A Hybrid Ecological Momentary Compassion–Focused Intervention for Enhancing Resilience in Help-Seeking Young People: Prospective Study of Baseline Characteristics in the EMIcompass Trial

Abstract

Background Young people are a target population for mental health–related early intervention and prevention. Although evidence for early intervention is promising, availability of and access to youth mental health services remain limited. Therefore, the development of an evidence-based hybrid intervention is urgently needed. Objective This study aimed to present a manual for a hybrid intervention, combining an ecological momentary intervention and face-to-face sessions aimed for enhancing resilience in help-seeking young people based on compassion-focused interventions, and explore whether participants’ baseline characteristics are associated with putative mechanisms and outcomes of the EMIcompass intervention. Specifically, we aimed to explore initial signals as to whether participants’ sociodemographic, clinical, and functional characteristics at baseline are associated with putative mechanisms (ie, change in self-compassion, change in emotion regulation, working alliance, training frequency); and whether participants’ sociodemographic, clinical, and functional characteristics, self-compassion, and emotion regulation at baseline are associated with clinical outcomes (ie, psychological distress and general psychopathology at postintervention and 4-week follow-ups) in the experimental condition and obtain first parameter estimates. Methods We recruited young people aged 14 to 25 years, with psychological distress, Clinical High At-Risk Mental State, or first episodes of severe mental disorder for an exploratory randomized controlled trial with assessments at baseline and postintervention and 4-week follow-ups. A structured manual was developed and optimized based on a pilot study’s manual, a scoping review of existing literature and manuals, exchange with experts, the team’s clinical experience of working with compassion-focused interventions, and the principles of ecological momentary interventions. This analysis focuses on the experimental condition receiving the EMIcompass intervention. Results A total of 46 young individuals were randomized to the experimental condition. There was evidence for initial signals of effects of age (B=0.11, 95% CI 0.00-0.22), general psychopathology (B=0.08, 95% CI −0.01 to 0.16), and clinical stage (B=1.50, 95% CI 0.06-2.93) on change in momentary self-compassion and change in emotion regulation from baseline to postintervention assessments. There was no evidence for associations of other baseline characteristics (eg, gender, minority status, and level of functioning) and putative mechanisms (eg, overall self-compassion, working alliance, and training frequency). In addition, except for an initial signal for an association of momentary self-compassion at baseline and psychological distress (B=−2.83, 95% CI −5.66 to 0.00), we found no evidence that baseline characteristics related to clinical outcomes. Conclusions The findings indicated the reach of participants by the intervention largely independent of sociodemographic, clinical, and functional baseline characteristics. The findings need to be confirmed in a definitive trial. Trial Registration German Clinical Trials Register NDRKS00017265; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017265 International Registered Report Identifier (IRRID) RR2-10.2196/27462

A control theoretic approach to evaluate and inform ecological momentary interventions

“…Moreover, the administered EMI also resulted in an overall pattern of improvement across predicted psychological variables, and exerted a stronger degree of system control than the mere (passive) indication of social presence and absence. This aligns well with previous observations of immediate EMI-driven mental health improvements [10], as well as the general motivation behind delivering these specific EMI (e.g., [11,36]). The consistency of these findings w.r.t.…”

“…As an example, the EMI selected in the current data set are based on principles of CFT that rest on cultivating and enhancing compassion in individuals. These compassion focused interventions (CFIs) are particularly designed to act on three interacting emotional systems -the soothing, the drive, and the threat system -and use intervention techniques (e.g., positive mental imagery) expected to exert momentary (i.e., "in-the-moment") effects on mental health [36]. For instance, by strengthening the soothing system, CFIs may down-regulate the threat-system and up-regulate the drive system, resulting in an overall mental health improvement.…”

Application of Positive Psychology in Digital Interventions for Children, Adolescents, and Young Adults: Systematic Review and Meta-Analysis of Controlled Trials

“…Four studies (11.4%) conducted the intervention through smartphone-based applications or SMS. One study (3%) used a hybrid setting, and another one conducted the intervention in a telehealth setting [84,85]. Interestingly, one study (3%) conducted the intervention through Instagram and one study (3%) used the Vivibot chatbot [86,87] (Table 3).…”

“…The Broaden-and-Build theory of positive emotion states that certain discrete positive emotions e.g., joy, contentment, pride, and love, share the ability to broaden momentary thought-action repertoires of people and build their enduring personal resources, ranging from physical and intellectual resources to social and psychological resources [91]. Other studies frequently mentioned in the articles included acceptance and commitment theory [78] (oriented towards development of psychological flexibility), affect theory [92] (emotions generating weak or strong ties to relations), attachment theory [84,92,93] (individuals born with innate behaviors function to attract proximity to attachment figures), Eisenberg's theory of parent emotion socialization [94] (parents' emotion socialization behaviors driving children's emotion socialization), emotion-focused therapy theory [95] (integrating person-focused care with modern emotion theory), motivational theory of life-span development (Heckausen's theory) [80] (role of individual in life-span development), Bandura's selfefficacy theory [96] (belief that one can execute needed steps to achieve a goal), social mentality theory [84,93] (both care-seeking and caregiving mentalities are activated when one is being selfcompassionate/reassuring), embodiment theory [77] (psychological processes influenced by body), self-determination theory [89] (internalizing regulation and self-regulation), theory of mindfulness [97] (being actively engaged is beneficial for a rigid and judgmental mindset), Festinger's social comparison theory [86] (based on social comparison), stress and coping theory [87] (coping with stressful situations) and humor theory [98] (cognitive view of humor).…”