Learning to Bounce Back? – Current Evidence From a Systematic Cochrane Review on Resilience Interventions in Healthcare Professionals and a Pilot Study on a Mobile-Based Positivity Bias Training

Background. There is an increasing interest in interventions to foster resilience, that is, the maintenance or quick recovery of mental health despite adversities. Healthcare professionals (HCP), exposed to various work-related stressors, are at an elevated risk of mental disorders and might benefit from such programs. Due to methodological weaknesses, previous reviews cannot answer the question of which interventions are really effective in HCP and how they should be implemented. Besides stressor exposure, biases in information processing may also determine mental health, with a focus on the reduction of negativity biases in previous research. Although a positivity bias (PB) is viewed as protective factor that might also facilitate a resilient response to stressors, training approaches to foster a PB have been neglected, especially at the level of action tendencies. Objectives. Overall, this thesis addresses the question of whether interventions to foster resilience are effective in improving resilience and mental health by the following two objectives: 1) To synthesize the evidence on the efficacy of resilience training (i.e., trainings fostering one or several resilience factors) in HCP and to explore the potential moderating role of intervention characteristics (e.g., setting), in order to assess the meaning of these programs. 2) To develop a mobile-based positivity training at the level of action tendencies using various affective stimuli which solely focuses on the resilience factor of PB and whose feasibility and effects are evaluated. Methods. Two complementary approaches were used. First, a systematic Cochrane review and meta-analysis was conducted. CENTRAL, MEDLINE, Embase, 11 other databases, and three trial registries were searched from 1990 to June 2019, with reference lists being checked and researchers in the field contacted. Randomized controlled trials (RCTs) in adults aged ≥ 18 years who are employed as HCP, comparing any form of psychological intervention to foster resilience, hardiness, or posttraumatic growth against a comparator, were eligible. Primary outcomes were resilience and mental health, secondary outcomes were resilience factors. Study selection, data extraction, quality assessment, and the rating of the certainty of evidence were performed in duplicate. Random-effects meta-analyses were conducted along with preplanned subgroup and sensitivity analyses. Second, in the empirical pilot study TRAIN4Positivity (single-group design), N = 41 healthy participants (university students) exposed to many microstressors underwent the three-week mobile-based intervention called “Breezly”. Based on the modified Approach Avoidance Task (AAT) and using pictures from validated databases, “Breezly” included daily sessions of picture training. Using a pre- and postassessment with Ecological Momentary Assessment (EMA) throughout the intervention, perceived stress and the perceived severity of microstressors served as primary outcomes, with the latter being compared to a (matched) historical control group (N = 70). Secondary outcomes included implicit action tendencies, measures of resilience and well-being, psychological EMA outcomes (e.g., mood), cognitive reappraisal, and emotional experience. Data were analyzed using various methods (e.g., multilevel modeling). Results. Overall, both projects provided mixed results concerning the positive effects of interventions to foster resilience. In the systematic review, 44 RCTs were identified, with 39 solely in HCP (N = 6,974) and four in mixed samples (N = 1,000). Most studies investigated high-intensity group interventions, delivered face-to-face, and based on combined theoretical foundations. At postintervention, very-low certainty evidence indicated that, compared to controls, HCP receiving resilience training may report higher levels of resilience and lower levels of depression, and stress. There was little or no evidence for any effect on anxiety and well-being. Effect sizes were small to moderate, with the positive effects maintained within 3 months after training, but mostly not evident at longer follow-ups. Data on undesired events were only available for three studies, with none reporting any adverse effects. Subgroup analyses showed no consistent effect modifiers. Controlled for stressor exposure and the baseline attributional style, the app-based study found no evidence for any training effects on the above-mentioned outcomes, with the changes in action tendencies not moderated by attributional style. Only the ability to distance from negative stimuli partly improved. Conclusions. Both projects contribute to resilience intervention research. The systematic review provides very-low certainty evidence that resilience training may result in higher levels of resilience, lower levels of depression, stress, and higher levels of certain resilience factors at postintervention, with the effects mostly sustained in the short-term. The paucity of medium- and long-term data, restricted geographical distribution, and heterogeneous interventions limit the generalizability of results; thus, conclusions should be drawn carefully. A need for high-quality replications and improved study designs is implied. Second, the findings of the pilot study indicate that the app-based training is feasible, but did not change most of the psychological outcomes, partly attributable to (methodological, intervention) limitations. The results arise the question of the suitability of the AAT as a measure of PB at the action level. Given the tendency for improvements for several outcomes, there is a need for further research to develop the training and examine its efficacy, for example in (stressor-exposed) individuals like HCP.XXIII, 468 Seite

Interventions to Ameliorate the Psychosocial Effects of the COVID-19 Pandemic on Children-A Systematic Review

The aim of this study was to identify interventions targeting children and their caregivers to reduce psychosocial problems in the course of the COVID-19 pandemic and comparable outbreaks. The review was performed using systematic literature searches in MEDLINE, Embase, PsycINFO and COVID-19-specific databases, including the CDC COVID-19 Research Database, the World Health Organisation (WHO) Global Database on COVID-19 Research and the Cochrane COVID-19 Study Register, ClinicalTrials.gov, the EU Clinical Trials Register and the German Clinical Trials Register (DRKS) up to 25th September 2020. The search yielded 6657 unique citations. After title/abstract and full text screening, 11 study protocols reporting on trials planned in China, the US, Canada, the UK, and Hungary during the COVID-19 pandemic were included. Four interventions targeted children \geq10 years directly, seven system-based interventions targeted the parents and caregivers of younger children and adolescents. Outcome measures encompassed mainly anxiety and depressive symptoms, different dimensions of stress or psychosocial well-being, and quality of supportive relationships. In conclusion, this systematic review revealed a paucity of studies on psychosocial interventions for children during the COVID-19 pandemic. Further research should be encouraged in light of the expected demand for child mental health management

Interrelations of resilience factors and their incremental impact for mental health: insights from network modeling using a prospective study across seven timepoints

Resilience can be viewed as trajectory of stable good mental health or the quick recovery of mental health during or after stressor exposure. Resilience factors (RFs) are psychological resources that buffer the potentially negative effects of stress on mental health. A problem of resilience research is the large number of conceptually overlapping RFs complicating their understanding. The current study sheds light on the interrelations of RFs in the face of the COVID-19 pandemic as a use case for major disruptions. The non-preregistered prospective study assessed a sample of 1275 German-speaking people from February 2020 to March 2021 at seven timepoints. We measured coping, hardiness, control beliefs, optimism, self-efficacy, sense of coherence (SOC), sense of mastery, social support and dispositional resilience as RFs in February 2020, and mental health (i.e., psychopathological symptoms, COVID-19-related rumination, stress-related growth) at all timepoints. Analyses used partial correlation network models and latent growth mixture modeling (LGMM). Pre-pandemic RFs were strongly interrelated, with SOC being the most central node. The strongest associations emerged between coping using emotional support and social support, SOC and sense of mastery, and dispositional resilience and self-efficacy. SOC and active coping were negatively linked. When we examined RFs as predictors of mental health trajectories, SOC was the strongest predictor of psychopathological symptoms and rumination, while trajectories of stress-related growth were predicted by optimism. Subsequent network analyses, including individual intercepts and slopes from LGMM, showed that RFs had small to moderate associations with intercepts but were unrelated to slopes. Our findings provide evidence for SOC playing an important role in mental distress and suggest further examining SOC’s incremental validity. However, our results also propose that RFs might be more important for stable levels of mental health than for adaptation processes over time. The differential associations for negative and positive outcomes support the use of multidimensional outcomes in resilience research

To sleep or not to sleep, that is the question: A systematic review and meta-analysis on the effect of post-trauma sleep on intrusive memories of analog trauma

Distressing intrusive memories of a traumatic event are one of the hallmark symptoms of posttraumatic stress disorder. Thus, it is crucial to identify early interventions that prevent the occurrence of intrusive memories. Both, sleep and sleep deprivation have been discussed as such interventions, yet previous studies yielded contradicting effects. Our systematic review aims at evaluating existing evidence by means of traditional and individual participant data (IPD) meta-analyses to overcome power issues of sleep research. Until May 16th, 2022, six databases were searched for experimental analog studies examining the effect of post-trauma sleep versus wakefulness on intrusive memories. Nine studies were included in our traditional meta-analysis (8 in the IPD meta-analysis). Our analysis provided evidence for a small effect favoring sleep over wakefulness, log-ROM = 0.25, p < .001, suggesting that sleep is associated with a lower number of intrusions but unrelated to the occurrence of any versus no intrusions. We found no evidence for an effect of sleep on intrusion distress. Heterogeneity was low and certainty of evidence for our primary analysis was moderate. Our findings suggest that post-trauma sleep has the potential to be protective by reducing intrusion frequency. More research is needed to determine the impact following real-world trauma and the potential clinical significance

Mental Health Impact of Early Stages of the COVID-19 Pandemic on Individuals with Pre-Existing Mental Disorders: A Systematic Review of Longitudinal Research

In view of disease-related threats, containment measures, and disrupted healthcare, individuals with pre-existing mental illness might be vulnerable to adverse effects of the COVID-19 pandemic. Previous reviews indicated increased mental distress, with limited information on peri-pandemic changes. In this systematic review, we aimed to identify longitudinal research investigating pre- to peri-pandemic and/or peri-pandemic changes of mental health in patients, focusing on the early phase and considering specific diagnoses. PsycINFO, Web of Science, the WHO Global literature on coronavirus disease database, and the Cochrane COVID-19 Study Register weresearched through 31 May 2021. Studies were synthesized using vote counting based on effect direction. We included 40 studies mostly from Western, high-income countries. Findings were heterogeneous, with improving and deteriorating mental health observed compared to pre-pandemic data, partly depending on underlying diagnoses. For peri-pandemic changes, evidence was limited, with some suggestion of recovery of mental distress. Study quality was heterogeneous; only few studies investigated potential moderators (e.g., chronicity of mental illness). Mental health effects on people with pre-existing conditions are heterogeneous within and across diagnoses for pre- to peri-pandemic and peri-pandemic comparisons. To improve mental health services amid future global crises, forthcoming research should understand medium- and long-term effects, controlling for containment measures

Mental health impact of the COVID-19 pandemic on older adults – Protocol for a systematic review and meta-analysis of longitudinal research

The objective of this systematic review is to summarize the available evidence on the mental health impact of the COVID-19 pandemic on older adults based on longitudinal and repeated cross-sectional observational studies measuring mental health in this age group. We aim at investigating both pre- to peri-pandemic as well as peri-pandemic changes in mental health

Aktuelle Konzepte der Resilienzforschung

BACKGROUND: Stress-related mental disorders are the most prevalent and cost-intensive disorders of our time. On the other hand, the maintenance of mental health despite stressors, i. e. resilience, is a frequent phenomenon. Research on psychological resilience and its underlying mechanisms offers innovative possibilities for health promotion. It requires a consistent understanding of resilience and adequate methods of operationalization. OBJECTIVES: Modern concepts of the definition, operationalization and assessment of resilience as well as its implications for study designs in resilience research. MATERIAL AND METHODS: Analysis and discussion of current works and expert recommendations for the design of resilience research. RESULTS: Resilience research is undergoing a period of transition. Based on a new understanding of resilience as a dynamic and modifiable process, new approaches for operationalization and assessment were proposed. These include, for example, a transdiagnostic approach and the identification of resilience mechanisms, the consideration of stressor exposure in measuring the construct, and longitudinal cohort studies. CONCLUSIONS: In the upcoming decades, further profitable findings from current prospective longitudinal studies can be expected. One challenge for future resilience research consists in the continuous dissemination and implementation of the approaches described.HINTERGRUND: Stressassoziierte psychische Erkrankungen gehören zu den häufigsten und kostenintensivsten Erkrankungen unserer Zeit. Andererseits ist die Erhaltung psychischer Gesundheit angesichts von Stressoren, d. h. Resilienz, ein häufiges Phänomen. Die Erforschung psychischer Resilienz und ihrer zugrunde liegenden Mechanismen bietet innovative Möglichkeiten zur Gesundheitsförderung. Voraussetzung hierfür sind ein einheitliches Verständnis von Resilienz sowie geeignete Methoden der Operationalisierung. FRAGESTELLUNG: Moderne Konzepte der Definition, Operationalisierung und Erfassung von Resilienz und deren Implikationen für Studiendesigns in der Resilienzforschung. MATERIAL UND METHODEN: Analyse und Diskussion aktueller Arbeiten und Expertenempfehlungen zur Gestaltung der Resilienzforschung. ERGEBNISSE: Die Resilienzforschung befindet sich seit einigen Jahren im Wandel. Ausgehend von einem neuen Verständnis von Resilienz als dynamischem und veränderbarem Prozess wurden neue Ansätze zur Operationalisierung und Messung vorgeschlagen. Hierzu gehören z. B. ein transdiagnostischer Ansatz und die Identifizierung von Resilienzmechanismen, die Berücksichtigung der Stressorexposition bei der Erfassung des Konstrukts oder längsschnittliche Kohortenstudien. DISKUSSION: Durch aktuelle prospektive Longitudinalstudien ist in den kommenden Jahrzehnten mit weiteren gewinnbringenden Erkenntnissen zu rechnen. Eine Herausforderung der zukünftigen Resilienzforschung besteht in der kontinuierlichen Verbreitung der vorgestellten Ansätze