On the relationship between mind wandering and mindfulness.

Mind wandering (MW) and mindfulness have both been reported to be vital moderators of psychological wellbeing. Here, we aim to examine how closely associated these phenomena are and evaluate the psychometrics of measures often used to quantify them. We investigated two samples, one consisting of German-speaking unpaid participants (GUP, n [Formula: see text] 313) and one of English-speaking paid participants (EPP, n [Formula: see text] 228) recruited through MTurk.com. In an online experiment, we collected data using the Mindful Attention Awareness Scale (MAAS) and the sustained attention to response task (SART) during which self-reports of MW and meta-awareness of MW were recorded using experience sampling (ES) probes. Internal consistency of the MAAS was high (Cronbachs [Formula: see text] of 0.96 in EPP and 0.88 in GUP). Split-half reliability for SART measures and self-reported MW was overall good with the exception of SART measures focusing on Nogo trials, and those restricted to SART trials preceding ES in a 10 s time window. We found a moderate negative association between trait mindfulness and MW as measured with ES probes in GUP, but not in EPP. Our results suggest that MW and mindfulness are on opposite sides of a spectrum of how attention is focused on the present moment and the task at hand.

Spacing, Feedback, and Testing Boost Vocabulary Learning in a Web Application.

Information and communication technology (ICT) becomes more prevalent in education but its general efficacy and that of specific learning applications are not fully established yet. One way to further improve learning applications could be to use insights from fundamental memory research. We here assess whether four established learning principles (spacing, corrective feedback, testing, and multimodality) can be translated into an applied ICT context to facilitate vocabulary learning in a self-developed web application. Effects on the amount of newly learned vocabulary were assessed in a mixed factorial design (3×2×2×2) with the independent variables Spacing (between-subjects; one, two, or four sessions), Feedback (within-subjects; with or without), Testing (within-subjects, 70 or 30% retrieval trials), and Multimodality (within-subjects; unimodal or multimodal). Data from 79 participants revealed significant main effects for Spacing [F(2,76) = 8.51, p = 0.0005, η p 2 = 0.18 ] and Feedback [F(1,76) = 21.38, p < 0.0001, η p 2 = 0.22 ], and a significant interaction between Feedback and Testing [F(1,76) = 14.12, p = 0.0003, η p 2 = 0.16 ]. Optimal Spacing and the presence of corrective Feedback in combination with Testing together boost learning by 29% as compared to non-optimal realizations (massed learning, testing with the lack of corrective feedback). Our findings indicate that established learning principles derived from basic memory research can successfully be implemented in web applications to optimize vocabulary learning.

Induction of Efficacy Expectancies in an Ambulatory Smartphone-Based Digital Placebo Mental Health Intervention: Randomized Controlled Trial.

BACKGROUND: There is certain evidence on the efficacy of smartphone-based mental health interventions. However, the mechanisms of action remain unclear. Placebo effects contribute to the efficacy of face-to-face mental health interventions and may also be a potential mechanism of action in smartphone-based interventions. OBJECTIVE: This study aimed to investigate whether different types of efficacy expectancies as potential factors underlying placebo effects could be successfully induced in a smartphone-based digital placebo mental health intervention, ostensibly targeting mood and stress. METHODS: We conducted a randomized, controlled, single-blinded, superiority trial with a multi-arm parallel design. Participants underwent an Android smartphone-based digital placebo mental health intervention for 20 days. We induced prospective efficacy expectancies via initial instructions on the purpose of the intervention and retrospective efficacy expectancies via feedback on the success of the intervention at days 1, 4, 7, 10, and 13. A total of 132 healthy participants were randomized to a prospective expectancy-only condition (n=33), a retrospective expectancy-only condition (n=33), a combined expectancy condition (n=34), or a control condition (n=32). As the endpoint, we assessed changes in efficacy expectancies with the Credibility Expectancy Questionnaire, before the intervention and on days 1, 7, 14, and 20. For statistical analyses, we used a random effects model for the intention-to-treat sample, with intervention day as time variable and condition as two factors: prospective expectancy (yes vs no) and retrospective expectancy (yes vs no), allowed to vary over participant and intervention day. RESULTS: Credibility (ß=-1.63; 95% CI -2.37 to -0.89; P<.001) and expectancy (ß=-0.77; 95% CI -1.49 to -0.05; P=.04) decreased across the intervention days. For credibility and expectancy, we found significant three-way interactions: intervention day×prospective expectancy×retrospective expectancy (credibility: ß=2.05; 95% CI 0.60-3.50; P=.006; expectancy: ß=1.55; 95% CI 0.14-2.95; P=.03), suggesting that efficacy expectancies decreased least in the combined expectancy condition and the control condition. CONCLUSIONS: To our knowledge, this is the first empirical study investigating whether efficacy expectancies can be successfully induced in a specifically designed placebo smartphone-based mental health intervention. Our findings may pave the way to diminish or exploit digital placebo effects and help to improve the efficacy of digital mental health interventions. TRIAL REGISTRATION: Clinicaltrials.gov NCT02365220; https://clinicaltrials.gov/ct2/show/NCT02365220.

Maternal psychopathology and offspring mental health service utilization in adolescents without mental disorders: a national representative survey.

We investigated whether maternal psychopathology predicts offspring mental health service utilization in adolescents without mental disorders. We used weighted data (N = 2317) from NCS-A participants (age: 13-18 years) who did not meet DSM-IV criteria for any lifetime mental disorder. Adolescent mental disorders were assessed with the WHO CIDI. Maternal psychopathology was obtained by self-report. Adolescent mental health service use was assessed with the Service Assessment for Children and Adolescents. Substantial associations between maternal psychopathology and mental health service use in offspring without mental disorders were found between affective disorders and the mental health/medical specialty (hazard ratio (HR) = 2.49, 95% confidence interval (CI) = 1.60-3.90) and any service sector (HR = 2.14, CI = 1.45-3.16), anxiety disorders and any service sector (HR = 1.63, CI = 1.13-2.35), behavior disorders and the school (HR = 3.69, CI = 1.39-9.77) and any service sector (HR = 2.81, CI = 1.12-7.07), substance use disorders and the mental health/medical specialty (HR = 3.75, CI = 1.75-8.03), the school (HR = 3.17, CI = 1.43-7.02), and any service sector (HR = 3.66, CI = 2.00-6.70), and any mental disorder and the mental health/medical specialty (HR = 2.10, CI = 1.34-3.30) and any service sector (HR = 2.03, CI = 1.40-2.92). Results were comparable when restricting analyses to offspring with no indication of suicidality and no more than three life events during the past 12 months. The likelihood of service use was higher among offspring of mothers with mental disorders, compared to mothers without mental disorders. Considering maternal mental disorder status may help to identify subjects at risk of overtreatment.

Personalized prediction of smartphone-based psychotherapeutic micro-intervention success using machine learning.

BACKGROUND: Tailoring healthcare to patients' individual needs is a central goal of precision medicine. Combining smartphone-based interventions with machine learning approaches may help attaining this goal. The aim of our study was to explore the predictability of the success of smartphone-based psychotherapeutic micro-interventions in eliciting mood changes using machine learning. METHODS: Participants conducted daily smartphone-based psychotherapeutic micro-interventions, guided by short video clips, for 13 consecutive days. Participants chose one of four intervention techniques used in psychotherapeutic approaches. Mood changes were assessed using the Multidimensional Mood State Questionnaire. Micro-intervention success was predicted using random forest (RF) tree-based mixed-effects logistic regression models. Data from 27 participants were used, totaling 324 micro-interventions, randomly split 100 times into training and test samples, using within-subject and between-subject sampling. RESULTS: Mood improved from pre- to post-intervention in 137 sessions (initial success-rate: 42.3%). The RF approach resulted in predictions of micro-intervention success significantly better than the initial success-rate within and between subjects (positive predictive value: 0.732 (95%-CI: 0.607; 0.820) and 0.698 (95%-CI: 0.564; 0.805), respectively). Prediction quality was highest using the RF approach within subjects (rand accuracy: 0.75 (95%-CI: 0.641; 0.840), Matthew's correlation coefficient: 0.483 (95%-CI: 0.323; 0.723)). LIMITATIONS: The RF approach does not allow firm conclusions about the exact contribution of each factor to the algorithm's predictions. We included a limited number of predictors and did not compare whether predictability differed between psychotherapeutic techniques. CONCLUSIONS: Our findings may pave the way for translation and encourage scrutinizing personalized prediction in the psychotherapeutic context to improve treatment efficacy.

Polypharmacy and drug-drug interactions among older and younger male prisoners in Switzerland.

PURPOSE: The purpose of this paper is to determine the prevalence of polypharmacy and drug-drug interactions (DDIs) in older and younger prisoners, and compared if age group is associated with risks of polypharmacy and DDIs. DESIGN/METHODOLOGY/APPROACH: For 380 prisoners from Switzerland (190 were 49 years and younger; 190 were 50 years and older), data concerning their medication use were gathered. MediQ identified if interactions of two or more substances could lead to potentially adverse DDI. Data were analysed using descriptive statistics and generalised linear mixed models. FINDINGS: On average, older prisoners took 3.8 medications, while younger prisoners took 2.1 medications. Number of medications taken on one reference day was higher by a factor of 2.4 for older prisoners when compared to younger prisoners (p = 0.002). The odds of polypharmacy was significantly higher for older than for younger prisoners (>=5 medications: odds ratio = 5.52, p = 0.035). Age group analysis indicated that for potentially adverse DDI there was no significant difference (odds ratio = 0.94; p = 0.879). However, when controlling for the number of medication, the risk of adverse DDI was higher in younger than older prisoners, but the result was not significant. ORIGINALITY/VALUE: Older prisoners are at a higher risk of polypharmacy but their risk for potentially adverse DDI is not significantly different from that of younger prisoners. Special clinical attention must be given to older prisoners who are at risk for polypharmacy. Careful medication management is also important for younger prisoners who are at risk of very complex drug therapies.

Mediation analysis of triple networks revealed functional feature of mindfulness from real-time fMRI neurofeedback.

The triple networks, namely the default-mode network (DMN), the central executive network (CEN), and the salience network (SN), play crucial roles in disorders of the brain, as well as in basic neuroscientific processes such as mindfulness. However, currently, there is no consensus on the underlying functional features of the triple networks associated with mindfulness. In this study, we tested the hypothesis that (a) the partial regression coefficient (i.e., slope): from the SN to the DMN, mediated by the CEN, would be one of the potential mindfulness features in the real-time functional magnetic resonance imaging (rtfMRI) neurofeedback (NF) setting, and (b) this slope level may be enhanced by rtfMRI-NF training. Sixty healthy mindfulness-naïve males participated in an MRI session consisting of two non-rtfMRI-runs, followed by two rtfMRI-NF runs and one transfer run. Once the regions-of-interest of each of the triple networks were defined using the non-rtfMRI-runs, the slope level was calculated by mediation analysis and used as neurofeedback information, in the form of a thermometer bar, to assist with participant mindfulness during the rtfMRI-NF runs. The participants were asked to increase the level of the thermometer bar while deploying a mindfulness strategy, which consisted of focusing attention on the physical sensations of breathing. rtfMRI-NF training was conducted as part of a randomized controlled trial design, in which participants were randomly assigned to either an experimental group or a control group. The participants in the experimental group received contingent neurofeedback information, which was obtained from their own brain signals, whereas the participants in the control group received non-contingent neurofeedback information that originated from matched participants in the experimental group. Our results indicated that the slope level from the SN to the DMN, mediated by the CEN, was associated with mindfulness score (rtfMRI-NF runs: r = 0.53, p = 0.007; p-value was corrected from 10,000 random permutations) and with task-performance feedback score (rtfMRI-NF run: r = 0.61, p = 0.001) in the experimental group only. In addition, during the rtfMRI-NF runs the level of the partial regression coefficient feature was substantially increased in the experimental group compared to the control group (p < 0.05 from the paired t-test; the p-value was corrected from 10,000 random permutations). To the best of our knowledge, this is the first study to demonstrate a partial regression coefficient feature of mindfulness in the rtfMRI-NF setting obtained by triple network mediation analysis, as well as the possibility of enhancement of the partial regression coefficient feature by rtfMRI-NF training.

Maternal psychopathology and mental health treatment delay in adolescents from a national cohort.

OBJECTIVE: To investigate whether maternal psychopathology predicts mental health service use and treatment delay in offspring with mental disorders. DATA SOURCES: Weighted data collected between 2001 and 2004 from NCS-A participants (age: 13-18 years; N = 2939) meeting DSM-IV criteria for any lifetime mental disorder, assessed with WHO CIDI, and from their biological mothers. STUDY DESIGN: National representative cohort. DATA COLLECTION: Maternal psychopathology was assessed with self-report, adolescent mental health service use with the Service Assessment for Children and Adolescents. PRINCIPAL FINDINGS: Maternal psychopathology predicted offspring mental health service use across various service sectors, except for school services. In the mental health specialty sector, estimates were highest for maternal affective (hazard ratio (HR) = 2.17, 95 percent confidence interval (CI) = 1.66-2.82) and any mental disorder (HR = 2.13, 95 percent CI = 1.53-2.97). For offspring use of any mental health services, estimates were highest for maternal behavior (HR = 1.60, 95 percent CI = 1.15-2.21) and substance use disorders (HR = 1.57, 95 percent CI = 1.09-2.24). Treatment delay of offspring mental health service use was predicted by maternal behavior disorders. CONCLUSIONS: Maternal psychopathology fostered mental health service use in offspring with mental disorders, while maternal behavior disorders might also retard treatment. Considering parental psychopathology may help improving the prevention of unmet offspring service needs.

Prescription of pain medication in prisons: A comparative analysis of younger and older male prisoners.

PURPOSE: In prison populations, treating pain is particularly challenging, especially for the growing number of older prisoners. The objective was to find out about prevalence, frequency, and types of pain medications prescribed to older prisoners (≥50 years) in comparison with younger prisoners (<50 years). METHODS: Data were collected in Switzerland as part of a study on ageing prisoners' health. Fifteen prisons (out of 26 of the total eligible population) agreed to take part, and data from medical records of 190 older and 190 younger male prisoners were analysed. Descriptive statistics on pain medication prescriptions (excluding drugs used in opioid dependence) were carried out and differences between the 2 age groups tested for statistical significance. RESULTS: More than half of younger and older prisoners were prescribed pain medication during the past 180 days, while 10% of younger and 15% of older prisoners were prescribed pain medication on a daily basis. Nonsteroidal anti-inflammatory drugs and "other analgesics and antipyretics" were most frequently prescribed. Significantly (P < .05), more younger than older prisoners were prescribed NSAIDs and drugs to treat muscle skeletal pain. Tramadol was the opioid most often prescribed. CONCLUSIONS: This is the first empirical study investigating prescriptions of pain medication in Swiss prisoners on a national level. It shows that nonopioid pain medication is an important part of health care provision inside prison, while there are only few prescriptions of strong opioids. Research is needed to investigate whether the standard set by the principle of equivalence is met regarding treatment of pain in prison.

Chronology of Onset of Mental Disorders and Physical Diseases in Mental-Physical Comorbidity - A National Representative Survey of Adolescents.

BACKGROUND: The objective was to estimate temporal associations between mental disorders and physical diseases in adolescents with mental-physical comorbidities. METHODS: This article bases upon weighted data (N = 6483) from the National Comorbidity Survey Adolescent Supplement (participant age: 13-18 years), a nationally representative United States cohort. Onset of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition lifetime mental disorders was assessed with the fully structured World Health Organization Composite International Diagnostic Interview, complemented by parent report. Onset of lifetime medical conditions and doctor-diagnosed diseases was assessed by self-report. RESULTS: The most substantial temporal associations with onset of mental disorders preceding onset of physical diseases included those between affective disorders and arthritis (hazard ratio (HR) = 3.36, 95%-confidence interval (CI) = 1.95 to 5.77) and diseases of the digestive system (HR = 3.39, CI = 2.30 to 5.00), between anxiety disorders and skin diseases (HR = 1.53, CI = 1.21 to 1.94), and between substance use disorders and seasonal allergies (HR = 0.33, CI = 0.17 to 0.63). The most substantial temporal associations with physical diseases preceding mental disorders included those between heart diseases and anxiety disorders (HR = 1.89, CI = 1.41 to 2.52), epilepsy and eating disorders (HR = 6.27, CI = 1.58 to 24.96), and heart diseases and any mental disorder (HR = 1.39, CI = 1.11 to 1.74). CONCLUSIONS: Findings suggest that mental disorders are antecedent risk factors of certain physical diseases in early life, but also vice versa. Our results expand the relevance of mental disorders beyond mental to physical health care, and vice versa, supporting the concept of a more integrated mental-physical health care approach, and open new starting points for early disease prevention and better treatments, with relevance for various medical disciplines.

Smartphone-Based Psychotherapeutic Micro-Interventions to Improve Mood in a Real-World Setting.

BACKGROUND: Using mobile communication technology as new personalized approach to treat mental disorders or to more generally improve quality of life is highly promising. Knowledge about intervention components that target key psychopathological processes in terms of transdiagnostic psychotherapy approaches is urgently needed. We explored the use of smartphone-based micro-interventions based on psychotherapeutic techniques, guided by short video-clips, to elicit mood changes. METHOD: As part of a larger neurofeedback study, all subjects-after being randomly assigned to an experimental or control neurofeedback condition-underwent daily smartphone-based micro-interventions for 13 consecutive days. They were free to choose out of provided techniques, including viscerosensory attention, emotional imagery, facial expression, and contemplative repetition. Changes in mood were assessed in real world using the Multidimensional Mood State Questionnaire (scales: good-bad, GB; awake-tired, AT; and calm-nervous, CN). RESULTS: Twenty-seven men participated on at least 11 days and were thus included in the analyses. Altogether, they underwent 335, generally well-tolerated, micro-intervention sessions, with viscerosensory attention (178 sessions, 53.13%) and contemplative repetition (68 sessions, 20.30%) being the most frequently applied techniques. Mixed models indicated that subjects showed better mood [GB: b = 0.464, 95%confidence interval (CI) [0.068, 0.860], t (613.3) = 2.298, p = 0.022] and became more awake [AT: b = 0.514, 95%CI [0.103, 0.925], t (612.4) = 2.456, p = 0.014] and calmer [CN: b = 0.685, 95%CI [0.360, 1.010], t (612.3) = 4.137, p < 0.001] from pre- to post-micro-intervention. These mood improvements from pre- to post-micro-intervention were associated with changes in mood from the 1st day until the last day with regard to GB mood (r = 0.614, 95%CI [0.297, 0.809], p < 0.001), but not AT mood (r = 0.279, 95%CI [-0.122, 0.602], p = 0.167) and CN mood (r = 0.277, 95%CI [0.124, 0.601], p = 0.170). DISCUSSION: Our findings provide evidence for the applicability of smartphone-based micro-interventions eliciting short-term mood changes, based on techniques used in psychotherapeutic approaches, such as mindfulness-based psychotherapy, transcendental meditation, and other contemplative therapies. The results encourage exploring these techniques' capability to improve mood in randomized controlled studies and patients. Smartphone-based micro-interventions are promising to modify mood in real-world settings, complementing other psychotherapeutic interventions, in line with the precision medicine approach. The here presented data were collected within a randomized trial, registered at ClinicalTrials.gov (Identifier: NCT01921088) https://clinicaltrials.gov/ct2/show/NCT01921088.

Comorbidity of Mental Disorders and Chronic Pain: Chronology of Onset in Adolescents of a National Representative Cohort.

UNLABELLED: This study sought to estimate (1) the prevalence of the co-occurrence of, (2) the association between, and (3) the sequence of onset of chronic pain and mental disorders in adolescents. We used weighted data (N = 6,483) from the National Comorbidity Survey Replication Adolescent Supplement (participants' age, 13-18 years). Lifetime chronic pain was assessed by adolescent self-report; lifetime DSM-IV mental disorders were assessed by the WHO Composite International Diagnostic Interview, complemented by parent report. Among the participants in the study, 1,600 of 6,476 (25.93%) had experienced any type of chronic pain and any mental disorder in their lifetime. All types of pain were related to mental disorders. The most substantial temporal associations were those with onset of mental disorders preceding onset of chronic pain, including those between affective disorders and headaches and any chronic pain; between anxiety disorders and chronic back/neck pain, headaches, and any chronic pain; between behavior disorders and headaches and any chronic pain; and between any mental disorder and chronic back/neck pain, headaches, and any chronic pain. PERSPECTIVE: Findings indicate that affective, anxiety, and behavior disorders are early risk factors of chronic pain, thereby highlighting the relevance of child mental disorders for pain medicine. To improve prevention and interventions for chronic pain, integrative care should be considered.

Association between mental disorders and physical diseases in adolescents from a nationally representative cohort.

OBJECTIVE: Pediatric health care and research focus mostly on single morbidities, although the single-disease framework has been challenged. The main objective was to estimate associations between childhood mental disorders and physical diseases. METHODS: This study is based on weighted data (n = 6482) from the National Comorbidity Survey Replication Adolescent Supplement (age, 13-18 years). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition lifetime mental disorders were assessed using the fully structured World Health Organization Composite International Diagnostic Interview, complemented by parent report. Lifetime medical conditions and doctor-diagnosed diseases were assessed by adolescent self-report. RESULTS: Of 6469 participants, 2137 (35.33%) reported at least one mental disorder and one physical disease. The most substantial associations included those between affective disorders and diseases of the digestive system (odds ratio [OR] = 3.46, 95% confidence interval [CI] = 2.28-5.24), anxiety disorders and arthritis (OR = 2.27, CI = 1.34-3.85), anxiety disorders and heart diseases (OR = 2.41, CI = 1.56-3.73), anxiety disorders and diseases of the digestive system (OR = 2.18, CI = 1.35-3.53), and eating disorders and epilepsy/seizures (OR = 5.45, CI = 1.57-18.87). Sociodemographic factors did not account for the association between mental disorders and physical diseases. CONCLUSIONS: Findings suggest that mental disorders and physical diseases often co-occur in childhood. This association is a major public health challenge, and the child health system needs additional strategies in patient-centered care, research, medical education, health policy, and economics to develop well-coordinated interdisciplinary approaches linking mental and physical care in children.

School mental health services: signpost for out-of-school service utilization in adolescents with mental disorders? A nationally representative United States cohort.

BACKGROUND: School mental health services are important contact points for children and adolescents with mental disorders, but their ability to provide comprehensive treatment is limited. The main objective was to estimate in mentally disordered adolescents of a nationally representative United States cohort the role of school mental health services as guide to mental health care in different out-of-school service sectors. METHODS: Analyses are based on weighted data (N = 6483) from the United States National Comorbidity Survey Replication Adolescent Supplement (participants' age: 13-18 years). Lifetime DSM-IV mental disorders were assessed using the fully structured WHO CIDI interview, complemented by parent report. Adolescents and parents provided information on mental health service use across multiple sectors, based on the Service Assessment for Children and Adolescents. RESULTS: School mental health service use predicted subsequent out-of-school service utilization for mental disorders i) in the medical specialty sector, in adolescents with affective (hazard ratio (HR) = 3.01, confidence interval (CI) = 1.77-5.12), anxiety (HR = 3.87, CI = 1.97-7.64), behavior (HR = 2.49, CI = 1.62-3.82), substance use (HR = 4.12, CI = 1.87-9.04), and eating (HR = 10.72, CI = 2.31-49.70) disorders, and any mental disorder (HR = 2.97, CI = 1.94-4.54), and ii) in other service sectors, in adolescents with anxiety (HR = 3.15, CI = 2.17-4.56), behavior (HR = 1.99, CI = 1.29-3.06), and substance use (HR = 2.48, CI = 1.57-3.94) disorders, and any mental disorder (HR = 2.33, CI = 1.54-3.53), but iii) not in the mental health specialty sector. CONCLUSIONS: Our findings indicate that in the United States, school mental health services may serve as guide to out-of-school service utilization for mental disorders especially in the medical specialty sector across various mental disorders, thereby highlighting the relevance of school mental health services in the trajectory of mental care. In light of the missing link between school mental health services and mental health specialty services, the promotion of a stronger collaboration between these sectors should be considered regarding the potential to improve and guarantee adequate mental care at early life stages.