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Background: Nonsuicidal self-injury (NSSI) is a prevalent and concerning behavior among adolescents, often triggered by negative interpersonal events. As social media is essential in the daily life of adolescents, gaining a better understanding of the impact of negative online events on NSSI urges and behaviors, distinct from that of real-life events, is warranted., Methods: We recruited 25 adolescents with a history of NSSI and 25 healthy controls. Participants reported on their stress, affect, and NSSI urges four times daily over seven days using ambulatory assessment. We examined the immediate effects of negative events in real-life and on social media on these psychological outcomes., Results: In adolescents who engage in NSSI, negative events on social media were positively associated with perceived stress, negative affect, and NSSI urges to a greater extent than real-life negative events. However, NSSI events during the sampling period were mostly triggered by real-life events. While the frequency of social media use was generally similar between groups, those with NSSI reported experiencing more negative events on social media., Conclusions: Our findings highlight the significant impact of social media on the mental health of adolescents who engage in NSSI, possibly exacerbating stress and negative affect more than real-life events. These results underscore the need for targeted interventions addressing online interactions to mitigate NSSI behaviors and improve adolescent mental health., Trial Registration: This study has been registered at the German Clinical Trials Register (ID: DRKS00025905, https://drks.de/search/en/trial/DRKS00025905 )., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the ethics committee of the Medical University of Vienna (1651/2019). Written consent was obtained from participants and their legal guardian(s) prior to participation. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objectives: The COVID-19 pandemic has had unprecedented and deteriorating effects on the mental health of adolescents and young adults. Various studies have described changes regarding substance abuse, but findings are conflicting., Study Design: We conducted a cross-sectional online survey on nicotine, alcohol, and illicit drug use., Methods: From March to May 2023, 502 participants aged 14-24 from a community-based sample completed the questionnaire., Results: We found a general trend of declining or stable substance use during the first 2 years of the pandemic; however, in the third year (i.e., 2022), substance use returned to pre-pandemic levels or exceeded it. Compared with young adults (age 19-24), adolescents' (age 14-18) use increased more clearly. Participants who scored above the cut-off on screening measures for problematic substance use showed a more pronounced increase in the use of cigarettes and illicit drugs but not of alcohol. Higher alcohol consumption during lockdowns was associated with increased likelihood of current problematic alcohol (odds ratio [OR]: 3.03) and cannabis use (OR: 2.60). Furthermore, individuals who reported increased usage of one psychotropic substance during lockdowns were more likely to have increased their use of other substances as well (OR: 2.66-4.87)., Conclusions: Although not optimally generalizable due to the retrospective online format and convenience sampling, our results support the notion that special attention ought to be paid to certain subgroups such as younger people and those who already exhibit problematic substance use during the pandemic. Following up on post-pandemic trends in substance use is crucial for developing prevention measures and targeted interventions., Competing Interests: Conflict of interest: S. Fanninger, A. Mayer, A. Goreis, O.D. Kothgassner, J. Matjazic, P. Schoegl, N. Schmelzle, V. Wollenek and K. Skala declare that they have no competing interests., (© 2024. The Author(s).)

Importance: Nonsuicidal self-injury (NSSI) is a significant clinical concern among adolescents. Exposure to NSSI-related content on social media platforms has been suspected to potentially act as a trigger for NSSI., Objective: To use free-viewing eye-tracking and dot-probe paradigms to examine attentional bias and psychophysiological responses to NSSI-related pictorial and textual stimuli in adolescents with and without a history of NSSI., Design, Setting, and Participants: From June 2022 to April 2023, adolescent participants in Vienna, Austria with and without a history of NSSI were exposed to NSSI-related stimuli in this nonrandomized controlled trial. Data were analyzed from December 2023 to January 2024., Exposure: Exposure to NSSI-related stimuli., Main Outcomes and Measures: During both tasks, subjective arousal, NSSI urges, and autonomic nervous system activity were assessed., Results: A total of 50 adolescents in 2 groups, 25 who engaged in NSSI (mean [SD] age 15.86 [1.14] years; 19 female participants [76%]) and 25 who did not (mean [SD] age 16.40 [1.71] years; 19 female participants [76%]) were included. Adolescents with a history of NSSI-but not those without a history of NSSI-showed a clear attentional bias toward NSSI-related images during eye-tracking, as indicated by increased initial fixations (500 ms stimulus presentation mean difference, 28.64%; 95% CI, 18.31%-38.98%; P < .001; 1000 ms stimulus presentation mean difference, 18.50%; 95% CI, 9.05%-27.95%; P < .001) and longer fixation durations (500 ms mean difference, 29.51 ms; 95% CI, 4.3-54.72 ms; P < .001; 1000 ms mean difference, 39.83 ms; 95% CI, 6.90-72.76 ms; P < .001), regardless of stimulus duration. This bias was associated with a heightened urge to engage in NSSI (d = 1.22; 95% CI, 0.69-1.73; P < .001), a trend not seen in adolescents without a history of NSSI. Similarly, in the dot-probe task, only the NSSI group showed an attentional bias toward NSSI images but not toward trauma images, emphasizing the specificity of their attentional bias. Physiological measures revealed no significant differences, suggesting that viewing NSSI images is not associated with increased autonomic arousal. Textual NSSI content did not provoke an attentional bias or heighten NSSI urges in either group., Conclusions and Relevance: In this nonrandomized controlled trial of 50 adolescents, results highlighted a specific attentional bias toward NSSI-related pictorial stimuli in adolescents with a history of NSSI, particularly a difficulty in disengaging from NSSI images. These findings contribute to understanding maladaptive information processing in NSSI and suggest implications for clinical management and cognitive models addressing NSSI triggers., Trial Registration: German Clinical Trials Register identifier: DRKS00025905.

Introduction: Mentalization-based therapy (MBT) and its adapted version for adolescents (MBT-A) are repeatedly highlighted as promising treatments for reducing self-harm, particularly in borderline personality disorder (BPD). Despite the availability of publications providing evidence of their efficacy in reducing self-harm, recent meta-analyses have yielded mixed results. To inform best-practice clinical decision-making, we conducted a systematic review and meta-analysis. We aimed to disentangle findings for both adolescents and adults on the efficacy of MBT(-A) in reducing self-harm (primary outcome) and symptoms of BPD and depression (secondary outcomes)., Methods: Web of Science, Scopus, Embase, PubMed/Medline, and Cochrane Review Database were searched for eligible studies published until September 2022. In total, 14 studies were identified, comprising 612 participants from nine MBT studies (six pre-post, three RCTs) and five MBT-A studies (two pre-post, three RCTs). Aggregated effect sizes were estimated using random-effects models. Meta-regressions were conducted to assess the effect of moderator variables (treatment duration, drop-out rates, and age) on effect sizes., Results: Overall, both MBT and MBT-A demonstrated promising effects in reducing self-harm (g = -0.82, 95% CI -1.15 to -0.50), borderline personality disorder (g = -1.08, 95% CI -1.38 to -0.77), and depression (g = -1.1, 95% CI -1.52 to -0.68) symptoms. However, when compared to control interventions (TAU, SCM), MBT(-A) did not prove to be more efficacious, with the exception of MBT showing superior effects on BPD symptoms in adults (g = -0.56, 95% CI -0.88 to -0.24)., Conclusion: Although the pre-post evaluations seem promising, this analysis, including RCTs, showed no superiority of MBT(-A) to control conditions, so that prioritizing the application of MBT (-A) for the treatment of self-harm is not supported. Possible explanations and further implications are discussed., (© 2024 The Authors. Suicide and Life‐Threatening Behavior published by Wiley Periodicals LLC on behalf of American Association of Suicidology.)

Background: Chronic ethnic discrimination may be associated with negative psychological consequences in ethnic minority groups. However, little is known about the impact of acute discriminatory events on people who experience chronic ethnic discrimination., Purpose: We examined the impact of chronic and acute ethnic discrimination on the daily lives of Turkish immigrants in Austria, a population often overlooked in discrimination research., Methods: Ninety male Turkish immigrants living in Austria (60 experiencing chronic and 30 infrequent ethnic discrimination) reported discriminatory events in real time for 30 days. Additionally, subjective stress, reactivity to daily hassles, affect, and maladaptive coping were assessed daily., Results: Participants experiencing chronic ethnic discrimination indicated higher daily values for stress, negative affect, reactivity to daily hassles, and anticipation and avoidance coping. Negative psychological states increased for all participants on days when discriminatory events occurred, but participants with chronic ethnic discrimination showed significantly stronger increases in maladaptive coping and reactivity to daily hassles, with the latter effect persisting until the next day., Conclusions: Our study is the first to demonstrate interaction effects of chronic and acute ethnic discrimination on psychological factors in daily life. The results may advance the understanding of the mechanisms that lead to health disparities in ethnic minority populations and may inform the development of targeted interventions., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.)

Background: While there are well-established treatments for post-traumatic stress disorder (PTSD), these interventions appear to be less effective for individuals with comorbid borderline personality disorder (BPD) symptoms. Dialectical Behavior Therapy (DBT) for PTSD and DBT Prolonged Exposure (PE) are both effective interventions for treating these patients, but a comprehensive analysis evaluating the efficacy of these two interventions is lacking. Objective: To determine the effect sizes of PTSD-specific DBT treatments. Methods: We conducted a systematic review and pre-registered meta-analysis of the DBT literature for treating PTSD (osf.io/62rfq). Eligible trials and treatment evaluations published before September 2023 were searched in SCOPUS, PubMed, and the Cochrane Library databases. Thirteen articles were identified, and data were extracted for primary (PTSD symptoms) and secondary outcomes (BPD, depression, dissociation, non-suicidal self-injury [NSSI]). Treatment effects were calculated for randomised controlled trials, controlled clinical trials, and pre-post evaluations. Results: Overall, the studies involved 663 participants. Compared with control groups, PTSD-specific DBT treatments showed moderate effects in reducing PTSD symptom severity g  = -0.69 (95% CI -1.03 to -0.34, p  < .001) and depression g  = -0.62 (95% CI -1.13 to -0.12, p  = .016). Moreover, the pre-post changes showed an overall effect size for dissociative symptoms of g  = -0.72 (95% CI -1.05 to -0.40, p  < .001), for BPD-associated symptoms of g  = -0.82 (95% CI -1.06 to -0.59, p  < .001), and for NSSI frequency ( g  = -0.70, 95% CI -1.12 to -0.28, p  = .001). Conclusions: Based on the results of our meta-analysis, DBT-PTSD and DBT PE were effective in reducing PTSD symptom severity and comorbid depressive symptoms. Further research on stage-based treatments should focus on systematically assessing NSSI, BPD symptoms, and suicidality.

Objective: Self-harm is associated with alterations in the psychobiological stress response. Specifically, the reactivity of the autonomic nervous system (ANS) and the endocrine hypothalamic-pituitary-adrenal (HPA) axis may differ in individuals who engage in self-harm. However, evidence in this regard is inconsistent., Background: We conducted a preregistered random-effects meta-analysis of sympathetic ANS, parasympathetic ANS, sympathetic-parasympathetic, i.e., mixed-influence ANS, and HPA axis reactivity following laboratory stress exposure in individuals who engage in self-harm and controls. Stress exposure consisted of paradigms using either social-evaluative (e.g., TSST), emotional (e.g., negatively valenced visual stimuli), or physical (e.g., cold pressor test) challenges. A total of 29 studies (self-harm: n = 954, controls: n = 1122, 74% females) were included in the analysis., Results: Regarding ANS reactivity to stress, no differences emerged between the two groups. However, parasympathetic ANS activity was lower before stress (g = -0.30, CI -0.51 to -0.09) and after stressor cessation (g = 0.54, CI -1.07 to -0.01) in the self-harm group compared to controls. Regarding HPA axis reactivity, individuals who engage in self-harm showed significantly lower cortisol responses to stress than did controls (g = -0.26, CI -0.45 to -0.08). After stressor cessation (i.e., during stress recovery), cortisol was also lower in individuals who engage in self-harm compared to controls (g = -0.26, CI -0.43 to -0.08)., Conclusions: Lower basal parasympathetic ANS activity and flattened cortisol responses indicate dysregulation of psychobiological stress systems in individuals who engage in self-harm. A better understanding of the psychobiological underpinnings of self-harm may allow for the establishment of biomarkers of risk stratification and treatment monitoring in affected individuals., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Oswald D. Kothgassner reports financial support that was provided by Austrian Science Fund (FWF): KLI963-B., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The cold pressor test (CPT) is a commonly used method to induce pain and stress in experimental settings. Previous research has found that the temperature of the water used in the test significantly affects outcome measures such as pain tolerance. Variations in CPT protocols, specifically regarding temperature, have been criticized. Hence, our objective is to investigate water temperature and associated methodological factors through a scoping review of the CPT in adults. Among 331 included trials, the most commonly reported temperature was 1°C (33.8°F). Reporting of the water temperature was adequate (93% of all trials), but a precise range within which the temperature was maintained was reported only in 27% of all trials. Pain measurement was the primary focus for most studies (90%), predominantly utilizing pain tolerance as the main outcome (78%). Water circulation was reported in 44% of studies, and 10% reported manually agitating the water. The most common maximum immersion time (i.e., ceiling time) was 180 s; notably, 64% of trials lacked information on participant awareness of this limit specification. The limb most immersed was the hand (76%). Overall, multiple methodological factors significantly impacting outcome measures were inconsistently implemented or reported. For future studies, we advocate for precise standardization of the water temperature used during the CPT. We suggest using 1°C (33.8°F), especially when assessing pain tolerance. A cooling apparatus allowing precise temperature control and continuous water circulation is advised. At the bare minimum, the temperature should be monitored continuously. While other decisions regarding the implementation of the CPT may differ depending on the specific aims of the respective study, it remains essential to standardize the water temperature and to provide a comprehensive report of the experimental protocol., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Social restrictions during the COVID-19 pandemic had a major impact on the mental health of youth. We analyzed a sample of 274 adolescents and young adults that participated in an online survey. We used the Brief Symptom Inventory 18 (BSI 18) and the Perceived Stress Scale to assess mental health status. Furthermore, we assessed the frequency and intensity of social media use in all participants. More than 50 % of the adolescents and young adults reported clinically relevant scores for somatization, depression, anxiety, and perceived stress. Females had significantly higher mental health burdens than males. Although adolescents used social media more frequently and intensely than young adults, the results showed no correlation with psychopathology. Young adults had significantly higher scores compared to adolescents in somatization, depression, and perceived stress the more time they spent on social media. Our results emphasise that frequency and intensity of social media use alone were not associated with worsemental health.However, the adverse effects of socialmedia use have to be considered carefully.

(1) Background: Many studies have used a well-known social exclusion task, namely Cyberball, to assess the psychophysiological reactions to ostracism in laboratory settings. However, this task has been recently criticized for its lack of realism. Instant messaging communication platforms are currently central communication channels where adolescents conduct their social life. These should be considered when recreating the emotional experiences that fuel the development of negative emotions. To overcome this limitation, a new ostracism task, namely SOLO (Simulated On-Line Ostracism), recreating hostile interactions (i.e., exclusion and rejection) over WhatsApp was developed. The aim of this manuscript is to compare adolescents' self-reported negative and positive affect, as well as physiological reactivity (i.e., heat rate, HR; heart rate variability, HRV) exhibited during SOLO to Cyberball. (2) Method: A total of 35 participants (Mage = 15.16; SD = 1.48; 24 females) took part in the study. The first group ( n = 23; transdiagnostic group), recruited at an inpatient and outpatient unit of a clinic for children and adolescent psychiatry, psychotherapy, and psychosomatic therapy in Baden-Württemberg (Germany), reported clinical diagnoses linked with emotional dysregulation (e.g., self-injury and depression). The second group (n = 12; control group), recruited in the district of Bavaria and Baden-Württemberg, had no pre-existing clinical diagnoses. (3) Results: The transdiagnostic group showed higher HR (b = 4.62, p < 0.05) and lower HRV (b = 10.20, p < 0.01) in SOLO than in Cyberball. They also reported increased negative affect (interaction b = -0.5, p < 0.01) after SOLO but not after Cyberball. In the control group, no differences in either HR ( p = 0.34) or HRV ( p = 0.08) between tasks were found. In addition, no difference in negative affect after either task ( p = 0.83) was found. (4) Conclusion: SOLO could be an ecologically valid alternative to Cyberball when assessing reactions to ostracism in adolescents with emotional dysregulation.

In 2019, the global Coronavirus (COVID-19) pandemic and associated prevention measures affected the mental health and psychological well-being of young people with and without a migratory background. The present study aimed to compare the mental health and psychological well-being of migrant and non-migrant young people before and after the COVID-19 vaccination campaign period in two countries which had different policies to deal with the pandemic. The "Psychological General Well-being" of young people and their experiences during the pandemic were investigated using an anonymous online survey during two pandemic waves before the vaccination campaign and 6 months after its start. A majority of the 6154 participants (aged between 15 and 25 years in all study groups) reported a decrease of mental health from the time period before the vaccination (BV) to after the vaccination (AV) campaign ( b  = 0.27, p  < .001). This association was higher in females ( b  = 0.04, p  = 0.008) and in youth with financial problems ( b  = 0.13, p  < .001). Furthermore, this decrease was more pronounced in people ≤17 years old (40% to 62%) than in those >17 years (59% to 67%). Contrary to expectation, vulnerable groups such as the economically disadvantaged, younger, and female participants did not experience a significant easing of the pandemic's psychological burden AV. Vaccination campaigns should continue emphasizing the beneficial effects of COVID-19 vaccination on general well-being, but with an acknowledgement that the road to recovery is still a long one. Concurrently, free access to psychological treatment and financial support should be offered, especially for vulnerable groups., Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-023-04366-x., Competing Interests: Conflict of interestAll authors declare no competing interest. T.W.: No conflict of interest. I had been invited to comment on the original proposal by the donor, but I see no conflict of interest as I receive no funding or any renumeration myself. I only participated as independent advisor and in writing of the final paper based on a request to WPA section. I do not work in the same department as the other authors., (© The Author(s) 2023.)

Background: Conspiracy beliefs have become widespread throughout the COVID-19 pandemic. Previous studies have shown that endorsing conspiracy beliefs leads to lower protective guideline adherence (i.e., wearing face masks), posing a threat to public health measures. The current study expands this research across the lifespan, i.e., in a sample of adolescents with mental health problems. Here, we investigated the association between conspiracy beliefs and guideline adherence while also exploring the predictors of conspiracy beliefs., Methods: N = 93 adolescent psychiatric outpatients (57% female, mean age: 15.8) were assessed using anonymous paper-pencil questionnaires. Endorsement of generic and COVID-19 conspiracy beliefs was assessed, in addition to items measuring adherence to protective guidelines and mental health (stress, depressive symptoms, emotional/behavioral problems, and adverse childhood experiences). Multiple regressions and supervised machine learning (conditional random forests) were used for analyses., Results: Fourteen percent of our sample fully endorsed at least one COVID-19 conspiracy theory, while protective guidelines adherence was relatively high (M = 4.92, on a scale from 1 to 7). The endorsement of COVID-19 conspiracy beliefs-but not of generic conspiracy beliefs-was associated with lower guideline adherence (β = - 0.32, 95% CI - 0.53 to - 0.11, p < .001). Conditional random forests suggested that adverse childhood experiences and peer and conduct problems were relevant predictors of both conspiracy belief categories., Conclusion: While a significant proportion of our sample of adolescents in psychiatric treatment endorsed conspiracy beliefs, the majority did not. Furthermore, and to some degree, contrary to public perception, we found that adolescents show relatively good adherence to public health measures-even while experiencing a high degree of mental distress. The predictive value of adverse childhood experiences and peer/conduct problems for conspiracy beliefs might be explained by compensatory mechanisms to ensure the safety, structure, and inclusion that conspiracies provide., (© 2023. The Author(s).)

As a global health crisis, COVID-19 has led to a rise in overall stress levels. Concurrently, conspiracy beliefs regarding the origin and spread of the disease have become widespread. Engaging in such beliefs can be explained as a form of coping in order to deal with elevated levels of stress. The present study investigated the indirect effects of coping strategies in the association between perceived chronic stress and COVID-related conspiracy beliefs. We report data from an online survey ( N  = 1,354 individuals: 807 female; 508 male; 8 diverse; 6 not specified; mean age 39.14 years) in German-speaking countries collected between January and March 2021. Our results indicate that people who felt more stressed were more prone to conspiracy beliefs. Coping via acceptance and self-blame was associated with decreased tendencies towards COVID-related conspiracy beliefs, while people who used denial as a strategy were more prone to these beliefs. These findings emphasize the need for stress management interventions and effective coping strategies during times of crisis in order to reduce chronic perceived stress, promote adaptive coping, and ultimately reduce conspiracy beliefs., Competing Interests: Conflict of interestAll authors declare no conflict of interest., (© The Author(s) 2022.)

Objective: Ethnic discrimination negatively affects the health of ethnic minorities. The dysregulation of psychobiological stress systems, such as the autonomic nervous system (ANS) or the hypothalamic-pituitary-adrenal (HPA) axis, might be an intermediary in this association and chronicity of ethnic discrimination may matter. We studied stress responses to a standardized discriminatory event in Turkish immigrants living in Austria., Background: Seventy-two male Turkish immigrants were recruited; n = 35 had experienced high levels of ethnic discrimination (high), n = 37 infrequent ethnic discrimination (low). During a two-hour laboratory appointment, they underwent a previously validated 10-minute ethnic discrimination paradigm, i.e., a simulated physician's consultation with verbal and non-verbal discriminatory cues. Perceived stress, perceived discrimination, salivary cortisol, and alpha-amylase were assessed seven times, and ANS measures (heart rate, heart rate variability, and electrodermal activity) were measured continuously. In addition, hair cortisol concentrations were determined., Results: The ethnic discrimination paradigm elicited stress responses across all outcomes in both groups. Compared to the low group, the high group reported higher levels of perceived stress and discrimination, exhibited a less steep increase in cortisol in response to the paradigm, and showed higher hair cortisol concentrations. No group differences were found regarding ANS measures., Conclusions: The combination of high subjective stress, flattened cortisol responses, and relatively high hair cortisol concentrations may indicate a dysregulation of the HPA axis in chronic ethnic discrimination. A better understanding of the psychobiological effects of chronic ethnic discrimination is crucial given that alterations in stress response systems may, over time, lead to illness and ultimately to substantial health inequities in ethnic minorities., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This systematic review and meta-analysis aimed to investigate the association of neonatal exposure to pain, stress, opiate administration alone, as well as opiate administration prior to a painful procedure on neuronal cell death, motor, and behavioral outcomes in rodents. In total, 36 studies investigating the effect of pain (n = 18), stress (n = 15), opiate administration (n = 13), as well as opiate administration prior to a painful event (n = 7) in rodents were included in our meta-analysis. The results showed a large effect of pain (g = 1.37, 95% CI 1.00-1.74, p < .001) on neuronal cell death. Moreover, higher number of neonatal pain events were significantly associated with increased neuronal cell death, increased anxiety (b = -1.18, SE = 0.43, p = .006), and depressant-like behavior (b = 1.74, SE = 0.51, p = .027) in rodents. Both opiates and pain had no impact on motor function (g = 0.26, 95% CI 0.18-0.70, p = .248)., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Virtual reality (VR)-based biofeedback is a relatively new intervention and is increasingly being used for the treatment of anxiety disorders. This is the first research synthesis regarding effects and efficacy of this novel mode of treatment., Method: We conducted a systematic review and meta-analysis of the VR biofeedback literature on treating anxiety symptoms. The MEDLINE/PubMed, Scopus and Web of Science databases were searched for eligible pre-post comparisons and randomized controlled trials (RCTs). We used self-reported anxiety, heart rate (HR), and heart rate variability (HRV) as primary outcome measures., Results: A total of 7 studies with 191 participants reported VR biofeedback interventions. Of these studies 5 were RCTs, with 103 participants receiving VR biofeedback and 99 control participants (either 2D biofeedback or waiting list controls). We found that VR biofeedback significantly lowers self-reported anxiety (g = -0.28) and HR (g = -0.45), but not HRV. Furthermore, there were no significant differences in outcomes between VR biofeedback and 2D biofeedback but a significant reduction in HR in the VR biofeedback group compared with the waiting list (g = -0.52)., Conclusion: While the first findings are optimistic, more controlled studies with a wider variety of samples are needed to bring this field forward. Particularly, children and adolescents may profit from the combination of gamification elements, VR, and biofeedback., (© 2022. The Author(s).)

The COVID-19 pandemic has been shown to have impaired the mental health and well-being of young people. This study, for the first time, explores these aspects in young people with and without a migratory background during the extended course of the pandemic and restrictive measures, comparing two countries with a high COVID-19 prevalence: Austria and Turkey., Methods: The authors used the "Psychological General Well-being" index as part of an anonymous online survey with 3665 participants (ages 15-25), recruited from both countries during the first and the second waves of the pandemic, collecting data on individual experiences and problems encountered during the pandemic., Results: Mental health (b = 0.06, p < 0.023) and general psychological well-being worsened with the progression of the pandemic. Participants with financial problems had the most severe negative effect on mental health (b = 0.12, p < 0.001). Furthermore, females living in Turkey, both natives (b = -0.21, p < 0.001) and migrants (b = 0.25, p < 0.001), reported a more deteriorated mental health status over time., Conclusions: The extended pandemic duration and resultant "lockdown" restrictions have negatively affected the mental health of young people to varying degrees, depending on country of residence and migration background. A strong "recovery plan" that considers group-specific needs and vulnerabilities is urgently needed.

Background: Although the Trier Social Stress Test (TSST) constitutes a valid paradigm for social stress induction, less is known about the effects of a virtual reality (VR) TSST on short- and long-term hypothalamic-pituitary-adrenal (HPA) axis and sympathetic-adreno-medullar (SAM) axis responses. Hence, this study set out to evaluate reactivity and habituation of self-reported stress and HPA and SAM reactivity in a real TSST and VR-TSST when compared to a placebo TSST., Method: Sixty-eight healthy young adults (50% female) were randomly assigned to either a real TSST, a VR-TSST, or a placebo TSST, all of which were conducted three times (one day and one week post initial exposure). Social presence, self-reported stress, salivary cortisol, heart rate (HR), and heart rate variability (HRV) were analyzed using ANOVAs and multilevel models., Findings: On the first exposure, both the real and VR-TSST showed significantly stronger cortisol and cardiovascular responses than the placebo. On the second visit, the cortisol response was still significantly high-and the HRV response low-for the real and VR-TSST. The third visit resulted in HR, HRV, and cortisol responses comparable to the placebo group. Furthermore, the real TSST induced more self-reported stress than the placebo on all three visits, the VR-TSST only on the first two visits. Social presence was stable across conditions and had no association with stress markers., Conclusion: These findings imply that the replicability of stress exposures at shorter intervals seems problematic for the traditional TSST, and for the VR-TSST., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: Chronic ethnic discrimination is associated with negative mental and physical health outcomes in ethnic minority groups. It is assumed that suffering from repeated discriminatory events leads, over time, to psychological consequences such as higher perceived stress, higher negative affect and lower positive affect. Higher stress reactivity to non-discriminatory stressors, such as daily hassles, as well as anticipation and avoidance behaviour regarding discriminatory events, may further contribute to the overall burden for affected individuals. Studies investigating chronic ethnic discrimination and its psychological consequences in the daily lives of affected persons are lacking. Here, we present a study protocol to investigate the impact of chronic ethnic discrimination and acute discriminatory events in the daily lives of Turkish immigrants living in Austria, using an ambulatory assessment design. The feasibility of our study design was tested and confirmed in a pilot study (n=10)., Methods and Analysis: Ninety male Turkish immigrants will complete daily questionnaires for 30 days. Participants will indicate stress, perceived discrimination, negative and positive affect, daily hassles, anticipation and avoidance behaviour, as well as rumination with regard to discriminatory events on a daily basis. Furthermore, they will use preprogrammed iPods to assess acute discriminatory events in real time. Our hypotheses will be tested using multilevel analyses., Ethics and Dissemination: This study has been approved by the institutional review board of the University of Vienna (reference number 00358). Results will be presented at conferences and submitted for publication in a peer-reviewed journal., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Given the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate treatments that reduce both self-harm and suicidal ideation in the context of broader adolescent psychopathology is critical., Methods: We conducted a systematic review and meta-analysis of the Dialectical Behaviour Therapy for Adolescents (DBT-A) literature on treating self-injury in adolescents (12-19 years). We searched for eligible trials and treatment evaluations published prior to July 2020 in MEDLINE/PubMed, Scopus, Google Scholar, EMBASE, and the Cochrane Library databases for clinical trials. Twenty-one studies were identified [five randomized-controlled trials (RCTs), three controlled clinical trials (CCTs), and 13 pre-post evaluations]. We extracted data for predefined primary (self-harm, suicidal ideation) and secondary outcomes (borderline personality symptoms; BPD) and calculated treatment effects for RCTs/CCTs and pre-post evaluations. This meta-analysis was pre-registered with OSF: osf.io/v83e7., Results: Overall, the studies comprised 1673 adolescents. Compared to control groups, DBT-A showed small to moderate effects for reducing self-harm (g = -0.44; 95% CI -0.81 to -0.07) and suicidal ideation (g = -0.31, 95% CI -0.52 to -0.09). Pre-post evaluations suggested large effects for all outcomes (self-harm: g = -0.98, 95% CI -1.15 to -0.81; suicidal ideation: g = -1.16, 95% CI -1.51 to -0.80; BPD symptoms: g = -0.97, 95% CI -1.31 to -0.63)., Conclusions: DBT-A appears to be a valuable treatment in reducing both adolescent self-harm and suicidal ideation. However, evidence that DBT-A reduces BPD symptoms was only found in pre-post evaluations.

Background: Post-traumatic stress disorder (PTSD) is a debilitating disorder that is often accompanied by alterations in the hypothalamic-pituitary (HPA) axis. While there is abundant evidence for the efficacy of psychological therapies in reducing post-traumatic stress symptoms, barely anything is known about pharmacological interventions. Given the role of the HPA axis in the pathophysiology of PTSD, the aim of this study was to provide the first meta-analysis of Hydrocortisone as a potential treatment for this condition., Method: A systematic review of randomized-controlled trials (RCTs) was conducted to investigate the efficacy of hydrocortisone in the prevention and curative treatment of post-traumatic stress symptoms. This study was pre-registered with the OSF (doi:10.17605/OSF.IO/GJAZF)., Findings: Eight studies (9 effect sizes) covering 362 participants met our inclusion criteria. We found that Hydrocortisone as compared to placebo significantly reduced PTSD symptoms (d = 0.96, 95% Cl 0.22-1.69 p = 0.011) and PTSD incidence (logRR = 0.85, 95% CI 1.12-1.59, p = 0.023). Subgroup analyses revealed a significant effect of Hydrocortisone when it was administered in a preventative context (d = 1.50; 95%CI 0.30-2.69, p = 0.014), but not when it was administered in a curative context (d = 0.28; 95%CI -0.11 to 0.66, p = 0.161)., Conclusion: Hydrocortisone appears to be a promising and efficient low-cost medication for the prevention of PTSD. However, the small number of included studies and their limited methodological quality emphasize the need for further rigorous studies in this field., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

While ostracism constitutes a social stressor with negative effects on physical and mental health, social inclusion seems to increase resilience. This may be true not only for face-to-face settings, but also for computer-mediated interactions. Hence, this study examined the differences between ostracism and social inclusion in real-life or Virtual Reality (VR) regarding self-reported stress, neuroendocrine and cardiovascular reactivity in a subsequent real-life socio-evaluative task. 84 females were randomly assigned to a 3 (agency: face-to-face/human controlled VR-avatar/computer VR-agent) x 2 (inclusion status: inclusion/exclusion) between-subject design using a Cyberball paradigm. Subsequently, they were exposed to a real-life Trier Social Stress Test (TSST). Results indicate that the experience of ostracism constitutes a threat to fundamental social needs independent of agency. Excluded participants showed cardiovascular reactivity during TSST; also face-to-face and avatar excluded individuals had elevated salivary cortisol levels. Included participants reported more perceived social support during Cyberball and showed a blunted cortisol response to the TSST. These results suggest that face-to-face and avatar-related ostracism provokes responses in the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS). Furthermore, they reveal that social inclusion may act as a stress-protector as it alters HPA- and SNS-related stress responsiveness to subsequent stressors., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Little is known about the impact of the COVID-19 pandemic on the mental health and psychological well-being of young people. The aim of this study is to investigate the psychological well-being and changes in the mental-health state of young people living in Austria and Turkey. By using an anonymous online survey, we recruited 1240 people aged 15-25 years from these two countries. We used the "Psychological General Well-being" and a self-created questionnaire to capture individual experiences during the COVID-19 pandemic and quarantine period. The native Turks indicated higher "anxiety" ( p s < 0.010), lower "vitality" ( p s < 0.011), and lower "general health" ( p s < 0.011) than native Austrians or Austrian migrants and increased "depression" ( p = 0.005) and lower "self-control" ( p = 0.022), than Austrian migrants. Moreover, 50.9% of native Turks reported a decrease in their mental health status, compared to 31.1% of native Austrians and 23.7% of Austrian migrants. Participants with financial problems (OR = 1.68) and prior mental health problems (i.e., already in treatment by the time of COVID-19, OR = 5.83) reported a higher probability for a worsening in their mental health status. Our results show that the COVID-19 pandemic impaired the psychological well-being and mental health of young people. Especially people in Turkey were most affected, probably due to the stringent policies to fight COVID-19.

Objective: Experiences of ethnic discrimination may constitute major stressors for ethnic minority groups. This study examined the associations between different forms of ethnic discrimination and levels of perceived stress in Russian immigrants living in Germany, taking into account potential moderating (in-group identification) and mediating (coping and social support) factors., Methods: Russian immigrants ( N = 308) were assessed using online questionnaires (e.g., perceived stress scale, behaviors from intergroup affect and stereotype treatment scale, and brief COPE). Three forms of ethnic discrimination were examined: active harm (e.g., open aggression), passive harm (e.g., paternalistic behavior), and everyday discrimination (e.g., receiving poor service). Moderation by in-group identification and mediation via coping and social support were tested., Results: Passive harm was more prevalent than everyday discrimination and active harm. Passive harm and everyday discrimination were associated with higher perceived stress ( r s = .22 and .18, p s <.01), and in-group identification did not moderate these associations ( p s >.27). The coping strategy self-blame mediated the association between active harm and stress. Substance use and self-blame mediated the association between passive harm and stress, whereas venting, behavioral disengagement, denial, self-blame, and social support mediated the association between everyday discrimination and stress. A direct effect remained for passive harm and everyday discrimination., Conclusion: The present study revealed that Russian immigrants encounter different forms of ethnic discrimination, and that this is associated with higher levels of stress. This association was partly explained by coping and social support, illustrating possibilities for interventions aimed at improving the use of adaptive coping strategies and promoting social support-seeking for Russian immigrants., (Copyright © 2020 Goreis, Asbrock, Nater and Mewes.)

Background: Parental beliefs about the cause of their child's illness are thought to affect parents' help-seeking behaviors, treatment decisions, and the child's health outcomes. Yet, research on parental beliefs about disease causation is still scarce. While a small number of studies assesses parental cause attributions for singular disorders (e.g., neurodevelopmental disorders), no study has compared disorders with differing physical versus mental conditions or with mixed comorbidities in children and adolescents or their caregivers. Furthermore, most pediatric research suffers from a lack of data on fathers., Objective: Hence, the objective of the current study was to test for possible differences in mothers' and fathers' perceptions about the etiology of their child's illness., Methods: Forty-two parent couples (overall N = 84) whose child had been diagnosed either with Attention Deficit Hyperactivity-Disorder (ADHD) or Autism Spectrum Disorder (ASD) (category "neurodevelopmental disorder") or with a primary physical illness and a comorbid mental disorder, e.g. depression (category "psychosomatic disorder") were asked to rate possible causes of their child's illness using a modified version of the revised Illness Perception Questionnaire (IPQ) Cause scale., Results: A two-way ANOVA showed that psychosomatic disorders were significantly more strongly attributed to be caused by medical and environmental stressors than neurodevelopmental disorders. A significant parent × illness category interaction revealed that this effect was more pronounced in fathers., Conclusions: By providing first insights into parental beliefs about the etiology of their children's neurodevelopmental versus psychosomatic disorders, this study paves ground for future research and tailored counseling of affected families., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Self-harm is a clinically relevant and prevalent behaviour which peaks in adolescence. Given the high prevalence of self-harm, the high levels of psychiatric comorbidity, and its role as a risk factor for suicide, delivering evidence-based care is critical., Methods: We conducted a systematic review and meta-analysis of the literature on treating self-harm in adolescents (12-19 years) published in the last 20 years, identifying 25 randomised controlled trials. We calculated the effect of treatment interventions relative to active control conditions in reducing self-harm, suicidal ideation and depressive symptoms., Results: Overall, treatment interventions fared slightly better than active controls in decreasing self-harm ( d  = 0.13, 95% CI 0.04-0.22, p  = .004), suicidal ideation ( d  = 0.31, 95% CI 0.12-0.50, p  = .001) and depressive symptoms ( d  = 0.22, 95% CI 0.07-0.38, p  = .006). Subgroup analysis of specific therapies revealed moderate effects of DBT-A in reducing self-harm ( d  = 0.51, 95% CI 0.18-0.85, p  = .002) and suicidal ideation ( d  = 0.48, 95% CI 0.17-0.80, p  = .003), as well as moderate effects of family-centred therapy in the treating suicidal ideation ( d  = 0.58, 95% CI 0.01-1.15, p  = .049)., Conclusions: The findings of our meta-analysis indicate that, overall, currently available treatments are effective in treating self-harm, suicidal ideation, and depressive symptoms in adolescence. Although the treatment intervention conditions showed only small to moderate effects in comparison to active controls, these differences were statistically significant and are clinically important. Further research is needed to understand the reduction in self-harm within active controls, which may arise due to the natural course of self-harm, or the potential efficacy of treatment as usual and enhanced usual care. Given the significant reduction of self-harm in active control conditions, delivering effective care to a large number of adolescents with self-harm may require developing stepped-care models in clinical practice. Expensive and poorly available treatments should be targeted at young people who most need them., Competing Interests: Competing interestsAll authors declare that they don’t have any competing interests regarding this manuscript., (© The Author(s) 2020.)

Numerous studies have demonstrated that acute psychological stress, induced by the Trier Social Stress Test (TSST) paradigm, affects salivary cortisol secretion and self-reported stress measures including anxiety. Allergy has been related to altered cortisol responsiveness and increased stress vulnerability. Here, we investigated acute stress responses and emotion regulation strategies in cohorts of allergic and healthy individuals. Groups of allergics and healthy individuals were subjected to the TSST and experienced levels of stress and anxiety, as well as emotion regulation strategies, were assessed. Cortisol and oxytocin concentrations were measured in saliva or plasma. The present findings confirm earlier results of altered stress responsiveness in allergic individuals. Acute stress by the TSST evoked higher physiological arousal in allergics by means of salivary cortisol secretion. Allergics also scored higher on emotion suppression. However, individuals who were more likely to use reappraisal recovered more efficiently from the cortisol increase. No such effect for reappraisal was found in the healthy population. No differences in self-reported anxiety and stress emerged between the groups. Plasma oxytocin levels prior to the TSST were significantly higher in allergics. Our data corroborate earlier findings on altered stress susceptibility in allergics. Moreover, we identified differences in emotion regulation and oxytocin secretion which should be further explored. Accounting for the emerging global prevalence of allergy, more in-depth research into the experience of stress, coping strategies and stress-related molecules in allergic people is warranted.Short summaryThis study addressed stress experiences and emotion regulation in allergic and non-allergic adults. Allergics scored higher on emotion suppression, had higher pre-stress concentrations of plasma oxytocin and exhibited a stronger salivary cortisol response to stress than healthy people. The research outcomes indicate that allergic individuals cope less efficiently with acute stress but may benefit from adaptive emotion regulation strategies such as reappraisal.

Post-traumatic stress disorder (PTSD) symptoms are prevalent in both civilian and military service members. As the number of smartphone-based applications (apps) grows rapidly in health care, apps are also increasingly used to help individuals with subthreshold PTSD or full PTSD. Yet, if the apps are self-managed, the feasibility and efficacy of such interventions are still rather unclear in these two populations with PTSD symptoms. Hence, the present meta-analysis set out to evaluate the effect of self-management smartphone-based apps on PTSD and depressive symptoms in populations with subthreshold PTSD or full PTSD. Studies were included if they conducted randomized controlled trials or pre-post comparisons. Six studies ( n = 2 randomized controlled trials) were identified for meta-analysis. In pre-post comparisons, N = 209 participants were included in the analyses. In randomized controlled trials, N = 87 participants received smartphone-based self-management interventions and N = 82 participants were in waitlist control conditions. Meta-analysis for pre-post comparisons concluded an effect of g = 0.55 ( p < 0.001) regarding the overall reduction in PTSD symptoms ( n = 6) and g = 0.45 ( p < 0.001) for reduction in depressive symptoms ( n = 5). Yet, in randomized controlled trials, no significant difference was found between app-based treatment and waitlist control groups ( g = 0.09, p = 0.574). The duration of the interventions did not significantly influence the results. Overall, despite positive pre-post effects, current results indicate that smartphone-apps for PTSD patients are not significantly more effective than waitlist control conditions. Nevertheless, a combined smartphone and standard therapy approach may be a fruitful field for future research., (Copyright © 2020 Goreis, Felnhofer, Kafka, Probst and Kothgassner.)

Contrary to specific phobias, for which Virtual Reality Exposure Therapy (VRET) constitutes an effective treatment, uncertainty still exists regarding the usefulness of VRET for posttraumatic stress disorder (PTSD). Therefore, this meta-analysis investigated the efficacy of VRET for PTSD as compared to waitlist and active comparators. A literature search yielded nine controlled studies encompassing 296 participants (124 VRET, 172 controls). The differences between conditions regarding the primary outcome of PTSD symptom severity and the secondary outcome of depressive and anxiety symptoms post-treatment were calculated using Hedges' g . Compared to waitlist controls, VRET showed a significantly better outcome for PTSD symptoms ( g = 0.62, p = .017) and depressive symptoms ( g = 0.50, p = .008). There was no significant difference between VRET and active comparators regarding PTSD symptoms ( g = 0.25, p = .356) and depressive symptoms ( g = 0.24, p = .340) post-treatment. No significant effects emerged for anxiety symptoms. These findings suggest that VRET may be as effective as active comparators for PTSD patients. However, the results must be interpreted with caution due to the limited number of trials and the substantial number of - predominantly male - military service members studied. Additional controlled trials, considering a wider range of trauma types and balanced gender, are required to strengthen the evidence.

Background and Objectives: Face-to-face and text-based social support have been shown to attenuate stress responses in past studies. Yet as social interactions increasingly take place online by means of virtual humans, our objective was to examine whether different forms of social support (virtual vs. real) prior to the Trier Social Stress Test (TSST) would also decrease stress. Additionally, the effect on subsequent real-life social behaviors (helping and approach) was evaluated while controlling for affective states and social presence., Methods: 56 participants were either supported by an avatar, an agent, a real human or received no support before completing the TSST and two subsequent social behavior tasks (pen task and seating task)., Results: Results show no difference in agency regarding social presence. Yet, participants with agent support and no support had significantly higher heart rates during the TSST and reported to be more worried. Also, they were more irritated and showed significantly slower helping reactions (picking up pens)., Limitations: A limitation to this study is that only emotional verbal and non-verbal support were provided by a stranger. Different forms of support as well as a different source (i.e., a friend) may have a more pronounced effect on stress buffering., Conclusions: Virtual social support is as effective as face-to-face support in terms of stress buffering, as long as the recipient has the impression that it is provided by another human (via an avatar). This has wide ranging implications not only for health-related application in prevention and treatment but also for further research., (Copyright © 2018. Published by Elsevier Ltd.)

In the last decade, the number of investigations of the beliefs in conspiracy theories has begun to increase in the fields of social, differential, and experimental psychology. A considerable number of variables have been suggested as predictors of conspiracy beliefs, amongst them personality factors such as low agreeableness (as disagreeableness is associated with suspicion and antagonism) and high openness to experience (due to its positive association to seek out unusual and novel ideas). The association between agreeableness, openness to experience and conspiracy beliefs remains unclear in the literature. The present study reviews the literature of psychological studies investigating conspiracy beliefs. Additionally, the association between Big Five personality factors and conspiracy beliefs is analyzed meta-analytically using random-effects models. Ninety-six studies were identified for the systematic review. A comprehensive account of predictors, consequences, operationalization, questionnaires, and most prominent conspiracy theories is presented. For meta-analysis, 74 effect sizes from 13 studies were extracted. The psychological literature on predictors of conspiracy beliefs can be divided in approaches either with a pathological (e.g., paranoia) or socio-political focus (e.g., perceived powerlessness). Generally, there is a lack of theoretical frameworks in this young area of research. Meta-analysis revealed that agreeableness, openness to experience, and the remaining Big Five personality factors were not significantly associated with conspiracy beliefs if effect sizes are aggregated. Considerable heterogeneity in designs and operationalization characterizes the field. This article provides an overview of instrumentation, study designs, and current state of knowledge in an effort toward advancement and consensus in the study of conspiracy beliefs.

While virtual humans are increasingly used to benefit the elderly, considerably little is still known about older adults' virtual experiences. However, due to age-related changes, older adults' perceptions of virtual environments (VEs) may be unique. Hence, our objective was to examine possible gender differences in immersion, flow, and emotional states as well as physical and social presence in elderly males and females interacting either with a computer-controlled agent or a human-controlled avatar. Seventy-eight German-speaking older adults were randomly assigned to an avatar or an agent condition and were exposed to a brief social encounter in a virtual café. Results indicate no overall gender differences, but a significant effect of agency on social presence, physical presence, immersion, and flow. Participants in the avatar condition reported higher levels in all measures, except for involvement. Furthermore, significant gender × agency interactions were found, with females showing more social presence, spatial presence, and flow when interacting with a human-controlled avatar and more realism when conversing with an agent. Also, all participants showed significant changes in their affect post exposure. In sum, older adults' virtual experiences seem to follow unique patterns, yet, they do not preclude the elderly from successfully participating in VEs.