Annual Research Review: Building a science of personalized intervention for youth mental health

Wearable fNIRS platform for dense sampling and precision functional neuroimaging

Precision mental health aims to improve care by tailoring interventions based on individual neurobiological features. Functional near-infrared spectroscopy (fNIRS) is a cost-effective and portable alternative to traditional neuroimaging, making it a promising tool for this purpose. This study evaluates a self-administered, wearable fNIRS platform designed for precision mental health applications, focusing on its reliability and specificity in capturing individualized functional connectivity patterns. The platform incorporates a wireless, portable multichannel fNIRS device, augmented reality guidance for reproducible device placement, and a cloud-based system for remote data access. In this proof-of-concept study, eight adults completed ten dense-sampled sessions involving cognitive tasks and resting-state measurements. Results demonstrated high test-retest reliability and within-participant consistency in functional connectivity and activation patterns. These findings support the platform's feasibility for individualized functional mapping. Future research with larger and more diverse cohorts, including clinical populations, is necessary to explore its potential for disorder-specific applications.

Using Neuropsychological Profiling to Tailor Mental Health Care for Children and Youth: a Quality Improvement Project to Measure Feasibility

OBJECTIVE

Precision child and youth mental healthcare has great potential to improve treatment success by tailoring interventions to individual needs. An innovative care pathway in a pediatric mental health outpatient clinic was designed to allow for neuropsychology data to be integrated in psychotherapeutic care. This paper describes the feasibility of this new pathway, including implementation outcomes, acceptability, and potential for future integration.

METHOD

The target population was outpatients 6-17 years old referred for individual treatment to a tertiary outpatient mental health (OPMH) clinic. The new care pathway was co-developed by neuropsychologists and mental health practitioners. A logic model was created to guide the evaluation, which was informed by the Reach Effectiveness Adoption Implementation Maintenance framework. As part of the logic model, a stepped assessment protocol was implemented, and reports on neuropsychological function were shared with patients, caregivers, and care providers. Evaluation data were collected from phone surveys, questionnaires, a focus group, and administrative records.

RESULTS

Forty-two patients scheduled to receive therapy over a 6-month period were offered the opportunity to participate in the new care pathway and 39 (93%) agreed. Self-reported outcome data showed that 83% of patients and 94% of caregivers valued neuropsychology-informed care, with some describing it as transformative. Almost all practitioners (91%) reported that the project added value to their clinical care. There were no adverse effects on participants nor the flow of patients through the system.

CONCLUSIONS

Neuropsychology-informed pediatric OPMH care was feasible and well-received. Clinical effectiveness should be studied in an experimental trial.

Collaborative care interventions to reduce suicidal behavior among patients with depression or at risk of suicide in primary-care settings: A systematic review and meta-analysis

INTRODUCTION

Suicide is a leading cause of preventable death worldwide. While Collaborative Care (CC) effectively treats depression in primary care led by general practitioners, its impact on reducing suicide behavior remains uncertain. Additionally, the optimal intensity and duration of CC interventions are unclear.

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the effect of CC interventions on suicidal behavior in patients with depression or at risk of suicide in primary care settings.

METHODS

We searched PubMed, Embase, and Cochrane databases from inception to April 2024. Two researchers independently performed data selection, extraction, and quality assessment. Data were pooled using the odds ratio (OR) and a random-effects model. The main outcome was suicidal behavior, including attempts and ideation. Subgroup analyses assessed the effectiveness of intensity and duration. A meta-analysis was conducted using the R "meta" package, and the protocol was registered with PROSPERO (CRD 42023477655).

RESULTS

From 3696 articles, 10 randomized controlled trials with 20,110 participants were included. CC interventions significantly reduced suicidal behavior compared to controls (pooled OR = 0.66; 95 % CI, 0.46-0.96). High-intensity interventions were particularly effective (pooled OR = 0.56; 95 % CI, 0.40-0.78). However, no significant relationship was found between intervention duration and suicidal behavior. There was no clear evidence of publication bias.

CONCLUSIONS

CC interventions can reduce suicidal behavior in primary care settings, especially with high-intensity interventions. However, caution is needed due to study heterogeneity and low quality.

Does Executive Functioning Moderate the Association Between Psychopathic Traits and Antisocial Behavior in Youth?

This study examined the interplay of psychopathic traits, executive functioning, and antisocial behavior among adjudicated youth, with a focus on the potential moderating role of executive function. The current study uses data from the Pathways to Desistance dataset was examined, utilizing the Psychopathy Checklist: Youth Version (PCL-YV) and the Stroop Color-Word Task to measure psychopathic traits and executive functioning, respectively. Violent and property offending frequencies were self-reported. Both psychopathic traits and lower executive functioning were initially associated with higher frequencies of both violent and property offending. Crucially, a significant interaction emerged: Youth exhibiting higher socially deviant/lifestyle psychopathic traits and weaker executive function were most likely to engage in property offenses. These findings offer insights into specific risk profiles for offending behaviors and underscore the importance of interventions promoting executive function, especially for youth with these characteristics. This study highlights the complex ways in which individual differences contribute to antisocial outcomes.

Randomised controlled trial of LGBTQ-affirmative cognitive-behavioural therapy for sexual minority women's minority stress, mental health and hazardous drinking: Project EQuIP protocol

INTRODUCTION

Sexual minority women represent one of the highest-risk groups for hazardous drinking and comorbid mental health problems (eg, depression, anxiety). Research has identified cognitive (eg, expectations of rejection), affective (eg, emotion dysregulation) and behavioural (eg, avoidant coping) pathways through which minority stress (eg, stigma) places sexual minority women at disproportionate risk of hazardous drinking and comorbid depression/anxiety; yet no evidence-based interventions have been tested to address these pathways in this population. This article describes the design of Project EQuIP (Empowering Queer Identities in Psychotherapy), a randomised controlled trial of a transdiagnostic lesbian, gay, bisexual, transgender, queer (LGBTQ)-affirmative cognitive-behavioural therapy intervention (CBT) designed to improve minority stress coping and reduce sexual minority women's hazardous drinking and mental health comorbidities.

METHODS AND ANALYSIS

This two-arm randomised controlled trial, funded by the National Institute on Alcohol Abuse and Alcoholism, has two objectives: (1) test the efficacy of 10 sessions of LGBTQ-affirmative CBT compared with 10 sessions of supportive counselling for sexual minority women in the community (anticipated n=450) who report hazardous alcohol use and meet criteria for a Diagnostic and Statistical Manual of Mental Disorders - 5 diagnosis of a depression or anxiety disorder and (2) examine psychosocial mechanisms and demographic factors as potential mediators and moderators, respectively, of the treatment-outcome relationship. This study's primary outcome is change in the proportion of heavy drinking days. Secondary outcomes are changes in depressive and anxious symptoms.

ETHICS AND DISSEMINATION

The Yale University Human Subjects Committee reviewed and approved the research protocol. Results of this study will be disseminated to researchers and practitioners through peer-review publications and conference presentations, and directly to study participants.

TRIAL REGISTRATION NUMBER

Registered on 17 August 2022 (ClinicalTrials.gov identifier: NCT05509166).

Efficacy of a process-based, Mobile-delivered personalized CBT for anxiety disorders: Study protocol for a randomized controlled trial

Background

Internet-based Cognitive Behavioral Therapy (ICBT) is effective in treating anxiety disorders, yet there is room for improvement in treatment response and reduction in dropout rates. This study proposes a personalized, modular ICBT intervention that leverages the extended evolutionary meta-model to provide a dynamic and adaptive treatment approach, aiming to enhance usability and efficacy.

Methods

The trial will be conducted in two phases. Phase I involves 182 participants who will undergo a 30-day ecological momentary assessment to record functional processes and anxiety levels three times a day. The data collected will help in identifying key functional predictors of anxiety for each participant through group iterative multiple model estimation. In Phase II, participants who complete Phase I will be randomized into three groups: personalized CBT, standard CBT, and a waiting list. Outcome measures will include Brief Symptom Inventory, specific measures of anxiety, usability metrics, and dropout rates. Assessments will be conducted at baseline, immediately post-treatment, and at 1- and 3-month follow-ups. A linear mixed model will be utilized to analyze the data and determine the intervention's efficacy.

Discussion

Anticipated outcomes from this study include advancements in personalized CBT for anxiety disorders, contributing valuable insights into their potential benefits and addressing existing challenges in the field.

Evaluating a mental health support mobile app for adults with type 1 diabetes living in rural and remote communities: The REACHOUT pilot study

AIMS

To evaluate a mobile app that delivers mental health support to adults with type 1 diabetes (T1D) living in rural and remote communities using the Reach, Effectiveness, Adoption, Intervention fidelity, Maintenance (RE-AIM) framework.

METHODS

This study recruited 46 adults to participate in a 6-month intervention using REACHOUT, a mobile app that delivers peer-led mental health support (one-on-one, group-based texting and face-to-face virtual). Baseline and 6-month assessments measured diabetes distress (DD), depressive symptoms and perceived support (from family/friends, health care team and peers) along with other RE-AIM metrics.

RESULTS

Calculations for reach and adoption found that 3% of eligible adults enrolled in REACHOUT and 55% of diabetes education centres participated in recruitment efforts. Maintenance metrics revealed 56% and 24% of peer supporters and participants, respectively, became peer supporters for a subsequent randomized controlled trial of REACHOUT. Post-intervention reductions were observed for overall distress (p = 0.007), powerlessness (p = 0.009), management distress (p = 0.001), social perception distress (p = 0.023), eating distress (p = 0.032) and depressive symptoms (p = 0.009); and elevations in support from family/friends and peers. After adjusting for sex and age, only support-related improvements persisted. When analysing women and men groups separately, women reported lower levels of overall distress, three distress subscales, and higher levels of family/friends and peer support whereas men did not.

CONCLUSIONS

While reach was relatively low, metrics for adoption and maintenance are promising. Improvements in distress were observed for the total sample, but these changes were reduced when controlling for sex and age, with significance maintained only for women. Digital health-enabled peer support may be instrumental in the delivery of mental health support to geographically isolated communities.

Investigating the psychophysiological effects of NaiKan Therapy: salivary oxytocin and cortisol release

NaiKan Therapy, a method of self-reflection and introspection, has garnered considerable interest for its psychological benefits. However, its physiological impacts, particularly on hormonal regulation, remain underexplored. In this study, we aimed to investigate the effects of NaiKan Therapy on salivary oxytocin and cortisol release, shedding light on the psychophysiological mechanisms underlying this introspective practice. Sixty participants underwent Naikan Therapy sessions over five consecutive days, during which salivary samples were collected at multiple time points. Salivary oxytocin and cortisol levels were measured using enzyme-linked immunosorbent assay (ELISA) kits. Our results revealed significant increases in salivary oxytocin levels following NaiKan Therapy, suggesting a potential role of this practice in enhancing social bonding and emotional regulation. Conversely, salivary cortisol levels exhibited a decrease post-therapy, indicating a reduction in stress reactivity. These findings provide novel insights into the neuroendocrine mechanisms underlying NaiKan Therapy and highlight its potential as a holistic approach to improving mental wellbeing. Further research exploring the long-term effects of NaiKan Therapy and its implications for clinical practice is warranted.

A Bibliometric Analysis of Healthcare Intervention-Related Studies Reporting Patient and Public Involvement and Engagement

BACKGROUND/OBJECTIVES

Patient and public involvement and engagement (PPIE) has gained global recognition as an innovative healthcare research practice. PPIE engages end-users throughout the research process, improving intervention effectiveness, resource efficiency, and user satisfaction. Despite its increasing inclusion in studies, comprehensive bibliometric reviews of healthcare intervention-related studies reporting PPIE are scarce. This study aims to conduct a bibliometric analysis of healthcare intervention-related studies reporting PPIE in recent decades to identify key worldwide bibliometric features, themes, and trends.

METHODS

The analysis includes 10,624 relevant English articles published in the Web of Science (WoS) Core Collection up to 26 November 2024. Search terms were selected based on PPIE conceptualization, interventional types, and related healthcare terms. Using WoS descriptive analysis and CiteSpace, we examined bibliometric features and identified major international themes and trends.

RESULTS

There has been a significant increase in the number of healthcare intervention-related studies reporting PPIE over the past five years, especially from the United States and the United Kingdom, with a recent rise in Asia. However, cross-national collaboration remains limited. Key research themes identified include "community participation", "health equity", "coronary heart disease", "web-based patient empowerment", "mental illness", and "obesity prevention", with growing interest in "mobile health" and "digital health".

CONCLUSIONS

This study provides a comprehensive and up-to-date overview of the bibliometric characteristics and evolving trends in healthcare intervention-related studies reporting PPIE. It highlights global regions with limited PPIE implementation, suggests pathways for further development, and identifies key research themes. The study offers researchers and practitioners valuable insights into tracking PPIE trends in healthcare interventions and fostering collaborations on evidence-based PPIE studies with leading scholars and institutions worldwide. Additionally, the findings drive innovations aimed at improving patient and public healthcare outcomes.

The impact of interventions for depression on self-perceptions in young people: A systematic review & meta-analysis

Negative self-perceptions are implicated in the development and maintenance of depression in young people, but little is known about their receptiveness to change in response to treatment. This paper reports on a pre-registered meta-analysis examining the extent to which treatments for depression in young people aged 11-24 result in changes to self-perceptions. Controlled treatment trials examining outcomes related to self-perceptions were synthesised (k = 20, N = 2041), finding small reductions in both symptoms of depression (g = -0.30; 95 % CI: -0.52, -0.08) and self-perception outcomes (g = 0.33; 95 % CI: 0.16, 0.49) for interventions compared with control groups. Meta-regression analyses found no significant association between reductions in depressive symptoms and improvements in self-perception following treatment, suggesting that despite interventions generally improving both outcomes these changes may be unrelated to each other. Our results indicate that young people's self-perceptions are sensitive to change following treatment for depression, however effect sizes are small and treatments could be more effective in targeting and changing negative self-perceptions. Given the importance that young people place on integrating work on their sense of self into treatments for depression, future interventions could aim to support young people with depression to develop a positive sense of self.

Childhood irritability-aggression profiles and parent-to-child violence: Evidence of interactive effect in predicting youth violence

OBJECTIVE

Early irritability, aggression, and parent-to-child violence (PCV) each are presumed to predict later violent behavior. Few studies, however, have examined these factors simultaneously. This study investigated how irritability and aggression jointly manifested during childhood and whether such manifestations, PCV, and their interactions were associated with late-adolescent violence.

METHOD

A prospective sample of 900 participants (55.8 % girls; 55.7 % Black, 24.7 % White, 11.9 % mixed race, 7.7 % other race) from the LONGitudinal Studies of Child Abuse and Neglect (LONGSCAN) was followed from 4 to 18 years old. Caregivers assessed children's irritability and aggression biyearly (ages 4-12), and self-reported violence toward their children by age 12. Children reported their violent behaviors at age 18.

RESULTS

Group-based dual trajectory modeling identified three profiles varying in the combined levels of irritability and aggression for both genders: Irritable and Aggressive profile, Irritable Only profile, and Typically Developing profile. Binomial logistic regression analyses showed an independent association of the Irritable and Aggressive profile with violence in boys. PCV was associated with violence only in boys with the Irritable Only profile. No such associations were found in girls.

CONCLUSIONS

Aggression manifested and persisted alongside irritability, but not vice versa during childhood. Comorbidly aggressive and irritable boys had an increased risk of violence, and irritable boys did so only when exposed to PCV. These findings suggest the gender-specific roles of irritability and aggression in portending violent antisociality, and indicate the need to address these problems in conjunction with violent parenting for preventing youth violence.

Heterogeneous Treatment Effects in the Incredible Years Teacher Classroom Management Programme - A Latent Profile Approach

Heterogeneous effects from interventions often remain hidden in between-group analyses, risking overgeneralized conclusions of treatment effects. In this exploratory study, we performed latent profile analysis to unveil differential treatment effects among children in The Incredible Years Teacher Classroom Management Programme (IY TCMP). This program has previously been shown to reduce behavioral problems in preschools and schools in total samples and subgroups. A total of 726 children (48.7% girls; Mage = 4.21 years; SDage = 0.86) from 92 childcare centers in Norway participated in either the intervention (n = 338) or the matched control condition (n = 388). First, by conducting latent profile analysis on baseline levels of child-teacher relationship (closeness, conflict), behavioral problems, and social competence, three distinct profiles were identified: High Risk (26.4%), Moderate Risk (42.8%), and Low Risk (30.7%) - each profile with unique characteristics. Second, we tested for within-profile, condition-by-time interactions following the intervention, showing distinct treatment responses for each profile. High-risk profiles profited most from the IY TCMP, with a substantial decrease in externalizing problems, more teacher closeness, and less teacher conflict. Moderate-risk profiles also gained better teacher-child relationships and improved social competence. The Low-Risk profiles showed no effects from the intervention. It is argued that latent profile analysis presents a feasible approach for examining within-sample heterogeneity in intervention research. It also reveals crucial information on treatment variability, as demonstrated in the Incredible Years Programme.

Integrating equifinality and multifinality into the of prevention programs in early childhood: The conceptual case for use of tiered models

Introduced in the context of developmental psychopathology by Cicchetti and Rogosh in the Journal, the current paper incorporates the principles of equifinality and multifinality to support the use of tiered models to prevent the development of emerging child psychopathology and promote school readiness in early childhood. We use the principles of equifinality and multifinality to describe the limitations of applying one intervention model to address all children presenting with different types of risk for early problem behavior. We then describe the potential benefits of applying a tiered model for having impacts at the population level and two initial applications of this approach during early childhood. The first of these tiered models, Smart Beginnings, integrates the use of two evidenced-based preventive interventions, Video Interaction Project, a universal parenting program, and Family Check-Up, a selective parenting program. Building on the strengths of Smart Beginnings, the second trial, The Pittsburgh Study includes Video Interaction Project and Family Check-Up, and other more and less-intensive programs to address the spectrum of challenges facing parents of young children. Findings from these two projects are discussed with their implications for developing tiered models to support children's early development and mental health.

The next generation of developmental psychopathology research: Including broader perspectives and becoming more precise

The current Special Issue marks a major milestone in the history of developmental psychopathology; as the final issue edited by Cicchetti, we have an opportunity to reflect on the remarkable progress of the discipline across the last four decades, as well as challenges and future directions for the field. With contemporary issues in mind, including rising rates of psychopathology, health disparities, and international conflict, as well as rapid growth and accessibility of digital and mobile technologies, the discipline of developmental psychopathology is poised to advance multidisciplinary, developmentally- and contextually- informed research, and to make substantial progress in supporting the healthy development of individuals around the world. We highlight key future directions and challenges for the next generation of developmental psychopathology research including further investigation of culture at multiple levels of analysis, incorporation of macro-level influences into developmental psychopathology research, methods advances to address heterogeneity in translational research, precision mental health, and the extension of developmental psychopathology research across the lifespan.

Improving Child and Adolescent Mental Health: A Bibliometric Analysis of Related Intervention Studies

In response to the increase in adolescent mental health problems, related intervention research has flourished. This study examined 2258 mental health intervention studies captured by the Web of Science, focusing on their distribution, interdisciplinary collaboration, and emerging trends, using bibliometric analysis. Our findings revealed a rise in studies and enhanced collaboration across disciplines, with studies from the United States, Australia, and the United Kingdom showing high academic output, intellectual impact, and strong scientific partnerships. However, there is a noticeable Western-centrism in the research. Identifying current trends and key areas of focus offers valuable insights for future practices in child and adolescent mental health.

The modular approach to therapy for youths with anxiety, depression, trauma, and conduct problems (MATCH): results from the Norwegian randomized-controlled trial

BACKGROUND

A randomized controlled trial was conducted to examine the effectiveness of the Modular Approach to Therapy for Youths with Anxiety, Depression, Trauma, and Conduct Problems (MATCH) for Norwegian youths referred to seven Child and Adolescent Psychiatric Outpatient Clinics. MATCH addresses comorbid problems that are common in children and youth, and its transdiagnostic design may therefore be more effective compared to standard treatments that often address single problems. MATCH has, however, never been evaluated in a Nordic context, and the present study aimed to fill this gap.

METHODS

A sample of 121 Norwegian youths (Mage = 9.83, 58.7% boys) was randomly assigned to MATCH (n = 73) or treatment as usual (TAU, n = 48). Primary treatment outcomes were youths' externalizing and internalizing problems as reported by parents, using the Child Behavior Checklist, the Behavior and Feelings Survey. In addition, the study included assessments of parent-reported Top Problems.

RESULTS

Overall, youths showed significant improvements in both externalizing and internalizing problems from intake to post-test. Results did not provide evidence that MATCH reduces symptoms of these problems compared to TAU.

CONCLUSIONS

The findings were inconclusive regarding whether MATCH was more effective than TAU in reducing youth internalizing and externalizing problems.

TRIAL REGISTRATION IDENTIFIER

ISRCTN24029895. Registration date: 8/8/2016.

Participatory logic model for a precision child and youth mental health start-up: scoping review, case study, and lessons learned

Background

The precision child and youth mental health (PCYMH) paradigm has great potential to transform CYMH care and research, but there are numerous concerns about feasibility, sustainablity, and equity. Implementation science and evaluation methodology, particularly participatory logic models created with stakeholders, may help catalyze PCYMH-driven system transformation. This paper aims to: (1) report results of a PCYMH logic model scoping review; (2) present a case study illustrating creation of a participatory logic model for a PCYMH start-up; and (3) share the final model plus lessons learned.

Methods

Phase 1: Preparation for the logic model comprised several steps to develop a preliminary draft: scoping review of PCYMH logic models; two literature reviews (PCYMH and implementation science research); an environmental scan of our organization's PCYMH research; a gap analysis of our technological capability to support PCYMH research; and 57 stakeholder interviews assessing PCYMH perspectives and readiness. Phase 2: Participatory creation of the logic model integrated Phase 1 information into a draft from which the final logic model was completed through iterative stakeholder co-creation.

Results

Phase 1: The scoping review identified 0 documents. The PCYMH literature review informed our Problem and Impact Statements. Reviewing implementation and evaluation literature resulted in selection of the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and Behavior Change Wheel (BCW) frameworks to guide model development. Only 1.2% (5/414) of the organization's research projects involved PCYMH. Three technological infrastructure gaps were identified as barriers to developing PCYMH research. Stakeholder readiness interviews identified three themes that were incorporated into the draft. Phase 2: Eight co-creation cycles with 36 stakeholders representing 13 groups and a consensus decision-making process were used to produce the final participatory logic model.

Conclusions

This is the first study to report the development of a participatory logic model for a PCYMH program, detailing involvement of stakeholders from initial planning stages to the final consensus-based product. We learned that creating a participatory logic model is time- and labour-intensive and requires a multi-disciplinary team, but the process produced stakeholder-program relationships that enabled us to quickly build and implement the PCYMH start-up. Our processes and final model can inform similar efforts at other sites.

The efficacy of personalized psychological interventions in adolescents: a scoping review and meta-analysis

This review compared the efficacy of personalized psychological interventions to standardized interventions for adolescents. We conducted a scoping review and meta-analysis of randomized controlled trials that compared personalized interventions with standardized interventions in adolescents. Data was analyzed using Bayesian multilevel random effects meta-analysis. Eligible studies were identified through five databases: Scopus, PsycINFO, MEDLINE, Web of Science, and EMBASE. Moderation analysis was conducted to explain potential sources of effect size heterogeneity. Eight studies across 13 articles (participant N = 2,490) met inclusion criteria for the review with seven studies across 10 articles (N = 1,347) providing sufficient data for inclusion in the meta-analysis. A small but significant effect size favoring personalized interventions was found (d = 0.21, 95% CrI [0.02, 0.39]), indicating that personalized interventions are associated with superior treatment outcomes compared to standardized interventions. Moderate between-study heterogeneity was found (I2 = 53.3%). There was no evidence of publication bias. The review also found significant variation in methods of treatment personalization. This review provides evidence that personalization of adolescent psychological interventions is an effective way to improve treatment outcomes. Given the large number of adolescents worldwide who will experience some sort of mental health problem, personalization could have a significantly large impact on global mental health outcomes.

Systematic review registration

https://doi.org/10.17605/OSF.IO/XRNCG.

What Should Personalised Mental Health Support Involve? Views of Young People with Lived Experience and Professionals from Eight Countries

Research demonstrates that young people value mental health support that is tailored to their needs and preferences, rather than a "one size fits all" offer, which is often not equitably accessible (National Children's Bureau, 2021). Understanding young people's lived experiences across different sociocultural contexts is important. The aim of this research was to conduct an international qualitative study on the views of young people with lived experience and professionals, on proposed aspects of personalised support for anxiety and/or depression. Participatory action focus groups were conducted with N = 120 young people with lived experience of anxiety and/or depression (14-24 years) and with N = 63 professionals in Brazil, India, Kenya, Pakistan, Portugal, South Africa, Turkey, and the United Kingdom. Data were analysed using the rigorous and accelerated data reduction (RADaR) technique. Overall, although some country-specific differences were found in terms of what aspects of support young people found to be most important, individual preferences were considered stronger, furthering the view that support should be personalised to the needs of the individual young person. Young people experiencing anxiety and/or depression should be able to choose for themselves which aspects of support they would prefer in their own care and support plans, with families and mental health professionals providing guidance where appropriate, rather than removing the young person from the decision-making process altogether. It should also be ensured that the aspects of personalised support can be understood by young people and professionals from different contexts, including marginalised and minoritised groups and communities.

Defining and operationalizing personalized psychological treatment - a systematic literature review

This systematic literature review aimed to propose a definition of personalized psychological treatment and to suggest how the definition can be operationalized. PsycINFO, Cochrane Library, MEDLINE and EMBASE were searched up to 11 December 2023 for studies in which a definition of personalized psychological treatment was included or a systematic operationalization of personalized psychological treatment was described. Based on a narrative synthesis of the collected definitions, summary categories were developed that informed the proposed definition. Operationalizations were described according to what aspect of treatment, how and when treatment was personalized. The extent to which the operationalizations deviated from the proposed definition was assessed. Thirty-four studies with definitions and 200 with operationalizations were included. The following definition was proposed: personalized psychological treatment aims to optimize treatment outcome for the individual patient by tailoring treatment to unique or specific needs, preferences or other characteristics and includes a systematic adaptation of treatment or a differentiation between treatment strategies. Based on the operationalizations, timing of personalization, specification of the systematic approach and treatment elements that could be personalized were added to the proposed definition. Evidence-based personalization of psychological treatments can be enhanced by clear operationalization based on a comprehensive definition of personalization.

Does behavioural parent training reduce internalising symptoms (or not) among children with externalising problems? Systematic review and meta-analysis

Behaviour parent training (BPT) is known to effectively reduce child externalising problems. However, evidence for BPT to have secondary benefits for reducing internalising symptoms remains unclear. To address this, electronic databases (PsycINFO, MEDLINE, EMBASE, CINAHL, and SCOPUS) were systematically searched for studies examining internalising outcomes from BPT among children aged 2-12 years with clinically elevated externalizing problems. Outcomes for internalising problems following BPT were analysed by meta-analysis. Of 9105 studies identified, 24 studies met the eligibility criteria. Results from meta-analysis demonstrated a significant small treatment effect size (g = - 0.41) for reducing internalising symptoms immediately after treatment. Studies showed moderate heterogeneity (I2 = 44%). Moderation analyses indicated that the overall treatment effect was robust against variations in treatment and study design characteristics. However, a review of individual study methods indicate that these results are limited by significant heterogeneity and limitations in clinical assessment. Overall, the results suggest that BPT programmes for reducing externalising problems have the potential to improve internalising outcomes, but that there is limited information to determine the reliability of these effects, highlighting the need for further investigation.

Advancing Personalized Interventions: A Paradigm Shift in Psychological and Health-Related Treatment Strategies

In recent years, the field of psychological and health-related interventions has seen a paradigm shift towards personalized and tailored approaches [...].

Identifying Person-Specific Drivers of Depression in Adolescents: Protocol for a Smartphone-Based Ecological Momentary Assessment and Passive Sensing Study

BACKGROUND

Adolescence is marked by an increasing risk of depression and is an optimal window for prevention and early intervention. Personalizing interventions may be one way to maximize therapeutic benefit, especially given the marked heterogeneity in depressive presentations. However, empirical evidence that can guide personalized intervention for youth is lacking. Identifying person-specific symptom drivers during adolescence could improve outcomes by accounting for both developmental and individual differences.

OBJECTIVE

This study leverages adolescents' everyday smartphone use to investigate person-specific drivers of depression and validate smartphone-based mobile sensing data against established ambulatory methods. We describe the methods of this study and provide an update on its status. After data collection is completed, we will address three specific aims: (1) identify idiographic drivers of dynamic variability in depressive symptoms, (2) test the validity of mobile sensing against ecological momentary assessment (EMA) and actigraphy for identifying these drivers, and (3) explore adolescent baseline characteristics as predictors of these drivers.

METHODS

A total of 50 adolescents with elevated symptoms of depression will participate in 28 days of (1) smartphone-based EMA assessing depressive symptoms, processes, affect, and sleep; (2) mobile sensing of mobility, physical activity, sleep, natural language use in typed interpersonal communication, screen-on time, and call frequency and duration using the Effortless Assessment of Risk States smartphone app; and (3) wrist actigraphy of physical activity and sleep. Adolescents and caregivers will complete developmental and clinical measures at baseline, as well as user feedback interviews at follow-up. Idiographic, within-subject networks of EMA symptoms will be modeled to identify each adolescent's person-specific drivers of depression. Correlations among EMA, mobile sensor, and actigraph measures of sleep, physical, and social activity will be used to assess the validity of mobile sensing for identifying person-specific drivers. Data-driven analyses of mobile sensor variables predicting core depressive symptoms (self-reported mood and anhedonia) will also be used to assess the validity of mobile sensing for identifying drivers. Finally, between-subject baseline characteristics will be explored as predictors of person-specific drivers.

RESULTS

As of October 2023, 84 families were screened as eligible, of whom 70% (n=59) provided informed consent and 46% (n=39) met all inclusion criteria after completing baseline assessment. Of the 39 included families, 85% (n=33) completed the 28-day smartphone and actigraph data collection period and follow-up study visit.

CONCLUSIONS

This study leverages depressed adolescents' everyday smartphone use to identify person-specific drivers of adolescent depression and to assess the validity of mobile sensing for identifying these drivers. The findings are expected to offer novel insights into the structure and dynamics of depressive symptomatology during a sensitive period of development and to inform future development of a scalable, low-burden smartphone-based tool that can guide personalized treatment decisions for depressed adolescents.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/43931.

What CBT Modules Work Best for Whom? Identifying Subgroups of Depressed Youths by Their Differential Response to Specific Modules

Prior research suggests that the effects of specific cognitive-behavioral therapy (CBT) modules on symptom outcomes can be estimated. We conducted a study utilizing idiographic and nomothetic methods to clarify which CBT modules are most effective for youth depression, and for whom they are most effective. Thirty-five youths received modular CBT for depression. Interrupted time series models estimated whether the introduction of each module was associated with changes in internalizing symptoms, whereby significant symptom reduction would suggest a therapeutic response to the module. Regression models were used to explore whether participant characteristics predicted subgroups of youths based on their estimated response to certain types (e.g., cognitive) of modules, and whether group membership was associated with posttreatment outcomes. Thirty youths (86%) had at least one module associated with a significant change in internalizing symptoms from premodule delivery to postmodule delivery. The specific modules associated with these changes varied across youths. Behavioral activation was most frequently associated with symptom decreases (34% of youths). No participant characteristics predicted estimated response to module type, and group membership was not significantly associated with posttreatment outcomes. Youths display highly heterogeneous responses to treatment modules, indicating multiple pathways to symptom improvement for depressed youths.

Cognitive Behavioral Therapy for Anxiety and Depression in Children and Adolescents

Anxiety and depression are prevalent and impairing psychiatric problems for children and adolescents. In this review, the authors summarize information about their prevalence and impact, the most common assessment methods, the main components of cognitive behavioral therapy (CBT), and research on the effectiveness of CBT for these disorders. Future directions, including improving access to CBT through technology-based approaches and increasing personalization of treatment, are discussed.

Modular CBT for Childhood Anxiety Disorders: Evaluating Clinical Outcomes and its Predictors

This study examined clinical outcomes of a modular individual CBT for children with anxiety disorders (AD), and predictors of outcomes, in usual clinical practice. Participants were 106 children with ADs (7-17 years), and parents. Assessments were pre-, mid-, post-test, and 10 weeks after CBT (follow-up). Predictors (measured pre-treatment) were child characteristics (gender, age, type of AD, comorbid disorders), fathers' and mothers' anxious/depressive symptoms, and parental involvement (based on parents' presence during treatment sessions and the use of a parent module in treatment). At follow-up, 59% (intent-to-treat analyses) to 70% (completer analysis) of the children were free from their primary anxiety disorder. A significant decrease in anxiety symptoms was found. Higher parental involvement was related to lower child anxiety at follow-up, but only for children with comorbid disorders. Findings suggest that it is beneficial to treat anxiety with modular CBT. Future steps involve comparisons of modularized CBT with control conditions.

A mixed methods analysis of youth mental health intervention feasibility and acceptability in a North American city: Perspectives from Seattle, Washington

In March 2021, the Governor of Washington declared a youth mental health crisis. State data revealed high rates of youth suicide and inadequate access to services. This study aims to ascertain the kinds of support across the mental health care continuum recommended by young people and key stakeholders who could assist with implementation in Seattle. We interviewed 15 key informants to identify the contextual, structural, and individual-level factors that increase the risk of poor mental health and deter access to care among youth. We complimented these data with a 25-item survey of 117 participants in King County to assess the feasibility and acceptability of interventions for youth mental health. We conducted a deductive thematic qualitative analysis of the interviews and performed descriptive analyses of the quantitative data, using t-tests and χ2 tests to summarize and compare participant characteristics stratified by age group. Qualitative informants attributed challenges to youth mental health to social isolation and relational problems. Example interventions included creating environments that increase belonging and implementation of culturally congruent mental health services. Quantitative study participants rated all evidence-based mental health interventions presented as highly acceptable. However, youth preferred interventions promoting social connectedness, peer support, and holistic approaches to care, while non-youth preferred interventions focused on suicide, and substance abuse prevention. Key informants and survey participants identified schools as the most important setting for mental health interventions. There were no significant differences among quantitative outcomes. Our findings highlight the need for interventions that reduce isolation and increase social connectedness to support youth mental health. As the city designs youth responsive interventions, schools and digital platforms should be prioritized. Engaging multiple stakeholders, particularly young people, tackling cultural stigma surrounding mental health, and improving access to safe community spaces are important considerations for youth mental health interventions.

Web-Based Screening, Brief Intervention, and Referral to Treatment for Traumatic Stress and Alcohol Misuse Among Survivors of Sexual Assault and Intimate Partner Violence: Usability and Acceptability Study

BACKGROUND

Recent survivors of intimate partner violence (IPV) and sexual assault (SA) are at a high risk for traumatic stress and alcohol misuse. IPV and SA survivors face barriers to services for traumatic stress and alcohol misuse and have low service utilization rates. One way to increase access to services for this population is the use of web-based screening, brief intervention, and referral to treatment (SBIRT), an evidence-informed approach for early identification of traumatic stress and alcohol and drug misuse and connecting individuals to treatment.

OBJECTIVE

This study aims to assess the usability and acceptability of a web-based SBIRT called CHAT (Choices For Your Health After Trauma) tailored to address traumatic stress and alcohol misuse following past-year IPV, SA, or both.

METHODS

Phase 1 involved gathering feedback about usability and acceptability from focus groups with victim service professionals (22/52, 42%) and interviews with past-year survivors of IPV, SA, or both (13/52, 25%). Phase 2 involved gathering feedback about the acceptability of an adapted version of CHAT in an additional sample of recent survivors (17/52, 33%). Survey data on history of IPV and SA, posttraumatic stress disorder symptoms, alcohol and drug use, and service use were collected from survivors in both phases to characterize the samples. Qualitative content and thematic analyses of the interviews and focus group data were conducted using a coding template analysis comprising 6 a priori themes (usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance).

RESULTS

Six themes emerged during the focus groups and interviews related to CHAT: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. Phase 1 providers and survivors viewed CHAT as acceptable, easy to understand, and helpful. Participants reported that the intervention could facilitate higher engagement in this population as the web-based modality is anonymous, easily accessible, and brief. Participants offered helpful suggestions for improving CHAT by updating images, increasing content personalization, reducing text, and making users aware that the intervention is confidential. The recommendations of phase 1 participants were incorporated into CHAT. Phase 2 survivors viewed the revised intervention and found it highly acceptable (mean 4.1 out of 5, SD 1.29). A total of 4 themes encapsulated participant's favorite aspects of CHAT: (1) content and features, (2) accessible and easy to use, (3) education, and (4) personalization. Six survivors denied disliking any aspect. The themes on recommended changes included content and features, brevity, personalization, and language access. Participants provided dissemination recommendations.

CONCLUSIONS

Overall, CHAT was acceptable among victim service professionals and survivors. Positive reactions to CHAT show promise for future research investigating the efficacy and potential benefit of CHAT when integrated into services for people with traumatic stress and alcohol misuse after recent IPV and SA.

Perceptions of community mental health services among culturally diverse adult Singaporeans with major depressive disorder: A descriptive qualitative study

Persons with major depressive disorder (PMDDs) often experience pernicious ramifications on the biopsychosocial aspects of their health. While community mental health services (CMHSs) in Singapore are increasingly leveraged to meet the escalating demand for mental healthcare, shortcomings such as a substantial treatment gap and the lack of holistic, culturally sensitive care have been highlighted. Of note, the perspectives of the service users, which have hardly been studied in the literature, are crucial to our understanding of their needs to continuously improve CMHSs. Accordingly, this qualitative descriptive study explored the perceptions and experiences of community-dwelling adults with major depressive disorder in their use of CMHSs in Singapore. Seventeen adults with major depressive disorder purposefully sampled from a CMHS provider were interviewed through a semi-structured guide between October and November 2021. Data analysis via Braun and Clarke's six-step thematic framework yielded five themes corresponding to three different phases: pre-CMHS encounter ((i) procrastination to seek help and (ii) factors influencing CMHS utilization); intra-CMHS encounter ((iii) incongruous perceptions of the impacts on biopsychosocial health and (iv) differing perceptions and experiences of culturally sensitive care); and post-CMHS encounter ((v) enhancing CMHSs for PMDDs based on end-users' experiences). Our findings underscore the need to improve the delivery of personalized mental healthcare services, use of settings- and culturally-specific anti-stigma strategies, and nationwide mental health literacy in symptom recognition and awareness of help-seeking resources.

Novel mechanism-based treatments for pediatric anxiety and depressive disorders

Pediatric anxiety and depressive disorders are common, can be highly impairing, and can persist despite the best available treatments. Here, we review research into novel treatments for childhood anxiety and depressive disorders designed to target underlying cognitive, emotional, and neural circuit mechanisms. We highlight three novel treatments lying along a continuum relating to clinical impact of the disorder and the intensity of clinical management required. We review cognitive training, which involves the lowest risk and may be applicable for problems with mild to moderate impact; psychotherapy, which includes a higher level of clinical involvement and may be sufficient for problems with moderate impact; and brain stimulation, which has the highest potential risks and is therefore most appropriate for problems with high impact. For each treatment, we review the specific underlying cognitive, emotional, and brain circuit mechanisms that are being targeted, whether treatments modify those underlying mechanisms, and efficacy in reducing symptoms. We conclude by highlighting future directions, including the importance of work that leverages developmental windows of high brain plasticity to time interventions to the specific epochs in childhood that have the largest and most enduring life-long impact.

Digital Psychosocial Follow-up for Childhood Critical Illness Survivors: A Qualitative Interview Study on Health Professionals' Perspectives

Background

Digital solutions have been reported to provide positive psychological and social outcomes to childhood critical illness survivors, a group with an increased risk for long-term adverse psychosocial effects.

Objective

To explore health professionals' perspectives on the potential of digital psychosocial follow-up for childhood critical illness survivors.

Methods

Using a qualitative approach, expert interviews with six health professionals working at a Norwegian hospital were conducted. Transcribed interviews were analyzed using Braun and Clarke's six-phase thematic analysis framework. Concurrent data collection and analysis using inductive coding was also employed, and a model of codes was constructed.

Results

The interview yielded thirteen unique codes regarding the health professionals' perspectives on the potential for digital psychosocial follow-up for childhood critical illness survivors, organized in a model comprising the two main themes: Affecting Factors and Digital Usage. Demographic factors (the child's medical condition, age, gender, and residence) and environmental factors (the child's family and health professionals) tended to affect the current psychosocial follow-up. Hospital limitations concerning a lack of digital solutions, worse relationship building with video communication, and children's already high screen time reflected the current state of digital usage. However, ongoing digitalization, existing successful digital solutions, children's good digital skills, and an ongoing process of creating an artifact are also seen as opportunities for digital usage in future psychosocial follow-up for childhood critical illness survivors.

Conclusions

Researchers can build further on these findings to investigate the potential of digital psychosocial follow-up for childhood critical illness survivors, and clinicians can use it as a starting point for improving psychosocial follow-up.

Development, reach, acceptability and associated clinical changes of a group intervention to improve caregiver-adolescent relationships in the context of adolescent depression

Background

Adolescents with depression often experience relationship problems with their caregivers, which predict poorer treatment outcomes. Personalising interventions by targeting factors associated with poor treatment outcomes may enhance the effectiveness of interventions. We report the development and initial evaluation of an intervention designed to target caregiver-adolescent relationship problems in the context of adolescent depression.

Methods

Following a literature search to identify established caregiver interventions, we developed a new group intervention for caregivers through an iterative process including six rounds of the group with n = 53 caregivers of adolescents age 13-18 in the context of an integrated care pathway for adolescent depression. Caregivers rated their family functioning at the beginning and end of the program and provided anonymous satisfaction ratings. Enrolment and attendance data were examined. Youth with lived experience of depression and their caregivers provided input that was incorporated in the final version of the intervention.

Results

The final intervention consists of 8 weekly, 1.5 h group sessions, delivered face-to-face, addressing: psychoeducation, the cognitive-behavioural model and caregiving, positive caregiving, listening and validation, expressing emotions effectively, and problem solving. Reach (56%), attendance (M = 63%, SD = 31%), and satisfaction (M = 92%; SD = 7%) supported the feasibility of the program. Caregivers reported significant improvements in family functioning, t(21) = 2.68, p = .014, d z = 0.56 [95% CI 0.11-1.0].

Discussion

A group intervention is acceptable to caregivers of adolescents with depression and may be associated with improved family functioning. Further research is needed, including a randomised controlled trial to test effects of the intervention on various dimensions of the caregiver-youth relationship and on youth depression outcomes.

Family-Based Interventions for Youth Depression: Meta-Analysis of Randomized Clinical Trials

Youth depression is an impairing pediatric condition for which psychotherapy effects are modest. Can outcomes be improved by treatments that address the family context, as proposed in practice parameters of the American Academy of Child and Adolescent Psychiatry? To find out, we searched five decades of research for randomized controlled trials testing family-based interventions; 11 trials were found for ages 4-18 years. Using robust variance estimation, we obtained estimates of effect size (ES) and tested candidate moderators that might explain variation in ES. Overall pooled ES of the studies was 0.33 at posttreatment, similar to that reported for all youth depression treatments in three prior meta-analyses (i.e., 0.36, 0.30, and 0.29), but higher for adolescents (ages ≥ 13, 0.50) than children (0.04). Taken together, our findings do not show superior outcomes for family-based interventions, and raise questions about how much confidence can be placed in the evidence base to date. The small number of relevant studies in more than five decades, together with the publication bias and risk of bias concerns, highlights the need for more trials testing family-based treatment, and for pre-registered reports, publicly-available preprints, and other mechanisms for improving the dissemination of completed research.

Associations Between Early Life Adversity and Youth Psychobiological Outcomes: Dimensional and Person-Centered Approaches

Exposure to early life adversity (ELA) is associated with increased externalizing symptoms (e.g., aggression and oppositionality), internalizing symptoms (e.g., withdrawal and anxiety), and biological indicators of accelerated aging (e.g., telomere length) in childhood. However, little is known about how distinct dimensions of ELA, such as threat and deprivation, impact youth psychobiological outcomes. The present study includes data from the Future of Families and Child Wellbeing Study (FFCWS), a large population-based, birth cohort study of majority (approximately 75%) racial and ethnic minority youth born between 1998 and 2000 across 20 large cities in the United States. The present study includes a subset of the original sample (N = 2,483, 51.6% male) who provided genetic data at age 9. First, confirmatory factor analyses were conducted, which revealed four distinct dimensions of ELA (home threat, community threat, neglect, and lack of stimulation) when children were age 3. Second, latent profile analyses identified an eight-profile solution based on unique patterns of the four ELA dimensions. Lastly, latent profiles were used to predict associations with child psychological and biological outcomes at age 9. Results suggest that exposure to specific combinations of ELA is differentially associated with internalizing and externalizing behaviors in childhood, but not with telomere length. Findings have implications for personalized early intervention and prevention efforts aimed at reducing ELA exposure to protect against downstream negative mental health outcomes for diverse youth.

Idiographic Coping Outcomes in Youth with Autism Spectrum Disorder and Co-Occurring Anxiety: Results from the TAASD Study

Versions of cognitive behavioral therapy (Coping Cat, CC; Behavioral Interventions for Anxiety in Children with Autism, BIACA) have shown efficacy in treating anxiety among youth with autism spectrum disorder. Measures of efficacy have been primarily nomothetic symptom severity assessments. The current study examined idiographic coping outcomes in the Treatment of Anxiety in Autism Spectrum Disorder study (N = 167). Longitudinal changes in coping with situations individualized to youth fears (Coping Questionnaire) were examined across CC, BIACA and treatment as usual (TAU) in a series of multilevel models. CC and BIACA produced significantly greater improvements than TAU in caregiver-reported coping. Youth report did not reflect significant differences. Results show the efficacy of CC and BIACA in improving idiographic caregiver-, but not youth-, reported youth coping.

Research Review: The internalizing paradox - youth anxiety and depression symptoms, psychotherapy outcomes, and implications for research and practice

BACKGROUND

Youth anxiety and depression have long been combined within the empirically derived internalizing syndrome. The two conditions show substantial comorbidity, symptom co-occurrence, and overlap in treatment procedures, but paradoxically diverge in psychotherapy outcomes: strong, positive effects for anxiety and weak effects for depression.

METHODS

Drawing on recent research, we examine candidate explanations for this paradox to help identify strategies for addressing it by improving outcomes for youth depression.

RESULTS

Candidate explanations include that youth depression, compared with youth anxiety, has more varied comorbidities and more heterogeneous symptom combinations, has greater uncertainty regarding mediators and mechanisms of change, is treated with more complex and potentially confusing protocols, and has characteristics that may impede client engagement. Candidate strategies for shrinking the psychotherapy effectiveness gap include personalizing through transdiagnostic modular treatment, simplifying therapy by focusing on empirically supported principles of change, developing effective strategies for engaging family members as intervention allies, using shared decision-making to inform clinical decisions and boost client engagement, capitalizing on youth-friendly technological advances, and shortening and digitizing treatments to enhance their accessibility and appeal.

CONCLUSIONS

Recent advances suggest explanations for the internalizing paradox, which in turn suggest strategies for shrinking the youth anxiety-depression psychotherapy outcome gap; these form an agenda for a promising new era of research.

Brief Interventions for Cannabis Using Adolescents

This article discusses the application of brief interventions to address adolescents with a cannabis use problem. Topics include a general model of brief interventions, the outcome literature, existing brief interventions that focus on youth cannabis use, adjustments to a brief intervention when addressing cannabis, referral to treatment issues, personalizing a brief intervention, the need to address coexisting problems, and future directions.

Data mining techniques in psychotherapy: applications for studying therapeutic alliance

Therapeutic Alliance (TA) has been consistently reported as a robust predictor of therapy outcomes and is one of the most investigated therapy relational factors. Research on therapists' and clients' contributions to the alliance development and the alliance-outcome relationship had shown mixed results. The relation of the therapist's and client's biological markers with the alliance is an important and under-investigated topic. Taking advantage of data mining techniques, this exploratory study aimed to investigate the role of different therapist and client factors, including heart rate (HR) and electrodermal activity (EDA), in relation to TA. Twenty-two dyads with 6 therapists and 22 clients participated in the study. The Working Alliance Inventory (WAI) was used to evaluate the client's and therapist's perception of the alliance at the end of each session and through the therapy processes. The Cross-Industry Standard Process for Data Mining (CRISP-DM) was used to explore patterns that may contribute to TA. Machine Learning (ML) models have been employed to provide insights into the predictors and correlates of TA. Our results showed that Linear Regression (LR) was the best technique for predicting the therapist's TA, with client "Diagnostic" and therapy "Termination" being identified as significant predictors of the therapist's TA. In addition, for clients' TA, the Random Forest (RF) was shown to have the best performance. The therapist's TA and therapy "Outcome" were observed as the most influential predictors for the client's TA. In addition, while the Heart Rate (therapist) was negatively associated with the therapist's TA, EDA in the client was a physiological indicator related to the client's TA. Overall, these findings can assist in identifying key factors that therapists should focus on to enhance the quality of therapeutic alliance. Results are discussed in terms of their consistency with empirical literature, innovative and interdisciplinary research on the therapeutic alliance field, and, in particular, the use of the Data Mining approach in a psychotherapy context.

Congruency of multimodal data-driven personalization with shared decision-making for StayFine: individualized app-based relapse prevention for anxiety and depression in young people

Tailoring interventions to the individual has been hypothesized to improve treatment efficacy. Personalization of target-specific underlying mechanisms might improve treatment effects as well as adherence. Data-driven personalization of treatment, however, is still in its infancy, especially concerning the integration of multiple sources of data-driven advice with shared decision-making. This study describes an innovative type of data-driven personalization in the context of StayFine, a guided app-based relapse prevention intervention for 13- to 21-year-olds in remission of anxiety or depressive disorders (n = 74). Participants receive six modules, of which three are chosen from five optional modules. Optional modules are Enhancing Positive Affect, Behavioral Activation, Exposure, Sleep, and Wellness. All participants receive Psycho-Education, Cognitive Restructuring, and a Relapse Prevention Plan. The personalization approach is based on four sources: (1) prior diagnoses (diagnostic interview), (2) transdiagnostic psychological factors (online self-report questionnaires), (3) individual symptom networks (ecological momentary assessment, based on a two-week diary with six time points per day), and subsequently, (4) patient preference based on shared decision-making with a trained expert by experience. This study details and evaluates this innovative type of personalization approach, comparing the congruency of advised modules between the data-driven sources (1-3) with one another and with the chosen modules during the shared decision-making process (4). The results show that sources of data-driven personalization provide complementary advice rather than a confirmatory one. The indications of the modules Exposure and Behavioral Activation were mostly based on the diagnostic interview, Sleep on the questionnaires, and Enhancing Positive Affect on the network model. Shared decision-making showed a preference for modules improving positive concepts rather than combating negative ones, as an addition to the data-driven advice. Future studies need to test whether treatment outcomes and dropout rates are improved through personalization.

Future Directions in Youth Irritability Research

Research on irritability in children and adolescents has proliferated over the last 20 years. The evidence shows the clinical and developmental significance of irritable mood and behavior in youth, and it has led to significant changes in mental health classification, diagnosis, and services. At the same time, this research (including our own) has led to relatively little new in terms of practical, empirically based guidance to improve interventions and outcomes. In this article, we briefly summarize some of these developments and current evidence-based practices. We then put forth two key substantive challenges (the "whats") for future research to address: (a) the need for more effective treatments, especially evaluating and adapting evidence-based treatments that are already well-established for problems related to irritability (e.g., cognitive-behavioral therapies for internalizing and externalizing problems); and (b) the need for a better mechanistic understanding of irritability's phenomenology (e.g., phasic vs. tonic irritability, how frustration unfolds) and putative underlying mechanisms (e.g., cognitive control, threat and reward dysfunction). Lastly, we suggest three methodological approaches (the "hows") that may expedite progress in such areas: (a) ecological momentary assessment, (b) digital health applications, and (c) leveraging existing datasets. We hope this article will be useful for students and early-career researchers interested in tackling some of these important questions to better meet the needs of severely irritable youth.

What caregivers like the most (and least) about cognitive behavioral therapy for youth anxiety: A mixed methods approach

Cognitive behavioral therapy (CBT) is an efficacious therapy for youth anxiety disorders. Caregivers are key stakeholders in youth therapy, and their feedback on treatment can help to inform intervention personalization. This mixed-methods study applied a systematic inductive thematic analysis to identify themes among most- and least-liked CBT features reported by caregivers using open-ended responses on the Client Satisfaction Questionnaire (CSQ-8). The sample included 139 caregivers of youth ages 7-17 (M = 12.21, SD = 3.05; 59% female; 79.1% Caucasian, 5.8% Black, 2.9% Asian, 2.2% Hispanic, 7.9% Multiracial, 2.2% Other) with principal anxiety diagnoses who completed 16-sessions of CBT. CSQ-8 quantitative satisfaction scores (M = 29.18, SD = 3.30; range: 16-32) and survey-based treatment response rates (responders n = 93, 67%) were high. Most-liked treatment features included: coping skills (i.e., exposure, understanding/identifying anxiety, rewards, homework), therapist factors (interpersonal style/skill, relationship, accessibility), caregiver involvement, one-on-one time with a therapist, structure, consistency, and personally tailored treatment. Least-liked treatment features included: questionnaires, logistical barriers, telehealth, need for more sessions, non-anxiety concerns not addressed, insufficient caregiver involvement, and aspects of exposure tasks. Proportional frequencies of most- and least-liked themes differed by treatment responder status (e.g., responders cited exposure and homework as most-liked more frequently).

Cognitive behavioral therapies for individuals with cerebral palsy: A scoping review

AIM

To synthesize the evidence about the main intervention characteristics of cognitive behavioral therapies (CBTs) for individuals with cerebral palsy and identify barriers and facilitators to their success, focusing on aspects of feasibility and markers of success.

METHOD

A scoping review methodology informed a literature search for papers published between 1991 and 2021. Articles were screened, reviewed, and categorized using the DistillerSR systematic review software, and critically appraised for quantitative and/or qualitative criteria.

RESULTS

Out of 1265 publications identified, 14 met the inclusion criteria. Elements associated with the specific study participant characteristics (46% female; aged 6-65 years), type of CBT techniques used (third-wave [n = 6], cognitive [n = 3], cognitive and behavioral [n = 2], biofeedback training [n = 2]), and features of the study context and methodological quality (two randomized clinical trials and small sample sizes [n ≤ 12]), were identified. Most studies had psychological targets of intervention (n = 10) and secondary physiological (n = 3) or social (n = 2) objectives. Feasibility indicators were described in nearly one-third of the papers.

INTERPRETATION

This study highlights the high flexibility within CBT interventions, enabling their adaptation for individuals with cerebral palsy. However, relatively little, and only low-certainty evidence was identified. More high-quality research in terms of specific CBT techniques, optimal treatment doses, and detailed population characteristics are needed.

Non-suicidal self-injury in Chinese population: a scoping review of prevalence, method, risk factors and preventive interventions

Non-suicidal self-injury behavior (NSSI) is a serious public health concern that requires immediate attention. Despite the high prevalence of NSSI among the Chinese population, there is a significant gap in research on the comprehensive picture of this field. Therefore, a scoping review was conducted to investigate the prevalence, methods, risk factors, and preventive intervention programs related to NSSI in China. The review found that the estimated lifetime prevalence of NSSI among Chinese youth population is alarmingly high at 24.7% (N = 1,088,433). Common methods of NSSI include scratching, hitting, and biting. Additionally, the review synthesized 249 risk factors based on the biopsychosocial-ecological framework, highlighting the urgent need for intervention. However, only 12 empirical studies focus on NSSI prevention or intervention programs were included. These findings underscore the necessity for more clinical practices and larger studies to identify effective interventions and ultimately alleviate the burden of NSSI on the Chinese population.

Funding

This review was supported by Humanity and Social Science Youth foundation of Ministry of Education (22YJCZH018), Science and Technology Innovation 2030 (STI2030-Major Projects:2021ZD0200702), National Natural Science Foundation of China (81825009), and Shuimu Tsinghua Scholar. No funding agencies were involved in the data collection, data analysis, and writing of this paper.

Personalised interventions for subgroups of children with conduct problems

BACKGROUND

Conduct problems are a range of disruptive behaviours in childhood that are associated with long-term adverse outcomes in adolescence and adulthood, including antisocial behaviour, substance misuse, and poor academic achievement. Children with conduct problems can vary according to age of onset, comorbidities, and environmental factors, and it has been suggested that certain groups of children may have different treatment outcomes. Therefore, it is important to assess the extent to which personalised interventions for different groups of children with conduct problems may affect outcomes. To our knowledge, this is the first review to systematically identify and appraise the effectiveness of personalised interventions, adapted, or developed, for prespecified subgroups of children with conduct problems.

OBJECTIVES

To assess whether personalised interventions, adapted or developed for subgroups of children with conduct problems are effective in improving outcomes.

SEARCH METHODS

We used standard, extensive Cochrane search methods. The latest search was 1 February 2022.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), in any setting, in children (aged two to 12 years) with conduct problems and within a prespecified subgroup, comparing a personalised intervention with a non-personalised intervention, waitlist control, or treatment as usual. Personalised interventions included adaptations to standard practice, such as parent-training programmes; other recommended interventions for children with conduct problems; or interventions developed specifically to target subgroups of children with conduct problems. We excluded non-personalised and non-psychological interventions (e.g. pharmacological or dietary intervention). Prespecified subgroups of children with conduct problems, however defined, were eligible for inclusion.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were 1. child conduct problems or disruptive behaviour and 2.

ADVERSE EVENTS

Our secondary outcomes were 3. personalised treatment outcomes relevant to each subgroup, 4. parenting skills and knowledge, 5. family functioning, engagement and decreased dropout, and 6. educational outcomes. We used GRADE to assess the certainty of the evidence.

MAIN RESULTS

We identified 13 RCTs (858 participants). Seven studies were conducted in the USA, five in Australia, and one in Germany. Eleven studies reported their source of funding, with five studies receiving grants from the National Institute of Mental Health. In total, 15 different funders supported the studies included in the review. We separated subgroups of children with conduct problems into three broad categories: children with co-occurring conditions (e.g. emotional difficulties), parent characteristics (e.g. conflict between parents), or familial/environmental circumstances (e.g. rural families). All studies delivered a personalised intervention that was adapted or developed for a prespecified subgroup of children with conduct problems. We rated all trials at unclear or high risk of bias in most domains. Below, we report the results of improvement in child conduct problems and disruptive behaviour, personalised treatment outcomes, and parenting skills and knowledge for our main comparison: personalised versus non-personalised interventions. Improvement in child conduct problems and disruptive behaviour Compared with a non-personalised intervention, a personalised intervention may result in a slight improvement in child conduct problems or disruptive behaviour measured using the Eyberg Child Behavior Inventory (ECBI) Problem subscale in the short term (mean difference (MD) -3.04, 95% confidence interval (CI) -6.06 to -0.02; 6 studies, 278 participants; P = 0.05), but may have little to no effect on improving child conduct problems or disruptive behaviour measured by the ECBI Intensity subscale (MD -6.25, 95% CI -16.66 to 4.15; 6 studies, 278 participants; P = 0.24), or the Externalising subscale of the Child Behaviour Checklist (CBCL) (MD -2.19, 95% CI -6.97 to 2.59; 3 studies, 189 participants, P = 0.37) in the short term. We graded the certainty of evidence as very low for all three outcomes, meaning any estimate of effect is very uncertain.  Personalised treatment outcomes, relevant to each subgroup Although six studies reported personalised treatment outcomes, relevant to each subgroup, we were unable to pool the data due to differences between the measures used in the studies and the heterogeneity this would produce in analysis. The results for this outcome were inconclusive. Parenting skills and knowledge Although seven studies reported parenting skills and knowledge, we were unable to pool the data due to differences between the measures used in the studies and the heterogeneity this would produce in analysis. The results for this outcome were inconclusive.  Adverse events None of the trials reported monitoring adverse events. Summary of results In summary, there is limited evidence that personalised intervention improves child conduct problems, personalised treatment outcomes, relevant to each subgroup, or parenting skills and knowledge compared with a non-personalised intervention.

AUTHORS' CONCLUSIONS

There is limited evidence for the effectiveness of personalised interventions for subgroups of children with conduct problems. The certainty of evidence for all outcomes was very low, meaning that we have very little confidence in the estimated effects and the true effects may be different to our findings, which will limit the relevance of our findings to clinical decisions. To overcome the limitations of the evidence, large-scale RCTs are needed to determine whether personalised interventions, adapted or developed, for subgroups of children with conduct problems are effective in improving outcomes. Consensus on the most appropriate measures to use in these studies is needed in order to facilitate cross-study comparisons. Persistent conduct problems predict a range of adverse long-term outcomes, so future research should investigate the medium- and long-term effects of personalised treatments. Studies are needed in low- and middle-income countries as well as studies recruiting children aged between nine and 12 years, as they were under-represented in the studies.

Resting-state functional connectivity predicting clinical improvement following treatment in female adolescents with non-suicidal self-injury

BACKGROUND

Non-suicidal self-injury (NSSI) is highly prevalent among adolescents and predicts future psychopathology including suicide. To improve therapeutic decisions and clinical outcome of patients engaging in NSSI, it seems beneficial to determine neurobiological markers associated with treatment response. The present study investigated whether resting-state functional brain connectivity (RSFC) served to predict clinical improvements following treatment in adolescents engaging in NSSI.

METHODS

N = 27 female adolescents with NSSI took part in a baseline MRI exam and clinical outcome was assessed at follow-ups one, two and three years after baseline. During the follow-up period, patients received in- and/or outpatient treatment. Mixed-effects linear regression models were calculated to examine whether RSFC was associated with clinical improvement.

RESULTS

Patients' clinical outcome improved across time. Lower baseline RSFC between left paracentral gyrus and right anterior cingulate gyrus was associated with clinical improvement from baseline to one-year and from two-year to three-year follow-up. Lower and higher baseline RSFC in several inter- and intrahemispheric cortico-cortical and cortico-subcortical connections of interest were associated with clinical symptomatology and its severity, independent from time.

LIMITATIONS

A relatively small sample size constrains the generalizability of our findings. Further, no control group not receiving treatment was recruited, therefore clinical changes across time cannot solely be attributed to treatment.

CONCLUSIONS

While there was some evidence that RSFC was associated with clinical improvement following treatment, our findings suggest that functional connectivity is more predictive of severity of psychopathology and global functioning independent of time and treatment. We thereby add to the limited research on neurobiological markers as predictors of clinical outcome after treatment.

Children subjected to family violence: A retrospective study of experiences of trauma-focused treatment

Exposure to adverse childhood experiences is a risk factor for the development of serious psychiatric and somatic illness. Although trauma-focused therapy is effective in reducing symptoms, not all children benefit from it. To improve treatment efficacy, the children's perspective on what they perceive as helpful versus hindering is necessary. This study aimed, retrospectively, to explore how children exposed to family violence experienced treatment at the Child and Adolescent Mental Health Service. Seventeen children and youths were interviewed 4-5 years after treatment. The thematic analysis resulted in five themes: confusion, the need to feel heard, fear of consequences, feelings of pain, and identifying oneself as an agent. The results emphasize the importance of the therapeutic relationship, and that trust, genuine interest, and reciprocity are necessary for the child to engage in treatment. However, neither the child's own agency nor external obstacles such as continuous exposure to abuse should be underestimated in terms of the child's engagement.

Behavioural and nondirective parent training for children with externalising disorders: First steps towards personalised treatment recommendations

For children with externalising disorders, parent training programmes with different theoretical foundations are available. Currently, there is little knowledge concerning which programme should be recommended to a family based on their individual needs (e.g., single parenthood). The personalised advantage index (PAI) indicates the predicted treatment advantage of one treatment over another. The aim of the present study was to examine the usefulness of this score in providing individualised treatment recommendations. The analysis considered 110 parents (per-protocol sample) of children (4-11 years) with attention-deficit/hyperactivity (ADHD) or oppositional defiant disorder (ODD), randomised to either a behavioural or a nondirective telephone-assisted self-help parent training. In multiple moderator analyses with four different regression algorithms (linear, ridge, k-nearest neighbors, and tree), the linear model was preferred for computing the PAI. For ODD, families randomised to their PAI-predicted optimal intervention showed a treatment advantage of d = 0.54, 95% CI [0.17, 0.97]; for ADHD, the advantage was negligible at d = 0.35, 95% CI [-0.01, 0.78]. For children with conduct problems, it may be helpful if the PAI includes the treatment moderators single parent status and ODD baseline symptoms when providing personalised treatment recommendations for the selection of behavioural versus nondirective parent training. TRIAL REGISTRATION: The study was registered prospectively with ClinicalTrials.gov (Identifier NCT01350986).

Do specific modules of cognitive behavioral therapy for depression have measurable effects on youth internalizing symptoms? An idiographic analysis

OBJECTIVE

Understanding the efficacy of each module of cognitive behavioral therapy (CBT) may inform efforts to improve outcomes for youth depression, but effects of specific modules have been difficult to examine. Idiographic interrupted time series models offer a robust way to estimate module effects on an individual's symptoms. This study examined the association of specific CBT modules for depression on internalizing symptoms among depressed youths who received modular CBT in a randomized trial.

METHODS

Individual models were created for three youths who met study criteria. Youths completed weekly symptom reports, and clinicians completed records of modules delivered. First order auto-regressive models quantified the change in average internalizing symptom severity between pre- and post-module delivery.

RESULTS

All youths had 1-3 modules that were significantly associated with symptom reduction and 1-3 modules associated with deterioration. The 5 modules associated with improvement in at least one youth also lacked association (engagement, relaxation, cognitive reframing), or were associated with worsening (activity selection, parent psychoeducation) in others. Seven modules showed no measurable benefit, or detriment to any youth.

CONCLUSION

This study demonstrated that specific modules have measurable effects, but more work is needed to build an evidence base of specific module effects to inform treatment personalization for youth depression.

Community-Delivered Collaborative and Proactive Solutions and Parent Management Training for Oppositional Youth: A Randomized Trial

The aim of this study was to examine the relative effectiveness of Collaborative and Proactive Solutions (CPS) and Parent Management Training (PMT) for youth with oppositional defiant disorder (ODD) in a community setting. Based on a semistructured diagnostic interview, 160 youth with ODD (ages 7-14; 72% male; ethnicity representative of the wider Australian population) were randomized to CPS (n = 81) or PMT (n = 79) for up to 16 weekly sessions. The primary hypothesis was that participants in the CPS group, treated in a community setting, would exhibit significant improvement in ODD, equivalent to that of an evidence-based treatment, PMT. Assessment was conducted at baseline, post-intervention, and at 6-month follow-up, using independently rated semistructured diagnostic interviews, parent ratings of ODD symptoms, and global ratings of severity and improvement. Analyses were conducted with hierarchical growth linear modeling, ANCOVA, and equivalence testing using an intent-to-treat sample. Both treatments demonstrated similar outcomes, with 45-50% of youth in the nonclinical range after treatment, and 67% considered much improved. No differences were found between groups, and group equivalency was shown on the independent clinician and parent-rated measures. Gains were maintained at the 6-month follow-up. In conclusion, CPS works as effectively as the well-established treatment, PMT, for youths with ODD, when implemented in a community-based setting. As such, CPS provides a viable choice for families who seek alternate treatments.

Supportive Emotion Socialization Mitigates Risk Between Maternal Emotion Regulation Difficulties and Preschooler Emotion Regulation

Few studies have examined protective maternal factors that may mitigate the intergenerational transmission of risk of maternal emotion regulation difficulties on child outcomes. The current study tested whether supportive maternal emotion socialization moderated the association between maternal emotion regulation difficulties and child emotion regulation behaviors. Participants were 68 mother-preschooler (aged 36-60 months) dyads that were oversampled for maternal symptoms of borderline personality disorder, in order to achieve greater variability in the range of maternal emotion regulation difficulties. Maternal emotion regulation difficulties and supportive emotion socialization behaviors were measured using self-report questionnaires, and child emotion regulation was coded during a frustration-eliciting blocked goal task. Results partially supported study hypotheses, such that trait maternal emotion regulation difficulties were associated with child displays of sadness at low levels of supportive maternal emotion socialization, but not when mothers engaged in higher levels of supportive emotion socialization. These findings suggest that maternal emotion regulation and emotion socialization are distinctly related to child emotion expression and regulatory actions, and that adaptive maternal emotion socialization may mitigate some of the adverse transgenerational impacts of impaired emotion regulation.