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Public Mental Health – ongoing studies

The Department of Public Mental Health currently conducts a series of studies into the ecological translation of evidence-based innovations in public mental health provision. The Department primarily seeks to address this translational challenge using innovative translational, participatory, evaluation, implementation science and health economic frameworks as well as cutting-edge digital technology for real-world delivery of evidence-based, personalized mental health promotion, mental illness prevention and mental health care in routine clinical, diverse societal and global settings.

Our ongoing studies include:  

  • EMIcompass – A novel transdiagnostic ecological momentary intervention for enhancing resilience in youth with early mental health problems
  • SELFIE – A transdiagnostic ecological momentary intervention for improving self-esteem in youth exposed to childhood adversity
  • INTERACT - Efficacy of Acceptance and Commitment Therapy in Daily Life: a multi-centre randomized controlled trial
  • Living lab AI4U – Artificial intelligence for personalized digital mental health promotion in youth
  • IMMERSE – The implementation of Digital Mobile Mental Health in clinical care pathways: Towards person-centered care in psychiatry
  • perPAIN - Improving outcomes in chronic musculoskeletal pain through a personalized medicine approach
  • DiSERVE@home - Digital forms of service delivery in crisis resolution and home treatment for people with severe mental health problems
  • Corona EMIcompass - A mobile training for handling stress and strain amid the current situation
  • DynAC - Modelling the temporal interplay of cannabis use, mood and psychotic experiences in daily life: an experience sampling study in youth
  • Evaluation of mental health first aid training in Germany
  • Assessment of need of informal caregivers
  • BEE - Assessment of need of parents

Please see below for further information on our ongoing studies.

 

EMIcompass – a novel transdiagnostic ecological momentary intervention for enhancing resilience in youth with early mental health problems

Most mental disorders first emerge in youth and, as such, contribute substantially to global disease burden. In developmentally earlier stages, risk often manifests in the form of co-occurring subclinical psychotic, affective or anxiety symptoms associated with a range of subsequent severe mental health problems. Addressing this, the EMIcompass study examines a mobile Health (mHealth) training for enhancing resilience in the everyday lives of help-seeking youths. Combining four training sessions with a clinical psychologist and a mHealth training via smartphone app (Ecological Momentary Intervention, EMI), participants learn various compassion-focused strategies and their application in everyday life.

Most mental disorders first emerge in youth and, as such, contribute substantially to global disease burden. In recent years, this has become particularly evident for psychotic disorders, for which risk manifests already at a developmentally earlier stage in the form of subclinical psychotic experiences. Contemporary research further suggests that subclinical psychotic experiences often co-occur with anxiety, depression and mania, reflecting a transdiagnostic phenotype associated with a range of subsequent psychopathological outcomes. Elevated stress sensitivity is one of the most widely studied psychological mechanism underlying psychotic and affective mental health problems. Thus, screening for, and targeting stress sensitivity as an underlying mechanism of, this transdiagnostic phenotype in youth is a promising indicated and translational strategy for preventing adverse outcomes later in life. Psychological help, however, remains difficult to access for youth and has limited efficacy under real-world conditions, calling for novel approaches. Compassion-Focused Interventions (CFIs) offer a wide range of innovative therapeutic techniques for targeting stress sensitivity and enhancing emotional resilience in psychosis, especially when co-occurring with affective disturbances. What is more, the recent rapid technological advances provide a unique opportunity to deliver youth-friendly, accessible, personalized, real-time, mobile health (mHealth) interventions, most prominently, ecological momentary interventions (EMIs) that enable youth to access interventions that are tailored to what a young person needs in a given moment and context in daily life.  EMIs further allow for investigating several causal criteria of candidate underlying psychological mechanisms, but robust, trial-based evidence on these interventions remains very limited.

The project aims to examine the clinical feasibility, candidate underlying mechanisms and initial signals of efficacy of a novel, accessible, transdiagnostic, ecological momentary, compassion-focused intervention for improving emotional resilience to stress (EMIcompass) in youth. In an exploratory randomized controlled trial, youth aged 14-25 with current distress, a broad Clinical High At-Risk Mental State (CHARMS) or a first episode of a severe mental disorder will be randomly allocated to the EMIcompass intervention in addition to treatment as usual (TAU) (experimental condition) or a control condition of TAU only. Stress sensitivity, emotional resilience, psychotic, depressive, anxiety and manic symptoms will be the primary outcomes obtained at baseline, post-intervention, and 4-week follow-up. Ecological interventionist causal models will be tested to improve our understanding of several causal criteria of underlying psychological mechanisms and contribute to enhancing efficacy of mHealth interventions for promoting resilience in youth, with the ultimate goal of preventing adverse outcomes later in life.

SELFIE – a transdiagnostic ecological momentary intervention for improving self-esteem in youth exposed to childhood adversity

Targeting low self-esteem in youth exposed to childhood adversity is a promising strategy for preventing adult mental disorder. The aim of the SELFIE study is to investigate the efficacy of a novel, youth-friendly, transdiagnostic ecological momentary intervention (EMI) for improving self-esteem in youth with prior exposure to childhood adversity. In a randomized controlled trial, individuals aged 12-26 in the experimental condition receive a digital app-based guided self-help EMI blended with three training sessions with mental health professionals allowing for real-time and real-world transfer of the intervention components in individuals’ daily lives.

Targeting low self-esteem in youth exposed to childhood adversity is a promising selective strategy for preventing adult mental disorder, but psychological help remains difficult to access and accept for youth, calling for novel, youth-friendly approaches. Mobile Health (mHealth) and, most prominently, ecological momentary interventions (EMIs) provide a unique opportunity to deliver youth-friendly, personalized, real-time, guided self-help interventions. The aim of this study is to investigate the efficacy of a novel, accessible, transdiagnostic ecological momentary intervention for improving self-esteem (‘SELFIE’) in youth with prior exposure to childhood adversity.

In a parallel-group, assessor-blind, multi-centre randomized controlled trial, individuals aged 12–26 years with prior exposure to childhood adversity and low self-esteem will be randomly allocated to SELFIE in addition to treatment as usual (TAU) as the experimental condition or the control condition of TAU only, which will include access to all standard health care. SELFIE is a digital guided self-help intervention using a guided self-help approach administered through a smartphone-based App to allow for interactive, personalized, real-time and real-world transfer of intervention components in individuals’ daily lives, blended with three training sessions delivered by trained mental health professionals over a 6-week period. Outcomes will be assessed at baseline, post-intervention, and 6-month follow-up by blinded assessors.  

The SELFIE project is conducted in close collaboration with Maastricht University, Academic Medical Center Amsterdam, de Bascule Amsterdam and Parnassia Group.

Efficacy of Acceptance and Commitment Therapy in Daily Life: a multi-centre randomized controlled trial (INTERACT)

Individuals with Ultra-High-Risk state (UHR) and a First-Episode Psychosis (FEP) may experience distress associated with psychotic experiences, social functioning and general psychopathology. Acceptance and Commitment Therapy (ACT) is a promising, next-generation Cognitive Behavioural Therapy (CBT) that aims to modify these targets. The aim of the INTERACT-study is to investigate the efficacy of a novel ecological momentary intervention (EMI) based on methods of ACT for individuals with UHR and FEP. In a multicenter randomized controlled trial, participants receive an app-based intervention teaching them to incorporate ACT-techniques in their daily life.

Distress associated with psychotic experiences, social functioning and general psychopathology are important targets for early intervention in individuals with Ultra-High-Risk state (UHR) and a First-Episode Psychosis (FEP). Acceptance and Commitment Therapy (ACT) is a promising, next-generation Cognitive Behavioural Therapy (CBT) that aims to modify these targets, but evidence on sustainable change and its underlying mechanisms in individuals’ daily lives remains limited. The aim of the current study is to investigate the efficacy of a novel ecological momentary intervention (EMI) based on methods of ACT.

Individuals with UHR or FEP will be randomly allocated to ACT-DL in addition to treatment as usual (TAU) as the experimental condition or a control condition of TAU only. Outcomes will be assessed at post-intervention, 6-month, and 12-month follow-up, and carried out by blinded assessors. The primary outcome will be distress associated with psychotic experiences, while secondary outcomes will include psychotic experiences, social functioning and general psychopathology. Process measures to assess putative mechanisms of change will include psychological flexibility, stress sensitivity and reward experiences. In addition, acceptability, treatment adherence and treatment fidelity of ACT-DL will be assessed.

This study is carried out jointly with the Center for Contextual Psychiatry at KU Leuven, Maastricht University, Academic Medical Center Amsterdam, Parnassia Group and other Dutch and Belgian academic and clinical partners.

Living lab AI4U - artificial intelligence for personalized digital mental health promotion in youth

Youth are particularly affected by mental health problems, but their use of, and access to, preventive interventions remains limited. The recent rapid advances in Artificial Intelligence (AI) and digitization enable the development of novel digital interventions. The overarching aim of this living lab is to investigate the digital transformation in public mental health provision based on the novel application of AI methods to a digital mHealth training for mental health promotion and prevention in adolescents and young adults that is tailored to person, moment and context in daily life. The living lab is carried out in transdisciplinary projects involving direct participation of relevant stakeholders, users from the target population and an interdisciplinary research group. Each of these projects includes one or more real-world experiments.

Youth are particularly affected by mental health problems, but  their use of, and access to, preventive interventions remains limited, as these are often not tailored to their personal needs and real-world settings. The recent rapid advances in Artificial Intelligence (AI) and digitization enable the development of novel digital interventions, which perfectly lend themselves to reach the generation of "digital natives" directly in their daily life and, thereby, improve access to interventions for mental health promotion and prevention. This applies in particular to digital ecological momentary interventions, which offer adaptive training components for mental health promotion and prevention via a smartphone app by real-time processing of ecological momentary assessment (EMA) and sensor data. Modern AI algorithms can significantly improve this process of personalizing training components by applying advanced prediction models (in particular, recurrent neural networks) to real-time multimodal EMA data and translating their findings back into personalized suggestions for mental health promotion and prevention.

To this end, we have recently launched the living lab “Artificial Intelligence for personalized digital mental health promotion and prevention in youth”. The overarching aim of this living lab is the exemplary and participatory investigation of the digital transformation (i.e., the processes underlying the rapid advances in digital technologies and AI) in public mental health provision based on the novel application of AI methods to a digital mHealth training for mental health promotion and prevention in adolescents and young adults that is tailored to person, moment and context in daily life. The living lab is carried out in transdisciplinary projects involving direct participation of relevant stakeholders, users from the target population and an interdisciplinary research group. Each of these projects includes one or more real-world experiments. These will be embedded in a transdisciplinary infrastructure, which will ensure ongoing quality assurance, sustainability assessment, public relations and networking.

The living lab is funded by the Ministry of Science, Research and Art of the State of Baden-Württemberg.

For further information and registration pleaste contact the study team Tel.: 0621 1703-1929 or via E-Mail christian.rauschenberg(at)zi-mannheim.de

IMMERSE - The implementation of Digital Mobile Mental Health in clinical care pathways: Towards person-centered care in psychiatry

The aim of IMMERSE (Implementing Mobile Mental health Recording Strategy for Europe) is to advance person-centered mental health care by including individuals seeking help for mental health problems in their treatment process and decision-making. For this purpose, IMMERSE will develop a clinical digital health tool, Digital Mobile Mental Health (DMMH), fed by data from ecological momentary assessment (EMA), mobile sensing and machine learning. In close collaboration with stakeholders, the implementation of the DMMH will be evaluated at 8 sites in 4 European countries in a cluster Randomized Controlled Trial (cRCT).

The overarching aim of IMMERSE (Implementing Mobile MEntal health Recording Strategy for Europe) is to advance the transformation of mental health care in Europe into true person-centered care, focused on the needs of each individual seeking help for mental health problems, while giving them an active role in their treatment process and decision-making. In order to do so, IMMERSE has identified the Experience Sampling Methodology (ESM), a structured diary technique, as the methodology that puts the service user at the heart of their treatment. IMMERSE will integrate 20 years of research evidence on ESM into an innovative, clinical digital health tool, Digital Mobile Mental Health (DMMH), in close collaboration with stakeholders and extending it with mobile sensing data and innovative machine learning models. DMMH consists of an ESM app, assessing self-reports of mental state in daily life (ecological momentary assessment, EMA), a data-platform that allows the analysis of these data, and dashboard for visualization and feedback. IMMERSE will thoroughly evaluate strategies, processes and outcomes of DMMH implementation in a cluster Randomized Controlled Trial (cRCT) at 8 sites in 4 countries in Europe representing different contexts for implementation evaluation. At the same time, IMMERSE will identify and overcome key barriers and strengthen facilitators for implementation, transfer and scale-up of DMMH to routine mental health clinical practice by closely collaborating with relevant stakeholders, aligning the innovative DMMH tool to their needs. Similarly, the diverse ethical, legal and policy challenges and requirements will be identified and DMMH will be developed and implemented accordingly. Finally, IMMERSE is set out to do a cost-benefit analysis of the implementation and present a framework for future implementation of DMMH, including forecasting scenarios, aiming at a further scale-up of DMMH across 4 countries in Europe and beyond. IMMERSE thus offers a unique potential to significantly innovate mental health care in Europe.

For further information visit: https://www.immerse-project.eu/

perPAIN - Improving outcomes in chronic musculoskeletal pain through a personalized medicine approach

Musculoskeletal pain diseases tend to become chronic, despite adequate medical treatment. The overarching aim of the perPAIN-project is to develop and evaluate the efficacy of a mechanism-based personalized treatment approach, in order to improve treatment outcomes in patients with chronic pain. In a randomized controlled feasibility trial, symptoms of chronic pain patients in everyday life will be assessed using ambulatory ecological momentary assessment (EMA) before participants will be allocated to a personalized therapy, including an innovative app-based mobile intervention (i.e., ecological momentary intervention; EMI) aimed at digital monitoring and feedback, positive refocusing, and behavioral activation.

Musculoskeletal pain conditions affect between 13.5% and 47% of the general population. Despite adequate medical treatment, these conditions tend to persist and become chronic. In addition to physical constraints, chronic musculoskeletal pain is associated with psychological and social impairments and can, therefore, contribute to a significant decrease in quality of life. This is why psychological mechanisms should be taken into account when treating chronic musculoskeletal pain. The overarching aim of the perPAIN-project is to develop and evaluate the efficacy of a mechanism-based personalized treatment approach in a feasibility trial, in order to improve treatment outcomes in patients with chronic musculoskeletal pain. This BMBF-funded project is carried out by a research consortium including the medical faculties Heidelberg and Mannheim as well as the Interdisciplinary Center for Clinical Trials, Mainz.

In order to develop a new personalized treatment approach, psychological factors that are relevant for pain to become chronic will be identified. For this purpose, momentary pain, mood and activities of adults (at least 18 years old) with primary chronic back pain, rheumatoid arthritis, osteoarthritis, or fibromyalgia syndrome will be measured in everyday life using app-based ecological momentary assessment (EMA) and by collecting activity and ECG sensor data. In a randomized controlled feasibility trial, participants will then receive a 12-week personalized therapy according to their individual symptoms and characteristics. In addition to psychological interventions for improving pain, this includes innovative  digital monitoring, feedback and personalized ecological momentary intervention (EMI) components that allow for real-time and real-world transfer of therapeutic principles based on common techniques in pain therapy aimed at positive refocusing and behavioral activation, tailored to their personal needs in their everyday life.

For further information and registration please contact the study team Tel.: 06221/ 5638 898 or via  E-Mail or click here.

DiSERVE@home – Digital forms of service delivery in crisis resolution and home treatment for people with severe mental health problems (STäB)

Ward-equivalent treatment (StäB), a form of crisis resolution and intensive home treatment in Germany, has been introduced in 2018 as a new model of mental health service delivery for people with an indication for inpatient care. The aim of this project is to model and initially evaluate novel digital forms of service delivery such as digital monitoring, feedback, and adaptive ecological momentary intervention in the daily lives of help-seeking individuals that may contribute to improving clinical and social outcomes as well as reducing direct and indirect costs. The project will model the application of these forms of care and carefully investigate their quality from the user perspective, safety, feasibility, initial process and outcome quality as well as barriers and facilitators of implementation.

Ward-equivalent treatment (StäB), a form of crisis resolution and home treatment in Germany, has been introduced in 2018 as a new model of mental health service delivery for people with an indication for inpatient care. The rapid progress in the field of information and communication technology offers entirely new opportunities for innovative digital mental health care such as telemedicine, eHealth, or mHealth interventions. The aim of this research project is to model and initially evaluate novel digital forms of service delivery in the daily lives of help-seeking individuals for personalized delivery of StäB that may contribute to improving clinical and social outcomes as well as reducing direct and indirect costs. In this project, we focus on four digital forms of service delivery that can be used for personalized delivery of StäB:

  1.  communication, continuity of care, and flexibility through online chat and video call;
  2. monitoring of symptoms and behaviour in real-time through ecological momentary assessment (EMA);
  3. use of multimodal EMA data to generate and offer personalized feedback on subjective experience and behavioural patterns as well as
  4. adaptive ecological momentary interventions (EMIs) tailored to the person, moment, and context in daily life.

These new digital forms of service delivery have considerable potential to increase the effectiveness and cost-effectiveness of crisis resolution, home treatment, and assertive outreach. The project will model the application of these forms of care and carefully investigate their quality from the user perspective, safety, feasibility, initial process and outcome quality as well as barriers and facilitators of implementation.

For further information please contact the study team Tel.: 0621 1703-1929 or via E-Mail christian.rauschenberg(at)zi-mannheim.de.

Corona EMIcompass – Mobiles Training zum Umgang mit Stress und Belastung in der aktuellen Lage

The Corona EMIcompass App offers a digital training to strengthen resilience by improving the way of coping with stress amid the current situation. The goal of the 6-week training is to manage an oftentimes changed everyday life and to treat yourself compassionately – as we would with a good friend. The training combines the use of the Corona EMIcompass app and 4 group training sessions via video communication to introduce various ways of coping with feelings and stress, and practice them together with the group.

The Corona EMIcompass app provides a digital training for strengthening your mental health from home by improving the way of coping with stress amid the current situation. The goal of the 6-week training is to manage an oftentimes changed everyday life and to treat yourself compassionately – as we would with a good friend. The training combines the use of the Corona EMIcompass app and 4 group training sessions. During the training sessions via video communication, our EMIcompass trainers will introduce various ways of coping with feelings and stress, and practice them together with the group. The app offers new content, supports with practicing previously learned strategies and provides support when it is needed.

As part of the EMIcompass study conducted by the department of Public Mental Health, the Corona EMIcompass app is scientifically monitored.

Our study team will provide further information by phone (0621 1703-1395) or via E-Mail. To participate in the mobile training using the Corona EMIcompass app, please click here.

DynAC - Modelling the temporal interplay of cannabis use, mood and psychotic experiences in daily life: an experience sampling study in youth

Cannabis use is common in youth and represents an important risk factor for the development of psychosis. In order to  develop digital prevention and treatment strategies , we need to understand more fully the real-time DYNamics of momentary Affect and Cannabis use  (DynAC) in the development of psychotic experiences in daily life. The DynAC study aims to investigate the temporal interplay of affect, craving, cannabis use, motives for use, and psychotic experiences in patients with psychotic disorder and comorbid substance use problems, and young individuals who regularly use cannabis. To this end, participants aged 14-30 years are asked to assess their thoughts, feelings and behaviour on six consecutive days in daily life using Ecological Momentary Assessment (EMA) implemented on a smartphone-based App.

For further information or registration please contact the study team Tel.: 0621 1703-1932 or via E-Mail dynac-studie(at)zi-mannheim.de or click here

Evaluation of mental health first aid training in Germany

Currently, the CIMH and MHFA Ersthelfer are introducing a mental health first aid course program in Germany. Further information on the MHFA courses can be found here

The MHFA study aims to evaluate the course program and to investigate whether knowledge about mental health increases, attitudes towards individuals with mental disorders changes and the willingness to provide mental health first aid increases after course participation. For this purpose, questionnaires are assessed at three points in time: before the course and immediately afterwards as well as 6 months after the course.

For further information or registration please contact the study team Tel.: 0621 1703-1932 oder via E-Mail mhfa-studie(at)zi-mannheim.de or click here

Registration for the MHFA course must be done separately.

Assessment of need of informal caregivers

Relatives of individuals with mental disorders are often exposed to various stressors  in their role as "informal caregivers" and thus have complex needs. In a participatory approach, the advisory board was involved in the development of the study and a joint interpretation of the results is planned. 

The study aims to identify unmet needs among relatives of individuals with severe mental disorders (major depression, bipolar disorder, psychosis, addiction). To this end, participants fill out a questionnaire once.

For further information or registration please contact the study team Tel.: 0621 1703-1932 oder via E-Mail bee-studie(at)zi-mannheim.de.

BEE - Assessment of need of parents

In Germany, approximately 3 million children live with a parent with mental health problems. The utilization of services is low in this group, although complex needs exist. The aim of the study is to investigate unmet needs as well as the utilization of existing care services in parents with mental health problems. Participants are invited to fill out a questionnaire.

For further information or registration please contact the study team Tel.: 0621 1703-1932 or via E-Mail bee-studie(at)zi-mannheim.de.



Zentralinstitut für Seelische Gesundheit (ZI) - https://www.zi-mannheim.de