Blended care in the treatment of subthreshold symptoms of depression and psychosis in emerging adults: A randomised controlled trial of Acceptance and Commitment Therapy in Daily-Life (ACT-DL)

Acceptance and Commitment Therapy-based Lifestyle Counselling Program for people with early psychosis on physical activity: A pilot randomized controlled trial

OBJECTIVE

To evaluate the feasibility, acceptability and efficacy of an Acceptance and Commitment Therapy-based Lifestyle Counselling Program (ACT-LCP) on health outcomes of individuals with early psychosis.

METHODS

In this assessor-blinded, parallel-group pilot randomized controlled trial, 72 early psychosis patients (mean age [SD] = 30.51 [8.02], 58.3 % female) were randomized to either the ACT-LCP group or a control group. The ACT-LCP group underwent a five-week group program focusing on ACT-based motivation for healthy lifestyles, a booster session, and two follow-up calls. The control group received standard care, one lifestyle education session, and three follow-up calls. Outcomes including physical activity, autonomous motivation, psychological flexibility, mental status, and quality of life were measured at baseline, 1-week, and 12-week post-intervention. Recruitment, retention, and adherence rates were evaluated. Focus group interviews explored participants' experiences.

RESULTS

Generalized estimating equation models demonstrated that when compared to the Control group, the ACT-LCP group showed a sixfold likelihood of engaging in at least 150 min of moderate to vigorous physical activity per week (adjusted prevalence ratio = 6.28, 95 % CI [2.09-18.93], P ≤ 0.001) at 12-week post-intervention. Improvements at 12-week also included autonomous motivation (adjusted mean difference, aMD = 4.74; P < .001), psychological inflexibility (aMD = -7.69; P < .001), mental status (aMD = -6.83; P < .001), and quality of life (aMD = 0.46; P = .006). Recruitment was successful at 55.8 %, retention at 89 %, and adherence at 80.6 %. Engagement challenges were noted in focus groups.

CONCLUSIONS

The ACT-LCP is feasible and acceptable, demonstrating initial efficacy in individuals with early psychosis. Further research should refine the intervention and explore long-term impacts.

CLINICALTRIAL

gov Identifier: NCT04916496.

Systematic review and meta-analysis of adverse events in clinical trials of mental health apps

Mental health apps are efficacious, yet they may pose risks in some. This review (CRD42024506486) examined adverse events (AEs) from mental health apps. We searched (May 2024) the Medline, PsycINFO, Web of Science, and ProQuest databases to identify clinical trials of mental health apps. The risk of bias was assessed using the Cochrane Risk of Bias tool. Only 55 of 171 identified clinical trials reported AEs. AEs were more likely to be reported in trials sampling schizophrenia and delivering apps with symptom monitoring technology. The meta-analytic deterioration rate from 13 app conditions was 6.7% (95% CI = 4.3, 10.1, I2 = 75%). Deterioration rates did not differ between app and control groups (OR = 0.79, 95% CI = 0.62-1.01, I2 = 0%). Reporting of AEs was heterogeneous, in terms of assessments used, events recorded, and detail provided. Overall, few clinical trials of mental health apps report AEs. Those that do often provide insufficient information to properly judge risks related to app use.

Engagement and Acceptability of Acceptance and Commitment Therapy in Daily Life in Early Psychosis: Secondary Findings From a Multicenter Randomized Controlled Trial

BACKGROUND

Acceptance and commitment therapy (ACT) is promising in the treatment of early psychosis. Augmenting face-to-face ACT with mobile health ecological momentary interventions may increase its treatment effects and empower clients to take treatment into their own hands.

OBJECTIVE

This study aimed to investigate and predict treatment engagement with and acceptability of acceptance and commitment therapy in daily life (ACT-DL), a novel ecological momentary intervention for people with an ultrahigh risk state and a first episode of psychosis.

METHODS

In the multicenter randomized controlled trial, 148 individuals with ultrahigh risk or first-episode psychosis aged 15-65 years were randomized to treatment as usual only (control) or to ACT-DL combined with treatment as usual (experimental), consisting of 8 face-to-face sessions augmented with an ACT-based smartphone app, delivering ACT skills and techniques in daily life. For individuals in the intervention arm, we collected data on treatment engagement with and acceptability of ACT-DL during and after the intervention. Predictors of treatment engagement and acceptability included baseline demographic, clinical, and functional outcomes.

RESULTS

Participants who received ACT-DL in addition to treatment as usual (n=71) completed a mean of 6 (SD 3) sessions, with 59% (n=42) of participants completing all sessions. App engagement data (n=58) shows that, on a weekly basis, participants used the app 13 times and were compliant with 6 of 24 (25%) notifications. Distribution plots of debriefing scores (n=46) show that 85%-96% of participants reported usefulness on all acceptability items to at least some extent (scores ≥2; 1=no usefulness) and that 91% (n=42) of participants reported perceived burden by number and length of notifications (scores ≥2; 1=no burden). Multiple linear regression models were fitted to predict treatment engagement and acceptability. Ethnic minority backgrounds predicted lower notification response compliance (B=-4.37; P=.01), yet higher app usefulness (B=1.25; P=.049). Negative (B=-0.26; P=.01) and affective (B=0.14; P=.04) symptom severity predicted lower and higher ACT training usefulness, respectively. Being female (B=-1.03; P=.005) predicted lower usefulness of the ACT metaphor images on the app.

CONCLUSIONS

Our results corroborate good treatment engagement with and acceptability of ACT-DL in early psychosis. We provide recommendations for future intervention optimization.

TRIAL REGISTRATION

OMON NL46439.068.13; https://onderzoekmetmensen.nl/en/trial/24803.

Leveraging Personal Technologies in the Treatment of Schizophrenia Spectrum Disorders: Scoping Review

BACKGROUND

Digital mental health is a rapidly growing field with an increasing evidence base due to its potential scalability and impacts on access to mental health care. Further, within underfunded service systems, leveraging personal technologies to deliver or support specialized service delivery has garnered attention as a feasible and cost-effective means of improving access. Digital health relevance has also improved as technology ownership in individuals with schizophrenia has improved and is comparable to that of the general population. However, less digital health research has been conducted in groups with schizophrenia spectrum disorders compared to other mental health conditions, and overall feasibility, efficacy, and clinical integration remain largely unknown.

OBJECTIVE

This review aims to describe the available literature investigating the use of personal technologies (ie, phone, computer, tablet, and wearables) to deliver or support specialized care for schizophrenia and examine opportunities and barriers to integrating this technology into care.

METHODS

Given the size of this review, we used scoping review methods. We searched 3 major databases with search teams related to schizophrenia spectrum disorders, various personal technologies, and intervention outcomes related to recovery. We included studies from the full spectrum of methodologies, from development papers to implementation trials. Methods and reporting follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

This search resulted in 999 studies, which, through review by at least 2 reviewers, included 92 publications. Included studies were published from 2010 to 2023. Most studies examined multitechnology interventions (40/92, 43%) or smartphone apps (25/92, 27%), followed by SMS text messaging (16/92, 17%) and internet-based interventions (11/92, 12%). No studies used wearable technology on its own to deliver an intervention. Regarding the stage of research in the field, the largest number of publications were pilot studies (32/92, 35%), followed by randomized control trials (RCTs; 20/92, 22%), secondary analyses (16/92, 17%), RCT protocols (16/92, 17%), development papers (5/92, 5%), and nonrandomized or quasi-experimental trials (3/92, 3%). Most studies did not report on safety indices (55/92, 60%) or privacy precautions (64/92, 70%). Included studies tend to report consistent positive user feedback regarding the usability, acceptability, and satisfaction with technology; however, engagement metrics are highly variable and report mixed outcomes. Furthermore, efficacy at both the pilot and RCT levels report mixed findings on primary outcomes.

CONCLUSIONS

Overall, the findings of this review highlight the discrepancy between the high levels of acceptability and usability of these digital interventions, mixed efficacy results, and difficulties with sustained engagement. The discussion highlights common patterns that may underscore this observation in the field; however, as this was a scoping review, a more in-depth systematic review or meta-analysis may be required to better understand the trends outlined in this review.

Coping with Transitions: A Promising Intensive Outpatient DBT Program for Emerging Adults and Their Families

Emerging adulthood is a period of significant exploration, transformation, variability, and growth. Simultaneously, this developmental period presents unique challenges as emerging adults work to achieve developmental milestones including self-identity formation, the establishment of long-term intimate relationships, career advancement, and independence from parents. For those who are vulnerable, this period is also marked by the development of significant mental health problems and associated impairment, which prevents individuals from successfully reaching these developmental milestones. To address the various challenges unique to this developmental period, we created and implemented a multifaceted DBT treatment protocol to specifically address emotional dysregulation within emerging adults. The current study presents an evaluation of a novel, intensive, outpatient DBT program called System for Adult Growth and Emergence-Foundations (SAGE-F). We aim to first introduce the SAGE-F treatment protocol, and then to assess both its short and long-term therapeutic value. Participants enrolled in SAGE-F were administered a testing battery assessing symptom severity, functioning capacities, and coping strategies at intake, upon completion of the program 6-weeks later, and at 3-month follow-up. It was found participants who completed SAGE-F reported significant reductions in depression and anxiety symptoms, as well as non-suicidal self-injurious behaviors. Simultaneously, participants also reported improvements in their daily functioning and coping capacities. Follow-up assessments indicated therapeutic progress remained.

Polygenic risk, familial liability and stress reactivity in psychosis: an experience sampling study

BACKGROUND

There is evidence for a polygenic contribution to psychosis. One targetable mechanism through which polygenic variation may impact on individuals and interact with the social environment is stress sensitization, characterized by elevated reactivity to minor stressors in daily life. The current study aimed to investigate whether stress reactivity is modified by polygenic risk score for schizophrenia (PRS) in cases with enduring non-affective psychotic disorder, first-degree relatives of cases, and controls.

METHODS

We used the experience sampling method to assess minor stressors, negative affect, positive affect and psychotic experiences in 96 cases, 79 first-degree relatives, i.e. siblings, and 73 controls at wave 3 of the Dutch Genetic Risk and Outcome of Psychosis (GROUP) study. Genome-wide data were collected at baseline to calculate PRS.

RESULTS

We found that associations of momentary stress with psychotic experiences, but not with negative and positive affect, were modified by PRS and group (all pFWE<0.001). In contrast to our hypotheses, siblings with high PRS reported less intense psychotic experiences in response to momentary stress compared to siblings with low PRS. No differences in magnitude of these associations were observed in cases with high v. low level of PRS. By contrast, controls with high PRS showed more intense psychotic experiences in response to stress compared to those with low PRS.

CONCLUSIONS

This tentatively suggests that polygenic risk may operate in different ways than previously assumed and amplify reactivity to stress in unaffected individuals but operate as a resilience factor in relatives by attenuating their stress reactivity.

Efficacy of Internet-Based Acceptance and Commitment Therapy for Depressive Symptoms, Anxiety, Stress, Psychological Distress, and Quality of Life: Systematic Review and Meta-analysis

BACKGROUND

Acceptance and commitment therapy (ACT) is an empirically supported transdiagnostic approach that involves mindfulness processes and behavior change processes for valued living.

OBJECTIVE

This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy of internet-based ACT (iACT) for depressive symptoms, anxiety, stress, psychological distress, and quality of life (QoL).

METHODS

PubMed, CINAHL, PsycINFO, and SCOPUS databases were searched to identify relevant RCTs published up to June 5, 2021. The included RCTs were assessed using the Cochrane Collaboration risk-of-bias tool. The use of either a random effects model or fixed effects model was determined using I2 statistic values for heterogeneity. Subgroup analyses were conducted according to the type of control group, the use of therapist guidance, delivery modes, and the use of targeted participants, when applicable.

RESULTS

A total of 39 RCTs met the inclusion criteria. Meta-analyses found small effects of iACT on depressive symptoms, anxiety, stress, psychological distress, and QoL at the immediate posttest and follow-up. There was no significant effect of iACT on stress at follow-up. Subgroup analyses showed small to medium effects of iACT on all the outcomes at the immediate posttest and follow-up compared with the passive control groups. In contrast, subgroup analyses that compared iACT with active control groups found no differences between groups on stress, psychological distress, and QoL at the immediate posttest or on depressive symptoms, anxiety, and stress at follow-up. In addition, subgroup analyses conducted according to the use of therapist guidance, delivery modes, and the use of targeted participants found no statistically significant subgroup differences among studies in all the outcomes, except for the subgroup difference among studies according to the use of targeted participants for depressive symptoms at the immediate posttest (ie, a statistically significant, larger effect of iACT when studies targeted people with depressive symptoms). The overall risk of bias across the studies was unclear.

CONCLUSIONS

The findings of this study contribute to the body of evidence regarding the effects of iACT on depressive symptoms, anxiety, stress, psychological distress, and QoL and may be applicable in any population, as ACT is a transdiagnostic approach. Few studies have compared iACT with active control conditions, especially for stress and psychological distress at the immediate posttest and follow-up. In addition, the active control conditions varied among the included studies. Further high-quality studies are needed to better understand whether iACT is comparable or superior to other evidence-based interventions, such as cognitive behavioral therapy, in decreasing depressive symptoms, anxiety, stress, and psychological distress and improving QoL.

Accessibility and availability of smartphone apps for schizophrenia

App-based interventions have the potential to enhance access to and quality of care for patients with schizophrenia. However, less is known about the current state of schizophrenia apps in research and how those translate to publicly available apps. This study, therefore, aimed to review schizophrenia apps offered on marketplaces and research literature with a focus on accessibility and availability. A search of recent reviews, gray literature, PubMed, and Google Scholar was conducted in August 2022. A search of the U.S. Apple App Store and Google Play App Store was conducted in July 2022. All eligible studies and apps were systematically screened/reviewed. The academic research search produced 264 results; 60 eligible studies were identified. 51.7% of research apps were built on psychosis-specific platforms and 48.3% of research apps were built on non-specific platforms. 83.3% of research apps offered monitoring functionalities. Only nine apps, two designed on psychosis-specific platforms and seven on non-specific platforms were easily accessible. The search of app marketplaces uncovered 537 apps; only six eligible marketplace apps were identified. 83.3% of marketplace apps only offered psychoeducation. All marketplace apps lacked frequent updates with the average time since last update 1121 days. There are few clinically relevant apps accessible to patients on the commercial marketplaces. While research efforts are expanding, many research apps are unavailable today. Better translation of apps from research to the marketplace and a focus on sustainable interventions are important targets for the field.

Nonpharmacological interventions for subthreshold depression in adults: A systematic review and network meta-analysis

Subthreshold depression (StD) is very common, with an estimated global incidence of 25%, and is associated with other clinical conditions. Nonpharmacological interventions have been demonstrated to be effective, but which one is best should be further investigated. This study aims to compare and rank the efficacy of nonpharmacological interventions in adults with StD. Ten databases were searched, and comparisons were made using a random-effects network meta-analysis using the frequentist framework. The assumption of local consistency was assessed by using the node-splitting method. The surface under the cumulative ranking curve (SUCRA) was used to separately rank each intervention. A total of 32 randomized controlled trials (RCTs) were included. The results showed that psychotherapy, as an intervention class, had significantly positive effects compared to control groups (SMD = -0.78, 95% CI: -1.06, -0.49) and had the highest rank (SUCRA, 79.0%; mean rank, 1.6). Cognitive behavioral therapy (CBT), as an individual intervention, had significantly positive effects relative to all control groups and had the highest rank (SUCRA, 82.5%; mean rank, 3.1). We speculate that psychotherapy, especially CBT, may be the most effective nonpharmacological intervention to improve StD in adults. More RCTs examining the efficacy of different nonpharmacological interventions are needed.

Effects of internet-based acceptance and commitment therapy on process measures: A systematic review and meta-analysis (Preprint)

Background

Acceptance and commitment therapy (ACT) is based on a psychological flexibility model that encompasses 6 processes: acceptance, cognitive defusion, self-as-context, being present, values, and committed action.

Objective

This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to examine the effects of internet-based ACT (iACT) on process measures.

Methods

A comprehensive search was conducted using 4 databases. The quality of the included RCTs was assessed using the Cochrane Collaboration Risk of Bias Tool. A random-effects or fixed-effects model was used. Subgroup analyses for each outcome were conducted according to the type of control group, use of therapist guidance, delivery modes, and use of targeted participants, when applicable.

Results

A total of 34 RCTs met the inclusion criteria. This meta-analysis found that iACT had a medium effect on psychological flexibility and small effects on mindfulness, valued living, and cognitive defusion at the immediate posttest. In addition, iACT had a small effect on psychological flexibility at follow-up. The overall risk of bias across studies was unclear.

Conclusions

Relatively few studies have compared the effects of iACT with active control groups and measured the effects on mindfulness, valued living, and cognitive defusion. These findings support the processes of change in iACT, which mental health practitioners can use to support the use of iACT.

Component analysis of a synchronous and asynchronous blended care CBT intervention for symptoms of depression and anxiety: Pragmatic retrospective study

BACKGROUND

Depression and anxiety are leading causes of disability worldwide. Though effective treatments exist, depression and anxiety remain undertreated. Blended care psychotherapy, combining the scalability of online interventions with the personalization and engagement of a live therapist, is a promising approach for increasing access to evidence-based care.

OBJECTIVES

To evaluate the effectiveness and individual contribution of two components - i) digital tools and ii) video-based therapist-led sessions - in a blended care CBT-based intervention under real world conditions.

METHODS

A retrospective cohort design was used to analyze N = 1372 US-based individuals who enrolled in blended care psychotherapy. Of these, at baseline, 761 participants had depression symptoms in the clinical range (based on PHQ-9), and 1254 had anxiety symptoms in the clinical range (based on GAD-7). Participants had access to the program as a mental health benefit offered by their employer. The CBT-based blended care psychotherapy program consisted of regular video sessions with therapists, complemented by digital lessons and digital exercises assigned by the clinician and completed in between sessions. Depression and anxiety levels and clients' treatment engagement were tracked throughout treatment. A 3-level individual growth curve model incorporating time-varying covariates was utilized to examine symptom trajectories of PHQ-9 scores (for those with clinical range of depression at baseline) and GAD-7 scores (for those with clinical range of anxiety at baseline).

RESULTS

On average, individuals exhibited a significant decline in depression and anxiety symptoms during the initial weeks of treatment (P < .001), and a continued decline over subsequent weeks at a slower rate (P < .001). Engaging in a therapy session in a week was associated with lower GAD-7 (b = -0.81) and PHQ-9 (b = -1.01) scores in the same week, as well as lower GAD-7 (b = -0.58) and PHQ-9 (b = -0.58) scores the following week (all P < .01). Similarly, engaging with digital lessons was independently associated with lower GAD-7 (b = -0.19) and PHQ-9 (b = -0.18) scores during the same week, and lower GAD-7 (b = -0.25) and PHQ-9 (b = -0.27) the following week (all P < .01).

CONCLUSIONS

Therapist-led video sessions and digital lessons had separate contributions to improvements in symptoms of depression and anxiety over the course of treatment. Future research should investigate whether clients' characteristics are related to differential effects of therapist-led and digital components of care.

Effects of a Novel, Transdiagnostic, Hybrid Ecological Momentary Intervention for Improving Resilience in Youth (EMIcompass): Protocol for an Exploratory Randomized Controlled Trial

BACKGROUND

Most mental disorders first emerge in youth and, in their early stages, surface as subthreshold expressions of symptoms comprising a transdiagnostic phenotype of psychosis, mania, depression, and anxiety. Elevated stress reactivity is one of the most widely studied mechanisms underlying psychotic and affective mental health problems. Thus, targeting stress reactivity in youth is a promising indicated and translational preventive strategy for adverse mental health outcomes that could develop later in life and for improving resilience. Compassion-focused interventions offer a wide range of innovative therapeutic techniques that are particularly amenable to being implemented as ecological momentary interventions (EMIs), a specific type of mobile health intervention, to enable youth to access interventions in a given moment and context in daily life. This approach may bridge the current gap in youth mental health care.

OBJECTIVE

This study aims to investigate the clinical feasibility, candidate underlying mechanisms, and initial signals of the efficacy of a novel, transdiagnostic, hybrid EMI for improving resilience to stress in youth-EMIcompass.

METHODS

In an exploratory randomized controlled trial, youth aged between 14 and 25 years with current distress, a broad Clinical High At-Risk Mental State, or the first episode of a severe mental disorder will be randomly allocated to the EMIcompass intervention (ie, EMI plus face-to-face training sessions) in addition to treatment as usual or a control condition of treatment as usual only. Primary (stress reactivity) and secondary candidate mechanisms (resilience, interpersonal sensitivity, threat anticipation, negative affective appraisals, and momentary physiological markers of stress reactivity), as well as primary (psychological distress) and secondary outcomes (primary psychiatric symptoms and general psychopathology), will be assessed at baseline, postintervention, and at the 4-week follow-up.

RESULTS

The first enrollment was in August 2019, and as of May 2021, enrollment and randomization was completed (N=92). We expect data collection to be completed by August 2021.

CONCLUSIONS

This study is the first to establish feasibility, evidence on underlying mechanisms, and preliminary signals of the efficacy of a compassion-focused EMI in youth. If successful, a confirmatory randomized controlled trial will be warranted. Overall, our approach has the potential to significantly advance preventive interventions in youth mental health provision.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00017265; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017265.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/27462.

[Digital life in a networked world: opportunities and risks for psychiatry]

This overview addresses some opportunities and risks of digital transformation in their significance for the diagnostics and therapy of mental illnesses under the aspect of the convergence of new digital technologies. Possibilities of smartphone-based technologies for the recording of the lifeworld context are explained and the application of this approach to the investigation of resilience mechanisms for improving mental well-being is presented on the basis of two current research results. Subsequently, the increasing networking of the environmental context itself is taken into account against the background of the so-called internet of things (IoT). These converging technologies, combined with new developments in artificial intelligence, enable a new generation of ecological momentary interventions (EMI) based on innovative sensors, local assessment of the lifeworld context and their evaluation using artificial intelligence.

Daily-Life Social Experiences as a Potential Mediator of the Relationship Between Parenting and Psychopathology in Adolescence

Adolescence is a vulnerable period for psychopathology development, and certain parenting styles are consistent and robust predictors of a broad range of mental health outcomes. The mechanisms through which maladaptive parenting styles affect the development of psychopathology are assumed to be largely social in nature. Yet, the social mechanisms linking parenting to psychopathology are unexplored at arguably the most important level of functioning: daily life. This study aims to identify the associations between three parenting styles, and the experience of daily-life social interactions. Furthermore, we aim to explore the extent to which these parenting styles and altered daily-life social experiences are associated with psychopathology. In this study, we recruited a sample of N = 1,913 adolescents (63.3% girls; mean age = 13.7, age range = 11 to 20) as part of the first wave of the longitudinal cohort study "SIGMA". Parenting styles (psychological control, responsiveness, and autonomy support) and psychopathology symptoms were assessed using a retrospective questionnaire battery. The experienced quality of social interactions in different types of company was assessed using the experience sampling method, ten times per day for 6 days. Direct associations between parenting styles and general quality of daily-life social experiences were tested using a three-level linear model, revealing significant associations between social experiences and different parenting styles. When interaction effects were added to this model, we found that maternal responsiveness and paternal psychological control mainly related to altered qualities of social interactions with parents, while paternal autonomy support was associated with better experiences of non-family social interactions. Finally, an exploratory path analysis highlighted how both paternal autonomy support and altered quality of non-family interactions are uniquely associated with psychopathology levels. These findings demonstrate the general and pervasive effects of maladaptive parenting styles, as parenting seems to broadly affect adolescents' interactions with different types of social partners in everyday life. Moreover, they illustrate a potential mediated relationship in which altered daily-life social interactions could drive the development of psychopathology. A stronger focus may be required on the role of altered day-to-day social experiences in the prevention and potentially, the treatment, of adolescent psychopathology.

A Compassion-Focused Ecological Momentary Intervention for Enhancing Resilience in Help-Seeking Youth: Uncontrolled Pilot Study

BACKGROUND

Digital interventions offer new avenues for low-threshold prevention and treatment in young people. Ecological momentary interventions (EMIs) represent a powerful approach that allows for adaptive, real-time, and real-world delivery of intervention components in daily life by real-time processing of ecological momentary assessment (EMA) data. Compassion-focused interventions (CFIs) may be particularly amenable to translation into an EMI to strengthen emotional resilience and modify putative risk mechanisms, such as stress sensitivity, in the daily lives of young help-seeking individuals.

OBJECTIVE

This study aims to investigate the feasibility, safety, and initial therapeutic effects of a novel, accessible, transdiagnostic, ecological momentary CFI for improving emotional resilience to stress (EMIcompass).

METHODS

In this uncontrolled pilot study, help-seeking youth with psychotic, depressive, or anxiety symptoms were offered the EMIcompass intervention in addition to treatment as usual. The EMIcompass intervention consisted of a 3-week EMI (including enhancing, consolidating, and EMA-informed interactive tasks) administered through a mobile health app and three face-to-face sessions with a trained psychologist intended to provide guidance and training on the CFI exercises presented in the app (ie, training session, follow-up booster session, and review session).

RESULTS

In total, 10 individuals (mean age 20.3 years, SD 3.8; range 14-25) were included in the study. Most (8/10, 80%) participants were satisfied and reported a low burden of app usage. No adverse events were observed. In approximately one-third of all EMAs, individuals scored high on stress, negative affect, or threat anticipation during the intervention period, resulting in real-time, interactive delivery of the CFI intervention components in addition to weekly enhancing and daily consolidating tasks. Although the findings should be interpreted with caution because of the small sample size, reduced stress sensitivity, momentary negative affect, and psychotic experiences, along with increased positive affect, were found at postintervention and the 4-week follow-up. Furthermore, reductions in psychotic, anxiety, and depressive symptoms were found (r=0.30-0.65).

CONCLUSIONS

Our findings provide evidence on the feasibility and safety of the EMIcompass intervention for help-seeking youth and lend initial support to beneficial effects on stress sensitivity and mental health outcomes. An exploratory randomized controlled trial is warranted to establish the feasibility and preliminary evidence of its efficacy.

Online Indicated Preventive Mental Health Interventions for Youth: A Scoping Review

Objective: Between the ages of 12 and 25 the onset of mental disorders typically occurs, and the burden of mental health problems is greatest for this group. Indicated preventive interventions to target individuals with subclinical symptoms to prevent the transition to clinical levels of disorders have gained considerable traction. However, the threshold to seek help appears to be high even when help is needed. Online interventions could offer a solution, especially during the COVID-19 pandemic. This scoping review will present an overview of the recent research of indicated online preventive interventions for youth (12-25 years) experiencing the early stages of mental health complaints with the aim of identifying the nature and extent of the research evidence. Methods: The 5-stage framework by Arksey and O'Malley was used. Academic literature published from 2013 onwards in printed or electronic format was included from Scopus, PsychINFO, and Ovid MEDLINE(R) ALL. Results: The search yielded 11,122 results, with the final selection resulting in inclusion of 30 articles for this review. In total, the articles included 4,950 participants. 26.7% of the selected articles focused on youth between 12 and 25 years. Of the articles 60% did not screen for, nor exclude participants with clinical levels of symptoms. Most studies used a common evidence-based therapy for the disorder-category targeted. More than half of the online interventions included some form of human support. Adherence levels ranged between 27.9 and 98%. The results indicate general effectiveness, usability and acceptability of online indicated preventive interventions. The most commonly used approach was CBT (n = 12 studies). Studies varied in their size, rigor of study, effectiveness and outcome measures. Online interventions with a combination of clinical and peer moderation (n = 3 studies) appear to result in the most stable and highest effect sizes. Conclusion: Online indicated preventive mental health interventions for youth with emerging mental health issues show promise in reducing various mental health complaints, and increasing positive mental health indicators such as well-being and resilience. Additionally, high levels of usability and acceptability were found. However, the included studies show important methodological shortcomings. Also, the research has mainly focused on specific diagnostic categories, meaning there is a lack of transdiagnostic approaches. Finally, clear definitions of- as well as instruments to measure- emerging or subclinical mental health symptoms in youth remain are missing.

Ecological momentary interventions for mental health: A scoping review

BACKGROUND

The development of mobile computing technology has enabled the delivery of psychological interventions while people go about their everyday lives. The original visions of the potential of these "ecological momentary interventions" were presented over a decade ago, and the widespread adoption of smartphones in the intervening years has led to a variety of research studies exploring the feasibility of these aspirations. However, there is a dearth of research describing the different dimensions, characteristics, and features of these interventions, as constructed.

OBJECTIVE

To provide an overview of the definitions given for "ecological momentary interventions" in the treatment of common mental health disorders, and describe the set of technological and interaction possibilities which have been used in the design of these interventions.

METHODS

A systematic search identified relevant literature published between 2009 and 2020 in the PubMed, PsycInfo, and ACM Guide to the Computing Literature databases. Following screening, data were extracted from eligible articles using a standardized extraction worksheet. Selected articles were then thematically categorized.

RESULTS

The search identified 583 articles of which 64 met the inclusion criteria. The interventions target a range of mental health problems, with diverse aims, intervention designs and evaluation approaches. The studies employed a variety of features for intervention delivery, but recent research is overwhelmingly comprised of studies based on smartphone apps (30 of 42 papers that described an intervention). Twenty two studies employed sensors for the collection of data in order to provide just-in-time support or predict psychological states.

CONCLUSIONS

With the shift towards smartphone apps, the vision for EMIs has begun to be realised. Recent years have seen increased exploration of the use of sensors and machine learning, but the role of humans in the delivery of EMI is also varied. The variety of capabilities exhibited by EMIs motivates development of a more precise vocabulary for capturing both automatic and human tailoring of these interventions.

Idiographic analyses of motivation and related processes in participants with schizophrenia following a therapeutic intervention for negative symptoms

BACKGROUND

Motivational negative symptoms hinder quality of life and daily functioning of individuals with schizophrenia spectrum disorders. A recently developed intervention, Switch, has shown promising effects on negative symptoms and functional outcomes. Switch targets multiple cognitive, emotional and behavioural processes associated with motivation and goal directed behaviours. We aimed to investigate its effects on motivation and associated processes in a naturalistic setting, and to explore the dynamics between the processes.

METHODS

We used a single case approach (n = 3), with a pre-post and follow-up assessment design, which also included ambulatory assessments (experience sampling method, ESM; and step count). We computed autoregressive lag 1 models to evaluate the effects of the intervention on daily motivation levels and related processes, descriptive pie-charts, and vector autoregressive modelling to reveal the dynamics of the processes over time.

RESULTS

The intervention was beneficial for each participant according to traditional evaluations of motivational negative symptoms, apathy, daily functioning and quality of life. The effects on the ESM variables revealed distinct outcomes for each individual. The dynamics between the various processes differed between participants, and fluctuated within participants (when comparing baseline, intervention phase, and follow-up).

CONCLUSIONS

This study used an innovative approach to look at the effectiveness of an intervention. The intervention seems to lead to meaningful improvements in motivational negative symptoms and functional outcomes. The mechanisms of change need to be further investigated.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov, NCT04325100 . Registered 27 March 27, 2020 -retrospectively registered.

REPORTING

Guidelines from the Transparent Reporting of Evaluations with Non-randomized Designs (TREND) statement were followed.