START adolescents: study protocol of a randomised controlled trial to investigate the efficacy of a low-threshold group treatment programme in traumatised adolescent refugees

IntroductionNo evaluated therapeutic approaches, that can efficiently be established in routine mental healthcare, are currently available for traumatised adolescent refugees in Germany. This study evaluates the efficacy of the Stress-Traumasymptoms-Arousal-Regulation-Treatment (START) programme to reduce trauma-related symptoms and psychological distress in traumatised adolescent refugees based in Germany.Methods and analysisThis randomised, waiting-list-controlled, multicentre trial with a 12-week follow-up will include 174 refugee minors with partial or full post-traumatic stress disorder who are fluent in either Arabic, Dari, English, German or Somali. Eligible refugee minors will be randomised to the START or waiting-list control groups. The manualised 8-week START programme is based on techniques of dialectical behaviour therapy (DBT), fosters adaptive coping with emotional distress and traumatic symptoms and comprises eight therapy modules and a booster session. Study assessments are planned at baseline, post-treatment (ie, after programme participation or waiting time), booster session at week 12 or 12-week waiting time, and at the 12-week follow-up. Primary and coprimary outcomes are changes in psychological distress and traumatic symptoms at post-treatment and will be analysed as response variables in linear mixed regression models. Secondary outcomes are changes in further trauma-related and other psychopathological symptoms, emotion regulation and intermediate effects of the programme at follow-up. We will also assess effects of the programme with ecological momentary assessments and on neuroendocrine stress parameters using hair cortisol.Ethics and disseminationThis study has been approved by the lead ethics committee of Rhineland-Palatinate and the ethics committees of participating sites. The study results will be disseminated through peer-reviewed publications and scientific conferences.Trial registration numberDRKS00020771.

Session 8: Final Session: Taking the Practice Forward

This final session provides a time and space for reflection—reflecting on the retreat experiences the participants have just had, their experiences with the program as a whole, and also their plans to take the practice forward. This might include how participants could seek additional support (e.g., joining a local mindfulness group) or even support each other in continued practice. In particular, time is taken to troubleshoot potential difficulties in keeping up with practice, and participants are reminded that, much like exercise, benefits will continue only with continued practice. If the optional booster session(s) will take place, time is spent scheduling and preparing for this.

Session 9: Booster Session

The standard for mindfulness training programs, including MBSR, is an 8-week, weekly format. This chapter provides the structure for an optional follow-up or booster session that can occur outside of the standard 8-week structure of the program. The booster can be scheduled for a one-month follow-up after the group ends. At the facilitator’s discretion, you may wish to schedule additional boosters, such as at 3 months or even 1 year (such as was done in the original Wisdom Mind study). A booster session can be used to enhance ongoing engagement by promoting continued connection between participants and to troubleshoot difficulties with the practices.

Session 8: Final Session: Taking the Practice Forward

This final session provides a time and space for reflection – reflecting on the retreat experiences you have just had, your experiences with the program as a whole, and also your plans to take the practice forward. This might include how you could seek additional support (e.g., joining a local mindfulness group) or even how the group itself can support one other in continued practice. In particular, time is taken to troubleshoot potential difficulties in keeping up with practice, and you are reminded that, much like exercise, benefits will continue only with continued practice. If the optional booster session(s) will take place, time is spent scheduling and preparing for this final session.

Intensive Mindfulness-based Resilience Training in First Responders: A Pilot Study

first responders offered in a compressed, residential immersion format (MBRT-I). Methods: Participants (N = 31) attended a 2.5-day immersion training to receive training in MBRT-I, with a booster session 30 days later. Self-report data measuring aspects of stress and health were collected at baseline, immediately following MBRT-I training, 30 days after MBRT-I training, and 90 days after MBRT-I training. Results: Participants reported significant improvements in emotional intelligence, emotional regulation, occupational stress, and fatigue (p < .05), with further trends approaching statistical significance regarding perceived stress, anger, and mindfulness. Conclusions: Whereas larger studies with longer follow-up are needed to establish the efficacy of this intervention, preliminary results suggest a compressed-format version of MBRT is (1) feasible, and (2) may be beneficial in reducing stress, anger, and fatigue, and improving likely mediators of positive health outcomes, such as emotional regulation and mindfulness among a broad range of first responders.

ZMILE, a multicomponent self-management intervention for adults with epilepsy: Rationale and description of the intervention

Objective: In this paper, we aim to provide a comprehensive description of the multicomponent self-management intervention for adults with epilepsy, ZMILE. Rationale or theory: Acquiring self-management skills has been shown to play a vital role in enabling patients with epilepsy overcoming (health-related) struggles in daily life and coping with limitations their condition poses on them. ZMILE is a course consisting of education (to increase concordance to treatment), goal-setting (proactive coping), and self-monitoring. Resources needed: The course is guided by two nurse practitioners and each patient is allowed to bring one family member or friend. Self-monitoring plays an important role and can be done through e-Health tools or written diaries. Processes involved: During and after the course, patients are required to work toward a personally defined goal using a five-step approach by means of pro-active coping. Moreover, patients are expected to use self-monitoring tools to reflect on their own behavior and identify ways to optimize medication intake when required. Quantification: ZMILE is provided in an outpatient setting over five weekly group sessions and one booster session. From the start, patients are encouraged to set individual goals. Each group session will have a different theme but part of every session is reflecting on personal goals and to learn from eachother. Conclusions: The ZMILE-intervention has been evaluated and may be a promising intervention in terms of effectiveness and feasibility for adults with epilepsy, relatives, and professionals. We present the adapted version which can be implemented in clinical practice.

Cognitive Reappraisal and Self-Compassion as Emotion Regulation Strategies for Parents during COVID-19: An online RCT

Objective. Parenting during pandemic restrictions places extreme demands on everyday family life, leading to increased stress levels for parents and distressed parent-child interactions. The goal of this RCT study was to investigate whether cognitive reappraisal and self-compassion are helpful emotion regulation (ER) strategies to reduce individual and parental stress during the COVID-19 pandemic.Method. An online intervention for parents was developed focusing on the application of ER strategies to pandemic requirements of families. N = 265 participants were randomly assigned to either cognitive reappraisal (CR; n = 88), self-compassion (SC; n = 90) or wait-list control (WLC; n = 87) group. Interventions included two video sessions (day 1 and day 3) and three email reminders to transfer the application of ER strategies to daily family life (days 2, 4, 5). Parents’ perceived individual stress and parental stress were assessed at baseline (T0), at T1 prior to the booster session, and at T2 (7 days after baseline).Results. Significant decreases from T0 to T2 emerged for both primary stress outcomes in both intervention groups. Individual stress significantly decreased in CR compared to WLC at T2. No time × group interactions for parental stress were found. However, mediation analyses suggested that parental stress was indirectly decreased via reductions in individual stress for CR compared to WLC at both time points.Conclusions. COVID-19 will not be the last pandemic to affect family life. Cognitive reappraisal as brief online intervention can ease acute stress and strengthen the mental health of parents in acute crises.

Internet-based and mobile-supported stress management as a universal prevention approach – Effectiveness and moderators from a large pragmatic randomized-controlled trial (Preprint)

UNSTRUCTURED Background: Emerging evidence indicates the effectiveness of Internet-based mobile supported stress management (iSMIs) in highly stressed employees. It is yet unclear, however, whether iSMIs are also effective without a preselection process in a universal prevention approach which more closely resembles routine occupational health care. Moreover, evidence for whom iSMIs might be suitable and for whom not is scarce. The present study aims to evaluate the iSMI GET.ON Stress without baseline inclusion criteria and examine moderators of intervention effects. Methods: 396 employees were randomly assigned to the intervention condition (IC) or the six-month waiting list control condition (WLC). The iSMI consisted of seven sessions and one booster session with and offered no therapeutic guidance. Self-report data were assessed at baseline, seven weeks, and at six months following randomization. The primary outcome was perceived stress (PSS-10). Several a priori defined moderators were explored as potential effect modifiers. Results: Participants of the IC reported significantly lower perceived stress at post-treatment (d=0.71) and six-month follow-up (d=0.61) compared to the WLC. Significant differences with medium to large effect sizes were found for all mental health and most work-related outcomes. Resilience, agreeableness, psychological strain and self-regulation moderated intervention effects. Discussion: This study indicates that iSMIs can be effective in a broad range of employees with no need for pre-selection to achieve substantial effects. The subgroups that might not profit all had extreme values on the respective measures and represented only a very small proportion of the investigated sample, indicating a broad applicability of GET.ON Stress.

S195. ROLE OF BOOSTER SESSION TRANSCRANIAL DIRECT CURRENT STIMULATION (TDCS) FOR PERSISTENT AUDITORY HALLUCINATIONS IN SCHIZOPHRENIA

Background Auditory verbal hallucinations (AH), one of the hallmark symptoms, are present in 60–80% of schizophrenia (SZ) patients. 25% of patients suffering from AH in schizophrenia fail to respond to any psychotropic medication. Non-invasive brain stimulation techniques like transcranial direct current stimulation (tDCS), with cathodal electrode placement on the left temporoparietal junction (TPJ) is known to alleviate such symptoms in SZ. In this study, we describe the effects of booster tDCS after relapse of AH in patients. The pattern and effectiveness of booster treatment cycles for alleviation of AH in a naturalistic clinical setting are explored in this study. Methods Patients with persistent AH (n=15) received an initial course (cycle) of add-on tDCS with cathode at left TPJ and anode over left dorsolateral prefrontal cortex (L-DLPFC) with 2mA current, twice-daily 20-minute sessions for 5 days with intersession interval of 3-hours. Clinical global impression- improvement scale (CGI-I) was rated at the end of the course for every patient. All the patients who were found to show response (“much improved” and “very much improved”) received repeat cycles of add-on booster tDCS after a varying duration ranging from 1–32 months from initial treatment course, due to relapse/persistence of AH. Thirteen out of fifteen patients received one booster cycle while one patient received 3 booster cycles and another received 12 booster cycles. We conducted a spearman’s rank correlation test to determine the correlation between CGI-I score rating at the end of add-on tDCS, and the duration of maintenance of improvement before relapse/ worsening of AH. Results Six of the fifteen patients (40%) had responded “very much improved” and nine (60%) patients had responded “much improved” to tDCS in the initial cycle. It was found that 50% of the initial “very much improved” responders (n=3) had a comparable response to tDCS after booster sessions for relapse of symptoms while 50% of patients showed “much improved” (n=2) and “minimally improved” (n=1) response in the booster sessions. Among the nine patients who showed “much improved” response from the initial cycle, one patient showed better response than initial cycle (“very much improved”) to booster session. Five patients showed “minimally changed” response in the second cycle in the booster sessions while three patients had comparable responses. The average duration of symptom free interval/ maintenance of improvement with initial cycle of tDCS was found to be 10.46± 9.23 months. The CGI improvement from the initial add-on tDCS course and the duration of the maintenance of improvement/symptom-free interval before the booster session was not found to be significantly correlated (r=0.332, p=0.226) Discussion A reduction in hallucinations was noted with booster tDCS in patients who had responded to the initial course of add-on tDCS. Booster tDCS is a feasible option and given its cost-effectiveness and ease of administration, booster sessions of tDCS can be considered for resurgence of symptoms. Future studies are recommended in systematically exploring maintenance tDCS as an add-on treatment for persistent/recurring AVH in schizophrenia.

Tactile Contact as a Marketing Tool for Improving an HIV/STD Education Program’s Compliance / Retention with Crack Cocaine Users

Background: This research brief reports results from an exploratory pilot study on the use of socially acceptable touch in a public setting that accompanies a request to improve program compliance with “street level” crack cocaine users. Methods: Study participants consisted of 120 crack cocaine-using participants in a larger community-based HIV/STD prevention and research program targeting at-risk African-Americans. They were required to return for a series of four booster health education sessions over 2-5 days and 6 month and 1 year follow-up assessments. The most difficult aspect of this program was no-shows for the second booster session; study participants who attended at least two sessions were much more likely to attend all sessions and complete the entire lengthy program. The program director randomly approached some participants after the first visit in a public setting and briefly touched them as part of a handshake; then, the director asked them to return for their follow-up sessions. Whether they were approached or not was random. Analysis comprised descriptive and non-parametric statistics. Results: Ninety-three percent of participants who were asked to return and were touched returned for the second session; only 75% returned who had been asked to do so but were not touched. A statistically significant difference favored being touched and complying, as measured by second-session returning participants (p < .01), though it appeared the touch / request had more of a preventive than a promotional effect. Extraneous demographic and background factors were ruled out with the exception of age (older participants), which contributed slightly. Conclusions: Results suggest that a request “anchored” to a socially acceptable public touch is promising in terms of improving program participation and engagement. Limitations and implications for future research are discussed.