Generalized Anxiety Disorder (GAD) is a common and debilitating anxiety disorder with a chronic course and a low rate of spontaneous remission. Previous internet-delivered treatments for GAD in clinical routine care has been shown to be effective but tend to use a mix of many different treatment components, often based in several theoretical models. Another approach could be to instead develop more focused and theory driven treatments, potentially allowing the protocol to be shorter and less demanding for patients. In this pilot-feasibility-trial we implemented a treatment focusing on one target core construct (intolerance of uncertainty) at the internet psychiatry clinic in Stockholm. The treatment was administered to 22 individuals with GAD. We found a significant reduction in GAD symptoms of similar effect size to previous studies of CBT and ICBT for GAD in routine clinical care. Patients rated overall high levels of treatment satisfaction and treatment credibility. Only two patients dropped out from the treatment. Among the remaining patients a median of 7.5 out of 8 modules were completed. We conclude that the treatment protocol is preliminarily effective, acceptable to patients and clinicians, and feasible to implement in routine psychiatric care.

Social anxiety disorder is a common mental health condition characterized by an intense fear of social situations that can lead to significant impairment in daily life. Cognitive behavioral therapy (CBT) has been recognized as an effective treatment; however, access to therapists is limited, and the fear of interacting with therapists can delay treatment seeking. Furthermore, not all individuals respond. Tailoring modular treatments to individual cognitive profiles may improve efficacy. We developed a novel digital adaptation of CBT for social anxiety that is both modular and fully digital without a therapist in the loop and implemented it in the smartphone app Alena.

This study aimed to evaluate the safety, acceptability, and efficacy of the new treatment in online participants with symptoms of social anxiety.

In total, 2 web-based randomized controlled trials (RCTs) comparing individuals with access to the treatment through the app to a waitlist control group were conducted. Participants were recruited on the web and reported Social Phobia Inventory (SPIN) total scores of ≥30. Primary outcomes were safety and efficacy over 6 weeks in 102 women aged 18 to 35 years (RCT 1) and symptom reduction (SPIN scores) after 8 weeks in 248 men and women aged 18 to 75 years (RCT 2).

In RCT 1, active and control arm adverse event frequency and severity were not distinguishable (intervention: 7/52, 13%; waitlist control: 8/50, 16%; χ21=0.007; P=.93). App acceptability was high, with a median completion rate of 90.91% (IQR 54.55%-100%). Secondary outcomes suggested greater symptom reduction in the active arm (mean SPIN score reduction -9.83, SD 12.80) than in the control arm (mean SPIN score reduction -4.13, SD 11.59; t90=-2.23; false discovery rate P=.04; Cohen d=0.47). RCT 2 replicated these findings. Adverse event frequency was comparable across the 2 groups (intervention: 20/124, 16.1%; waitlist control: 21/124, 16.8%; χ21<0.001; P>.99). Despite a longer treatment program, median completion remained high (84.85%, IQR 51.52%-96.97%). SPIN score reduction was greater in the active arm (mean -12.89, SD 13.87) than in the control arm (mean -7.48, SD 12.24; t227=-3.13; false discovery rate P=.008; Cohen d=0.42).

The web-only, modular social anxiety CBT program appeared safe, acceptable, and efficacious in 2 independent RCTs on online patient groups with self-reported symptoms of social anxiety.

ClinicalTrials.gov NCT05858294; https://clinicaltrials.gov/study/NCT05858294 (RCT 1) and ClinicalTrials.gov NCT05987969; https://clinicaltrials.gov/study/NCT05987969 (RCT 2).

Preliminary evidence suggests that mental imagery-based elaboration of rewarding activities enhances anticipated pleasure, motivation, and behavioral engagement in non-clinical samples, but its effects in individuals experiencing anhedonia (loss of pleasure/interest) is unclear. Study 1 (N = 90) contrasted imagery-enhanced activity scheduling with two scheduling-only control conditions (Reminder/No Reminder Control) in an unselected sample. Study 2 (N = 108) compared imagery-enhanced activity scheduling with two control conditions (Neutral Imagery/Motivational Verbal Reasoning) in individuals experiencing mild to moderate anhedonia. Both studies measured changes in activity appraisal (anticipated pleasure, anticipated reward/mastery, motivation) in the lab, and behavioral engagement across a subsequent 7-day period. Additionally, Study 2 assessed heart rate as a psychophysiological marker of emotional response across conditions. Results showed that anticipated pleasure increased more in the imagery-enhanced activity scheduling condition compared to control conditions in Study 1, but not Study 2. Across both studies, conditions did not differ regarding changes in anticipated reward/mastery, motivation, or behavioral engagement. The present findings indicate that although mental imagery may enhance anticipated pleasure in non-clinical individuals, its effects in participants experiencing anhedonia remains to be further investigated.

Progress in the treatment of psychopathology has slowed and much remains unknown about how treatments achieve their beneficial effects. We propose that computational models can be used to provide new insights into how treatments may work and how they may be improved. We argue that treatments can be understood as interventions on systems of interacting components, and that computational models are needed if we are to accurately and precisely determine the effect an intervention will have on this system. We demonstrate this approach by using a computational model of panic disorder to conduct an in silico dismantling study of cognitive behavioral therapy. This simulated trial allows us to: identify a common source of treatment failure; propose a revised treatment protocol that mitigates this source of failure; and demonstrate that, if the model is accurate, this revised protocol will lead to improved treatment outcomes for 10% of patients. We conclude with a discussion of the promise and challenges of using computational models for treatment research.

While benzodiazepines have been a mainstay of the pharmacotherapy of anxiety disorders, their short-term efficacy and risk of abuse have driven the exploration of alternative treatment approaches. The endocannabinoid (eCB) system has emerged as a key modulator of anxiety-related processes, with evidence suggesting dynamic interactions between the eCB system and the GABAergic system, the primary target of benzodiazepines. According to the existing literature, the activation of the cannabinoid receptors has been shown to exert anxiolytic effects, while their blockade or genetic deletion results in heightened anxiety-like responses. Moreover, studies have provided evidence of interactions between the eCB system and benzodiazepines in anxiety modulation. For instance, the attenuation of benzodiazepine-induced anxiolysis by cannabinoid receptor antagonism or genetic variations in the eCB system components in animal studies, have been associated with variations in benzodiazepine response and susceptibility to anxiety disorders. The combined use of cannabinoid-based medications, such as cannabinoid receptor agonists and benzodiazepine co-administration, has shown promise in augmenting anxiolytic effects and reducing benzodiazepine dosage requirements. This article aims to comprehensively review and discuss the current evidence on the involvement of the eCB system as a key modulator of benzodiazepine-related anxiolytic effects, and further, the possible mechanisms by which the region-specific eCB system-GABAergic connectivity modulates the neuro-endocrine/behavioral stress response, providing an inclusive understanding of the complex interplay between the eCB system and benzodiazepines in the context of anxiety regulation, to inform future research and clinical practice.

Partial hospitalization programs (PHPs) offer a critical level of care that bridges the gap between outpatient and inpatient treatment. Many PHPs implement transdiagnostic approaches, treating patients with a wide range of presenting problems. Despite research suggesting that transdiagnostic PHPs are associated with favorable treatment outcomes, research has yet to examine possible heterogeneity in symptom trajectories as well as factors which may be related to said heterogeneity. We analyzed daily depression symptoms (both cognitive/affective and somatic) of 2,640 patients receiving treatment in a transdiagnostic PHP and identified latent subgroups characterized by heterogeneous trajectories. We then sought to determine if certain patient demographic factors or diagnostic factors were related to trajectories of depression symptoms throughout treatment. Results indicated three classes of trajectories for both cognitive/affective and somatic symptoms of depression: (1) low initial symptoms with steady improvement, (2) consistently high symptoms, and (3) initial worsening then rapid improvement. Female sex and greater psychiatric comorbidity were significantly associated with the consistently high symptom trajectory. Implications and future directions are discussed.

Digital health interventions (DHIs) offer scalable solutions for improving mental health care access in underserved settings. This study is part of a multi-phased project aimed at adapting a depression prevention DHI for Jordanian adolescents. It evaluated the feasibility, cultural acceptability, and effectiveness of the translated and culturally adapted DHI, named Al-Khaizuran, with comparisons to school-based group CBT.

A two-arm, single-blind randomized controlled trial with a mixed-methods design was conducted among 109 Jordanian adolescents aged 15-17 years experiencing mild to moderate depression. Participants were randomly assigned to either Al-Khaizuran DHI (n=55) or school-based group CBT (n=54). The adaptation of Al-Khaizuran DHI components was guided by the Ecological Validity Framework, while the procedural adaptation followed Barrera and Castro's Heuristic Framework, incorporating iterative refinement based on user feedback and contextual considerations.

Al-Khaizuran DHI was found to be a culturally relevant and acceptable intervention for Jordanian adolescent. Over half of the participants reported that the intervention was effective, empowering, and easy to use, with 51% expressing satisfaction and willingness to recommend it. However, challenges such as limited access to personal devices, privacy concerns, and participants' reliance on shared family resources emerged as significant barriers to consistent engagement. Participants showed a preference for individualized, blended interventions, with a significant reduction in support for group CBT. No significant difference was found in depression scores between the two groups. However, the Al-Khaizuran DHI group demonstrated higher post-intervention resilience scores (p=0.026). Beliefs about the effectiveness of the intervention significantly predicted behavioral intention (p=0.022), while perceived difficulty was a barrier to adherence (p=0.015).

Al-Khaizuran DHI exemplifies the potential of culturally adapted digital interventions in bridging mental health care gaps in resource-limited settings. However, its effectiveness is contingent upon addressing barriers to access, enhancing program interactivity, and integrating hybrid support systems that combine digital tools with in-person guidance. Future implementations should consider strategies to actively engage parents to foster a supportive environment that promotes the well-being of adolescents.

https://doi.org/10.1186/ISRCTN14751844, identifier ISRCTN14751844.

Harmonizing core outcome domains allows for pooling data, comparing interventions, and streamlining research evaluation. At the same time clinicians require concise and feasible measures for routine practice. Considering the heterogeneity of post-COVID-19 condition, a biopsychosocial approach requires sufficient coverage of the psychosocial dimension with assessments. Previous recommendations for core outcome sets have serious limitations regarding the psychosocial aspects of post-COVID-19 condition. This paper specifically focuses on psychosocial outcomes for adults with post-COVID-19 condition, providing both a comprehensive set of outcome domains for research and a streamlined clinical core set tailored for routine clinical use.

In a structured Consensus Development Approach, the European Network to improve diagnostic, treatment, and healthcare for patients with persistent somatic symptoms (EURONET-SOMA) developed psychosocial core outcome domains and assessments regarding post-COVID-19 condition. The experts identified variables and instruments which should be considered in studies on adults suffering from post-COVID-19 condition, and which are feasible in the clinical setting and relevant for research.

We identified three higher-order dimensions with each encompassing several domains: The first higher-order dimension, "outcomes", encompasses (1) the classification/ diagnostics of post-COVID-19 condition, (2) somatic symptoms (including fatigue), (3) the psychopathological status and mental comorbidities, (4) the physical status and somatic comorbidities, (5) neurocognitive symptoms, and (6) illness consequences. The second higher-order domain "mechanisms" encompasses (7) cognitive components, (8) affective components, (9) behavioral components, (10) social components, and (11) psychobiological bridge markers (e.g., neuroimmunological and psychoneuroendocrinological variables). The third higher-order domain, "risk factors", includes factors such as (12) socioeconomic status and sociocultural factors, (13) pre-existing mental and somatic health issues, (14) personality factors (e.g., neuroticism), (15) adverse childhood experiences, (16) ongoing disability or pension claim, and (17) social media use. For each domain, specific instruments are suggested for research purposes and clinical use.

The recommended core domains help to increase consistency in a biopsychosocial approach to post-COVID-19 condition across investigations, improve synergies, and facilitate decision-making when comparing different interventional approaches. It allows to better identify relevant subgroups in heterogeneous post-COVID-19 condition populations offering practical tools for routine clinical practice through the clinical core set.

A cognitively demanding, alcohol-specific inhibition training (Alc-IT) might enhance treatment success in patients with severe alcohol use disorder (AUD; Stein et al., 2023). An inhibitory working mechanism for Alc-IT has been discussed, but compelling evidence supporting this hypothesis is yet lacking. The present study investigates inhibitory performance during Alc-IT and examines whether inhibitory parameters mediate drinking outcome.

Patients with AUD (N = 232) completed six sessions of either a standard or improved Alc-IT, differing in their inhibitory demands determined by Go/NoGo-ratios in a modified Go-NoGo-task, or a control training. During these training sessions, data on inhibitory performance was collected. To assess differences in inhibitory performance and its improvement, alcohol-related errors of commission and relative performance, integrating accuracy and speed, were analyzed with hierarchical linear contrast models. Mediation analyses tested whether inhibitory performance predicted drinking outcome (percent days abstinent at 3-month follow-up).

Patients in improved Alc-IT started with higher errors of commission (γ01(standard) =  -2.74, p < 0.001, R2 = 0.885) and a lower relative performance in the first training session compared to standard Alc-IT (γ01(standard) = 0.51, p = 0.004). They showed a steeper increase in relative performance until the final sixth session (γ1(s6),(standard) = -0.37, p = 0.024, R2 = 0.882). The effect of improved Alc-IT on drinking outcome was mediated by relative performance increase (bootstrap-CI [0.15, 7.11]).

Higher inhibitory demands enable larger improvements across sessions. Mediation analysis supports an inhibitory working mechanism. Tailoring inhibitory demands to individual performance capacity could optimize future Alc-IT.

Negative self-perceptions are implicated in the development and maintenance of depression in young people, but little is known about their receptiveness to change in response to treatment. This paper reports on a pre-registered meta-analysis examining the extent to which treatments for depression in young people aged 11-24 result in changes to self-perceptions. Controlled treatment trials examining outcomes related to self-perceptions were synthesised (k = 20, N = 2041), finding small reductions in both symptoms of depression (g = -0.30; 95 % CI: -0.52, -0.08) and self-perception outcomes (g = 0.33; 95 % CI: 0.16, 0.49) for interventions compared with control groups. Meta-regression analyses found no significant association between reductions in depressive symptoms and improvements in self-perception following treatment, suggesting that despite interventions generally improving both outcomes these changes may be unrelated to each other. Our results indicate that young people's self-perceptions are sensitive to change following treatment for depression, however effect sizes are small and treatments could be more effective in targeting and changing negative self-perceptions. Given the importance that young people place on integrating work on their sense of self into treatments for depression, future interventions could aim to support young people with depression to develop a positive sense of self.

Graphical Abstract.

While the efficacy of digital interventions for the treatment of depression is well established, comprehensive knowledge on how therapeutic changes come about is still limited. This systematic review aimed to provide an overview of research on change mechanisms in digital interventions for depression and meta-analytically evaluate indirect effects of potential mediators.

The databases CENTRAL, Embase, MEDLINE, and PsycINFO were systematically searched for randomized controlled trials investigating mediators of digital interventions for adults with depression. Two reviewers independently screened studies for inclusion, assessed study quality and categorized potential mediators. Indirect effects were synthesized with a two-stage structural equation modeling approach (TSSEM).

Overall, 25 trials (8110 participants) investigating 84 potential mediators were identified, of which attentional (8 %), self-related (6 %), biophysiological (6 %), affective (5 %), socio-cultural (2 %) and motivational (1 %) variables were the scope of this study. TSSEM revealed significant mediation effects for combined self-related variables (ab = -0.098; 95 %-CI: [-0.150, -0.051]), combined biophysiological variables (ab = -0.073; 95 %-CI: [-0.119, -0.025]) and mindfulness (ab = -0.042; 95 %-CI: [-0.080, -0.015]). Meta-analytical evaluations of the other three domains were not feasible.

Methodological shortcomings of the included studies, the considerable heterogeneity and the small number of investigated variables within domains limit the generalizability of the results.

The findings further the understanding of potential change mechanisms in digital interventions for depression and highlight recommendations for future process research, such as the consideration of temporal precedence and experimental manipulation of potential mediators, as well as the application of network approaches.

Scarce treatment resources put pressure on mental health services prompting innovations in service provision. Various innovative strategies have been introduced to provide patients with improved and effective treatment due to increased demands for mental health services. In 2016 a district psychiatric centre (DPC) started a brief treatment program to provide early and effective help for moderate depression and anxiety. There is little evidence regarding the potential benefits that different mental health patients may experience after receiving brief therapy treatment. Moreover, few studies have explored the experiences of referring general practitioners (GPs) with different patient outcomes after brief therapy. The aim of this study was to investigate the long-term experiences of patients who received brief therapy at a DPC at least one year ago, as well as the experiences of general practitioners (GPs) who referred patients for such treatment since 2016. Specifically, the study sought to determine patterns in the patients' stories and GPs' experiences to see if it could provide new insight for further studies.

We conducted individual interviews with a total of seventeen participants, consisting of eleven patients and six GPs. Using an exploratory approach, we analyzed patients' narratives as they described them in the interviews, employing inductive and thematic analysis techniques. The GPs' experiences of referring several patients to brief therapy were also subjected to thematic analysis. In addition, we synthesized the patients' experiences into condensed stories for comparison. The experiences of GPs, who had referred patients to this brief treatment program over several years, were compared with the patients' experiences and reflections one year after receiving brief therapy. This comparison aimed to challenge and deepen the understanding of condensed patient stories.

The main results are presented as three condensed patient stories: A) Coping with mental problems; B) A path to another treatment; and C) Confusion and lost hope. The GPs' experiences are included in each condensed patient story to challenge and elaborate on relevant aspects.

Time-limited brief therapy was experienced as beneficial for patients with moderate affective and anxiety disorders but was experienced as unsuitable for those with more severe conditions. This raises important questions about the appropriateness of offering brief therapy to a diverse patient population and the efficient use of healthcare resources. We recommend further research to enhance understanding and develop tailored treatment services for different ailments. Identifying which patients benefit most from specific therapies can improve outcomes and resource allocation. An important improvement measure might be to enhance early communication between patients, General Practitioners (GPs), and District Psychiatric Centres (DPCs) before referrals. Ensuring brief therapy is targeted to those likely to benefit the most will enhance treatment effectiveness. Additionally, we suggest implementing joint assessment meetings to facilitate comprehensive information exchange and coordination among different care levels. This approach would improve assessments, treatment planning, and follow-up strategies, ultimately leading to better patient care and resource management.

The phenomenon of neural plasticity pertains to the intrinsic capacity of neurons to undergo structural and functional reconfiguration through learning and experiential interaction with the environment. These changes could manifest themselves not only as a consequence of various life experiences but also following therapeutic interventions, including the application of noninvasive brain stimulation (NIBS) and psychotherapy. As standalone therapies, both NIBS and psychotherapy have demonstrated their efficacy in the amelioration of psychiatric disorders' symptoms, with a certain variability in terms of effect sizes and duration. Consequently, scholars suggested the convenience of integrating the two interventions into a multimodal treatment to boost and prolong the therapeutic outcomes. Such an approach is still in its infancy, and the physiological underpinnings substantiating the effectiveness and utility of combined interventions are still to be clarified. Therefore, this opinion paper aims to provide a theoretical framework consisting of compelling arguments as to why adding NIBS to psychotherapy can promote therapeutic change. Namely, we will discuss the physiological effects of the two interventions, thus providing a rationale to explain the potential advantages of a combined approach.

Difficulties with emotion regulation are associated with the development and maintenance of psychiatric symptoms. Focusing on emotion regulation can be beneficial when treating symptoms and behavioral problems. Here we describe a seven-session transdiagnostic approach to regulating emotions, delivered jointly to adolescents and parents in a child and adolescent psychiatric outpatient setting, and we explore the perceptions and acceptability of the methodological aspects of the intervention.

Quantitative and qualitative data were analyzed. Participants (n = 117) were adolescents and parents.

Participants reported positive attitudes toward the skills training and would recommend it to others. Three overarching themes were developed. "Treatment components" relates to the content of the skills training. Participants appreciated focusing on ER skills but had different perceptions of the content. "The learning climate" contains process-related experiences, such as the skills trainers' approach and the timing of the intervention. Participants preferred when skills trainers used self-disclosure. "Pedagogical aspects", describes the structure of the training with perceptions of group constellations, length of sessions and homework. Adolescents particularly requested variety in the pedagogy and found long sessions to be challenging.

Recommendations for therapeutic practices are discussed.

Suicide is a leading cause of death among adolescents and young adults. While only few evidence-based treatments with limited efficacy are available, family processes have recently been posed as a possible alternative target for intervention. Here, we review the evidence for Attachment-Based Family Therapy (ABFT), a guideline-listed treatment targeting intrafamilial ruptures and building protective caregiver-child relationships.

PubMed, PsycINFO, Embase, and Scopus were searched for prospective trials on ABFT in youth published up until November 6th, 2023, and including measures of suicidality. Results were independently screened by two researchers following PRISMA guidelines. Risk of bias was assessed using the Cochrane RoB-2 framework. A random effects meta-analysis was conducted on suicidal ideation and depressive symptoms post-intervention scores in randomized-controlled trials (RCTs).

Seven articles reporting on four RCTs (n = 287) and three open trials (n = 45) were identified. Mean age of participants was M pooled = 15.2 years and the majority identified as female (~80%). Overall, ABFT was not significantly more effective in reducing youth suicidal ideation, gpooled = 0.40, 95% CI [-0.12, 0.93], nor depressive symptoms, gpooled = 0.33, 95% CI [-0.18, 0.84], compared to investigated controls (Waitlist, (Enhanced) Treatment as Usual, Family-Enhanced Nondirective Supportive Therapy).

Evidence is strongly limited, with few available trials, small sample sizes, high sample heterogeneity, attrition rates, and risk of bias. While not generally superior to other treatments, ABFT might still be a clinically valid option in specific cases and should be further investigated. Clinicians are currently recommended to apply caution when considering ABFT as stand-alone intervention for suicidal youth and to decide on a case-by-case basis.

Compared to efficacy research, studies investigating the processes of change in psychological therapy are rare, especially for internet-based interventions. While many online therapies are based on face-to-face therapy protocols, it is unknown whether the processes of clinical improvement differ between these treatment formats.

To examine candidate change processes in an online therapist-guided cognitive therapy intervention for social anxiety disorder (iCT-SAD), and compare the results to the corresponding face-to-face therapy (CT-SAD).

Data from a randomised controlled trial (n = 99) were analysed using Multilevel Structural Equation Models, incorporating the temporal precedence of the process variable, and disaggregating the within- and between-subject components of the predictors. These examined three candidate change processes: self-focused attention, negative social cognitions, and depressed mood. Moderated mediation models provided an additional test of the moderating effect of treatment format.

Negative social cognitions and self-focused attention were supported as significant mediators of clinical improvement in both CT-SAD and iCT-SAD. Effects were of similar strength and moderated mediation was not observed. There was also evidence of cyclical relationships between social anxiety symptoms and these process variables. Depressed mood also emerged as a significant but weak mediator in CT-SAD, but not in iCT-SAD. Moderated mediation was not observed.

The online format of therapy showed a similar pattern of change processes to face-to-face treatment, with self-focused attention and negative social cognitions mediating clinical improvement in both treatments. Efforts to improve the efficacy and efficiency of SAD interventions by targeting these factors may therefore be equally applicable to online and face-to-face interventions.

Impulsivity has well-documented associations with risky alcohol use. Little evidence exists on the causal mechanisms, but emerging experimental evidence suggests a role for reward-related impulsivity. Recent work experimentally increased reward-related impulsivity to increase drinking using standardised reward-cue stimuli. The present study piloted participant-generated reward-cue stimuli to increase laboratory alcohol consumption. Sixteen participants (56.3 % male; M age = 20.13, SD = 1.78) attended two laboratory sessions (experimental and control). In the experimental session, the Individualised Reward-seeking Induction Schedule (IRIS) had participants re-experience an intense, vivid memory of an approach motivational state (control session: no induction) before completing a laboratory drinking task. Self-reported reward-seeking, positive, and negative affect were measured. IRIS significantly increased alcohol consumption by 53.65 ml (SE = 29.11, p <.001) when controlling for positive and negative affect. IRIS also produced significantly higher state reward-seeking (Δꭓ2 (1) = 14.02, p <.001). Findings provide preliminary validation of IRIS, a new experimental methodology to investigate impulsivity-related alcohol use. Replication of observed effects in a larger sample is required. The present study supports the use of IRIS in future research to understand the causal role of reward-related impulsivity on alcohol consumption.

The increasing rates of mental health challenges among young people highlight an urgent need for accessible and effective treatment. However, current mental health systems face unprecedented demand, leaving most young people globally with unmet mental health needs. Smartphones present a promising solution to this issue by offering in-the-moment support through innovative just-in-time adaptive interventions, which provide support based on real-time data.

This study explores young people's experiences with Mello, a just-in-time adaptive intervention that focuses on the transdiagnostic mechanism of repetitive negative thinking (RNT), a significant factor contributing to youth depression and anxiety.

Semistructured qualitative interviews were conducted with 15 participants aged 16 to 25 years, all of whom had previously participated in a pilot randomized controlled trial of Mello. Of the 15 participants, 9 (60%) identified as women, 4 (27%) as men (including 1 transgender man), and 2 (13%) as nonbinary. Interviews focused on participants' experiences with the Mello app, factors influencing engagement, perceived benefits and limitations, and suggestions for future improvements. Thematic analysis was used to analyze the data.

The analysis identified three superordinate themes: Mello as a tool for intentional reflection; doing therapy your own way; and barriers to engagement during low mood, anxiety, and RNT. Theme 1 explored young people's experiences of how the app facilitated active management of negative thoughts and supported the development of reflective habits, contrasting with their typical strategies of avoidance or resistance. Theme 2 highlighted the value of the app's self-guided nature, with a particular focus on its flexibility and accessibility, particularly when compared to traditional face-to-face therapy. Finally, theme 3 addressed barriers to engagement, particularly during emotionally difficult times, with participants reporting feeling "stuck" in their negative thoughts. To mitigate these challenges, participants suggested incorporating gamification elements, such as progress-tracking visuals, to enhance motivation and increase engagement with the app.

Our findings underscored the value of Mello in promoting intentional engagement and reflection with RNT, consistent with prior research that emphasizes the effectiveness of tailored interventions. Although some users valued the self-guided nature of the application, others encountered difficulties with motivation. Future research should explore strategies to enhance engagement for young people with low mood and motivation, such as co-design methodologies, advanced personalization features, and gamification techniques.

Adolescents exhibit a high prevalence of mental health disorders, with more than half of all cases emerging before the age of 14 years. Since the advent of the COVID-19 pandemic, there has been a marked upsurge in anxiety and depression among adolescents across several nations. Emotional disorders often lead to severe outcomes, including school absenteeism, self-harm, and suicidal tendencies. The suboptimal efficacy of pharmacotherapy, compounded by limited availability and substantial costs associated with individual psychotherapy, underscores the critical need for identifying simple yet efficacious psychotherapeutic interventions suitable for both individual and group settings. Tension and Trauma Release Exercise (TRE) is a mind-body therapeutic approach that efficiently alleviates symptoms of anxiety and depression. This randomized controlled trial (RCT) aims to evaluate the effectiveness of a mother-child intervention model using TRE in enhancing the clinical management of adolescent patients diagnosed with emotional disorders.

This study recruits 140 dyads of adolescents with emotional disorders and their mothers, randomly assigned to intervention or control groups. The intervention arm combines eight weeks of standard pharmacotherapy with an eight-week TRE group therapy, assessing at baseline, post-8-week treatment, and three-month follow-up. Initially, controls receive eight weeks of standard medication with parallel assessments, later transitioning to the same TRE intervention while maintaining continuous evaluation. The study further examines the influence of maternal emotional health on adolescent treatment response and investigates associated neurophysiological and psychological mechanisms.

This research endeavors to identify a straightforward and potent body-oriented psychological intervention that could improve the clinical outcomes for adolescent patients with emotional disorders. Such findings would carry profound implications not only for the healthy development of teenagers but also for potentially mitigating the burden on families, educational institutions, and society as a whole.

ChiCTR2100044553, Registered March 24, 2021.

Randomised controlled trials have demonstrated the benefit of diet modification to improve diet quality in the treatment of adult major depressive disorder (MDD). However, research examining nutritional interventions for adolescents with MDD is sparse. This pilot study examined the feasibility of a personalised nutrition intervention for adolescents with MDD. Ten adolescents with MDD and their parents recruited from a tertiary care setting participated in an 8-week, single-arm mixed-methods study. Feasibility was assessed using five criteria (demand, acceptability, implementation, adaptation and limited efficacy testing) alongside qualitative interviews. The intervention involved four bi-weekly virtual nutrition counselling sessions with a stepped approach to dietary change, menu planning, grocery delivery and educational eHealth messages. Study participants sought positive changes in diet, health and lifestyle for adolescents and family-wide benefits. Recruitment challenges included concerns about managing mood fluctuations, anticipated dietary restrictions and the potential time and effort required for diet adherence. Feedback based on interviews emphasised moderate to high acceptability, satisfaction with menu planning and counselling and recognition of the benefits of trying new foods and sustaining positive dietary changes beyond the study. Improvements in depression symptoms (Cohen's d = 0·36, 95 % CI (-0·24, 3·36)), parent food modeling (Cohen's d = 0·24, 95 % CI (-0·43, 1·16) and the family food environment (Cohen's d = 0·61, 95 % CI (-0·04, 2·61)) were observed. This nutrition intervention was feasible for adolescents with MDD and was acceptable to both parents and depressed adolescents. These preliminary data suggest that further examination of the intervention and its potential benefits on depression symptoms and family food dynamics are warranted.

Changes in sleep and circadian function are leading candidate markers for the detection of relapse in Major Depressive Disorder (MDD). Consumer-grade wearable devices may enable remote and real-time examination of dynamic changes in sleep. Fitbit data from individuals with recurrent MDD were used to describe the longitudinal effects of sleep duration, quality, and regularity on subsequent depression relapse and severity.

Data were collected as part of a longitudinal observational mobile Health (mHealth) cohort study in people with recurrent MDD. Participants wore a Fitbit device and completed regular outcome assessments via email for a median follow-up of 541 days. We used multivariable regression models to test the effects of sleep features on depression outcomes. We considered respondents with at least one assessment of relapse (n = 218) or at least one assessment of depression severity (n = 393).

Increased intra-individual variability in total sleep time, greater sleep fragmentation, lower sleep efficiency, and more variable sleep midpoints were associated with worse depression outcomes. Adjusted Population Attributable Fractions suggested that an intervention to increase sleep consistency in adults with MDD could reduce the population risk for depression relapse by up to 22 %.

Limitations include a potentially underpowered primary outcome due to the smaller number of relapses identified than expected.

Our study demonstrates a role for consumer-grade activity trackers in estimating relapse risk and depression severity in people with recurrent MDD. Variability in sleep duration and midpoint may be useful targets for stratified interventions.

Although parenting programs are the most widely used approach to reduce disruptive behavior in children, there is a notable lack of understanding of the exact changes in parenting that underlie their effects. Challenges include the frequent use of composite measures of parenting behavior and insufficient power to detect mediation effects and individual differences in these in individual trials.

Individual participant data from 14 European randomized controlled trials of social learning-based parenting programs were pooled to examine which specific parenting behaviors best explain program effects. Participants included 3,252 families with children ages 1 to 13 years. Parental use of praise, tangible rewards, physical discipline, harsh verbal discipline, and not following through on discipline were included as putative mediators. Additionally, the study explored whether subgroups of families showing different mediational pathways exist.

Changes in parenting partially mediated program effects, with all included parenting behaviors except parental use of praise serving as unique mediators. Less harsh verbal discipline and increased following through on discipline were the strongest mediators. The study identified 3 subgroups with distinct responses to parenting programs. Most families benefited, partly through increased following through on discipline; families with the least or most difficulties were more likely to benefit less or not at all.

These findings offer insight into the specific parenting behavior changes key to reducing disruptive child behavior, while highlighting the need for innovative research methodologies to gain a deeper understanding of individual differences in parenting program benefits and mechanisms.

Study Preregistration: Individual Participant Data Meta-analysis: Individual Differences in Mediators of Parenting Program Effects on Disruptive Behavior; https://doi.org/10.1016/j.jaac.2023.11.005.

Experiencing trauma leads to intrusive memories (IMs), a hallmark symptom of post-traumatic stress disorder (PTSD), which also occurs transdiagnostically. Understanding why IMs increase or decrease is pivotal in developing interventions to support mental health. In this preregistered meta-analysis (PROSPERO: CRD42021224835), we included 134 articles (131 techniques, 606 effect sizes and 12,074 non-clinical participants) to investigate how experimental techniques alter IM frequency, intrusion-related distress and symptoms arising from lab-analogue trauma exposure. Eligible articles were identified by searching eight databases until 12 December 2023. To test potential publication biases, we employed methods including Egger's test and three-parameter selection models. We employed three-level multilevel modelling and meta-regressions to examine whether and how experimental techniques would modulate IM frequency and associated outcomes. Results showed that techniques (behavioural, pharmacological, neuromodulation) significantly reduced intrusion frequency (g = 0.16, 95% confidence interval [0.09, 0.23]). Notably, techniques aimed to reduce IMs also ameliorated intrusion-related distress and symptoms, while techniques that increased IMs exacerbated these related outcomes, thus highlighting IM's centrality in PTSD-like symptoms. Techniques tapping into mental imagery processing (for example, trauma reminder followed by playing Tetris) reduced intrusions when administered immediately after, or at a delayed time after trauma. Although our meta-analysis is limited to symptoms induced by lab-analogue trauma exposure, some lab-based results have now generalized to real-world trauma and IMs, highlighting the promising utility of lab-analogue trauma paradigms for intervention development.

Preliminary research supports the feasibility of metacognitive therapy (MCT) in children with generalized anxiety, but the effectiveness of MCT in treating children with other anxiety and depressive disorders largely remains unknown. The purpose of this study was to investigate the effects associated with MCT in targeting symptoms of anxiety and depression in children and adolescents and to investigate mechanisms proposed by the metacognitive model. Ninety-seven participants aged 10-17 years (M = 12.9 ± 1.9, 82.5 % females) with anxiety and depressive disorders received eight sessions of group MCT. Participants were diagnostically assessed at pre- and post-treatment and completed symptom and process measures before, during, and after treatment, and again at three- and six-month follow-up. Multilevel models were conducted to investigate treatment-related and mediation effects. Results showed large reductions in total symptoms following treatment (d = 1.28). These reductions were associated with, and temporally preceded by changes in cognitive attentional syndrome (CAS), metacognitive beliefs, and self-reported attention control, but not objective attention control. Treatment gains were maintained at six-month follow-up (d = 1.18). Our results indicate that MCT may be a promising treatment for children and adolescents with anxiety and depression and provide preliminary evidence of changes in CAS, metacognition, and perceived attention control as potential drivers of treatment effects.

Intrusive memories of psychologically traumatic events bring distress both sub-clinically and clinically. This parallel-group, two-arm randomised controlled trial evaluated the effect of a brief behavioural intervention on reducing intrusive memories in frontline healthcare workers exposed to traumatic events during the COVID-19 pandemic.

Participants with at least two intrusive memories of work-related trauma in the week before recruitment were randomised 1:1 to an imagery-competing task intervention (n = 73) or attention-based control task (n = 71). The number of intrusive memories was assessed at baseline and 5 weeks after the guided session (primary endpoint).

The intervention significantly reduced intrusive memory frequency compared with control [intervention Mdn = 1.0 (IQR = 0-3), control Mdn = 5.0 (IQR = 1-17); p < 0.0001, IRR = 0.30; 95% CI = 0.17-0.53] and led to fewer post-traumatic stress-related symptoms at 1, 3 and 6 month follow-ups (secondary endpoints). Participants and statisticians were blinded to allocation. Adverse events data were acquired throughout the trial, demonstrating safety. There was high adherence and low attrition.

This brief, single-symptom, repeatable digital intervention for subclinical-to-clinical samples after trauma allows scalability, taking a preventing-to-treating approach after trauma.

2020-07-06, ClinicalTrials.gov identifier: NCT04460014.

People with lived experience have had limited opportunities to meaningfully contribute to the design of caring contacts interventions. The objective of this study was to co-design text messages with peer support specialist staff to determine optimal language and delivery, within a cultural context.

In this qualitative study, participants were professional peer support specialist staff with lived experience employed by specialist mental health services. They were asked to evaluate the initial series of text messages by taking part in a focus group using a semi-structured interview. This was audiotaped, transcribed and analysed using reflexive thematic analysis with specific coding of cultural themes.

Three main themes were identified: upholding a person's autonomy; establishing connection as a bridge to safety; and, words as healing rongoā (remedy). The last theme contained a cultural subtheme: Māori language providing entry to the Māori world.

People with lived experience breathe empowerment and hope into caring contacts interventions and should be considered vital partners in developing any suicide prevention initiative. Feeling genuinely cared for promotes connection and may enable an internal sense of safety. Tailoring of texts can be enhanced by culturally nuanced language.

Mental health disorders affect a substantial portion of the global population. Despite preferences for psychotherapy, access remains limited due to various barriers. Digital mental health interventions (DMHIs) have emerged to increase accessibility, yet engagement and treatment completion rates are concerning. Evidence across healthcare where some degree of self-management is required show that treatment engagement is negatively influenced by contextual complexity. This article examines the non-random factors influencing patient engagement in digital and face-to-face psychological therapies. It reviews established models and introduces an adapted version of the Cumulative Complexity Model (CuCoM) as a framework for understanding engagement in the context of digital mental health. Theoretical models like the Fogg Behavior Model, Persuasive System Design, Self-Determination Theory, and Supportive Accountability aim to explain disengagement. However, none adequately consider these broader contextual factors and their complex interactions with personal characteristics, intervention requirements and technology features. We expand on these models by proposing an application of CuCoM's application in mental health and digital contexts (known as DiCuCoM), focusing on the interplay between patient burden, personal capacity, and treatment demands. Standardized DMHIs often fail to consider individual variations in burden and capacity, leading to engagement variation. DiCuCoM highlights the need for balancing patient workload with capacity to improve engagement. Factors such as life demands, burden of treatment, and personal capacity are examined for their influence on treatment adherence. The article proposes a person-centered approach to treatment, informed by models like CuCoM and Minimally Disruptive Medicine, emphasizing the need for mental healthcare systems to acknowledge and address the unique burdens and capacities of individuals. Strategies for enhancing engagement include assessing personal capacity, reducing treatment burden, and utilizing technology to predict and respond to disengagement. New interventions informed by such models could lead to better engagement and ultimately better outcomes.

Mindfulness skills training is a core component of Dialectical Behavior Therapy and aims to improve emotion dysregulation (ED) in people with Borderline Personality Disorder (BPD). However, the underlying mechanisms of change are not fully understood.

A total of 75 BPD outpatients participated in a 10-week mindfulness skills training. Multilevel models with a time-lagged approach were conducted to examine the temporal dynamics between the proposed mechanisms and ED. Decentering, nonjudgment, body awareness and attention awareness as putative mechanisms and ED as outcome were assessed on a session-by-session basis.

Greater nonjudgment and body awareness showed within-person effects; participants who reported higher nonjudgement of inner experience and body awareness than their own personal average at a given week showed improvement in ED at the following week. Notably, decentering moderated these associations, such that increased nonjudgment and body awareness predicted improvements in ED more strongly in those participants with high decentering ability. Lastly, a bidirectional relationship between the mechanisms and ED was found; when participants were more emotionally dysregulated than their usual state, they showed less gain in the mechanisms at the following week.

Knowing how mindfulness training works is relevant to optimize treatments. Clinicians may use strategies to increase these mechanisms when the goal is to improve emotion regulation difficulties in BPD.

Depressive and anxiety disorders are common mental disorders ranking among the leading causes of global disease burden. Not all clients currently benefit from therapy and clients are looking for modern ways of therapy. Online psychotherapy is a promising option for better meeting clients' needs. Recently, a new psychotherapy concept has emerged that combines videoconferencing sessions with support through a mobile application. The latter allows for ecological momentary assessments and interventions, facilitates communication between patients and therapists in between sessions through chat, and allows for incorporating feedback-informed treatment principles.

The study was a retrospective observational matched cohort study, comparing online psychotherapy with Therapy As Usual (TAU) for clients with depressive or anxiety disorders. Data were obtained via questionnaires, which are part of standard clinical care. Primary outcomes included general mental functioning, and symptoms of depression and anxiety. Secondary outcomes were efficiency, client satisfaction, and therapy costs. Primary endpoints were analyzed using linear mixed models analysis, with an interaction term between time and group. Secondary outcomes were analyzed using linear regression.

Larger improvements were observed in the online compared to the TAU group for general mental functioning and depressive disorder (i.e., General mental functioning: B = -8.50, 95 CI: -15.01 - -1.97, p = 0.011; Depressive disorder: B = - 3.66, 95 % CI: -5.79 - -1.54p < 0.01). No significant differences in change over time between the two groups were observed for anxiety disorder (B = -3.64, 95 % CI: (-13.10 - 5.82) p = 0.447). The total number of sessions was significantly higher in the online psychotherapy group than in TAU (B = 3.71, p < 0.01), although clients were matched on treatment time in weeks. Treatment session duration in minutes was comparable across the groups.

Online psychotherapy with app support showed to be a promising alternative to TAU for depressive and anxiety disorders. More research is needed to evaluate the effectiveness, cost-effectiveness and client satisfaction of online psychotherapy compared to TAU, such as randomized controlled trials or studies multiple baseline series designs, and in-depth qualitative research.

Clinicians and researchers should consider the expected benefits and potential harms of an intervention. Parenting programmes are a widely used evidence-based intervention for child behaviour problems. However, few data are available on potential negative effects. The aims of this paper were to increase systematic knowledge of adverse event (AE) assessment in parenting programmes and to provide an AE assessment tool.

As part of the RISE project (prevention of child mental health problems in South-eastern Europe-adapt, optimise, test and extend parenting for lifelong health), we developed and tested an AE assessment procedure in three sequential studies for parents of children with child behaviour problems aged 2 to 9 years in North Macedonia, Republic of Moldova, and Romania. This paper reports on the development of the assessment tool in phase 1 (N = 140), phase 2 (N = 835), and the final experiences with using the optimised procedures in phase 3 (multisite randomised controlled trial, N = 823) in which AEs were assessed before, three times during intervention delivery, and at 1 year follow-up. At each time point, the participants completed a 12-item AE checklist. If moderate-to-severe problems of parent or child were reported, a structured follow-up interview was conducted.

The response rate on the AE assessment tool increased from 6% (phase 1) to 100% (phase 3) indicating improvement in collecting these data based on the experiences of each phase. Results of the RCT (phase 3) showed generally low (S)AE frequencies with the finally optimised procedure: During the intervention, no serious adverse events (SAE) were registered; at least one AE was reported by 10% (after the first session), 7% (after the third session), and 4% (after the last fifth session) of participants. None of the identified (S)AEs was causally related to the study or intervention. Cost-benefit considerations are needed to determine the best way to ensure participant safety in parenting programmes.

The applied active AE assessment procedure provides a comprehensive AE assessment tool that can be used by others-with adaptations for the specific context, if needed. Based on our experiences, we outline recommendations for future studies.

ClinicalTrials.gov, registration number phase 1: NCT03552250; phase 2: NCT03865485, phase 3: NCT04721730 . Registered on 13 January 2021.

Suicide prevention requires diverse, integrated, and evidence-based measures. Comprehensive evaluation of interventions and reliable suicide data are crucial for guiding policy-making and advancing suicide prevention efforts. This study aimed to analyze current issues and gaps in the evaluation of suicide prevention measures and the quality of suicide data in Germany, Austria, and Switzerland to derive specific recommendations for improvement.

Online, semi-structured interviews were conducted with 36 experts in suicide prevention from Germany, Austria, and Switzerland, covering insights from policy, science, and practice. The interviews took place between September 2022 and February 2023, were audio-recorded, transcribed verbatim, and analyzed using the Framework method.

While solid evidence supports the effectiveness of some suicide prevention interventions, experts indicated that the evaluation of many other measures is weak. Conducting effectiveness studies in suicide prevention presents a range of methodological and practical challenges, including recruitment difficulties, choosing adequate outcome criteria, ethical considerations, and trade-offs in allocating resources to evaluation efforts. Many interviewees rated the quality of national suicide statistics in Germany, Austria, and Switzerland as comparatively high. However, they noted limitations in the scope, timeliness, and reliability of these data, prompting some regions to implement their own suicide monitoring systems. None of the three countries has national routine data on suicide attempts.

While some challenges in evaluating suicide prevention measures are inevitable, others can potentially be mitigated. Evaluations could be enhanced by combining traditional and innovative research designs, including intermediate outcomes and factors concerning the implementation process, and employing participatory and transdisciplinary research to engage different stakeholders. Reliable suicide data are essential for identifying trends, supporting research, and designing targeted prevention measures. To improve the quality of suicide data, a standardized monitoring approach, including uniform definitions, trained professionals, and cross-sector agreement on leadership and financing, should be pursued. This study provides actionable recommendations and highlights existing good practice approaches, thereby supporting decision-makers and providing guidance for advancing suicide prevention on a broader scale.

Most mental disorders have their onset in adolescence. Preventive interventions during this period are important; however, help-seeking behavior is generally poor in this age group resulting in low treatment rates. Internet interventions are expected to be an effective, low-threshold, and scalable approach to overcome barriers to help-seeking, particularly for individuals experiencing subclinical symptoms. Internet-delivered indicated prevention seems promising as it targets individuals with minimal symptoms of mental disorders who might need care but are not help-seeking yet. Previous indicated prevention-approaches have mainly targeted specific risk-syndromes. However, this contradicts the increasing recognition of emerging psychopathology as a complex system characterized by co-occurrence and rapid shifts of subclinical symptoms cutting across diagnostic categories. Therefore, this study will investigate the efficacy, mediators, moderators, and core symptomatic changes of a transdiagnostic Internet-delivered indicated prevention program (EMPATIA program) for adolescents.

This randomized controlled trial (RCT) will be conducted in a general population sample (planned n = 152) of adolescents aged 12-18 years with subclinical symptoms but without any current or past mental disorder. Participants will be randomly assigned to the EMPATIA program or a care as usual (CAU) control condition. The 8-week guided EMPATIA program encompasses 8 modules targeting the following transdiagnostic mechanisms: repetitive negative thinking, self-perfectionism, emotion regulation, intolerance of uncertainty, rejection sensitivity, and behavioral avoidance. Participants will be asked to answer online self-report questionnaires at baseline, after 8 weeks, and at 6-, 9-, and 12-month follow-up. Diagnostic telephone interviews will be conducted at baseline and at 12-month follow-up. Additionally, intervention-specific constructs (motivation, alliance, negative effects, satisfaction, adherence) will be assessed during and after the EMPATIA program. The level of self-reported general psychopathology post-intervention is the primary outcome.

Results will be discussed considering the potential of Internet interventions as a scalable, low-threshold option for indicated prevention in adolescents experiencing subclinical symptoms. The EMPATIA program introduces a novel Internet prevention program targeting six transdiagnostic mechanisms associated with various mental health outcomes. Thereby, this trial pursues a very timely and important topic because it may contribute to narrow the current care gap for adolescents, to prevent mental health problems and related negative consequences, and to promote mental health in the long-term.

The trial was approved by Swissmedic (Registration Number: 10001035, 08/22/2022) and the Ethics Committee of Bern (Registration Number: 2022-D0036, 08/22/2022). The trial was registered at ClinicalTrials.gov NCT05934019 on 07-03-2023.

Currently, there is a paucity of up-to-date estimates of the economic burden caused by mental disorders. Such information could provide vital insight into one of the most serious and costly-yet to some extent preventable-health challenges facing the world today.

Data from a national psychiatric-epidemiological cohort study (NEMESIS-2, N = 6506) were used to provide reliable, relevant, and up-to-date cost estimates (in 2019 Euro) regarding healthcare costs, productivity losses, and patient and family costs associated with DSM-IV mental disorders both at individual level, but also in the general population and in the workforce of the Netherlands (per 1 million population).

In the general population, the costs of mood disorders, specifically depression, are substantial and rank above those from the anxiety disorders, whilst costs of anxiety disorders are more substantial than those stemming from substance use disorders, even when the per-person costs of drug abuse appear highest of all. In the workforce, specific and social phobias are leading causes of excess costs. The workforce has lower healthcare costs but higher productivity costs than general population.

The findings suggest that (preventive) healthcare interventions targeting the workforce are likely to become cost-effective and underscore the importance for employers to create healthy work environments. Overall, the results highlight the need to strengthen the role of mental health promotion and prevention of mental disorders in the social domain before people require treatment to reduce the staggering and costly burden caused by mental disorders to individuals and society.

Extending on previous findings that computerized Memory Specificity Training (c-MeST) improves memory specificity and depressive symptoms in Major Depressive Disorder (MDD) in adults, this study aimed to assess the effects of c-MeST in youth with MDD on memory specificity and depression in addition to other treatment.

Participants aged 15-25 (N = 359, 76 % female; M age = 19.2, SD = 3.1), receiving predominantly psychological therapy or counseling (85 %) and/or antidepressants (52 %) were randomized to usual care and c-MeST or usual care. Cognitive and clinical outcomes were assessed at baseline and at one, three, and six-month follow-ups.

The usual care and c-MeST group reported higher memory specificity at one-month (d = 0.42, p = .022), but not at three or six months (d's < 0.15, p's > 0.05). The rate of MDE was numerically lower in the c-MeST group at each follow-up time-point, but group was not a statistically significant predictor at one month (64 % usual care and c-MeST vs. 68 % usual care, OR = 0.81, p = .606), three months (67 % usual care and c-MeST vs. 72 % usual care, OR = 0.64, p = .327) or six months (55 % usual care and c-MeST vs. 68 % usual care, OR = 0.56, p = .266). The usual care and c-MeST group did report lower depressive symptoms at one month (d = 0.42, p = .023) and six-months (d = 0.84, p = .001), but not three-months (d = 0.13, p > .05).

c-MeST may reduce symptoms in youth with MDD when provided alongside other treatments. However, there are significant limitations to this inference, including high attrition in the study and a need for more data on the acceptability of the intervention.

Technology improves accessibility of psychological interventions for youth. An ecological momentary intervention (EMI) is a digital intervention geared toward intervening in daily life to enhance the generalizability and ecological validity, and to be able to intervene in moments most needed. Identifying working mechanisms of the use of ecological momentary interventions might generate insights to improve interventions.

The present study investigates the working mechanisms of the use and acceptability of an ecological momentary intervention, named SELFIE, targeting self-esteem in youth exposed to childhood trauma, and evaluates under what circumstances these mechanisms of use and acceptability do or do not come into play. A realist evaluation approach was used for developing initial program theories (data: expert interviews and a stakeholders focus group), and subsequently testing (data: 15 interviews with participants, a focus group with therapists, debriefing questionnaire), and refining them.

The SELFIE intervention is offered through a smartphone application enabling constant availability of the intervention and thereby increasing accessibility and feasibility. When the intervention was offered on their personal smartphone, this enhanced a sense of privacy and less hesitance in engaging with the app, leading to increased disclosure and active participation. Further, the smartphone application facilitates the practice of skills in daily life, supporting the repeated practice of exercises in different situations leading to the generalizability of the effect. Buffering against technical malfunction seemed important to decrease its possible negative effects.

This study enhanced our understanding of possible working mechanisms in EMIs, such as the constant availability supporting increased accessibility and feasibility, for which the use of the personal smartphone was experienced as a facilitating context. Hereby, the current study contributes to relatively limited research in this field. For the field to move forward, mechanisms of use, and acceptability of EMIs need to be understood. It is strongly recommended that alongside efficacy trials of an EMI on specific target mechanisms, a process evaluation is conducted investigating the working mechanisms of use.

The current paper reports on a realist evaluation within the SELFIE trial (Netherlands Trial Register NL7129 (NTR7475)).

Psychotherapy may have many benefits for patients with mental health problems, but patients may also have negative experiences related to the therapy. Not much is known about these negative psychotherapy experiences and their impact on treatment outcome. The aim of this study was to examine the association between positive and negative psychotherapy experiences and treatment outcome.

A total of 130 patients participated in the study. They received treatment as usual and were assessed for positive and negative psychotherapy experiences at mid-treatment and post-treatment using the Positive and Negative Experiences of Psychotherapy Questionnaire (PNEP). Treatment outcome was measured by the Outcome Questionnaire - 45 (OQ-45). Multiple linear regression was used to analyze the data.

All patients reported positive psychotherapy experiences at mid-treatment. At least one negative experience was reported by 69% of participants. After correction for baseline severity (i.e., OQ-45 at baseline) and relevant demographic variables, positive psychotherapy experiences at mid-treatment emerged as a predictor for treatment outcome. In contrast, negative psychotherapy experiences did not predict treatment outcome. However, reporting more negative experiences was associated with reporting fewer positive experiences at mid- and end of treatment.

Both positive and negative psychotherapy experiences commonly occur. Although in this study negative psychotherapy experiences did not predict treatment outcome in terms of symptom reduction, the findings do suggest that negative experiences may influence the way in which patients evaluate their treatment. Although positive experiences outweigh negative experiences, patients should be informed that negative experiences may also occur.

Although psychological treatments are broadly recognized as evidence-based interventions for various mental disorders, challenges remain. For example, a substantial proportion of patients receiving such treatments do not fully recover, and many obstacles hinder the dissemination, implementation, and training of psychological treatments. These problems require those in our field to rethink some of our basic models of mental disorders and their treatments, and question how research and practice in clinical psychology should progress. To answer these questions, a group of experts of clinical psychology convened at a Think-Tank in Marburg, Germany, in August 2022 to review the evidence and analyze barriers for current and future developments. After this event, an overview of the current state-of-the-art was drafted and suggestions for improvements and specific recommendations for research and practice were integrated. Recommendations arising from our meeting cover further improving psychological interventions through translational approaches, improving clinical research methodology, bridging the gap between more nomothetic (group-oriented) studies and idiographic (person-centered) decisions, using network approaches in addition to selecting single mechanisms to embrace the complexity of clinical reality, making use of scalable digital options for assessments and interventions, improving the training and education of future psychotherapists, and accepting the societal responsibilities that clinical psychology has in improving national and global health care. The objective of the Marburg Declaration is to stimulate a significant change regarding our understanding of mental disorders and their treatments, with the aim to trigger a new era of evidence-based psychological interventions.

Current psychiatric diagnoses are not defined by neurobiological measures which hinders the development of therapies targeting mechanisms underlying mental illness 1,2 . Research confined to diagnostic boundaries yields heterogeneous biological results, whereas transdiagnostic studies often investigate individual symptoms in isolation. There is currently no paradigm available to comprehensively investigate the relationship between different clinical symptoms, individual disorders, and the underlying neurobiological mechanisms. Here, we propose a framework that groups clinical symptoms derived from ICD-10/DSM-V according to shared brain mechanisms defined by brain structure, function, and connectivity. The reassembly of existing ICD-10/DSM-5 symptoms reveal six cross-diagnostic psychopathology scores related to mania symptoms, depressive symptoms, anxiety symptoms, stress symptoms, eating pathology, and fear symptoms. They were consistently associated with multimodal neuroimaging components in the training sample of young adults aged 23, the independent test sample aged 23, participants aged 14 and 19 years, and in psychiatric patients. The identification of symptom groups of mental illness robustly defined by precisely characterized brain mechanisms enables the development of a psychiatric nosology based upon quantifiable neurobiological measures. As the identified symptom groups align well with existing diagnostic categories, our framework is directly applicable to clinical research and patient care.

Theories propose that judgment of and reactivity to inner experiences are mediators of the effect of mindfulness-based interventions on generalized anxiety disorder (GAD). However, no study has tested such theories using brief, mindfulness ecological momentary intervention (MEMI). We thus tested these theories using a 14-day MEMI versus self-monitoring app (SM) control for GAD.

Participants (N = 110) completed self-reports of trait mindfulness (Five Facet Mindfulness Questionnaire), GAD severity (GAD-Questionnaire-IV), and trait perseverative cognitions (Perseverative Cognitions Questionnaire) at prerandomization, posttreatment, and 1-month follow-up (1MFU). Counterfactual mediation analyses with temporal precedence were conducted.

Improvement in pre-post mindfulness domains (acceptance of emotions, describing feelings accurately, acting with awareness, judgment of inner experience, and reactivity to inner experience) predicted pre-1MFU reduction in GAD severity and pre-1MFU reduction in trait perseverative cognitions from MEMI but not SM. MEMI reduced pre-post reactivity to inner experiences (but not other mindfulness domains) significantly more than SM. Only reduced pre-post reactivity significantly mediated stronger efficacy of MEMI over SM on pre-1MFU reductions in GAD severity (indirect effect: β = -2.970 [-5.034, -0.904], p = .008; b path: β = -3.313 [-6.350, -0.276], p = .033; percentage mediated: 30.5%) and trait perseverative cognitions (indirect effect: β = -0.153 [-0.254, -0.044], p = .008; b path: β = -0.145 [-0.260, -0.030], p = .014; percentage mediated: 42.7%). Other trait mindfulness domains were non-significant mediators.

Reactivity to inner experience might be a mindfulness-based intervention change mechanism and should be targeted to optimize brief MEMIs for GAD.