Effectiveness and underlying mechanisms of Applied Relaxation as indicated preventive intervention in subjects at increased risk for mental disorders

由于精神障碍构成了21世纪世纪的核心卫生保健挑战，因此加强预防干预措施的研究工作是必不可少的。在临床心理学领域，针对那些最初的精神分裂症的预防性干预措施似乎特别有希望。应用放松（AR）是一种成熟的干预技术，被证明可以有效地减少紧张/痛苦，焦虑和抑郁症状，在治疗各种明显的精神障碍以及躯体疾病的背景下。然而，到目前为止，尚未研究AR作为初始精神障碍但没有全阈值精神障碍的受试者的预防性干预是否能够防止进一步的症状升级。这项在紧张/痛苦、焦虑或抑郁性精神障碍受试者中进行的随机对照试验旨在研究AR干预（10次，每次60分钟）是否可以（a）有效减少当前的精神病理学症状以及（B）防止症状进一步进展为全阈值DSM-5精神障碍。将额外研究干预/预防有效性的假定介质（生理、情绪、认知和行为变化，包括心率和心率变异性、毛发和唾液皮质醇分泌、情感、自我效能、内部控制点和认知/行为应对）和调节因素（性别、年龄、基线时的症状严重程度和干预过程中的家庭作业依从性）。将在日常生活中以常规方式（通过个人访谈、问卷调查和相应主要评估期间的生理测量）和生态瞬时评估（EMA，在相应主要评估后1周内通过智能手机应用）评估预测指标和结局指标。

As mental disorders constitute a core health care challenge of the 21th century, increased research efforts on preventive interventions are indispensable. In the field of clinical psychology, indicated preventive interventions targeted to those with initial symptomatology appear particularly promising. Applied relaxation (AR) is a well-established intervention technique proven to effectively reduce tension/distress, anxiety and depressive symptoms in the context of treatment of a wide variety of manifest mental disorders as well as somatic illnesses. However, it has not been studied so far whether AR as indicated preventive intervention in subjects with initial symptomatology but no full-threshold mental disorder yet is capable to prevent a further symptom escalation. This randomized controlled trial in subjects with elevated tension/distress, anxiety or depressive symptomatology aims to investigate whether an AR intervention (10 sessions à 60 min) can (a) effectively reduce present psychopathological symptoms as well as (b) prevent a further symptom progression to full-threshold DSM-5 mental disorders. Putative mediators (physiological, emotional, cognitive and behavioral changes including heart rate and heart rate variability, hair and salivary cortisol secretion, affectivity, self-efficacy, internal locus of control and cognitive / behavioral coping) and moderators (sex, age, symptom severity at baseline and homework adherence during the intervention course) of the intervention/preventive efficacy will be additionally studied. Predictor and outcome measures will be assessed both conventionally (via personal interview, questionnaires and physiological measures during the respective main assessment) and with ecological momentary assessments (EMA, applied via smart phone over a 1-week interval following the respective main assessment) in everyday life.