Coping as a resource to allow for psychosocial adjustment in fatal disease: results from patients with amyotrophic lateral sclerosis.

Background: Amyotrophic lateral sclerosis (ALS) is a fatal disorder, which imposes a severe emotional burden on patients. Appropriate coping mechanisms may alleviate this burden and facilitate wellbeing, with social support known to be a successful coping strategy. This observational study aimed to determine the interplay of general coping traits of hope for success and fear of failure, coping behavior of social activity, and patients' wellbeing. Methods: In this cross-sectional study, patients with ALS from a clinical-epidemiological registry in Southwestern Germany were interviewed regarding coping traits (achievement-motivated behavior: hope for success and fear of failure), coping behavior of social activity, and psychosocial adjustment, determined using measures of depressiveness, anxiety [both measured by Hospital Anxiety and Depression Scale (HADS)], and quality of life [Anamnestic Comparative Self-Assessment (ACSA)]. Demographics, clinical [ALS Functional Rating Scale revised version (ALSFRS-R)], and survival data were recorded. Results: A total of 868 patients [60.70% male patients, mean age: 64.70 (±10.83) years, mean ALSFRS-R: 37.36 ± 7.07] were interviewed. Anxiety in patients was found to be associated with a high fear of failure. In contrast, a generally positive attitude in patients exemplified in high hopes for success was associated with better wellbeing. Finally, coping behavior of social activity explained up to 65% of the variance of depressiveness among the patients with ALS. Conclusion: In this study, we present evidence that the wellbeing of patients with ALS is not an immediate fatalistic consequence of physical degradation but rather determined by coping traits and behavior, which may be trained to substantially increase the wellbeing of patients with ALS.

HBMIRT: A SAS macro for estimating uni- and multidimensional 1- and 2-parameter item response models in small (and large!) samples.

Item response theory (IRT) has evolved as a standard psychometric approach in recent years, in particular for test construction based on dichotomous (i.e., true/false) items. Unfortunately, large samples are typically needed for item refinement in unidimensional models and even more so in the multidimensional case. However, Bayesian IRT approaches with hierarchical priors have recently been shown to be promising for estimating even complex models in small samples. Still, it may be challenging for applied researchers to set up such IRT models in general purpose or specialized statistical computer programs. Therefore, we developed a user-friendly tool - a SAS macro called HBMIRT - that allows to estimate uni- and multidimensional IRT models with dichotomous items. We explain the capabilities and features of the macro and demonstrate the particular advantages of the implemented hierarchical priors in rather small samples over weakly informative priors and traditional maximum likelihood estimation with the help of a simulation study. The macro can also be used with the online version of SAS OnDemand for Academics that is freely accessible for academic researchers.

Training-related improvements in mental well-being through reduction in negative interpretation bias: A randomized trial of online socio-emotional dyadic and mindfulness interventions.

BACKGROUND: Effects of online contemplative practices, especially partner-based practices, on psychological well-being remain mixed, with sparse understanding of potential affective-cognitive mechanisms. The study aimed to assess the efficacy of two online contemplative interventions in improving depression, anxiety, emotion regulation (ER), and resilience, and to evaluate the mechanistic role of negative attention and interpretation biases. METHODS: Employing a randomized controlled design (n = 285), we compared the efficacy of 10-week online mindfulness-based and partner-based socio-emotional dyadic interventions, both supported by weekly coaching sessions. Mental health aspects were assessed using validated self-report measures and negative biases using the mouse-contingent Scrambled Sentences Task. RESULTS: Both interventions, compared to waitlist control, led to reductions in depression and ER difficulties, while trait anxiety decreased only after mindfulness training. Increases in multidimensional resilience were observed only after socio-emotional training and in stress recovery only after mindfulness-based training, both compared to waitlist control. Socio-emotional training led to significant reductions in negative interpretation bias and this mediated reductions in depression and trait anxiety. Neither training led to reductions in state anxiety or negative attention bias. LIMITATIONS: The subclinical nature and overrepresentation of females in the sample limits generalizability. CONCLUSIONS: Findings indicate that online mindfulness-based and socio-emotional partner-based interventions, supported by online coaching sessions, can reduce depression and ER difficulties. Though mindfulness practice reduced trait anxiety and enhanced stress recovery, socio-emotional training increased multidimensional resilience. Socio-emotional training reduced negative interpretation bias, which emerged as an intervention-specific mechanism. These findings highlight the potential benefits of online contemplative intervention approaches for psychological well-being.

Cystatin C based estimation of chronic kidney disease and amyotrophic lateral sclerosis in the ALS registry Swabia: associated risk and prognostic value.

Kidney function as part of metabolic changes could be associated with amyotrophic lateral-sclerosis (ALS). We investigated the associations between estimated chronic kidney disease (CKD), based on the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) cystatin C equation, and the risk at onset and prognostic value of CKD for ALS. Between October 2010 and June 2014, 362 ALS cases (59.4% men, mean age 65.7 years) and 681 controls (59.5% men, means age 66.3 years) were included in a population-based case-control study based on the ALS registry Swabia in Southern Germany. All ALS cases were followed-up (median 89.7 months), 317 died. Serum samples were measured for cystatin C to estimate the glomerular filtration rate (eGFR) according to the CKD-EPI equation. Information on covariates were assessed by an interview-based standardized questionnaire. Conditional logistic regression models were applied to calculate odds ratios (OR) for risk of ALS associated with eGFR/CKD stages. Time-to-death associated with renal parameters at baseline was assessed in ALS cases only. ALS cases were characterized by lower body mass index, slightly lower smoking prevalence, more intense occupational work and lower education than controls. Median serum cystatin-C based eGFR concentrations were lower in ALS cases than in controls (54.0 vs. 59.5 mL/min pro 1.73 m2). The prevalence of CKD stage ≥ 3 was slightly higher in ALS cases than in controls (14.1 vs. 11.0%). In the adjusted models, CKD stage 2 (OR 1.82, 95% CI 1.32, 2.52) and stage 3 (OR 2.34, 95% CI 1.38, 3.96) were associated with increased ALS risk. In this cohort of ALS cases, eGFR and CKD stage ≥ 3 (HR 0.94; 95% CI 0.64, 1.38) were not associated with prognosis. In this case-control study, higher CKD stages were associated with increased ALS risk, while in the prospective cohort of ALS cases, no indication of an association of CysC-based CKD on mortality was seen. In addition, our work strengthens the importance to evaluate renal function using a marker independent of muscle mass in ALS patients.

Guideline "Motor neuron diseases" of the German Society of Neurology (Deutsche Gesellschaft für Neurologie).

INTRODUCTION: In 2021, the Deutsche Gesellschaft für Neurology published a new guideline on diagnosis and therapy of motor neuron disorders. Motor neuron disorders affect upper motor neurons in the primary motor cortex and/or lower motor neurons in the brain stem and spinal cord. The most frequent motor neuron disease amyotrophic lateral sclerosis (ALS) is a rapidly progressive disease with an average life expectancy of 2-4 years with a yearly incidence of 3.1/100,000 in Central Europe (Rosenbohm et al. in J Neurol 264(4):749-757, 2017. https://doi.org/10.1007/s00415-017-8413-3 ). It is considered a rare disease mainly due to its low prevalence as a consequence of short disease duration. RECOMMENDATIONS: These guidelines comprise recommendations regarding differential diagnosis, neuroprotective therapies and multidisciplinary palliative care including management of respiration and nutrition as well as provision of assistive devices and end-of-life situations. CONCLUSION: Diagnostic and therapeutic guidelines are necessary due the comparatively high number of cases and the aggressive disease course. Given the low prevalence and the severe impairment of patients, it is often impossible to generate evidence-based data so that ALS guidelines are partially dependent on expert opinion.

Heterogeneous Mental Health Responses to the COVID-19 Pandemic in Germany: An Examination of Long-Term Trajectories, Risk Factors, and Vulnerable Groups.

Abundant studies have examined mental health in the early periods of the COVID-19 pandemic. However, empirical work examining the mental health impact of the pandemic's subsequent phases remains limited. In the present study, we investigated how mental vulnerability and resilience evolved over the various phases of the pandemic in 2020 and 2021 in Germany. Data were collected (n = 3522) across seven measurement occasions using validated and self-generated measures of vulnerability and resilience. We found evidence for an immediate increase in vulnerability during the first lockdown in Germany, a trend towards recovery when lockdown measures were eased, and an increase in vulnerability with each passing month of the second lockdown. Four different latent trajectories of resilience-vulnerability emerged, with the majority of participants displaying a rather resilient trajectory, but nearly 30% of the sample fell into the more vulnerable groups. Females, younger individuals, those with a history of psychiatric disorders, lower income groups, and those with high trait vulnerability and low trait social belonging were more likely to exhibit trajectories associated with poorer mental well-being. Our findings indicate that resilience-vulnerability responses in Germany during the COVID-19 pandemic may have been more complex than previously thought, identifying risk groups that could benefit from greater support.

Day-to-day coordination of the stress and reproductive axes: A continuous-time analysis of within-person testosterone and cortisol relationships in athletic and healthy men.

Day-to-day coordination of the stress (i.e., hypothalamic-pituitary-adrenal [HPA]) and reproductive (i.e., hypothalamic-pituitary-gonadal [HPG]) axes is central to allostatic regulation, reproductive success, and survival. Reports of positive, within-person testosterone and cortisol relationships (or coupling) suggest cross-talk of a facilitative nature, but longitudinal evidence is scarce and has methodological and analytical limitations. To address this, we used a continuous-time (CT) model to investigate day-to-day, within-person coupling of testosterone and cortisol in two male cohorts. Salivary testosterone and cortisol fluctuations were monitored in 35 athletic men across two international tournaments (M = 19.3 tests) and in 41 healthy men during normal daily living (M = 27.9 tests). Bayesian CT analysis revealed a diminishing effect of each hormone on itself as time-interval length or lag increased. In both groups, cortisol had a negative lagged effect on testosterone that persisted for around three days. The cortisol effect on testosterone peaked after 0.71 and 0.51 days in athletic (standardized estimate = -0.13) and healthy men (standardized estimate = -0.11), respectively. Further estimates of non-lagged, contemporaneous correlations revealed positive testosterone and cortisol relationships (athlete r = 0.04, healthy r = 0.46). In summary, complex within-person HPA and HPG interplay emerged in two independent male cohorts. Specifically, a rising cortisol concentration was linked to a fall in testosterone concentration at later time points, but concurrently these hormones tended to rise and fall together. Our results suggest that inhibitory and facilitatory hormonal actions coexist on varying timescales, thereby expanding knowledge of HPG and HPA cross-talk in everyday life.

Systematic Potency and Property Assessment of VHL Ligands and Implications on PROTAC Design.

Herein, we describe a systematic SAR- and SPR-investigation of the peptidomimetic hydroxy-proline based VHL-ligand VH032, from which most to-date published VHL-targeting PROTACs have been derived. This study provides for the first time a consistent data set which allows for direct comparison of structural variations including those which were so far hidden in patent literature. The gained knowledge about improved VHL binders was used to design a small library of highly potent BRD4-degraders comprising different VHL exit vectors. Newly designed degraders showed favorable molecular properties and significantly improved degradation potency compared to MZ1.

Modeling dynamic personality theories in a continuous-time framework: An illustration.

OBJECTIVE: Personality psychology has traditionally focused on stable between-person differences. Yet, recent theoretical developments and empirical insights have led to a new conceptualization of personality as a dynamic system (e.g., Cybernetic Big Five Theory). Such dynamic systems comprise several components that need to be conceptually distinguished and mapped to a statistical model for estimation. METHOD: In the current work, we illustrate how common components from these new dynamic personality theories may be implemented in a continuous time-modeling framework. RESULTS: As an empirical example, we reanalyze experience sampling data with N = 180 persons (with on average T = 40 [SD = 8] measurement occasions) to investigate four different effects between momentary happiness, momentary extraverted behavior, and the perception of a situation as social: (1) between-person effects, (2) contemporaneous effects, (3) autoregressive effects, and (4) cross-lagged effects. CONCLUSION: We highlight that these four effects must not necessarily point in the same direction, which is in line with assumptions from dynamic personality theories.

Stroke care during the COVID-19 pandemic: Case numbers, treatments, and mortality in two large German stroke registries.

Background and purpose: At the beginning of the SARS-CoV-2 pandemic, an alarming decline in hospitalizations for stroke was reported in several countries, including Germany. We assessed hospitalization numbers and indicators of the quality of stroke care in 2020 during the pandemic containment measures. Materials and methods: The analysis was based on data of two large stroke quality assurance registries in the north and the south of Germany (Qualitätssicherung Schlaganfall Nordwestdeutschland and Bayerische Arbeitsgemeinschaft für Qualitätssicherung in der stationären Versorgung). We included 395 hospitals with 467,931 documented cases in 2018-2020. The time interval between admission and thrombolysis, frequency of systemic thrombolysis and intra-arterial therapy (IAT), National Institutes of Health Stroke Scale (NIHSS) score on admission and in-hospital mortality were assessed. Changes in the second (Q2) and fourth (Q4) quarters of 2020 were compared to corresponding quarters in 2019 by chi-squared tests. Results: Hospitalization numbers decreased in the two stroke registries by 8% and 10% in Q2 of 2020 and by 5% and 15% in Q4 of 2020 compared to the same quarters in 2019, respectively. The decline was particularly seen in women and patients with transient ischemic attacks. In cases with cerebral infarction, no increase in NIHSS scores on admission was observed, and the proportion of patients with a time interval between admission and thrombolysis of ≤60 min was unchanged. No clear pattern was found in the frequency of systemic thrombolysis and IAT. In one of the registries, in-hospital mortality of patients with cerebral infarction increased in Q2 of 2020 compared to Q2 of 2019. Conclusion: Case numbers slightly decreased under pandemic conditions, while our quarterly analysis indicated that the quality of stroke care was largely unchanged throughout the year 2020.

Exploring the Structure and Interrelations of Time-Stable Psychological Resilience, Psychological Vulnerability, and Social Cohesion.

The current study explores the relationship between three constructs of high relevance in the context of adversities which have, however, not yet been systematically linked on the level of psychological dispositions: psychological vulnerability, psychological resilience, and social cohesion. Based on previous theoretical and empirical frameworks, a collection of trait questionnaires was assessed in a Berlin sample of 3,522 subjects between 18 and 65 years of age. Using a confirmatory factor analytical approach, we found no support for a simple three-factor structure. Results from exploratory structural analyses suggest that instead of psychological resilience and psychological vulnerability constituting two separate factors, respective indicators load on one bipolar latent factor. Interestingly, some psychological resilience indicators contributed to an additional specific latent factor, which may be interpreted as adaptive capacities, that is, abilities to adapt to changes or adjust to consequences of adversities. Furthermore, instead of evidence for one single social cohesion factor on the psychological level, indicators of perceived social support and loneliness formed another specific factor of social belonging, while indicators of prosocial competencies were found to form yet another distinct factor, which was positively associated to the other social factors, adaptive capacities and social belonging. Our results suggest that social cohesion is composed of different independent psychological components, such as trust, social belonging, and social skills. Furthermore, our findings highlight the importance of social capacities and belonging for psychological resilience and suggest that decreasing loneliness and increasing social skills should therefore represent a valuable intervention strategy to foster adaptive capacities.

Coping with the COVID-19 Pandemic: Perceived Changes in Psychological Vulnerability, Resilience and Social Cohesion before, during and after Lockdown.

The COVID-19 pandemic and associated lockdowns have posed unique and severe challenges to our global society. To gain an integrative understanding of pervasive social and mental health impacts in 3522 Berlin residents aged 18 to 65, we systematically investigated the structural and temporal relationship between a variety of psychological indicators of vulnerability, resilience and social cohesion before, during and after the first lockdown in Germany using a retrospective longitudinal study design. Factor analyses revealed that (a) vulnerability and resilience indicators converged on one general bipolar factor, (b) residual variance of resilience indicators formed a distinct factor of adaptive coping capacities and (c) social cohesion could be reliably measured with a hierarchical model including four first-order dimensions of trust, a sense of belonging, social interactions and social engagement, and one second-order social cohesion factor. In the second step, latent change score models revealed that overall psychological vulnerability increased during the first lockdown and decreased again during re-opening, although not to baseline levels. Levels of social cohesion, in contrast, first decreased and then increased again during re-opening. Furthermore, participants who increased in vulnerability simultaneously decreased in social cohesion and adaptive coping during lockdown. While higher pre-lockdown levels of social cohesion predicted a stronger lockdown effect on mental health, individuals with higher social cohesion during the lockdown and positive change in coping abilities and social cohesion during re-opening showed better mental health recovery, highlighting the important role of social capacities in both amplifying but also overcoming the multiple challenges of this collective crisis.

Comparing group means with the total mean in random samples, surveys, and large-scale assessments: A tutorial and software illustration.

In many disciplines of the social sciences, comparisons between a group mean and the total mean is a common but also challenging task. As one solution to this statistical testing problem, we propose using linear regression with weighted effect coding. For random samples, this procedure is straightforward and easy to implement by means of standard statistical software. However, for complex or clustered samples with imputed or weighted data, which are common in survey analyses, there is a lack of easy-to-use software solutions. In this paper, we discuss scenarios that are commonly encountered in the social sciences such as heterogeneous variances, weighted samples, and clustered samples, and we describe how group means can be compared to the total mean in these situations. We introduce the R package eatRep, which is a front end that makes the presented methods easily accessible for researchers. Two empirical examples, one using survey data (MIDUS 1) and the other using large-scale assessment data (PISA 2015), are given for illustration. Annotated R code to run group to total mean comparisons is provided.

Investigating differential effects of socio-emotional and mindfulness-based online interventions on mental health, resilience and social capacities during the COVID-19 pandemic: The study protocol.

BACKGROUND: The SARS-CoV-2 pandemic has led to a mental health crisis on a global scale. Epidemiological studies have reported a drastic increase in mental health problems, such as depression and anxiety, increased loneliness and feelings of disconnectedness from others, while resilience levels have been negatively affected, indicating an urgent need for intervention. The current study is embedded within the larger CovSocial project which sought to evaluate longitudinal changes in vulnerability, resilience and social cohesion during the pandemic. The current second phase will investigate the efficacy of brief online mental training interventions in reducing mental health problems, and enhancing psychological resilience and social capacities. It further provides a unique opportunity for the prediction of intervention effects by individual biopsychosocial characteristics and preceding longitudinal change patterns during the pandemic in 2020/21. METHODS: We will examine the differential effects of a socio-emotional (including 'Affect Dyad') and a mindfulness-based (including 'Breathing Meditation') intervention, delivered through a web- and cellphone application. Participants will undergo 10 weeks of intervention, and will be compared to a retest control group. The effectiveness of the interventions will be evaluated in a community sample (N = 300), which is recruited from the original longitudinal CovSocial sample. The pre- to post-intervention changes, potential underlying mechanisms, and prediction thereof, will be assessed on a wide range of outcomes: levels of stress, loneliness, depression and anxiety, resilience, prosocial behavior, empathy, compassion, and the impact on neuroendocrine, immunological and epigenetic markers. The multi-method nature of the study will incorporate self-report questionnaires, behavioral tasks, ecological momentary assessment (EMA) approaches, and biological, hormonal and epigenetic markers assessed in saliva. DISCUSSION: Results will reveal the differential effectiveness of two brief online interventions in improving mental health outcomes, as well as enhancing social capacities and resilience. The present study will serve as a first step for future application of scalable, low-cost interventions at a broader level to reduce stress and loneliness, improve mental health and build resilience and social capacities in the face of global stressors. TRIAL REGISTRATION: This trial has been registered on May 17, 2020 with the ClinicalTrials.gov NCT04889508 registration number (clinicaltrials.gov/ct2/show/NCT04889508).

A longitudinal investigation of bidirectional and time-dependent interrelationships between testosterone and training motivation in an elite rugby environment.

In sport, testosterone has been positioned as a substrate for motivation with both directional and time dependencies. However, evidence is scarce when considering the complexities of competitive sport and no work has explicitly modeled these dependencies. To address these gaps, we investigated the bidirectional and time-dependent interrelationships between testosterone and training motivation in an elite rugby environment. Thirty-six male athletes were monitored across training weeks before and after eight international rugby matches. Pre-breakfast measures of salivary testosterone and training motivation (1-10 rating) were taken on training, competition, and recovery days (up to 40 tests). Using a continuous-time (CT) model, within-person estimates of autoregressive effects (persistence) and cross-lagged effects (relationships) were derived. A stronger, more persistent temporal association was identified for testosterone than for motivation. Cross-lagged effects verified that training motivation was positively related to testosterone at latter time points (p < 0.001). Discrete-time analyses revealed a non-linear association; increasing in strength from a zero-time lag to peak after 2.83 days (standardized effect = 0.25), before dissipation over longer lagged intervals. The testosterone relationship with ensuing training motivation was also positive, but non-significant. Match effects also appeared (p < 0.001) with a predicted decline in training motivation, but a rise in testosterone, at match onset. In summary, a positive association emerged between within-person fluctuations in self-appraised motivation to train and testosterone concentration in an elite rugby environment. The lagged, non-linear nature of this relationship and match predictions on both outcomes support, and extend, theoretical models linking testosterone and competitive behaviors.

How sure can we be that a student really failed? On the measurement precision of individual pass-fail decisions from the perspective of Item Response Theory.

BACKGROUND: In high-stakes assessments in medical education, the decision to let a particular participant pass or fail has far-reaching consequences. Reliability coefficients are usually used to support the trustworthiness of assessments and their accompanying decisions. However, coefficients such as Cronbach's Alpha do not indicate the precision with which an individual's performance was measured. OBJECTIVE: Since estimates of precision need to be aligned with the level on which inferences are made, we illustrate how to adequately report the precision of pass-fail decisions for single individuals. METHOD: We show how to calculate the precision of individual pass-fail decisions using Item Response Theory and illustrate that approach using a real exam. In total, 70 students sat this exam (110 items). Reliability coefficients were above recommendations for high stakes test (> 0.80). At the same time, pass-fail decisions around the cut score were expected to show low accuracy. CONCLUSIONS: Our results illustrate that the most important decisions-i.e. those based on scores near the pass-fail cut-score-are often ambiguous, and that reporting a traditional reliability coefficient is not an adequate description of the uncertainty encountered on an individual level.

Prior Specification for More Stable Bayesian Estimation of Multilevel Latent Variable Models in Small Samples: A Comparative Investigation of Two Different Approaches.

Bayesian approaches for estimating multilevel latent variable models can be beneficial in small samples. Prior distributions can be used to overcome small sample problems, for example, when priors that increase the accuracy of estimation are chosen. This article discusses two different but not mutually exclusive approaches for specifying priors. Both approaches aim at stabilizing estimators in such a way that the Mean Squared Error (MSE) of the estimator of the between-group slope will be small. In the first approach, the MSE is decreased by specifying a slightly informative prior for the group-level variance of the predictor variable, whereas in the second approach, the decrease is achieved directly by using a slightly informative prior for the slope. Mathematical and graphical inspections suggest that both approaches can be effective for reducing the MSE in small samples, thus rendering them attractive in these situations. The article also discusses how these approaches can be implemented in Mplus.

Institutional strategies related to test-taking behavior in low stakes assessment.

Low stakes assessment without grading the performance of students in educational systems has received increasing attention in recent years. It is used in formative assessments to guide the learning process as well as in large-scales assessments to monitor educational programs. Yet, such assessments suffer from high variation in students' test-taking effort. We aimed to identify institutional strategies related to serious test-taking behavior in low stakes assessment to provide medical schools with practical recommendations on how test-taking effort might be increased. First, we identified strategies that were already used by medical schools to increase the serious test-taking behavior on the low stakes Berlin Progress Test (BPT). Strategies which could be assigned to self-determination theory of Ryan and Deci were chosen for analysis. We conducted the study at nine medical schools in Germany and Austria with a total of 108,140 observations in an established low stakes assessment. A generalized linear-mixed effects model was used to assess the association between institutional strategies and the odds that students will take the BPT seriously. Overall, two institutional strategies were found to be positively related to more serious test-taking behavior: discussing low test performance with the mentor and consequences for not participating. Giving choice was negatively related to more serious test-taking behavior. At medical schools that presented the BPT as evaluation, this effect was larger in comparison to medical schools that presented the BPT as assessment.

Bayesian continuous-time Rasch models.

Continuous-time modeling offers a flexible approach to analyze longitudinal data from designs with unequally spaced measurement occasions. Measurement models are popular tools in psychological research to control for measurement error. The objective of the present article is to introduce the continuous-time Rasch model, a combination of the Rasch model and a continuous-time dynamic model. In a series of simulations we demonstrate the performance of the proposed model and that ignoring individual unequal time interval lengths, choosing a wrong measurement model, and selecting a wrong analysis strategy results in poor parameter estimates. The newly proposed continuous-time Rasch model overcomes these problems and offers a powerful new approach to longitudinal analysis with dichotomous items. A step-by-step tutorial on how to run a continuous-time Rasch model with the R package ctsem and an illustrative empirical example is given. (PsycINFO Database Record (c) 2019 APA, all rights reserved).