Gender identity is a collection of thoughts and feelings about one's own gender, which may or may not correspond to the sex assigned at birth. How this sense is linked to the perception of one's own masculine or feminine body remains unclear. Here, in a series of three behavioral experiments conducted on a large group of control volunteers (N = 140), we show that a perceptual illusion of having the opposite-sex body is associated with a shift toward a more balanced identification with both genders and less gender-stereotypical beliefs about own personality characteristics, as indicated by subjective reports and implicit behavioral measures. These findings demonstrate that the ongoing perception of one's own body affects the sense of one's own gender in a dynamic, robust, and automatic manner. Gender identity is a collection of thoughts and feelings about one's own gender, which may or may not correspond to the sex assigned at birth 1-5. This multifaceted, subjective sense of being male, female, both, or neither occurs in our conscious self-awareness, but the associated perceptions and beliefs can also be largely implicit 3-5. In the past, gender identity was conceptualized as a male-female dichotomy; however, current theories consistently postulate that gender identity is a spectrum of associations with both genders 1,3-6. There is also a general consensus in the field that gender identity is determined by multiple factors, such as person's genes, hormones, patterns of behaviors, or social interactions 4-8 ; and that the sense of own gender (e.g., "I'm male") is closely linked to one's beliefs about males and females in general (e.g., "males are competitive"), as well as to the associated beliefs about own personality ("I am competitive") 1,3,6. The specific content of such beliefs and their strength contribute to what it means for a given person to be male or female in a given sociocultural context, which in some cases hinders the realization of one's full personal or professional potential. Although gender identity has a profound impact on our lives, little is known about how this sense is formed or maintained. A better understanding of the neurocognitive mechanisms of gender identity is also important in the context of gender dysphoria (DSM-5 9 ; gender incongruence ICD-11 10), which is characterized by the prolonged and clinically relevant distress that some transgender individuals experience due to inconsistency between their sex assigned at birth and their subjective sense of gender. Various observations suggest that gender identity and the perception of one's own body are tightly connected. For example, people with gender dysphoria (see above) often avoid looking in the mirror, hide their bodies under loose-fitting clothes, and seek hormonal and/or surgical procedures to adjust their physical appearance to meet their subjective sense of own gender 6,11,12. Moreover, among individuals whose gender identity matches their sex assigned at birth, mastectomy and androgen deprivation cancer therapies, which both ...

IMPORTANCE Atopic dermatitis is a common and debilitating skin condition characterized by intense itching and chronic inflammation. Research on behavioral treatments with high accessibility is needed.OBJECTIVE To investigate the efficacy of a highly scalable internet-delivered cognitive behavior therapy (CBT) for adults with atopic dermatitis. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial from a medical university in Stockholm, Sweden, included 102 adults with atopic dermatitis, recruited from across Sweden, who received 12 weeks of internet-delivered CBT (March 29, 2017, to February 16, 2018. The first participant provided screening data on November 27, 2016, and the last 1-year follow-up assessment was conducted on June 28, 2019.INTERVENTIONS Participants were randomized in a 1:1 ratio to 12 weeks of therapist-guided internet-delivered CBT (n = 51) or a control condition (n = 51) that gave instructions about standard care. MAIN OUTCOMES AND MEASURESThe primary outcome was the between-group difference in mean reduction of atopic dermatitis symptoms as measured by the Patient-Oriented Eczema Measure and modeled intention to treat during the 12-week treatment period.RESULTS A total of 102 participants (mean [SD] age, 37 [11] years; 83 [81%] female) were recruited and randomized. The primary analysis indicated that participants receiving internet-delivered CBT, relative to the controls, had a significantly larger mean weekly reduction in symptoms of atopic dermatitis as measured with the Patient-Oriented Eczema Measure (B = 0.32; 95% CI, 0.14-0.49; P < .001), with a moderate to large, controlled effect size after treatment (d = 0.75; 95% CI, 0.32-1.16). Secondary analyses indicated that internet-delivered CBT also produced significantly larger reductions in itch intensity, perceived stress, sleep problems, and depression. Gains were sustained at 12 months of follow-up. Treatment satisfaction was high, and therapists spent a mean (SD) of 39.7 (34.7) minutes per treated patient providing internet-delivered CBT.CONCLUSIONS AND RELEVANCE Internet-delivered CBT appears to be efficacious for reducing symptoms of atopic dermatitis, despite requiring minimal therapist resources. Thus, internet-delivered CBT has the potential to increase access to effective adjunct behavioral treatment for patients with this common skin condition.

Depression is common in primary care, and most patients prefer psychological treatment over pharmacotherapy. Cognitive behaviour therapy (CBT) is an effective treatment, but there are gaps in current knowledge about CBT in the primary care context, especially with regard to long-term effects and the efficacy of specific delivery formats. This is an obstacle to the integration of primary care and specialist psychiatry. We conducted a systematic review and meta-analysis of randomised controlled trials of CBT for primary care patients with depression to investigate the effect of CBT for patients with depression in primary care. A total of 34 studies, with 2543 patients in CBT and 2815 patients in control conditions, were included. CBT was more effective than the control conditions [g = 0.22 (95% confidence interval (CI) 0.15–0.30)], and the effect was sustained at follow-up [g = 0.17 (95% CI 0.10–0.24)]. CBT also led to a higher response rate [odds ratio (OR) = 2.47 (95% CI 1.60–3.80)] and remission rate [OR = 1.56 (95% CI 1.15–2.14)] than the control conditions. Heterogeneity was moderate. The controlled effect of CBT was significant regardless of whether patients met diagnostic criteria for depression, scored above a validated cut-off for depression, or merely had depressive symptoms. CBT also had a controlled effect regardless of whether the treatment was delivered as individual therapy, group therapy or therapist-guided self-help. We conclude that CBT appears to be effective for patients with depression in primary care, and recommend that patients with mild to moderate depression be offered CBT in primary care.

ImportancePersistent pain is a common and disabling health problem that is often difficult to treat. There is an increasing interest in medicinal cannabis for treatment of persistent pain; however, the limited superiority of cannabinoids over placebo in clinical trials suggests that positive expectations may contribute to the improvements.ObjectiveTo evaluate the size of placebo responses in randomized clinical trials in which cannabinoids were compared with placebo in the treatment of pain and to correlate these responses to objective estimates of media attention.Data SourcesA systematic literature search was conducted within the MEDLINE and Embase databases. Studies published until September 2021 were considered.Study SelectionCannabinoid studies with a double-blind, placebo-controlled design with participants 18 years or older with clinical pain of any duration were included. Studies were excluded if they treated individuals with HIV/AIDS or severe skin disorders.Data Extraction and SynthesisThe study followed the Preferred Reporting Items for Systematic Review and Meta-analyses reporting guideline. Data were extracted by independent reviewers. Quality assessment was performed using the Risk of Bias 2 tool. Attention and dissemination metrics for each trial were extracted from Altmetric and Crossref. Data were pooled and analyzed using a random-effects statistical model.Main Outcomes and MeasuresChange in pain intensity from before to after treatment, measured as bias-corrected standardized mean difference (Hedges g).ResultsTwenty studies, including 1459 individuals (mean [SD] age, 51 [7] years; age range, 33-62 years; 815 female [56%]), were included. Pain intensity was associated with a significant reduction in response to placebo, with a moderate to large effect size (mean [SE] Hedges g, 0.64 [0.13]; P &amp;lt; .001). Trials with low risk of bias had greater placebo responses (q1 = 5.47; I2 = 87.08; P = .02). The amount of media attention and dissemination linked to each trial was proportionally high, with a strong positive bias, but was not associated with the clinical outcomes.Conclusions and RelevancePlacebo contributes significantly to pain reduction seen in cannabinoid clinical trials. The positive media attention and wide dissemination may uphold high expectations and shape placebo responses in future trials, which has the potential to affect the outcome of clinical trials, regulatory decisions, clinical practice, and ultimately patient access to cannabinoids for pain relief.

Supplemental Digital Content is Available in the Text. Imagining pressure pain to be self-induced led to increased pressure pain thresholds. Such sensory attenuation of pain was also seen in actual self-induced pressure.