Search

For sexual dysfunction, the research and implementation of Internet- and Mobile-based Psychological Interventions (IMIs) is still in its infancy compared to other mental disorders such as anxiety disorders and depression. IMIs are particularly suitable as a treatment modality for sexual dysfunctions, as sexual difficulties are often associated with strong feelings of shame and rarely addressed in routine care. Despite progressive sexual education and social openness in many European countries, sexual dysfunctions are still a taboo subject in many societies around the globe and are associated with stigmatization, which has a negative effect on the utilization of available treatments. The characteristics of IMIs such as anonymity and low-threshold access can be helpful to lower treatment barriers. Not seeing the therapist face to face can make it easier to address sensitive issues such as sexual problems. To provide evidence-based treatment independent of time and place can help to address the underuse and availability of treatments for sexual dysfunction. Furthermore, the core treatment elements for sexual dysfunction are designed in such a way that they can usually be carried out by patients in the privacy of their own homes. The fact that therapy elements have already been designed for self-directed use and include highly structured behavioral exercises is another advantage of IMIs. The last systematic review of internet-based interventions on sexual dysfunctions was done by van Lankveld (2016) and focused solely on women. Due to new studies, a broader scope, as well as stricter guidelines on risk of bias, we see the need for an update.

Psychological treatments for female sexual dysfunctions have proven to be effective. However, not all women benefit from treatment to the same extent with regard to treatment outcomes and some women even show symptom deterioration. Therefore, it is important to find out for whom interventions are effective, how differential effects can be explained and how treatment outcomes can be optimized. To improve the efficacy of treatment for female sexual dysfunction, identifying effect modifiers (predictors and moderators) that influence treatment outcomes seems to be crucial. The heterogeneous results regarding predictors and moderators of different treatment studies so far warrant a systematic summary. The goal of this study is to provide a review of the current state of research on variables that are accountable for differential effects of psychological treatment targeting sexual dysfunctions.

In a four days App-based stress-reduction training, participants with high subjective stress are instructed to either approach stress-reducing attitudes, or to avoid stress-inducing attitudes (Approach and Avoidance Modification Training [AAMT]). Approaching stress-reducing attitudes was reached by displaying a positive emotion. Avoidance of stress-inducing attitudes was reached by displaying a negative emotion. Of no relevance for the present study is the inactive control group, the group that approach or avoid by swiping the attitudes towards or away with the finger (swipe AAMT), and the emotional AAMT with more stress-reducing than –inducing attitudes (1:4 AAMT). Before (first day, pre) and after training (fourth day, post) the breathing rate and heart activity was measured via a highly innovative radar device during three minutes resting phase. We aimed to investigate if our stress reduction training goes along with changes in psychophysiological stress/resilience markers (heart rate variability [HRV] via the amount of high frequency-[HF]index). Changes in HF band of HRV was chosen since HF seems to be valuable for (para-)sympathetic activity and therefore, seems to a suitable stress index.

Background: Panic disorder with and without agoraphobia (PD) is a common psychological disorder. Internet-based interventions have the potential to offer highly scalable low-threshold evidence-based care to people suffering from PD. GET.ON Panic is a newly developed internet-based intervention addressing symptoms of PD. In order to transfer the training into the daily life of the individuals, we integrated mobile components in the training and created a so-called hybrid online training. The development and beta-testing of such a training requires a novel interdisciplinary approach between IT specialists and psychologists. From this point of view, we would like to share our experiences in this exploratory paper. Methods: This initial feasibility study (N = 10) offers, on the one hand, a brief overview of the interdisciplinary development phase of the mobile application and on the other hand, provides first insights into the usage, usability and acceptance of this mobile application using qualitative interview data as well quantitative measures of 8 completing participants. For these reasons, we used a pre-posttest design without a control group. Furthermore, we present initial clinical outcomes of the intervention on e.g. panic symptom severity, depressive symptoms as well additional anxiety measures. Finally, we end with implications for further research in the relatively new field of mobile mental health. Results: Overall, usability, user satisfaction, motivational value and technology acceptance of the app were perceived as high. The usage of app components was diverse: The use of interoceptive exposure exercises and daily summaries on anxiety and mood was highest while using in-vivo exposure exercises and monitoring panic symptoms was perceived as difficult. Furthermore, participants showed after the training less clinical symptoms as at baseline-assessment. Discussion: The current feasibility study contributes to an in-depth understanding of the potential of mobile technology in e-mental health. Overall, the GET.ON Panic app appears to be an acceptable and motivational part of a CBT-based hybrid online training for PD that has the potential to promote training success. After some suggested adjustments have been made, the efficacy should be investigated in a randomized controlled trial. BackgroundPanic disorder with and without agoraphobia (PD) is a common psychological disorder. Internet-based interventions have the potential to offer highly scalable low-threshold evidence-based care to people suffering from PD. GET.ON Panic is a newly developed internet-based intervention addressing symptoms of PD. In order to transfer the training into the daily life of the individuals, we integrated mobile components in the training and created a so-called hybrid online training. The development and beta-testing of such a training requires a novel interdisciplinary approach between IT specialists and psychologists. From this point of view, we would like to share our experiences in this exploratory paper.MethodsThis initial feasibility study (N = 10) offers, on the one hand, a brief overview of the interdisciplinary development phase of the mobile application and on the other hand, provides first insights into the usage, usability and acceptance of this mobile application using qualitative interview data as well quantitative measures of 8 completing participants. For these reasons, we used a pre-posttest design without a control group. Furthermore, we present initial clinical outcomes of the intervention on e.g. panic symptom severity, depressive symptoms as well additional anxiety measures. Finally, we end with implications for further research in the relatively new field of mobile mental health.ResultsOverall, usability, user satisfaction, motivational value and technology acceptance of the app were perceived as high. The usage of app components was diverse: The use of interoceptive exposure exercises and daily summaries on anxiety and mood was highest while using in-vivo exposure exercises and monitoring panic symptoms was perceived as difficult. Furthermore, participants showed after the training less clinical symptoms as at baseline-assessment.DiscussionThe current feasibility study contributes to an in-depth understanding of the potential of mobile technology in e-mental health. Overall, the GET.ON Panic app appears to be an acceptable and motivational part of a CBT-based hybrid online training for PD that has the potential to promote training success. After some suggested adjustments have been made, the efficacy should be investigated in a randomized controlled trial.

Background Depression and anxiety are highly prevalent and often co-occur. Several studies indicate the potential of disorder-specific psychological interventions for the prevention of each of these disorders. To treat comorbidity, transdiagnostic treatment concepts seem to be a promising approach, however, evidence for transdiagnostic concepts of prevention remains inconclusive. Internet- and mobile-based interventions (IMIs) may be an effective means to deliver psychological interventions on a large scale for the prevention of common mental disorders (CMDs) such as depression and anxiety. IMIs have been shown to be effective in treating CMDs, e.g. in reducing symptoms of depression and anxiety. However, there is a lack of studies examining the efficacy of interventions reducing the incidence of CMDs. Moreover, the comparative cost-effectiveness of guided versus unguided IMIs for the prevention of depression and anxiety has not been studied yet. Hence, this study aims at investigating the (cost-) effectiveness of guided and unguided internet- and mobile-based transdiagnostic individually tailored indicated prevention of depression and anxiety. Methods A multi-country three-armed randomized controlled trial will be conducted to compare a guided and unguided intervention to treatment as usual (TAU). Both active conditions are based on the same intervention, ICare Prevent, and differ only with regard to guidance format. Altogether, 954 individuals with subclinical symptoms of depression (CES-D ≥ 16) and anxiety (GAD-7 ≥ 5) who do not have a full-blown disorder will be recruited in Germany, Switzerland, Spain and the Netherlands, and randomized to one of three conditions (guided intervention, unguided intervention, or TAU). The TAU arm will receive access to the training after a 12-month waiting period. The primary outcome will be time to CMD onset (any depression/anxiety disorder) within a follow-up period of 12 months after baseline. Secondary outcomes will include disorder-specific symptom severity (depression/anxiety) assessed by diagnostic raters blinded to intervention condition at post-intervention, self-reports, acceptability, health related quality of life, and psychosocial variables associated with developing a CMD. Assessments will take place at baseline, mid-intervention (5 weeks into the intervention), post-intervention (8 weeks after randomization) and follow-up (6 and 12 months after randomization). Data will be analyzed on an intention-to-treat basis and per protocol. Cost-effectiveness will be evaluated from a public health and a societal perspective, including both direct and indirect costs. Discussion The present study will further enhance the evidence-base for transdiagnostic preventive interventions and provide valuable information about optimal trade-off between treatment outcome and costs. Trial registration German Clinical Trial Registration (DRKS - http://www.drks.de/drks_web/): DRKS00011099., Highlights • Depression and anxiety are highly comorbid, but often not treated together. • Transdiagnostic treatment provides potential to reduce comorbidity. • Individual tailoring can help adapt treatment to individual profiles. • Large multi-country transdiagnostic prevention trial in a subclinical population. • Cost-effectiveness for a guided and unguided internet- and mobile-based intervention will be investigated.

Introduction. Diabetes mellitus type 1 and type 2 are linked to higher prevalence and occurrences of depression. Internet-based depression- and diabetes-specific cognitive behavioral therapies (CBT) can be effective in reducing depressive symptom severity and diabetes-related emotional distress. The aim of the study was to test whether disease-specific severity indicators moderate the treatment outcome in a 6-week minimally guided web-based self-help intervention on depression and diabetes (GET.ON Mood Enhancer Diabetes (GET.ON M.E.D.)) and to determine its effectiveness in a nonsuicidal severely depressed subgroup. Methods. Randomized controlled trial- (RCT-) based data (N = 253) comparing GET.ON M.E.D. to an online psychoeducation control group was used to test disease-specific severity indicators as predictors/moderators of a treatment outcome. Changes in depressive symptom severity and treatment response were examined in a nonsuicidal severely depressed subgroup (CES - D>40; N = 40). Results. Major depressive disorder diagnosis at the baseline (pprf6 = 0 01), higher levels of depression (Beck Depression Inventory II; pprpo = 0 00; pprf6 = 0 00), and lower HbA1c (pprpo = 0 04) predicted changes in depressive symptoms. No severity indicator moderated the treatment outcome. Severely depressed participants in the intervention group showed a significantly greater reduction in depressive symptom severity (dprpo = 2 17, 95% Confidence Interval (CI): 1.39-2.96) than the control condition (dprpo = 0 92; 95% CI: 0.001-1.83), with a between-group effect size of dprpo = 1 05 (95% CI: 0.11-1.98). Treatment response was seen in significantly more participants in the intervention (4/20; 20%) compared to the control group (0/20, 0%; χ 2 2 N = 40 = 4 44; p < 0 02). At the 6-month follow-up, effects were maintained for depressive symptom reduction (dpr6f = 0 71; 95% CI: 0.19-1.61) but not treatment response. Conclusion. Disease-specific severity indicators were not related to a differential effectiveness of guided self-help for depression and diabetes. Clinical meaningful effects were observed in nonsuicidal severely depressed individuals, who do not need to be excluded from web-based guided self-help. However, participants should be closely monitored and referred to other treatment modalities in case of nonresponse.

Deficits in general emotion regulation skills have been shown to be associated with various mental disorders. Thus, general affect-regulation training has been proposed as promising transdiagnostic approach to the treatment of psychopathology. In the present study, we aimed to evaluate the efficacy of a general affect-regulation as a stand-alone, group-based treatment for depression. For this purpose, we randomly assigned 218 individuals who met criteria for major depressive disorder (MDD) to the Affect Regulation Training (ART), to a waitlist control condition (WLC), or to a condition controlling for common factors (CFC). The primary outcome was the course of depressive symptom severity as assessed with the Hamilton Rating Scale for Depression and the Beck Depression Inventory. Multi-level analyses indicated that participation in ART was associated with a greater reduction of depressive symptom severity than was participation in WLC (d = 0.56), whereas the slight superiority of ART over CFC (d = 0.25) was not statistically significant. Mediation analyses indicated that changes in emotion regulation skills mediated the differences between ART/CFC and WLC. Thus, the findings provide evidence for enhancing emotion regulation skills as a common mechanism of change in psychological treatments for depression. The study was registered with ClinicalTrials.gov (NCT01330485) and was supported by grants from the German Research Association (DFG; BE 4510/3-1; HI 456/6-2). Future research should compare the (cost-) efficacy of ART with that of disorder-specific interventions.

Background Childhood trauma increases the risks of both depression and dysfunctional emotion regulation, which is a factor that has been strongly linked to depression. Because of these demonstrated relationships, it can be hypothesized that dysfunctional emotion regulation is a mediator of the association between childhood trauma and depression. Methods To test this hypothesis, we assessed the indirect effect of emotion regulation (Emotion Regulation Skills Questionnaire) on the relationship between childhood trauma (Childhood Trauma Questionnaire) and depression severity (24-item Hamilton Rating Scale for Depression) as well as depression lifetime persistency (i.e., lifetime percentage spent in major depressive episodes; assessed via SCID and Life Chart Interviews) in 269 patients with major depressive disorder (MDD). Results Bootstrapping-enhanced mediation analyses indicated that deficits in general emotion regulation mediated the association of childhood trauma to both depression severity and depression lifetime persistency. Further exploratory analyses indicated that specific emotion regulation skills (such as the ability to mindfully observe, accept, and tolerate undesired emotions or the willingness to voluntarily confront situations that prompt negative emotions in order to attain personally relevant goals) significantly mediated the association between childhood trauma and depression severity. Willingness to confront was a mediator for both depression outcomes (depression severity and lifetime persistency). Limitations The employed mediation analyses are cross-sectional in nature, which limits any firm conclusions regarding causality. Conclusions The findings support the assumption that a sophisticated emotion regulation may help prevent the onset or unfavorable course of depression in individuals who have experienced childhood trauma.

Increasingly, colleges across the world are contending with rising rates of mental disorders, and in many cases, the demand for services on campus far exceeds the available resources. The present study reports initial results from the first stage of the WHO World Mental Health International College Student project, in which a series of surveys in 19 colleges across 8 countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, United States) were carried out with the aim of estimating prevalence and basic sociodemographic correlates of common mental disorders among first-year college students. Web-based self-report questionnaires administered to incoming first-year students (45.5% pooled response rate) screened for six common lifetime and 12-month DSM-IV mental disorders: major depression, mania/hypomania, generalized anxiety disorder, panic disorder, alcohol use disorder, and substance use disorder. We focus on the 13,984 respondents who were full-time students: 35% of whom screened positive for at least one of the common lifetime disorders assessed and 31% screened positive for at least one 12-month disorder. Syndromes typically had onsets in early to middle adolescence and persisted into the year of the survey. Although relatively modest, the strongest correlates of screening positive were older age, female sex, unmarried-deceased parents, no religious affiliation, nonheterosexual identification and behavior, low secondary school ranking, and extrinsic motivation for college enrollment. The weakness of these associations means that the syndromes considered are widely distributed with respect to these variables in the student population. Although the extent to which cost-effective treatment would reduce these risks is unclear, the high level of need for mental health services implied by these results represents a major challenge to institutions of higher education and governments. (PsycINFO Database Record (c) 2018 APA, all rights reserved). ispartof: JOURNAL OF ABNORMAL PSYCHOLOGY vol:127 issue:7 pages:623-638 ispartof: location:United States status: published

Background: Although internet-based and mobile-based stress management interventions (iSMIs) may be a promising strategy to reach employees suffering from high chronic stress, it remains unknown whether participants with high symptom severity of depression or anxiety also benefit from iSMIs or should be excluded. Objective: This study aimed to evaluate the efficacy of iSMIs in subgroups with high symptom severity and to test whether baseline symptom severity moderates treatment outcome. Methods: Data from three randomized controlled trials (N=791) were pooled to identify effect modifiers and to evaluate efficacy in subgroups with different levels of initial symptom severity. The outcomes perceived stress (Perceived Stress Scale, PSS), depression severity (Center for Epidemiological Depression Scale, CES-D), and anxiety (Hospital Anxiety and Depression Scale, HADS) symptom severity were assessed at baseline, 7-week postassessment, and 6-month follow-up. Potential moderators were tested in predicting differences in the change of outcome in multiple moderation analyses. Simple slope analyses evaluated efficacy of the iSMI comparing the intervention group with the waitlist control group in subgroups with low, moderate, and severe initial symptomology based on means and SDs of the study population. In addition, subgroups with clinical values of depression (CES-D=16) and anxiety (HADS=8) at baseline were explored, and response rates (RRs; 50% symptom reduction) and symptom-free (SF) status (CES-Dpost=0.86-1.16, dFU=0.93-1.35), depression (dpost=0.69-1.08, dFU=0.91-1.19), and anxiety (dpost=0.79-1.19, dFU=1.06-1.21), and effects were sustained at 6-month follow-up. Symptom severity moderated treatment outcomes, as individuals with higher symptom severity at baseline benefited significantly more from the intervention than individuals with lower symptom severity. Furthermore, 82.9% (656/791) of individuals had clinical depression values at baseline, of which significantly more individuals in the intervention group reached at least 50% symptom reduction or fell under clinical cut-off (RR: 29.2%, 93/318; SF: 39.6%, 126/318) compared with the waitlist control group (RR: 8.0%, 27/338; SF: 18.6%, 63/338) at postassessment. Significantly more individuals with clinical anxiety values at baseline (HADS=8, 85.3%, 675/791) in the intervention group achieved at least 50% symptom reduction or fell under clinical cut-off (RR: 27.7%, 94/339; SF: 39.8%, 135/339) compared with the WLC (RR: 4.8%, 16/336; SF: 15.5%, 52/336). Conclusions: Highly burdened individuals benefit greatly from iSMIs and therefore should not be excluded from participation. Stress management may be a valid entry point to reach highly burdened individuals who otherwise may not seek treatment. Trial Registration: 1) German Clinical Trials Register DRKS00005112; https://www.drks.de/DRKS00005112 (Archived by WebCite at http://www.webcitation.org/6zmIZwvdA); 2) German Clinical Trials Register DRKS00005384; https://www.drks.de/ DRKS00005384 (Archived by WebCite at http://www.webcitation.org/6zmIerdtr); and 3) German Clinical Trials Register DRKS00004749; https://www.drks.de/DRKS00004749 (Archived by WebCite at http://www.webcitation.org/6zmIjDQPx).

BACKGROUND: Mental health problems are highly prevalent among college students. Most students with poor mental health, however, do not receive professional help. Internet-based self-help formats may increase the utilization of treatment.OBJECTIVE: The aim of this randomized controlled trial was to evaluate the efficacy of an internet-based, app-supported stress management intervention for college students.METHODS: College students (n=150) with elevated levels of stress (Perceived Stress Scale 4-item version, PSS-4 ≥8) were randomly assigned to either an internet- and mobile-based stress intervention group with feedback on demand or a waitlist control group. Self-report data were assessed at baseline, posttreatment (7 weeks), and 3-month follow-up. The primary outcome was perceived stress posttreatment (PSS-4). Secondary outcomes included mental health outcomes, modifiable risk and protective factors, and college-related outcomes. Subgroup analyses were conducted in students with clinically relevant symptoms of depression (Center for Epidemiological Studies' Depression Scale >17).RESULTS: A total of 106 participants (76.8%) indicated that they were first-time help-seekers, and 77.3% (intervention group: 58/75; waitlist control group: 58/75) showed clinically relevant depressive symptoms at baseline. Findings indicated significant effects of the intervention compared with the waitlist control group for stress (d=0.69; 95% CI 0.36-1.02), anxiety (d=0.76; 95% CI 0.43-1.09), depression (d=0.63; 95% CI 0.30-0.96), college-related productivity (d=0.33; 95% CI 0.01-0.65), academic work impairment (d=0.34; 95% CI 0.01-0.66), and other outcomes after 7 weeks (posttreatment). Response rates for stress symptoms were significantly higher for the intervention group (69%, 52/75) compared with the waitlist control group (35%, 26/75, P

Aims: To test the efficacy of a web-based alcohol intervention with and without guidance. Design: Three parallel groups with primary end-point after 6 weeks. Setting: Open recruitment in the German working population. Participants: Adults (178 males/256 females, mean age 47 years) consuming at least 21/14 weekly standard units of alcohol (SUA) and scoring ≥ 8/6 on the Alcohol Use Disorders Identification Test. Intervention: Five web-based modules including personalized normative feedback, motivational interviewing, goal setting, problem-solving and emotion regulation during 5 weeks. One intervention group received an unguided self-help version (n=146) and the second received additional adherence-focused guidance by eCoaches (n=144). Controls were on a waiting list with full access to usual care (n=144). Measurements: Primary outcome was weekly consumed SUA after 6 weeks. SUA after 6 months was examined as secondary outcome, next to numbers of participants drinking within the low-risk range, and general and work-specific mental health measures. Findings: All groups showed reductions of mean weekly SUA after 6 weeks (unguided: −8.0; guided: −8.5; control: −3.2). There was no significant difference between the unguided and guided intervention (P=0.324). Participants in the combined intervention group reported significantly fewer SUA than controls [B=−4.85, 95% confidence interval (CI)=−7.02 to −2.68, P

Introduction: Genito-pelvic pain/penetration disorder (GPPPD) not only adversely affects women’s sexuality and sexual satisfaction but is also associated with a wide range of psychosocial consequences such as reduced quality of life and well-being, mental health comorbidities, and relationship distress. Evidence for effective treatment options is scarce.Aim: This article describes the rationale, treatment protocol, and study design for a randomized controlled trial examining the efficacy of an Internet-based guided intervention for GPPPD.Method: Two hundred women who meet the criteria for GPPPD and have not been able to experience sexual intercourse for at least the last 6 months will be recruited and randomly assigned either to the intervention group (IG) or a 6-month waitlist control group. Assessments take place at baseline (T1), peritreatment after completion of Session 5 in IG (T2), after completion of Session 8 or 12 weeks after randomization (T3), and after 6 months (T4). Data will be analyzed on an intention-to-treat and a completer basis.Main outcome measures: The primary outcome will be sexual intercourse involving the insertion of the partner’s penis at posttreatment. Secondary outcomes include, e.g., improved non-intercourse penetration, sexual functioning, dyadic stress coping, reduced fear of sexuality and negative penetration-related cognitions. Fear of sexuality, penetration-related cognitions, and exercise intensity will be assessed as mediators of intercourse in the IG. Sexual dysfunctions of partners will be measured at baseline (T1) and investigated as a potential moderator of the primary treatment outcome.Discussion: Given the burden associated with GPPPD and the need for specialized treatment, there is a surprising lack of evidence-based treatment options. This study aims to assess whether Internet-based interventions could contribute to closing this treatment gap.

Introduction: Depression often co-occurs with chronic back pain (CBP). Internet and mobile-based interventions (IMIs) might be a promising approach for effectively treating depression in this patient group. In the present study, we will evaluate the effectiveness and cost-effectiveness of a guided depression IMI for individuals with CBP (eSano BackCare-D) integrated into orthopaedic healthcare. Methods and analysis: In this multicentre randomised controlled trial of parallel design, the groups eSano BackCare-D versus treatment as usual will be compared. 210 participants with CBP and diagnosed depression will be recruited subsequent to orthopaedic rehabilitation care. Assessments will be conducted prior to randomisation and 9 weeks (post-treatment) and 6 months after randomisation. The primary outcome is depression severity (Hamilton Rating Scale for Depression-17). Secondary outcomes are depression remission and response, health-related quality of life, pain intensity, pain-related disability, self-efficacy and work capacity. Demographic and medical variables as well as internet affinity, intervention adherence, intervention satisfaction and negative effects will also be assessed. Data will be analysed on an intention-to-treat basis with additional per-protocol analyses. Moreover, a cost-effectiveness and cost-utility analysis will be conducted from a societal perspective after 6 months. Ethics and dissemination: All procedures are approved by the ethics committee of the Albert-Ludwigs-University of Freiburg and the data security committee of the German Pension Insurance (Deutsche Rentenversicherung). The results will be published in peer-reviewed journals and presented on international conferences. Trial registration number: DRKS00009272; Pre-results., publishedVersion

Major depressive disorder (MDD) is one of the most common mental health disorders, which causes substantial suffering in depressed individuals and results in high socioeconomic cost. A large percentage of MDD patients do not respond to current psychotherapeutic treatments for MDD or show substantial residual symptoms after being treated successfully. Deficits in emotion regulation (ER) have often been discussed as a putative maintaining factor in depression and might therefore be an important mechanism of change to improve treatment efficacy for depression. Aim of the current thesis was to examine prospective associations between different aspects of emotion regulation and depressive psychopathology, aiming to better understand longitudinal associations between those two variables. We assessed adaptive ER and psychopathology in a sample of patients suffering from MDD during inpatient treatment for depression at the end of every treatment week. Data were analyzed using latent growth curve (LGC) and latent change score (LCS) models, a specialized type of structural equation models (SEM) well suited for the analysis of reciprocal associations in longitudinal data sets. The first publication of the present thesis examined the longitudinal relation between adaptive ER and depressive symptom severity (DSS). An increase in adaptive ER was found to be related to a decrease in DSS. Furthermore, adaptive ER predicted subsequent changes in DSS. With regard to specific ER skills, the abilities to modify emotions and to accept emotions if necessary showed a significant influence on DSS. Aim of the second investigation was to further investigate differences in adaptive ER of specific affective states and their relation to subsequent DSS. Because emotion regulation is usually operationalized across emotions, it remains unclear whether depressed mood, sadness, anger and anxiety - specific affective states known to be significant in the maintenance of MDD - affect depressive psychopathology in different ways. We found that the adaptive regulation of depressed mood and sadness predicts subsequent reduction of DSS, but not regulation of anger and anxiety. Accordingly, dealing successfully with depressed mood and sadness seems to be of great importance to improving symptoms of MDD. Patients with Major Depression frequently suffer from co-morbid anxiety disorders or an elevated distress level. The third publication therefore investigated whether successful adaptive ER would also improve symptoms of anxiety and general distress. However, no associations between adaptive ER and anxiety symptoms were found. An increase in adaptive ER was associated with decrease in general distress level, but no association of a subsequent reduction were found. Therefore, while adaptive ER seems to play an important role in reducing depressed symptoms, it did not predict a reduction of comorbid anxiety symptoms and general distress. Taken together, the findings of this dissertation emphasize the role of adaptive ER as an important maintaining factor for Major Depression. Furthermore, they underline the importance of a more differentiated view of ER, both in terms of skills and different affective states, which, besides deepening general knowledge about ER skills, could greatly help in augmenting and improving current treatment approaches for Major Depression., Major Depression (MD) gilt als eine der häufigsten psychischen Erkrankungen, die bei den Betroffen mit enormem Leiden verbunden ist und zu hohen sozioökonomischen Kosten führt. Ein großer Anteil der Betroffenen spricht nicht oder nur teilweise auf die derzeitigen psychotherapeutischen Behandlungsansätze an. Defizite in der Emotionsregulation (ER) gelten als ein möglicher Faktor, der zur Aufrechterhaltung von MD beitragen kann und somit als ein wichtiger Ansatzpunkt zur Verbesserung der Therapieangebote. Ziel der vorliegenden Dissertation war es, prospektive Zusammenhänge zwischen verschiedenen Aspekten von Emotionsregulation und dem Symptomspektrum von Major Depression zu untersuchen, um so ein differenzierteres Verständnis über die zeitlichen Zusammenhänge dieser beiden Variablen gewinnen zu können. In einer längsschnittlichen Studie wurden bei depressiven Patienten einer psychosomatischen Fachklinik wöchentlich adaptive ER und psychopathologische Symptombelastung im Selbstbericht erfasst. Diese Verlaufsdaten wurden mittels Strukturgleichungsmodellen zur Analyse von reziproken Veränderungen ausgewertet. Es kamen bivariate Wachstumskurvenmodelle und latente Veränderungsmodelle zur Anwendung, um den wechselseitigen Einfluss von Emotionsregulation und Psychopathologie zu untersuchen. Der erste Artikel fokussierte auf längsschnittliche Zusammenhänge zwischen adaptiver ER und depressiver Symptomschwere (DSS). Es zeigte sich, dass eine Verbesserung der adaptiven ER mit einer Abnahme der DSS in Zusammenhang steht und adaptive ER die nachfolgende Reduktion der DSS signifikant vorhersagen konnte. Unter den spezifischen ER Kompetenzen zeigten sich die Fertigkeiten, Emotionen zielgerichtet beeinflussen zu können, und unerwünschte Emotionen bei Bedarf auch akzeptieren und aushalten zu können, als relevant. Die Fragestellung des zweiten Artikels zielte darauf ab, mögliche Unterschiede in der Regulation spezifischer affektiver Zustände und deren Zusammenhang mit nachfolgender DSS zu untersuchen. Emotionsregulation wird bislang häufig emotionsübergreifend erfasst. Unklar ist daher, ob die adaptive Regulation spezifischer affektiver Zustände wie depressive Stimmung, Traurigkeit, Ärger und Angst, die alle als bedeutsam zur Aufrechterhaltung von Major Depression angesehen werden, den gleichen Einfluss auf depressive Psychopathologie haben. Es zeigte sich, dass nur die adaptive Regulation der affektiven Zustände depressive Stimmung und Traurigkeit die nachfolgende Reduktion depressiver Symptomschwere vorhersagten. Der adaptive Umgang mit Angst und Ärger wurde im Gegensatz dazu durch das depressive Belastungsniveau bestimmt. Der konstruktive Umgang mit depressiver Stimmung und Traurigkeit scheint für eine Verbesserung der depressiven Symptomatik von besonderer Bedeutung zu sein. Ein Großteil der Patienten mit Major Depression leidet unter komorbiden Angststörungen und einem erhöhten allgemeinen Belastungsniveau. Ziel des dritten Artikels war es, zu untersuchen, ob adaptive ER auch einen Einfluss auf diese komorbiden Beschwerden hat. Nur zwischen adaptiver ER und DSS konnte ein eindeutiger Zusammenhang gefunden werden; kein Zusammenhang zeigte sich zwischen adaptiver ER und ängstlicher Symptomschwere. Eine Verbesserung der adaptiven ER ist mit einer Reduktion des generalisierten Belastungsniveaus assoziiert, jedoch es auch hier keinen Zusammenhang zwischen ER und nachfolgender Veränderung des Belastungsniveaus. Adaptive ER scheint nach diesen Ergebnissen zwar einen Einfluss auf die Reduktion der depressiven Kernsymptomatik zu haben, nicht jedoch auf weitere mit Depression assoziierte Symptome und Beschwerden. Die vorliegende Arbeit verdeutlicht die Bedeutung von adaptiver ER bei der Aufrechterhaltung von Major Depression. Besonders wichtig ist dabei die differenzierte Betrachtung von ER, bezüglich spezifischer Kompetenzen und affektiver Zustände, durch die wichtige Erkenntnisse über den Prozess der ER gewonnen werden können, die zur Verbesserung der derzeitigen Behandlungskonzepte von Major Depression einen wichtigen Beitrag leisten können.

Background Although mental disorders and suicidal thoughts-behaviors (suicidal thoughts and behaviors) are common among university students, the majority of students with these problems remain untreated. It is unclear what the barriers are to these students seeking treatment. Aims The aim of this study is to examine the barriers to future help-seeking and the associations of clinical characteristics with these barriers in a cross-national sample of first-year college students. Method As part of the World Mental Health International College Student (WMH-ICS) initiative, web-based self-report surveys were obtained from 13,984 first-year students in eight countries across the world. Clinical characteristics examined included screens for common mental disorders and reports about suicidal thoughts and behaviors. Multivariate regression models adjusted for socio-demographic, college-, and treatment-related variables were used to examine correlates of help-seeking intention and barriers to seeking treatment. Results Only 24.6% of students reported that they would definitely seek treatment if they had a future emotional problem. The most commonly reported reasons not to seek treatment among students who failed to report that they would definitely seek help were the preference to handle the problem alone (56.4%) and wanting to talk with friends or relatives instead (48.0%). Preference to handle the problem alone and feeling too embarrassed were also associated with significantly reduced odds of having at least some intention to seek help among students who failed to report that they would definitely seek help. Having 12-month major depression, alcohol use disorder, and suicidal thoughts and behaviors were also associated with significantly reduced reported odds of the latter outcome. Conclusions The majority of first-year college students in the WMH-ICS surveys report that they would be hesitant to seek help in case of future emotional problems. Attitudinal barriers and not structural barriers were found to be the most important reported reasons for this hesitation. Experimental research is needed to determine whether intention to seek help and, more importantly, actual help-seeking behavior could be increased with the extent to which intervention strategies need to be tailored to particular student characteristics. Given that the preference to handle problems alone and stigma and appear to be critical, there could be value in determining if internet-based psychological treatments, which can be accessed privately and are often build as self-help approaches, would be more acceptable than other types of treatments to student who report hesitation about seeking treatment., Fondo de Investigacion Sanitaria, Instituto de Salud Carlos III-FEDER, Grant/Award Numbers: PI13/00343 and PI13/00506; Instituto de Salud Carlos III, Grant/Award Numbers: CD12/00440 and CM14/00125; Northern Ireland Public Health Agency; Bristol-Myers Squibb; GlaxoSmithKline; Ortho-McNeil Pharmaceutical; Pan American Health Organization; Fogarty International Center, Grant/Award Number: FIRCA R03-TW006481; US Public Health Service, Grant/Award Numbers: R01 DA016558, R01-MH069864 and R13-MH066849; Pfizer Foundation; John D. and Catherine T. MacArthur Foundation; Consejo Nacional de Ciencia y Tecnologia (CONACyT), Grant/Award Number: CB-2016-01-285548; Ulster University; Northern Ireland Public Health Agency (HSC R & D); European Union Regional Development Fund (ERDF) EU Sustainable Competitiveness Programme for Northern Ireland; FPU, Grant/Award Number: FPU15/05728; DIUE Generalitat de Catalunya, Grant/Award Number: 2017 SGR 452; Ministerio de Sanidad, Servicios Sociales e Igualdad, PNSD, Grant/Award Number: 2015I015; ISCIII, Grant/Award Numbers: CD12/00440 and CM14/00125; Ithemba Foundation; South African Medical Research Council; Protestants Fonds voor de Geestelijke Volksgezondheid; ZonMw, Grant/Award Number: 636110005; BARMER; Eli Lilly and Company, Grant/Award Number: IIT-H6U-BX-I002; King Baudouin Foundation United States, Grant/Award Number: 2014-J2140150-102905; Belgian Fund for Scientific Research, Grant/Award Numbers: 1114717N, 11N0514N and 11N0516N; National Institute of Mental Health (NIMH), Grant/Award Numbers: R56MH109566 and R01MH070884

Background: The perspective of users should be taken into account in the evaluation of Web-based health interventions. Assessing the users’ satisfaction with the intervention they receive could enhance the evidence for the intervention effects. Thus, there is a need for valid and reliable measures to assess satisfaction with Web-based health interventions. Objective: The objective of this study was to analyze the reliability, factorial structure, and construct validity of the Client Satisfaction Questionnaire adapted to Internet-based interventions (CSQ-I). Methods: The psychometric quality of the CSQ-I was analyzed in user samples from 2 separate randomized controlled trials evaluating Web-based health interventions, one from a depression prevention intervention (sample 1, N=174) and the other from a stress management intervention (sample 2, N=111). At first, the underlying measurement model of the CSQ-I was analyzed to determine the internal consistency. The factorial structure of the scale and the measurement invariance across groups were tested by multigroup confirmatory factor analyses. Additionally, the construct validity of the scale was examined by comparing satisfaction scores with the primary clinical outcome. Results: Multigroup confirmatory analyses on the scale yielded a one-factorial structure with a good fit (root-mean-square error of approximation =.09, comparative fit index =.96, standardized root-mean-square residual =.05) that showed partial strong invariance across the 2 samples. The scale showed very good reliability, indicated by McDonald omegas of .95 in sample 1 and .93 in sample 2. Significant correlations with change in depressive symptoms (r=−.35, P

Internet interventions for common mental disorders, such as depression and anxiety disorder, have become popular in research and are now gradually implemented in practice. However, many interventions suffer from low adherence of users which in turn leads to reduced effectiveness. In this context, research on adherence has frequently outlined the need for a better understanding of user engagement. To this end, our goal is to adapt, translate and validate a questionnaire for user engagement and use this questionnaire in several randomised controlled trials. From the results, we hope to get insights into how user engagement affects adherence and therapy success.

Eine Vielzahl von Studien belegen die Wirksamkeit von psychotherapeutischen Methoden bei Major Depression und Angststörungen. Trotz der Verfügbarkeit von evidenzbasierten pharmakologischen sowie psychotherapeutischen Behandlungsansätzen führen diese bei einer großen Zahl von Patienten nach Therapieende zu keiner vollständigen Remission, sondern zu einer erheblichen Residualsymptomatik. Zudem deuten erste Befunde darauf hin, dass es nach Abschluss der Therapie eine klinisch bedeutsame Anzahl von Rückfällen gibt und darüber hinaus häufig chronische Verläufe von Erkrankungen zu verzeichnen sind. Zusammengenommen sprechen diese Befunde für eine weiterhin eingeschränkte kurz- und langfristige Effektivität der eingesetzten Behandlungskonzepte für Depressionen und Angststörungen. Aktuelle systematische Übersichtsarbeiten postulieren einen engen Zusammenhang zwischen einer defizitären Emotionsregulation und affektiven Störungen, wobei es weiterhin an prospektiven Studien, insbesondere im Verlauf von psychotherapeutischen Behandlungen, mangelt. Die vorliegende Dissertation beschäftigt sich daher mit einer möglichen Verbesserung der gängigen Therapieverfahren und beleuchtet hierbei die Emotionsregulation als einen potentiellen Wirkfaktor in der Entstehung und Aufrechterhaltung von Depressionen und Angststörungen. In den hier dargestellten Studien 1 und 2 werden die längsschnittlichen reziproken Zusammenhänge von emotionaler Kompetenz und Ängstlichkeit bzw. Depressivität über einen Zeitraum von fünf Jahren untersucht. Darüberhinaus werden die reziproken Zusammenhänge zwischen den spezifischen Emotionsregulationsstrategien (Berking 2015; Berking & Whitley, 2014) und diesen Symptombereichen exploriert. So konnte in Studie 1 und Studie 2 aufgezeigt werden, dass die emotionale Kompetenz nicht nur die nachfolgende Ängstlichkeit, sondern auch die Depressivität fünf Jahre nach der Baseline-Erfassung vorhersagt. Mittels Cross-lagged-Panel Analysen wurde zudem gezeigt, dass die umgekehrte Wirkrichtung von Ängstlichkeit bzw. Depressivität auf die nachfolgende emotionale Kompetenz keine signifikanten Effekte erzielt. Zudem zeigen die explorativen Untersuchungen zum Zusammenhang von emotionaler Kompetenz und Ängstlichkeit, dass insbesondere die spezifischen Emotionsregulationsstrategien der Akzeptanz und Toleranz, der Konfrontationsbereitschaft sowie der Klarheit im Erkennen affektiver Zustände die wichtigsten Prädiktoren für die nachfolgende Ängstlichkeit sind. Ein Vergleich der Effektstärken der spezifischen Emotionsregulationsstrategien für die nachfolgende Depressivität ergibt, dass alle verwendeten Strategien von ähnlicher Relevanz sind. Zusammenfassed zeigen die Studien 1 und 2 somit die Bedeutung der emotionalen Kompetenz für die Entstehung und Aufrechterhaltung von Ängstlichkeit und Depressivität in einer nichtklinischen Stichprobe auf. In Studie 3 wurde der wechselseitige Zusammenhang zwischen der emotionalen Kompetenz und der Depressivität, Ängstlichkeit und des allgemeinen Disstress im Verlauf der ersten drei Behandlungswochen einer stationären Therapie untersucht. Hierzu wurden moderne Strukturgleichungsmodelle (Latent Change Score Modelle) eingesetzt, um die Veränderung in der Psychopathologie auf die Veränderung der Emotionsregulation in der vorherigen Woche zurückzuführen oder den entgegengesetzten Wirkmechanismus empirisch zu belegen. Im Verlauf einer stationären Depressionsbehandlung zeigte sich, dass eine verbesserte emotionale Kompetenz mit einer nachfolgenden Reduktion der Depressivität einherging. Dieser Wirkzusammenhang konnte im stationären Kontext jedoch nicht für die Ängstlichkeit und das pathologische Stresserleben der Patienten aufgezeigt werden. Zusammengefasst liefert die vorliegende Dissertation somit Hinweise, dass (1) eine defizitäre emotionale Kompetenz die Entstehung und Aufrechterhaltung von Ängsten und Depressivität in einer nicht klinischen Stichprobe begünstigt, (2) während einer stationären Psychotherapie adaptivere emotionale Kompetenzen zu einer Reduktion der Depressivität führen. Somit könnte eine systematische Verbesserung der emotionalen Kompetenzen ein relevantes Behandlungsziel darstellen, das die Standardinterventionen zur Behandlung von Major Depression ergänzt und (3) die transdiagnostische Relevanz von adaptiven emotionalen Kompetenzen im Verlauf der stationären Therapie in zukünftigen Studien differenzierter beleuchtet werden muss.