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Projects: RG Ecological Translation in Public Mental Health Provision (E.T.)

Reininghaus U. EU - Europäische Union 945263: IMMERSE - The implementation of Digital Mobile Mental Health in clinical care pathways: Towards person-centered care in psychiatry. 04/2021-03/2025.

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.

Reininghaus U. MWK - Ministerium für Wissenschaft Forschung und Kunst Baden-Württemberg : Reallabor Künstliche Intelligenz für digitale personalisierte psychische Gesundheitsförderung bei jungen Menschen. 01/2021-12/2023.

Reininghaus U, Flor H. BMBF - Bundesministerium für Bildung und Forschung 01EC1904B: perPAIN - Improving outcomes in chronic musculoskeletal pain through a personalized medicine approach. 05/2020-04/2023.

Chronische muskuloskelettale Schmerzen (CMSK) können durch kompensatorisches Verhalten, welches durch kurzfristige Schmerzreduktion und soziale Verstärkung aufrechterhalten bleibt, zu einer Chronifizierung der Schmerzen führen und werden durch Furcht vor den Schmerzen, komorbide Angsterkrankungen und Depression noch verstärkt. Ziel des Teilvorhabens ist es, eine auf Extinktions- und Expositionstraining basierende Therapie bei Patienten mit CMSK zu optimieren, zu implementieren und zu analysieren. Dieses Therapieverfahren wird im Vergleich zu einer auf die Reduktion emotionaler Belastung zugeschnittenen Behandlung oder einer Smartphone-basierten Minimalintervention untersucht. Ziel von Teilvorhaben 3 ist die Untersuchung von Schmerz auslösenden und aufrechterhaltenden Mechanismen, prognostischen Markern und behandlungs-bedingten Veränderungen im alltäglichen Leben durch Smartphone- und Sensoren-basiertes ambulatorisches Assessment sowie die Analyse der therapeutischen Effekte einer Minimal-Intervention mittels Smartphone-basiertem Aktivitätstagebuch in der personalisierten Behandlung bei Patienten mit CMSK. In Kooperation mit den Verbundpartnern wird ein Zuweisungsalgorithmus entwickelt und in einer Proof-of-Concept-Studie getestet und optimiert. Durch die frühe Personalisierung der Therapie für spezifische Subgruppen soll der Therapieeffekt bei gleichzeitiger Kostenreduktion deutlich verbessert werden.

Meyer-Lindenberg A, Tost H. MWK - Ministerium für Wissenschaft Forschung und Kunst Baden-Württemberg : Psychoepidemiologisches Zentrum: Digitalisierte Methoden zur personalisierten Gesundheitsförderung und Krisenprävention in der Pandemie (Digi-PEZ). 04/2021-12/2022.

Die Covid-19-Pandemie ist eine noch nie dagewesene Herausforderung für die öffentliche Gesundheit mit schwerwiegenden Auswirkungen auf die Bewegungs- und Entfaltungsfreiheit, das Wohlergehen und die psychische Gesundheit der Bevölkerung. Das Ziel dieses Antrags ist es, durch die gezielte strategische Erweiterung des Psychoepidemiologischen Zentrums (PEZ) am Zentralinstitut für Seelische Gesundheit in Mannheim die Bekämpfung der Pandemie und ihrer Wirkungen mittels alltagstauglicher digitaler Erfassungs- und Interventionsmethoden nachhaltig zu unterstützen. Hierfür planen wir die Bereitstellung einer neuartigen digitalen Methodenplattform, die es ermöglicht, (i) soziale und individuelle Einflussfaktoren auf das Pandemie-bezogene Verhalten und Erleben in der gesunden Allgemeinbevölkerung und psychiatrischen Patienten mittels elektronischer Tagebücher (e-Tagebücher) und Sensoren im Alltag zu erfassen, (ii) psychosoziale und umweltbedingte Risikofaktoren für Pandemie-bezogene psychische Krisen mittels Echtzeit-Erhebungen zu identifizieren, und (iii) personalisierte und digitalisierte Hilfestrategien zur situationsgerechten Bewältigung der Pandemiefolgen zu entwickeln. Die geplante inhaltliche Anpassung des PEZ im Rahmen der Pandemie schafft einen neuen Zugang zur digitalisierten Diagnostik und Frühintervention psychischer Erkrankungen, ist unmittelbar auf die Standorte unserer Kollaborationspartner im Land übertragbar und verstärkt somit maßgeblich den Gesundheitsstandort Baden-Württemberg und seine Vorbildfunktion in der Personalisierten Medizin in Deutschland.

Reininghaus U. DFG - Deutsche Forschungsgemeinschaft RE 3832/2-1: Heisenberg-Professur. Integrated models of mental disorder: social risk architecture, targeted mHealth interventions, and public health gains. 12/2018-11/2021.

The overarching aim of this Heisenberg professorship is to transform evidence on integrated aetiological models and transdiagnostic dimensions across the entire continuum of mental health into real public health gains. Therefore, ecological translation (E.T.) is at the very heart of the research programme this professorship aims to deliver by a) identifying momentary risk and protective mechanisms, socio-environmental contexts and settings across the continuum of mental health and, b) in a next step, translating this into novel digital interventions and services – ecological momentary interventions (EMI) in particular – that target these mechanisms, contexts and settings in real time and in the real world, outside the research lab or clinic. We seek 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.

Reininghaus U. DFG - Deutsche Forschungsgemeinschaft RE 3832/3-1: EMIcompass - Efficacy of a novel, accessible, transdiagnostic, compassion-focused ecological momentary intervention for enhancing resilience in help-seeking youth. 12/2018-11/2021.

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 efficacy and clinical feasibility of a novel, accessible, transdiagnostic, ecological momentary, compassion-focused intervention for improving emotional resilience to stress (EMIcompass) in help-seeking youth. In an exploratory randomized controlled trial, youth aged 12-25 with psychotic, depressive, anxiety, and/or manic symptoms presenting to mental health services of the Central Institute of Mental Health, Mannheim, 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.

Reininghaus U. Heinrich-Lanz-Zentrum für Digitale Gesundheit: DiSERVE@home - Digital forms of service delivery in crisis resolution and home treatment for people with severe mental health problems. 06/2020-05/2021.

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.

Reininghaus U. MWK - Ministerium für Wissenschaft Forschung und Kunst Baden-Württemberg PMH1/20: AI4U - Living lab artificial Intelligence for personalized digital mental health promotion in youth. 01/2020-06/2020.

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.


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