Location-scale modeling as an integrative approach to symptom dynamics during psychotherapy: An illustration with depressive symptoms.

OBJECTIVE: Depressive symptom dynamics, including change trajectories and symptom variability, have been related to therapy outcomes. However, such dynamics have often been examined separately and related to outcomes of interest using two-step analyses, which are characterized by several limitations. Here, we show how to overcome these limitations using location-scale models in a dynamic structural equation modeling framework. METHOD: We introduce location-scale modeling in an accessible manner to pave the way for its use in research integrating within-person dynamics and intervention-related change in psychopathology, and we illustrate this modeling approach in a large-scale internet-based intervention for depression (N = 1,656). Using eight data points sampled across about 8 weeks, we predicted improvement across the intervention (50% symptom reduction) as a function of early change and symptom variability. RESULTS: Early symptom change was associated with a more likely improvement across therapy. Variability of symptoms beyond change trajectories during the intervention was associated with less likely improvement. CONCLUSIONS: Location-scale models, and dynamic structural equation modeling more generally, are well suited to modeling how patterns of symptom change during psychotherapy are related to important (e.g., therapy) outcomes. Our illustrative application of location-scale modeling showed that symptom variability was associated with less overall improvement in depressive symptoms. However, this finding requires replication with more intensive sampling of symptoms before final conclusions can be drawn on when and how to distinguish maladaptive from adaptive variability during psychotherapy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Footprints of atomic-scale features in plasmonic nanoparticles as revealed by electron energy loss spectroscopy.

We present a first-principles theoretical study of the atomistic footprints in the valence electron energy loss spectroscopy (EELS) of nanometer-size metallic particles. Charge density maps of excited plasmons and EEL spectra for specific electron paths through a nanoparticle (Na380 atom cluster) are modeled using ab initio calculations within time-dependent density functional theory. Our findings unveil the atomic-scale sensitivity of EELS within this low-energy spectral range. Whereas localized surface plasmons (LSPs) are particularly sensitive to the atomistic structure of the surface probed by the electron beam, confined bulk plasmons (CBPs) reveal quantum size effects within the nanoparticle's volume. Moreover, we prove that classical local dielectric theories mimicking the atomistic structure of the nanoparticles reproduce the LSP trends observed in quantum calculations, but fall short in describing the CBP behavior observed under different electron trajectories.

The Cost-Effectiveness of a Novel Online Social Therapy to Maintain Treatment Effects From First-Episode Psychosis Services: Results From the Horyzons Randomized Controlled Trial.

BACKGROUND: Digital interventions have potential applications in promoting long-term recovery and improving outcomes in first-episode psychosis (FEP). This study aimed to evaluate the cost-effectiveness of Horyzons, a novel online social therapy to support young people aged 16-27 years following discharge from FEP services, compared with treatment as usual (TAU) from a healthcare sector and a societal perspective. STUDY DESIGN: A cost-effectiveness analysis (CEA), based on the change in social functioning, and a cost-utility analysis (CUA) using quality-adjusted life years were undertaken alongside a randomized controlled trial. Intervention costs were determined from study records; resources used by patients were collected from a resource-use questionnaire and administrative data. Mean costs and outcomes were compared at 18 months and incremental cost-effectiveness ratios were calculated. Uncertainty analysis using bootstrapping and sensitivity analyses was conducted. STUDY RESULTS: The sample included 170 participants: Horyzons intervention group (n = 86) and TAU (n = 84). Total costs were significantly lower in the Horyzons group compared with TAU from both the healthcare sector (-AU$4789.59; P < .001) and the societal perspective (-AU$5131.14; P < .001). In the CEA, Horyzons was dominant, meaning it was less costly and resulted in better social functioning. In the CUA, the Horyzons intervention resulted in fewer costs but also yielded fewer QALYs. However, group differences in outcomes were not statistically significant. When young people engaged more with the platform, costs were shown to decrease and outcomes improved. CONCLUSIONS: The Horyzons intervention offers a cost-effective approach for improving social functioning in young people with FEP after discharge from early intervention services.

Molecular Doping in the Organic Semiconductor Diindenoperylene: Insights from Many-Body Perturbation Theory.

Molecular doping provides a route toward designing new organic compounds with improved performance for optoelectronics. Here, we investigate the p-type doping of crystalline diindenoperylene (DIP) with two recently proposed electron-accepting molecular dopants using many-body perturbation theory. For the pristine DIP crystal, the quasiparticle band structure and the optical absorption spectra are found in agreement with the experimental data. Using the same methodology, we then characterize the optical and electronic properties of the two doped DIP crystals. The bandgap of both doped crystals is narrowed considerably due to the formation of hybridized states at the valence band edge. Moreover, a hybrid unoccupied mid-gap band is created with a host-dopant charge-transfer characteristic, giving rise to broader absorption spectra and a much lower absorption onset as compared to pristine DIP. Our results highlight that the interaction and hybridization with the host environment, including many-body effects, must be carefully considered in order to identify appropriate molecular dopants for a given organic crystal.

Re-appraising stressors from a distance: effects of linguistic distancing on cognitive appraisals and emotional responses to interpersonal conflict.

Reflecting on stressors from a detached perspective - a strategy known as distancing - can facilitate emotional recovery. Researchers have theorised that distancing works by enabling reappraisals of negative events, yet few studies have investigated specifically how distancing impacts stressor appraisals. In this experiment, we investigated how participants' (N = 355) emotional experience and appraisals of an interpersonal conflict differed depending on whether they wrote event-reflections from a linguistically immersed (first-person) or distanced (second/third-person) perspective. Partly replicating previous findings, distanced reflection predicted increases in positive affect, but not reductions in negative affect, relative to immersed reflection. Linguistic distancing also predicted increases in motivational congruence appraisals (i.e. perceived advantageousness of the event), but did not influence other appraisal dimensions. We discuss how linguistic distancing may facilitate emotional recovery by illuminating the benefits of stressful experiences, enabling people to "see the good in the bad".

Moderated Online Social Therapy for Carers of Early Psychosis Clients in Real-World Settings: Cluster Randomized Controlled Trial.

BACKGROUND: Family carers of youth recovering from early psychosis experience significant stress; however, access to effective family interventions is poor. Digital interventions provide a promising solution. OBJECTIVE: Our objective was to evaluate across multiple Australian early psychosis services the effectiveness of a novel, web-based early psychosis intervention for carers. METHODS: In this cluster randomized controlled trial conducted across multiple Australian early psychosis services, our digital moderated online social therapy for carers (Altitudes) plus enhanced family treatment as usual (TAU) was compared with TAU alone on the primary outcome of perceived stress and secondary outcomes including mental health symptoms and family variables at the 6-month follow-up. RESULTS: Eighty-six caregivers were randomized and data were available for 74 young people in their care. Our primary hypothesis that carers randomized to Altitudes+TAU would report greater improvements in perceived stress at follow-up compared with carers randomized to TAU alone was not supported, with the TAU alone group showing more improvement. For secondary outcomes, the TAU alone group showed improved mindfulness over time. Regardless of group assignment, we observed improvements in satisfaction with life, quality of life, emotional overinvolvement, and burden of care. In contrast, hair cortisol concentration increased. Post hoc analyses revealed more contact with early psychosis services in the intervention group compared to TAU alone and that improvements in perceived stress and social support were associated with use of the intervention in the Altitudes+TAU group. In this study, 80% (12/15) reported a positive experience with Altitudes and 93% (14/15) would recommend it to others. CONCLUSIONS: Our trial did not show a treatment effect for Altitudes in perceived stress. However, our post hoc analysis indicated that the amount of use of Altitudes related to improvements in stress and social support. Additional design work is indicated to continue users' engagement and to significantly improve outcomes in problem-solving, communication, and self-care. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12617000942358; https://trialsearch.who.int/Trial2.aspx?TrialID=ACTRN12617000942358.

A randomized controlled trial of moderated online social therapy for family carers of first-episode psychosis patients in a specialist treatment setting.

BACKGROUND: Family members, who provide the majority of informal care during the recovery period from first-episode psychosis (FEP), experience high levels of psychological distress. However, there is a lack of effective and accessible interventions for FEP carers. OBJECTIVE: To determine the effectiveness of an online intervention ("Altitudes") in relation to the primary outcome of FEP-carer stress at 6 months follow-up. METHODS: We conducted a cluster randomized controlled trial in which FEP carers were randomized to Altitudes combined with specialized treatment as usual (STAU) or STAU alone. In addition to questionnaires, we included multiple waves of intensive ecological momentary assessment (EMA) to measure carer stress and family outcomes in 164 carers of young (15-27 years) FEP patients. RESULTS: Both groups improved over time on stress and a range of secondary outcomes, including mental health symptoms, self-efficacy, and expressed emotion with no group by time interactions. At 12 months there were significantly fewer visits to emergency departments by FEP patients in the Altitudes group (p = 0.022). Modelling of multiple EMA waves revealed that more time spent by carers with FEP patients predicted greater worry, expressed emotion, and adaptive coping. CONCLUSIONS: Engagement and usability findings for Altitudes were positive. Further refinements to our online carer interventions may be needed to engage carers in purposeful skill development for improved management of stress and communication with the young person compared with existing specialist family interventions. TRIAL REGISTRATION: ACTRN12616000968471.

Everyday emotional functioning in COVID-19 lockdowns.

Throughout the COVID-19 pandemic, policy makers have tried to balance the effectiveness of lockdowns (i.e., stay-at-home orders) with their potential mental health costs. Yet, several years into the pandemic, policy makers lack solid evidence about the toll of lockdowns on daily emotional functioning. Using data from two intensive longitudinal studies conducted in Australia in 2021, we compared the intensity, persistence, and regulation of emotions on days in and out of lockdown. Participants (N = 441, observations = 14,511) completed a 7-day study either entirely in lockdown, entirely out of lockdown, or both in and out of lockdown. We assessed emotions in general (Dataset 1) and in the context of social interactions (Dataset 2). Lockdowns took an emotional toll, but this toll was relatively mild: In lockdown, people experienced slightly more negative and less positive emotion; returned to a mildly negative emotional state more quickly; and used low-effort emotion-regulation strategies (i.e., distraction). There are three interpretations for our findings, which are not mutually exclusive. First, people may be relatively resilient to the emotional challenges posed by repeated lockdowns. Second, lockdowns may not compound the emotional challenges of the pandemic. Third, because we found effects even in a mostly childless and well-educated sample, lockdowns may take a greater emotional toll in samples with less pandemic privilege. Indeed, the high level of pandemic privilege of our sample limits the generalizability of our findings (e.g., to people with caregiving roles). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emotion regulation in everyday life: Mapping global self-reports to daily processes.

Recent theory conceptualizes emotion regulation as occurring across three stages: (a) identifying the need to regulate, (b) selecting a strategy, and (c) implementing that strategy to modify emotions. Yet, measurement of emotion regulation has not kept pace with these theoretical advances. In particular, widely used global self-report questionnaires are often assumed to index people's typical strategy selection tendencies. However, it is unclear how well global self-reports capture individual differences in strategy selection and/or whether they may also index other emotion regulation stages. To address this issue, we examined how global self-report measures correspond with the three stages of emotion regulation as modeled using daily life data. We analyzed data from nine daily diary and experience sampling studies (total N = 1,097), in which participants provided daily and global self-reports of cognitive reappraisal, expressive suppression, and rumination. We found only weak-to-moderate correlations between global self-reports and average daily self-reports of each regulation strategy (indexing strategy selection). Global self-reports also correlated with individual differences in the degree to which (a) preceding affect experience predicted regulation strategies (representing the identification stage), and (b) regulation strategies predicted subsequent changes in affective experience (representing the implementation stage). Our findings suggest that global self-report measures of reappraisal, suppression, and rumination may not strongly and uniquely correlate with individual differences in daily selection of these strategies. Moreover, global self-report measures may also index individual differences in the perceived need to regulate, and the affective consequences of regulation in daily life. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Social Support Predicts Differential Use, but not Differential Effectiveness, of Expressive Suppression and Social Sharing in Daily Life.

While emotion regulation often happens in the presence of others, little is known about how social context shapes regulatory efforts and outcomes. One key element of the social context is social support. In two experience sampling studies (Ns = 179 and 123), we examined how the use and affective consequences of two fundamentally social emotion-regulation strategies-social sharing and expressive suppression-vary as a function of perceived social support. Across both studies, we found evidence that social support was associated with variation in people's use of these strategies, such that when people perceived their environments as being higher (vs. lower) in social support, they engaged in more sharing and less suppression. However, we found only limited and inconsistent support for context-dependent affective outcomes of suppression and sharing: suppression was associated with better affective consequences in the context of higher perceived social support in Study 1, but this effect did not replicate in Study 2. Taken together, these findings suggest that the use of social emotion-regulation strategies may depend on contextual variability in social support, whereas their effectiveness does not. Future research is needed to better understand the circumstances in which context-dependent use of emotion regulation may have emotional benefits, accounting for personal, situational, and cultural factors. Supplementary Information: The online version contains supplementary material available at 10.1007/s42761-022-00123-8.

Concordance in salivary cortisol and subjective anxiety to the trier social stress test in social anxiety disorder.

BACKGROUND: Social anxiety disorder (SAD) is characterised by an excessive fear of negative social evaluation. There is a limited understanding of how individuals with SAD react physiologically and subjectively to social stress. METHOD: The Trier Social Stress Test (TSST), an acute social stress task, was completed by 40 SAD individuals (50% female) and 41 healthy controls (matched on age, sex, and education) to examine salivary cortisol and self-reported stress reactivity. Salivary cortisol concentrations and self-reported affect (anxiety, sadness, tiredness, withdrawal, and happiness) were assessed at baseline and across nine-time points during the TSST. RESULTS: Bayesian salivary cortisol analyses revealed no group differences in salivary cortisol levels at baseline or during the TSST, with results comparative after the removal of 17 cortisol non-responders (21%). Contrastingly, the groups significantly differed on self-reported affect. At baseline, the SAD group (vs. controls) reported heightened negative affect and diminished happiness. In response to the TSST, the SAD group (vs. controls) displayed greater negative affect reactivity and diminished happiness reactivity, and significantly higher rates of change in their anxiety and sadness over time. After accounting for differences in the temporal resolution of self-reported versus cortisol responses, a moderate positive association was found between salivary cortisol and anxiety reactivity to social stress that was comparable between the groups. CONCLUSIONS: Despite elevated subjective anxiety, our findings suggest concordance in psychobiological stress reactivity in SAD and healthy controls. We discuss the possibility of heightened subjective sensitivity to social evaluative stress as a core treatment target for SAD.

Blinded by and Stuck in Negative Emotions: Is Psychological Inflexibility Across Different Domains Related?

Psychological inflexibility is theorized to underlie difficulties adjusting mental processes in response to changing circumstances. People show inflexibility across a range of domains, including attention, cognition, and affect. But it remains unclear whether common mechanisms underlie inflexibility in different domains. We investigated this possibility in a pre-registered replication and extension examining associations among attentional, cognitive, and affective inflexibility measures. Participants (N = 196) completed lab tasks assessing (a) emotion-induced blindness, the tendency for task-irrelevant emotional stimuli to impair attention allocation to non-emotional stimuli; (b) emotional inertia, the tendency for feelings to persist across time and contexts; and global self-report measures of (c) repetitive negative thinking, the tendency to repeatedly engage in negative self-focused thoughts (i.e., rumination, worry). Based on prior research linking repetitive negative thinking with negative affect inertia, on one hand, and emotion-induced blindness, on the other, we predicted positive correlations among all three measures of inflexibility. However, none of the three measures were related and Bayes factors indicated strong evidence for independence. Supplementary analyses ruled out alternative explanations for our findings, e.g., analytic decisions. Although our findings question the overlap between attentional, cognitive, and affective inflexibility measures, this study has methodological limitations. For instance, our measures varied across more than their inflexibility domain and our sample, relative to previous studies, included a high proportion of Asian participants who may show different patterns of ruminative thinking to non-Asian participants. Future research should address these limitations to confirm that common mechanisms do not underlie attentional, cognitive, and affective inflexibility. Supplementary Information: The online version contains supplementary material available at 10.1007/s42761-022-00145-2.

Some Recommendations on the Use of Daily Life Methods in Affective Science.

Real-world emotions are often more vivid, personally meaningful, and consequential than those evoked in the lab. Therefore, studying emotions in daily life is essential to test theories, discover new phenomena, and understand healthy emotional functioning; in short, to move affective science forward. The past decades have seen a surge of research using daily diary, experience sampling, or ecological momentary assessment methods to study emotional phenomena in daily life. In this paper, we will share some of the insights we have gained from our collective experience applying such daily life methods to study everyday affective processes. We highlight what we see as important considerations and caveats involved in using these methods and formulate recommendations to improve their use in future research. These insights focus on the importance of (i) theory and hypothesis-testing; (ii) measurement; (iii) timescale; and (iv) context, when studying emotions in their natural habitat.

On-surface synthesis of Mn-phthalocyanines with optically active ligands.

The synthesis of novel organic prototypes combining different functionalities is key to achieve operational elements for applications in organic electronics. Here we set the stage towards individually addressable magneto-optical transducers by the on-surface synthesis of optically active manganese-phthalocyanine derivatives (MnPc) obtained directly on a metallic substrate. We created these 2D nanostructures under ultra-high vacuum conditions with atomic precision starting from a simple phthalonitrile precursor with reversible photo-induced reactivity in solution. These precursors maintain their integrity after powder sublimation and coordinate with the Mn ions into tetrameric complexes and then transform into MnPcs on Ag(111) after a cyclotetramerization reaction. Using scanning tunnelling microscopy and spectroscopy together with DFT calculations, we identify the isomeric configuration of two bi-stable structures and show that it is possible to switch them reversibly by mechanical manipulation. Moreover, the robust magnetic moment brought by the central Mn ion provides a feasible pathway towards magneto-optical transducer fabrication. This work should trigger further research confirming such magneto-optical effects in MnPcs both on surfaces and in liquid environments.

A multiple needs framework for climate change anxiety interventions.

Climate change anxiety is a growing problem for individual well-being the world over. However, psychological interventions to address climate change anxiety may have unintended effects on outcomes other than individual well-being, such as group cohesion and pro-environmental behavior. In order to address these complexities, we outline a multiple needs framework of climate change anxiety interventions, which can be used to analyze interventions in terms of their effects on individual, social, and environmental outcomes. We use this framework to contextualize a systematic review of the literature detailing the effects of climate change anxiety interventions. This analysis identifies interventions centered around problem-focused action, emotion management, and enhancing social connections as those which have beneficial effects on the widest range of outcomes. It also identifies interventions that may have detrimental effects on one or more outcomes. We identify gaps where more research is required, including research that assesses the effects of climate change anxiety interventions on individual, social, and environmental outcomes in concert. An interactive website summarizes these insights and presents the results of the systematic review in a way that is, accessible to a range of stakeholders. The multiple needs framework provides a way to conceptualize the effectiveness of climate change anxiety interventions beyond their impact on individual well-being, contributing to a more holistic understanding of the effects of this global phenomenon. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Inelastic scattering of electrons in water from first principles: cross sections and inelastic mean free path for use in Monte Carlo track-structure simulations of biological damage.

Modelling the inelastic scattering of electrons in water is fundamental, given their crucial role in biological damage. In Monte Carlo track-structure (MC-TS) codes used to assess biological damage, the energy loss function (ELF), from which cross sections are extracted, is derived from different semi-empirical optical models. Only recently have first ab initio results for the ELF and cross sections in water become available. For benchmarking purpose, in this work, we present ab initio linear-response time-dependent density functional theory calculations of the ELF of liquid water. We calculated the inelastic scattering cross sections, inelastic mean free paths, and electronic stopping power and compared our results with recent calculations and experimental data showing a good agreement. In addition, we provide an in-depth analysis of the contributions of different molecular orbitals, species and orbital angular momenta to the total ELF. Moreover, we present single-differential cross sections computed for each molecular orbital channel, which should prove useful for MC-TS simulations.

Negative emotion and nonacceptance of emotion in daily life.

Nonacceptance of emotion is consistently linked with increased levels of psychopathology and diminished well-being. Research has found that negative emotion and nonacceptance of emotion are positively associated cross-sectionally but has yet to directly investigate temporal associations between these constructs. Given that negative emotions are frequently the target of negative thoughts and other emotions, and that acceptance of emotion is associated with prospective decreases in negative emotion, we hypothesized that the temporal relation between negative emotion and nonacceptance of emotion is bidirectional. The present study examined the association between these variables during people's daily lives using an experience sampling methodology. Multilevel modeling was used for all analyses, including hierarchical generalized linear modeling and log-normal hurdle modeling. A total of 187 women from the United States and Australia reported negative emotion and nonacceptance of emotion 14 times a day for 5 days. Negative emotion and nonacceptance of emotion were positively associated contemporaneously. Across time, nonacceptance of emotion was prospectively and positively associated with the intensity of negative emotion independent of immediately prior negative emotion, and negative emotion intensity was prospectively and positively associated with nonacceptance of emotion independent of immediately prior nonacceptance. Results support a bidirectional model of negative emotion and nonacceptance of emotion wherein each variable predicts increases in the other across time. Our findings elucidate how individuals fall into maladaptive emotional patterns that are difficult to break and could possibly pave the way to the development and maintenance of psychopathology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Evaluation of a Fourth-Year Student Pharmacist Research Process at a Community Teaching Health System.

Objective. To evaluate a process developed to support research by fourth-year student pharmacists enrolled in an advanced pharmacy practice experience at a health system affiliated with a school of pharmacy.Methods. In 2017, clinical, non-tenure track faculty transitioned from facilitating a fourth-year research elective to implementing a new student research process that matches students to research preceptors at the beginning of the academic year and provides training and resources to them throughout the year. This pre-post study evaluated student pharmacist research participation, dissemination, and placement into a residency or job position at the time of graduation, and then compared data for the three years before the new process was implemented to data for the three years after implementation.Results. Thirty-three fourth-year students assigned to the health system graduated from 2015 to 2017, and 31 graduated from 2018 to 2020. The percentage of students in each cohort who completed research projects increased significantly (48.5% vs 87.1%), the number of projects increased significantly (18 vs 35), the number of presentations increased significantly (29 vs 63), and the number of publications increased significantly (9 vs 20). The percentage of research students who pursued postgraduate training increased (68.8% vs 96.3%), as did their rate of placement into training programs (81.8% vs 92.3%). Of those students who did not participate in research, the percent who pursued training also increased (17.6% vs 75%), but the rate of placement remained the same (66.7%).Conclusion. Matching fourth-year student pharmacists to research preceptors at the beginning of the academic year and providing them with training and resources throughout the year was associated with increased research productivity.

Does prediction error during exposure relate to clinical outcomes in cognitive behavior therapy for social anxiety disorder? A study protocol.

Facing your fears, or exposure therapy, is an effective psychological intervention for anxiety disorders that is often thought to work through fear extinction learning. Fear extinction learning is a type of associative learning where fear reduces through repeated encounters with a feared situation or stimulus in the absence of aversive outcomes. Laboratory research suggests fear extinction learning is driven by threat prediction errors, defined as when fearful predictions do not eventuate. Threat prediction error and its relationship to exposure therapy outcomes haven't been studied enough in actual therapy settings. It remains unclear whether prediction error and extinction learning are central mechanisms of exposure therapy. We are conducting a longitudinal and observational study of how threat prediction error during exposure in social anxiety disorder (SAD) treatment relates to session-by-session symptom change and treatment outcome in addition to exposure surprise and learning outcome. We aim to recruit 65 adults with a primary diagnosis of SAD through an outpatient psychology clinic. Participants will receive 12 sessions of individual manualized cognitive behavioral therapy (CBT), adapted from an efficacious group protocol, that includes graded exposure. Exposure processes, including self-report measures of anxiety, threat prediction, threat outcomes, surprise, and learning outcome, will be measured with smartphone-based event-contingent ecological momentary assessments (EMAs) of all behavioral experiments completed during treatment. Clinical outcomes include self-reported social anxiety symptoms and social threat appraisals, at each session, post and 3-months after treatment. Prediction error will be operationalized as the mismatch between the threat prediction and threat outcome. The joint effect of threat prediction and threat outcome on session-by-session symptom change, treatment outcome, exposure surprise, and learning outcome will be explored using multilevel modeling. The present study will help determine whether threat prediction error during exposures in SAD treatment is related to theoretically implied clinical outcomes. This would contribute to the larger research aim of clarifying exposure therapy mechanisms.

The Horyzons project: a randomized controlled trial of a novel online social therapy to maintain treatment effects from specialist first-episode psychosis services.

This study aimed to determine whether, following two years of specialized support for first-episode psychosis, the addition of a new digital intervention (Horyzons) to treatment as usual (TAU) for 18 months was more effective than 18 months of TAU alone. We conducted a single-blind randomized controlled trial. Participants were people with first-episode psychosis (N=170), aged 16-27 years, in clinical remission and nearing discharge from a specialized service. They were randomly assigned (1:1) to receive Horyzons plus TAU (N=86) or TAU alone (N=84) between October 2013 and January 2017. Horyzons is a novel, comprehensive digital platform merging: peer-to-peer social networking; theory-driven and evidence-informed therapeutic interventions targeting social functioning, vocational recovery and relapse prevention; expert clinician and vocational support; and peer support and moderation. TAU involved transfer to primary or tertiary community mental health services. The primary outcome was social functioning at 18 months as measured by the Personal and Social Performance Scale (PSP). Forty-seven participants (55.5%) in the Horyzons plus TAU group logged on for at least 6 months, and 40 (47.0%) for at least 9 months. Social functioning remained high and stable in both groups from baseline to 18-month follow-up, with no evidence of significant between-group differences (PSP mean difference: -0.29, 95% CI: -4.20 to 3.63, p=0.77). Participants in the Horyzons group had a 5.5 times greater increase in their odds to find employment or enroll in education compared with those in TAU (odds ratio, OR=5.55, 95% CI: 1.09-28.23, p=0.04), with evidence of a dose-response effect. Moreover, participants in TAU were twice as likely to visit emergency services compared to those in the Horyzons group (39% vs. 19%; OR=0.31, 95% CI: 0.11-0.86, p=0.03, number needed to treat, NNT=5). There was a non-significant trend for lower hospitalizations due to psychosis in the Horyzons group vs. TAU (13% vs. 27%; OR=0.36, 95% CI: 0.11-1.08, p=0.07, NNT=7). So, although we did not find a significant effect of Horyzons on social functioning compared with TAU, the intervention was effective in improving vocational or educational attainment, a core component of social recovery, and in reducing usage of hospital emergency services, a key aim of specialized first-episode psychosis services. Horyzons holds significant promise as an engaging and sustainable intervention to provide effective vocational and relapse prevention support for young people with first-episode psychosis beyond specialist services.