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Psychological trials, such as behavioural avoidance tests (BAT), are a fundamental part of the phobia therapeutic process. In order to link physiological reactions with specific points in time during psychological trials, it is necessary to integrate observation data with data collected automatically by sensors, such as wearable devices. To this end, this paper introduces FRAME - a framework for combining real-world events occurring during psychological trials with physiological data collected by wearables. FRAME consists of three parts, an Observation App, a data integration module and a Virtual Reality (VR) App. The Observation App captures events and their exact time of occurrence. The integration module links the observations with the respective physiological data, allowing an in-depth analysis of physiological reactions. The VR App provides a virtual scenario based on the BAT in vivo, thus enabling a BAT in virtuo. The practical applicability of FRAME is tested within a study comparing behavioural avoidance tests in vivo and in virtuo, assessing 25 patients with arachnophobia wearing an Empatica E4.

Background: Tobacco use is globally recognized by the World Health Organization as the foremost risk factor for premature mortality. Individuals with mental disorders exhibit a notably heightened dependence on tobacco, approximately twice as high as that of the general population. The long-term effects of nicotine consumption include an exacerbation of depressive symptoms and a decline in mental health, which can be considered additional risk factors for the vulnerable population of smokers with preexisting mental disorders. Successful smoking cessation is associated with an increase in mental health, comparable or superior to that of pharmacological antidepressant treatments. However, smoking is frequently disregarded within the realm of psychotherapeutic care, unlike in the treatment of other substance use disorders. Smoking may hinder patients' recovery and responsiveness to psychotherapy, potentially distorting improvements in symptom severity or negative affect. Integrating smoking cessation initiatives into standard psychotherapeutic interventions thus holds significant potential and may be considered essential for long-term mental health. The current study's objective is to assess the potential of a guideline-based smoking cessation intervention within an outpatient psychotherapeutic setting concerning changes in smoking intensity, nicotine dependence, and mental health outcomes among patients with a mental disorder adjunct to concurrent psychotherapy. This trial aims to bridge the gap between the state of research in light of evidence of the positive effects of successful smoking cessation and the actual practical provision of care in Germany. Methods: The effects of an intensified smoking cessation intervention versus a treatment-as-usual (TAU) control intervention on smokers' smoking intensity, nicotine dependence, and mental health symptoms related to a primary mental disorder will be examined in a single-center randomized controlled trial in an outpatient psychotherapeutic clinic using variance analysis methods. In this case, TAU is referred to as regular psychotherapy sessions without any additional smoking cessation treatment. The smoking intervention consists of a common guideline-based cognitive-behavioral program supplemented by a digital health application. Secondary outcomes include patients' motivation to quit, self-efficacy, and attitudes toward online interventions. Potential moderators or mediators will be investigated in exploratory analyses. Discussion: This study aims to elucidate the potential benefits of integrating smoking cessation interventions into standard psychotherapeutic treatment, akin to approaches used for other substance use disorders. While existing research highlights the positive impact of smoking cessation on mental health, its practical implications within the field of psychotherapy remain unclear. To address this gap, the current study examines the effectiveness of an intensive smoking cessation program alongside ongoing psychotherapy, focusing on both smoking status and mental health outcomes. By doing so, we aim to provide practical insights for psychotherapeutic providers regarding the integration of smoking cessation into comprehensive mental health care. Trial registration: Prospectively registered on ISCRTN on 01.05.2024, reference number ISRCTN12859609. [ABSTRACT FROM AUTHOR]

In healthy individuals, the majority of cortisol secretion occurs within several hours surrounding morning awakening. A highly studied component of this secretory period is the cortisol awakening response (CAR), the rapid increase in cortisol levels across the first 30 to 45 minutes after morning awakening. This strong cortisol burst at the start of the active phase has been proposed to be functional in preparing the organism for the challenges of the upcoming day. Here, we review evidence on key regulatory and functional processes of the CAR and develop an integrative model of its functional role. Specifically, we propose that, in healthy individuals, the CAR is closely regulated by an intricate dual-control system, which draws upon key circadian, environmental, and neurocognitive processes to best predict the daily need for cortisol-related action. Fine-tuned CAR expression, in turn, is then assumed to induce potent glucocorticoid action via rapid nongenomic and slower genomic pathways (eg, affecting circadian clock gene expression) to support and modulate daily activity through relevant metabolic, immunological, and neurocognitive systems. We propose that this concerted action is adaptive in mediating two main functions: a primary process to mobilize resources to meet activity-related demands and a secondary process to help the organism counterregulate adverse prior-day emotional experiences. [ABSTRACT FROM AUTHOR]

Automatic tendencies to approach addictionrelated stimuli have been linked to the development and maintenance of harmful drug use behavior. Recent studies have shown that these automatic approaches can be directly addressed and modified by cognitive bias modification (CBM). However, the training and treatment effects are rather small and compliance could be impaired by time-consuming, multiple laboratory training sessions. Here we present a mobile variant of the Approach-Avoidance Task (app-AAT), which is evaluated by a feasibility study. The app-AAT is designed to improve the efficiency of CBM training by allowing smokers to access the training at any time, and by offering the option to track consumed cigarettes. Our first run with eight participants showed that the app was rated very positively with 4.2 out of 5 points (engagement: 3.7, functionality: 4.5, aesthetics: 4.4) by using the german Mobile App Rating Scale (MARS-G).