The Future of Immersive Mood Induction in Affective Science: Using Virtual Reality to Test Effects of Mood Context on Task Performance.

A fundamental premise of affective and clinical science is that fluctuations in mood drive meaningful changes in cognition and behavior. These theories are often tested via laboratory mood induction procedures followed by performing an established task. Despite advances in understanding the temporal dynamics of emotions, it is still unclear whether it is the enduring mood that impacts subsequent task performance. Additionally, this design requires task switching, which may limit the impact of mood and affect task performance. We suggest that virtual reality (VR) offers a more powerful, immersive alternative to traditional mood induction methods and effectively addresses these limitations because it can be used to create mood contexts that occur simultaneously with task performance. VR creates an immersive, real-world experience while benefiting from a well-controlled laboratory setting (Diniz Bernardo et al., 2021). We first summarize the literature on mood induction methodologies, including evidence that VR creates a more immersive environment, leading to mood inductions that are greater in magnitude than other methods. We then report a novel empirical study on the feasibility of utilizing VR to create a mood context that occurs simultaneously with a gold-standard emotion regulation task. Our results indicate that VR was a powerful and enduring positive mood induction tool, resulting in immediate changes in mood and greater trial-by-trial positivity ratings during the concurrent task. Portions of this study were pre-registered on August 3, 2020, on the Clinical Trials website (project citation: https://clinicaltrials.gov/ct2/show/NCT04496258). Supplementary Information: The online version contains supplementary material available at 10.1007/s42761-023-00213-1.

Using the Delphi Method for Determining Key Performance Elements for Delivery of Optimal Suicide-Specific Interventions in Emergency Departments.

OBJECTIVE: Evidence-based suicide prevention interventions directed to those seeking psychiatric crisis services for suicidality in the emergency department (ED) can reduce death by suicide and related suffering. Best practice guidelines for the care of suicidal patients in the ED exist but are not accompanied by fidelity tools for use in determining whether the interventions were applied, particularly when more than one intervention is delivered concurrently. We sought to develop a universal, treatment-agnostic Suicide Care Fidelity Checklist comprised of Key Performance Elements (KPE) across the recommended suicide-specific ED interventions. METHOD: A comprehensive review of published care standards was first conducted to determine suicide-specific ED best practice treatment domains and KPEs. Subject matter experts (SMEs) were identified for each domain. Using the Delphi Consensus method, SMEs iteratively revised and refined the KPEs within their domain until achieving KPE item consensus. RESULTS: A total of three iterations was required to obtain consensus in five of six domains: comprehensive suicide assessment, lethal means counseling, suicide crisis planning, behavioral skills training, and psychoeducation about suicidality. Consensus was not fully attained for the domain involving engagement with people with lived experience. CONCLUSIONS: We successfully identified six intervention domains and 74 KPEs across domains (60 deemed essential, and 14 deemed optional), with full consensus reached for 70 KPEs. While replication of the initial findings is required, the Suicide Care Fidelity Checklist can be used as a fidelity checklist to verify delivery of suicide-specific ED interventions.HIGHLIGHTSApplied Delphi Consensus method with suicide-specific subject matter experts.Generated a treatment-agnostic, universal set of suicide prevention KPEs for EDs.Expert-derived KPEs help real-world settings to assess suicide care fidelity.

A Smartphone App for Parental Management of Adolescent Conduct Problems: Randomized Clinical Trial of iKinnect.

OBJECTIVE: This study evaluates iKinnect, a linked caregiver-teen mobile app system designed to address serious adolescent conduct problems through a focus on key targets of evidence-based treatments for juvenile offending, such as parent expectation setting, monitoring, consistency, and positive reinforcement. Additional gamification and autonomy-supporting features are designed to maximize youth engagement. Digital therapeutics such as mobile apps have great potential to expand access to effective interventions, particularly for youth who engage in serious conduct problems and substance abuse, since most never receive an evidence-based treatment and few apps exist for these concerns. METHODS: This randomized clinical trial used a short-term (12 week) longitudinal design with four time points. Recruited was a U.S. national sample of teens (n = 72, age 13-17, 59.7% male, 68.1% White) receiving services for a serious conduct problem and their primary caregiver. The efficacy of iKinnect, used by parent and teen dyads, was measured against an active control condition, Life360, an app that provided mutual GPS-based location tracking to dyads. RESULTS: Across 12 weeks of app use, youth who used iKinnect showed significantly greater reductions in alcohol use, marijuana use, school delinquency, status offenses, and general delinquency than did controls. Parents who used iKinnect Reported greater improvements in structure/rule clarity and discipline consistency relative to control parents. Teen and parent iKinnect app use and acceptability ratings were high. CONCLUSIONS: Real-world use of iKinnect in future applications can, like other emerging digital health technologies, help to expand the reach of evidence-based interventions to children, youth, and families.Registered at clinicaltrials.gov (NCT03065517).

Competitive interactions between cognitive reappraisal and mentalizing.

To better understand how cognitive context can impact emotion regulation through cognitive reappraisal, we evaluated the effects of an additional mentalizing instruction on reappraisal. This manipulation models an existing therapeutic technique in which a client is instructed to imagine advising a friend in a similar situation. We examined the effects of this manipulation on self-reported affect and difficulty as well as fMRI measures of neural function. We hypothesized that the mentalizing context would facilitate the cognitive processing and performance of reappraisal due to the engagement of common neurocognitive resources across these processes. We trained participants to reappraise negative pictures using reinterpretation, and crossed mentalizing with reappraisal in a within-subjects factorial design. Self-report results indicated that the mentalizing instruction did not impact reappraisal performance. We did, however, identify neural interactions between mentalizing and reappraisal. The particular patterns of interaction suggested that reappraisal processing may have been dominant and mentalizing processing diminished when both were instructed. Overall, our findings suggested that mentalizing and reappraisal did engage shared neurocognitive resources, but this overlap resulted in competition between these processes rather than facilitation. We discuss potential mechanisms and identify directions for future research. This study was preregistered at https://osf.io/ym28u/.

Using a Tablet-Based App to Deliver Evidence-Based Practices for Suicidal Patients in the Emergency Department: Pilot Randomized Controlled Trial.

BACKGROUND: Emergency departments (EDs) have the potential to provide evidence-based practices for suicide prevention to patients who are acutely suicidal. However, few EDs have adequate time and personnel resources to deliver recommended evidence-based assessment and interventions. To raise the clinical standard of care for patients who are suicidal and seeking psychiatric crisis services in the ED, we developed Jaspr Health, a tablet-based app for direct use by such patients, which enables the delivery of 4 evidence-based practices. OBJECTIVE: This study aims to evaluate the feasibility, acceptability, and effectiveness of Jaspr Health among suicidal adults in EDs. METHODS: Patients who were acutely suicidal and seeking psychiatric crisis services participated in an unblinded pilot randomized controlled trial while in the ED. Participants were randomly assigned to Jaspr Health (n=14) or care as usual (control; n=17) groups. Participants were assessed at baseline, and a 2-hour posttest using self-report measures and a semistructured interview were conducted. RESULTS: Conditions differed significantly at baseline with regard to age but not other demographic variables or baseline measures. On average, participants had been in the ED for 17 hours before enrolling in the study. Over their lifetime, 84% (26/31) of the sample had made a suicide attempt (mean 3.4, SD 6.4) and 61% (19/31) had engaged in nonsuicidal self-injurious behaviors, with an average rate of 8.8 times in the past 3 months. All established feasibility and acceptability criteria were met: no adverse events occurred, participants' app use was high, Jaspr Health app user satisfaction ratings were high, and all participants using Jaspr Health recommended its use for other suicidal ED patients. Comparisons between study conditions provide preliminary support for the effectiveness of the app: participants using Jaspr Health reported a statistically significant increase in receiving 4 evidence-based suicide prevention interventions and overall satisfaction ratings with their ED experience. In addition, significant decreases in distress and agitation, along with significant increases in learning to cope more effectively with current and future suicidal thoughts, were observed among participants using Jaspr Health compared with those receiving care as usual. CONCLUSIONS: Even with limited statistical power, the results showed that Jaspr Health is feasible, acceptable, and clinically effective for use by ED patients who are acutely suicidal and seeking ED-based psychiatric crisis services. TRIAL REGISTRATION: ClinicalTrials.gov NCT03584386; https://clinicaltrials.gov/ct2/show/NCT03584386.