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ZusammenfassungIn den letzten Jahren haben sich die Anstrengungen im Bereich der Public Mental Health intensiviert, die psychische Gesundheit und Gesundheitskompetenz auf Bevölkerungsebene zu stärken sowie Fortschritte in der Prävention und Versorgung von psychischen Erkrankungen zu erzielen. Der vorliegende Beitrag gibt einen Überblick über derzeitige Konzeptualisierungen von Indikatoren und Determinanten der Public Mental Health sowie von populationsbasierten Interventionsstrategien aus internationaler Perspektive. Derzeitige konzeptionelle und methodische Herausforderungen von sogenannten Hochrisikostrategien, Populationsstrategien und dem vulnerablen Populationsansatz werden kritisch diskutiert. Zukünftige Anstrengungen in Politik, Forschung und Praxis sollten fundamentale Ursachen sozialer und gesundheitlicher Ungleichheiten unter Einbezug aller gesellschaftlichen Handlungsfelder stärker in den Blick nehmen, um einen Beitrag zur Verbesserung der populationsbasierten Gesundheit zu leisten.

Background/Hypothesis Digital interventions targeting transdiagnostic mechanisms in daily life may be a promising translational strategy for prevention and early intervention of psychotic and other severe mental disorders. We aimed to investigate the feasibility and initial signals of efficacy of a transdiagnostic, compassion-focused, hybrid ecological momentary intervention for improving resilience (ie, EMIcompass) in youth with early mental health problems. Study Design In an exploratory, assessor-blind randomized controlled trial, youth aged 14–25 with current distress, broad at-risk mental state, or first episode of severe mental disorder were randomly allocated to experimental (EMIcompass+treatment as usual [TAU]) or control condition (TAU). Data on primary (stress reactivity) and secondary candidate mechanisms as well as candidate primary (psychological distress) and secondary outcomes were collected. Study Results Criteria for the feasibility of trial methodology and intervention delivery were met (n = 92 randomized participants). No serious adverse events were observed. Initial outcome signals were evident for reduced momentary stress reactivity (stress×time×condition, B = −0.10 95%CI −0.16–−0.03, d = −0.10), aberrant salience (condition, B = −0.38, 95%CI −0.57–−0.18, d = −0.56) as well as enhanced momentary resilience (condition, B = 0.55, 95%CI 0.18–0.92, d = 0.33) and quality of life (condition, B = 0.82, 95%CI 0.10–1.55, d = 0.60) across post-intervention and 4-week follow-up. No outcome signals were observed for self-reported psychological distress (condition, B = 0.57, 95%CI −1.59–2.72, d = 0.09), but there was suggestive evidence of reduced observer-rated symptoms at the 4-week follow-up (B = −1.41, 95%CI −2.85–0.02, d = −0.41). Conclusions Our findings provide evidence of feasibility and initial signals that EMIcompass may reduce stress reactivity and improve quality of life. A definitive trial is now warranted.

Recent technological advances enable the collection of intensive longitudinal data. This scoping review aimed to provide an overview of methods for collecting intensive time series data in mental health research as well as basic principles, current applications, target constructs, and statistical methods for this type of data.In January 2021, the database MEDLINE was searched. Original articles were identified that (1) used active or passive data collection methods to gather intensive longitudinal data in daily life, (2) had a minimum sample size of N ⩾ 100 participants, and (3) included individuals with subclinical or clinical mental health problems.In total, 3799 original articles were identified, of which 174 met inclusion criteria. The most widely used methods were diary techniques (e.g. Experience Sampling Methodology), various types of sensors (e.g. accelerometer), and app usage data. Target constructs included affect, various symptom domains, cognitive processes, sleep, dysfunctional behaviour, physical activity, and social media use. There was strong evidence on feasibility of, and high compliance with, active and passive data collection methods in diverse clinical settings and groups. Study designs, sampling schedules, and measures varied considerably across studies, limiting the generalisability of findings.Gathering intensive longitudinal data has significant potential to advance mental health research. However, more methodological research is required to establish and meet critical quality standards in this rapidly evolving field. Advanced approaches such as digital phenotyping, ecological momentary interventions, and machine-learning methods will be required to efficiently use intensive longitudinal data and deliver personalised digital interventions and services for improving public mental health.

Positive Appraisal Style Theory of Resilience posits that a person’s general style of evaluating stressors plays a central role in mental health and resilience. Specifically, a tendency to appraise stressors positively (positive appraisal style; PAS) is theorized to be protective of mental health and thus a key resilience factor. To this date no measures of PAS exist. Here, we present two scales that measure perceived positive appraisal style, one focusing on cognitive processes that lead to positive appraisals in stressful situations (PASS-process), and the other focusing on the appraisal contents (PASS-content). For PASS-process, the items of the existing questionnaires Brief COPE and CERQ-short were analyzed in exploratory and confirmatory factor analyses (EFA, CFA) in independent samples (N=1157 and N=1704) . The resulting 10-item questionnaire showed was internally consistent (α = .78, 95% CI [.86, .87]) and showed good convergent and discriminant validity in comparisons with self-report measures of trait optimism, neuroticism, urgency, and spontaneity. For PASS-content, a newly generated item pool of 29 items across stressor appraisal content dimensions (probability, magnitude, and coping potential) were subjected to EFA and CFA in two independent samples (N=1174 and N=1611). The resulting 14-item scale showed good internal consistency (α = .87, 95% CI [.86, .87]), as well as good convergent and discriminant validity within the nomological network. The two scales are a new and reliable way to assess self-perceived positive appraisal style in large-scale studies, which could offer key insights into mechanisms of resilience.

Childhood adversity is associated with psychopathology. First evidence in adults suggests that threat anticipation, i.e., an enhanced anticipation of unpleasant events creating an enduring sense of threat, may be a putative mechanism linking childhood adversity to psychopathology. This study aimed to test the indirect effect of childhood adversity on psychopathology via threat anticipation in a large community sample of adolescents. We measured childhood trauma and bullying victimization (as indicators of childhood adversity), threat anticipation, general psychopathology and prodromal psychotic symptoms in adolescents aged 12–16 years (full sample size N = 1682; minimum sample size in the complete case sample N = 449) in wave I of the SIGMA study. We found strong evidence that childhood adversity (e.g. childhood trauma, adj. β (aβ) = 0.54, p p indirect effect = 0.13, p

Zusammenfassung Hintergrund Die stationsäquivalente psychiatrische Behandlung (StäB) wurde 2018 als Krankenhausleistung für Menschen eingeführt, die die Kriterien einer stationären Behandlung erfüllen. Die rasanten Fortschritte im Bereich der Informations- und Kommunikationstechnologie bieten neue Chancen für innovative digitale Versorgungsangebote wie telemedizinische, eHealth- oder mHealth-Verfahren. Ziel der Arbeit Diese Übersichtsarbeit soll einen umfassenden Überblick über neue digitale Versorgungsformen geben, die zur Personalisierung der StäB bei schweren psychischen Erkrankungen beitragen und somit klinische und soziale Outcomes verbessern sowie direkte und indirekte Kosten reduzieren könnten. Methode Diese Arbeit basiert auf einer selektiven Literaturrecherche (Narratives Review). Ergebnisse Es wurden vier primäre digitale Versorgungsformen identifiziert, die in der StäB gewinnbringend genutzt werden könnten: (1) Kommunikation, Behandlungskontinuität und -flexibilität durch Online-Chat und Videotelefonie, (2) Monitoring von Symptomen und Verhaltensweisen in Echtzeit durch Anwendung des ambulatorischen Assessments („ecological momentary assessment“ [EMA]), (3) Nutzung multimodaler EMA-Daten für die Generierung von personalisiertem Feedback über subjektives Erleben und Verhaltensmuster sowie (4) auf Person, Moment und Kontext zugeschnittene, adaptive ambulatorische Interventionen („ecological momentary interventions“ [EMIs]). Diskussion Digitale Versorgungsformen haben erhebliches Potenzial die Effektivität und Kosteneffektivität der StäB zu steigern. Ein wichtiger nächster Schritt besteht darin, die Anwendung dieser Versorgungsformen im Bereich der StäB zu modellieren und deren Qualität aus Sicht der Patient*innen, Sicherheit und initiale Prozess- und Ergebnisqualität sowie Implementierungsbedingungen sorgfältig zu untersuchen.

BACKGROUND Identifying momentary risk and protective mechanisms may enhance our understanding and treatment of mental disorders. Affective stress reactivity is one mechanism that has been reported to be altered in individuals with early and later stages of mental disorder. Additionally, initial evidence suggests individuals with early and enduring psychosis may have an extended recovery period of negative affect in response to daily stressors (i.e., a longer duration until affect reaches baseline levels after stress), but evidence on positive affective recovery as a putative protective mechanism remains limited. OBJECTIVE This study aimed to investigate trajectories of positive affect in response to stress across the continuum of mental disorder in a transdiagnostic sample. METHODS Using the Experience Sampling Method, minor activity-, event-, and overall stress and positive affect were assessed 10 times a day, with time points approximately 90 minutes apart on six consecutive days in a pooled data set including 367 individuals with mental disorder, 217 individuals at risk for a severe mental disorder, and 227 controls. Multilevel analysis and linear contrasts were used to investigate trajectories of positive affect within and between groups. RESULTS Baseline positive affect differed across groups and we observed stress reactivity in positive affect within each group. We found evidence for positive affective recovery after reporting activity- or overall stress within each group. While controls recovered to baseline positive affect about 90 minutes after stress, patients and at-risk individuals required about 180 minutes to recover. However, between-group differences in the affective recovery period fell short of significance. CONCLUSIONS The results provide first evidence that positive affective recovery may be relevant within transdiagnostic subclinical and clinical stages of mental disorder suggesting it may be a potential target for mobile health interventions fostering resilience in daily life.

Background Negative symptoms occur in individuals at ultrahigh risk (UHR) for psychosis. Although there is evidence that observer ratings of negative symptoms are associated with level of functioning, the predictive value of subjective experience in daily life for individuals at UHR has not been studied yet. Objective This study therefore aims to investigate the predictive value of momentary manifestations of negative symptoms for clinical outcomes in individuals at UHR. Methods Experience sampling methodology was used to measure momentary manifestations of negative symptoms (blunted affective experience, lack of social drive, anhedonia, and social anhedonia) in the daily lives of 79 individuals at UHR. Clinical outcomes (level of functioning, illness severity, UHR status, and transition status) were assessed at baseline and at 1- and 2-year follow-ups. Results Lack of social drive, operationalized as greater experienced pleasantness of being alone, was associated with poorer functioning at the 2-year follow-up (b=−4.62, P=.01). Higher levels of anhedonia were associated with poorer functioning at the 1-year follow-up (b=5.61, P=.02). Higher levels of social anhedonia were associated with poorer functioning (eg, disability subscale: b=6.36, P=.006) and greater illness severity (b=−0.38, P=.045) at the 1-year follow-up. In exploratory analyses, there was evidence that individuals with greater variability of positive affect (used as a measure of blunted affective experience) experienced a shorter time to remission from UHR status at follow-up (hazard ratio=4.93, P=.005). Conclusions Targeting negative symptoms in individuals at UHR may help to predict clinical outcomes and may be a promising target for interventions in the early stages of psychosis.

Background Digital interventions offer new avenues for low-threshold prevention and treatment in young people. Ecological momentary interventions (EMIs) represent a powerful approach that allows for adaptive, real-time, and real-world delivery of intervention components in daily life by real-time processing of ecological momentary assessment (EMA) data. Compassion-focused interventions (CFIs) may be particularly amenable to translation into an EMI to strengthen emotional resilience and modify putative risk mechanisms, such as stress sensitivity, in the daily lives of young help-seeking individuals. Objective This study aims to investigate the feasibility, safety, and initial therapeutic effects of a novel, accessible, transdiagnostic, ecological momentary CFI for improving emotional resilience to stress (EMIcompass). Methods In this uncontrolled pilot study, help-seeking youth with psychotic, depressive, or anxiety symptoms were offered the EMIcompass intervention in addition to treatment as usual. The EMIcompass intervention consisted of a 3-week EMI (including enhancing, consolidating, and EMA-informed interactive tasks) administered through a mobile health app and three face-to-face sessions with a trained psychologist intended to provide guidance and training on the CFI exercises presented in the app (ie, training session, follow-up booster session, and review session). Results In total, 10 individuals (mean age 20.3 years, SD 3.8; range 14-25) were included in the study. Most (8/10, 80%) participants were satisfied and reported a low burden of app usage. No adverse events were observed. In approximately one-third of all EMAs, individuals scored high on stress, negative affect, or threat anticipation during the intervention period, resulting in real-time, interactive delivery of the CFI intervention components in addition to weekly enhancing and daily consolidating tasks. Although the findings should be interpreted with caution because of the small sample size, reduced stress sensitivity, momentary negative affect, and psychotic experiences, along with increased positive affect, were found at postintervention and the 4-week follow-up. Furthermore, reductions in psychotic, anxiety, and depressive symptoms were found (r=0.30-0.65). Conclusions Our findings provide evidence on the feasibility and safety of the EMIcompass intervention for help-seeking youth and lend initial support to beneficial effects on stress sensitivity and mental health outcomes. An exploratory randomized controlled trial is warranted to establish the feasibility and preliminary evidence of its efficacy.

BACKGROUND Negative symptoms occur in individuals at ultrahigh risk (UHR) for psychosis. Although there is evidence that observer ratings of negative symptoms are associated with level of functioning, the predictive value of subjective experience in daily life for individuals at UHR has not been studied yet. OBJECTIVE This study therefore aims to investigate the predictive value of momentary manifestations of negative symptoms for clinical outcomes in individuals at UHR. METHODS Experience sampling methodology was used to measure momentary manifestations of negative symptoms (blunted affective experience, lack of social drive, anhedonia, and social anhedonia) in the daily lives of 79 individuals at UHR. Clinical outcomes (level of functioning, illness severity, UHR status, and transition status) were assessed at baseline and at 1- and 2-year follow-ups. RESULTS Lack of social drive, operationalized as greater experienced pleasantness of being alone, was associated with poorer functioning at the 2-year follow-up (b=−4.62, P=.01). Higher levels of anhedonia were associated with poorer functioning at the 1-year follow-up (b=5.61, P=.02). Higher levels of social anhedonia were associated with poorer functioning (eg, disability subscale: b=6.36, P=.006) and greater illness severity (b=−0.38, P=.045) at the 1-year follow-up. In exploratory analyses, there was evidence that individuals with greater variability of positive affect (used as a measure of blunted affective experience) experienced a shorter time to remission from UHR status at follow-up (hazard ratio=4.93, P=.005). CONCLUSIONS Targeting negative symptoms in individuals at UHR may help to predict clinical outcomes and may be a promising target for interventions in the early stages of psychosis.

BackgroundOne putative psychological mechanism through which momentary stress impacts on psychosis in individuals with increased liability to the disorder is via affective disturbance. However, to date, this has not been systematically tested. We aimed to investigate whether (i) cross-sectional and temporal effects of momentary stress on psychotic experiences via affective disturbance, and (ii) the reverse pathway of psychotic experiences on stress via affective disturbance were modified by familial liability to psychosis.MethodsThe Experience Sampling Method was used in a pooled data set of six studies with three groups of 245 individuals with psychotic disorder, 165 unaffected first-degree relatives, and 244 healthy control individuals to index familial liability. Multilevel moderated mediation models were fitted to investigate indirect effects across groups cross-sectionally and multilevel cross-lagged panel models to investigate temporal effects in the proposed pathways across two measurement occasions.ResultsEvidence on indirect effects from cross-sectional models indicated that, in all three groups, effects of stress on psychotic experiences were mediated by negative affect and, vice versa, effects of psychotic experiences on stress were mediated by negative affect, with all indirect effects being weakest in relatives. Longitudinal modelling of data provided no evidence of temporal priority of stress in exerting its indirect effects on psychotic experiences via affective disturbance or, vice versa.ConclusionsOur findings tentatively suggest a rapid vicious cycle of stress impacting psychotic experiences via affective disturbances, which does, however, not seem to be consistently modified by familial liability to psychosis.

Ward-equivalent treatment (StäB), a form of crisis resolution and home treatment in Germany, has been introduced in 2018 as a new model of mental health service delivery for people with an indication for inpatient care. The rapid progress in the field of information and communication technology offers entirely new opportunities for innovative digital mental health care, such as telemedicine, eHealth, or mHealth interventions.This review aims to provide a comprehensive overview of novel digital forms of service delivery that may contribute to a personalized delivery of StäB and improving clinical and social outcomes as well as reducing direct and indirect costs.This work is based on a narrative review.Four primary digital forms of service delivery have been identified that can be used for personalized delivery of StäB: (1) communication, continuity of care, and flexibility through online chat and video call; (2) monitoring of symptoms and behavior in real-time through ecological momentary assessment (EMA); (3) use of multimodal EMA data to generate and offer personalized feedback on subjective experience and behavioral patterns as well as (4) adaptive ecological momentary interventions (EMI) tailored to the person, moment, and context in daily life.New digital forms of service delivery have considerable potential to increase the effectiveness and cost-effectiveness of crisis resolution, home treatment, and assertive outreach. An important next step is to model and initially evaluate these novel digital forms of service delivery in the context of StäB and carefully investigate their quality from the user perspective, safety, feasibility, initial process and outcome quality as well as barriers and facilitators of implementation.HINTERGRUND: Die stationsäquivalente psychiatrische Behandlung (StäB) wurde 2018 als Krankenhausleistung für Menschen eingeführt, die die Kriterien einer stationären Behandlung erfüllen. Die rasanten Fortschritte im Bereich der Informations- und Kommunikationstechnologie bieten neue Chancen für innovative digitale Versorgungsangebote wie telemedizinische, eHealth- oder mHealth-Verfahren.Diese Übersichtsarbeit soll einen umfassenden Überblick über neue digitale Versorgungsformen geben, die zur Personalisierung der StäB bei schweren psychischen Erkrankungen beitragen und somit klinische und soziale Outcomes verbessern sowie direkte und indirekte Kosten reduzieren könnten.Diese Arbeit basiert auf einer selektiven Literaturrecherche (Narratives Review).Es wurden vier primäre digitale Versorgungsformen identifiziert, die in der StäB gewinnbringend genutzt werden könnten: (1) Kommunikation, Behandlungskontinuität und -flexibilität durch Online-Chat und Videotelefonie, (2) Monitoring von Symptomen und Verhaltensweisen in Echtzeit durch Anwendung des ambulatorischen Assessments („ecological momentary assessment“ [EMA]), (3) Nutzung multimodaler EMA-Daten für die Generierung von personalisiertem Feedback über subjektives Erleben und Verhaltensmuster sowie (4) auf Person, Moment und Kontext zugeschnittene, adaptive ambulatorische Interventionen („ecological momentary interventions“ [EMIs]).Digitale Versorgungsformen haben erhebliches Potenzial die Effektivität und Kosteneffektivität der StäB zu steigern. Ein wichtiger nächster Schritt besteht darin, die Anwendung dieser Versorgungsformen im Bereich der StäB zu modellieren und deren Qualität aus Sicht der Patient*innen, Sicherheit und initiale Prozess- und Ergebnisqualität sowie Implementierungsbedingungen sorgfältig zu untersuchen.

BACKGROUND Most mental disorders first emerge in youth and, in their early stages, surface as subthreshold expressions of symptoms comprising a transdiagnostic phenotype of psychosis, mania, depression, and anxiety. Elevated stress reactivity is one of the most widely studied mechanisms underlying psychotic and affective mental health problems. Thus, targeting stress reactivity in youth is a promising indicated and translational preventive strategy for adverse mental health outcomes that could develop later in life and for improving resilience. Compassion-focused interventions offer a wide range of innovative therapeutic techniques that are particularly amenable to being implemented as ecological momentary interventions (EMIs), a specific type of mobile health intervention, to enable youth to access interventions in a given moment and context in daily life. This approach may bridge the current gap in youth mental health care. OBJECTIVE This study aims to investigate the clinical feasibility, candidate underlying mechanisms, and initial signals of the efficacy of a novel, transdiagnostic, hybrid EMI for improving resilience to stress in youth—EMIcompass. METHODS In an exploratory randomized controlled trial, youth aged between 14 and 25 years with current distress, a broad Clinical High At-Risk Mental State, or the first episode of a severe mental disorder will be randomly allocated to the EMIcompass intervention (ie, EMI plus face-to-face training sessions) in addition to treatment as usual or a control condition of treatment as usual only. Primary (stress reactivity) and secondary candidate mechanisms (resilience, interpersonal sensitivity, threat anticipation, negative affective appraisals, and momentary physiological markers of stress reactivity), as well as primary (psychological distress) and secondary outcomes (primary psychiatric symptoms and general psychopathology), will be assessed at baseline, postintervention, and at the 4-week follow-up. RESULTS The first enrollment was in August 2019, and as of May 2021, enrollment and randomization was completed (N=92). We expect data collection to be completed by August 2021. CONCLUSIONS This study is the first to establish feasibility, evidence on underlying mechanisms, and preliminary signals of the efficacy of a compassion-focused EMI in youth. If successful, a confirmatory randomized controlled trial will be warranted. Overall, our approach has the potential to significantly advance preventive interventions in youth mental health provision. CLINICALTRIAL German Clinical Trials Register DRKS00017265; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017265 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/27462

BACKGROUND Digital interventions offer new avenues for low-threshold prevention and treatment in young people. Ecological momentary interventions (EMIs) represent a powerful approach that allows for adaptive, real-time, and real-world delivery of intervention components in daily life by real-time processing of ecological momentary assessment (EMA) data. Compassion-focused interventions (CFIs) may be particularly amenable to translation into an EMI to strengthen emotional resilience and modify putative risk mechanisms, such as stress sensitivity, in the daily lives of young help-seeking individuals. OBJECTIVE This study aims to investigate the feasibility, safety, and initial therapeutic effects of a novel, accessible, transdiagnostic, ecological momentary CFI for improving emotional resilience to stress (EMIcompass). METHODS In this uncontrolled pilot study, help-seeking youth with psychotic, depressive, or anxiety symptoms were offered the EMIcompass intervention in addition to treatment as usual. The EMIcompass intervention consisted of a 3-week EMI (including enhancing, consolidating, and EMA-informed interactive tasks) administered through a mobile health app and three face-to-face sessions with a trained psychologist intended to provide guidance and training on the CFI exercises presented in the app (ie, training session, follow-up booster session, and review session). RESULTS In total, 10 individuals (mean age 20.3 years, SD 3.8; range 14-25) were included in the study. Most (8/10, 80%) participants were satisfied and reported a low burden of app usage. No adverse events were observed. In approximately one-third of all EMAs, individuals scored high on stress, negative affect, or threat anticipation during the intervention period, resulting in real-time, interactive delivery of the CFI intervention components in addition to weekly enhancing and daily consolidating tasks. Although the findings should be interpreted with caution because of the small sample size, reduced stress sensitivity, momentary negative affect, and psychotic experiences, along with increased positive affect, were found at postintervention and the 4-week follow-up. Furthermore, reductions in psychotic, anxiety, and depressive symptoms were found (r=0.30-0.65). CONCLUSIONS Our findings provide evidence on the feasibility and safety of the EMIcompass intervention for help-seeking youth and lend initial support to beneficial effects on stress sensitivity and mental health outcomes. An exploratory randomized controlled trial is warranted to establish the feasibility and preliminary evidence of its efficacy. CLINICALTRIAL

Background: Most mental disorders first emerge in youth and, in their early stages, surface as subthreshold expressions of symptoms comprising a transdiagnostic phenotype of psychosis, mania, depression and anxiety. Elevated stress reactivity is one of the most widely studied mechanisms underlying psychotic and affective mental health problems. Thus, targeting stress reactivity in youth is a promising indicated and translational preventive strategy for adverse mental health outcomes later in life and for improving resilience. Compassion-focused interventions (CFIs) offer a wide range of innovative therapeutic techniques particularly amenable to being implemented as Ecological Momentary Interventions (EMIs), a specific type of mHealth intervention, to enable youth to access interventions in a given moment and context in daily life. This approach may bridge a gap in current youth mental health care. Objectives: The aim of this study will be to investigate the clinical feasibility, candidate underlying mechanisms and initial signals of efficacy of a novel, transdiagnostic, hybrid EMI for improving resilience to stress in youth (EMIcompass).Methods: In an exploratory randomized controlled trial (RCT), youth aged 14-25 with current distress, a broad Clinical High At-Risk Mental State (CHARMS) or a first episode of a severe mental disorder will be randomly allocated to the EMIcompass intervention (EMI plus face-to-face training sessions) in addition to treatment as usual (TAU) or a control condition of TAU only. Primary (stress reactivity) and secondary candidate mechanisms (resilience, interpersonal sensitivity, threat anticipation, negative affective appraisals, momentary physiological markers of stress reactivity) as well as primary (psychological distress) and secondary outcomes (primary psychiatric symptoms, general psychopathology) will be assessed at baseline, post-intervention and 4-week follow-up. Results: The first enrolment was in August 2019 and as of May 2021, enrolment and randomization has been completed (n = 92 participants). We expect the end of data collection in August 2021.Conclusions: The current study is the first to establish feasibility, evidence on underlying mechanisms, and preliminary signals of efficacy of a compassion-focused EMI in youth. If successful, a confirmatory RCT will be warranted. Overall, our approach has the potential to significantly advance preventive interventions in youth mental health provision. Trial registration: German Clinical Trials Register (DRKS), DRKS00017265; Date of registration: 31.07.2019.

Digital interventions offer new avenues for prevention and treatment in youth. Ecological momentary interventions (EMIs) allow for adaptive and real-time delivery of intervention components in daily life. Compassion-focused interventions may be particularly amenable to translation into an EMI to strengthen emotional resilience in youth. We aimed to investigate initial therapeutic effects, feasibility, and safety of a novel, accessible, transdiagnostic, ecological momentary, compassion-focused intervention for improving emotional resilience (‘EMIcompass’) in an uncontrolled pilot study including help-seeking youth with psychotic, depressive, and/or anxiety symptoms. The EMIcompass intervention consisted of three sessions with a trained psychologist and a 3-week EMI administered through a mobile health app. In total, ten individuals (Mage=20.3 years) were included. Reduced stress sensitivity, momentary negative affect, and psychotic experiences as well as increased positive affect were found at post-intervention and 4-week follow-up. Further, reductions in psychotic, anxiety, and depressive symptoms of medium to large effect size were found (r=0.30-0.65). Most participants were satisfied (80%) and reported low burden of app usage. No adverse events were observed. Our findings provide initial evidence on beneficial effects, feasibility, and safety of the EMIcompass intervention in help-seeking youth. An exploratory randomised controlled trial is warranted to establish feasibility and preliminary evidence of efficacy.

BACKGROUND Accumulating evidence suggests the COVID-19 pandemic has negative effects on public mental health. Digital interventions that have been developed and evaluated in recent years may be used to mitigate the negative consequences of the pandemic. However, evidence-based recommendations on the use of existing telemedicine and internet-based (eHealth) and app-based mobile health (mHealth) interventions are lacking. OBJECTIVE The aim of this study was to investigate the theoretical and empirical base, user perspective, safety, effectiveness, and cost-effectiveness of digital interventions related to public mental health provision (ie, mental health promotion, prevention, and treatment of mental disorders) that may help to reduce the consequences of the COVID-19 pandemic. METHODS A rapid meta-review was conducted. The MEDLINE, PsycINFO, and CENTRAL databases were searched on May 11, 2020. Study inclusion criteria were broad and considered systematic reviews and meta-analyses that investigated digital tools for health promotion, prevention, or treatment of mental health conditions and determinants likely affected by the COVID-19 pandemic. RESULTS Overall, 815 peer-reviewed systematic reviews and meta-analyses were identified, of which 83 met the inclusion criteria. Our findings suggest that there is good evidence on the usability, safety, acceptance/satisfaction, and effectiveness of eHealth interventions. Evidence on mHealth apps is promising, especially if social components (eg, blended care) and strategies to promote adherence are incorporated. Although most digital interventions focus on the prevention or treatment of mental disorders, there is some evidence on mental health promotion. However, evidence on process quality, cost-effectiveness, and long-term effects is very limited. CONCLUSIONS There is evidence that digital interventions are particularly suited to mitigating psychosocial consequences at the population level. In times of physical distancing, quarantine, and restrictions on social contacts, decision makers should develop digital strategies for continued mental health care and invest time and efforts in the development and implementation of mental health promotion and prevention programs.

Childhood trauma is associated with an elevated risk for psychosis, but the psychological mechanisms involved remain largely unclear. This study aimed to investigate emotional and psychotic stress reactivity in daily life as a putative mechanism linking childhood trauma and clinical outcomes in individuals at ultra-high risk (UHR) for psychosis. Experience sampling methodology was used to measure momentary stress, affect and psychotic experiences in the daily life of N=79 UHR individuals in the EU-GEI High Risk study. The Childhood Trauma Questionnaire was used to assess self-reported childhood trauma. Clinical outcomes were assessed at baseline, 1- and 2-year follow-up. The association of stress with positive (β=-0.14, P=.010) and negative affect (β=0.11, P=.020) was modified by transition status such that stress reactivity was greater in individuals who transitioned to psychosis. Moreover, the association of stress with negative affect (β=0.06, P=.019) and psychotic experiences (β=0.05, P=.037) was greater in individuals exposed to high vs. low levels of childhood trauma. We also found evidence that decreased positive affect in response to stress was associated with reduced functioning at 1-year follow-up (B=6.29, P=.034). In addition, there was evidence that the association of childhood trauma with poor functional outcomes was mediated by stress reactivity (e.g. Bindirect effect =-2.13, P=.026), but no evidence that stress reactivity mediated the association between childhood trauma and transition (e.g. Bindirect effect=0.14, P=.506). Emotional and psychotic stress reactivity may be potential mechanisms linking childhood trauma with clinical outcomes in UHR individuals.

Background: Digital interventions may be used to mitigate psychosocial consequences of the COVID-19 pandemic but evidence-based recommendations are lacking. The aim of this rapid meta-review was to investigate the theoretical base, user perspective, safety, effectiveness, and cost effectiveness of digital interventions in public mental health provision (i.e. mental health promotion, prevention of, and treatment for mental disorder). Methods: A rapid meta-review was conducted. MEDLINE, PsychINFO, and CENTRAL databases were searched on May 11, 2020. Study inclusion criteria were broad and considered systematic reviews that investigated digital tools for health promotion, prevention, or treatment of mental health conditions likely affected by the COVID-19 pandemic. Findings: We identified 813 reviews of which 82 met inclusion criteria. Overall, there is good evidence on the usability, safety, acceptance/satisfaction, and effectiveness of eHealth interventions while evidence on mHealth apps is promising, especially if social components (e.g. blended care) and strategies to promote adherence are incorporated. Although most digital interventions focus on the prevention or treatment of mental disorders, there is some evidence on mental health promotion. However, evidence on long-term clinical effects, process quality, and cost-effectiveness is very limited. Interpretation: Accumulating evidence suggests negative effects of the COVID-19 pandemic on public mental health. There is evidence that digital interventions are particularly suited to mitigating psychosocial consequences at the population level. Decision-makers should develop digital strategies for continued mental health care and the development and implementation of mental health promotion and prevention programs in times of quarantine and social distancing.

Highly arousing, affective stimuli have adverse effects on cognition and performance. Perception of affective stimuli is, however, highly subjective and may impact on the interaction of emotion and cognition. Here, we tested the impact of high- versus low-threatening stimuli on response inhibition as a function of perceived threat intensity. Response inhibition was probed using a stop-signal paradigm in 62 healthy adults. We used stop-signals that had previously been paired with an unpleasant electrodermal stimulation (i.e., high-threat stimuli) or that had never been paired with electrodermal stimulation (i.e., low-threat stimuli). High-threat stimuli did not affect stopping performance in general. Only participants who perceived the high-threat stimuli as highly painful showed impaired response inhibition on high-threat trials relative to low-threat trials. Participants who perceived the high-threat as mildly painful, however, showed improved response inhibition on high-threat trials. This effect was not moderated by the current anxious state. This suggests that the impact of negative affective stimuli on cognition critically depends on subjective threat perception. Ratings of affective stimuli should be included in studies probing the emotion-cognition interaction because subjective perception might strongly impact on that interaction. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Resilience has been defined as the maintenance or quick recovery of mental health during and after times of adversity. Such good longer-term mental health outcomes despite adversity presumably result from complex and dynamic processes of adaptation to stressor exposure (‘resilience processes’), which in many cases include changes in individual properties. Measuring resilience and identifying resilience processes in observational studies requires longitudinal designs involving repeated and frequent monitoring of mental health, stressor exposure, and potential adaptations. We here present a generic design solution that is currently employed in two cohort studies, the Mainz Resilience Project (MARP) and the Longitudinal Resilience Assessment (LORA). Both projects focus on resilience to everyday life stressors (i.e., microstressors), but we argue that the design scheme is also suitable for studying resilience to macrostressors, or trauma, and can solve some of the pertinent problems of trauma resilience research. We quantify resilience by indexing the reactivity of individuals’ mental health to stressors during a time interval of several months in a ‘stressor reactivity’ (SR) score, derived using a previously introduced residualization approach. SR scores are regularly re-calculated in sliding time windows, to thus build SR time courses that reflect intra-individual temporal variability in resilience. By linking these time courses to repeated measures of (temporally varying) individual properties, resilience processes can be identified. We finish by a discussion of limitations of our approach and potential future developments.

Aktuelle Forschungskonzepte definieren Resilienz als Adaptation an bereits erlebte und gegenwartige Expositionen. Adaptation ist damit ein dynamisches Geschehen, das in Populationsgruppen verschieden verlaufen kann. Prospektive Langsschnittstudien bieten die einzigartige Moglichkeit, dynamische Verlaufe von Resilienz zu untersuchen. Ziele dieses Artikels sind das Konzept Resilienz zu definieren, beispielhaft Langsschnittstudien, die Resilienz bei Kindern, Erwachsenen und alteren Menschen untersuchen, zu beschreiben, exemplarisch vier derzeit laufende Langsschnittstudien zu Resilienz, an denen die Autoren dieses Artikels beteiligt sind, vorzustellen und methodische Herausforderungen bei der empirischen Untersuchung von Resilienz zu beschreiben und zu analysieren. Diese Arbeit basiert auf einem qualitativen Literaturreview prospektiver Langsschnittstudien, die in PubMed publiziert wurden sowie auf den Studienprotokollen von vier derzeit durchgefuhrten Langsschnittstudien. Die exemplarisch vorgestellten Studien haben gezeigt, dass Resilienzverlaufe in allen Altersgruppen veranderlich sind und zudem unterschiedliche Einflussfaktoren vorliegen. Die spezifische und ggf. altersabhangige Art der Veranderung ist bislang jedoch nur schwer zu erfassen und muss weiter untersucht werden. Angesichts des dynamischen Verlaufes von Resilienz sind prospektive reprasentative Langsschnittstudien dringend notwendig. Diese haben das Potenzial, Resilienzmechanismen und Pradiktoren resilienter Verlaufe bei Kindern, Jugendlichen, Erwachsenen und alteren Menschen zu identifizieren. Resilienzforschung hat derzeit zudem noch die Aufgabe, eine prazise Erfassung der Stressorexposition zu entwickeln.

Motivated by the recent replicability crisis we tested replicability of functional magnetic resonance imaging (fMRI) group activations in two independent samples. An identical behavioral and fMRI test battery for the longitudinal investigation of stress resilience mechanisms was developed for the Mainz Resilience Project (MARP) and conducted in a discovery (N = 54) and a replication sample (N = 103). The test battery consisted of a stress reactivity task, a reward sensitivity task, a fear conditioning and extinction paradigm, two volitional reappraisal tasks and an emotional interference inhibition task. Replicability of group activations was tested with the Jaccard index and the Intra Class Correlation (ICC). Overall, we observed good to excellent replicability of activations at the whole brain level. Only a minority of contrasts showed unsatisfactory replicability. Replicability at the level of individual regions of interest (ROIs) was generally lower. Tasks with stronger activation in the discovery sample showed better replicability.

Contains fulltext : 179627.pdf (Publisher’s version ) (Closed access) Consistent failure over the past few decades to reduce the high prevalence of stress-related disorders has motivated a search for alternative research strategies. Resilience refers to the phenomenon of many people maintaining mental health despite exposure to psychological or physical adversity. Instead of aiming to understand the pathophysiology of stress-related disorders, resilience research focuses on protective mechanisms that shield people against the development of such disorders and tries to exploit its insights to improve treatment and, in particular, disease prevention. To fully harness the potential of resilience research, a critical appraisal of the current state of the art - in terms of basic concepts and key methods - is needed. We highlight challenges to resilience research and make concrete conceptual and methodological proposals to improve resilience research. Most importantly, we propose to focus research on the dynamic processes of successful adaptation to stressors in prospective longitudinal studies. 7 p.

In case of uncertainty, predictions that are based on prior, similar experiences guide our decision by processes of generalization. Over-generalization of negative information has been identified as an important feature of several psychopathologies, including anxiety disorders and depression, and might underlie biased interpretation of ambiguous information. Here, we investigated the neural correlates of valence generalization to ambiguous stimuli using a translational affective conditioning task during fMRI. Twenty-five healthy individuals participated in a conditioning procedure with (1) an initial acquisition phase, where participants learned the positive and negative valence of two different tones (reference tones) through their responses and subsequent feedback and (2) a test phase, where participants were presented with the previously learned reference tones and three additional tones with intermediate frequency to the learned reference tones. By recording the responses to these intermediate stimuli we were able to assess the participantsi interpretation of ambiguous tones as either positive or negative. Behavioral results revealed a graded response pattern to the three intermediate tones, which was mirrored on the neural level. More specifically, parametric analyses OF BOLD responses to all five tones revealed a linear effect in bilateral anterior insula and SMA with lowest activation to the negative reference tone and highest activation to the positive negative tone. In addition, a cluster in the SMA showed a reverse-quadratic response, i.e., the strongest response for the most ambiguous tone. These findings suggest overlapping regions in the salience network that mediate valence generalization and decision-making under ambiguity, potentially underlying biased ambiguous cue interpretation.

Affective state can influence cognition leading to biased information processing, interpretation, attention, and memory. Such bias has been reported to be essential for the onset and maintenance of different psychopathologies, particularly affective disorders. However, empirical evidence has been very heterogeneous and little is known about the neurophysiological mechanisms underlying cognitive bias and its time-course. We therefore investigated the interpretation of ambiguous stimuli as indicators of biased information processing with an ambiguous cue-conditioning paradigm. In an acquisition phase, participants learned to discriminate two tones of different frequency, which acquired emotional and motivational value due to subsequent feedback (monetary gain or avoidance of monetary loss). In the test phase, three additional tones of intermediate frequencies were presented, whose interpretation as positive (approach of reward) or negative (avoidance of punishment), indicated by a button press, was used as an indicator of the bias. Twenty healthy volunteers participated in this paradigm while a 64-channel electroencephalogram was recorded. Participants also completed questionnaires assessing individual differences in depression and rumination. Overall, we found a small positive bias, which correlated negatively with reflective pondering, a type of rumination. As expected, reaction times were increased for intermediate tones. ERP amplitudes between 300 and 700 ms post-stimulus differed depending on the interpretation of the intermediate tones. A negative compared to a positive interpretation led to an amplitude increase over frontal electrodes. Our study provides evidence that in humans, as in animal research, the ambiguous cue-conditioning paradigm is a valid procedure for indirectly assessing ambiguous cue interpretation and a potential interpretation bias, which is sensitive to individual differences in affect-related traits.

Investigations of cognitive biases in animals are conceptually and translationally valuable because they contribute to animal welfare research and help to extend and refine our understanding of human emotional disorders, where biased information processing is a critical causal and maintenance factor. We employed the “learned helplessness” genetic rat model of depression in studying cognitive bias and its modification by environmental manipulations. Using a spatial judgment task, responses to ambiguous spatial cues were assessed before and after environmental enrichment to test whether this manipulation would cause an optimistic shift in emotional state. Twenty-four congenitally helpless and nonhelpless male rats were trained to discriminate two different locations, “rewarded” versus “aversive.” After successful acquisition of this spatial discrimination, cognitive bias was probed by measuring responses to three ambiguous locations. Latencies to “reach” and to actively “choose” a goal pot were recorded alongside exploratory behaviors. An overall strain difference was observed, with helpless rats displaying longer “reach” latencies than nonhelpless rats. This implies a “pessimistic” response bias in helpless rats, underscoring their depressive-like phenotype. No strain differences were observed regarding other behavioral measures. Half of the animals were then transferred to enriched cages and retested. Environmental enrichment resulted in reduced “choose” latencies in both rat strains, associating enrichment with more optimistic interpretations of ambiguous cues. Our results emphasize the suitability of cognitive bias measurement for animal emotion assessment. They extend the methodological repertoire for characterizing complex phenotypes and bear implications for animal welfare research and for the use of animal models in preclinical research.

Resilience is the maintenance or rapid recovery of mental health during and after stressor exposure. It is becoming increasingly clear that resilience results from a complex and dynamic process of adaptation to stressors involving the biological, psychological and social levels. Positive appraisal style theory of resilience (PASTOR) claims that the common final pathway to maintained mental health lies in the non-negative (non-catastrophizing, non-pessimistic) appraisal of potential stressors, permitting the organism to fine-tune stress responses to optimal levels, thus avoiding unnecessary stress, inefficient deployment of resources and concomitant deleterious allostatic load effects. Successful adaptation consists in developing or strengthening a positive appraisal style. Another key element of PASTOR is that a positive appraisal style is strongly determined by the efficacy and efficiency of the neural and cognitive processes that underlie positive stressor appraisal. We here present a combined behavioral and functional magnetic resonance imaging (fMRI) battery designed to assess such processes repeatedly in longitudinal settings. The battery includes tests of stress reactivity and recovery, reward sensitivity, safety learning and memory in the context of fear conditioning and extinction, volitional situation-focused reappraisal, volitional self-focused reappraisal, and emotional interference inhibition, along with structural MRI and resting-state MRI scans. A detailed description of the battery methods is provided. The feasibility of the battery was successfully tested in N=55 healthy subjects; group results of the individual tasks largely replicate existing literature.

Deep learning approaches can uncover complex patterns in data. In particular, variational autoencoders (VAEs) achieve this by a non-linear mapping of data into a low-dimensional latent space. Motivated by an application to psychological resilience in the Mainz Resilience Project (MARP), which features intermittent longitudinal measurements of stressors and mental health, we propose an approach for individualized, dynamic modeling in this latent space. Specifically, we utilize ordinary differential equations (ODEs) and develop a novel technique for obtaining person-specific ODE parameters even in settings with a rather small number of individuals and observations, incomplete data, and a differing number of observations per individual. This technique allows us to subsequently investigate individual reactions to stimuli, such as the mental health impact of stressors. A potentially large number of baseline characteristics can then be linked to this individual response by regularized regression, e.g., for identifying resilience factors. Thus, our new method provides a way of connecting different kinds of complex longitudinal and baseline measures via individualized, dynamic models. The promising results obtained in the exemplary resilience application indicate that our proposal for dynamic deep learning might also be more generally useful for other application domains.