Potential Mechanisms Of Change Research Articles

Change in emotion-based narrative as a potential mechanism of change in a brief treatment for borderline personality disorder

Background: The move from inconsistent and problematic autobiographical narrative to a more coherent and reality-based narrative construction of the Self has been discussed as potential mechanism of change in psychotherapies for personality disorders. So far, little empirical evidence exists that demonstrates in a time-dependent design the role of narrative construction in the treatment of borderline personality disorder, in particular when it comes to understanding the integration of body-related information from the affective system with the autobiographical narrative. The present study aims at demonstrating change in emotion-based narrative markers over brief psychiatric treatment and to assess the impact of these changes on subsequent symptom change. Methods: A total of N = 57 clients with borderline personality disorder were assessed at three timepoint over the course of four months of brief psychiatric treatment, within the context of a secondary process-outcome analysis of a randomized controlled trial. Symptom change was assessed using the OQ-45.2 and emotion-narrative change was assessed using the Narrative-Emotion Process Coding System to code client’s in-session speech in terms of problem, transition and change markers. Results: All three emotion-based marker categories evidenced significant changes in the assumed direction. The reduction in problem emotion-based narrative markers (e.g., empty story telling) between session 1 and 5 into the treatment predicted the symptom reduction assessed between session 5 and 10. Conclusions: Emotion-based narrative construction may be a suitable method to study the pathway of change toward a more coherent and reality-based narrative construction of the Self-in-interaction-with-the-Other. Reduction of emotion-based problem-marker may be a promising candidate for a mechanism of change in treatments for personality disorders which should be tested in a time-dependent controlled design.

Scoping review of the role of social support in women veterans’ psychosocial and health outcomes

Women veterans are a steadily growing population and have unique military experiences (e.g., report high rates of sexual harassment and assault) that are impactful across the lifespan. High levels of positive social support have been linked to a range of positive outcomes in both civilian and military populations. However, research has not consistently explored social support and interpersonal functioning in women veterans, or as potential mechanisms of change within interventions for women veterans. This is a scoping review of peer-reviewed articles that evaluated social support. Articles with at least 10% women or formally evaluated sex or gender in reference to social support were included. A total of 69 studies evaluated social support in relation to women veterans’ health outcomes. From a biopsychosocial perspective, social support is an important construct to examine relative to health care engagement and response. Limited research considered aging women veterans needs or focused on the intersectional identities of women veterans. Positive social support can have major physical and mental health benefits, yet limited research and disparate methodological approaches minimize the ability to draw conclusions on how social support can best be leveraged to support women veterans. Women veterans’ roles and military experiences (e.g., increased likelihood of combat exposure) are changing and this population is aging. Research is needed to inform best practices for this growing segment of the veteran population.

Mechanisms of Change in Nature-Based Pediatric Occupational Therapy: The Ecology of Change in Outdoor Therapy Model

The purpose of this qualitative constructivist grounded theory study was to develop a model to explain potential mechanisms of change in the nature-based pediatric occupational therapy process, based on analysis of the perspectives of occupational therapy practitioners currently engaging in nature-based practice with children. Using 27 photos and interview data from 22 participants the Ecology of Change in Outdoor Therapy (ECO-Therapy) Model was developed. The model suggests mechanisms of change in nature-based pediatric occupational therapy may involve six iterative phases: Longing for Freedom, Embarking on Adventure, Dancing with Nature, Claiming Self-Agency, Braving Real-Life Challenges, and Growing Adaptive Capacity. The practitioner and child experiencing these phases throughout the nature-based occupational therapy process may lead to improved participation and performance in the child’s daily life.

Laser‐Induced Nucleation of Acetaminophen through the Addition of Insoluble Impurities and Acidic Polymers

AbstractThis study investigates the crystallization of acetaminophen (ACET) in ultrapure water and a 10 wt.% aqueous polyacrylic acid (PAA) solution using non‐photochemical laser‐induced nucleation (NPLIN) for the first time. Using a 532 nm nanosecond laser, two distinct crystal morphologies—rhombic and tetragonal plate‐like—are formed in both solvents after adding impurities. Notably, the PAA solution showed a reduced number of crystals and slower growth rates compared to ultrapure water, suggesting that the acidic polymer modulates crystal growth. Interestingly, crystals are not induced by the laser without impurities. However, impurities like copper phthalocyanine (CuPc) or boron carbide (CB4) enabled successful NPLIN, with CB4 showing higher nucleation efficiency than CuPc. The study also explores how laser power affects nucleation probability and identifies potential laser energy thresholds. Experimental data on ACET crystal sizes over time are fitted to derived equations, which accurately represented trends and predicted results. The nanoparticle heating mechanism and the role of acidic polymers in affecting nucleation probability and growth rate are discussed, along with potential mechanisms for changes in crystal morphology.

Postpartum Depression: A Clinical Review of Impact and Current Treatment Solutions.

Depression during the first year postpartum (postpartum depression) impacts millions of women and their families worldwide. In this narrative review, we provide a summary of postpartum depression, examining the etiology and consequences, pharmacological and psychological treatments, and potential mechanisms of change and current barriers to care. Psychological treatments are effective and preferred by many perinatal patients over medications, but they often remain inaccessible. Key potential mechanisms underlying their effectiveness include treatment variables (e.g., dosage and therapeutic alliance) and patient behaviors (e.g., activation and avoidance and emotional regulation). Among pharmacological treatments, the selective serotonin reuptake inhibitor (SSRI) sertraline is generally the first-line antidepressant medication recommended to women in the postpartum period due to its minimal passage into breastmilk and the corresponding decades of safety data. Importantly, most antidepressant drugs are considered compatible with breastfeeding. Neurosteroids are emerging as an effective treatment for postpartum depression, although currently this treatment is not widely available. Barriers to widespread access to treatment include those that are systematic (e.g., lack of specialist providers), provider-driven (e.g., lack of flexibilityin treatment delivery), and patient-driven (e.g., stigma andlack of timefor treatment engagement). We propose virtual care, task-sharing to non-specialist treatment providers, and collaborative care models as potential solutions to enhance the reach and scalability of effective treatments to address the growing burden of postpartum depression worldwide and its negative impact on families and society.

Culturally adapted training for community volunteers to improve their knowledge, attitude and practice regarding non-communicable diseases in Vietnam

BackgroundThe burden of non-communicable diseases is becoming unmanageable by primary healthcare facilities in low- and middle-income countries. Community-based approaches are promising for supporting healthcare facilities. In Vietnam, community health volunteers are trained in providing health promotion and screening in a culturally adapted training. This study aims to assess the change in knowledge, attitude and practice regarding NCD prevention and management after a culturally adapted training, and the potential mechanisms leading to this change.MethodsThe Knowledge Attitude and Practice survey was assessed before and after an initial training, and before and after a refresher training (n = 37). We used a focus group discussion with community health volunteers (n = 8) to map potential mechanisms of the training and applying learned knowledge in practice. Data were collected in the districts Le Chan and An Duong of Hai Phong, Vietnam, in November 2021 and May 2022.ResultsWe found that knowledge increased after training (mean = 5.54, 95%-confidence interval = 4.35 to 6.74), whereas attitude and practice did not improve. Next, knowledge decreased over time (m=-12.27;-14.40 to -10.11) and did not fully recover after a refresher training (m=-1.78;-3.22 to -0.35). As potential mechanisms for change, we identified the use of varying learning methods, enough breaks, efficient coordination of time located for theory and practice, handout materials, large group size and difficulty in applying a digital application for screening results.ConclusionCulturally adapted trainings can improve knowledge among community health volunteers which is important for the support of primary healthcare in low- and middle-income countries. Using a digital screening application can be a barrier for the improvement of knowledge, attitude and practice and we suggest using an intergenerational or age-friendly approach, with the supervision of primary healthcare professionals. Future research on behavioral change should include additional components such as self-efficacy and interrelationships between individuals.

Emotionally Based School Avoidance in the Aftermath of the COVID-19 Pandemic: Neurodiversity, Agency and Belonging in School

Lockdowns at the peak of the COVID-19 pandemic led to extended school closures globally, and in many countries school attendance has not recovered to pre-pandemic levels. In England, education leaders have expressed concern both about increased anxiety among pupils and chronic absenteeism post-pandemic, against a backdrop of over a decade of increasing mental health need among children and young people. This article presents a narrative review with the aims of (a) conceptualising emotionally based school avoidance (EBSA), and (b) identifying strategies for supporting children and young people experiencing psychological barriers to attending school. The underlying reasons for school being experienced as a hostile environment by a minority of pupils are explored, with research findings specifically relating to the school experiences of neurodivergent pupils in mainstream settings included as an illustrative example. The psychological constructs of belongingness and agency are discussed as potential mechanisms of change. Finally, psychologically informed strategies to address EBSA are reviewed, drawing on the framework of multiple systems of support. To reduce absenteeism in pupils experiencing EBSA, and thus avoid exacerbating educational inequalities in disadvantaged groups, it is essential to understand psychological barriers to school attendance and to work collaboratively and compassionately with pupils and families towards solutions.

Treatment credibility as a mechanism of change in cognitive behavioral therapy: Effects on depression and anxiety.

This study aimed to provide evidence for treatment credibility (TC) as a potential mechanism of change in cognitive behavioral therapy (CBT). Therefore, it focused on within-person effects that are free of the influence of stable characteristics and thus allow to exclude certain alternative explanations for the association under study. The sample included 1,423 patients receiving outpatient CBT, who presented a wide variety of psychiatric diagnoses (mostly affective and anxiety disorders). TC, depression, and anxiety were measured every fifth session from Session 5 to 25 using the Credibility Expectancy Questionnaire (CEQ), the Patient Health Questionnaire-9 (PHQ-9), and the General Anxiety Disorder-7 (GAD-7), respectively. Symptom severity was assessed every session using the Hopkins Symptom Checklist-11. Within- and between-person effects of TC, depression, and anxiety were analyzed using the latent curve model with structured residuals (LCM-SRs). In exploratory analyses, within-person effects of TC on next-session symptom severity were assessed using a modification of the LCM-SR. LCM-SRs exhibited excellent fit in main analyses. There were significant negative correlations of both intercepts and slopes (between-person level) of CEQ and PHQ-9 as well GAD-7. No significant cross-lagged effects (within-person level) were found over the five-session interval. However, session-wise analyses revealed significant cross-lagged effects of CEQ on Hopkins Symptom Checklist-11. This study is the first to find significant within-person effects of TC in session-wise analyses. This lends preliminary support to the notion of TC as a mechanism of change. The lack of significant findings at the five-session interval is discussed considering the specific design used in this study. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Islamic trauma healing (ITH): A scalable, community-based program for trauma: Cluster randomized control trial design and method

BackgroundSomalia has long been in a state of humanitarian crisis; trauma-related mental health needs are extremely high. Access to state-of-the-art mental health care is limited. Islamic Trauma Healing (ITH) is a manualized mosque-based, lay-led group intervention aimed at healing the individual and communal mental wounds of war and refugee trauma. The 6-session intervention combines Islamic principles with empirically-supported exposure and cognitive restructuring principles for posttraumatic stress disorder (PTSD). ITH reduces training time, uses a train the trainers (TTT) model, and relies on local partnerships embedded within the strong communal mosque infrastructure. MethodsWe will conduct a hybrid effectiveness-implementation randomized control trial (RCT) in the Somaliland, with implementation in the cities of Hargeisa, Borama, and Burao. In this study, a lay-led, mosque-based intervention, Islamic Trauma Healing (ITH), to promote mental health and reconciliation will be examined in 200 participants, randomizing mosques to either immediate ITH or a delayed (waitlist; WL) ITH conditions. Participants will be assessed by assessors masked to condition at pre, 3 weeks, 6 weeks, and 3-month follow-up. Primary outcome will be assessor-rated posttraumatic stress symptoms (PTSD), with secondary outcomes of depression, somatic symptoms, and well-being. A TTT model will be tested, examining the implementation outcomes. Additional measures include potential mechanisms of change and cost effectiveness. ConclusionThis trial has the potential to provide effectiveness and implementation data for an empirically-based principle trauma healing program for the larger Islamic community who may not seek mental health care or does not have access to such care. Clinical trial registration numberClinicalTrials.gov NCT05890482. World health organization trial registration data set informationSee Supplemental Appendix 1.

Meaning reconstruction 70 years later: Processing older adults' unfinished business in a drama therapy group.

Unfinished business (UB), when individuals appraise their relationship with others or themselves as incomplete or unresolved, entails difficult emotions such as regret, remorse, and guilt. UB is often associated with bereavement and is considered to be a predictor of complicated grief. Here we report two case studies describing the processing of the sudden death of a significant other in the context of a randomized controlled study of 12-week drama therapy groups for older adults. The intervention followed the format of Playback Theater, an improvised form of theater based on personal stories, and a life review paradigm. A mixed-methods approach explored the course of individual therapy within the group and potential mechanisms of change. The participants completed mental health questionnaires in a pre-post-follow-up design. The qualitative data included video recordings and postintervention interviews. One participant reported a clinically significant (CS) change in depressive symptoms and psychological well-being on the post and follow-up measurement indices. The second reported a CS change in self-esteem and relationship satisfaction at the end of the intervention, but not at follow-up. The findings suggest that the drama therapy contributed to the resolution of UB through restorative work in the three domains defined in meaning reconstruction theory: the "event story" of the loss, the "back story" of the relationship with the deceased, and the "personal story" of self. The results point to the need for additional research on meaning reconstruction in the context of drama therapy and encourage the broader application of performative techniques to treat complicated bereavement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

P165: Music-assisted reminiscence therapy: The theory behind a new frontier for enhancing the wellbeing outcomes for older adults

Objective:Reminiscence therapy is an evidence-based treatment for late life depressive symptoms, and has been associated with improvements in cognitive function, loneliness, happiness, and wellbeing for older people. While music is often involved in reminiscence therapy, little is known about how music is used or works in this context. Specifically, we do not know what purpose music serves, or how it works to enhance the experience when combined with reminiscence therapy. This presentation will provide an overview of two studies exploring how music enhances reminiscence therapy.Method:A narrative literature review was conducted with a structured search strategy to identify all relevant literature. Furthermore, a single-case repeated measures experimental EEG study with 4 older adults experiencing psychological distress was conducted. Participants were randomly assigned to a single session of either verbal reminiscence therapy or music-assisted reminiscence therapy. EEG recordings of resting states (e.g., eyes closed) were taken before and after the session, together with different epochs recorded during the session (e.g., during the start of reminiscence, the problem solving success, and music played). Analysis involved calculating the standardised LORETA (sLORETA) calculations to map regions and sources of EEG activity during these epochs.Results:The SEED model proposed that music enhances reminiscence through: Summoning autobiographical memories, eliciting physiological responses, evoking emotional reactions and pleasure, and defining and describing self-identity and social connectedness. Findings of the EEG study suggested that for the individual participants, both verbal and music-assisted reminiscence therapy resulted in widespread and lateralised activation. These activations were stronger for music- assisted reminiscence than for verbal reminiscence, particularly in the central and frontal areas. Only participants who received music-assisted reminiscence demonstrated activation in areas associated with emotional regulation and meditation, providing preliminary evidence for the SEED model.Conclusion:The two presented studies contribute to our understanding of the potential mechanisms for change when applying reminiscence and music-assisted reminiscence therapy interventions to improve wellbeing for older people.

Pressurized electro-osmotic dewatering treatment of sludge: focusing on the influences on nutrients for agricultural application

ABSTRACT Sewage sludge requires effective dewatering and high nutrients retention before disposal for agricultural application. Pressurized electro-osmotic dewatering (PEOD) process with low energy consumption can effectively remove water from sludge, but the influences of PEOD process on nutrients for agricultural application still lacks in-depth research. In this study, the influences of PEOD process on nutrients for agricultural application were investigated, including organic matter, nitrogen, phosphorus, potassium and silicon contents. Layered experiments were conducted to investigate the layered variation of nutrients in sludge and to understand the potential change mechanisms. The experimental results showed that PEOD process caused small losses (<10%) of organic matter and total phosphorus (TP) in sludge, but caused 11.2−18.4% loss of total nitrogen (TN). PEOD process also caused 18.6−27.0% loss of total potassium (TK) and over 80% loss of available potassium in sludge, and could weaken the potential salt damage during the agricultural application of sludge. Furthermore, the available phosphorus content of sludge in the anode area increased significantly after the PEOD process, indicating that PEOD process could enhance the phosphorus bioavailability of sludge in the anode area. Besides, PEOD process caused a slight loss of silicon components in sludge, but improved the long-term silicon dissolution and release ability of sludge. This work could expand the knowledge about the influences of PEOD process on sludge nutrients and provide scientific guidance for the agricultural application of PEOD sludge.

Photoinduced modification of optical properties of ferroelectric PZT thin films

This study investigates ultrafast photoinduced changes in optical properties of ferroelectrics (PZT) on femtosecond to nanosecond timescales, using broadband transient reflectivity studies. Surprisingly, spectral features were observed below the bandgap, which could not be attributed to ground state bleaching, excited state absorption, and/or stimulated emission. A model based on probe energy independent changes in refractive index and extinction coefficient showed good agreement with experimental results. Three relaxation processes were phenomenologically considered for the temporal evolution. Laser-induced heating was ruled out as the cause of short timescale behavior and photorefractive effect was suggested as a potential mechanism for changes in the optical properties.Graphical abstract

Multispecies Occupations Involving Equines: An Action-Oriented Inquiry to Inform Occupational Therapy Practitioners.

Research related to human-animal engagement often fails to address the complexity and nuance present in occupations and occupational therapy services that incorporate animals. The goal of this research was to develop a basic understanding of multispecies occupations (MSO) involving humans and equines, focusing on the action-oriented processes and transactions during socialization in outdoor, non-therapeutic contexts. We employed a multi-modal qualitative design with interviews and videography with n = 6 horse-human dyads, creating opportunities to understand and represent engagement beyond anthropocentric norms. Findings included a variety of dyad-specific features of occupation, including processes of embodied communication, the presence of behavioral synchrony, and perceptions of attunement arising from these processes. Examining MSO via a multi-modal inquiry offers new perspectives about the nature and experience of such occupations and supports a deeper understanding of potential mechanisms of change when animals are incorporated in occupational therapy interventions and practice.

Acceptability, feasibility and preliminary efficacy of a compassion-based cognitive behavioural intervention for low self-esteem in sexual minority young adults.

Low self-esteem can impair daily functioning and is a risk or maintenance factor for several mental health problems. Sexual minority young adults, for example, those identifying as lesbian, gay or bisexual, on average have lower self-esteem than their heterosexual peers. Compassion-based interventions for low self-esteem might be especially beneficial for sexual minority young adults, whose higher levels of shame and self-criticism are likely to be contributing to maintenance of their low self-esteem. This study explored the acceptability, feasibility and preliminary efficacy of a new compassion-based cognitive behavioural intervention for low self-esteem tailored to sexual minority young adults. Participants were a community sample of 24 sexual minority young adults aged 16-24 experiencing clinically significant low self-esteem. An uncontrolled pre-/post-design was used with qualitative feedback and quantitative outcomes. Self-report standardised measures were completed at baseline, pre-intervention, intervention mid-point, post-intervention and 2-month follow up. Preliminary efficacy was examined through post-intervention changes in self-esteem, functioning, anxiety and depression. Potential mechanisms of change were examined through changes in self-compassion, self-criticism and unhelpful coping responses to minority stress. Results showed good acceptability and feasibility and preliminary evidence of intervention efficacy for improving self-esteem, functioning, depression and anxiety. There was evidence for improvement in self-compassion and reduction in self-criticism, and these constructs could be investigated in future studies as treatment mediators. Randomised controlled studies are needed to further examine efficacy of the intervention.

A randomized clinical trial to support adherence regimens in children with epilepsy: Examining potential mechanisms of change

ObjectiveA family-tailored education and problem-solving intervention, Supporting Treatment Adherence Regimens (STAR), was developed to address the adherence challenges common in youth with epilepsy and their families. Randomized clinical trial (RCT) results indicated a 21% adherence improvement in the STAR group compared with an education-only (EO) group 12-months post-intervention. The current study examined group differences (STAR vs. EO) in epilepsy-specific knowledge, barriers to medication adherence, problem-solving skills, caregiver emotional distress, and family functioning over time and whether these factors mediated group differences in adherence at 12-months post-intervention. MethodsTwo-hundred children (ages 2–12) with epilepsy and their caregivers were included as RCT participants. Children with new-onset epilepsy and adherence <95% were randomized to receive either the STAR (n = 27) or EO (n = 29) intervention. Caregivers completed questionnaires assessing outcomes of interest at baseline, midpoint of the intervention, post-intervention, and 3-, 6-, and 12-month follow-ups. Regression-based analyses of covariance and longitudinal mixed effect linear models were conducted. ResultsResults generally revealed no significant group differences across outcomes of interest at post-intervention or over time. However, one significant model did emerge for social problem-solving skills (b = −1.74, p = 0.04), such that these scores were initially higher in the STAR group compared to the EO group, then decreased slightly in the STAR group over time while remaining stable in the EO group. None of these factors mediated group differences in adherence at 12-months post-intervention. ConclusionFuture research should examine other potential mechanisms of treatment change after adherence interventions, such as STAR. Nonsignificant findings can inform the development of future study designs and intervention efforts.

Moderators and mediators of change of an internet-based mindfulness intervention for college students: secondary analysis from a randomized controlled trial.

Existing evidence suggests internet- and mobile-based interventions (IMIs) improve depressive symptoms in college students effectively. However, there is far less knowledge about the potential mechanisms of change of mindfulness-based IMIs, which could contribute to optimizing target groups and interventions. Hence, within this secondary analysis of data from a randomized controlled trial (RCT), potential moderators and mediators of the effectiveness of the IMI StudiCare Mindfulness were investigated. Moderation and mediation analyses were based on secondary data from a RCT that examined the effectiveness of the 7-module IMI StudiCare Mindfulness in a sample of college students (intervention group: n = 217; waitlist control group: n = 127). Assessments were collected before (t0; baseline), 4 weeks after (t1; during intervention), and 8 weeks after (t2; post-intervention) randomization. Longitudinal mediation analyses using structural equation modeling were employed, with depressive symptom severity as the dependent variable. For moderation analyses, bilinear interaction models were calculated with depressive symptom severity and mindfulness at t2 as dependent variables. All data-analyses were performed on an intention-to-treat basis. Mediation analyses showed a significant, full mediation of the intervention effect on depressive symptom severity through mindfulness (indirect effect, a*b = 0.153, p < 0.01). Only the number of semesters (interaction: β = 0.24, p = 0.035) was found to moderate the intervention's effectiveness on depressive symptom severity at t2, and only baseline mindfulness (interaction: β = -0.20, p = 0.047) and baseline self-efficacy (interaction: β = -0.27, p = 0.012) were found to be significant moderators of the intervention effect on mindfulness at t2. Our results suggest a mediating role of mindfulness. Moderation analyses demonstrated that the intervention improved depressive symptom severity and mindfulness independent of most examined baseline characteristics. Future confirmatory trials will need to support these findings. The trial was registered a priori at the WHO International Clinical Trials Registry Platform via the German Clinical Studies Trial Register (TRN: DRKS00014774; registration date: 18 May 2018).

An online contextual schema therapy workshop for social anxiety symptoms – A randomized controlled trial

Given the high prevalence of social anxiety, developing accessible psychological interventions for this condition becomes a priority. Self-criticism and experiential avoidance have been established as two transdiagnostic mechanisms involved in social anxiety. Contextual Schema Therapy (Cst; roediger, stevens, & brockman, 2018) is a novel psychological treatment addressing these two mechanisms by conceptualizing them as two distinct patterns of schema activation (modes). We therefore aimed to test the efficacy of a brief (single session) CST intervention, delivered in an online group format, for individuals with social anxiety symptoms. We also examined experiential avoidance as a potential mechanism of change. 112 participants with social anxiety symptoms above cut-off were randomized to either the CST group intervention or a waitlist control group. The Brief Fear of Negative Evaluation Scale – Second Version (BFNE-II) and the Acceptance and Action Questionnaire – Second Version (AAQ-2) were filled in by participants at baseline, immediately after the intervention and at a two-week follow-up. The CST intervention comprised psychoeducation, a conceptualization of social anxiety in schema and mode terms, reflection exercises, chairwork and imagery techniques. At follow-up, significant reductions in fear of negative evaluation and experiential avoidance were found in the CST group. Experiential avoidance was a marginally significant mediator of the changes in fear of negative evaluation from pre-test to follow-up. The results support the potential large-scale usefulness of brief online CST interventions with socially anxious individuals.

Prevention and Treatment of Social Anxiety Disorder in Adolescents: Protocol for a Randomized Controlled Trial of the Online Guided Self-Help Intervention SOPHIE.

Social anxiety symptoms are highly prevalent among adolescents and are associated with poor quality of life and low psychosocial functioning. If untreated, social anxiety often persists into adulthood and increases the risk for comorbid disorders. Therefore, early interventions for social anxiety to prevent negative long-term consequences are critical. However, adolescents rarely seek help and often avoid face-to-face psychotherapeutic interventions due to the perceived lack of autonomy and anonymity. Thus, online interventions represent a promising opportunity to reach adolescents who have social anxiety but do not seek help yet. This study aims to evaluate the efficacy, moderators, and mediators of an online intervention developed to reduce social anxiety in adolescents. A total of 222 adolescents aged 11-17 years with subclinical social anxiety (N=166) or with a diagnosis of social anxiety disorder (N=56) are randomly assigned to the online intervention or a care-as-usual control group. The 8-week guided online intervention is based on the Cognitive Model of Social Phobia and evidence-based online interventions for social anxiety adapted to the specific needs of adolescents. The care-as-usual group will be given access to the online intervention after the follow-up assessment. Participants are assessed at baseline, at 4 and 8 weeks post intervention, and at 3-month follow-up assessment on the primary outcome, that is, social anxiety, on secondary outcomes (eg, level of functioning, fear and avoidance, general anxiety, depression, quality of life, self-esteem, and negative effects of the intervention), on potential moderators (eg, therapy motivation, therapy expectancy, and satisfaction with the intervention), and potential mediators (eg, therapeutic alliance and adherence to the intervention). Data will be analyzed based on an intention-to-treat approach and both groups (intervention and care-as-usual) will be compared at each assessment time point. Furthermore, potential mechanisms of change and generalization of intervention effects on daily life are assessed using an ecological momentary assessment procedure that includes items on maintaining mechanisms of social anxiety, social context, and affect. Participants are prompted 3 times a day during the first 8 weeks of the study and again for 2 weeks following the follow-up assessment. Recruitment is ongoing; initial results are expected in 2024. Results are discussed considering the potential of online interventions as a low-threshold prevention and treatment option for adolescents with social anxiety and in light of current advances in dynamic modeling of change processes and mechanisms in early intervention and psychotherapy in adolescents. ClinicalTrials.gov NCT04782102; https://clinicaltrials.gov/ct2/show/NCT04782102. DERR1-10.2196/44346.

Rationale and design of a pilot randomized controlled trial to increase moderate-to-vigorous physical activity in preadolescent Latina girls and their mothers

BackgroundHispanic/Latina girls have a low prevalence of moderate-intensity physical activity (PA) compared to their male counterparts and non-Hispanic White girls. Mothers influence their children's activity levels by creating and supporting PA opportunities, modeling PA, and reinforcing children's efforts to be physically active. The Conmigo trial will evaluate a mother-daughter intervention to promote PA and examine potential mechanisms of change including mothers' PA, parenting regarding PA, and mother-daughter communication. MethodThis randomized controlled trial examines the feasibility, acceptability, and impact of a 12-week intervention promoting PA in preadolescent Latina girls in San Diego County, CA. Participants (n = 90 dyads) are randomized to the Conmigo PA intervention or to a control group that receive an abbreviated version of the intervention. The intervention was informed by Social Cognitive Theory and Family Systems Theory and emphasize family-level factors to promote PA using an actor-partner model. Mothers and daughters attend weekly 90-min sessions in English or in Spanish via Zoom video conferencing, supported by facilitator follow-ups and WhatsApp supportive chat group for mothers. Objective (accelerometer) and self-report measures at baseline, 3 months, and 6 months capture the frequency and intensity of PA and correlates and predictors of PA. We also examine the impact of the intervention on the bidirectional influence of mother-daughter PA. ImplicationsThe findings from the Conmigo trial will form the basis of a randomized controlled community trial and will move the field forward in identifying targets of change in preventing chronic disease risk in Hispanic/Latino communities.