Usability of the experience sampling method in specialized mental healthcare:A pilot study

Background:Although mental health problems occur in interaction with the natural environment, bringing this contextualized information into the therapy room is challenging. The experience sampling method (ESM) may facilitate this by assessing clients' thoughts, feelings, symptoms, and behavior as they are experienced in everyday life. However, ESM is still primarily used in research settings with little uptake in clinical practice. One aspect that may facilitate clinical implementation concerns the use of 'ESM protocols', which involves providing practitioners with ready-to-use ESM questionnaires, sampling schemes, visualizations, and training.Objective:This pilot study's objective was to evaluate the usability of an ESM protocol in clinical practice using a mixed-methods approach.Methods:In this pilot study, we created an ESM protocol and tested its usability in clinical practice. The ESM protocol was tailored to the m-Path software platform, consisting of a dashboard for practitioners and an app for clients. The dashboard was used to configure an ESM questionnaire template we designed. Additionally, the dashboard contained custom data visualizations that were made based on end-user feedback. The app was used for completing ESM assessments. A total of 8 practitioners and 17 clients used ESM in practice between December 2020 and July 2021. Usability was assessed using questionnaires, ESM compliance rates, and semi-structured interviews.Results:The usability was overall rated reasonable to good by practitioners (Mean scores to usability items ranging from 5.33 [SD = 0.91] to 6.06 [SD = 0.73] on a cale from 1 to 7]). However, practitioners expressed difficulty personalizing the template and reported insufficient guidelines on how to use ESM in clinical practice. On average, clients completed 55% (SD=25%) of the ESM questionnaires. They rated the usability as reasonable to good but slightly lower and more variable than the practitioners (mean scores to usability items ranging from 4.18 [SD = 1.7] to 5.94 [SD = 1.5] on a cale from 1 to 7). Clients also voiced several concerns over the piloted ESM template, with some indicating no interest in the continued use of ESM.Conclusions:The findings suggest that using an ESM protocol may facilitate the implementation of ESM as a mobile health assessment tool in psychiatry. However, further adaptions should be made prior to further implementation. Adaptions include training on personalizing questionnaires, adding additional sampling scheme formats, and creating a dynamic data visualization interface. Future studies should also identify factors determining the suitability of ESM for specific treatment goals among different client populations

Psycho-social factors associated with mental resilience in the Corona lockdown.

The SARS-CoV-2 pandemic is not only a threat to physical health but is also having severe impacts on mental health. Although increases in stress-related symptomatology and other adverse psycho-social outcomes, as well as their most important risk factors have been described, hardly anything is known about potential protective factors. Resilience refers to the maintenance of mental health despite adversity. To gain mechanistic insights about the relationship between described psycho-social resilience factors and resilience specifically in the current crisis, we assessed resilience factors, exposure to Corona crisis-specific and general stressors, as well as internalizing symptoms in a cross-sectional online survey conducted in 24 languages during the most intense phase of the lockdown in Europe (22 March to 19 April) in a convenience sample of N = 15,970 adults. Resilience, as an outcome, was conceptualized as good mental health despite stressor exposure and measured as the inverse residual between actual and predicted symptom total score. Preregistered hypotheses (osf.io/r6btn) were tested with multiple regression models and mediation analyses. Results confirmed our primary hypothesis that positive appraisal style (PAS) is positively associated with resilience (p < 0.0001). The resilience factor PAS also partly mediated the positive association between perceived social support and resilience, and its association with resilience was in turn partly mediated by the ability to easily recover from stress (both p < 0.0001). In comparison with other resilience factors, good stress response recovery and positive appraisal specifically of the consequences of the Corona crisis were the strongest factors. Preregistered exploratory subgroup analyses (osf.io/thka9) showed that all tested resilience factors generalize across major socio-demographic categories. This research identifies modifiable protective factors that can be targeted by public mental health efforts in this and in future pandemics

Tampa Scale For Kinesiophobia

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Learning to predict pain: differences in people with persistent neck pain and pain-free controls

Background: Learning to predict threatening events enables an organism to engage in protective behavior and prevent harm. Failure to differentiate between cues that truly predict danger and those that do not, however, may lead to indiscriminate fear and avoidance behaviors, which in turn may contribute to disability in people with persistent pain. We aimed to test whether people with persistent neck pain exhibit contingency learning deficits in predicting pain relative to pain-free, gender-and age-matched controls. Method: We developed a differential predictive learning task with a neck pain-relevant scenario. During the acquisition phase, images displaying two distinct neck positions were presented and participants were asked to predict whether these neck positions would lead to pain in a fictive patient with persistent neck pain (see fictive patient scenario details in Appendix A). After participants gave their pain-expectancy judgment in the hypothetical scenario, the verbal outcome (PAIN or NO PAIN) was shown on the screen. One image (CS+) was followed by the outcome "PAIN", while another image (CS-) was followed by the outcome "NO PAIN". During the generalization phase, novel but related images depicting neck positions along a continuum between the CS+ and CS- images (generalization stimuli; GSs) were introduced to assess the generalization of acquired predictive learning to the novel images; the GSs were always followed by the verbal outcome "NOTES UNREADABLE" to prevent extinction learning. Finally, an extinction phase was included in which all images were followed by "NO PAIN" assessing the persistence of pain-expectancy judgments following disconfirming information. Results: Differential pain-expectancy learning was reduced in people with neck pain relative to controls, resulting from patients giving significantly lower pain-expectancy judgments for the CS+, and significantly higher pain-expectancy judgments for the CS-. People with neck pain also demonstrated flatter generalization gradients relative to controls. No differences in extinction were noted. Discussion: The results support the hypothesis that people with persistent neck pain exhibit reduced differential pain-expectancy learning and flatter generalization gradients, reflecting deficits in predictive learning. Contrary to our hypothesis, no differences in extinction were found. These findings may be relevant to understanding behavioral aspects of chronic pain.status: accepte

Acute but not Permanent Effects of Propranolol on Fear Memory Expression in Humans

Experimental evidence in humans and non-human animals suggests that the administration of propranolol shortly after the retrieval of an emotional memory can lead to an attenuation of its later expression, a phenomenon known as post-reactivation amnesia. Using more potent amnestic drugs, post-reactivation amnesia has been shown in animals to be reversible by re-administration of the drug prior to memory retention testing. The latter finding suggests that, at least under some circumstances, post-reactivation amnesia may not reflect a disruption of reconsolidation (i.e., a memory storage deficit) but an acquired state-dependency of memory expression (i.e., a memory retrieval deficit that is relieved when the drug state is recreated during testing). We conducted a double-blind, placebo-controlled study to investigate whether the previously established amnestic effects of post-reactivation propranolol administration on memory retention in humans may similarly reflect a retrieval deficit. In four groups of participants, fear memories were first established through differential fear conditioning. One day later, a single presentation of the CS+ without shock was used to reactivate the memory in three of the four groups, followed by the administration of 40 mg Propranolol HCl (Groups PrPl and PrPr) or placebo (Group PlPl). Memory was not reactivated in the fourth group (Group NR). Another 24 h later, Propranolol HCl (Group PrPr) or placebo (Groups PrPl, PlPl, and NR) was again administered, followed by a test of memory retention (extinction testing) and recovery (reinstatement testing). We did not observe any effects of post-reactivation propranolol on memory retention; conditioned responding was similar for all groups at the start of retention testing and similarly sensitive to recovery through reinstatement. We did observe an acute effect of propranolol administration on fear-potentiated startle responding during retention testing in Group PrPr, where participants exhibited attenuated startle responses during extinction testing but similar sensitivity to reinstatement as participants in the other groups. While our findings fail to corroborate previous reports of propranolol-induced post-reactivation amnesia in humans, they do point to acute effects of propranolol administration on extinction performance.status: Published onlin

Practitioner perspectives on the use of the experience sampling software in counseling and clinical psychology

Facilitating the uptake and making better use of technological advances will be pivotal for counseling and clinical psychology to respond to the rising call for more community-based and person-centred care. While the Experience Sampling Method (ESM), a structured self-report digital diary, could help facilitate this transition, it is currently unclear how practitioners envision using ESM in clinical practice. Therefore, we organised focus groups with 36 mental health practitioners (M age = 39.37, SD age = 12.18, 58.33% female) across Flanders (Belgium). Four broad topics were discussed: (1) how to use ESM, (2) how to visualise clinically relevant information, (3) the software requirements thereof, and (4) barriers and facilitators for implementing ESM in clinical practice. Thematic analysis was conducted and Cohen's Kappa was calculated (κ =.79). Different clinical applications emerged, such as screening, evaluating the effectiveness of therapy, and elucidating determinants of mental health problems in daily life. However, practitioners also expressed difficulty determining how to visualise ESM data, and novel features for use emerged (e.g. integration with electronic health records). Various barriers (e.g. lack of best-practice guidelines) and facilitators (e.g. simplicity) were identified, with the implications of these findings for future clinical implementation studies discussed.</p

Description and psychometric properties of a prototype to test tactile acuity in the neck

Background: Clinical tools assessing tactile acuity in people with persistent pain have limitations. Therefore, a novel and semi-automated tool was developed: The Imprint Tactile Acuity Device (iTAD). Aim: To describe the iTAD prototype and present the psychometric properties of its tactile acuity assessments: the localisation test, the orientation test and the overall score (mean of both tests). Method: A test-retest design with fifty healthy participants was used to assess intra-rater reliability (ICC), internal consistency (ICC) and measurement error (SEM) of the three assessments (0–100% accuracy scores each) performed at the neck. Using a known-group comparison design, balanced by age and sex, scores of thirty individuals with persistent neck pain were compared to thirty healthy controls to determine construct validity. Results: The ICC and ICC were 0.60 and 0.78 for the localisation test, 0.66 and 0.77 for the orientation test, and 0.73 and 0.84 for the overall score. The SEMs were 9.0%, 8.1% and 6.0%, respectively. No fixed or proportional bias, or signs of heteroscedasticity were observed. Overall, no between group differences were observed (p = 0.49). In the male subgroup, however, the overall score was lower for people with neck pain than for healthy participants (mean difference (SE); 7.6% (2.5); p = 0.008). Discussion: The tactile acuity assessments of the iTAD demonstrate moderate reliability and good internal consistency. Measurement errors appear comparable to currently preferred methods. Clear construct validity was not established, but results may be biased by design issues of the prototype. Taken together, the iTAD shows promise but further fine-tuning is needed

Psychological Resilience Factors and Their Association With Weekly Stressor Reactivity During the COVID-19 Outbreak in Europe: Prospective Longitudinal Study

Background!#!Cross-sectional relationships between psychosocial resilience factors (RFs) and resilience, operationalized as the outcome of low mental health reactivity to stressor exposure (low 'stressor reactivity' [SR]), were reported during the first wave of the COVID-19 pandemic in 2020.!##!Objective!#!Extending these findings, we here examined prospective relationships and weekly dynamics between the same RFs and SR in a longitudinal sample during the aftermath of the first wave in several European countries.!##!Methods!#!Over 5 weeks of app-based assessments, participants reported weekly stressor exposure, mental health problems, RFs, and demographic data in 1 of 6 different languages. As (partly) preregistered, hypotheses were tested cross-sectionally at baseline (N=558), and longitudinally (n=200), using mixed effects models and mediation analyses.!##!Results!#!RFs at baseline, including positive appraisal style (PAS), optimism (OPT), general self-efficacy (GSE), perceived good stress recovery (REC), and perceived social support (PSS), were negatively associated with SR scores, not only cross-sectionally (baseline SR scores; all P&amp;lt;.001) but also prospectively (average SR scores across subsequent weeks; positive appraisal (PA), P=.008; OPT, P&amp;lt;.001; GSE, P=.01; REC, P&amp;lt;.001; and PSS, P=.002). In both associations, PAS mediated the effects of PSS on SR (cross-sectionally: 95% CI -0.064 to -0.013; prospectively: 95% CI -0.074 to -0.0008). In the analyses of weekly RF-SR dynamics, the RFs PA of stressors generally and specifically related to the COVID-19 pandemic, and GSE were negatively associated with SR in a contemporaneous fashion (PA, P&amp;lt;.001; PAC,P=.03; and GSE, P&amp;lt;.001), but not in a lagged fashion (PA, P=.36; PAC, P=.52; and GSE, P=.06).!##!Conclusions!#!We identified psychological RFs that prospectively predict resilience and cofluctuate with weekly SR within individuals. These prospective results endorse that the previously reported RF-SR associations do not exclusively reflect mood congruency or other temporal bias effects. We further confirm the important role of PA in resilience

Dynamic Modelling of Mental Resilience in Young Adults: Protocol for a Longitudinal Observational Study (DynaM-OBS)

Background!#!Stress-related mental disorders are highly prevalent and pose a substantial burden on individuals and society. Improving strategies for the prevention and treatment of mental disorders requires a better understanding of their risk and resilience factors. This multicenter study aims to contribute to this endeavor by investigating psychological resilience in healthy but susceptible young adults over 9 months. Resilience is conceptualized in this study as the maintenance of mental health or quick recovery from mental health perturbations upon exposure to stressors, assessed longitudinally via frequent monitoring of stressors and mental health.!##!Objective!#!This study aims to investigate the factors predicting mental resilience and adaptive processes and mechanisms contributing to mental resilience and to provide a methodological and evidence-based framework for later intervention studies.!##!Methods!#!In a multicenter setting, across 5 research sites, a sample with a total target size of 250 young male and female adults was assessed longitudinally over 9 months. Participants were included if they reported at least 3 past stressful life events and an elevated level of (internalizing) mental health problems but were not presently affected by any mental disorder other than mild depression. At baseline, sociodemographic, psychological, neuropsychological, structural, and functional brain imaging; salivary cortisol and α-amylase levels; and cardiovascular data were acquired. In a 6-month longitudinal phase 1, stressor exposure, mental health problems, and perceived positive appraisal were monitored biweekly in a web-based environment, while ecological momentary assessments and ecological physiological assessments took place once per month for 1 week, using mobile phones and wristbands. In a subsequent 3-month longitudinal phase 2, web-based monitoring was reduced to once a month, and psychological resilience and risk factors were assessed again at the end of the 9-month period. In addition, samples for genetic, epigenetic, and microbiome analyses were collected at baseline and at months 3 and 6. As an approximation of resilience, an individual stressor reactivity score will be calculated. Using regularized regression methods, network modeling, ordinary differential equations, landmarking methods, and neural net-based methods for imputation and dimension reduction, we will identify the predictors and mechanisms of stressor reactivity and thus be able to identify resilience factors and mechanisms that facilitate adaptation to stressors.!##!Results!#!Participant inclusion began in October 2020, and data acquisition was completed in June 2022. A total of 249 participants were assessed at baseline, 209 finished longitudinal phase 1, and 153 finished longitudinal phase 2.!##!Conclusions!#!The Dynamic Modelling of Resilience-Observational Study provides a methodological framework and data set to identify predictors and mechanisms of mental resilience, which are intended to serve as an empirical foundation for future intervention studies.!##!International registered report identifier (irrid)!#!DERR1-10.2196/39817