A Novel Blended Transdiagnostic Intervention (eOrygen) for Youth Psychosis and Borderline Personality Disorder: Uncontrolled Single-Group Pilot Study

BACKGROUND

Integrating innovative digital mental health interventions within specialist services is a promising strategy to address the shortcomings of both face-to-face and web-based mental health services. However, despite young people's preferences and calls for integration of these services, current mental health services rarely offer blended models of care.

OBJECTIVE

This pilot study tested an integrated digital and face-to-face transdiagnostic intervention (eOrygen) as a blended model of care for youth psychosis and borderline personality disorder. The primary aim was to evaluate the feasibility, acceptability, and safety of eOrygen. The secondary aim was to assess pre-post changes in key clinical and psychosocial outcomes. An exploratory aim was to explore the barriers and facilitators identified by young people and clinicians in implementing a blended model of care into practice.

METHODS

A total of 33 young people (aged 15-25 years) and 18 clinicians were recruited over 4 months from two youth mental health services in Melbourne, Victoria, Australia: (1) the Early Psychosis Prevention and Intervention Centre, an early intervention service for first-episode psychosis; and (2) the Helping Young People Early Clinic, an early intervention service for borderline personality disorder. The feasibility, acceptability, and safety of eOrygen were evaluated via an uncontrolled single-group study. Repeated measures 2-tailed t tests assessed changes in clinical and psychosocial outcomes between before and after the intervention (3 months). Eight semistructured qualitative interviews were conducted with the young people, and 3 focus groups, attended by 15 (83%) of the 18 clinicians, were conducted after the intervention.

RESULTS

eOrygen was found to be feasible, acceptable, and safe. Feasibility was established owing to a low refusal rate of 25% (15/59) and by exceeding our goal of young people recruited to the study per clinician. Acceptability was established because 93% (22/24) of the young people reported that they would recommend eOrygen to others, and safety was established because no adverse events or unlawful entries were recorded and there were no worsening of clinical and social outcome measures. Interviews with the young people identified facilitators to engagement such as peer support and personalized therapy content, as well as barriers such as low motivation, social anxiety, and privacy concerns. The clinician focus groups identified evidence-based content as an implementation facilitator, whereas a lack of familiarity with the platform was identified as a barrier owing to clinicians' competing priorities, such as concerns related to risk and handling acute presentations, as well as the challenge of being understaffed.

CONCLUSIONS

eOrygen as a blended transdiagnostic intervention has the potential to increase therapeutic continuity, engagement, alliance, and intensity. Future research will need to establish the effectiveness of blended models of care for young people with complex mental health conditions and determine how to optimize the implementation of such models into specialized services.

Emotion regulation in everyday life: Mapping global self-reports to daily processes

Recent theory conceptualizes emotion regulation as occurring across three stages: (a) identifying the need to regulate, (b) selecting a strategy, and (c) implementing that strategy to modify emotions. Yet, measurement of emotion regulation has not kept pace with these theoretical advances. In particular, widely used global self-report questionnaires are often assumed to index people's typical strategy selection tendencies. However, it is unclear how well global self-reports capture individual differences in strategy selection and/or whether they may also index other emotion regulation stages. To address this issue, we examined how global self-report measures correspond with the three stages of emotion regulation as modeled using daily life data. We analyzed data from nine daily diary and experience sampling studies (total N = 1,097), in which participants provided daily and global self-reports of cognitive reappraisal, expressive suppression, and rumination. We found only weak-to-moderate correlations between global self-reports and average daily self-reports of each regulation strategy (indexing strategy selection). Global self-reports also correlated with individual differences in the degree to which (a) preceding affect experience predicted regulation strategies (representing the identification stage), and (b) regulation strategies predicted subsequent changes in affective experience (representing the implementation stage). Our findings suggest that global self-report measures of reappraisal, suppression, and rumination may not strongly and uniquely correlate with individual differences in daily selection of these strategies. Moreover, global self-report measures may also index individual differences in the perceived need to regulate, and the affective consequences of regulation in daily life. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Social Support Predicts Differential Use, but not Differential Effectiveness, of Expressive Suppression and Social Sharing in Daily Life

While emotion regulation often happens in the presence of others, little is known about how social context shapes regulatory efforts and outcomes. One key element of the social context is social support. In two experience sampling studies (Ns = 179 and 123), we examined how the use and affective consequences of two fundamentally social emotion-regulation strategies-social sharing and expressive suppression-vary as a function of perceived social support. Across both studies, we found evidence that social support was associated with variation in people's use of these strategies, such that when people perceived their environments as being higher (vs. lower) in social support, they engaged in more sharing and less suppression. However, we found only limited and inconsistent support for context-dependent affective outcomes of suppression and sharing: suppression was associated with better affective consequences in the context of higher perceived social support in Study 1, but this effect did not replicate in Study 2. Taken together, these findings suggest that the use of social emotion-regulation strategies may depend on contextual variability in social support, whereas their effectiveness does not. Future research is needed to better understand the circumstances in which context-dependent use of emotion regulation may have emotional benefits, accounting for personal, situational, and cultural factors.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s42761-022-00123-8.

A Systematic and Meta-Analytic Review of Identity Centrality among LGBTQ Groups: An Assessment of Psychosocial Correlates

The degree to which an identity is an important aspect of one's self-concept (i.e., identity centrality) relates to both health and prejudice experiences of minority groups. Individuals with greater levels of identity centrality view their world through the lens of that identity. This allows them to engage in more positive identity-relevant experiences. However, it could also heighten their perceptions of in-group threat. Among LGBTQ groups, the relationship between identity centrality and psychosocial outcomes is yet to be established. In this paper, we investigated the relationship between LGBTQ identity centrality and psychosocial outcomes via a comprehensive systematic (k = 89, N = 35,950) and meta-analytic (k = 57, N = 26,704) literature review. Results indicated that greater levels of LGBTQ centrality relates to more positive identity-relevant affirmations (.155 ≤ r's ≤ .419), but also greater prejudice/discrimination perceptions and experiences (-.271 ≤ r's ≤ -.128). We found no evidence of a relationship between LGBTQ centrality and health outcomes (-.052 ≤ r's ≤ .040). Importantly, we found that these relationships are more beneficial for some LGBTQ groups (gay men), than for others (bisexual/transgender individuals). Findings from this review provide important and necessary insights on the role of LGBTQ identity centrality and identify crucial gaps in the literature that should be addressed.

A systematic review of the relationship between religion and attitudes toward transgender and gender-variant people

Background: Prejudice against transgender people is widespread, yet in spite of the prevalence of this negativity relatively little is known about the antecedents and predictors of these attitudes. One factor that is commonly related to prejudice is religion, and this is especially true for prejudice targets that are considered to be "value violating" (as is the case for transgender individuals). Method: In this paper, we present the findings of our systematic search of the literature on this topic and present the synthesized evidence. Our search strategy was conducted across five databases and yielded 29 studies (across 28 articles). Results: We found consistent evidence that self-identifying as with either being "religious" or as Christian (and to a lesser extent, being Muslim) was associated with increased transprejudice relative to being nonreligious (and to a lesser extent, being Jewish). Additionally, we found consistent evidence that certain forms of religiosity were also related to transprejudice - specifically religious fundamentalism, church attendance, and interpretations of the bible as literal (transprejudice was unrelated to religious education). Conclusion: Although this young, but important field of research is growing, more empirical exploration is needed to fully understand that nuances of the religion-transprejudice relationship.