Negative Affect Research Articles

The role of emotional eating as relief mechanism from psychological distress and its impact on overall wellbeing

Emotional eating, characterized by the consumption of highly palatable and calorie dense foods in response to psychological distress and negative emotions, poses a significant challenge to global public health and well-being. Based on the studies showing the complex interplay between emotional states and dietary choices, highlighted the motivational role of relief seeking, which according to a Hull's drive reduction theory, emphasizes the role of internal drives and external cues. Inability to cope with negative feelings and/or high tension indicates that emotion regulation can be a critical factor in maintaining well-being, as adaptive regulation protects against negative emotions and external stressors; which if not developed properly, can lead to avoidant coping strategies, which can contribute to eating disorder symptoms. Therefore, dysregulation of the hedonic and homeostatic food intake, compromised cortical control, and alterations in the gut signaling are implicated in obesity triggered by stress-induced eating. Therefore this review aim to further discuss these observations to provide better understanding of the role of emotional eating in providing a relief from the psychological distress, emphasizing impact of the food on the reward system; while providing insights in emerging holistic mitigating approaches which by promoting alternative coping mechanisms and adequate nutrition and supplementation, may help to aid the emotional eating management and reduce burden on related to that illnesses.

The use of multilevel emotion regulation strategies in the context of critical public events: the more the better?

Critical public events, like COVID-19, significantly impact individuals’ emotional and mental health. People tend to use multi-level emotion regulation strategies (intrapersonal, interpersonal and hyper-personal) to cope with these events, resulting in various strategy profiles. However, few studies have examined ER strategies from a multilevel perspective. Therefore, this study examines the use of multi-level strategies during COVID-19, and evaluates the effectiveness of these strategies, with a particular interest in identifying strategy profiles promoting mental health. We conducted a two-wave study (an interval of 1 week) using online questionnaires during COVID-19, with an initial sample of 1,189 participants and 895 samples completing the surveys across the two waves. Cross-lagged analysis indicated that experiential avoidance was reciprocally positively related to negative emotions while perspective-taking and humorous-meme-saving were reciprocally positively related to life satisfaction or positive emotions over time. Cluster analysis suggested that there were 9 different profiles which scored differently on mental health indicators. Specifically, the use of multi-level strategies tended to be associated with greater positive emotions and life satisfaction while with lower negative emotions and loneliness. This study revealed that the use of multi-level strategies plays a protective role in mental health when facing critical public events. These findings expanded our understanding of how multilevel emotion regulation strategies impact mental health during critical public events and identify protective profiles for mental health.

Pandemic Paranoia Scale for Adolescents (PPS-A): An Initial Psychometric Evaluation and Prevalence Study of Adolescents in the United States and United Kingdom.

Paranoid thoughts have been reported in 20-30% of adolescents, and preliminary research has shown that paranoia and psychotic-like experiences have increased during the COVID-19 pandemic. However, previous research has typically used general measures to assess paranoia, rather than those specific to COVID-19, which may overlook particular facets of paranoia related to the pandemic and result in an under-reporting of paranoia prevalence rates during this time. Therefore, this study aimed to examine the psychometric properties of the Pandemic Paranoia Scale for Adolescents (PPS-A), which was adapted from the original scale to be appropriate for younger respondents, and to assess the prevalence of pandemic paranoia among adolescents. Adolescents (N = 462) recruited on Qualtrics from the United States (US) and United Kingdom (UK) completed an online survey consisting of the PPS-A and measures of general paranoia and negative affect. A subset of adolescent's parents (N = 146) also completed an online survey providing dyadic data. Findings showed that the PPS-A shared the same three factor structure as the adult PPS (i.e., persecutory threat, paranoid conspiracy, and interpersonal mistrust) and across participant nationality, race, gender, and mental health diagnosis. It also demonstrated strong psychometric properties. The overall prevalence rate of pandemic-related paranoia among adolescents was 21% and prevalence rates were higher among US participants than UK participants. This study provides the most comprehensive psychometric evaluation of a pandemic paranoia scale designed for adolescents and highlights the continued prevalence of pandemic paranoia in this age-group nearly two years after COVID-19 began.

The promotive influence of positive moral emotions on prosocial behavior in 3–5‐year‐old children

AbstractProsocial behaviour is a hallmark of social and emotional competence during childhood. Thus, promoting the development of children's prosocial behaviour can have important downstream benefits for individuals and society. Previous studies indicated that there is a positive effect of negative moral emotions on prosocial behaviour, but the influence of positive moral emotions on prosocial behaviour remains largely unknown. This study adopted three experiments to investigate the influence of positive moral emotions on three aspects of prosocial behaviour in 3–5‐year‐old children. After inducing positive moral emotions in children, they were observed either in helping (Experiment 1, N = 151, 75 boys), sharing (Experiment 2, N = 141, 69 boys) or comforting (Experiment 3, N = 132, 66 boys) scenarios. Results showed that: (1) children's helping, sharing and comforting behaviours in the moral emotions (experimental) group were significantly higher than those in the control group, suggesting that positive moral emotions could positively influence the examined prosocial behaviours; (2) there were age differences in children's helping, sharing and comforting, but the effect of positive moral emotions on the examined prosocial behaviours did not differ by age and gender. These findings point to the need for fostering positive moral emotions in early cultivation of children's prosocial behaviour during pre‐schooler education.

Outpatient reception via collaboration between nurses and a large language model: a randomized controlled trial.

Reception is an essential process for patients seeking medical care and a critical component influencing the healthcare experience. However, current communication systems rely mainly on human efforts, which are both labor and knowledge intensive. A promising alternative is to leverage the capabilities of large language models (LLMs) to assist the communication in medical center reception sites. Here we curated a unique dataset comprising 35,418 cases of real-world conversation audio corpus between outpatients and receptionist nurses from 10 reception sites across two medical centers, to develop a site-specific prompt engineering chatbot (SSPEC). The SSPEC efficiently resolved patient queries, with a higher proportion of queries addressed in fewer rounds of queries and responses (Q&Rs; 68.0% ≤2 rounds) compared with nurse-led sessions (50.5% ≤2 rounds) (P = 0.009) across administrative, triaging and primary care concerns. We then established a nurse-SSPEC collaboration model, overseeing the uncertainties encountered during the real-world deployment. In a single-center randomized controlled trial involving 2,164 participants, the primary endpoint indicated that the nurse-SSPEC collaboration model received higher satisfaction feedback from patients (3.91 ± 0.90 versus 3.39 ± 1.15 in the nurse group, P < 0.001). Key secondary outcomes indicated reduced rate of repeated Q&R (3.2% versus 14.4% in the nurse group, P < 0.001) and reduced negative emotions during visits (2.4% versus 7.8% in the nurse group, P < 0.001) and enhanced response quality in terms of integrity (4.37 ± 0.95 versus 3.42 ± 1.22 in the nurse group, P < 0.001), empathy (4.14 ± 0.98 versus 3.27 ± 1.22 in the nurse group, P < 0.001) and readability (3.86 ± 0.95 versus 3.71 ± 1.07 in the nurse group, P = 0.006). Overall, our study supports the feasibility of integrating LLMs into the daily hospital workflow and introduces a paradigm for improving communication that benefits both patients and nurses. Chinese Clinical Trial Registry identifier: ChiCTR2300077245 .

The effect of cognitive reappraisal on emotion recognition in mothers of children with special needs

Intrinsic family dynamics are an important factor in the development of children with special needs, and mothers' emotion regulation ability influences children's development to some extent. This study examined the intrinsic mechanism of cognitive reappraisal of emotion regulation strategies affecting the emotion recognition ability of mothers of children with special needs. Results indicated that mothers of children with special needs recognized negative emotions significantly faster than typically developing child mothers. After receiving cognitive reappraisal emotion regulation strategies, they significantly improved emotional recognition of surprise and reduced attention bias towards anger. Overall, mothers of children with special needs may have obvious attention bias towards negative emotions, and cognitive reappraisal can target negative emotions to help them to better improve emotional resilience.

Bad beauty: Aesthetic judgments are influenced by references to morally contentious content in photographs

Affective responses can influence evaluative judgments, but how are subjective beauty ratings affected by references to morally contentious elements in aesthetic stimuli? In an online experiment (N = 460), we investigated the relationship between two types of descriptive texts (Neutral vs. Negative) and the beauty ratings of 25 photographs that depict sources of environmental pollution. For each photograph, the neutral descriptive text contained general information, whereas the negative descriptive text addressed the pollution source. Further, we explored whether this relationship is mediated by changes in positive and negative affect, and how it interacts with the biospheric values of participants. Our results showed that (1) participants in the Negative Condition rated the photographs as less beautiful than in the Neutral Condition, (2) this relationship was partially mediated by changes in negative affect, and (3) in the Negative Condition, participants with higher levels of biospheric values rated the photographs as less beautiful. Our results indicate that individual values, as well as affective responses induced by aesthetic stimuli, directly influence subjective beauty. This aligns with current theoretical frameworks and fills a gap in experimental research. Finally, we discuss limitations and directions for future studies. PsychINFO Classification Code2340

Examining the Psychological Measures and Feasibility of Recreational Trail Rides in Reducing Cravings for Addictive Substances among Veterans: A Replication Pilot Study.

Equine-assisted services have been gaining popularity as complementary therapies for a variety of populations with a diversity of diagnoses. Interventions using equines might benefit the military Veteran population through building therapeutic alliance as well as reducing symptoms. This pilot observational study is primarily aimed to investigate safety, feasibility, and acceptability of equine-assisted services for Veterans with substance abuse disorders. It is the second pilot observational study, the first being completed in 2022. Secondary outcomes included recording the impact of trail riding on psychological measures among Veterans at a large Veterans Administration medical center. The study included a total of 32 Veterans who participated in trail riding sessions from May 4, 2022 to August 31, 2022. The study utilized the Positive and Negative Affect Scale, Adult Hope Scale, and Craving Experience Questionnaire to assess changes in positive affect, negative affect, hope components, and substance craving. The results indicated significant reductions in negative affect and substance craving after the first session, with positive effects observed in subsequent sessions. However, demographic and diagnostic variables did not predict significant changes in psychological instruments. Overall, the study demonstrated that trail riding was a safe and feasible intervention and may have potential benefits for improving emotional well-being and reducing substance cravings among Veterans. It is recommended that future studies research mechanisms of action, as well as conduct more rigorous investigations, including controlled trials using larger sample sizes and longitudinal research, to best determine lasting effects of these types of complementary therapies.

Pharmacy students' process of learning of real patients in a simple first-person perspective patient simulation exercise — A qualitative analysis

IntroductionPharmacists need more insight into patients' perspectives on medicine to target their counseling and improve patient outcomes. Patient simulation exercises, where pharmacy students are asked to consume medicine-like products, have been shown to foster such understandings, although the specifics of how this occurs, in particularly, how students turn their first-person perspectives toward generalizations about real patients' lives with medicines, are not well documented.The aim was to identify central aspects of the learning process by introducing reflection questions about real patients and follow students' development during a study period. MethodsThe study was conducted with students in their 4th semester in the second year of Pharmacy Education at the University of Copenhagen who were asked to respond to free text questions in a survey instrument about their daily experiences of taking a licorice product for one week as well as answering patient reflection questions. Qualitative deductive analysis was performed by coding students' experiences according to concepts of ‘experiential learning’. Pattern identification within each concept was then inferred, as were their interrelationships. ResultsPatient reflection questions enabled students to turn their first-person perspectives toward relevant generalizations about real patients' lives with medicines, including involved psychological mechanisms and how real patient groups differ in their ability to take medicine regularly. Students who during the week faced challenges with following the required dosing scheme came to more nuanced realizations that medicine adherence requires special efforts and restricts one's daily life; hence, negative emotions were involved in the learning process. ConclusionsThe design of the simple patient simulation exercise gave rise to new types of insights into real patients' lives with medicines. Negative emotions due to interference between the requirements of the exercise and students' normal social lives, as well as commitment to the exercise, were important aspects of this process.

Cross-condition risk and protective factors for psychosocial distress in parents and carers of children and young people with appearance-affecting conditions and injuries

Alongside typical parenting challenges, initial condition-specific research suggests thadifferent experiences and support needs.t parents of children with different visible differences may experience similar psychosocial difficulties. Despite this, large-scale cross-condition research to identify risk and protective factors for parental distress and psychosocial adjustment has been lacking. Two hundred and nine parents and carers of children with a range of visible differences completed an online survey comprised of standardised outcome measures, study-specific measures, and open-ended questions. Multiple regression modelling identified possible risk and protective factors, and data collected via open-ended questions were analysed using content analysis. Findings support themes previously identified in small-scale cross-condition qualitative research with parents of children with visible differences. Risk factors for parental negative affect and stress included parental reports of the noticeability of their child’s visible difference and teasing. Protective factors included good parent-child communication, self-compassion, knowledge of their child’s condition and satisfaction with treatment. The risk and protective factors identified provide important insight into the experiences of this parent population and indicate possible avenues for psychosocial intervention.

Retrospecting Digital Media Use, Negative Emotions, and Trust Gaps During the COVID-19 Pandemic in China: Cross-Sectional Web-Based Survey.

Retrospecting the trust gaps and their dynamics during the pandemic is crucial for understanding the root causes of postpandemic challenges and offers valuable insights into preparing for future public health emergencies. The COVID-19 pandemic eroded people's trust in strangers and acquaintances, while their trust in family members remained relatively stable. This resulted in 2 trust gaps, namely, the family members-strangers trust gap and the family members-acquaintances trust gap. Widening trust gaps impede social integration and undermine the effective management of public health crises. However, little is known about how digital media use shaped trust gaps during a pandemic. This study aims to investigate the relationships between digital media use, negative emotions, the family members-strangers trust gap, and the family members-acquaintances trust gap during the COVID-19 pandemic in China. We test the mediating role of negative emotions between digital media use and 2 trust gaps and compare the indirect effect of digital media use on 2 trust gaps through negative emotions. A cross-sectional web-based survey was conducted in China between January 31, 2020, and February 9, 2020. A total of 1568 adults participated in the survey. Questions related to digital media use, negative emotions, trust in family members, trust in acquaintances, and trust in strangers during the pandemic were asked. Regression analyses were performed to test the associations between the examined variables. We used a 95% bootstrap CI approach to estimate the mediation effects. Digital media use was positively associated with negative emotions (B=0.17, SE 0.03; P<.001), which in turn were positively associated with the family members-strangers trust gap (B=0.15, SE 0.03; P<.001). Likewise, digital media use was positively associated with negative emotions (B=0.17, SE 0.03; P<.001), while negative emotions were positively associated with the family members-acquaintances trust gap (B=0.08, SE 0.03; P=.01). Moreover, the indirect effect of digital media use on the family members-strangers trust gap (B=0.03, SE 0.01; 95% CI 0.01-0.04) was stronger than that on the family members-acquaintances trust gap (B=0.01, SE 0.01; 95% CI 0.003-0.027). The results demonstrate that negative emotions resulting from the frequent use of digital media are a key factor that accounts for the widening trust gaps. Considering the increasing reliance on digital media, the findings indicate that the appropriate use of digital media can prevent the overamplification of negative emotions and curb the enlargement of trust gaps. This may help restore social trust and prepare for future public health crises in the postpandemic era.

Inconsistent advice by ChatGPT influences decision making in various areas

The ChatGPT technology is increasingly becoming a part of our daily lives and is starting to be utilized in various decision-making contexts. The current study builds upon prior research, demonstrating that people’s moral decision-making is influenced by ChatGPT across three perspectives, as evidenced by two studies (total n = 1925). The findings suggested that ChatGPT advice impacted decision-making similarly to expert advice, although not all decisions were susceptible to influence, particularly those based on negative emotions. Additionally, ChatGPT advice affected decisions beyond moral judgments, but no effect was observed when the advice recommended immediate low rewards. Moreover, individuals with a higher tendency for personal fear of invalidity were more likely to be influenced by both expert and AI advice, but this was not related to trust in AI.

In the Eye of the Beholder: Visualizing Strengths, Burdens and Desires Through the Lens of Neurodivergent Children, Their Parents, and Professionals Using the Yucel Method

Abstract Objectives In mental healthcare, there is a growing emphasis on one’s strengths and context instead of focusing primarily on individual deficiencies, pathologies, risks, and negative emotions. Using the visual and tactile Yucel method, this study gains insight into strengths, burdens, and desires of neurodivergent children in residential care and their parents from different perspectives. Methods In this qualitative study, a total of 45 interviews with the Yucel method were conducted with nine neurodivergent children, their parents, and involved professionals. All built a constellation of the child and family’s strengths, burdens, and desires using the Yucel method. To explore if by applying this visual and tactile method additional information is provided to that gathered in the standard diagnostic process, the information of the Yucel method was compared to the information found in the multidisciplinary reports of the children. Results Thematic analysis showed that besides common mentioned strengths (e.g., mother, sports and activities) and burdens (mental health problems), differences in the informants' perspectives were found. Parents mentioned strengths and burdens that were not addressed by other informants and a diversity in needs was found. The comparison of the results from the interviews with the Yucel method with the information in the multidisciplinary reports showed that the Yucel method provided additional information. Conclusions The Yucel method brought more strengths and perspectives into view than diagnostics as usual in the first three months of residential care. This study contributes to the knowledge regarding personal, strength-based, and family-oriented diagnostics in mental healthcare of neurodivergent children and their families.

Inconsistent advice by ChatGPT influences decision making in various areas

The ChatGPT technology is increasingly becoming a part of our daily lives and is starting to be utilized in various decision-making contexts. The current study builds upon prior research, demonstrating that people’s moral decision-making is influenced by ChatGPT across three perspectives, as evidenced by two studies (total n = 1925). The findings suggested that ChatGPT advice impacted decision-making similarly to expert advice, although not all decisions were susceptible to influence, particularly those based on negative emotions. Additionally, ChatGPT advice affected decisions beyond moral judgments, but no effect was observed when the advice recommended immediate low rewards. Moreover, individuals with a higher tendency for personal fear of invalidity were more likely to be influenced by both expert and AI advice, but this was not related to trust in AI.

Pet your cat, walk your dog: The spillover effects of morning quality time with pets on outcomes during and after the workday.

For decades, psychologists have explored dynamics within the realm of human-animal interaction. Organizational psychologists are no different; research has found that exchanges with pets and other animals have the potential to influence important work outcomes, such as performance, well-being, and satisfaction. Relatively little is understood, however, regarding the potential spillover effects of human-animal interaction from the non-work to work context. To address this gap in the literature, the present research-synthesising Broaden and Build Theory and Conservation of Resources Theory-explores the daily spillover effects of morning quality time with pets on affective, behavioural, and cognitive outcomes for employees, both during and after the workday. It is also suggested that openness to experience may act as a cross-level moderator for these daily relationships. An occupationally heterogenous daily diary sample of employed pet owners from the United Kingdom (NLevel 1=405, NLevel 2=81) was used to test these relationships. Using a mixed effects modelling approach, it was revealed that morning quality time with pets was associated with reduced Negative Affect (NA) during the workday, and reduced incivility and withdrawal upon returning home from work. Moreover, higher levels of trait openness to experience strengthened the negative relationships between daily morning quality time with pets and daily workday NA and afterwork incivility. Implications for research and practice are discussed.

Pet your cat, walk your dog: The spillover effects of morning quality time with pets on outcomes during and after the workday.

For decades, psychologists have explored dynamics within the realm of human-animal interaction. Organizational psychologists are no different; research has found that exchanges with pets and other animals have the potential to influence important work outcomes, such as performance, well-being, and satisfaction. Relatively little is understood, however, regarding the potential spillover effects of human-animal interaction from the non-work to work context. To address this gap in the literature, the present research-synthesising Broaden and Build Theory and Conservation of Resources Theory-explores the daily spillover effects of morning quality time with pets on affective, behavioural, and cognitive outcomes for employees, both during and after the workday. It is also suggested that openness to experience may act as a cross-level moderator for these daily relationships. An occupationally heterogenous daily diary sample of employed pet owners from the United Kingdom (NLevel 1=405, NLevel 2=81) was used to test these relationships. Using a mixed effects modelling approach, it was revealed that morning quality time with pets was associated with reduced Negative Affect (NA) during the workday, and reduced incivility and withdrawal upon returning home from work. Moreover, higher levels of trait openness to experience strengthened the negative relationships between daily morning quality time with pets and daily workday NA and afterwork incivility. Implications for research and practice are discussed.

Test-takers’ perspectives on consumer genetic testing for hereditary cancer risk

PurposeWith few exceptions, research on consumer genetic testing for hereditary cancer risk has focused on tests with limited predictive value and clinical utility. Our study advances the existing literature by exploring the experiences and behaviors of individuals who have taken modern consumer genetic tests for cancer susceptibility that, unlike earlier tests, screen for medically significant variants.MethodsWe interviewed 30 individuals who had undergone consumer genetic testing for hereditary cancer risk between 2014 and 2019. We explored participants’ pre-test sentiments (7 items), experiences receiving results (5 items), behavioral and health-related changes (6 items), and attitudes and beliefs (3 items). Data were analyzed for thematic content.ResultsMost participants reported a personal (n = 6) and/or family history (n = 24) of cancer, which influenced their choice to pursue testing. Before testing, most participants did not consult with a physician (n = 25) or receive genetic counseling (n = 23). Nevertheless, the majority felt that they understood test-related information (n = 20) and their results (n = 20), though a considerable number reported experiencing negative emotions related to their results. Most also shared their results with family members (n = 27). Overall, participants’ attitudes towards consumer genetic testing for cancer risk were predominantly positive (n = 23).ConclusionThis study offers new insights into how individuals use and perceive modern consumer genetic tests for hereditary cancer risk, focusing on their perceptions of the risks, benefits, and limitations of these services. Understanding test-takers’ perspectives can potentially inform improvements aimed at ensuring that tests meet users’ needs and deliver clinically valuable genetic risk assessments.

Disparities in being able to donate human milk impacts upon maternal wellbeing: Lessons for scaling up milk bank service provision.

Receiving donor human milk for a baby can have a protective effect upon parental wellbeing. A growing body of research also finds that being able to donate milk to a milk bank, particularly after infant loss, can also boost maternal wellbeing through feelings of altruism and purpose. However, most studies are qualitative, with small sample sizes outside the United Kingdom, and often do not include the experiences of those who have been unable to donate. Our aim was therefore to examine the impact of being able to donate milk, as well as the impact of not being able to do so, using a survey containing open and closed questions in a large UK sample. Overall, 1149 women completed the survey, 417 (36.3%) who donated their milk and 732 (63.7%) who did not. Most women who donated found it had a positive impact upon their wellbeing, feeling proud, useful and that they had achieved something important. Conversely, those unable to donate often felt rejected, frustrated, and excluded, especially if they received no response or felt that restrictions were unfair. Thematic analysis found that being able to donate could help women heal from experiences such as birth trauma, difficult breastfeeding experiences, neonatal unit stays, and infant loss; however, being unable to donate could exacerbate negative emotions arising from similar experiences. A minority of women who donated experienced raised anxiety over following guidelines. These findings further extend the impacts of milk banking services beyond infant health and development and support expanded service delivery.

Linguistic style as a digital marker for depression severity: An ambulatory assessment pilot study in patients with depressive disorder undergoing sleep deprivation therapy.

Digital phenotyping and monitoring tools are the most promising approaches to automatically detect upcoming depressive episodes. Especially, linguistic style has been seen as a potential behavioral marker of depression, as cross-sectional studies showed, for example, less frequent use of positive emotion words, intensified use of negative emotion words, and more self-references in patients with depression compared to healthy controls. However, longitudinal studies are sparse and therefore it remains unclear whether within-person fluctuations in depression severity are associated with individuals' linguistic style. To capture affective states and concomitant speech samples longitudinally, we used an ambulatory assessment approach sampling multiple times a day via smartphones in patients diagnosed with depressive disorder undergoing sleep deprivation therapy. This intervention promises a rapid change of affective symptoms within a short period of time, assuring sufficient variability in depressive symptoms. We extracted word categories from the transcribed speech samples using the Linguistic Inquiry and Word Count. Our analyses revealed that more pleasant affective momentary states (lower reported depression severity, lower negative affective state, higher positive affective state, (positive) valence, energetic arousal and calmness) are mirrored in the use of less negative emotion words and more positive emotion words. We conclude that a patient's linguistic style, especially the use of positive and negative emotion words, is associated with self-reported affective states and thus is a promising feature for speech-based automated monitoring and prediction of upcoming episodes, ultimately leading to better patient care.

Study Protocol: Pegasus: psychotherapy incorporating horses for ‘therapy-resistant’ adolescents with autism spectrum disorders, a study with series of randomised, baseline controlled n-of-1 trials

BackgroundFor people with autism spectrum disorder (ASD), daily life can be highly stressful with many unpredictable events that can evoke emotion dysregulation (ED): a strong difficulty with appropriately negative affect regulation. For some of the patients with ASD, treatment as usual does not prove to be effective for ED. They may be at risk of life-long impairment, development of other disorders and loss of motivation for most regular forms of therapy. A highly promising method that may prove effective for therapy-resistant individuals with ASD is Psychotherapy incorporating horses (PIH). PIH uses the interactions of the horse and the patients on the ground and does not include horseriding. While often met with prejudgment and scepticism, reports from parents and therapists as well as a recent systematic review suggest that PIH may have beneficial effects on youths with ASD. Therefore, we examine clinical outcomes both in the short and in the long terms of PIH offered to adolescents with ASD and severe ED despite regular therapy.MethodsA total of 35 adolescents aged 11–18 years with ASD will receive PIH during 15 sessions once a week with randomization to five different groups differentiating in baseline phase from 2 to 6 weeks. PIH uses horses to promote social awareness and self-awareness as well as relationship management and self-management. The primary outcome is the response to treatment on the Emotion Dysregulation Index (EDI). The secondary outcome measures include ASD symptom severity, quality of life, self-esteem, global and family functioning, and goal attainment. Assessments take place at the baseline (T0), at the end of baseline phase A (T1), after completion of intervention phase B (T2), after the end of post-measurement phase C (T3) and after one year (T4). Qualitative interviews of participants, parents and therapists will be held to reveal facilitators and barriers of PIH and a cost-effectiveness study will be performed.DiscussionThis study aims at contributing to clinical practice for adolescents with ASD and persistent emotion regulation problems despite 1.5 year of treatment by offering Psychotherapy incorporating horses in a study with series of randomised, baseline controlled n-of-1 trials.Trial registrationwww.ClinicalTrials.gov NCT05200351, December 10th 2021.