Efficacy of a novel, accessible, transdiagnostic, compassion-focused ecological momentary intervention for enhancing resilience in help-seeking youth
Final Report Abstract
Most mental disorders first emerge in youth and, as such, contribute substantially to global disease burden. Psychological help, however, remains difficult to access for youth and has limited efficacy under real-world conditions, calling for novel approaches. Digital interventions targeting transdiagnostic mechanisms in daily life may be a promising translational strategy for prevention and early intervention of severe mental health conditions in young people. Elevated stress reactivity is one of the most widely studied transdiagnostic mechanisms underlying a range of mental health problems. Thus, targeting this mechanism reflects a promising indicated strategy for preventing adverse outcomes later in life. Compassion-Focused Interventions (CFIs) offer a wide range of innovative preventive and therapeutic techniques for targeting stress reactivity and enhancing emotional resilience. Further, the recent rapid technological advances provide a unique opportunity to deliver youth-friendly, accessible, personalized, realtime, mobile health (mHealth) interventions, most prominently, ecological momentary interventions (EMIs) that enable youth to access interventions that are tailored to what a young person needs in a given moment and context in daily life. This project aimed to examine the feasibility and initial signals of efficacy of a novel, accessible, transdiagnostic, ecological momentary, compassion-focused intervention for improving emotional resilience to stress (EMIcompass) in youth with early mental health problems. 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 only). Data on primary (stress reactivity) and secondary candidate mechanisms as well as candidate primary (psychological distress) and secondary outcomes were collected at baseline, postintervention, and 4-week follow-up. We found that criteria for feasibility of trial methodology and intervention delivery were met (n=92 randomised participants). In addition, no serious adverse events were observed. We further found initial signals of efficacy for reduced momentary stress reactivity (primary candidate mechanism) and aberrant salience as well as enhanced momentary resilience and quality of life. No signals of efficacy were evident for selfreported psychological distress (candidate primary outcome) and general psychopathology, but there was suggestive evidence on an initial signal of reduced observer-rated symptoms at post-intervention. Overall, our findings provide evidence on the feasibility and safety of our trial methodology and intervention delivery. Evidence from this exploratory RCT further suggests initial signals that EMIcompass may reduce stress reactivity and enhance both resilience in daily life and quality of life in youth as priority target population. A definitive multi-centre RCT is now warranted as an important next step with appropriate design elements and strategies for implementation in routine public mental health services. This will provide the basis for addressing the longrecognized but still often neglected research-to-practice gap for this novel EMI at an early stage, with the goal of transfer, uptake, and scale-up of EMIcompass as an evidence-based innovation generated along the translational chain from risk and protective mechanisms to improving population mental health.
Publications
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A Compassion-Focused Ecological Momentary Intervention for Enhancing Resilience in Help-Seeking Youth: Uncontrolled Pilot Study. JMIR Mental Health, 8(8), e25650.
Rauschenberg, Christian; Boecking, Benjamin; Paetzold, Isabell; Schruers, Koen; Schick, Anita; van Amelsvoort, Thérèse & Reininghaus, Ulrich
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Effects of a Novel, Transdiagnostic, Hybrid Ecological Momentary Intervention for Improving Resilience in Youth (EMIcompass): Protocol for an Exploratory Randomized Controlled Trial. JMIR Research Protocols, 10(12), e27462.
Schick, Anita; Paetzold, Isabell; Rauschenberg, Christian; Hirjak, Dusan; Banaschewski, Tobias; Meyer-Lindenberg, Andreas; Boehnke, Jan R.; Boecking, Benjamin & Reininghaus, Ulrich
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A Hybrid Ecological Momentary Compassion–Focused Intervention for Enhancing Resilience in Help-Seeking Young People: Prospective Study of Baseline Characteristics in the EMIcompass Trial. JMIR Formative Research, 6(11), e39511.
Paetzold, Isabell; Schick, Anita; Rauschenberg, Christian; Hirjak, Dusan; Banaschewski, Tobias; Meyer-Lindenberg, Andreas; Butz, Sebastian; Floesser, Chiara; Schueltke, Leonie; Boehnke, Jan Rasmus; Boecking, Benjamin & Reininghaus, Ulrich
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Effects of a Novel, Transdiagnostic Ecological Momentary Intervention for Prevention, and Early Intervention of Severe Mental Disorder in Youth (EMIcompass): Findings From an Exploratory Randomized Controlled Trial. Schizophrenia Bulletin, 49(3), 592-604.
Reininghaus, Ulrich; Paetzold, Isabell; Rauschenberg, Christian; Hirjak, Dusan; Banaschewski, Tobias; Meyer-Lindenberg, Andreas; Boehnke, Jan R.; Boecking, Benjamin & Schick, Anita
