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BACKGROUND: Poor memory for treatment is associated with poorer treatment adherence and poorer patient outcomes. The memory support intervention (MSI) was developed to improve patient memory for treatment with the goal of improving patient outcomes. The aim of this study protocol is to conduct a confirmatory efficacy trial to test whether a new, streamlined, and potent version of the MSI improves outcomes for midlife and older adults. This streamlined MSI is comprised of constructive memory supports that will be applied to a broader range of treatment content. The platform for this study is the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C). We will focus on midlife and older adults who are low income and experiencing mobility impairments. METHODS: Participants (N = 178) will be randomly allocated to TranS-C + MSI or TranS-C alone. Both intervention arms include eight 50-min weekly sessions. Assessments will be conducted at pre-treatment, post-treatment, 6-, and 12-month follow-up (6FU and 12FU). Aim 1 will compare the effects of TranS-C + MSI versus TranS-C alone on sleep and circadian functioning, daytime functioning, well-being, and patient memory. Aim 2 will test whether patient memory for treatment mediates the relationship between treatment condition and patient outcomes. Aim 3 will evaluate if previously reported poor treatment response subgroups will moderate the relationship between treatment condition and (a) patient memory for treatment and (b) treatment outcome. Exploratory analyses will compare treatment condition on (a) patient adherence, patient-rated treatment credibility, and patient utilization of treatment contents, and (b) provider-rated acceptability, appropriateness, and feasibility. DISCUSSION: This study has the potential to provide evidence for (a) the efficacy of a new simplified version of the MSI for maintaining health, well-being, and functioning, (b) the wider application of the MSI for midlife and older adults and to the treatment of sleep and circadian problems, and (c) the efficacy of the MSI for sub-groups who are likely to benefit from the intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT05986604. Registered on 2 August 2023.

BACKGROUND: Research suggests that effort-cost decision-making (ECDM), the estimation of work required to obtain reward, may be a relevant framework for understanding motivational impairment in psychotic and mood pathology. Specifically, research has suggested that people with psychotic and mood pathology experience effort as more costly than controls, and thus pursue effortful goals less frequently. This study examined ECDM across psychotic and mood pathology. HYPOTHESIS: We hypothesized that patient groups would show reduced willingness to expend effort compared to controls. STUDY DESIGN: People with schizophrenia (N = 33), schizoaffective disorder (N = 28), bipolar disorder (N = 39), major depressive disorder (N = 40), and controls (N = 70) completed a physical ECDM task. Participants decided between completing a low-effort or high-effort option for small or larger rewards, respectively. Reward magnitude, reward probability, and effort magnitude varied trial-by-trial. Data were analyzed using standard and hierarchical logistic regression analyses to assess the subject-specific contribution of various factors to choice. Negative symptoms were measured with a clinician-rated interview. STUDY RESULTS: There was a significant effect of group, driven by reduced choice of high-effort options in schizophrenia. Hierarchical logistic regression revealed that reduced choice of high-effort options in schizophrenia was driven by weaker contributions of probability information. Use of reward information was inversely associated with motivational impairment in schizophrenia. Surprisingly, individuals with major depressive disorder and bipolar disorder did not differ from controls. CONCLUSIONS: Our results provide support for ECDM deficits in schizophrenia. Additionally, differences between groups in ECDM suggest a seemingly similar behavioral phenotype, reduced motivation, could arise from disparate mechanisms.

BACKGROUND: Although research on the implementation of evidence-based psychological treatments (EBPTs) has advanced rapidly, research on the sustainment of implemented EBPTs remains limited. This is concerning, given that EBPT activities and benefits regularly decline post-implementation. To advance research on sustainment, the present protocol focuses on the third and final phase-the Sustainment Phase-of a hybrid type 2 cluster-randomized controlled trial investigating the implementation and sustainment of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for patients with serious mental illness and sleep and circadian problems in community mental health centers (CMHCs). Prior to the first two phases of the trial-the Implementation Phase and Train-the-Trainer Phase-TranS-C was adapted to fit the CMHC context. Then, 10 CMHCs were cluster-randomized to implement Standard or Adapted TranS-C via facilitation and train-the-trainer. The primary goal of the Sustainment Phase is to investigate whether adapting TranS-C to fit the CMHC context predicts improved sustainment outcomes. METHODS: Data collection for the Sustainment Phase will commence at least three months after implementation efforts in partnering CMHCs have ended and may continue for up to one year. CMHC providers will be recruited to complete surveys (N = 154) and a semi-structured interview (N = 40) on sustainment outcomes and mechanisms. Aim 1 is to report the sustainment outcomes of TranS-C. Aim 2 is to evaluate whether manipulating EBPT fit to context (i.e., Standard versus Adapted TranS-C) predicts sustainment outcomes. Aim 3 is to test whether provider perceptions of fit mediate the relation between treatment condition (i.e., Standard versus Adapted TranS-C) and sustainment outcomes. Mixed methods will be used to analyze the data. DISCUSSION: The present study seeks to advance our understanding of sustainment predictors, mechanisms, and outcomes by investigating (a) whether the implementation strategy of adapting an EBPT (i.e., TranS-C) to the CMHC context predicts improved sustainment outcomes and (b) whether this relation is mediated by improved provider perceptions of treatment fit. Together, the findings may help inform more precise implementation efforts that contribute to lasting change. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05956678 . Registered on July 21, 2023.

Background: Eveningness chronotype—the tendency for later sleep and wake times—arises from a confluence of psychosocial, behavioral, and biological factors. With the onset and progression of puberty, many young people develop an eveningness chronotype, which remains prevalent through the transition into adulthood. Eveningness has been associated with increased risk for poorer health. While eveningness is modifiable, maintaining the necessary behavior changes can be challenging. The science on habits demonstrates that habit formation is a key mechanism for maintaining behavior change over time. Learning theory offers schedules of reinforcement that also hold promise for enhancing the maintenance of behavior change. The present study will evaluate the Habit-based Sleep Health Intervention (HABITs)—which combines the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) with the science of habits—and a text message intervention informed by learning theory to attempt to sustainably modify the contributors to eveningness among young adults (18–30 years of age). Methods: Participants (N = 160) will be randomly allocated to HABITs and HABITs + Texts. Both interventions include HABITs which involves three 50-min sessions followed by six 30-min sessions. Alongside the latter six sessions, HABITs + Texts will concurrently receive the text message intervention. Aims 1–3 will compare HABITs + Texts to HABITs on improvements in the outcomes of (1) utilization of sleep health behaviors and habit formation, (2) sleep and circadian functioning, and (3) functioning in five health-relevant domains, in the short (post-treatment) and longer (6-month and 12-month follow-up) term. Exploratory analysis will (1) compare HABITs and HABITs + Texts on (a) if sleep health behavior habit formation mediates the effects of intervention on improvement in outcomes and (b) if intervention effects are moderated by select variables, and (2) to evaluate if HABITs (regardless of the text message intervention) is associated with an improvement in outcomes in the short and longer term. Discussion: This study has the potential to advance knowledge on (1) the value of leveraging the science of habits and learning theory in behavior change interventions, (2) the use of a low-cost and efficient intervention for habit formation and maintenance, (3) interventions that address eveningness chronotype, and (4) processes related to behavior change during emerging adulthood. Trial registration: Clinicaltrials.gov NCT05167695. Registered on December 22, 2021. [ABSTRACT FROM AUTHOR]

Background: Obsessive-compulsive (OC) traits (i.e., tendency to implement stereotyped behaviors to avoid negative consequences) are transversally observed in psychiatric disorders largely differing in terms of clinical manifestations and etiopathogenesis. Interestingly, OC traits were also extensively found in the prodromal phases of the full-blown psychopathology and in healthy relatives of affected individuals. Moreover, OC traits were found to be associated—and possibly underlain by—cognitive control impairments. Nonetheless, the role of such interplay in the onset of OC disorders is yet to be understood. We hypothesized that OC traits are associated with abnormalities in proactively implement cognitive control for solving conflict. Methods: We administered healthy individuals (n = 104) with the perifoveal spatial Stroop task to measure their ability of solving conflict in a proactive fashion, and with Obsessive-Compulsive Inventory (OCI) to stratify population according to the severity of OC traits. Results: Analysis of response times by means of Linear Mixed-effect models revealed that proactive control performance was not associated with and the severity of OC traits. Furthermore, an equivalence test (Two One-Sided Test) revealed that the association between OCI scores and task performance was equivalent to zero. Conclusion: These results suggest that the interplay between OC traits and proactive control abnormalities might not contribute to the development of OC-related disorders. Therefore, the role of other cognitive endophenotypes should be scrutinized for exploiting alternative prevention and intervention strategies. [ABSTRACT FROM AUTHOR]

Individual differences in reward functioning have been associated with numerous disorders in adolescence. Given relations with multiple forms of psychopathology, it is unclear whether these associations are disorder specific or reflective of shared variance across multiple disorders. In a sample of adolescents (N = 418), we examined associations between neural and self-reported indices of early reward functioning (age 12) with different levels of a hierarchical psychopathology model assessed later in adolescence (age 18). We examined whether prospective relationships between reward functioning are specific to individual disorders or better explained by transdiagnostic dimensions. We found modest results for prospective associations between reward indices and different dimensions of psychopathology, with most significant associations not surviving correction for multiple comparisons. We discuss the benefits and limitations of the modeling approach used to examine dimension-specific associations that future work can build on. Overall, more work is needed to better understand how reward functioning is specifically associated with different forms of and hierarchical levels of psychopathology. General Scientific Summary: Adolescent reward functioning is associated with numerous forms of psychopathology, leaving uncertainty whether the relationships are disorder specific or better explained by transdiagnostic factors. Here, we examined prospective relationships between early adolescent reward functioning and a psychopathology hierarchy measured later in adolescence. We found modest results and discuss implications that future work can build on. [ABSTRACT FROM AUTHOR]

Internalizing psychopathology is associated with abnormalities in heart rate variability (HRV). Lower HRV that reflects reduced parasympathetic nervous system activity has been observed in depressive and anxiety disorders. Existing studies predominantly used categorical rather than dimensional approaches, the latter of which better addresses clinical comorbidity and heterogeneity. Moreover, there is little evidence on the role of HRV in longitudinal symptom trajectory in adolescents and young adults. The current study examined the association between HRV and internalizing symptom trajectory using a dimensional approach—the tri-level model of depression and anxiety. Adolescents and young adults (N = 362) were recruited in a 3-year longitudinal study, where they completed electrocardiogram recordings and self-report symptom questionnaires. Multilevel modeling was conducted with high-frequency power bands (HF power) of interbeat intervals at baseline as the predictor, and tri-level symptom factors over 3 years as the outcome. HF power significantly predicted the trajectory of the broad General Distress symptom factor, but not the intermediate Fears or Anhedonia-Apprehension symptom factors. Higher HF power was associated with a decline in General Distress over time. This association was held when neuroticism, other tri-level symptom factors, and demographic variables were covaried. That is, greater parasympathetic nervous system activity at baseline was significantly associated with a greater decline in the broad internalizing symptom factor, but not symptom factors that are more specific to depressive or anxiety disorders. Parasympathetic activity, therefore, may be a transdiagnostic biomarker for internalizing symptoms in adolescents and young adults. General Scientific Summary: Chronically low variability in heart rate has been found to be a risk factor for depression and anxiety. The current study examined the link between heart rate variability (HRV) and the trajectory of symptom dimensions over time. We found that higher HRV was linked to a decline in the broad symptom dimension over time, but not the more disorder-specific symptom dimensions, suggesting that HRV might be a risk factor that accounts for comorbid depressive and anxiety disorders. [ABSTRACT FROM AUTHOR]

• HiTOP is a dimensional alternative to traditional diagnostic systems. • The HiTOP approach has the potential to improve outcomes across clinical tasks. • HiTOP is consistent with other transdiagnostic approaches to treatment. • Future work should focus on dissemination and the establishment of clinical utility. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a dimensional framework for psychopathology advanced by a consortium of nosologists. In the HiTOP system, psychopathology is grouped hierarchically from super-spectra, spectra, and subfactors at the upper levels to homogeneous symptom components and maladaptive traits and their constituent symptoms, and maladaptive behaviors at the lower levels. HiTOP has the potential to improve clinical outcomes by planning treatment based on symptom severity rather than heterogeneous diagnoses, targeting treatment across different levels of the hierarchy, and assessing distress and impairment separately from the observed symptom profile. Assessments can be performed according to this framework with the recently developed HiTOP-Self-Report (HiTOP-SR). Examples of how to use HiTOP in clinical practice are provided for the internalizing spectrum, including the use of the Unified Protocol and other modularized treatments, measurement-based care, psychopharmacology, and in traditionally underserved populations. Future directions are discussed in this State of the Science review including HiTOP's use in further developing transdiagnostic treatments, extending the model to include other information such as environmental factors, establishing the treatment utility of clinical assessment for the HiTOP-SR, developing new treatments, and disseminating the model. [ABSTRACT FROM AUTHOR]

• Neuroticism contributes to the development and maintenance of emotional disorders. • The UP targets shared mechanisms of neuroticism and related emotion dysregulation. • The UP is an effective treatment for emotional disorders and neuroticism. • The UP can address a variety of problems across different cultures and identities. Before the development of the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP), evidence-based treatment options for commonly co-occurring anxiety, mood, and related disorders consisted of numerous single-disorder protocols that shared many similarities, reflecting the overlap among these disorders themselves. The UP distilled common elements of cognitive behavioral protocols into a unified intervention directly targeting core temperamental features underlying these disorders of emotion, namely neuroticism and associated emotion dysregulation. The UP has since become a leading "transdiagnostic" treatment for emotional disorders, which is now available in several formats (e.g., individual, group, digital) and has accumulated a strong evidence base, leading to international implementation. There is now also research evidence that the UP can be flexibly applied to a range of clinical presentations, including borderline personality disorder, trauma- and stressor-related disorders, eating disorders, alcohol use disorder, and comorbid chronic physical health conditions. Yet additional research is needed to evaluate the UP in routine clinical settings, with more heterogeneous patient populations, and under circumstances that mirror actual clinical practice. Thus, we must also continue to explore the benefits of large-scale UP training initiatives and implementation in major healthcare systems. [ABSTRACT FROM AUTHOR]

• Sleep and circadian problems are often comorbid with mental disorders. • Sleep and circadian problems are mechanistic contributors to mental disorders. • TranS-C treats sleep and circadian problems across mental disorders via one protocol. • TranS-C is grounded in basic sleep and circadian science and existing EBPTs. • TranS-C includes cognitive-behavioral therapy for insomnia (CBT-I) The transdiagnostic intervention for sleep and circadian dysfunction (TranS-C) was developed to provide one protocol that treats a range of sleep and circadian problems across a range of mental disorders. The focus of TranS-C includes, and goes beyond, categorically defined sleep and circadian disorders to facilitate healthy sleep along empirically derived "sleep health" dimensions. In this State of the Science review, we highlight key advantages of a transdiagnostic approach to sleep and circadian problems, including (a) the potential to better understand and treat comorbidity between various sleep and circadian problems and mental disorders, as well as the potential to better understand and treat the heterogeneous sleep and circadian problems that are present within a specific mental disorder; (b) the opportunity to explore the hypothesis that sleep and circadian problems are an important transdiagnostic mechanism in the multifactorial maintenance of mental disorders; (c) the potential to transfer breakthroughs made across siloed areas of research and practice; (d) its suitability for dissemination into a broad range of settings, particularly lower resource settings; and (e) the opportunity to improve a range of important outcomes. We also explain the theoretical underpinnings of TranS-C, including the two-process model of sleep regulation and the Sleep Health Framework. TranS-C includes cognitive-behavioral therapy for insomnia (CBT-I) and we offer recommendations for when to use CBT-I versus TranS-C. The process for developing TranS-C is discussed along with outcome data, applications to underserved communities, and future directions for research. [ABSTRACT FROM AUTHOR]

• People living with HIV experience "syndemics." • Transdiagnostic treatment can address multiple psychiatric and medical problems. • Developed a transdiagnostic CBT treatment to address the needs of people living with HIV. • Treatment description and case examples are provided as a guide for clinicians. People living with HIV (PLWH) experience a range of co-occurring psychosocial stressors, mental health symptoms, and structural barriers (e.g., "syndemics") that can impair their ability to adhere to medical recommendations for treatment. This has consequences for their health and the health of others as nonadherence increases the likelihood of unsuppressed HIV viral load, and therefore the ability to transmit HIV to others. Transdiagnostic treatment, or treatment not focused on a single mental health condition, can efficiently address a range of mental health problems by skills training to reduce symptoms. Additionally, cognitive behavioral and problem-solving approaches can be used to address larger, structural factors by helping individuals navigate systemic challenges using evidence-based skills. This article describes the development of a transdiagnostic treatment for PLWH and illustrates the application of the treatment through case examples. This treatment might be appropriate for integration into an HIV clinic or within an outpatient setting when working with a patient who is experiencing syndemic conditions and living with HIV. [ABSTRACT FROM AUTHOR]

Autistic children frequently have one or more co‐occurring psychological, behavioral, or medical conditions. We examined relationships between child behaviors, sleep, adaptive behavior, autistic traits, mental health conditions, and health in autistic children using network analysis. Network analysis is hypothesis generating and can inform our understanding of relationships between multiple conditions and behaviors, directing the development of transdiagnostic treatments for co‐occurring conditions. Participants were two child cohorts from the Autism Treatment Network registry: ages 2–5 years (n = 2372) and 6–17 years (n = 1553). Least absolute‐shrinkage and selection operator (LASSO) regularized partial correlation network analysis was performed in the 2–5 years cohort (35 items) and the 6–17 years cohort (36 items). The Spinglass algorithm determined communities within each network. Two‐step expected influence (EI2) determined the importance of network variables. The most influential network items were sleep difficulties (2 items) and aggressive behaviors for young children and aggressive behaviors, social problems, and anxious/depressed behavior for older children. Five communities were found for younger children and seven for older children. Of the top three most important bridge variables, night‐waking/parasomnias and anxious/depressed behavior were in both age‐groups, and somatic complaints and sleep initiation/duration were in younger and older cohorts respectively. Despite cohort differences, sleep disturbances were prominent in all networks, indicating they are a transdiagnostic feature across many clinical conditions, and thus a target for intervention and monitoring. Aggressive behavior was influential in the partial correlation networks, indicating a potential red flag for clinical monitoring. Other items of strong network importance may also be intervention targets or screening flags. Lay Summary: Most autistic children also have other conditions and behaviors. These conditions and behaviors are often related to each other. Learning about important links between these conditions and behaviors may help us to offer better support for autistic children. We looked at how mental health, physical health, sleep, everyday skills, and autistic signs are linked. We found sleep problems and aggression were most strongly linked to other conditions and behaviors. Sleep problems were the most important condition; mood and anxiety were also important. Our findings can help people decide if an autistic child needs more support and help to develop and offer useful treatments. [ABSTRACT FROM AUTHOR]

The Beliefs about Losing Control Inventory (BALCI) was developed to assess negative beliefs about losing control in obsessive-compulsive disorder (OCD). Since its creation, research and theoretical work support negative beliefs about losing control as a potential transdiagnostic construct. The present study revised and expanded the original BALCI to be more inclusive of control-related concerns beyond those that would be expected in OCD (e.g. concerns about losing control over how one comes across to others in social anxiety disorder; SAD). Undergraduate students (N = 440) completed a questionnaire battery including the BALCI-II item pool. An exploratory factor analysis of the 32-item BALCI-II supported a four-factor solution. Three of the identified factors capture the feared consequences of losing control: 1) overwhelming emotions, 2) dangerous behaviour, and 3) madness. The fourth factor captures inflated beliefs about probability/severity of those losses. The BALCI-II was found to have good convergent and divergent validity, good to excellent internal, and retest reliability and was shown to have predictive utility in both OCD and SAD, above and beyond existing disorder-specific maladaptive belief domains. Results suggest the BALCI-II is an improvement over the previous version and supports the relevance of these beliefs beyond OCD. [ABSTRACT FROM AUTHOR]

Over the past two decades, it has become clear that psychopathology exists on continuous spectra organized hierarchically from broad, general symptom dimensions to more specific ones. This structure is best represented by the Hierarchical Taxonomy of Psychopathology (HiTOP) framework that incorporates individual signs, symptoms, and behaviors at its most specific level while encompassing higher-order dimensions at its broadest level. This commentary gives an overview of studies that evaluated higher-order dimensions of psychopathology and their alignment with the HiTOP framework. Studies consistently support the alignment of youth psychopathology with the HiTOP framework, particularly its general dimension of psychopathology and the broad internalizing and externalizing spectrum. The model also identifies distinct, lower-level dimensions such as fear, affectivity, antagonism, and attention problems. This hierarchical structure is evident across the entire age span but with specific makeup of dimensions appearing to differ between children and adolescents. Rapidly gaining momentum, current evidence indicates HiTOP's effectiveness in conceptualizing youth mental health. Future studies should focus on exploring the HiTOP structure across different ages and populations, testing its real-world generalizability, selecting the most appropriate assessment tools, and understanding how the framework applies to youth from diverse societies and cultures. [ABSTRACT FROM AUTHOR]

The present study aimed to examine the association between the presence, number, and type of positive psychotic symptoms (PPS) and clinical severity in adolescent patients. Five hundred-six patients aged 11–17 years were assigned to either the noPPS (n = 341), the delusional beliefs only (del; n = 32), the hallucinations only (hall; n = 80), or the delusional beliefs and hallucinations (del&hall; n = 53) group. Generalized Structural Equation Modeling was applied to identify the best-fitting model representing clinical severity indicated by psychiatric diagnoses, depressivity, personality pathology, non-suicidal self-injury, suicide attempts, perceived stress, and psychosocial impairments, assessed by interviews and questionnaires. The groups were compared concerning the final model's factors. The final model consisted of three factors representing psychopathology and functional impairments, self-harming behavior, and perceived stress (BIC difference to reference model: 103.99). Participants with any PPS scored higher on all factors than the noPPS group (differences in SD: 0.49–1.48). Additionally, the del&hall group scored 1.31 SD higher on psychopathology and functional impairments than the hall group, and 1.16 SD higher on self-harming behavior compared to the del group. Finally, the hall group scored 0.84 SD higher on self-harming behavior than the del group, with no group differences in the other factors. In adolescent patients, the presence of PPS may represent a marker for a more severe form of mental disorder, with hallucinations being indicative of self-harming behavior. Early transdiagnostic assessment of PPS seems indicated as it may inform treatment in the context of clinical staging. [ABSTRACT FROM AUTHOR]

Background: Deficits in mentalizing and attachment occur in the autism and schizophrenia spectrum, and their extended traits in the general population. Parental attachment and the broader social environment highly influence the development of mentalizing. Given the similarities in the symptomatology and neurodevelopmental correlates of autism spectrum disorder (ASD) and schizophrenia (SCH), it is crucial to identify their overlaps and differences to support screening, differential diagnosis, and intervention. Methods: This cross-sectional study utilized questionnaire data from 2203 adults (65.1% female, mean age[SD] = 37.98[9.66]), including participants diagnosed with ASD, SCH, and those exhibiting subclinical traits to investigate the associations between mentalizing, attachment, and perceived social support during adolescence across the autistic and schizotypy spectrum. Results: It was revealed that both autistic and schizotypal traits have comparable effects on insecure adult attachment, primarily through challenges in mentalizing. The impact of mentalizing deficits on adult attachment slightly varies between autistic and schizotypal traits. Conversely, perceived social support during adolescence relates to improved mentalizing and secure adult attachment as a protective factor during development. Conclusions: These outcomes highlight the significance of supportive therapeutic relationships and community care while suggesting directions for further research and collaborative treatments addressing ASD and SCH, considering the differential impact of mentalizing on adult attachment. [ABSTRACT FROM AUTHOR]

Background: Understanding the relationship between psychopathology and major domains of human neurobehavioral functioning may identify new transdiagnostic treatment targets. However, studies examining the interrelationship between psychopathological symptoms, sensorimotor, cognitive, and global functioning in a transdiagnostic sample are lacking. We hypothesized a close relationship between sensorimotor and cognitive functioning in a transdiagnostic patient sample. Methods: We applied network analysis and community detection methods to examine the interplay and centrality [expected influence (EI) and strength] between psychopathological symptoms, sensorimotor, cognitive, and global functioning in a transdiagnostic sample consisting of 174 schizophrenia spectrum (SSD) and 38 mood disorder (MOD) patients. All patients (n = 212) were examined with the Positive and Negative Syndrome Scale (PANSS), the Heidelberg Neurological Soft Signs Scale (NSS), the Global Assessment of Functioning (GAF), and the Brief Cognitive Assessment Tool for Schizophrenia consisted of trail making test B (TMT-B), category fluency (CF) and digit symbol substitution test (DSST). Results: NSS showed closer connections with TMT-B, CF, and DSST than with GAF and PANSS. DSST, PANSS general, and NSS motor coordination scores showed the highest EI. Sensory integration, DSST, and CF showed the highest strength. Conclusions: The close connection between sensorimotor and cognitive impairment as well as the high centrality of sensorimotor symptoms suggests that both domains share aspects of SSD and MOD pathophysiology. But, because the majority of the study population was diagnosed with SSD, the question as to whether sensorimotor symptoms are really a transdiagnostic therapeutic target needs to be examined in future studies including more balanced diagnostic groups. [ABSTRACT FROM AUTHOR]

In many everyday decisions, individuals choose between trialling something novel or something they know well. Deciding when to try a new option or stick with an option that is already known to you, known as the "explore/exploit" dilemma, is an important feature of cognition that characterises a range of decision-making contexts encountered by humans. Recent evidence has suggested preferences in explore/exploit biases are associated with psychopathology, although this has typically been examined within individual disorders. The current review examined whether explore/exploit decision-making represents a promising transdiagnostic target for psychosis, depression, and anxiety. A systematic search of academic databases was conducted, yielding a total of 29 studies. Studies examining psychosis were mostly consistent in showing that individuals with psychosis explored more compared with individuals without psychosis. The literature on anxiety and depression was more heterogenous; some studies found that anxiety and depression were associated with more exploration, whereas other studies demonstrated reduced exploration in anxiety and depression. However, examining a subset of studies that employed case-control methods, there was some evidence that both anxiety and depression also were associated with increased exploration. Due to the heterogeneity across the literature, we suggest that there is insufficient evidence to conclude whether explore/exploit decision-making is a transdiagnostic target for psychosis, depression, and anxiety. However, alongside our advisory groups of lived experience advisors, we suggest that this context of decision-making is a promising candidate that merits further investigation using well-powered, longitudinal designs. Such work also should examine whether biases in explore/exploit choices are amenable to intervention. [ABSTRACT FROM AUTHOR]

Chronic low-grade inflammation is observed across mental disorders and is associated with difficult-to-treat-symptoms of anhedonia and functional brain changes, reflecting a potential transdiagnostic dimension. Previous investigations have focused on distinct illness categories in people with enduring illness, but few have explored inflammatory changes. We sought to identify an inflammatory signal and the associated brain function underlying anhedonia among young people with recent-onset psychosis and recent-onset depression. Resting-state functional magnetic resonance imaging, inflammatory markers, and anhedonia symptoms were collected from 108 (mean [SD] age = 26.2 [6.2] years; female = 50) participants with recent-onset psychosis (n = 53) and recent-onset depression (n = 55) from the European Union/Seventh Framework Programme–funded PRONIA (Personalised Prognostic Tools for Early Psychosis Management) study. Time series were extracted using the Schaefer atlas, defining 100 cortical regions of interest. Using advanced multimodal machine learning, an inflammatory marker model and a functional connectivity model were developed to classify participants into an anhedonic group or a normal hedonic group. A repeated nested cross-validation model using inflammatory markers classified normal hedonic and anhedonic recent-onset psychosis/recent-onset depression groups with a balanced accuracy of 63.9% and an area under the curve of 0.61. The functional connectivity model produced a balanced accuracy of 55.2% and an area under the curve of 0.57. Anhedonic group assignment was driven by higher levels of interleukin 6, S100B, and interleukin 1 receptor antagonist and lower levels of interferon gamma, in addition to connectivity within the precuneus and posterior cingulate. We identified a potential transdiagnostic anhedonic subtype that was accounted for by an inflammatory profile and functional connectivity. Results have implications for anhedonia as an emerging transdiagnostic target across emerging mental disorders. [ABSTRACT FROM AUTHOR]

Prenatal maternal stress is linked to offspring outcomes; however, there is little research on adolescents, behavioral, transdiagnostic outcomes, or the mechanisms through which relations operate. We examined, in N = 268 adolescents (Mage = 15.31 years; SD = 1.063; 57.8% boys) whether prenatal maternal stress is associated with adolescent affective outcomes; whether this association is mediated, serially, by childhood home atmosphere and adolescent behavioral inhibition system (BIS) sensitivity; and whether mediational effects are moderated by adolescent attention-deficit/hyperactivity disorder or maternal internalizing symptomology. Prenatal maternal daily stress and major life events were associated with adolescent outcomes through childhood negative atmosphere/neglect and BIS sensitivity, with no evidence of moderation. Results have implications regarding the effect of prenatal maternal stress on offspring outcomes and regarding corresponding sensitive periods. [ABSTRACT FROM AUTHOR]

The Diagnostic Statistical Manual of Mental Disorders (DSM-5) recommends diagnosing neurocognitive disorders (i.e., cognitive impairment) when a patient scores beyond – 1 SD below neurotypical norms on two tests. I review how this approach will fail due to cognitive tests' power limitations, validity issues, imperfect reliabilities, and biases, before summarizing their resulting negative consequences. As a proof of concept, I use developmental prosopagnosia, a condition characterized by difficulties recognizing faces, to show the DSM-5 only diagnoses 62–70% (n1 = 61, n2 = 165) versus 100% (n1 = 61) through symptoms alone. Pooling the DSM-5 missed cases confirmed the presence of group-level impairments on objective tests, which were further evidenced through meta-analyses, thus validating their highly atypical symptoms. These findings support a paradigm shift towards bespoke diagnostic approaches for distinct cognitive impairments, including a symptom-based method when validated effective. I reject dogmatic adherence to the DSM-5 approach to neurocognitive disorders, and underscore the importance of a data driven, transdiagnostic approach to understanding patients' subjective cognitive impairments. This will ultimately benefit patients, their families, clinicians, and scientific progress. [ABSTRACT FROM AUTHOR]

The person-centered approach has provided numerous evidence for three clinically relevant personality types: a Resilient, an Undercontrolled, and an Overcontrolled type (RUO). The present study investigated whether (1) the RUO types could be identified within a large, diverse clinical population based upon transdiagnostical temperament factors, including Behavioral Approach and Inhibition Systems (BIS/BAS) and Effortful Control (EC), and (2) these types differed in terms of psychopathology. Self-report questionnaires, including the BIS/BAS scales, EC scale, Symptom-Checklist-90-Revised, and The Assessment of DSM-IV Personality Disorder, were administered to 2693 psychiatric inpatients. Based on a two-step cluster analysis we corroborated a Resilient (n = 959), an Undercontrolled/Dysregulated (n = 859), and an Overcontrolled/Inhibited (n = 875) type. The latter exhibited more internalizing psychopathology, whereas the undercontrolled/dysregulated type revealed more externalizing psychopathology. The resilient type showed the lowest levels of psychopathology. The present findings strengthen evidence that RUO typologies can be generalized across different psychopathologies and transdiagnostically shed light on the clinical importance of distinguishing subtypes to inform therapeutic interventions, which might possibly improve outcome and reduce relapse. [ABSTRACT FROM AUTHOR]

Discharge from psychiatric treatment has been established as an emotionally intense and vulnerable time for patients; however, to date no studies have investigated symptoms directly preceding discharge and the impact on post-discharge outcomes. Our primary aim was to assess the prevalence of elevations in depression and anxiety symptoms prior to discharge from a partial hospitalization program (PHP). Our secondary aim was to assess whether these pre-discharge elevations predict post-discharge outcomes. We analyzed daily depression and anxiety symptom severity from 4211 patients attending a PHP. Two subsamples (n = 113 and n = 70) completed post-discharge outcome measures of symptom severity, well-being, and/or functional impairment at two-weeks, one-month, and three-months post-discharge. Approximately two-thirds of patients demonstrated a significant increase in depression (p < .001) and anxiety (p < .001) symptom severity prior to discharge. These pre-discharge elevations did not significantly predict post-discharge measures when controlling for symptom severity at discharge. Our results suggest patients experience an increase in symptom severity preceding discharge, even after improvement; however, these elevations do not provide additional prognostic information. Clinicians may consider sharing these results with patients to normalize the experience of symptom elevation prior to discharge and highlight that it is not a prognostic indicator. [ABSTRACT FROM AUTHOR]

The advent of multiple transdiagnostic treatments in recent decades has advanced the field of clinical psychology while also raising questions for clinicians and patients about how to decide between treatments and how to best deliver a chosen treatment. The purpose of this paper is to review two prominent transdiagnostic treatments that target emotion dysregulation: dialectical behaviour therapy and the unified protocol for transdiagnostic treatment for emotional disorders. First, we review the theoretical underpinnings, research support and proposed mechanisms of action for these treatments. Next, we discuss patient and therapist variables that might indicate which treatment is more appropriate for a given patient and discuss decision‐making guidelines to help make this determination with an emphasis on complex patients who may present with risk and/or clinical comorbidities. Finally, we discuss areas for future research that can help further ensure we work to match patients to the treatment that is most likely to benefit them. [ABSTRACT FROM AUTHOR]

Objectives: The network approach to psychopathology posits that mental disorders emerge from dynamic interactions among psychopathology‐relevant variables. Ecological Momentary Assessment (EMA) is frequently used to assess these variables in daily life. Considering the transdiagnostic nature of the network approach to psychopathology, this study describes the development of a transdiagnostic EMA protocol for psychopathology. Methods: First, 96 clinicians completed an online survey, providing three EMA constructs for up to three disorders they specialize in, and three EMA constructs relevant across disorders (transdiagnostic constructs). Second, 12 focus groups were conducted with clinical experts for specific types of diagnoses (e.g., mood disorders, anxiety disorders). Finally, a selection of items was reached by consensus. Two raters independently coded the online survey responses with an inter‐rater agreement of 87.3%. Results: Jaccard indices showed up to 52.6% overlap in EMA items across types of diagnoses. The most frequently reported transdiagnostic constructs were mood, sleep quality, and stress. A final set of EMA items is created based on items' frequency and informativeness, ensuring completeness across diagnoses and minimizing burden. Conclusions: The described procedure resulted in a feasible EMA protocol to examine psychopathology transdiagnostically. Feasibility was helped by the overlap in mentioned symptoms across disorders. Such overlap raises questions about the validity of DSM categories. [ABSTRACT FROM AUTHOR]

Background: Gender clinic and single‐item questionnaire‐based data report increased co‐occurrence of gender diversity and neurodevelopmental conditions. The nuances of these associations are under‐studied. We used a transdiagnostic approach, combining categorical and dimensional characterization of neurodiversity, to further the understanding of its associations with gender diversity in identity and expression in children. Methods: Data from 291 children (Autism N = 104, ADHD N = 104, Autism + ADHD N = 17, neurotypical N = 66) aged 4–12 years enrolled in the Province of Ontario Neurodevelopmental Network were analyzed. Gender diversity was measured multi‐dimensionally using a well‐validated parent‐report instrument, the Gender Identity Questionnaire for Children (GIQC). We used gamma regression models to determine the significant correlates of gender diversity among age, puberty, sex‐assigned‐at‐birth, categorical neurodevelopmental diagnoses, and dimensional neurodivergent traits (using the Social Communication Questionnaire and the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Rating Scales). Internalizing and externalizing problems were included as covariates. Results: Neither a categorical diagnosis of autism nor ADHD significantly correlated with current GIQC‐derived scores. Instead, higher early‐childhood dimensional autistic social‐communication traits correlated with higher current overall gender incongruence (as defined by GIQC‐14 score). This correlation was potentially moderated by sex‐assigned‐at‐birth: greater early‐childhood autistic social‐communication traits were associated with higher current overall gender incongruence in assigned‐males‐at‐birth, but not assigned‐females‐at‐birth. For fine‐grained gender diversity domains, greater autistic restricted‐repetitive behavior traits were associated with greater diversity in gender identity across sexes‐assigned‐at‐birth; greater autistic social‐communication traits were associated with lower stereotypical male expression across sexes‐assigned‐at‐birth. Conclusions: Dimensional autistic traits, rather than ADHD traits or categorical neurodevelopmental diagnoses, were associated with gender diversity domains across neurodivergent and neurotypical children. The association between early‐childhood autistic social‐communication traits and overall current gender diversity was most evident in assigned‐males‐at‐birth. Nuanced interrelationships between neurodivergence and gender diversity should be better understood to clarify developmental links and to offer tailored support for neurodivergent and gender‐diverse populations. [ABSTRACT FROM AUTHOR]

Youth of parents who are experiencing psychopathology are more likely to develop emotional concerns, and these mental health symptoms can have a deleterious impact on parents' mental health. However, the relationship between the presentation of specific symptoms in parents and youth is infrequently examined. Symptom network analysis is an analytic approach that is increasingly being used to better understand the relationship of symptoms within and between disorders and can also be used to examine symptom relations within a dyad. The present study used symptom network analysis to examine bidirectional relationships among depressive and anxiety psychopathology in a transdiagnostic sample of treatment-seeking youth and their primary caregiver. Parental anhedonia and child worthlessness exhibited the greatest centrality within the network, suggesting that these may act as risk and maintenance factors for parent–child psychopathology and may be important intervention targets. Findings support the use of symptom network analysis to inform an understanding of the complex relationships among parent and child depressive and anxiety symptoms. Future research should consider the use of network analytic methods to examine the temporal relationships between parent and child psychopathology and to inform joint parent–child interventions for those with internalizing concerns. [ABSTRACT FROM AUTHOR]

Objectives: Theory and research suggest that distinct self‐damaging behaviours (SDBs; e.g., nonsuicidal self‐injury [NSSI], restrictive eating, binge eating, drug misuse, alcohol misuse) share similar motives. However, few studies have used a common self‐report inventory to investigate the shared relevance and relative salience of motives for SDBs. Accordingly, the present study: (1) examined whether self‐report scales assessing intrapersonal motives (i.e., relieving negative emotions, enhancing positive emotions, punishing oneself) and interpersonal motives (i.e., bonding with others, conforming with others, communicating distress, communicating strength, reducing demands) have invariant factor structures across SDBs; and (2) compared the salience of these motives across SDBs. Methods: 1018 adults (54.6% men, Mage = 35.41 years) with a history of SDBs were allocated to the following groups: NSSI (n = 213), restrictive eating (n = 200), binge eating (n = 200), drug misuse (n = 200) or alcohol misuse (n = 205). Participants reported on their motives for engaging in their allocated SDB. Measurement invariance analyses compared the factor structures and latent means of the motive scales across SDBs. Results: The motive scales had comparable factor structures across SDBs. Intrapersonal motives were most strongly endorsed for NSSI and drug misuse. Interpersonal motives were most strongly endorsed for drug and alcohol misuse. All motives were least salient to restrictive eating. Conclusions: Results suggest that common motives underlie distinct SDBs and that they can be adequately assessed using a single self‐report inventory. However, certain motives are more relevant to some SDBs than others, with restrictive eating being the most motivationally distinct SDB. This knowledge can inform transdiagnostic models and interventions for SDBs. [ABSTRACT FROM AUTHOR]

Abstract Over the past two decades, it has become clear that psychopathology exists on continuous spectra organized hierarchically from broad, general symptom dimensions to more specific ones. This structure is best represented by the Hierarchical Taxonomy of Psychopathology (HiTOP) framework that incorporates individual signs, symptoms, and behaviors at its most specific level while encompassing higher-order dimensions at its broadest level. This commentary gives an overview of studies that evaluated higher-order dimensions of psychopathology and their alignment with the HiTOP framework. Studies consistently support the alignment of youth psychopathology with the HiTOP framework, particularly its general dimension of psychopathology and the broad internalizing and externalizing spectrum. The model also identifies distinct, lower-level dimensions such as fear, affectivity, antagonism, and attention problems. This hierarchical structure is evident across the entire age span but with specific makeup of dimensions appearing to differ between children and adolescents. Rapidly gaining momentum, current evidence indicates HiTOP’s effectiveness in conceptualizing youth mental health. Future studies should focus on exploring the HiTOP structure across different ages and populations, testing its real-world generalizability, selecting the most appropriate assessment tools, and understanding how the framework applies to youth from diverse societies and cultures.

Abstract Background Deficits in mentalizing and attachment occur in the autism and schizophrenia spectrum, and their extended traits in the general population. Parental attachment and the broader social environment highly influence the development of mentalizing. Given the similarities in the symptomatology and neurodevelopmental correlates of autism spectrum disorder (ASD) and schizophrenia (SCH), it is crucial to identify their overlaps and differences to support screening, differential diagnosis, and intervention. Methods This cross-sectional study utilized questionnaire data from 2203 adults (65.1% female, mean age[SD] = 37.98[9.66]), including participants diagnosed with ASD, SCH, and those exhibiting subclinical traits to investigate the associations between mentalizing, attachment, and perceived social support during adolescence across the autistic and schizotypy spectrum. Results It was revealed that both autistic and schizotypal traits have comparable effects on insecure adult attachment, primarily through challenges in mentalizing. The impact of mentalizing deficits on adult attachment slightly varies between autistic and schizotypal traits. Conversely, perceived social support during adolescence relates to improved mentalizing and secure adult attachment as a protective factor during development. Conclusions These outcomes highlight the significance of supportive therapeutic relationships and community care while suggesting directions for further research and collaborative treatments addressing ASD and SCH, considering the differential impact of mentalizing on adult attachment.

Abstract Background Poor memory for treatment is associated with poorer treatment adherence and poorer patient outcomes. The memory support intervention (MSI) was developed to improve patient memory for treatment with the goal of improving patient outcomes. The aim of this study protocol is to conduct a confirmatory efficacy trial to test whether a new, streamlined, and potent version of the MSI improves outcomes for midlife and older adults. This streamlined MSI is comprised of constructive memory supports that will be applied to a broader range of treatment content. The platform for this study is the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C). We will focus on midlife and older adults who are low income and experiencing mobility impairments. Methods Participants (N = 178) will be randomly allocated to TranS-C + MSI or TranS-C alone. Both intervention arms include eight 50-min weekly sessions. Assessments will be conducted at pre-treatment, post-treatment, 6-, and 12-month follow-up (6FU and 12FU). Aim 1 will compare the effects of TranS-C + MSI versus TranS-C alone on sleep and circadian functioning, daytime functioning, well-being, and patient memory. Aim 2 will test whether patient memory for treatment mediates the relationship between treatment condition and patient outcomes. Aim 3 will evaluate if previously reported poor treatment response subgroups will moderate the relationship between treatment condition and (a) patient memory for treatment and (b) treatment outcome. Exploratory analyses will compare treatment condition on (a) patient adherence, patient-rated treatment credibility, and patient utilization of treatment contents, and (b) provider-rated acceptability, appropriateness, and feasibility. Discussion This study has the potential to provide evidence for (a) the efficacy of a new simplified version of the MSI for maintaining health, well-being, and functioning, (b) the wider application of the MSI for midlife and older adults and to the treatment of sleep and circadian problems, and (c) the efficacy of the MSI for sub-groups who are likely to benefit from the intervention. Trial registration ClinicalTrials.gov NCT05986604. Registered on 2 August 2023.

BACKGROUND: Since the COVID-19 pandemic, psychosocial therapies have been provided in varying formats, including remote, in-person, and hybrid services. It is unclear whether varying formats are similarly efficacious in improving psychiatric symptoms and functioning, lead to similar rates of treatment retention, and are equally acceptable to patients. This study compared youth with mood disorders and/or psychosis-risk syndromes who participated in a group cognitive behavioral therapy (CBT) in-person prior to COVID-19, to youth in the same treatment given remotely during the pandemic. METHODS: Adolescents ages 13-17 years participated in 9 sessions of group-based CBT given in-person (2018-2019) or remotely (2020-2021). Youth participants provided self-report ratings of psychiatric symptoms, psychosocial functioning, and emotional regulation at the study baseline and post-treatment and ratings of treatment satisfaction and burden at post-treatment. RESULTS: There were no differences between in-person and remote treatment improvements in psychiatric symptoms, psychosocial functioning or emotional regulation. However, youth in remote treatment had increased retention compared to youth who received treatment in person. Youth in the remote treatment reported similar levels of satisfaction but reported lower burden compared to those who received in-person treatment. LIMITATIONS: Participants were not randomized into remote or in-person treatment. Participants prior to COVID did not have the same frame of reference for alternative treatment delivery options as those during or post-COVID. CONCLUSIONS: Remote group treatment can provide similar levels of psychiatric benefit but less burden than in-person treatment for youth with mood disorders and/or psychosis-risk syndromes.

Sleep and circadian problems are intertwined with serious mental illness (SMI). Thus, optimizing treatments that target comorbid sleep and circadian problems and SMI is critical. Among adults with sleep and circadian problems and SMI, the present study conducted a secondary data analysis of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C). TranS-C targets a range of sleep and circadian problems and SMI with 15 modules, seven of which are optional. In a real world sample recruited from a community setting (N=121, 52.07% female, 42.97% African American or Black), we aimed to (1) elucidate patterns of sleep and circadian problems that met criteria for full diagnoses and subdiagnostic symptoms across (a) the full sample and (b) SMI diagnoses, and (2) determine whether TranS-C optional modules were delivered as intended based on participants sleep and circadian problems. Results indicated that most participants (> 85.0%) had full diagnoses or subdiagnostic symptoms of two or more sleep and circadian problems. Further, participants exhibited heterogenous comorbidities between sleep and circadian problems and SMI diagnoses. Specifically, participants with a schizophrenia spectrum disorder (n=50), bipolar disorder (n=35), and major depressive disorder (n=26) exhibited 25, 24, and 21 patterns of sleep and circadian comorbidity, respectively. Notably, most participants with insomnia, hypersomnia, and an advanced or delayed circadian rhythm phase disorder did not receive the intended TranS-C optional modules designed to target these problems. Results underscore sleep and circadian and SMI diagnostic complexity in the community. Additionally, findings reveal discrepancies between intended and real-world use of treatment modules. Future research investigating clinician decision-making-particularly when treating patients with comorbidities or using modularized treatments-is needed.

Models focusing on transdiagnostic mechanisms, such as repetitive negative thinking, may be of additive value to existing conceptualizations of obsessive-compulsive disorder (OCD). One such model is the Contrast Avoidance Model (CAM), which posits that individuals with generalized anxiety disorder (GAD) are sensitive to sharp increases in emotions, and use worry to maintain heightened states of negative arousal to avoid these emotional shifts. The current study used receiver operator characteristic (ROC) curve analyses to examine the predictive utility of two contrast avoidance questionnaires in detecting probable OCD. Undergraduate students (N = 2880) completed measures of contrast avoidance (CAQ-GE and CAQ-W) and obsessive-compulsive symptoms. A subset of participants were selected for the probable OCD group (n = 431) and the non-OCD group (n = 433). Results showed significant differences in total CAQ-GE and CAQ-W scores between the probable OCD group and the non-OCD group. Area under the curve values demonstrated excellent accuracy in predicting probable OCD on the CAQ-GE and CAQ-W, (.87 and.88, respectively). Correlation analyses for the entire screening sample revealed that certain OC symptom dimensions (e.g., Unacceptable Thoughts; Responsibility for Harm) were more closely associated with the CAQ-GE and the CAQ-W relative to other symptom dimensions. The study had a cross-sectional design and relied on an undergraduate sample. Identifying shared mechanisms across OCD and its comorbidities is an important and novel approach to understanding the etiology and maintenance of symptoms. • We tested the Contrast Avoidance Model in people with and without probable OCD. • People with probable OCD scored significantly higher on the CAQ-GE and CAQ-W relative to controls • Area under the curve values demonstrated excellent accuracy in predicting probable OCD on the CAQ-GE and CAQ-W • Optimal sensitivity and specificity was achieved at a cutoff score of 48.5 on the CAQ-GE and 73.5 on the CAQ-W • The unacceptable thoughts dimension was significantly more correlated with the CAQ-GE and CAQ-W than other dimensions [ABSTRACT FROM AUTHOR]

The most common reason for help-seeking in ultra-high risk (UHR) for psychosis patients is comorbid symptoms, mainly anxiety and depression. However, psychological interventions are mainly focused on subthreshold psychotic symptoms. There is a growing push to include transdiagnostic therapies in specialized intervention teams for psychosis in young people. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) has demonstrated efficacy in emotional disorders, and its application has recently expanded to other pathologies such as borderline personality disorder (BPD) and bipolar disorder (BD). This pilot study was conducted with 36 patients with UHR for psychosis and symptoms of comorbid emotional disorders who were receiving treatment in an early intervention programme for psychosis. This is a randomised control trial (RCT) with two conditions: treatment as usual (TAU) with the group and online application of the UP (UP+TAU) (n = 18) and TAU (n = 18). Evaluations were conducted at baseline, after treatment, and at the three-month follow-up. Comorbid anxiety and depression symptoms improved significantly in patients in the UP+TAU group compared to those in the TAU. Significant improvements in negative affect, emotional dysregulation, neuroticism, extraversion, functioning, and quality of life were also observed, and satisfaction with the intervention was high. UP may be an acceptable and effective intervention for the treatment of symptoms of comorbid emotional disorders in patients with UHR for psychosis. The sample size was small, and further studies are needed to test this intervention with larger samples of patients with UHR for psychosis with emotional comorbidities. • This is the first study about the efficacy of UP in UHR patients for psychosis. • UP was effective in reducing anxiety and depression symptoms in patients with UHR. • UP was effective in reducing negative affect and neuroticism in patients with UHR. • UP was effective in increasing positive affect, extraversion and emotion regulation. • Patients in the UP condition showed a tendency towards greater improvement in UHR symptoms. • Early intervention services for psychosis can benefit from integrating the UP. [ABSTRACT FROM AUTHOR]

Background: This study sought to determine whether cognitive disengagement syndrome (CDS, formerly sluggish cognitive tempo) has different external correlates relative to ADHD‐inattentive presentation (INP), ADHD‐hyperactive/impulsive presentation (HIP), and ADHD‐combined presentation (CP). Methods: Parents of a nationally representative sample of 5,525 Spanish youth (ages: 5–16, 56.1% boys) completed measures of CDS, ADHD‐inattention (IN), and ADHD‐hyperactivity/impulsivity (HI) and other measures. Scores greater/less than the top 5% on CDS, ADHD‐IN, and ADHD‐HI were used to create control (n = 5,013, 90.73%), CDS‐only (n = 131, 2.37%), ADHD‐INP‐only (n = 83, 1.50%), ADHD‐HIP‐only (n = 113, 2.05%), ADHD‐CP‐only (n = 48, 0.97%), CDS + ADHD‐INP (n = 44, 0.80%), CDS + ADHD‐HIP (n = 25, 0.45%), and CDS + ADHD‐CP (n = 68, 1.23%) groups. Results: Forty‐nine percent of youth with clinically elevated CDS did not qualify for any ADHD presentation, whereas 64% of youth with clinically elevated ADHD did not qualify for CDS. The CDS‐only group was higher than the ADHD‐INP‐only, ADHD‐HIP‐only, and ADHD‐CP‐only groups on anxiety, depression, somatization, daytime sleep‐related impairment, nighttime sleep disturbance, and peer withdrawal, whereas the CDS‐only and ADHD‐INP‐only groups did not differ on ODD (ADHD‐HIP‐only and ADHD‐CP‐only higher) and academic impairment (ADHD‐CP‐only higher than CDS‐only and ADHD‐HIP‐only lower than CDS‐only). The CDS‐only group also had higher rates of anxiety, depression, and bipolar disorder diagnoses than the ADHD‐only group. Conclusions: A distinction was found between CDS and each ADHD presentation, thus providing support for CDS as a syndrome that frequently co‐occurs with yet is distinct from each ADHD presentation. [ABSTRACT FROM AUTHOR]

The goal of this qualitative study was to understand the perspectives of school community members (adolescents, parents, school administrators, teachers, mental health providers) regarding the adaptation of an evidence-based transdiagnostic mental health treatment, known as the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents, for delivery in racially/ethnically diverse schools. Thirty-three school community members (n = 9 adolescents, n = 4 parents, n = 5 school administrators, n = 10 teachers, n = 5 mental health providers) participated in a series of focus groups or individual interviews. We used a rapid qualitative analysis to summarize their recommendations for adapting our intervention across seven themes: (1) consider social determinants of health, (2) include content related to social media and digital literacy, (3) provide teachers and staff with training on identifying and referring to mental health services and basic psychoeducation, (4) build trust and reduce stigma, (5) use qualified mental health providers to conduct culturally relevant sessions in person during school hours, (6) consider flexible format offerings and extended intervention delivery window, and (7) anticipate low parental engagement. These data were critical for informing systematic content and procedural modifications to our adapted intervention, such as scheduling sessions for school lunch hours and identifying coaches (e.g., teachers, school administrators) to support students with check-ins regarding session attendance and skill practice. These adaptations may be applied more broadly to the implementation of evidence-based mental health interventions in diverse school settings. [ABSTRACT FROM AUTHOR]

Abstract Background Most mental disorders have their onset in adolescence. Preventive interventions during this period are important; however, help-seeking behavior is generally poor in this age group resulting in low treatment rates. Internet interventions are expected to be an effective, low-threshold, and scalable approach to overcome barriers to help-seeking, particularly for individuals experiencing subclinical symptoms. Internet-delivered indicated prevention seems promising as it targets individuals with minimal symptoms of mental disorders who might need care but are not help-seeking yet. Previous indicated prevention-approaches have mainly targeted specific risk-syndromes. However, this contradicts the increasing recognition of emerging psychopathology as a complex system characterized by co-occurrence and rapid shifts of subclinical symptoms cutting across diagnostic categories. Therefore, this study will investigate the efficacy, mediators, moderators, and core symptomatic changes of a transdiagnostic Internet-delivered indicated prevention program (EMPATIA program) for adolescents. Methods This randomized controlled trial (RCT) will be conducted in a general population sample (planned n = 152) of adolescents aged 12–18 years with subclinical symptoms but without any current or past mental disorder. Participants will be randomly assigned to the EMPATIA program or a care as usual (CAU) control condition. The 8-week guided EMPATIA program encompasses 8 modules targeting the following transdiagnostic mechanisms: repetitive negative thinking, self-perfectionism, emotion regulation, intolerance of uncertainty, rejection sensitivity, and behavioral avoidance. Participants will be asked to answer online self-report questionnaires at baseline, after 8 weeks, and at 6-, 9-, and 12-month follow-up. Diagnostic telephone interviews will be conducted at baseline and at 12-month follow-up. Additionally, intervention-specific constructs (motivation, alliance, negative effects, satisfaction, adherence) will be assessed during and after the EMPATIA program. The level of self-reported general psychopathology post-intervention is the primary outcome. Discussion Results will be discussed considering the potential of Internet interventions as a scalable, low-threshold option for indicated prevention in adolescents experiencing subclinical symptoms. The EMPATIA program introduces a novel Internet prevention program targeting six transdiagnostic mechanisms associated with various mental health outcomes. Thereby, this trial pursues a very timely and important topic because it may contribute to narrow the current care gap for adolescents, to prevent mental health problems and related negative consequences, and to promote mental health in the long-term. Trial registration The trial was approved by Swissmedic (Registration Number: 10001035, 08/22/2022) and the Ethics Committee of Bern (Registration Number: 2022-D0036, 08/22/2022). The trial was registered at ClinicalTrials.gov NCT05934019 on 07–03-2023.

Impulsivity increases the risk for depression and anxiety. However, the granular pathways among them remain unknown. A network approach that moves from disorder-level analysis to symptom-level analysis can provide further understanding of psychopathological mechanisms. In this study, we examined the network structure of impulsivity and separate and comorbid symptoms of depression and anxiety. Regularized partial-correlation networks were estimated using cross-sectional data from 1047 Chinese participants aged 18–26 years (main dataset, mean age = 21.45 ± 2.01 years) and 325 Chinese participants aged 18–36 years (an independent replication dataset, mean age = 21.49 ± 3.73 years), including impulsivity-depression, impulsivity-anxiety, and impulsivity-depression-anxiety networks. The datasets were collected from 1 June 2023 to 4 August 2023 and from 27 April 2022 to 16 May 2022, respectively. Impulsivity, depression, and anxiety were assessed using Barratt Impulsiveness Scale Version 11, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7, respectively. Bridge centrality was analyzed, and a network comparison test (NCT) was conducted to investigate the differences between the main dataset and replication dataset. The motor impulsivity dimension was revealed to be closely connected with individual symptoms of depression and anxiety regardless of whether they were in separate disorder forms or comorbid forms. In all the networks, motor impulsivity was the most important bridge node. The NCT showed comparable network connectivity and network structure between the main and replication datasets. The use of cross-sectional data limited the inferences about the direction of causality between variables. These findings elucidate the psychopathological mechanisms underlying how impulsivity functions within depression, anxiety, and comorbidity and support that motor impulsivity is an important risk factor across different mental disorders and is responsible for comorbidity. The implications of these findings are discussed. • The links of impulsivity with depression, anxiety and comorbidities were examined. • Motor impulsivity was strongly associated with depression and anxiety symptoms. • Motor impulsivity was a risk factor across depression, anxiety, and comorbidity. • Disorders and comorbidity were understood from the perspective of impulsivity. • Network connectivity and structure showed no significant difference (p s ≥ 0.10). [ABSTRACT FROM AUTHOR]

Background Neurocognitive dysfunction is a transdiagnostic finding in psychopathology, but relationships among cognitive domains and general and specific psychopathology dimensions remain unclear. This study aimed to examine associations between cognition and psychopathology dimensions in a large youth cohort. Method The sample (N = 9350; age 8–21 years) was drawn from the Philadelphia Neurodevelopmental Cohort. Data from structured clinical interviews were modeled using bifactor confirmatory factor analysis (CFA), resulting in an overall psychopathology ('p') factor score and six orthogonal psychopathology dimensions: dysphoria/distress, obsessive-compulsive, behavioral/externalizing, attention-deficit/hyperactivity, phobias, and psychosis. Neurocognitive data were aggregated using correlated-traits CFA into five factors: executive functioning, memory, complex cognition, social cognition, and sensorimotor speed. We examined relationships among specific and general psychopathology dimensions and neurocognitive factors. Results The final model showed both overall and specific associations between cognitive functioning and psychopathology, with acceptable fit (CFI = 0.91; TLI = 0.90; RMSEA = 0.024; SRMR = 0.054). Overall psychopathology and most psychopathology dimensions were negatively associated with neurocognitive functioning (phobias [ p < 0.0005], behavioral/externalizing [ p < 0.0005], attention-deficit/hyperactivity [ p < 0.0005], psychosis [ p < 0.0005 to p < 0.05]), except for dysphoria/distress and obsessive-compulsive symptoms, which were positively associated with complex cognition (p < 0.05 and p < 0.01, respectively). Conclusion By modeling a broad range of cognitive and psychopathology domains in a large, diverse sample of youth, we found aspects of neurocognitive functioning shared across clinical phenotypes, as well as domain-specific patterns. Findings support transdiagnostic examination of cognitive performance to parse variability in the link between neurocognitive functioning and clinical phenotypes. [ABSTRACT FROM AUTHOR]

Graduate students frequently experience anxiety, depression, and psychological distress. Counseling centers struggle to meet this need. Brief, skills-based treatments to mitigate burgeoning or mild mental health problems could alleviate this problem. Participants were 51 graduate students in years one through seven of their respective programs. We examined a single-session virtual cognitive behavioral workshop and outcomes up to 6-months later. The program was feasible, acceptable, and beneficial for mood, anxiety, and emotion regulation, even during the COVID-19 pandemic. A majority of participants reported ongoing skills use at follow-up. Primary barriers to more frequent use were forgetting, time constraints, and difficulty when experiencing strong emotions. Few participants endorsed expecting that skills would not be helpful or forgetting how to use skills. This intervention may provide scalable, much needed aid to graduate schools. Moreover, results highlight opportunities for further enhancing brief interventions. [ABSTRACT FROM AUTHOR]

Background The DSM Level 1 Cross-Cutting Symptom Measure (DSM-XC) allows for assessing multiple psychopathological domains. However, its capability to screen for mental disorders in a population-based sample and the impact of adverbial framings (intensity and frequency) on its performance are unknown. Methods The study was based on cross-sectional data from the 1993 Pelotas birth cohort in Brazil. Participants with completed DSM-XC and structured diagnostic interviews (n = 3578, aged 22, 53.6% females) were included. Sensitivity, specificity, positive (LR+), and negative (LR−) likelihood ratios for each of the 13 DSM-XC domains were estimated for detecting five internalizing disorders (bipolar, generalized anxiety, major depressive, post-traumatic stress, and social anxiety disorders) and three externalizing disorders (antisocial personality, attention-deficit/hyperactivity, and alcohol use disorders). Sensitivities and specificities >0.75, LR+ > 2 and LR− < 0.5 were considered meaningful. Values were calculated for the DSM-XC's original scoring and for adverbial framings. Results Several DSM-XC domains demonstrated meaningful screening properties. The anxiety domain exhibited acceptable sensitivity and LR− values for all internalizing disorders. The suicidal ideation, psychosis, memory, repetitive thoughts and behaviors, and dissociation domains displayed acceptable specificity for all disorders. Domains also yielded small but meaningful LR+ values for internalizing disorders. However, LR+ and LR− values were not generally meaningful for externalizing disorders. Frequency-framed questions improved screening properties. Conclusions The DSM-XC domains showed transdiagnostic screening properties, providing small but meaningful changes in the likelihood of internalizing disorders in the community, which can be improved by asking frequency of symptoms compared to intensity. The DSM-XC is currently lacking meaningful domains for externalizing disorders. [ABSTRACT FROM AUTHOR]

The transdiagnostic approach to psychopathology has emerged as an alternative to traditional taxonomic approaches. The Multidimensional Emotional Disorders Inventory (MEDI) is a specifically designed self-report to measure the transdiagnostic dimensions proposed by Brown and Barlow (2009). This study aims to analyse the psychometric properties of the MEDI scores in adolescents with subthreshold anxiety and depression. The sample consisted of a total of 476 students. The mean age was 13.77 years (SD = 1.43) (range 10 to 18 years), 73.9 % were females. Several questionnaires assessing positive affect, negative affect, mental health difficulties, and quality of life were used. The original 9-factor structure of the MEDI was confirmed with good fit indices. Satisfactory levels of internal consistency were observed in most of the MEDI scores using McDonald's Omega, ranging from 0.58 to 0.87. The MEDI dimensions were associated with psychopathology, positive affect, negative affect, and quality of life. Reliance on self-reported data, a cross-sectional design limiting temporal assessment, and a 73.9 % female gender imbalance. The MEDI scores showed adequate psychometric properties among adolescents with subclinical emotional symptoms. The results found might have potential clinical implications for conceptualization, assessment, intervention, and prevention of emotional disorders at both clinical and research levels. • Emotional disorders and symptoms constitute one of the major public health challenges among youths. • The transdiagnostic approach to psychopathology has emerged as an alternative to traditional taxonomic approaches. • MEDI scores showed adequate psychometric properties among adolescents with subclinical emotional symptoms. • MEDI is a useful tool for assessing transdiagnostic dimensions of emotional disorders in young people. [ABSTRACT FROM AUTHOR]

Background: Emotion regulation tendencies are well-known transdiagnostic markers of psychopathology, but their neurobiological foundations have mostly been examined within the theoretical framework of cortical–subcortical interactions. Methods: We explored the connectome-wide neural correlates of emotion regulation tendencies using functional and diffusion magnetic resonance images of healthy young adults (N = 99; age 20–30; 28 females). We first tested the importance of considering both the functional and structural connectome through intersubject representational similarity analyses. Then, we employed a canonical correlation analysis between the functional–structural hybrid connectome and 23 emotion regulation strategies. Lastly, we sought to externally validate the results on a transdiagnostic adolescent sample (N = 93; age 11–19; 34 females). Results: First, interindividual similarity of emotion regulation profiles was significantly correlated with interindividual similarity of the functional–structural hybrid connectome, more so than either the functional or structural connectome. Canonical correlation analysis revealed that an adaptive-to-maladaptive gradient of emotion regulation tendencies mapped onto a specific configuration of covariance within the functional–structural hybrid connectome, which primarily involved functional connections in the motor network and the visual networks as well as structural connections in the default mode network and the subcortical–cerebellar network. In the transdiagnostic adolescent dataset, stronger functional signatures of the found network were associated with higher general positive affect through more frequent use of adaptive coping strategies. Conclusions: Taken together, our study illustrates a gradient of emotion regulation tendencies that is best captured when simultaneously considering the functional and structural connections across the whole brain. [ABSTRACT FROM AUTHOR]

• Youth treated in acute psychiatric settings are diagnostically heterogeneous. • Transdiagnostic CBT is acceptable to families in acute psychiatric settings. • Transdiagnostic CBT is associated with clinically meaningful symptom improvements. • Transdiagnostic CBT is associated with improvements in functioning and regulation. Acute mental health treatment (e.g., partial hospitalization or PHP) is a critical component of the mental health services landscape for youth whose symptoms are too acute for a typical outpatient setting, but for whom inpatient psychiatric hospitalization is not recommended or desired. Very few interventions have been developed, adapted for, or evaluated in these fundamentally different delivery contexts. Transdiagnostic treatments may be ideal for addressing the comorbidity, complexity, and heterogeneity typical of acute mental health settings. Our aim was to examine initial acceptability and effectiveness of an adaptation of the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A; Ehrenreich-May, Kennedy, et al., 2017), delivered as part of comprehensive therapeutic programming in a general psychiatric PHP. We recruited 152 youths (M age = 13.1 years, 62.5% female) and caregivers, who participated in an average of 11 days of intensive UP-C/A intervention. Participants rated symptoms and functioning at baseline, weekly, posttreatment, and 1-month follow-up. Latent growth curve modeling was used to examine patterns of change and evaluate the impact of potential demographic and treatment-related covariates. For all outcomes, a quadratic model best fit the data, with symptoms and emotional reactivity decreasing significantly during treatment and then leveling off during follow-up. There was a medium-sized change in functional impairment from baseline to the 1-month follow-up, and ≥90% of participants reported treatment as acceptable and helpful. Results provide initial support for use of a transdiagnostic, cognitive-behavioral intervention in acute mental health settings and suggest important future directions, including controlled trials and investigation of implementation supports. [ABSTRACT FROM AUTHOR]

The Unified Protocol (UP) theoretically leads to reductions in emotional disorder symptoms by reducing aversive reactions to emotions. However, aversive reactions can take many forms (e.g., non-acceptance, behavioral avoidance). We examined if (1) multiple aspects of aversive reactivity predicted session-to-session changes in anxiety and depression in the UP, (2) these aspects reflected a single latent construct, and (3) changes in this latent construct predicted changes in anxiety and depression. Participants (N = 70, Mage = 33.74, 67.1% female, 74.3% white) completed six sessions of UP modules and measures of aversive reactivity, anxiety, and depression before each session. We used hierarchical linear modeling and random-intercept cross-lagged panel models to test aspects of aversive reactivity and a latent factor of aversive reactivity, respectively, as predictors of session-to-session changes in anxiety and depression. Within-person improvements in four of five aspects of aversive reactivity predicted decreases in anxiety, and improvements in two aspects predicted decreases in depression. However, within-person improvements in latent aversive reactivity predicted decreases in anxiety at five sessions and in depression across all sessions. These results add to the growing literature highlighting the role of aversive reactivity as a potential transdiagnostic process involved in improvements in emotional disorder symptoms during treatment. [ABSTRACT FROM AUTHOR]

Meta-analyses of mindfulness-based interventions (MBIs) in schools consistently show small, positive effects, but the field remains dominated by studies with low methodological rigour. Recent large randomised controlled trials in adolescents demonstrate poor traction in this age group together with some adverse effects, creating a crossroads for their future. In their recent commentary on the null effects of the MYRIAD trial (Kuyken et al., 2022), Strohmaier and Bailey (2023) postulated that making mindfulness practice available within the school day may increase the dosage and benefits of MBIs for adolescents, and called for funders to direct efforts at developing and testing this approach. We agree that identifying ways to increase dose beyond weekly classroom lessons is important, but explore whether this suggestion is practical or developmentally appropriate for secondary school settings. Our commentary broadens to group together other large and moderately large RCTs that have also shown disappointing results in adolescents, and presents seven barriers that together may be compounding the lack of effect in this age group. We offer alternative suggestions for future school-based research and delivery of MBIs. [ABSTRACT FROM AUTHOR]

Background and Hypothesis Symptoms that precede a first episode of psychosis (FEP) can ideally be targeted by early intervention services with the aim of preventing or delaying psychosis onset. However, these precursor symptoms emerge in combinations and sequences that do not rest fully within traditional diagnostic categories. To advance our understanding of illness trajectories preceding FEP, we aimed to investigate combinations and temporal associations among precursor symptoms. Study Design Participants were from PEPP-Montréal, a catchment-based early intervention program for FEP. Through semistructured interviews, collateral from relatives, and a review of health and social records, we retrospectively measured the presence or absence of 29 precursor symptoms, including 9 subthreshold psychotic and 20 nonpsychotic symptoms. Sequences of symptoms were derived from the timing of the first precursor symptom relative to the onset of FEP. Study Results The sample included 390 participants (68% men; age range: 14–35 years). Combinations of precursor symptoms most frequently featured depression, anxiety, and substance use. Of 256 possible pairs of initial and subsequent precursor symptoms, many had asymmetrical associations: eg, when the first symptom was suspiciousness, the incidence rate ratio (IRR) of subsequent anxiety was 3.40 (95% confidence interval [CI]: 1.79, 6.46), but when the first symptom was anxiety, the IRR of subsequent suspiciousness was 1.15 (95% CI: 0.77, 1.73). Conclusions A detailed examination of precursor symptoms reveals diverse clinical profiles that cut across diagnostic categories and evolve longitudinally prior to FEP. Their identification may contribute to risk assessments and provide insights into the mechanisms of illness progression. [ABSTRACT FROM AUTHOR]

AbstractObjective:Method:Results:Conclusion:The network approach implies that the persistence of a mental disorder is rooted in a dense causal interconnection of symptoms. This study attempts to replicate and generalize previous findings in support of the assumption that higher density predicts poorer outcomes. The study examines the predictive value of network density at admission for recovery after inpatient treatment.N = 1375 adult patients with various forms of mental illness were classified as recovered (28%) versus not recovered (72%) after inpatient treatment. Recovery was defined as clinically significant improvement in impairment from admission to discharge. Networks of transdiagnostic symptoms at the time of admission were estimated. Network density, measured by global strength d, was compared between the recovered and not recovered groups using a permutation test.Global strength at the time of admission tended to be higher in the No-Recovery group (d = 10.83) than the Recovery group (d = 7.53) but the association was not significant (p = .12). Similar results were found after controlling for group size and symptom severity.The predictive value of network density for treatment outcomes remains unclear. There might be structural differences between the groups that the current measure of network density does not adequately represent. [ABSTRACT FROM AUTHOR]

Background: Recent research has found a strong link between loneliness and social anxiety above and beyond other psychological constructs. Given these strong relationships, the present study sought to determine if mechanisms that maintain social anxiety may also play a role in loneliness. Specifically, the present study used two samples to explore the role of social safety behavior (SBs; behaviors intended to avoid, prevent, or manage threat) in loneliness. Methods: In Study 1, we explored this relationship in an unselected sample (N = 98). In Study 2, participants (N = 132) with elevated social anxiety were randomized to a two-week SB fading manipulation or a no-instruction control. Results: SBs were positively associated with loneliness, independent of co-occurring social anxiety. Further, changes in SBs were associated with changes in loneliness one-month later, and social anxiety was no longer significantly associated with loneliness once SBs were entered in these models. SB fading led to significantly lower loneliness at post-manipulation, relative to the control condition, though this effect was only found in individuals high in baseline loneliness. Additionally, a moderated mediation model found that for individuals high in pre-manipulation loneliness, change in loneliness was accounted for by change in negative interpretation bias, a key mechanism in both loneliness and social anxiety. Conclusions: Taken together, these findings indicate that targeting SB may be a viable method of addressing loneliness, though further research is needed. [ABSTRACT FROM AUTHOR]