Efficacy of a novel, accessible, transdiagnostic, compassion-focused ecological momentary intervention for enhancing resilience in help-seeking youth

大多数精神障碍首先出现在青年中，因此大大增加了全球疾病负担。近年来，这在精神障碍中变得尤为明显，其风险已经在发育早期以亚临床精神病经历的形式表现出来。当代研究进一步表明，亚临床精神病经历通常与焦虑、抑郁和躁狂共同发生，反映了一种与一系列后续精神病理结果相关的跨诊断表型。应激敏感性升高是精神病性和情感性心理健康问题中研究最广泛的心理机制之一。因此，筛查和靶向应激敏感性作为青少年这种跨诊断表型的潜在机制，是一种有希望的指示和转化策略，可以预防以后生活中的不良后果。然而，青少年仍然难以获得心理帮助，并且在现实世界条件下效果有限，需要新的方法。以同情为中心的干预（cfi）提供了广泛的创新治疗技术，用于针对精神病患者的压力敏感性和增强情绪恢复能力，特别是当与情感障碍同时发生时。此外，最近的快速技术进步提供了一个独特的机会，可以提供对青年友好的、可获得的、个性化的、实时的移动健康（mHealth）干预措施，最突出的是生态瞬时干预措施（EMIs），使青年能够获得针对年轻人在特定时刻和日常生活环境中所需的干预措施。EMIs进一步允许调查候选潜在心理机制的几个因果标准，但关于这些干预措施的可靠的、基于试验的证据仍然非常有限。本研究旨在探讨一种新颖的、可及的、跨诊断的、生态的、瞬间的、以同情为中心的干预措施对改善寻求帮助的青少年的情绪应变能力（EMOCOMPASS）的有效性和临床可行性。在一项探索性随机对照试验中，在曼海姆中央精神卫生研究所的精神卫生服务中出现精神病、抑郁、焦虑和/或躁狂症状的12-25岁青年将被随机分配到除常规治疗（TAU）（实验条件）或仅TAU的对照条件外的EMOCOMPASS干预组。压力敏感性、情绪恢复力、精神病、抑郁、焦虑和躁狂症状将是基线、干预后和4周随访时获得的主要结局。将对生态干预主义因果模型进行测试，以提高我们对潜在心理机制的几个因果标准的理解，并有助于提高移动健康干预措施在促进青年复原力方面的功效，最终目标是预防生命后期的不良后果。

Most mental disorders first emerge in youth and, as such, contribute substantially to global disease burden. In recent years, this has become particularly evident for psychotic disorders, for which risk manifests already at a developmentally earlier stage in the form of subclinical psychotic experiences. Contemporary research further suggests that subclinical psychotic experiences often co-occur with anxiety, depression and mania, reflecting a transdiagnostic phenotype associated with a range of subsequent psychopathological outcomes. Elevated stress sensitivity is one of the most widely studied psychological mechanism underlying psychotic and affective mental health problems. Thus, screening for, and targeting stress sensitivity as an underlying mechanism of, this transdiagnostic phenotype in youth is a promising indicated and translational strategy for preventing adverse outcomes later in life. Psychological help, however, remains difficult to access for youth and has limited efficacy under real-world conditions, calling for novel approaches. Compassion-Focused Interventions (CFIs) offer a wide range of innovative therapeutic techniques for targeting stress sensitivity and enhancing emotional resilience in psychosis, especially when co-occurring with affective disturbances. What is more, the recent rapid technological advances provide a unique opportunity to deliver youth-friendly, accessible, personalized, real-time, mobile health (mHealth) interventions, most prominently, ecological momentary interventions (EMIs) that enable youth to access interventions that are tailored to what a young person needs in a given moment and context in daily life. EMIs further allow for investigating several causal criteria of candidate underlying psychological mechanisms, but robust, trial-based evidence on these interventions remains very limited. The proposed research aims to examine the efficacy and clinical feasibility of a novel, accessible, transdiagnostic, ecological momentary, compassion-focused intervention for improving emotional resilience to stress (EMOCOMPASS) in help-seeking youth. In an exploratory randomized controlled trial, youth aged 12-25 with psychotic, depressive, anxiety, and/or manic symptoms presenting to mental health services of the Central Institute of Mental Health, Mannheim, will be randomly allocated to the EMOCOMPASS intervention in addition to treatment as usual (TAU) (experimental condition) or a control condition of TAU only. Stress sensitivity, emotional resilience, psychotic, depressive, anxiety and manic symptoms will be the primary outcomes obtained at baseline, post-intervention, and 4-week follow-up. Ecological interventionist causal models will be tested to improve our understanding of several causal criteria of underlying psychological mechanisms and contribute to enhancing efficacy of mHealth interventions for promoting resilience in youth, with the ultimate goal of preventing adverse outcomes later in life.