), loosening (looseness, illogicality) and peculiarities (peculiar words, peculiar sentences), with excellent fit (Comparative Fit Index: 0.997, root mean square error of approximation: 0.040) and metric invariance over time. Impoverishment and peculiarities predicted functioning at baseline and 3–12 months later (cross-sectional: β = –0.196, p < 0.001 and β = –0.298, p = 0.001, respectively; longitudinal: β = –0.201, p = 0.037 and β = –0.336, p = 0.042, respectively). Looseness and poverty of speech were putative primary features influencing other FTD phenomena. Weakening of goal and peculiar sentences were the most connected phenomena.

By integrating latent variable and network approaches, we provide a unified, empirically grounded framework to interpret FTD assessed using a brief speech task. We report a replicable three-dimensional structure, identify central symptoms that may maintain the FTD syndrome, and the specific dimensions that influence functional disability. These findings clarify the prognostically valuable features of FTD for future mechanistic and interventional research.

Social cognitive deficits are common across many psychiatric conditions and contribute to broader social dysfunction. One hypothesized mechanism involves altered basic visual processing, which may disrupt the perception of low-level social cues and, in turn, compromise broader social cognitive processes. Here, we examined relations between basic visual processing and different levels of social cognition in a transdiagnostic youth sample.

A sample of 148 youth, ranging from healthy individuals to individuals with neuropsychiatric diagnoses and significant social dysfunction, completed two measures of basic visual processing (contrast sensitivity and visual integration) and a battery of social cognition tasks spanning lower-level (gaze perception) to mid-level (emotion recognition) to higher-level (theory of mind) social cognition. We used a four-level path model to test whether basic visual processing predicts gaze perception, which in turn predicts emotion recognition, which predicts theory of mind.

Poorer contrast sensitivity and visual integration were associated with less precise gaze perception, which was, in turn, associated with worse emotion recognition, which was associated with worse theory of mind. This four-level path model demonstrated good fit and showed superior fit compared to alternative models.

These findings suggest that basic visual processing influences the perception of basic social cues (e.g. gaze direction), which subsequently impairs more complex social perception and inference. Notably, this study extends prior observations from individuals with chronic schizophrenia to a transdiagnostic youth sample, indicating that altered basic visual processing may be a shared mechanism contributing to social cognitive deficits across psychiatric disorders and illness stages.

Language impairments are common in affective and psychotic disorders, yet their patterns and underlying pathomechanisms remain insufficiently understood. A transdiagnostic perspective provides a framework for identifying shared and disorder-specific language alterations across diagnostic boundaries. Combining natural language processing (NLP) with network analysis enables the investigation of complex associations between linguistic, cognitive, and psychopathological features.

Spontaneous speech from N = 372 participants (119 MDD, 27 BD, 48 SSD and 178 HC) was elicited using four Thematic Apperception Test pictures (~12 min per participant). NLP models were applied to extract latent linguistic variables across various levels, including lexical diversity, syntactic complexity, semantic coherence, and disfluencies. Network analysis was used to relate linguistic variables, psychopathology (SAPS, SANS, HAM-A, HAM-D, YMRS, TLI, GAF), and cognitive performance (attention, verbal memory, recognition, and verbal fluency).

Linguistic variables formed the densest network cluster, with type–token ratio, mean length of utterance, and syntactic complexity emerging as central nodes. Psychopathology variables were less cohesive, while TLI “Impoverishment”, coherence mean, and executive functioning bridged linguistic, cognitive, and psychopathological domains. Network comparison tests revealed no significant differences in linguistic–cognitive network structure across HC, MDD, BD, and SSD.

Linguistic networks show high structural consistency across healthy individuals and patients, whereas psychopathological symptom networks reflect transdiagnostic profiles. These findings support a dimensional and transdiagnostic framework underscore shared language–cognition mechanisms, and highlight executive functioning as key cross-domain connection, which opens up new avenues for dimensional research into the pathophysiological and etiological mechanisms underlying language dysfunctions.

Exercise improves stress perception and sleep quality and reduces repetitive negative thinking in patients with various mental disorders. However, it is unclear whether changes in these processes mediate treatment effects on psychopathology in a transdiagnostic sample.

Physically inactive adult outpatients with depressive disorders, agoraphobia, panic disorder, post-traumatic stress disorder, and/or nonorganic primary insomnia were randomly allocated to ImPuls – a 6-month transdiagnostic group exercise intervention – plus treatment-as-usual (n = 198), or to a treatment-as-usual alone control group (n = 201) at 10 study sites between March 2021 and May 2022. The primary outcome was global symptom severity; perceived stress, repetitive negative thinking, and sleep quality were included as mediators. All variables were assessed at baseline, 6 months, and 12 months using validated rating scales. As a secondary analysis of an RCT, intention-to-treat analyses were performed using structural equation modeling to test whether changes in stress perception, repetitive negative thinking, and sleep quality mediate treatment effects on changes in global symptom severity in two path models (from baseline to 6 and 12 months, respectively).

Treatment effects on global symptom severity were fully mediated by changes in perceived stress (6 months: β = −0.99, p = .024; 12 months: β = −1.28, p = .014) and repetitive negative thinking (6 months: β = −1.34, p = .004; 12 months: β = −0.94, p = .024).

Our results suggest that changes in perceived stress and repetitive negative thinking may be key transdiagnostic mechanisms underlying the treatment effect of exercise on global symptom severity.

Impairments in mentalizing, or theory of mind, occur across psychiatric disorders. Static illustrations are widely used to assess mentalizing due to their simplicity, and they allow assessment of specific cognitive processes. However, systematic comparisons of impairments between psychiatric disorders, neurodevelopmental disorders, and at-risk groups in mentalizing tasks with static illustrations are currently lacking.

A systematic review with pairwise and network meta-analyses (NMA) was conducted to evaluate mentalizing impairments using tasks with static illustrations across psychiatric disorders compared to healthy controls (HCs) and between groups. Subgroup analyses examined specific mentalizing domains (false belief, humor, and intentionality), and meta-regression analyses explored potential moderators. The ceiling effects of specific tasks were also examined.

Eighty-nine studies were included, involving 9,038 participants and 11 psychiatric conditions. Significant mentalizing deficits were observed across all conditions versus HCs, except for the familial risk for bipolar disorder group. NMA demonstrated that schizophrenia (g = −0.960) and early schizophrenia (g = −0.785) exhibited the most pronounced impairments, followed by borderline personality disorder (g = −0.612) and obsessive-compulsive disorder (g = −0.613). Particularly, schizophrenia showed significantly greater deficits than autism, bipolar disorder, clinical and familial high risk for schizophrenia, and depression. Domain-specific analyses highlighted differential impairment patterns. The presence of prominent ceiling effects suggests major limitations of tasks with static illustrations.

This review provides detailed insights into transdiagnostic and disorder-specific patterns of mentalizing impairments with tasks using static illustrations. Findings highlight the importance of domain-specific approaches, examining interindividual variability, refining assessment tools, and implementing targeted interventions.

High uncertainty in recent global health, geopolitical, and climate crises has been proposed as one important driver of the rise in youth mental health problems. This makes intolerance of uncertainty – a transdiagnostic risk factor for mental health problems – a promising target for intervention.

This study presents a novel single-session online training that took a synergistic mindset approach to promote uncertainty-as-adaptive and growth mindsets. The novel Uncertainty-Mindset Training was compared with Psychoeducation and No-Training control groups in 259 older adolescents/emerging adults (18-to-24-year-olds).

The Uncertainty-Mindset Training reduced intolerance of uncertainty, anxiety symptoms, and depression symptoms 1 month later. Importantly, the clinical gains were mediated by reductions in intolerance of uncertainty.

Given that this ultra-brief training can be delivered at scale globally and at no cost to the users, it shows promise for significant public health impacts.

How psychotic symptoms, depressive symptoms, cognitive deficits, and functional impairment may interact with one another in schizophrenia or bipolar disorder is unclear.

This study explored these interactions in a discovery sample of 339 Chinese, of whom 146 had first-episode schizophrenia and 193 had bipolar disorder. Psychotic symptoms were assessed using the Positive and Negative Symptom Scale; depressive symptoms, using the Hamilton Depression Rating Scale; cognitive deficits, using tests of processing speed, executive function, and logical memory; and functional impairment, using clinical assessments. Network models connecting the four types of variables were developed and compared between men and women and between disorders. Potential causal relationships among the variables were explored through directed acyclic graphing. The results in the discovery sample were compared to those obtained for a validation sample of 235 Chinese, of whom 138 had chronic schizophrenia and 97 had bipolar disorder.

In the discovery and validation cohorts, schizophrenia and bipolar disorder showed similar networks of associations, in which the central hubs included ‘disorganized’ symptoms, depressive symptoms, and deficits in processing speed during the digital symbol substitution test. Directed acyclic graphing suggested that disorganized symptoms were upstream drivers of cognitive impairment and functional decline, while core depressive symptoms (e.g. low mood) drove somatic and anxiety symptoms.

Our study advocates for transdiagnostic, network-informed strategies prioritizing the mitigation of disorganization and depressive symptoms to disrupt symptom cascades and improve functional outcomes in schizophrenia and bipolar disorder.

Given substantial comorbidity among, and considerable heterogeneity within, psychiatric diagnoses, researchers have suggested alternative systems for classifying psychopathology. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a recently proposed framework for understanding mental disorders based on how symptoms and diagnoses tend to cluster across individuals. While the model is grounded in existing research and supported by recent meta-analytic evidence, its structure has not yet been directly tested using large, representative clinical datasets. In this study, we used electronic health record (EHR) data to examine the overall organization of mental disorders as proposed by HiTOP, with the goal of informing future research on biological and environmental risk factors as well as important life outcomes.

Data were drawn from the All of Us Research Program, a landmark nationwide US biobank initiative designed to advance population-scale health research, and included participants’ psychiatric diagnoses and sociodemographic correlates as documented in their EHRs. A total of 127,963 participants and 39 primary diagnoses were identified. We analyzed patterns of co-occurrence among psychiatric diagnoses to identify broader psychopathology dimensions, assess the overall structure of mental disorders, and clarify the placement of conditions that have been inconsistently categorized in past research. Several competing dimensional models were compared based on their statistical fit and complementary assessments of factor strength, specificity, and reproducibility.

A model identifying six broad and correlated dimensions – Fear, Distress, Externalizing, Substance Use, Thought Problems, and Neurodevelopmental Disorders – provided the best fit to the data. This structure was highly consistent across analyses and showed strong split-half replicability and meaningful associations with relevant clinical and demographic characteristics.

These findings support a 6-factor model of psychopathology that broadly resembles major dimensions in the HiTOP framework. By addressing key gaps in the literature, this study advances our understanding of the structure and correlates of mental disorders. The results offer a foundation for more nuanced investigations into the etiology, progression, and treatment of mental health conditions.

Test whether a dissonance-based transdiagnostic eating disorder treatment, body project treatment (BPT), produces greater reduction in brain reward region response to the thin ideal and behaviors used to pursue this ideal and eating disorder symptoms, and higher abstinence from eating disorder behaviors and remittance from eating disorder diagnoses than a matched transdiagnostic interpersonal psychotherapy (IPT).

Women with various eating disorders (N = 83) were randomized to 8-week group-implemented BPT or IPT and completed functional magnetic resonance imaging (fMRI) at pretest and posttest, and surveys and masked diagnostic interviews at pretest, posttest, and 6-month follow-up.

BPT versus IPT participants showed significantly greater reductions in mid cingulate cortex response to thin models, anterior cingulate cortex response to eating disorder behavior words, eating disorder symptoms (d = 0.54), and body dissatisfaction (d = 0.57), and marginally greater reductions in psychosocial impairment (d = 0.39) at posttest, as well as significantly greater reductions in body dissatisfaction (d = 0.68) and psychosocial impairment (d = 0.63), and marginally greater reductions in eating disorder symptoms (d = 0.53) at 6-month follow-up. At posttest, BPT versus IPT participants showed significantly greater abstinence from binge eating and purging (48% versus 23%, respectively) but did not differ on remittance from eating disorder diagnoses (52% versus 44%, respectively).

Results provide further evidence of target engagement for BPT and suggest that it is more effective than IPT in treating a range of eating disorders.

Suicide represents a significant public health concern. Suicide prevention strategies are shifting toward transdiagnostic perspectives examining interrelated risk factors, but their interrelationships remain unclear. This study investigated relationships between psychopathological dimensions, impulsivity, and childhood maltreatment in individuals with suicidal ideation (SI), comparing those with versus without intention to act using network analysis.

Data were obtained from the Suicide Prevention and Intervention Study project. Participants were categorized into two groups based on their intention to act according to the Columbia Suicide Severity Rating Scale. Psychological symptoms, impulsivity traits, and childhood maltreatment were assessed. Network analysis was performed, and centrality measures were computed.

A total of 1,265 individuals were categorized into the SI without intention to act (n = 345) and SI with intention to act (n = 920) groups. The former showed lower depression and hostility scores, and lower prevalence of major depressive and anxiety disorders. Network analyses revealed that in the SI without intention to act group, obsessive-compulsive symptoms were central, connecting to depression and anxiety, while negatively correlating with non-planning impulsivity. In contrast, the SI with intention to act group showed a more densely interconnected network where emotional abuse served as a bridge between childhood maltreatment and other psychopathological dimensions.

This study identifies symptom interaction patterns between individuals with SI without and with intention to act. Understanding these relationships may improve suicide risk assessment and inform personalized interventions, potentially reducing the transition from ideation to action. Trauma-focused approaches addressing emotional abuse may be especially relevant for individuals at high risk.

Mentalization-based treatment (MBT) has promising transdiagnostic applications. The evidence base for its application in non-specialist settings, including general adult community mental health services requires further evaluation. This study explores the implementation of an MBT introductory (MBTi) group in an Irish secondary mental health service.

Two online MBTi groups were delivered between 2020 and 2021. A concurrent mixed-methods design was engaged. Qualitative pre- and post-intervention measures include the Clinical Outcomes in Routine Evaluation (CORE) scale, the World Health Organization Quality-of-Life (WHOQoL-BREF) scale and the Reflective Functioning Questionnaire (RFQ). Paired sample t-test was employed to analyse change. Interviews were conducted with seven participants post-intervention and inductive thematic analysis was utilised to identify themes.

Participants exhibited hypomentalizing tendencies, which improved following the delivery of the intervention (RFQu: MD = 0.54, p = 0.032, Cohen’s d = 0.71). There were improvements across the wellbeing, problems and functioning subscales of the CORE. There was no change in the risk domain, which was low at baseline. Improvements were observed in the WHOQoL-BREF subscale of psychological health and social relationships. Five main themes emerged from post-intervention interviews: barriers and facilitators; attitudes to design and delivery; perceived intervention effectiveness; intervention coherence; COVID-19 specific issues.

MBTi delivered in a non-specialist setting is associated with improvements in mentalizing capacity. The intervention is perceived as relevant and useful by participants, although the psychoeducation and online format conferred specific limitations. The findings support the role of MBTi as a feasible transdiagnostic intervention in general adult services, as part of a range of interventions.